Ethical Principles in Nursing: A Nurse’s Complete Guide to Ethics, Ethical Principles, and the Nursing Code of Ethics

Ethical principles in nursing form the foundation upon which professional judgment, responsibility, and trust in healthcare are built. Every nurse encounters situations that require more than technical skill or clinical knowledge; they demand thoughtful consideration of ethics, ethical values, and professional obligations. From respecting patient choices to acting in the best interest of individuals and communities, ethical practice is inseparable from the daily realities of nursing care. These principles provide a structured way to navigate complex clinical environments while maintaining integrity, accountability, and respect for human dignity.

Within the nursing profession, ethics serves as a guiding framework that supports consistent, fair, and compassionate decision-making. Ethical principles in nursing help nurses make decisions in situations involving uncertainty, competing values, or limited resources. They clarify what it means to provide high-quality care, promote health, and protect vulnerable populations. Grounded in both moral philosophy and professional standards, ethical nursing practice connects individual actions at the bedside with broader responsibilities to health professionals and the public. This connection is reinforced through established ethical standards and the nursing code of ethics, which articulate expectations for conduct, accountability, and professional behavior across diverse care settings.

This article provides a comprehensive examination of ethical principles in nursing, beginning with foundational concepts and progressing through professional standards, ethical dilemmas, education, and everyday clinical application. Drawing on scholarly inquiry and guidance established by the American Nurses Association, the discussion explores how ethical principles such as beneficence, autonomy, justice, and fidelity shape nursing practice and professional identity. By integrating theory, practical examples, and ethical decision-making frameworks, this guide is designed to support nursing students and practicing nurses in understanding, applying, and sustaining ethical nursing throughout their careers.

Foundations of Ethical Principles in Nursing

Understanding Ethics and Ethical Principles in Nursing Practice

Ethics in healthcare refers to the systematic study of what is right and wrong in situations that affect human life, health, and dignity. Within the nursing profession, ethics provides a formal framework that helps nurses analyze complex situations and determine appropriate actions when patient well-being, rights, or safety are involved. Rather than relying on personal opinions alone, ethical nursing is grounded in shared professional standards that support consistency and accountability in nursing practice.

Key aspects of ethics in healthcare include:

• Evaluating actions that affect patient care and outcomes
• Balancing competing interests, values, and responsibilities
• Supporting ethical decision-making in uncertain or high-risk situations
• Promoting trust between nurses, patients, and health professionals

It is essential for nursing students to understand the distinction between ethics, morals, and professional values, as these concepts influence practice in different ways:

• Morals
  • Personal beliefs about right and wrong
  • Shaped by culture, religion, family, and life experiences
• Ethics
  • A structured and reasoned approach to decision-making
  • Based on ethical standards shared across the nursing profession
  • Used to justify and evaluate professional actions
• Professional values
  • Core ideals of nursing, such as compassion, integrity, and accountability
  • Expressed through professional nursing behavior and responsibilities

Ethical principles are central to nursing identity because nurses routinely make decisions that directly affect patient safety, dignity, and quality of nursing care. Whether administering medication, educating patients, or advocating within healthcare systems, nurses must consistently apply ethical values to guide actions. Ethical principles in nursing provide a reliable foundation that supports fair treatment, protects vulnerable populations, and reinforces public trust in nursing and health services.

Core Ethical Principles in Nursing and Their Role in Patient Care

Several widely accepted principles of ethics guide ethical nursing practice and professional judgment. These principles serve as a common language for addressing ethical issues and resolving ethical problems in clinical settings.

The core ethical principles in nursing include:

• Autonomy – Respecting the patient’s right to make informed decisions
• Beneficence – Acting to promote health and support patient well-being
• Nonmaleficence in nursing – Avoiding actions that cause harm
• Principle of justice – Ensuring fairness in access to care and resource allocation

These principles work together to guide nurse–patient relationships and professional conduct. For example:

• Respecting autonomy strengthens trust by honoring patient preferences
• Beneficence supports compassionate care that prioritizes comfort and healing
• Justice helps reduce health disparities by promoting fair treatment

Ethical principles also provide a framework for safe and compassionate care. In fast-paced clinical environments, nurses often face ethical challenges related to limited resources, cultural differences, or end-of-life decisions. By applying ethical nursing principles, nurses can:

• Maintain focus on patient-centered care
• Make decisions that align with professional expectations
• Provide high-quality care even under pressure

This ethical foundation supports consistency, fairness, and integrity across all areas of nursing care.

