Professional Nursing Ethics: Code, Values, and Obligations

Introduction

It is possible — though not advisable — to enter the nursing profession today without knowing what the Nightingale Pledge is, or more importantly, what it represents. The reason this is inadvisable is straightforward: nursing is a field that carries enormous social, moral, and ethical responsibility. That accountability is now guided by the Code of Ethics with Interpretive Statements; however, the original blueprint was the Nightingale Pledge, which can be considered nursing's equivalent to the physicians' Hippocratic Oath. The modern version — the Code of Ethics with Interpretive Statements — is a thorough guide that helps both new and experienced nurses carry out their responsibilities in a way that meets all ethical duties required by the profession.

The Nightingale Pledge has evolved over more than a century, and throughout that time the healthcare industry has changed in countless ways — as have the responsibilities of nurses. At each step, the code of ethics has been present to provide goals, values, and obligations for those practicing the art of nursing. The code's ethical commitments have been updated as needed, and this paper will describe several of these ethical principles and their real-world implications.

Social Responsibility

The Nightingale Pledge has moved beyond its original principles and evolved into the Code of Ethics with Interpretive Statements, which incorporates more modern social and ethical values. For example, the code holds that the nursing community should collaborate with other health professions and citizens in order to promote community and national efforts to advance societal health. This obligation extends into the political arena as well. During the legislative push for the Affordable Care Act, nurses across the country worked alongside policymakers to advance meaningful healthcare reform. As then-ANA President Rebecca M. Patton noted:

"This has been a historic week of events for advocates of health care reform. The House passed H.R. 3962, 'The Affordable Health Care for America Act.' I wanted to take the opportunity to thank nurses across the country for their help and support in advancing meaningful health care reform. Whether you took part in town halls, wrote letters to the editor, or contacted your own representatives to voice your opinion — your actions had an impact." (Patton)

This example illustrates how the nursing community's ethical obligations can direct its members well beyond the clinical setting and into all aspects of civic life.

Legal and Ethical Issues

Like any industry, healthcare understands that delivering quality service requires commitment at every level of an organization. Nurses fulfill this commitment through two core ethical duties: respecting patient autonomy and meeting patient needs. Through these duties, nurses must act to safeguard clients and the public from incompetent, unethical, or illegal acts by any person. It is equally important, however, to distinguish between legal and ethical obligations, as the two do not always align — though they frequently overlap.

Consider healthcare fraud and its impact on the duty of autonomy. If a nurse knowingly updates an official medical record — whether for a real or fictitious patient — with false information, such as claiming a medication was administered when it was not, that action is clearly unethical. More significantly, it is also illegal. In such a situation, the nurse has not only violated the profession's ethical code but has also crossed into the territory of criminal statutes.

There are ample opportunities to commit fraud — whether deliberately or accidentally — over the course of a nursing career. Submitting false billing for services either rendered or not rendered is one clear example of failing a legal and ethical obligation. A common form of this fraud involves requesting reimbursement for non-covered or non-performed services, costing Medicare and communities millions — possibly billions — of dollars annually.

Other illegal practices in healthcare include billing for duplicate services, performing medically unnecessary procedures, exaggerating the severity of a condition, and other forms of misrepresentation. If a night-shift staff claims to have taken a patient's temperature every hour when they were in fact absent from their duties, they are falsifying the description of services rendered. All of these actions constitute fraud and carry legal consequences. In no way can such conduct be considered consistent with the standards of professional nursing.

Conclusion

This paper examined ethics as they pertain to the daily obligations of the nursing community. There are essentially two types of ethics for nurses. The first encompasses a nurse's personal ethics — her individual values shaped by religion, politics, family upbringing, education, and life experience — alongside her work ethic and capacity for teamwork. These influences collectively shape how a nurse approaches her responsibilities. Because nurses frequently work without direct supervision, they must be self-reliant and capable of doing the right thing at the right time without external prompting.

The second type is the formal Code of Ethics with Interpretive Statements established by the American Nurses Association. This code forms the foundation for how patients and society are to be treated. Its guidelines define the legal and professional obligations by which nurses describe clinical problems, assess patient status, support health outcomes, document accurately, and participate in the decision-making process — all in service of making patients well. Both personal and professional ethics are essential, and together they define what it means to practice nursing with integrity.

Works Cited

American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. ANA Publications, 2009.

Gallagher, Ann. "Editorial." Nursing Ethics, vol. 16, no. 6, Nov. 2009, pp. 679–680.

HHS. "Health Information Privacy." U.S. Department of Health and Human Services, 2009, www.hhs.gov/ocr/privacy/.

Patton, Rebecca M. "A Message From ANA President Rebecca M. Patton." American Nurses Association, 2009.

Whitty-Rogers, Joanne, et al. "Working with Children in End-of-Life Decision Making." Nursing Ethics, vol. 16, no. 6, Nov. 2009, pp. 743–758.