In a culture where skepticism reigns supreme, not many professions can uphold the highest industry-wide standards for honesty and integrity. Nursing, however, is the exception. In 2025, nursing has again been ranked the most ethical and most trusted profession in the U.S.
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Source: Saad, L. (2025, March 27). Americans’ ratings of U.S. professions stay historically low. Gallup.com. https://news.gallup.com/poll/655106/americans-ratings-professions-stay-historically-low.aspx
Ethics in healthcare is absolutely critical to upholding standards of patient care and treating patients with the inherent dignity which is their right. To that end, the American Nurses Association has published and regularly updated the Code of Ethics for Nurses since its inception in 1950, providing a framework for ethical principles and health policy to guide the entire nursing profession.
Here, we’ll examine the nursing code of ethics as outlined by the ANA, and how it can be applied to individual or group nursing practice. We’ll also look at how nurses, in a particularly skeptical and litigious society, can help protect themselves from liability with the same amount of dedication they give to providing excellent care and protecting patients’ rights.
What Is the ANA Code of Ethics for Nurses?
The ANA Code of Ethics for Nurses is the industry benchmark for ethical decision-making in nursing. The code was originally intended to act as a moral compass for nurses in the post-Florence Nightingale era, replacing the unofficial Nightingale Pledge with an established guiding ethical principle.
While the traditional ethical obligations have remained for over 70 years, the code has adapted and evolved with the times, incorporating 21st-century sensibilities and a stronger push toward advocacy, health disparities, and social justice.
The code is intended to help nurses navigate an industry in which ethical dilemmas could mean the difference between life and death for patients, with the core values of beneficence and nonmaleficence.
Today, the Code of Ethics for Nurses is a foundational document for nursing education programs as well as a roadmap for any ethical nursing practice.
Understanding How the Code of Ethics is Structured
The nursing code of ethics is a vast compendium of knowledge on ethical standards for nursing professionals that contribute to a safer and more effective healthcare environment. The structure of the Code of Ethics includes:
Guiding Principles
The guiding ethical principles of the Code of Ethics for Nurses include:
- Autonomy: The nursing profession respects the right of the individual to make their own decisions regarding their healthcare.
- Nonmaleficence: Nurses are committed to doing no harm to their patients.
- Beneficence: A nurse’s primary commitment is to help the patient and take actions for their benefit.
- Justice: Nurses have a responsibility to preserve social justice and fill gaps and health disparities.
- Veracity: Nurses should value truthfulness and honesty in their interactions with patients and colleagues.
- Accountability: All nurses are responsible for the decisions they make while patients are in their care.
- Fidelity: Nurses should always strive to fulfill their promises and maintain a transparent relationship with patients.
Provisions
After a 2015 update, the code remained largely unchanged until a major revision in 2025. This version of the code has one very prominent and notable change: the addition of one new core provision to the previous nine. In-depth information on each of the 10 provisions is featured below.
Interpretive Statements
Each of the provisions in the code contains a number of interpretive statements (35 total) that translate lofty goals and ideals into real-world actions and applications. These statements help nurses with practical insights that can guide ethical decision-making and contribute to their professional development. The interpretive statements are meant to clarify the provisions and provide both explanations and examples of how they can be implemented in any nurse’s practice.
A Quick Summary of the 10 Provisions of the ANA Code of Ethics
The real heart of the code is the 10 provisions around which it’s built. They include:
Provision 1: Compassion and Respect for Every Person
From the code:
“The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.”
What does it mean? This provision guides a nurse in treating every patient with dignity and respect, regardless of their background, culture, or beliefs. An example of it in action could be a nurse seeking out a translator to make a non-native speaker more comfortable and to ensure clear and accurate communication while respecting the patient’s cultural background.
Provision 2: Commitment to the Patient
From the code:
“A nurse’s primary commitment is to the recipient(s) of nursing care, whether an individual, family, group, community, or population.”
What does it mean? This provision means that a nurse is an advocate for the patient and speaks out for their needs and rights. For instance, if a patient chooses not to pursue life-saving treatment and instead opts for palliative care, it is the nurse’s responsibility to support that choice, regardless of whether the patient’s family members or community agree.
Provision 3: Advocacy and Protection
From the code:
“The nurse establishes a trusting relationship and advocates for the rights, health, and safety of recipient(s) of nursing care.”
