What is the Nursing Code of Ethics? Updated for 2025

The Nursing Code of Ethics, the foundational ethical framework for nurses, has finally been revised and updated to include the rapid changes and developments in the nursing profession and healthcare sector. 

“It is the tremendous responsibility and honor held by the American Nurses Association to maintain the Code of Ethics for Nurses. The Code is the social commitment from nurses to the public that we will uphold the ethical responsibility of our profession in pursuit of the health of our patients,” said Liz Stokes, PhD, JD, RN, director of the ANA Center for Ethics & Human Rights. “The Code was revised to guide the nurses of today and tomorrow who exemplify our profession's moral duty to provide and advocate for safe, quality, and compassionate care for all patients and communities.”

The 2025 update was the collective insight of over 6,000 nurses worldwide that underwent an extensive and inclusive revision, including a panel of 49 nursing experts and six co-chairs that spent more than 600 hours redefining the code. 

The Code of Ethics includes an updated version of the provisions to specifically address professional boundaries, practicing with compassion and respect, nurses having increased authority over their practice including increased responsibilities, an emphasis on privacy and confidentiality, and identifying racism as a public health crisis. 

The four main principles of the nursing code of ethics - autonomy, beneficence, justice, and non-maleficence - are still included in the current 2025 Nursing Code of Ethics, but there is less of an emphasis on them as in prior versions.

What is the Nursing Code of Ethics?

According to the American Nurses Association (ANA), the nursing code of ethics is a guide for “carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession.”

Ethics, in general, are the moral principles that dictate how a person will conduct themselves. Ethical values are essential for ALL healthcare workers, but ethical principles in nursing are particularly important given their role as caregivers.

2025 Nursing Code of Ethics Update

The newest update revised the Code of Ethics and kept the nine provisions, with some edits, as well as added a tenth provision. According to the ANA, the revision addresses current and emerging changes in caring science, health science, nursing humanities, and technology, including artificial intelligence, racism and systemic oppression, allyship and advocacy, political action, and more.

“The Code of Ethics for Nurses is a living, breathing body of work that is exercised and interpreted by nurses every day in all they do. Whether in the boardroom or at the bedside, the Code is a necessary instrument for practice, policy, and standards in all facets of nursing,” said American Nurses Association’s President Jennifer Mensik Kennedy, PhD, MBA, RN, NEA-BC, FAAN. “The phrase ‘nursing is a calling,’ is true. The identity of being a nurse permeates our very being and all that we do—be it as caretakers, advocates, or educators—we are dedicated to delivering healthcare for all.” 

Nursing Code of Ethics Interpretive Statements

Revised in 2025 to include 10 provisions, the ANA’s nursing code of ethics now includes interpretative statements that can provide more specific guidance for nursing practice.

10 Provisions of the Nursing Code of Ethics 

Currently, the nurse’s code of ethics contains 10 main provisions, with provision 10 being new to this update:

• Provision 1: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.
• Provision 2: A nurse’s primary commitment is to the recipient(s) of nursing care, whether an individual, family, group, community, or population.
• Provision 3: The nurse establishes a trusting relationship and advocates for the rights, health, and safety of recipient(s) of nursing care.
• Provision 4: 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.
• Provision 5: 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.
• Provision 6: 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.
• Provision 7: Nurses advance the profession through multiple approaches to knowledge development, professional standards, and the generation of policies for nursing, health, and social concerns.
• Provision 8: Nurses build collaborative relationships and networks with nurses, other healthcare and non-healthcare disciplines, and the public to achieve greater ends.
• Provision 9: 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.
• Provision 10: Nursing, through organizations and associations, participates in the global nursing and health community to promote human and environmental health, well-being, and flourishing.

4 Ethical Principles in Nursing 

These principles are, ideally, what every nurse should be aware of in their daily nursing practice. While ethical principles are sometimes confusing and often taught briefly during undergraduate nursing, they should be constants in nursing practice to provide the best, safest, and most humane care to all patients.