Beneficence and Autonomy as Cornerstones of Nursing Care

Among the core ethical principles, beneficence and autonomy are especially prominent in everyday nursing practice. Together, they shape how nurses provide care, communicate with patients, and make clinical decisions.

Beneficence in nursing involves:

• Acting in ways that promote health and prevent harm
• Providing timely, evidence-based interventions
• Offering emotional support and compassionate care
• Advocating for patients when needs are unmet

For example, ensuring adequate pain management or preventing complications through close monitoring reflects the principle of beneficence by prioritizing patient comfort and safety.

Autonomy focuses on:

• Respecting patients as active participants in their care
• Supporting informed consent through clear communication
• Acknowledging the patient’s right to accept or refuse treatment

A nurse who explains treatment options, answers questions honestly, and supports patient preferences is actively upholding autonomy in nursing care.

Conflicts may arise when beneficence and autonomy appear to compete. For instance, a patient may decline a treatment that the healthcare team believes is necessary for recovery. In such cases, ethical decision-making requires nurses to:

• Communicate respectfully and provide complete information
• Collaborate with other health professionals
• Balance the patient’s best interest with respect for choice
• Adhere to ethical standards and professional responsibility

Professional Ethical Standards and the Nursing Code of Ethics

Overview of the Nursing Code of Ethics

The nursing code of ethics provides the formal ethical foundation that governs professional nursing conduct across all care settings. While ethical principles offer theoretical guidance, the code of ethics translates those principles into clear expectations for behavior, accountability, and responsibility within the nursing profession. It serves as a shared framework that guides nurses in addressing ethical issues consistently, regardless of role, specialty, or practice environment.

The primary purpose of the code of ethics for nurses is to:

• Define ethical obligations and duties in nursing practice
• Support ethical decision-making in complex clinical situations
• Promote integrity, trust, and professionalism
• Protect patient rights and human dignity

The code is structured around a set of ethical statements—often referred to as provisions or interpretive statements—that explain how ethical principles apply to real-world nursing situations. These statements clarify what ethical nursing looks like in practice, from bedside care to leadership, education, research, and policy involvement. Rather than functioning as a legal rulebook, the code of ethics helps nurses reflect critically, navigate ethical challenges, and fulfill their ethical obligation to patients and society.

Importantly, the relationship between ethical principles and professional standards is deeply interconnected. Ethical principles such as beneficence, autonomy, fidelity, accountability, and justice inform professional nursing standards, while the code operationalizes those principles into expectations for conduct. Together, they ensure that nursing care remains ethical, consistent, and aligned with the values of the profession.

The American Nurses Association and Ethical Guidance for Nurses

In the United States, ethical leadership within nursing is formally established by the American Nurses Association (ANA). The ANA develops, maintains, and interprets the nursing code of ethics, ensuring that it reflects evolving healthcare environments, emerging ethical challenges, and the realities of modern nursing practice. The code is established by the American Nurses Association and represents the collective ethical voice of the profession.

The ANA plays a critical role in ethical guidance by:

• Defining ethical standards for professional nursing
• Providing interpretive statements that guide nurses in practice
• Supporting nursing education and ethical competence
• Addressing ethical challenges at organizational and policy levels

The ANA code of ethics supports ethical decision-making by offering a structured approach to analyzing ethical problems. When nurses face situations involving competing values—such as limited resources, patient refusal of treatment, or conflicts within care teams—the code helps nurses make decisions grounded in ethical reasoning rather than personal preference. It reinforces that ethical decision-making in nursing is not optional but an essential part of professional responsibility.

Using ANA guidance in clinical scenarios may include:

• Consulting the code when addressing ethical dilemmas related to patient care
• Applying interpretive statements to clarify ethical considerations
• Collaborating with ethics committees or leadership when uncertainty arises
• Reflecting on how professional standards align with patient needs

By serving as both a moral compass and a professional standard, the ANA helps guide nurses in navigating ethical challenges while maintaining trust with patients, colleagues, and the public.

