Week 6: Exam 3

A complete set of vocabulary and conceptual flashcards covering nursing ethics, professional identity, the ANA Code of Ethics, and regulatory acts based on Week 6 lecture notes.

Advocacy

The act or process of pleading for, supporting, or recommending a cause or course of action — for a person, group, or issue.

Accountability

Being answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard such as the Code of Ethics.

Responsibility (in nursing)

Being answerable for judgments and actions under one's control; nurses are morally praiseworthy or blameworthy in proportion to their control over an action and its conformity with standards.

An example of responsibility in nursing

The nurse is responsible for providing care consistent with professional standards and promoting client health.

Confidentiality

Nondisclosure of personal information shared within the nurse-client relationship; includes all settings such as social media and electronic health records.

Autonomy

The client's freedom to make their own informed healthcare choices; nurses also have autonomy to speak up about unsafe conditions or initiate independent interventions.

Example of autonomy

An individual declines a prescribed pain medication, explaining that it causes excessive drowsiness. The healthcare provider respects this decision, ensuring the person is fully informed about the options and supports their right to choose based on personal preferences and comfort.​

Beneficence

Doing good and taking actions that support the client's well-being; acting in the best interest of those receiving care.

Example of beneficence

A nurse notices a colleague struggling with a new client admission and offers assistance. This supportive action helps ensure the client receives timely and effective care, reflecting a commitment to promoting the well-being of others.​ 

Nonmaleficence

Avoiding harm; 'do no harm.' When treatments have both positive and negative effects, benefits must outweigh the risks.

Example of nonmaleficence

A healthcare provider chooses not to administer a treatment that could cause unnecessary harm or discomfort to a client, even if it might offer some benefit. Instead, they explore safer alternatives that align with the client’s condition and well-being, honoring the commitment to avoid causing harm. 

Justice

Fairness in healthcare; ensuring equal access to care regardless of financial status, background, or circumstance.

Example of justice

A nurse delivers the same high standard of care to two individuals—one with extensive financial resources and health coverage, and the other facing homelessness. This approach reflects a commitment to fairness and equity, ensuring that all clients receive compassionate and quality care regardless of their socioeconomic status. 

Fidelity

Keeping promises and staying true to professional responsibilities; being dependable builds trust with clients and colleagues.

Example of fidelity

A nurse assures a client that assistance with bathing and dressing will be provided in 30 minutes. At the promised time, the nurse returns and fulfills the commitment, demonstrating reliability and faithfulness to professional responsibilities.  

Veracity

Telling the truth; clients and research participants must receive honest and complete information.

Example of veracity

When conducting a research study, participants must be fully informed about all aspects of their involvement. Failing to disclose relevant information constitutes a breach of veracity, which is the ethical obligation to communicate truthfully.

What are the code of ethics for nurses?

It’s ten provisions explore the nurse's commitments and fundamental principles, describe duty and loyalty, and even guide the nurse in interactions outside the practice setting.

Provision 1 (ANA Code of Ethics)

Dignity and Respect: The nurse practices with compassion and respect for the inherent dignity, worth, and unique attributes of every person.

Provision 2 (ANA Code of Ethics)

Primary Commitment: A nurse's primary commitment is to the recipient(s) of nursing care — individual, family, group, community, or population.

Provision 3 (ANA Code of Ethics)

Trust and Advocacy: The nurse establishes a trusting relationship and advocates for the rights, health, and safety of those receiving care.

Provision 4 (ANA Code of Ethics)

Responsibility and Accountability: Nurses have authority over nursing practice and are responsible and accountable for promoting health, preventing illness, and providing optimal care.

Provision 5 (ANA Code of Ethics)

Duties to Self: The nurse has moral duties to self, including the expectation of a safe workplace, authenticity, self-respect, and professional competence.

Provision 6 (ANA Code of Ethics)

Ethical Work Environments: Nurses establish, maintain, and improve the ethical environment of the workplace through individual and collective effort.

