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The Code of Ethics for Nurses With Interpretative Statements was developed to guide nurses in ethical decision making and analysis.  

Nurses are expected to adhere to and embrace the standards of these provisions which include our values, morals, and ideals of the nursing profession (ANA, 2015).

This Code of Ethics outlines the very essence of what it means to be a nurse.

This module will introduce you to the nine provisions outlined in the Code of Ethics for Nurses. 



American Nurses Association (2015).  Code of ethics for nurses with interpretative statements.  Retrieved 8/20/23  from

Step 1:  Begin by reading the material in the following three links:


2. Click Code of Ethics 2015 Part 1.pdf for part I of an article discussing the Code of Ethics. I ATTACHED THIS BELOW

3. Click The New Code of Ethics for Nurses Practical Clinical Application Part II.pdf for part II of an article discussing the Code of Ethics. I ATTACHED THIS BELOW

Step Two:  The paper

  1. You will have one written assignment for this module using APA format student paper writing.


  1. Include a title page.
  2. Include an introduction.
    1. An abstract is not       required. 
  3. Use each provision as a      Level 1 heading
    1. Each provision should have at least 2 well constructed paragraphs.
    2. A paragraph is comprised of at least 3 well constructed sentences.
    3. You may use first person and discuss what the provision means to you (or perhaps a personal experience relating to the provision).
  4. The body of the paper should be at least 8 pages and not exceed 9-10 pages
    1. This excludes the title page and the reference page.
    2. Include a summary or conclusion at the end of your paper.
  5. This assignment will be submitted to TurnitIn and be less than 26% similarity score.
  6. Spelling and grammar are important.
    1. Use the editor feature in Word to correct most issues. 
  7. This paper must be in APA format. 

July-August 2015 • Vol. 24/No. 4268

Jill Winland-Brown, EdD, FNP-BC, DPNAP, is Professor Emeritus,
Christine E. Lynn College of Nursing, Florida Atlantic University, and
member of American Nurses Association Ethics and Human Rights
Advisory Board.

Vicki D. Lachman, PhD, APRN, MBE, FAAN, is President, V.L.
Associates, a consulting and coaching firm, Avalon, NJ, and Sarasota,
FL. She is Chair, American Nurses Association Ethics and Human
Rights Advisory Board, and serves on a hospital ethics committee.

Elizabeth O’Connor Swanson, DNP, MPH, APRN-BC, is Assistant
Professor of Nursing, Mary Black School of Nursing, University of
South Carolina Upstate; Nurse Practitioner/Clinical Nurse Specialist,
South Carolina Department of Juvenile Justice; and member of the
American Nurses Association Ethics and Human Rights Advisory

The New ‘Code of Ethics for Nurses
With Interpretive Statements’ (2015):
Practical Clinical Application, Part I

F or the 13th year in a row, Gallup poll results indi-
cate Americans rate nursing as the most honest
profession and nurses as having the highest ethi-

cal standards (Gallup, 2014). In addition, the American
Nurses Association (ANA) identified the focus of 2015
National Nurses Week as “Ethical Practice, Quality Care”
as part of its effort for 2015 to be named “The Year of
Ethics.” The new Code of Ethics for Nurses with Interpretive
Statements (ANA, 2015) (Code) was released in January
after a 4-year review process involving input from sever-
al thousand RNs (OnCourse Learning Corporation,
2015). The second edition of the Guide to the Code of
Ethics for Nurses with Interpretative Statements:
Development, Interpretation, and Application (Fowler,
2015) was released in April.

This two-part series will explore the new Code and its
use in every day clinical practice with a case situation
for each article. Part I will introduce the Code, discuss
the glossary, and use a nursing case situation to explore
the first four provisions. The second part of the series
will continue discussion of the last five provisions.

The Code (ANA, 2015) articulates the ethical obliga-
tions of all registered nurses. The nine provisions iden-
tify the responsibilities of nurses, while the interpretive
statements provide guidance in their application. The
introduction to the Code explains why certain terms
were chosen, such as patient versus client, as well as the
use of moral and ethical word choices. This introduc-
tion also gives an overview of some terms, and includes
links to foundational and supplemental documents on

the ANA ethics web page. Because many terms in nurs-
ing ethics are used imprecisely and interchangeably
with possible misconceptions, this edition of the Code
includes a glossary of 49 terms, such as compassion
fatigue, moral distress, and social media (ANA, 2015, pp.

