Nursing requires more than clinical skill and technical expertise. It also requires a strong ethical foundation that guides everyday decisions, from routine assessments to complex patient interactions. Ethics play a central role in shaping patient care, impacting how nurses communicate and act in challenging situations. Understanding the nursing code of ethics is essential for every specialist who wants to uphold professional standards while delivering care that demonstrates compassion and respect.

This article explores how ethical principles form the foundation of nursing practice. You will learn about the core concepts outlined in the American Nurses Association (ANA) Code of Ethics, how nurses apply these concepts in their daily work, and common dilemmas that can arise.

You will also learn how nursing education prepares future professionals to navigate these situations with confidence and integrity.

The Core Principles of Nursing Ethics

The ANA Code of Ethics for Nurses serves as the primary moral and professional framework for nursing in the United States. It outlines both the values and obligations that guide nurses as they provide safe and compassionate care, reflecting the importance of ethics in everyday practice.

Several key ethical principles support the ANA Code and shape professional conduct:^[1]

• Autonomy: Respecting autonomy means honoring a patient’s right to make decisions about their own healthcare. It also recognizes the nurse’s professional autonomy and judgment within legal and professional boundaries.
• Beneficence: Nurses strive to act in the best interest of each patient. This principle ensures that decisions and interventions support patient well-being, promote health, and quality of life.
• Justice: Justice emphasizes equitable treatment. Nurses must provide fair and unbiased care to all patients, regardless of background, identity, or circumstance.
• Nonmaleficence: This principle requires nurses to avoid causing harm. It includes carefully weighing risks and benefits, preventing unnecessary suffering, and protecting patients from unsafe practices.

In addition to these core concepts, the ANA encourages values such as accountability, veracity (truthfulness), and fidelity (keeping commitments). Together, these principles form a strong ethical backbone that supports patient advocacy and professional excellence. These principles also help define the nursing competencies  expected of practitioners and guide how those competencies are applied in clinical decision-making. Nurses in programs like the Bachelor’s of Science in Nursing learn how to navigate ethical challenges by applying these competencies from the very start of their clinical training.

Historical and Professional Context of Nursing Ethics

The evolution of nursing ethics spans centuries, and early foundations can be traced to Florence Nightingale.^[2] Her emphasis on integrity, responsibility, compassion, and respect shaped what it means to be a professional nurse. As the field advanced, so did its ethical standards.

The ANA first published a formal code of ethics in the mid-20th century. Since then, it has undergone several revisions to reflect changes in healthcare and societal expectations. Today, the ANA Code remains the most authoritative guide for ethical nursing practice in the United States, referenced widely in nursing education, research, professional organizations, and policy. Advanced programs such as the Master’s of Science in Nursing, Direct Entry integrate these ethical frameworks to support students transitioning into nursing from other careers.

Ethical Decision-Making in Nursing Practice

A helpful tool for ensuring nursing ethics in practice is the seven-step ethical decision-making model. It is adapted from professional counseling and healthcare ethics frameworks:^[3]

1. Identify the issue: Determine whether the concern is ethical, legal, clinical, or a combination.
2. Consult the code of ethics: Review relevant AHA provisions to understand obligations and guiding principles.
3. Clarify the core problem: Define the central conflict or question.
4. Brainstorm options: Generate possible courses of action without judging them prematurely.
5. Weigh the consequences: Consider how each option affects patients, families, colleagues, and the healthcare system.
6. Evaluate choices through justice: Ensure that the decision promotes fairness and equitable treatment.
7. Implement a solution: Put the decision into action and document the reasoning when appropriate.

In fast-paced clinical environments, decisions may require quick reflection or consultation with a supervisor, mentor, or interdisciplinary team. Ethical practice is strengthened through collaboration and open communication. Leadership roles, such as those prepared for in Master’s of Science in Nursing, Nurse Executive programs, emphasize mentoring other nurses and modeling ethical decision-making in complex healthcare systems.