Provision 7 (ANA Code of Ethics)

Knowledge Development and Social Policy: Nurses advance the profession through knowledge development, professional standards, and policy generation.

Provision 8 (ANA Code of Ethics)

Collaborative Relationships: Nurses build collaborative networks with other healthcare disciplines and the public to achieve greater outcomes.

Provision 9 (ANA Code of Ethics)

Commitment to Society and Social Justice: Nurses and professional organizations promote social justice, eliminate health inequities, and facilitate human flourishing.

Provision 10 (ANA Code of Ethics)

Global Nursing Community: Nursing organizations participate in the global health community to promote human and environmental health and well-being worldwide.

Specific contents of Provision 3

Protecting client privacy/confidentiality, advocating for clients, promoting a culture of safety, acting on questionable or impaired practice, and whistleblowing.

Specific contents of Provision 4

Nursing authority, accountability, and responsibility; addressing barriers to nursing practice authority; ethical awareness, discernment, and judgment; and assignment and delegation.

The 7 reciprocal relationships in the ANA Code of Ethics

Nurse to patient, nurse to nurse, nurse to self, nurse to profession, nurse to others, nurse/nursing to society, and nursing to the global community.

Nurse-to-patient provisions

Provisions 1, 2, and 3 — addressing direct client care and the nurse's most fundamental values and commitments.

Nurse-to-nurse provisions

Provisions 4 and 6 — focusing on creating and sustaining ethical work environments individually and collectively.

Nurse-to-self provision

Provision 5 — reviews how 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. 

Nurse-to-profession

Provision 7 — discusses how nurses contribute to the advancement of the profession by fostering knowledge, upholding professional standards, and shaping policies that address nursing, health, and broader social issues. 

Nurse-to-others

Provision 8 — discusses how nurses foster collaborative partnerships across healthcare and non-healthcare disciplines, as well as with the public, to achieve shared goals and enhance outcomes.

Nurse/Nursing to Society

Provision 9 — Nurses and their professional organizations advocate for social justice by supporting policies, practices, and legislation that reduce health disparities and promote human well-being. 

Nursing to Global Community

Provision 10 — Through professional organizations, nurses engage with the global health community to advance human and environmental well-being and support the flourishing of people worldwide. 

2025 ANA Code of Ethics Revision

Added a 10th provision to address ethical issues in nursing that are global in nature, focusing on the global nursing and health community.

Right to self-determination (Provision 1)

Clients have the right to informed decision-making, culturally sensitive care, and autonomy — even in complex situations like end-of-life care.

Respect for Human Dignity and Relationships with Clients (Provision 1)

Nurses are committed to sustaining an ethical environment to ensure the nurse-client relationship can flourish. Nurses build trust-based relationships and provide care that respects each client’s unique background, values, and choices. They engage in self-reflection to recognize and reduce bias, while also taking appropriate action when client decisions pose serious risks to health or safety. 

The Nature of Health (Provision 1)

Health is a universal right, and nursing care honors the dignity of every individual, regardless of their background or circumstances. Nurses provide patient-centered care that respects each individual's values and choices, while also using evidence-based practices to promote well-being across the lifespan. When interventions no longer offer meaningful benefit, nurses engage in shared decision-making to align care with the client’s definition of quality of life. 

Ethical Dilemma

Arises when a nurse faces two conflicting yet morally defensible choices, making it difficult to determine the right course of action; almost always involves conflicting values.

Moral Distress

Occurs when a nurse identifies the ethically appropriate action but feels unable to implement it due to external pressures or institutional limitations.

Just Culture

An environment that promotes open discussion of mistakes without fear of punishment; focuses on systemic factors rather than blaming individuals.

Chain of Command

The structured hierarchy of authority used to address clinical or safety concerns; a staff nurse raises concerns first with the charge nurse, then escalates as needed.