Ethical Responsibilities to Patients, Colleagues, and Society

Professional ethical standards extend beyond individual patient interactions to encompass responsibilities to colleagues, health professionals, and society at large. These responsibilities reinforce the nurse’s role as both a caregiver and a steward of public trust.

Ethical responsibilities to patients include:

• Respecting dignity, autonomy, and privacy
• Safeguarding confidentiality and sensitive information
• Advocating for patient needs, safety, and best interest
• Providing honest, compassionate, and competent care

For example, a nurse who speaks up when patient safety is compromised is fulfilling an ethical responsibility rooted in accountability and fidelity to professional values.

Responsibilities to colleagues and interprofessional teams involve:

• Collaborating respectfully with other health professionals
• Communicating ethically and transparently
• Supporting ethical practice within healthcare teams
• Addressing unethical behavior through appropriate channels

Ethical nursing practice recognizes that high-quality care depends on effective teamwork and mutual respect across disciplines.

Beyond the clinical setting, nurses also hold ethical obligations to the public and community health. These obligations reflect nursing’s commitment to social responsibility and justice in nursing and health.

Ethical responsibilities to society include:

• Promoting public health and reducing health disparities
• Supporting principles of social justice in healthcare systems
• Advocating for ethical nursing and health policy
• Protecting human rights within healthcare delivery

Ethical Decision-Making and Ethical Dilemmas in Nursing Practice

Common Ethical Dilemmas Encountered in Nursing Practice

Ethical dilemmas arise when a nurse faces a situation in which two or more ethical principles conflict, making it difficult to determine the most appropriate course of action. These situations are common in nursing practice because nurses work at the intersection of patient needs, professional standards, institutional policies, and legal requirements. Ethical dilemmas require careful reasoning, collaboration, and a clear understanding of ethical considerations rather than quick or emotionally driven responses.

Common ethical dilemmas encountered in nursing practice include:

• End-of-life care and informed consent
  • Decisions about life-sustaining treatments, resuscitation, or withdrawal of care
  • Respecting patient wishes when family members disagree
  • Ensuring informed consent when patients have limited decision-making capacity
  Example: A terminally ill patient may refuse aggressive treatment, while family members insist that “everything be done.” In this case, the nurse must respect autonomy, act in the patient’s best interest, and support ethical decision-making grounded in professional standards.
• Resource allocation and justice in healthcare
  • Limited availability of beds, medications, or specialized services
  • Fair distribution of care among patients with competing needs
  • Addressing inequities that contribute to unequal access to care
  These situations highlight the principle of justice and challenge nurses to balance fairness with clinical urgency.
• Cultural, legal, and institutional ethical conflicts
  • Cultural beliefs that differ from standard medical recommendations
  • Legal mandates that may conflict with patient preferences
  • Institutional policies that limit individualized nursing care
  Such conflicts require sensitivity, respect, and collaboration with health professionals to reach ethically sound solutions.

Ethical Decision-Making Models in Nursing

Ethical decision-making in nursing is strengthened by the use of structured models that guide nurses through complex situations in a systematic and reflective manner. These models help nurses analyze ethical problems, consider relevant ethical principles, and justify decisions using professional standards rather than personal bias.

Key elements of structured ethical decision-making models include:

• Identifying the ethical issue or ethical problem
• Gathering relevant clinical, legal, and contextual information
• Considering applicable ethical principles and values
• Exploring possible courses of action and their consequences
• Making and evaluating an ethical decision

Applying ethical principles alongside the nursing code of ethics ensures that decisions are aligned with professional expectations. For example, when a patient refuses treatment, nurses can use ethical decision-making models to evaluate autonomy, beneficence, and nonmaleficence while consulting the code of ethics to guide professional responsibility.

Documentation and accountability are essential components of ethical decision-making. Nurses must clearly document:

• The ethical issue identified
• Information provided to the patient or family
• Interdisciplinary consultations
• The rationale for decisions made

Balancing Accountability, Fidelity, and the Patient’s Best Interests

Balancing accountability, fidelity, and the patient’s best interest is one of the most challenging aspects of ethical nursing practice. Fidelity refers to faithfulness, loyalty, and trustworthiness in the nurse–patient relationship. Patients rely on nurses to be honest, consistent, and committed to their care, particularly during vulnerable moments.