The first three provisions explain the most basic val-
ues and commitments of the nurse, all of which might
be helpful in exploring the following nursing case situ-
ation. These provisions address the nurse’s duties to
respect the patient, unrestricted by considerations of
social or economic status, personal attributes, or the
nature of health problems. The fourth provision discuss-
es the nurse’s accountability in practice.

The following nursing case situation is used to illus-
trate some of the Code violations:

Keisha and Kyle are two RNs on the night
shift. They have been out of school for sever-
al years and are trying to move to the day
shift to normalize their lives. They have got-
ten very close through their years in nursing
school together; he was one of her major
supports as she re-entered nursing after an
addiction to oxycodone due to a shoulder
injury. Kyle understands Keisha has some
biases against major surgical interventions
for palliation and engaging patients in Phase
1 clinical trials.

Tonight, they are caring for Mrs. Williams,
a 44-year-old married woman with four chil-
dren ages 3-20. She was admitted with an
intestinal obstruction and is scheduled for
surgery tomorrow. After some imaging stud-
ies, the physician suspects a massive tumor
that will likely require removal for palliative
purposes only. He believes the cancer has
spread to all surrounding organs and lymph
nodes. However, nothing is certain until sur-

Leaving the unit in the morning, Keisha
and Kyle are talking about the case when
Mrs. Williams’s 20-year-old daughter Wendy
gets on the elevator. Wendy recognizes the

Ethics, Law,
and Policy

Jill Winland-Brown
Vicki D. Lachman

Elizabeth O’Connor Swanson

July-August 2015 • Vol. 24/No. 4 269

The New Code of Ethics for Nurses with Interpretative Statements (2015): Practical Clinical Application, Part I

nurses from her mother’s unit. She overhears
them saying “What a shame with such a
massive tumor and with four children at
home!” Although Wendy assumes they are
talking about her mother, she thought her
mother only had a minor intestinal obstruc-
tion. She does not know what to do as her
mother is going to surgery very soon.

Provision 1
The nurse practices with compassion and respect for

the inherent dignity, worth, and unique attributes of
every person.

This provision is more concise than the previous
Provision 1, but encompasses the same concepts. Five
interpretive statements are similar to the previous edi-
tion, but the language is updated to articulate the con-
tent more clearly. The first two statements address nurs-
es’ fundamental ethical obligations for patient respect
and development of trust between nurse and patient.

The first interpretive statement addresses “respect for
human dignity.” Keisha and Kyle seemed to have com-
passion for their patient, but they did not respect her
right to confidentiality. The second interpretive state-
ment identifies “relationships with patients” and the
importance of trust. While Keisha and Kyle may have
developed a relationship with Mrs. Williams, they vio-
lated the trust by discussing her health situation in a
public place. It is not clear if Mrs. Williams was aware of
her diagnosis or the physician’s surgical plans. As this
interpretative statement indicates, nurses do not need
to agree with patient choices, but they are required to
set aside any bias or prejudice (e.g., Keisha’s bias con-
cerning palliative care surgeries).

The third interpretive statement for Provision 1 con-
cerns the “nature of health.” To promote Mrs.
Williams’s health fully, the nurses should have encour-
aged an honest dialogue between the patient and sur-
geon. She has the right to know what the surgeon is
anticipating. Also, this statement addresses the need for
support for the family and significant others, including
the patient’s daughter Wendy.

The fourth interpretive statement focuses on “the
right to self-determination.” Mrs. Williams has the
capacity to understand her diagnosis and participate in
the decision for her surgery. From the case situation, the
husband should be included in discussion and Mrs.
Williams may like her daughter Wendy to be involved
in the decision-making process as well. As this state-
ment indicates, “patients have a moral and legal right to
determine what will be done with and to their person”
(p. 2). The physician, patient, and family need to know
the diagnosis and prognosis in order to make an
informed decision for surgery. If the surgery is only for
palliation, then the patient and family need to engage
in an advance care planning conversation with the
physician. The nurse’s obligation is to assure the patient
has accurate, complete, and understandable informa-
tion on which to base her decision.