7 steps to resolving an ethical dilemma

1) Ask if it's an ethical dilemma.

2) Gather all details.

3) Identify ethical aspects/values.

4) Define the problem clearly.

5) Explore possible actions.

6) Develop and carry out a plan.

7) Review whether the plan worked.

4 guiding principles for ethical dilemma discussions

Assume good intentions, keep discussions confidential, focus decisions on the client, and encourage family/caregiver participation.

Example of clinical ethical dilemma

A family from a culture where discussing death is taboo asks the nurse not to disclose a terminal diagnosis to the client, conflicting with the client's right to informed consent.

Example of moral distress

A nurse knows a client has a DNR but is directed by the provider to perform CPR due to family pressure.

Addressing moral distress

Discuss with a colleague or supervisor, gently remind the provider of documented client wishes, and debrief with a nursing supervisor after the incident.

Ethics Committee role

Helps with tough decisions like end-of-life care, informed consent, and organ donation; available for request by nurses, providers, clients, and families.

Legal issues vs. Ethics

Legal issues reference concrete laws. Ethics is broader — it refers to behavior and character and goes beyond what the law requires.

'Who' of nursing scope

All registered nurses, including advanced practice registered nurses, who have completed required education, earned a nursing title, and hold an active license.

'What' of nursing scope

The responsibilities and actions that define nursing care — safe, evidence-based treatments, clinical judgment, and coordination with others to meet client needs.

'Where' of nursing scope

Any environment where a client needs care, information, or advocacy — hospitals, clinics, homes, schools, community centers, or online.

'When' of nursing scope

Whenever there is a need for nursing knowledge, wisdom, caring, leadership, practice, or education — anytime, anywhere.

'Why' of nursing scope

Nursing exists to respond to society's changing health needs and improve outcomes for individuals and communities.

'How' of nursing scope

The methods and approaches nurses use to deliver professional care, including clinical judgment, delegation, evidence-based practices, and following prescriptions.

ANA Standards total count

$18$ total: $6$ Standards of Practice (based on the nursing process) and $12$ Standards of Professional Performance.

6 Standards of Nursing Practice

Assessment, Nursing Diagnosis, Outcomes Identification, Planning, Implementation, and Evaluation.

12 Standards of Professional Performance

Ethics, Advocacy, Respectful & equitable practice, Communication, Collaboration, Leadership, Education, Scholarly inquiry, Quality of practice, Professional practice evaluation, Resource stewardship, Environmental health.

Standard 7: Ethics

Nurses show respect and compassion to all, support client autonomy, maintain fidelity, keep professional boundaries, protect privacy, and ensure justice in all nursing actions.

• Treat every person with respect and compassion, no matter their background (beneficence).​

• Support clients’ rights to make their own choices (autonomy).​

• Stay committed to those they care for in all situations (fidelity).​

• Keep professional boundaries and build healthy relationships.​

• Protect client privacy and confidentiality.​

• Apply fairness and social justice in all nursing actions (justice).​

Standard 8: Advocacy

Protecting client rights, ensuring fair access to care, empowering clients in care decisions, embracing diversity and equity, and developing policies for underserved populations.

Standard 12: Leadership

Guiding practice within the profession, influencing decision-making, fostering collaboration, promoting quality and safety, and resolving conflict.

Standard 13: Education

Continuously seeking current knowledge and skills, participating in continuing professional development, and maintaining knowledge relevant to role, population, and setting.

Standard 14: Scholarly Inquiry

Incorporating evidence-based research and best practices into client care to ensure informed decision-making and improved health outcomes.

Standard 15: Quality of Practice

Promoting care that is safe, effective, efficient, equitable, timely, and person-centered; using research and teamwork to improve care and track progress.

