Inquirers

This section is those wishing to learn about nursing ethics, and for those wishing to start a bit of self-study in nursing ethics. This page is intended to provide answers to a few common questions and to identify a few starting places for nursing ethics. It also serves those learners who are deep introverts who prefer to be alone in their reflections. This page will continue to be built further out in the future.

Hummm…What is nursing ethics?

A quick definition of nursing ethics is the professional ethics of nursing, as developed by nursing for nurses, and as an ongoing tradition of moral reflection and guidance for all nurses in all roles and settings.

A less quick definition: Nursing ethics, for modern nursing which began in the 1860s, is a 150 years old. In the terminology of philosophy, it is an applied normative professional ethics (applied to nursing; normative meaning a rule or standard), applicable to nurses and nursing. It does not serve to inform the practice of any other profession. Philosopher Pamela Grace says that nursing ethics has two senses. First, it is a field of inquiry about “why nursing exists, what purposes it serves, its relationship to other professions and disciplines, and what characteristics are needed for nurses to practice well” (Grace, 2018, p.36), and ‘”the nature of nursing responsibilities may vary depending on the level of development of nursing in a given country.  It results in a code of ethics or an ethical standard of practice.” She identifies a second sense: “Nursing ethics is also the enactment of the country’s code of ethics in practice; an appraisal of how well nurses meet their responsibilities to individuals and society despite obstacles.” Sometimes, nursing ethics is used less definitionally to mean both of these, plus the whole of everything related to nursing ethics, including its entire body of literature and collateral works such as a code of ethics, ethics committees papers, ethics policies, ethics textbooks and more. 

An even less quick definition: Nursing ethics is the applied normative professional ethics promulgated by the nursing community and from within its longstanding tradition, to provide moral guidance for nurses and the profession itself; to set forth its values, virtues and duties that constitute good nursing in a moral sense; to explicate the goods, aims and perspectives of nursing for what furthers health and well-being for individuals receiving direct care and for society; to assist in discerning what is right, good, and fitting for patients and society from a nursing perspective; and to make plain to society what constitutes morally good nursing and what society may there expect of nurses. Nursing ethics is an ongoing tradition and field of inquiry that grapples with how nursing ethics ought to be enacted amidst changes in society and in nursing, and is subject to ongoing renewal. The ANA Code of Ethics for Nurses, (as well as codes of ethics for other nations and the International Council of Nurses), constitutes a concentrated distillation of the entire body of nursing ethics for nurses and for the profession profession.

Well, I was taught bioethics, isn’t that the same thing?

No. Nursing ethics is all about nursing, and only applies to nursing. It is nursing-centric in that it is focused on what constitutes morally good nursing, the concerns and perspectives of nurses, the ends that nursing seeks in its practice, and the reason for nursing’s existence in society.

Aren’t the principles of biomedical ethics nursing ethics principles?

Th “principles of biomedical ethics,” as specified by Tom Beauchamp and James Childress in their groundbreaking and widely used textbook, are: respect for autonomy, nonmaleficence, beneficence and distributive justice. Though, contextually, aspects of the principles can be found to some degree in the ANA Code of Ethics for Nurses, they are not specified as principles for nursing in the Code. The principles of biomedical ethics are universal, abstract, philosophical principles that apply to all humanity, that is, to every human capable of moral decision making. They are not “bioethical principles,” that is to say that they are not unique to the domain of bioethics, ether individually or together. They are universal (everyone!) principles and, as such, they are “universal principles applied within bioethics,” not “bioethical principles” per se. This is a small technical distinction but an important one conceptually and in ethics theory.

Are there other principles of biomedical ethics?

Well, yes. There are other principles in ethics, and rules as well. Rules are subsidiary to principles; they further specify aspects of the “parent” principle. Beauchamp and Childress chose the four principles noted above and developed some subsidiary rules that support each principle. Other principles? Yes. Philosopher W.D. Ross, for example, names fidelity and reparations as two principles of ethics. Fidelity certainly speaks to relationships in nursing and is widely discussed in the early nursing ethics textbooks. Reparations (making good for a wrong that has been committed against another) is a principled basis for malpractice insurance among other things. Some of this is an argument over what are principles versus rules, but there are larger issues here as well in terms of what principles are chosen.

But, do I have to give up bioethics? I really like it, and it took me forever to learn.

Heavens no! The “principles of biomedical ethics” are useful analytical tools to guide analysis and reflection on moral dilemmas, problems, and conflicts in biomedicine — keep them, use them! They point out moral elements that need to be considered, and they can help clarify issues at hand. They are useful to nursing but they are not nursing ethics as they do not encompass or address moral features that are central to nursing ethics. More specifically they do not address what it means to be a good nurse, or address the goods of nursing, neither do they address nursing concerns such as the corporatization of health care and its effects upon nursing practice, or short staffing, nor the extraordinary range and depth of social concerns with which nursing has always engaged. The principles of biomedical ethics are necessary but not sufficient.

But what might nursing ethics offer, and is it worth my time to explore it?

