As anyone in the medical sector will tell you, all patients are unique. Naturally, this means that each healthcare scenario is wholly different, making it sometimes difficult for nurses to make the right decision on the spot.
That is why nurses face moral and ethical questions on a daily basis. They have to ensure that their decisions are always in the patient’s best interest and are decisions that they will be able to morally and ethically justify.
That is why the American Nurses Association created its own Code of Ethics for Nurses. The code exists to help guide nurses in their daily duties, providing a contract of sorts between the patient and provider by which the end user can be sure that the nurse will always act in their best interests.
But what are the main ethical principles in nursing practice, why are they so important, and what happens if they are not strictly adhered to? Let’s take a closer look.
What are ‘ethical principles’?
The ethical principles of nursing are rules of conduct by which each nurse must conduct themselves. By following these conditions, the goal for a practicing nurse is always to be as respectful, helpful and professional as possible.
These ethical principles are also in place to set a standard by which each nurse must be measured in their daily tasks.
It is important to remember that while being professionals, nurses are also human. There is no ‘how-to’ set for each patient, as each case is always likely to be different. Naturally, this can make the job of being a nurse very challenging. This is when it’s essential to bring it ‘back to basics’.
The seven main ethical principles are there to gently guide qualified nurses, above all else. When in doubt, a nurse can consult the ethical principles in their practice to ensure that their decisions are morally and ethically justified.
For example, a difficult decision regarding a patient in a coma, or even a patient who is being deliberately obstructive, may need a nurse in practice to refer to their ethics. Below, we break down each of the seven main ethical principles and explain why they’re so pivotal in day-to-day nursing.
The seven main ethical principles in nursing
Justice
Justice is a key part of being a nurse – in the sense that nurses intend to see their patients succeed, or find justice, over the illnesses and conditions that make them unwell! However, this principle also revolves around ensuring that care is fair and measured regardless of patient background.
Nurses care for all kinds of people from all different types of backgrounds every day. There is no room for judgment based on appearances, age, religion, sexual orientation, ethnicity or socioeconomic status. It is each nurse’s duty to treat their patients equally, no matter who they are. This is essential for making the patients feel the care they need and leads to better responses in their treatment.
Nurses are therefore only permitted to and should only make decisions about the patient’s care based on their health facts and nothing else. In some cases, religion may dictate that a patient cannot receive certain care (such as a blood transfusion), and cases can start to become complex.
Accountability
Although nursing often relies on teamwork, each professional must hold themselves accountable for their own actions. By being responsible for their own practices, nurses are more likely to carefully consider the options in patient care and be confident in their choices.
This will also inevitably make their patients feel more confident in their care and make the nurses seem more dependable and trustworthy to their colleagues, all of which lead to better patient care.
Beneficence
Many in the profession define beneficence as being charitable and kind to others – and kindness is at the heart of nursing in general.
Although nursing is not seen generally as an act of charity, each nurse must make all of their decisions based on kindness and how to benefit their patients best.
To practice kindness in line with this ethical principle, a nurse must remember to treat each patient individually, with their own circumstances and needs. And, of course, no matter the nurse’s personal feelings about the patient in question, they must act with that patient’s best interest at heart.
This crucially means that nurses must withhold personal prejudice in line with providing effective care that patients expect.
Autonomy
Again, even though nursing is often a team-based profession, professionals must be able to do their job autonomously based on knowledge and skills, many of which they will learn through, for example, an accelerated BSN nursing program at Elmhurst University.
To provide the best-quality care, each nurse must have honed their own skills and knowledge to ensure that each decision and act is carefully measured.
Although seeking advice is never frowned upon, a nurse must be somewhat autonomous to ensure that the care they give is justified and based on facts. Moreover, autonomy can help keep busy departments running efficiently without risking anyone’s health.
Being autonomous also allows a nurse to hold themselves accountable. By relying on their skills, experience and knowledge, nurses can fully hold themselves responsible for their choices.
It also helps reassure the patient that the person providing their care is basing their decisions on critical thinking. No patient would want care from an uncertain practitioner!
Nonmaleficence
Nonmaleficence may seem as though it is an obvious part of being a nurse, yet it is an essential principle by which all medical care providers must practice.
Simply put, nonmaleficence means doing no harm to others. Each nurse must do whatever is in their capabilities to prevent further harm from coming to their patients. This means caring for them in the most gentle and kind way possible.
Doctors must also abide by this essential point in patient care. Maleficence may occur through acts of willful negligence as much as through genuine want to do harm. Therefore, nurses must keep aware of how their actions can affect a patient’s overall health.
It’s extremely rare that maleficence will occur without reprimand. However, it’s vital that nurses always remain aware of how they treat and manage patients.
Veracity
Veracity refers to the truth-telling element of being a nurse. As any nurse knows, being in this field of work means having to deal with the fact that, sometimes, the outcome is not always going to be positive for their patients.
However, being completely open and honest with your patient is essential. The truth may hurt and even cause them distress, which is why sharing bad news can be scary even for the most experienced of nurses. Even those nurses with years in the industry will tell you that this element of the job never gets easier.
Yet, it is an essential part of a nurse’s duties. By being completely honest, the nurse creates a relationship based on trust between them and their patient.
This helps the patient to feel more confident in their care. It also allows the patient to make better decisions on their health and care by providing them with all the facts. In some cases, this falls under a ‘bedside manner’ – offering patients care and kindness without sugar-coating the bad news.
Fidelity
Being open and honest isn’t enough. Patients need to know that they can count on their nurses, which is where fidelity comes in. There may be some confusion and/or crossover between these points, but fidelity crucially comes down to loyalty.