• Promotes nursing practice that is safe, effective, efficient, equitable, timely, and person-centered.​

• Applies evidence-based knowledge to improve client outcomes.​

• Documents nursing practice in ways that support quality and performance improvement.​

• Acknowledges the importance of professional and specialty certification.​

Standard 16: Professional Practice Evaluation

Regularly reviewing one's own work against professional guidelines; engaging in self-reflection, addressing learning needs, and ensuring alignment with licensure requirements.

• Regularly engages in self-reflection and evaluation to identify strengths and areas for professional growth.​

• Ensures that nursing practice aligns with licensure requirements, statutes, and regulations.​

• Provides evidence to support clinical decisions and actions during evaluations.​

• Takes initiative to address learning needs and goals identified through evaluation.​

Standard 17: Resource Stewardship

Using resources wisely and cost-consciously; partnering with clients and stakeholders to assess costs, risks, and benefits; advocating for equitable resources.

• Partners with the healthcare consumer and other stakeholders to identify care needs and necessary resources to achieve desired outcomes.

• Collaborates with the healthcare consumer and other stakeholders to assess costs, availability, risks, and benefits in decisions about care.

• Advocates for equitable resources that support and enhance nursing practice and health outcomes.​

• Integrates connected health technologies into practice to promote positive interactions between healthcare consumers and care providers.​

Board of Nursing (BON)

A state government agency that protects public health by ensuring nurses meet legal and professional standards; investigates complaints and handles disciplinary actions.

Nurse Practice Act (NPA)

State law that defines the scope of nursing practice, licensure requirements, educational standards, disciplinary grounds, and the authority of the BON.

Specific details of a Nurse Practice Act vary from state to state, but ALL include…

• definitions

• authority, power, and composition of a board of nursing (BON)

• educational program standards

• standards and scope of nursing practice

• types of titles and licenses

• protection of titles

• requirements for licensure

• grounds for disciplinary action, other violations, and possible remedies

Nurse Practice Act: Definitions

The Nurse Practice Act (NPA) provides the legal foundation for nursing in each state, with clearly defined terms to guide enforcement (Boehning & Haddad, 2023). Accurate interpretation depends on clear language—for instance, an “unencumbered license” means one without restrictions or disciplinary actions (Nurses Service Organization, 2025).

Nurse Practice Act: Authority, Power, and Composition of a Board of Nursing

The BON regulates nursing practice based on the NPA and is responsible for protecting public health and safety. Members are typically appointed by the governor or senators, often with input from professional organizations. The BON members may include nurses, doctors, attorneys, and public members. The BON office may include nurses, attorneys, and administrative staff, who have investigative duties and are not members of the BON (Boehning & Haddad, 2023). 

Nurse Practice Act: Educational Program Standards

Nursing regulations require collaboration among hospitals, clinics, and nursing schools to ensure client safety and nurse education, supporting public protection. The Nurse Practice Act (NPA) outlines standards for prelicensure education and clinical training, used in program accreditation. These standards may include curriculum details, faculty qualifications, and board exam performance data (Boehning & Haddad, 2023).

Nurse Practice Act: Standards and Scope of Practice

This key section of the NPA guides nursing professionals by setting practice expectations and outlining proper delegation (NSO, 2025). The NPA sets nursing practice standards and a code of conduct that support the ongoing privilege to practice. It clearly defines the scope of nursing aligned with the nursing process, emphasizing care planning and client advocacy (Boehning & Haddad, 2023).

Nurse Practice Act: Title and Licensure

The NPA protects the public by setting licensure standards and defining nursing titles. Licenses are granted by the BON after meeting education, exam, and background check requirements (Boehning & Haddad, 2023).

Nurse Practice Act: Grounds of Disciplinary Action

The BON is responsible for investigating issues such as misuse of controlled substances and significant errors in care. The BON is responsible for taking appropriate action, based on what is permitted under the NPA (NSO, 2025). Standards reflect professional, ethical, and legal expectations. The NPA also guarantees due process for nurses facing complaints. When a nurse violates the standard of care, the BON may impose disciplinary actions—called stipulations—which can include fines, supervised practice, remedial education, or license suspension/revocation (Boehning & Haddad, 2023).