Maintaining fidelity in nursing involves:

• Honoring commitments made to patients
• Communicating truthfully and respectfully
• Protecting confidentiality and trust

Professional accountability requires nurses to take responsibility for their actions and decisions. This includes adhering to ethical standards, recognizing personal limitations, and seeking guidance when uncertainty arises. A nurse must be willing to justify decisions ethically and professionally, especially in high-risk or emotionally charged situations.

Ethical dilemmas can also lead to moral distress, which occurs when nurses know the ethically appropriate action but feel constrained from acting due to institutional, legal, or hierarchical barriers. Managing moral distress and ethical uncertainty involves:

• Seeking support from peers, mentors, or ethics committees
• Reflecting on ethical values and professional obligations
• Engaging in open dialogue within the healthcare team

Ethics Education for Nursing Students and New Nurses

Integrating Ethical Principles and Social Justice in Nursing Education

Ethics education is a foundational component of nursing education because ethical competence does not develop automatically through clinical skills alone. From the earliest stages of training, nursing programs are responsible for helping nursing students understand that ethics in nursing is inseparable from professional identity, responsibility, and accountability. Teaching ethics as part of professional nursing formation ensures that ethical nursing is viewed not as an abstract concept, but as an essential part of everyday nursing care.

Integrating ethical principles and principles of social justice into nursing education helps students recognize the broader impact of nursing decisions on individuals, families, and communities. Social justice, equity, and fairness are central to ethical nursing practice, particularly in healthcare systems where disparities in access, treatment, and outcomes persist.

Key educational goals when integrating ethics and social justice include:

• Helping students understand ethical values and nursing values that guide practice
• Linking ethical principles in nursing to real patient care situations
• Addressing justice into nursing and health, including efforts to reduce health disparities
• Preparing students to provide care in culturally diverse and resource-limited settings

For example, students may explore how social determinants of health influence ethical challenges in underserved populations. By examining these issues, nursing students learn that ethical obligations extend beyond individual patient encounters to include responsibilities to communities and the public to protect human rights.

Developing Ethical Competence Through Education and Reflection

Ethical competence develops through intentional learning strategies that combine theory, application, and reflection. Nursing programs use multiple approaches to help students build ethical reasoning skills and clinical judgment, ensuring that ethical decision-making in nursing becomes a practiced and confident skill rather than a reactive response.

Effective educational strategies include:

• Case studies
  • Analysis of ethical dilemmas drawn from real clinical scenarios
  • Application of ethical principles and professional standards to complex situations
• Simulations
  • Safe environments to practice ethical decision-making without risk to patients
  • Opportunities to navigate ethical challenges involving communication, consent, or end-of-life care
• Reflective practice
  • Guided reflection on personal beliefs, ethical values, and professional responsibilities
  • Identification of areas for growth and ethical uncertainty

Through these methods, students learn how to identify an ethical problem, evaluate options, and make decisions that align with ethical standards and professional nursing expectations. Reflection also supports self-awareness, helping students recognize how emotions, stress, or bias may influence ethical judgment.

Mentorship, Institutional Support, and Ethical Work Environments

The transition from student to practicing nurse is a critical period for ethical development. Mentorship plays a vital role in helping new nurses apply ethical principles in real-world nursing practice. Experienced nurses and nurse leaders serve as role models by demonstrating honest and ethical behavior, professional accountability, and ethical decision-making in complex situations.

Effective mentorship supports ethical development by:

• Providing guidance when ethical challenges arise
• Encouraging open discussion of ethical issues without fear of punishment
• Reinforcing adherence to ethical standards and professional values

Institutional support is equally important in shaping ethical nursing practice. Organizational policies, leadership commitment, and access to ethics resources all contribute to the ethical environment of the work setting. When healthcare organizations prioritize ethics, nurses are better equipped to navigate ethical challenges and fulfill their ethical obligation to patients and society.