Common Ethical Dilemmas in Nursing

While nurses strive to uphold ethical principles at all times, real-world conditions often create emotionally complex and morally challenging situations. Some of the most common dilemmas include:

Withholding or Communicating Diagnoses

Families may request that information be withheld from a patient. This creates tension between veracity, autonomy, and beneficence. Nurses must advocate for honest communication while respecting cultural or familial contexts.

End-of-Life Conflicts

A patient’s wishes regarding life support or comfort care may differ from family demands. These situations require careful balancing of autonomy and compassion.

Pain Management Decisions

A nurse might face pressure to administer pain medication while also worrying about potential adverse effects. Beneficence and nonmaleficence play key roles in making these kinds of decisions.

Patient Advocacy During High-Stress Decisions

Patients may struggle to understand urgent or complex treatment options. Nurses must support comprehension and informed consent without coercion.

The Impact of Ethics on Patient Care

Strong ethical practice enhances every dimension of patient care. When nurses adhere to the ANA Code and core ethical principles, they build trust and establish meaningful patient relationships. 

Ethics also benefits nurses themselves. When personal values align with professional practice, nurses may experience increased job satisfaction and confidence in their clinical decisions. Engaging with professional organizations and continuous learning helps nurses maintain ethical integrity and professional growth.

Measuring Ethical Outcomes

Ethical practice in nursing is closely associated with measurable indicators of healthcare quality and safety. Research suggests that ethical frameworks can help reduce medical errors.^[4] When nurses are encouraged to speak up and prioritize patient safety over hierarchy or convenience, error reporting increases and preventable harm decreases.

Studies also find that higher ethical scores in nursing correlate with better self-evaluated care quality, particularly in high-pressure situations like pandemic care.^[5] In other words, ethical support enhances how nurses interpret and deliver high-quality care.

The Future of Nursing Ethics

Nursing ethics continues to evolve in response to changes in patient populations and technology. For instance, national healthcare organizations such as the National Academy of Medicine have identified ethical considerations related to telehealth, digital privacy, and the use of artificial intelligence as growing areas of concern for nursing practice.^[6]

These developments highlight the importance of preparing nurses to apply ethical reasoning in complex, technology-driven care environments.

Preparing for Ethical Challenges in Nursing Education

Nursing education plays a vital role in shaping ethical practitioners. Ethics is integrated into coursework, case studies, simulation labs, and clinical rotations to ensure that students develop both conceptual understanding and practical judgement.

If you are interested in nursing and wondering, “Is nursing a good career,” explore the nursing programs at Alliant University and learn how you can build the ethical foundation required for a meaningful career in patient care.

---

Sources:

^[1] “Nursing Management and Professional Concepts [Internet]. 2nd ed. Ethical Practice.” National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK610435/. Accessed January 8, 2026.

^[2] “Nursing Fundamentals [Internet]: Chapter 1, Scope of Practice.” National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK591808/. Accessed January 8, 2026.

^[3] “A Systematic Approach to Ethical Decision-Making for Nurses.” American Psychiatric Nurses Association. December 2022. https://www.apna.org/news/a-systematic-approach-to-ethical-decision-making-for-nurses/. Accessed January 8, 2026.

^[4] Jee-In Hwang, Hyeoun-Ae Park. “Nurses’ Perception of Ethical Climate, Medical Error Experience and Intent-to-Leave.” National Library of Medicine. February 21, 2014. https://pubmed.ncbi.nlm.nih.gov/23793070/. Accessed January 8, 2026.

^[5] Wenjing Jiang, Xing’e Zhao, Jia Jiang, Huilin Zhang, Shujuan Sun, Xianhong Li. “The Association Between Perceived Hospital Ethical Climate and Self-Evaluated Care Quality for COVID-19 Patients: The Mediating Role of Ethical Sensitivity Among Chinese Anti-Pandemic Nurses.” Springer Nature Link. October 27, 2021. https://link.springer.com/article/10.1186/s12910-021-00713-4. Accessed January 8, 2026.

^[6] Dariush D. Farhud, Shaghayegh Zokaei. “Ethical Issues of Artificial Intelligence in Medicine and Healthcare.” National Library of Medicine. November 2021. https://pmc.ncbi.nlm.nih.gov/articles/PMC8826344/. Accessed January 8, 2026.