Ethics are universal across healthcare settings and providers and are an important element that drives safety, trust, and quality patient care. This may lead some people to wonder if nurses are held to the same ethical traditions as physicians.
Ethical principles guide how healthcare professionals make decisions, treat patients, and interact with families and colleagues. This ethical foundation isn't new, and its roots can be traced back to some of the earliest ethical concepts in healthcare, most notably the Hippocratic Oath.
Originating in ancient Greece, the Hippocratic Oath is an ethical pledge traditionally taken by physicians. It emphasizes principles like patient confidentiality and non-maleficence. While this pledge isn’t legally required, over time, it has evolved, with new versions being created, into a symbol that underscores a physician’s commitment to ethical medical practice.
However, do nurses take the Hippocratic Oath? The short answer is no. Instead, nurses adhere to their own set of ethical guidelines tailored to their profession.
"While both professions operate under shared ethical principles of beneficence, nonmaleficence, autonomy, and justice, the focus and application of these principles differ based on role, scope, and context," said Mary Lynch, MSN, RN, Curriculum Designer at Relias.
To understand what guides nursing ethics, it's helpful to look at the history and significance of the Nightingale Pledge and other modern nursing codes of ethics.
The Nightingale Pledge: Nursing's ethical commitment
Lystra Gretter and a committee at the Farrand Training School for Nurses in Detroit, Michigan, crafted the Nightingale Pledge in 1893. This pledge was named for Florence Nightingale, who is considered the founder of modern nursing.
This pledge emphasizes concepts like purity, fidelity, and commitment to patient care. While not universally adopted, some nursing schools incorporate the Nightingale Pledge into their pinning ceremonies, marking the transition from student nurse to professional.
Within the pledge, nurses vow “to pass my life in purity and to practice my profession faithfully,” and “to do all in my power to maintain and elevate the standard of [the] profession.” It also highlights the importance of confidentiality and patient welfare, reminding to “hold in confidence all personal matters” and “devote [themselves] to the welfare of those committed to [their] care.”
Over time, the Nightingale Pledge has undergone revisions to reflect the evolution of nursing and societal values. Modern versions focus on patient advocacy, confidentiality, and continuous professional development to better align with present standards.
For instance, in 2020, nurses from the Massachusetts Nurses Association shared a modern version in light of the COVID-19 pandemic, pledging to “honor the nurse-patient relationship as the locus for healing,” uphold ethical principles like beneficence and justice, and “protect Planet Earth as our home.”
The American Nurses Association Code of Ethics
Beyond ceremonial pledges, nurses in the U.S. are guided by the American Nurses Association (ANA) Code of Ethics. This comprehensive document outlines the ethical obligations and duties of every nurse, providing a framework for ethical decision-making.
Additionally, it also serves as a moral compass, explained Mary, a nurse with over 10 years of experience, highlighting its strong emphasis on individual ethical standards and personal accountability in practice.
The ANA Code of Ethics encompasses these principles:
- Respect for human dignity: Treat all patients with compassion and respect, regardless of background or circumstances.
- Commitment to the patient: Maintain a commitment to the patient and ensure their needs and well-being are prioritized.
- Advocacy: Advocate for the rights, health, and safety of patients, ensuring they receive appropriate care.
- Accountability and responsibility: Be accountable for your own actions and maintain competence in practice.
- Commitment to self: Care for your own health and well-being, recognizing that self-care enhances the ability to care for others.
- Ethical work environment: Contribute individually and collectively to creating and sustaining an ethical work environment that supports quality care and nurse well-being.
- Continuous professional development: Advance the profession by shaping knowledge, setting standards, and influencing policies on health and social issues.
- Collaboration: Effective nursing practice involves collaboration with other healthcare professionals to provide comprehensive care.
- Advocating for policies and legislation: Advocate for policies and practices that promote social justice and reduce health inequities.
- Promoting human and environmental health: Advance human and environmental health on a global scale through active involvement in professional organizations and advocacy efforts.
The ANA periodically updates the Code of Ethics to address challenges in healthcare, such as technological advancements, cultural diversity, and evolving patient needs.
The International Council of Nurses Code of Ethics
On an international scale, the International Council of Nurses (ICN) provides a Code of Ethics that serves as a guide for nurses worldwide. This code emphasizes the importance of respect for human rights, cultural sensitivity, and the promotion of health and well-being.
The ICN Code of Ethics addresses the following:
- Nurses and patients: The nurse's central duty is to those requiring nursing care.
- Nurses and practice: They're responsible for maintaining competence and continuing professional development.
- Nurses and the profession: They play a role in determining and implementing acceptable evidence-based standards of clinical nursing practice, management, research, and education.
- Nurses and global health: They sustain a collaborative and respectful relationship with coworkers in nursing and other fields.
These principles reflect nurses' global commitment to upholding ethical standards, providing equitable care, and fostering collaborative practice across cultures and healthcare systems.
Mary recalled caring for a postpartum patient from India who followed the Hindu faith. The patient requested only female OB (obstetrics) providers and asked for a third person to be present if a male provider needed to speak with her while her husband was away.
When concerns arose from the patient and no female OB was available, Mary quickly set up a partition in the room so a male provider could consult from behind it without performing an exam unless the situation became critical. The provider trusted Mary’s assessment, and the conversation lasted only a few minutes. The patient expressed deep gratitude to Mary for the respectful handling of her needs.
Final thoughts
"Jointly, these codes provide a shared language of ethics across healthcare settings, as well as support culturally sensitive, patient-centered care," said Mary. "They also provide professional protection for nurses, should an ethical dilemma arise, and empower advocacy, especially in support of equitable care."
While nurses don’t take the Hippocratic Oath, they’re bound by ethical standards and pledges that reflect the profession's core values. Through the Nightingale Pledge, the ANA Code of Ethics, and international guidelines, nurses commit to providing compassionate, ethical, and competent care to all patients.