Characteristics of supportive ethical work environments include:

• Clear policies aligned with the nursing code of ethics
• Access to ethics committees or consultation services
• Leadership that promotes accountability and transparency
• A culture that values ethical nursing practice and respectful collaboration

Creating environments that support ethical nursing practice improves the ethical environment, strengthens professional integrity, and enhances quality of nursing care. When nurses feel supported ethically, they are more likely to advocate for patients, collaborate effectively with other health professionals, and provide high-quality care grounded in compassion and respect.

Applying Ethical Principles and Beneficence in Everyday Nursing Care

Practicing Beneficence and Patient-Centered Care in Nursing

Beneficence in nursing is the ethical principle that obliges nurses to act in ways that promote health, provide optimal care, and prevent harm. In everyday nursing practice, beneficence is expressed through deliberate actions that support the patient’s well-being while respecting autonomy and preferences. Nurses must integrate ethical principles in nursing into all aspects of care, ensuring that patient-centered approaches guide clinical decisions.

Key aspects of practicing beneficence and patient-centered care include:

• Actions that promote health, safety, and dignity
  • Administering timely treatments to improve outcomes
  • Implementing safety measures to prevent falls, infections, or complications
  • Upholding patient dignity by ensuring privacy, respect, and compassionate care
  Example: A nurse in a geriatric ward ensures that a patient’s mobility limitations are addressed by using fall-prevention strategies while maintaining privacy and respect during personal care.
• Ethical communication and advocacy in patient care
  • Providing clear, honest information about treatments and procedures
  • Supporting patients in understanding options and participating in decisions
  • Acting as an advocate when patient needs or rights are at risk
  Example: When a patient is hesitant to undergo a recommended procedure, the nurse explains the risks and benefits, advocates for informed consent, and coordinates with other health professionals to support the patient’s choice.
• Preventing harm while supporting patient preferences
  • Balancing nonmaleficence in nursing (avoiding harm) with respect for autonomy
  • Negotiating care plans that accommodate patient values without compromising safety
  Example: A patient may refuse certain medications due to cultural or religious beliefs. The nurse collaborates with the care team to identify safe alternatives that respect preferences while ensuring effective treatment.

Professional Accountability and Ethical Obligations in Nursing Practice

Professional accountability is integral to ethical nursing practice. Nurses are expected to adhere to ethical standards, maintain competence, and demonstrate integrity while fulfilling their ethical obligations to patients, colleagues, and the broader healthcare system.

Key components include:

• Standards of practice and ethical accountability
  • Adhering to professional nursing standards and guidelines
  • Ensuring care aligns with the nursing code of ethics and ethical nursing principles
  • Reporting unethical or unsafe practices
  Example: A nurse notices a colleague documenting falsified vital signs. Ethical accountability requires addressing the issue through proper channels to uphold patient safety and professional standards.
• Maintaining competence and integrity
  • Engaging in continuous professional development to enhance nursing skills
  • Reflecting on practice to ensure ethical nursing and professional nursing conduct
  • Staying informed about current evidence-based practices to provide high-quality care
• Ethical documentation and professional responsibility
  • Accurately recording patient information and care decisions
  • Using documentation to support ethical decision-making in nursing practice
  • Ensuring transparency and accountability in patient care and interprofessional communication

Nursing Advocacy, Health Policy, and Ethical Leadership

Beyond bedside care, nurses play a vital role in ethical leadership and advocacy within healthcare systems. Ethical nursing extends to shaping policies, improving institutional standards, and promoting fairness and justice in healthcare delivery.

Key responsibilities include:

• Nurses as advocates for ethical healthcare systems
  • Promoting patient rights, safety, and equitable access to care
  • Collaborating with health professionals to improve ethical practices and standards
  • Addressing systemic issues that may compromise patient-centered care
• Influence of health policy on ethical nursing practice
  • Understanding how policies affect ethical decision-making and patient outcomes
  • Participating in policy development to align regulations with ethical principles
  • Advocating for laws and policies that reduce health disparities and promote justice into nursing and health
• Promoting ethical standards at institutional and societal levels
  • Establishing codes of conduct and ethical guidelines within organizations
  • Educating colleagues and nursing students about professional values and ethical nursing principles
  • Engaging in public health advocacy and ethics for nurses with interpretive actions that protect human rights

Example: A nurse leader may advocate for a hospital-wide initiative to implement ethical triage protocols, ensuring that limited resources are distributed fairly while maintaining patient safety and dignity.

