Issues up close

Constant change is a part of life, affecting registered nurses (RNs) in their everyday practice and professional relationships. Navigating the complexities of the healthcare system, the use of new technology and related privacy concerns, and the dynamics of interprofessional collaboration are but a few of the areas where new ethical questions arise.

While change is continuous, RNs must hold true to the core values of the profession—a legacy that dates back to the origin of ANA. An Ethics Advisory Board (EAB) for the Center for Ethics and Human Rights has addressed ethical issues in nursing practice since 1921, advising the ANA Board of Directors. One function of the EAB is to review and assure that the Code of Ethics for Nurses is a dynamic document meeting the needs of all nurses.

The current Code of Ethics for Nurses with Interpretive Statements (2001) reflects the commitments and ideals of nurses. The document articulates those enduring core values in a statement of nurses’ ethical obligations and duties. Many of the stated ethical beliefs can be traced to similar values and commitments found in the Nightingale Pledge and the initial 1950 Code for Professional Nurses. The document provides nurses with an ethical framework for decision-making. Considered vital to the profession, the Code of Ethics is not negotiable, and only through formal processes within ANA can it be changed. The current document has remained unchanged for more than 12 years. (See Code of Ethics timeline by clicking the PDF icon above.)

Conducting a review

The EAB recently recommended and, with the ANA Board’s approval, initiated the first formal review of the 2001 Code of Ethics. A 12-member review group was formed with representation from the EAB, the former ANA Congress on Nursing Practice and Economics, prior drafters and authors, a student nurse, a staff nurse, and ANA staff. The ANA Board charged the review group with determining whether the current publication required revision.

To accomplish their task, the review group examined relevant codes in nursing and other health professions, then designed a survey for soliciting public comments. The survey was widely advertised to capture a broad representation of nurses. Data collection was conducted from February 5 through March 15, 2013.

The survey drew 2,783 responses from nurses representing diverse educational levels, roles, and practice settings. Representative comments were annotated and significant or repeating clusters were identified, allowing general themes to emerge. Each comment was assigned to one of five categories: “to add,” “delete,” “other changes,” “questions raised,” and “vocabulary or grammar changes.”

Findings and conclusions

After discussion and evaluation, the review group concluded that revision to the Code of Ethics was required, and emphasized the following points:

  • A revision of the entire Code is needed to address content, format, and language to freshen its impact on practicing nurses and permit its continuing alignment with today’s evolving, complex healthcare system. Some comments suggested that nurses misunderstand the provisions or are not familiar with them; others asked that the Code be presented in a way that all nurses can relate to and easily apply to their practice.
  • The preface should articulate more clearly the overarching ethical themes, establish context, and provide guidance for use.
  • The revisions must clarify the first seven provisions and interpretive statements and thoroughly rework the eighth and ninth.
  • The most frequently cited issues needing to be addressed were the widespread use of technology and social media and attendant threats to privacy and individual nurses’ integrity, as well as the growing importance of interprofessional collaboration and the differing demands on the RN. Social justice as a core value also requires stronger emphasis, as does more direct inclusion of the global health responsibilities of the profession.
  • The Code could leverage its meaning for everyday nursing practice by linking it with various ANA position statements, foundational documents, and publications.

The proposed timeline for the revision includes convening a special panel to begin work in fall 2013, drafting a revised code using comments from the survey and the qualitative analysis, posting the proposed revisions for comment in early 2014, editing as needed by late spring, and finalizing the document for submission to the ANA Board for approval in late fall 2014.

A code of ethics is a defining criterion for a profession. The profession’s values of caring and the science of patient care are grounded in our ethical conduct. Nursing has been identified as the most trusted profession in America. Revising and updating the Code of Ethics is undertaken with a strong focus on nursing’s proud ethical heritage. All RNs are encouraged to follow and participate in the revision process. Please check www.NursingWorld.org for information and updates on how you can participate in the revision of the Code of Ethics for Nurses.

Laurie Badzek is the director of the ANA Center for Ethics and Human Rights and a professor at West Virginia University School of Nursing. Martha Turner is assistant director of the ANA Center for Ethics and Human Rights.

Selected references

American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD: Author; 2001.

American Nurses Association. Informational report: Progress report on integrating ethics and human rights in the American Nurses Association, introduced by Lucille Joel, president. 1991.

American Nurses Association. The Nonnegotiable Nature of the ANA Code for Nurses with Interpretive Statements. Position Statement. Effective December 8, 1994. http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically
. Accessed July 23, 2013.

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