What does it mean? This provision means that the nurse is responsible for protecting the privacy of a patient, keeping their care confidential, and building a culture of safety. As an example, if a nurse sees that a colleague is working while physically or mentally impaired in a way that could compromise the well-being of patients, the nurse is duty-bound to report and/or intervene in order to preserve the patient’s safety.
Provision 4: Accountability and Responsibility
From the code:
“Nurses have authority over nursing practice and are responsible and accountable for their practice consistent with their obligations to promote health, prevent illness, and provide optimal care.”
What does it mean? This provision speaks to the obligation the nurse has to the practice where he or she works, and the responsibility to ensure it is operating ethically efficiently. This can include working toward meeting all regulatory requirements in an institutional capacity, breaking down barriers that impede nursing practice, and appropriately designating or assigning job duties to co-workers or student nurses.
Provision 5: Duties to Self and Others
From the code:
“The nurse has moral duties to self as a person of inherent dignity and worth including an expectation of a safe place to work that fosters flourishing, authenticity of self at work, and self-respect through integrity and professional competence.”
What does it mean? This provision details how nurses must care first for themselves so they can better care for others. For example, a nurse who is dealing with professional burnout may be more likely to make harmful mistakes, and has a responsibility to remove themselves from practice until their mental and physical health can be addressed. Or, a nurse who has worked a double shift and is struggling to stay awake should let a supervisor know so a replacement can be found as quickly as possible to prevent lapses in care.
Provision 6: Creating an Ethical Workplace
From the code:
“Nurses, through individual and collective effort, establish, maintain, and improve the ethical environment of the work setting that affects nursing care and the well-being of nurses.”
What does it mean? This provision deals with the way a nurse interacts with his or her colleagues within the work environment, and outlines the moral obligations of each nurse to maintain respect, transparency, and civility among co-workers. For example, bullying behaviors should never be tolerated, and nurses should make every effort to connect with their peers in a way that is positive and builds community.
Provision 7: Advancing the Profession
From the code:
“Nurses advance the profession through multiple approaches to knowledge development, professional standards, and the generation of policies for nursing, health, and social concerns.”
What does it mean? This provision addresses the ethics around advancements in the nursing field through research, knowledge, and science. In this case, the nurse’s obligation is to the human beings impacted by the research or technology used to make these strides forward. For example, if a nurse assisting a research study sees that a subject is uncomfortable with study-related procedures, it is the nurse’s responsibility to advocate for the subject’s safety and well-being.
Provision 8: Collaboration to Promote Human Rights
From the code:
“Nurses build collaborative relationships and networks with nurses, other healthcare and nonhealthcare disciplines, and the public to achieve greater ends.”
What does it mean? This provision deals with health equity and social justice on a broad scale. It clarifies that a nurse has an obligation to work toward the greater good by advocating for human rights and providing equitable care. For instance, a modern nurse should be trauma-informed and culturally sensitive to patients and their families, not just for individual care, but for the improvement of the entire community.
Provision 9: Upholding the Integrity of Nursing
From the code:
“Nurses and their professional organizations work to enact and resource practices, policies, and legislation to promote social justice, eliminate health inequities, and facilitate human flourishing.”
What does it mean? This provision speaks to the responsibility every nurse has to uphold ethical standards on a much wider scale than in their practice or their community. This relates to the entire nursing profession and healthcare as an industry. Nurses should be advocates for improvements in healthcare policy, public health, equity, and intersectionality. Quality healthcare is only possible when our government enacts legislation that supports it, and healthcare professionals have an obligation to understand and speak out for policies and programs that benefit not just the profession of nursing or the healthcare system, but every single human.
Provision 10: Embracing a Global Nursing Community
From the code:
“Nursing, through organizations and associations, participates in the global nursing and health community to promote human and environmental health, well-being, and flourishing.”
What does it mean? This provision addresses the fact that we live in a global society now, and what we do for the good of our communities should also be done for the good of our shared world. For example, nurses should maintain a commitment to the environment, looking for ways to practice more sustainability, conserve energy, or enact policies that address global concerns. Additionally, nurses should act in solidarity with their professional peers, regardless of where or how they practice.
Why the Nursing Code of Ethics Is Essential for Everyday Nursing Practice
The nursing landscape is always shifting, and it helps if nurses have the knowledge and moral foundation to see them through the unexpected and adverse situations. The Code of Ethics for Nurses sets them up for success by equipping them to make informed decisions when faced with ethical dilemmas, which might include:
Shifting Regulations
Compliance is critical in all practice settings, but regulatory requirements change rapidly and can be difficult to understand and maintain. Knowledge about issues like informed consent, which require meticulous documentation, can be the difference between total compliances and consequential violations.