Unencumbered license

A nursing license that has no restrictions or disciplinary actions attached to it.

Stipulations (BON disciplinary actions)

Actions the BON can impose on a nurse who violates the standard of care: fines, supervised practice, remedial education, or license suspension/revocation.

NCSBN

National Council of State Boards of Nursing — a leading organization in nursing regulation providing a unified platform for regulatory bodies to collaborate on public health issues.

Nurse Licensure Compact (NLC)

An agreement allowing nurses to practice in other NLC states without obtaining additional licenses; one multistate license covers all participating states.

Enhanced Nurse Licensure Compact (eNLC)

Allows a registered nurse to hold one multistate license and practice in-person or via telehealth in their home state and any other eNLC-participating state.

First state to enact a Nurse Practice Act

North Carolina.

Applicable standards under the NLC

The nurse must uphold the standards of the state where the client or practice setting is located.

National Practitioner Data Bank (NPDB)

A federal database where adverse actions against healthcare licenses must be reported; accessible by hospitals and state licensing boards.

Ethical profession ranking duration

Nursing has been rated the most ethical profession for $23$ consecutive years as of 2024.

ANA Code definition of 'Practice'

All the ways in which nurses influence the health of society, including educational, leadership, and research roles.

Primary purpose of nursing

To respond to society's changing health needs and improve outcomes for individuals and communities through care, knowledge, advocacy, and ethical practice.

Defining nursing as a profession

Involves a trusted role with ethical obligations, a code of conduct, ongoing education, and commitment to public good — not merely a collection of tasks or skills.

Clinical practice nurse autonomy example

Independently encouraging coughing and deep-breathing exercises for a post-surgical client without needing a direct medical order.

Impaired practice reporting obligation

If a nurse observes a colleague appearing impaired, they are ethically obligated to intervene or report to protect patients.

Whistleblowing in nursing

Reporting unsafe, unethical, or illegal practices — such as a colleague who falsely documented client care — to a nursing manager or appropriate authority.

Delegation in nursing

Assigning specific nursing tasks to other team members while ensuring those individuals are competent and following up on results.

Medication error in a Just Culture

The error is examined systemically (e.g., drug stocking issues) rather than only blaming the individual; the nurse remains accountable while the system is improved.

Example of justice in care

Providing the same high standard of care to a patient with full insurance and to a patient experiencing homelessness.

What are some of nursing’s core professional values? Select all that apply.

• Responsibility

• Competition

• Advocacy

• Confidentiality

• Accountability

• Independence

Responsibility

Advocacy

Confidentiality

Accountability

• Nurses study ethics to understand their responsibilities to act ethically and be accountable for their actions as guided by nursing professional standards. Nursing guidelines reflect our core values of advocacy, responsibility, accountability, and confidentiality.

• Independence and competition are not core values of nursing.

Which organization is responsible for nursing’s code of ethics?

• American Nurses Association

• American Nurses Credentialing Center

• American Association of Colleges of Nursing

• International Council of Nurses

American Nurses Association

• The American Nurses Association (ANA) is responsible for revising and publishing the nurse’s code of ethics.

• The International Council of Nurses represents nursing worldwide, advances the profession, promotes the well-being of nurses, and advocates for health in all policies. It does not publish the code of ethics. ​

• The American Nurses Credentialing Center credentials both organizations and individuals who advance nursing.​

• The American Association of Colleges of Nursing (AACN) is a national organization dedicated to advancing nursing education. ​

The American Nurses Association Code of Ethics is a nonnegotiable ______ standard for nursing ______.

The American Nurses Association Code of Ethics is a nonnegotiable moral standard for nursing practice.

• The American Nurses Association Code of Ethics is a nonnegotiable moral (not personal or business) standard for nursing practice (not students or universities). This moral standard is applicable in all practice settings.