Conclusion

Ethical principles in nursing serve as the cornerstone of professional nursing practice, guiding nurses in providing high-quality care while navigating complex clinical, cultural, and institutional challenges. Across diverse healthcare settings, nurses rely on a structured framework of ethical principles—such as beneficence in nursing, autonomy, nonmaleficence, justice, and fidelity—to make decisions that uphold patient safety, dignity, and well-being. These core ethical principles in nursing are not merely theoretical constructs; they are actively applied through patient-centered care, ethical decision-making, and advocacy, ensuring that the nursing profession maintains integrity, trust, and accountability.

Integration of ethics, professional standards, and patient care is essential for consistent and compassionate nursing practice. The nursing code of ethics, supported by the American Nurses Association (ANA), provides nurses with interpretive guidance, enabling them to translate ethical principles into concrete actions. In daily practice, nurses combine this guidance with clinical judgment, interprofessional collaboration, and reflective practice to navigate ethical dilemmas such as end-of-life decisions, informed consent, or allocation of scarce resources. By documenting ethical decisions, maintaining accountability, and adhering to professional standards, nurses ensure that care is both morally responsible and aligned with the principles of ethical nursing practice.

Preparing nurses for ethical leadership and lifelong ethical practice begins in education and extends throughout the nursing career. Nursing students and new nurses learn to integrate ethical values, principles of ethics in nursing, and social justice into nursing and health through case studies, simulations, mentorship, and reflective practice. These educational strategies develop ethical decision-making in nursing, ethical reasoning skills, and the ability to navigate ethical challenges confidently. Beyond the bedside, nurses exercise ethical leadership by advocating for patients, influencing health policy, and creating ethical environments of the work that uphold justice, equity, and professional accountability.

Ultimately, ethical nursing is a dynamic, ongoing process. By consistently applying ethical principles, adhering to the nursing code of ethics, and fostering professional nursing values, nurses ensure that their practice not only provides high-quality care but also strengthens the trust of patients, colleagues, and society. Through lifelong learning, mentorship, and ethical leadership, nurses are equipped to meet evolving ethical challenges, champion patient rights, and sustain the integrity and honor of the nursing profession.

Frequently Asked Questions

What do 7 ethical principles in nursing mean?

The 7 ethical principles in nursing are foundational guidelines that help nurses make ethical decisions and provide high-quality patient care. They include:

1. Autonomy – respecting the patient’s right to make informed decisions.
2. Beneficence – acting to promote health and well-being.
3. Nonmaleficence – avoiding harm to patients.
4. Justice – ensuring fairness in care and resource allocation.
5. Fidelity – being faithful and maintaining trust in nurse–patient relationships.
6. Accountability – taking responsibility for professional actions and decisions.
7. Veracity – providing honest and transparent communication.

What are the 10 Ethics of nursing?

The 10 ethics of nursing refer to a set of professional guidelines for nurses to uphold moral, legal, and professional responsibilities:

1. Respect for human dignity
2. Patient autonomy
3. Beneficence in nursing
4. Nonmaleficence in nursing
5. Justice and fairness
6. Fidelity and trust
7. Accountability for nursing actions
8. Ethical communication
9. Confidentiality
10. Professional integrity

What are the 4 ethical principles in nursing NMC?

The Nursing and Midwifery Council (NMC) in the UK emphasizes four core principles in nursing practice, widely used internationally:

1. Autonomy – respecting patient choice and informed consent.
2. Beneficence – promoting patient health and well-being.
3. Nonmaleficence – avoiding actions that cause harm.
4. Justice – delivering fair and equitable care.

What are the 4 principles of ethics in nursing?

The four principles of ethics in nursing are often summarized as:

• Autonomy – honoring the patient’s right to make decisions.
• Beneficence – acting in the best interest of the patient.
• Nonmaleficence – avoiding harm in all aspects of care.
• Justice – promoting fairness in treatment, access, and resource distribution.