Evolving Technology
Technological advances can be lifesaving and life-changing for many patients, but they can also lead to ethical gray areas for nurses in a professional practice. Developments like artificial intelligence and machine learning may make certain aspects of the job easier or less prone to error, but these systems must be managed properly, used appropriately, and never without human oversight.
Longer Lifespans
Thanks to advances in science and human knowledge, people live longer than any other time in history. While this is accepted gladly by many, others may be reluctant to embrace a longer life without understanding the consequences. It is critical that nurses understand their obligation to each patient, to advocate not just for length of life but quality of life, and to be the voice of the patient if they are at any point unable to express their wishes. If a nurse has a personal belief that is counter to the patient’s wishes, he or she will need to have the ethical foundation to make the right decision for the patient, or seek support to avoid conflicts of interest.
Staffing Shortages
During a time when staff turnover in the nursing industry is at an all-time high, nurses need to know how to make ethical decisions that impact their colleagues or their practice. A nurse might be reluctant to report a co-worker who is impaired on the job because of the extra load it will place on the rest of the team, but not doing so would be in violation of the code. Or a nurse might take on too many shifts or too much responsibility knowing he or she can’t handle it, but feeling compelled to pick up the slack when staff numbers are low. In this case, the nurse would be violating the moral and ethical obligation to themselves.
FAQs About the ANA Code of Ethics
Still have questions about the American Nurses Association Code of Ethics? We have the answers you need.
Is the Code of Ethics for Nurses legally binding?
While the Code of Ethics for Nurses is not a legally binding document, it does outline a framework of ethical behavior that may touch on certain laws and policies in the healthcare field. Violating this code could have professional consequences and, if the ethical decision in question violates an existing law, it could have legal consequences as well. It can be helpful to understand how to use the code to handle legal or litigious situations, along with other industry best practices, like carrying
malpractice insurance.
Do all nurses need to know the nursing code of ethics by heart?
No, all nurses do not need to know the nursing code of ethics by heart, primarily because it is a long and complex document that would be difficult to memorize and recite verbatim. However, it is expected that nursing professionals have a full understanding of the code and practice according to the standards it sets. Many nursing schools require students to take courses in nursing ethics, while some nursing professionals opt to complete refresher courses throughout their career for professional development and to stay on top of any changes or updates.
How often is the ANA Code updated?
The ANA Code of Ethics for Nurses is updated every 10 years to stay current with national and global trends and concerns. The most recent update of the ANA code was released in January 2025, and included the addition of a tenth provision to the existing nine. This provision centers around the nurse’s obligation to the global community.
What is the role of nurse leaders and ethics committees?
The role nurse leaders and ethics committees play in healthcare settings is critical in upholding the standards set forth in the ANA Code of Ethics for Nurses. Leaders and committee members shape the culture of the workplace and the industry as a whole, and are responsible for building ethical practices that prioritize high-quality care for every person. Additionally, nurse leaders are responsible for putting protections in place for their nursing staff. This may include business or practice owners carrying
professional liability coverage for employees.
Resources for Learning More About Nursing Ethics
There are a number of resources any nurse can leverage to increase their knowledge of the nursing code of ethics. Some valuable resources include:
- The American Nurses Association: The ANA is the entity behind the Code of Ethics for Nurses, and it offers unparalleled insights and information into how the code should be used. The organization also offers online learning courses for a deeper understanding.
- Nursing Ethics: This peer-reviewed journal is an industry standard, and is a must-read for all nurses who want to practice according to the ethics code.
- Nursing Center: This is a repository of industry and practice information for nurses who wish to grow their knowledge of the industry and the profession of nursing.
- ICN: The International Council of Nurses is a great place to get a more global perspective on nursing ethics. It offers a library of resources on different topics related to professional ethics, including social-economic welfare and nursing regulation.
How NSO Can Help Nurses
Even ethical and morally responsible nurses can face legal ramifications in their practice. Following the ANA Code of Ethics for Nurses is a key first step to preventing or preparing for legal discrepancies in your career. The next step is to ensure you have adequate protections in place if you ever find yourself being litigated. At NSO, we offer
individual malpractice insurance for registered nurses, nurse practitioners, nursing students, and more. Our policies go beyond those provided by your employer to help you mitigate your risk and provide you with the peace of mind you need to stay focused on what really matters — the patients who need your care.
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Request a quote today.