Well, this is not a practical outcome of nursing ethics, but once you get into it, it will feel like home, or like that worn out pair of jeans that feels so comfy that you can’t throw them out. But if you want some quick examples, nursing ethics is worth your time and energy…

  • Because it focuses on relationships structurally and relationship interpersonally, making for better care.
    • Structural relationships (nurse to profession, nurse to society, nurse to colleagues, nurse to globe) are, among other things, supportive of and essential to good nursing in direct patient care
    • Better direct nursing care because nursing ethics expresses and supports the relational norms, values and perspectives of nursing in direct patient care, as norms of what good nursing is.
  • Because it makes for excellence in practice and helps to know what and who is a good nurse
    • It supports the goods of nursing (e.g., compassion, dignity, comfort, well-being…) and their manifestation in practice  for excellence and effective, skilled, wise practice; that is, for “good nursing” and how to go about being a good nurse when the chips are down.
  • Because it knows the reality of nursing and nursing practice in context
    • It helps sort out the interpersonal, social, political and other factors that bring about painful issues for nurses, and helps to navigate those
  • It can help in a difficult workplace environment because
    • It identifies articulates nursing ethics’ normative expectations of the nurse-to-colleagues relationship
    • It gives the knowledge needed for modeling the norms of nursing ethics to demonstrate ethical comportment that can be powerfully and openly normative

Okay, I will think about it. But is this some fringe group trying to kidnap me from bioethics?

Well maybe not so fringy. The members or SONEI are well established, well known leaders in ethics in nursing. They may or may not be members of fringe groups, but this is not one such group. But I understand that you are not convinced. Do take a look (actually read) Pamela Grace’s (Dr., Professor, philosopher, and nurse) chapter: Grace, Pamela J. “An Argument for the Distinct Nature of Nursing Ethics,” in Deem, Michael, and Lingler, Jennifer (Eds.) Nursing Ethics: normative foundations, advanced concepts, and emerging. Oxford, 2024, 3-31.

Alright. If I were to dip one foot in, where might I start?

Welcome! The water is warm, come on in! One easily accessible place to start is the ANA Code of Ethics for Nurses. The Code is not posted on the ANA website, only the provisions are, which are not the whole Code. Sorry. You will need to read a full copy. You might also want to read the full ICN Code of Ethics for Nurses as well. Not yet, but down the road you will want to read the journal Nursing Ethics. There is lots for you to read but, like drinking from a firehose, we caution guzzling with restraint.

So, read the full Code of Ethics for Nurses (not just the provisions). Read it slowly, sipping a beverage of your choice, with Cheetos or popcorn at hand and fingerprints on the pages. Read it again. Mark it up. Put questions in the white space. Underline what you really like. The Code is a distillation or nursing ethics, so keep that in mind.

Okay, what if I decide to put both feet in to the ankles? What’s next?

I am so glad that you asked. You might start by subscribing to our website to receive an email when new blogs are posted. Just enter your email into the subscribe box that appears on any and all pages, and click — you’re in! You can also begin your nursing ethics learning with two books and a blog site that cover different aspects of nursing ethics. The first is a website and blog Nursology.net and then the two books. We will soon begin offering blogs here on the SONEI website as well.

Nursology.net is a resource for the history and future development of nursing knowledge, including empirics, ethics, personal knowing, aesthetics, and emancipatory knowing.  There are a number of ethics related blogs on this website and a tab for ethical ways of knowing. Blogs related to Nursing Ethics. Then there are two books for you.

Fowler, Marsha (2024). Nursing Ethics, 1880s to the Present: An Archeology of Lost Wisdom and Identity. Routledge. ISBN 9781032200712. This text provides a detailed history and development of nursing’s ethics, from the 1880s forward, the social context from which it arose and which informs its ethics to the present, its extensive body of literature, and explanations that justify and define the nature of nursing ethics, including the distinction of nursing ethics from bioethics. It also discussed the rise of bioethics as a field, and its importation into nursing. In addition, Dr. Fowler’s blog posts on Nursology.net provide explanations of nursing ethics relative to current social, political, and professional challenges.

The other book for starting a deeper dive into nursing ethics: Grace, Pamela J., and Melissa K. Uveges. Nursing Ethics and Professional Responsibility in Advanced Practice. 4th ed. Jones & Bartlett Learning, 2022.

This book provides a philosophical grounding that distinguished between bioethics and nursing ethics, and underlines an argument for a distinct nursing ethics. It covers ethical parameters, practice, and issues in varied practice settings. This book remains the only comprehensive textbook available on the ethical issues faced by APRNs providing front-line care. It introduces the foundations of professional responsibility and makes difficult philosophical and ethical concepts accessible to students so they can facilitate their own ethical decision-making. The authors, both APRNs and ethicists, demystify the principles and language of healthcare ethics. Beginning from a foundation of nursing practice, this unique resource guides students in developing ethical decision-making skills they can apply to a range of circumstances, from everyday issues to complex dilemmas. The updated Fourth Edition features expanded information on social justice, including advocacy for vulnerable populations and global issues, as well as new discussions on managing social media, electronic health records, and ethical issues specific to CRNAs and CNSs in the perioperative setting.

And here is a bonus chapter from another book:

  • Chinn, P. L. (2018). The evolution of nursing’s ethics of caring. In W. Rosa, S. Horton-Deutsch, & J. Watson (Eds.), A Handbook for Caring Science (1 edition, pp. 257–276). Springer Publishing Company. https://doi.org/10.1891/9780826133892.0003