The last interpretive statement for Provision 1
involves the nurse’s “relationships with colleagues and
others.” Keisha and Kyle failed to demonstrate respect
for persons when they had their conversation, which
included identifying information about the patient, in a
public place. Nurses have a responsibility to create an
ethical environment, including an affirmative duty to
prevent harm. Their violation of confidentiality could
cause significant harm to the needed trust as Mrs.
Williams and her family struggle to make the best deci-
sion for her. Additionally, this interaction in the eleva-
tor initiated a great deal of distress for Wendy.

Provision 2
The nurse’s primary commitment is to the patient,

whether an individual, family, group, community, or

This provision has retained the previous four inter-
pretive statements, with added clarity in the explana-
tions. It focuses on the nurse’s obligation to assure the
primacy of the patient’s interests regardless of conflicts
that arise between clinicians or patient and family.

The first interpretive statement is for the “primacy of
the patient’s interests.” Keisha’s and Kyle’s primary com-
mitment is to Mrs. Williams and her family. They need
to provide opportunities for Mrs. Williams and her fam-
ily to participate in her care, including honest discus-
sions about available resources and treatment options.
Wendy’s reactions seem to indicate she is unaware of
her mother’s prognosis or the purpose of the surgery.

The second interpretive statement involves the “con-
flict of interest for nurses.” This nursing case situation
illustrates several possible conflicts: between physician
and nurses, physician and patient, physician and family
members, and nurses and family members. Nurses pro-
mote Mrs. Williams’s best interests when they speak up
and raise questions about her understanding of her
prognosis, thus supporting interprofessional collabora-
tion with physicians. Nurses must address conflicting
expectations from patients, families, and physicians, as
well as conflicts arising between their own professional
and personal values.

The third interpretive statement relates to “collabora-
tion.” “Nurses are responsible for articulating, represent-
ing, and preserving the scope of nursing practice, and
the unique contributions of nursing to patient care” (p.
6). This collaboration “requires mutual trust, recogni-
tion, respect, transparency, shared decision-making and
open communication among all who share concern and
responsibility for health outcomes” (p. 6). If nurses are
reluctant to open a dialogue with the physician con-
cerning a patient’s possible lack of understanding of
diagnosis and/or prognosis, other professionals can be
used: other health care colleagues, leaders, and the hos-
pital ethics committee. With collaboration, the desired
outcome is always a demonstrated commitment to the

The final interpretive statement for this provision
illustrates the importance of “professional boundaries.”

July-August 2015 • Vol. 24/No. 4270

Keisha and Kyle committed several boundary violations.
“Nurse-patient and nurse-colleague relationships have
as their foundation the promotion, protection, and
restoration of health” (p. 7). The nurse-patient relation-
ship needs to remain therapeutic and professional.
Concerns arise in this situation about the casual way in
which Keisha and Kyle engaged in an end-of-shift con-
versation about a patient.

Provision 3
The nurse promotes, advocates for, and protects the

rights, health, and safety of the patient.
The six interpretive statements within this provision

combine two from the previous Code (ANA, 2001) (pri-
vacy and confidentiality) and add a new one: “profes-
sional responsibility in promoting a culture of safety.”
This provision focuses on the nurse’s obligation to pro-
tect patients from harm.

The first interpretive statement for this provision
addresses “protection of the rights of privacy and confi-
dentiality.” This statement was most violated in the case
situation. Keisha and Kyle should have known the
importance of maintaining confidentiality and should
not be discussing this case on the elevator. While they
did not give any specifics related to the case, how many
other patients on their unit are likely to have an intes-
tinal problem and four children at home? This violates
the fundamental trust between patient and nurse.
“Patients rights are the primary factors in any decisions
concerning personal information, whether from or
about the patient” (p. 10).

The second interpretive statement centers on “pro-
tection of human participants in research” and is similar
to the third statement in the previous edition. This
addresses the importance of informed consent and the
fact participants may decline to participate or withdraw
from any research. Nurses have the obligation to raise
questions about the individual’s capacity to consent and
honor the patient’s right to withdraw from research. If
Mrs. Williams chooses to engage in a Phase 1 clinical
trial, nurses may have to support her withdrawal.