1. Autonomy 

Autonomy in nursing is recognizing each individual patient’s right to self-determination and decision-making. As patient advocates, it is imperative that nurses ensure that patients receive all medical information, education, and options in order to choose the option that is best for them. This includes all potential risks, benefits, and complications to make well-informed decisions. 

Once the patient has all the relevant information, the medical and nursing team can make a plan of care in compliance with the medical wishes of the patient. 

It is important that nurses support the patient in their medical wishes and ensure that the medical team is remembering those wishes. Sometimes, nurses will need to continue to advocate for a patient despite the wishes being verbalized because the medical team might not agree with those wishes.

Many factors may influence a patient's acceptance or refusal of medical treatment, such as culture, age, gender, sexual orientation, general health, and social support system.

2. Beneficence

Beneficence in nursing is acting for the good and welfare of others and including such attributes as kindness and charity. The American Nurses Association defines this as “actions guided by compassion.”

3. Justice

Justice means that there should be an element of fairness in all medical and nursing decisions and care. Nurses must care for all patients with the same level of fairness despite the individual's financial abilities, race, religion, gender, and/or sexual orientation. 

An example of this is when working at a free flu clinic or diabetes screening clinic. These are open to all individuals in the community regardless of the previously mentioned factors.

4. Nonmaleficence 

Nonmaleficence means to do no harm. This is the most well-known of the main principles of nursing ethics. More specifically, it is selecting interventions and care that will cause the least amount of harm to achieve a beneficial outcome

The principle of nonmaleficence ensures the safety of the patient and community in all care delivery. Nurses are also responsible for reporting treatment options that are causing significant harm to a patient, which may include suicidal or homicidal ideations.

History of the Nursing Code of Ethics

Interestingly, the nursing code of ethics is suggested to have been founded in 1893 and named the “Nightingale Pledge” after Florence Nightingale, the founder of modern nursing. As a modification of the Hippocratic Oath, taken by medical doctors, the Nightingale Pledge has been recited by nursing students at graduations with little changes since its inception. 

The formal code of ethics was developed in the 1950s by the American Nurses Association (ANA) and has undergone numerous modifications since. The most significant recent change was in 2015 when 9 interpretative statements or provisions were added to the code of ethics to help guide nursing practice in a more definitive way. 

Many states include the ANA’s nursing code of ethics in their practice statements. Even though the code of ethics is primarily ethics-related, it also has legal implications. Given the importance of the code to the nursing profession, revisions continue regularly.

How Nurses Use the Nursing Code of Ethics

Knowing the nursing code of ethics is essential for nurses because it will help guide everyday practice and navigate the daily complexities of the healthcare profession. Nurses often use the four major ethical principles throughout a shift, even if not fully aware of them. 

This may include,

• Providing pain medication to a post-operative hip replacement
• Holding the hand of a dying patient who is alone
• Advocating for the patient who wants to end chemotherapy and enter hospice care

Nursing is consistently regarded as the most honest and ethical profession and practicing with the nursing code of ethics is essential to ensuring that patients and their families receive the care they have come to know and expect. Utilizing the ethical codes of justice, nonmaleficence, autonomy, and beneficence daily allows nurses to provide the safest and most compassionate care for their patients.

FAQs

• What is the Professional Code of Ethics for Nurses?

  • The Professional Code of Ethics for Nurses is the guiding outline for how nurses should behave ethically within their profession and how they should decide to act if they encounter barriers that prevent them from fulfilling their professional obligations. 

• Why is the code of ethics important in nursing? 

  • It can guide nurses’ professional behavior, provide a framework for decision-making when faced with challenges, and provide support and help prevent moral distress. 

• What is the code of ethics in healthcare? 

  • There is not one board ethical code for every healthcare professional, although it has been proposed. Instead, each branch of healthcare, from quality control to medical directors to physicians to nursing, has its own ethical codes. 

• What is scholarly ethics in nursing? 

  • The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.