Ethics in Nursing – A Changing Landscape

Remembering the Code of Ethics even when things seem out of our control

A quick Google search for “ethics definition” brings up the following: “moral principles that govern a person’s behavior or the conducting of an activity.”  As individuals, we act according to our own personal ethical codes daily. For example, do we steal an apple from the store or lie to a friend? Probably not!

In nursing, we also employ ethical codes in our practice.  For example, do we force our patients to take medication if they do not want to? Do we perform chest compressions on a patient whose heart has stopped beating? In both situations, the answer is “maybe.”  In the first example, we generally allow the patient the opportunity to make an autonomous decision, unless they are unable to competently decide on their own.  In the second example, we perform chest compressions unless we know explicitly that the patient desires otherwise.

We learned about ethics in nursing school.  We committed these concepts to memory, and they’ve guided our practice ever since. The code still stands…but do you remember the terminology?

The Code of Ethics for Nurses with Interpretive Statements, also known as “The Code”, is updated regularly based on changes in healthcare, finances, and delivery.  The Code helps nurses provide safe, respectful, humane, and dignified care to their patients.

According to the American Nurses Association, The Code “…is the social contract that nurses have with the U.S. public. It exemplifies our profession’s promise to provide an advocate for safe, quality care for all patients and communities. It binds nurses to support each other so that all nurses can fulfill their ethical and professional obligations.”

Autonomy is the term that refers to the patient’s right to have control over his or her own body.  While a healthcare professional can make suggestions, coercing the patient to make a decision would be considered violating this principle.  Although the professional may disagree with the patient’s decisions, a patient who is acting competently is doing so autonomously.

Beneficence is the term that refers to the healthcare professional’s behavior in which they must always attempt to benefit the patient.  For example, when ordering diagnostic tests and procedures, they must be ordered with the intention that the benefit would do the most good for the patient.  According to Saint John’s University, “… medical practitioners must develop and maintain a high level of skill and knowledge, make sure that they are trained in the most current and best medical practices, and must consider their patients’ individual circumstances; what is good for one patient will not necessarily benefit another.”

Non-maleficence is the term that basically means “to do no harm.”  As healthcare professionals, we must always assess whether our actions are harming our patients, weighing the pros and cons.  If there is a benefit, is the benefit more than the harm?

Justice is the term that refers to fairness.  There should be fairness in all medical decisions, such as the equal distribution of scarce resources and medical treatments.  Justice also refers to the fact that the law should be upheld when providing care to patients.

Right now, healthcare is evolving at a rapid speed.  With technology advancing both in and outside the workplace, expectations of nurses are constantly adjusting. Insurance seems to be ever-changing, which unfortunately impacts reimbursement and makes parts of the job even more challenging. Social media is increasingly prevalent which puts nurses in the limelight more than ever before and ultimately, all of this has a direct impact on both staff satisfaction and the overall care of the patient.  

Examples of ethical dilemmas that nurses are finding themselves in today include:

  • Increased staffing ratios; this means that the nurse-to-patient ratio is going up. How do we provide the best care when we can’t be everywhere at once?
  • As the nurse-to-patient ratio is going up, the acuity of patients is also worsening as insurance reimbursements are lessening.  Why? People are being discharged sooner, so the people who are hospitalized are those who are sicker.
  • People seem to be angrier. Hospital violence has been on the news at an ever-increasing rate but litigation can be tricky as sueing a patient who is out of control may not “work” and it doesn’t make the situation any better.
  • Workplace bullying is still occurring, despite rules and regulations in most facilities that it won’t be tolerated.
  • The costs of medications are increasing, such as insulin, meaning that we’re working harder to help our patients find ways to pay for them – so that they don’t come back critically ill.
  • Even offhand comments or seemingly harmless pictures posted on social media have to be carefully scrutinized to make sure rights and feelings are protected.

As Nurses, it is our job to not only understand today’s rapidly changing landscape but to find ways to make these changes work in ways that are in the best interest of our patients. It is our responsibility to remember ‘The Code’ even when grappling with situations that are not necessarily in our control.  

If you find yourself faced with an ethical situation at your facility, don’t be afraid to reach out and ask for advice. Contact your ethics committee or ethics hotline – each facility should have one. If you don’t, it may be time to advocate for one. Remember – nothing changes if we don’t do something about it and if you don’t ask the questions, the answer will always be no!


American Nurses Association.  Ethics and human rights.  Retrieved from

Saint Joseph’s University.  (2019). How the four principles of health care ethics improve patient care.  Retrieved from

Wood, Debra.  (2016). The top ethical challenges for nurses.  Retrieved from

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