Each nurse must be loyal to their patients and to their care. They must do whatever they can to fulfill their duties to those in their care.
Being loyal to a patient allows the patient to feel more confident in their care and in their nurse. Without this relationship based on loyalty, patients are more likely to feel afraid and untrusting and have fewer positive outcomes.
Why are ethical principles so important in nursing?
Ethical principles aren’t just guidelines, but are absolutely essential when it comes to providing quality care to patients everywhere. Here are a few reasons why.
They help to provide nurses with the tools to make good judgment calls
Even with all the experience and knowledge in the world, it can still be difficult to make a judgment call. Nurses face impossible situations frequently and need to rely on key principles. The seven principles outlined above can help medical professionals make tough calls even in dire circumstances.
They help nurses provide exceptional care
As each patient presents different needs and challenges, it can be easy for some nurses to forget the basics. By referring to their core principles, nurses know which fundamental facts they must refer to when caring for each patient. That way, no matter the outcome, they can rest assured that each patient was treated with the same level of care, honesty and kindness.
They help to create stronger bonds between patients and nurses
Nurses following these principles can help patients feel safer and more confident in the care provided, thereby creating stronger relationships. A calm, happy patient will likely feel better before getting treated or cured! Furthermore, better patient relations can lead to a reputational uptick for nurses administering the care.
They help to promote both patient and nurse safety
Nursing principles exist to ensure that the best care possible reaches patients and that healthcare systems can support more responsible and independent nurses. By following these guidelines, nurses reduce risks to their own safety and patients. Workplace safety for nurses is, of course, already paramount elsewhere.
The seven principles help ensure that nurses follow various treatment and care paths without losing sight of their accountability.
They can improve health organizations
Health organizations that revolve around the core principles produce nurses and care conditions that are generally favorable. For example, a responsible nursing unit is likely to be more efficient and more open to finding various solutions to support their patients.
What’s more, nurses who follow their ethical guidelines and work for organizations that prioritize them are likely to feel a greater sense of job satisfaction than they might expect elsewhere.
As you can see, the benefits of the main ethical principles in nursing practice are far from negligible. Ethical practices, while effectively guidelines and not ‘set in stone’, can help ensure that carers and patients get the best possible experiences out of often very complex situations.
However, following the principles strictly can be difficult, especially when one or two of them may conflict with each other in certain situations.
Are there any conflicts between ethical principles?
When reading through the ethical principles of modern nursing, you may have found two in particular that could conflict with one another in practice. Those are veracity with patients (which allows them to become autonomous in their care) and beneficence.
This conflict begs the question, is it morally right to keep looking for solutions for a patient when none may help, or to stop looking altogether?
Each adult patient has the right to be autonomous in receiving care. In other words, they have the right to refuse certain treatments, disregard suggestions, and essentially do something that goes against what the nurse has said. As mentioned earlier, religion may play this part in some cases.
On some occasions, this can go directly against beneficence. The nurse must do whatever is necessary to help the patient and prevent any further harm from coming to them.
But how can a nurse do that if the patient is not compliant? Sadly, this is a balancing act that each nurse must come to deal with.
The only way to manage this type of situation is by conversing openly with the patient. It is up to the nurse to provide the best space for open communication between the two. They must explain the situation fully to the patient and provide them with all of the necessary information for them to be able to make up their mind.
They must also be aware of the options available to them and even which one the nurse recommends. Should the patient still refuse the care, it is up to the nurse to continue in their duties while following the ethical principles of their position and also understanding and respecting the autonomy of the patient’s choices.
There is nothing inherently easy about this element of nursing, but it is a key part of the role – and will likely arise during your career more than once. That is why ethical guidelines can be a great relief when making professional choices regarding the patient.
There will always be difficult puzzles – but with ethical guidelines, there are always possible routes toward a solution.
What are the consequences of non-ethical practice?
As you may imagine, there are multiple consequences of non-ethical nursing practice, all of which are extremely serious. Some of the consequences include:
- Poor relationships between the nurses and the patients.
- Nurses suffering ‘burnout’ due to fatigue, stress or mental pressure.
- Loss of nursing or medical licenses.
- Risks to the safety and wellbeing of patients.
- Patient non-compliance.
- Poor communication between patients and nurses.
These consequences obviously reflect actions that go against ethical guidelines or lack thereof. Therefore, each potential consequence depends entirely on the specifics of the situation. As mentioned, non-ethical practice can be negligent and accidental as much as it can be deliberately harmful.
However, nurses should not take the principles listed lightly. Being unable to follow or even holding yourself ignorant of the ethical principles of nursing practice can easily lead to one of the terrible consequences mentioned above. That is why they are so important – and nurses should follow them to the best of their individual capabilities
It is also important to remember that these principles exist for a reason. They are there to create a safer, more efficient healthcare system, effectively protecting both nurses and patients.
Conclusion
The seven main ethical principles in nursing practice have been carefully chosen and defined by the American Nurses Association. They have been adhered to by the country’s best nurses. They have also proven to be efficient and worthy of their name.
It’s easy to assume that simply applying the expected level of care is enough to succeed as a nurse. There’s much more at play!
This is a code of ethics that each nurse should perfect during their career, observe during their training, and learn about during their courses. No matter where you are in your career, it’s always possible to learn and grow in this profession.
Balancing ethics to ensure that patients receive the best care isn’t an easy job. It’s why only the most talented of medical graduates go on to become celebrated nurses. Studying nursing and practicing in a working hospital can lead to exciting challenges!
Above all, however, it’s vital to keep aware of ethical practices. Without ethics, you could be doing more than putting your own career on the line. Consider your patients and also the hospital at large before you act!