The third interpretive statement, which focuses on
“performance standards and review mechanisms,” is
clearer and more concise than the previous edition. The
statement addresses the need for nurses to continue
their professional development to maintain their com-
petence because nurses “are responsible and account-
able for nursing practice and professional behaviors” (p.
11). Maintenance of confidentiality is considered a basic
performance standard in nursing.

Interpretive statement four is entirely new: “profes-
sional responsibility in promoting a culture of safety.”
This statement addresses the importance of the nurse’s
role in patient safety. The nurse is responsible for report-
ing any errors or near misses to the appropriate author-
ity, ensuring disclosure of the errors to patients, and
establishing processes to investigate these errors to pre-
vent recurrence. The nurse also must not remain silent
in the event of an error. If a colleague would overhear

Ethics, Law, and Policy

Keisha’s and Kyle’s conversation, he or she would be
required to address this violation with them. Not
addressing their error could be seen as condoning their

The fifth statement in Provision 3 centers on the
“protection of patient health and safety by acting on
questionable practice.” This is similar to the previous
edition, addressing the need to support nurses who
become whistleblowers. As mentioned previously, the
nurse overhearing Keisha and Kyle’s conversation has
an obligation to confront them and organizational lead-
ers have an obligation to protect the confronting nurse
from any retaliation. “Reporting questionable practice,
even when done appropriately, may present substantial
risk to the nurse; however, such risk does not eliminate
the obligation to address threats to patient safety” (p.

The sixth and final interpretative statement focuses
on “patient protection and impaired practice” and is
similar to the previous version. The definition of
impaired practice is broadened in this revision to
include “mental or physical illness, fatigue, substance
abuse, or personal circumstances” (p. 13). This state-
ment not only addresses reporting the impaired nurse
but also ensures the nurse receives assistance. This advo-
cacy includes supporting the return of the individual to
practice after recovery, as Kyle did for Keisha.

Provision 4
The nurse has authority, accountability, and

responsibility for nursing practice; makes decisions;
and takes action consistent with the obligation to pro-
mote health and to provide optimal care.

Provision 4 has four interpretive statements empha-
sizing responsibilities and obligations of the profession-
al nurse to his or her patients. These statements remain
essentially unchanged in this revised Code. Patients are
seen as individuals, families, or populations. “Nursing
practice includes independent direct nursing care activ-
ities; care as ordered by an authorized healthcare
provider, care coordination; evaluation of interventions
and delegation of nursing interventions…” (p. 15).

Emphasis of the first interpretative statement is on
“authority, accountability, and responsibility.” Nurses
have authority in every role, and are accountable and
responsible for the quality of the care they provide and
in meeting nurse practice acts, regulations, and the
Code. Advanced practice registered nurses (APRNs) are
included in Provision 4, specifically APRNs with pre-
scribing privileges; the revised Code states both the
ARPN who orders a treatment and the nurse who
accepts the order are responsible for the judgments each
makes and accountable for the actions each takes. The
issuance of a prescriptive order by an APRN is not an act
of delegation.

The second interpretative statement reviews
“accountability for nursing judgments, decisions, and
actions.” The revised Code recognizes technology that
assists nurses in the clinical arena but identifies these

July-August 2015 • Vol. 24/No. 4 271

The New Code of Ethics for Nurses with Interpretative Statements (2015): Practical Clinical Application, Part I

systems and technologies are aids, rather than a substi-
tute for the nurse’s skill and judgment. This statement
reminds the professional nurse of two important issues
in accountability. First, nurses are accountable for all
decisions and actions in the course of practice. Second,
system or technology failure does not relieve the nurse
of practice accountability because these are seen as
adjuncts to nursing knowledge and skill rather than
replacements for them. Nurses are always accountable
for their actions, decisions, and judgments, just as
Keisha and Kyle are for their failure in judgment to
honor patient confidentiality.

The third interpretative statement focuses on
“responsibility for nursing judgments, decisions, and
actions.” Keisha and Kyle exhibited poor nursing judg-
ment by speaking about a patient in the elevator. This
statement emphasizes the need to provide safeguards
for patients, nurses, colleagues, and the environment,
and nurses’ responsibility to “bring forward difficult
issues related to patient care and/or institutional con-
straints upon ethical practice for discussion and review”
(p. 16). This revised Code places a duty on nurse execu-
tives for safeguarding nurses’ access to organizational
committees and institutional boards, as well as inclu-
sion in decision-making processes that touch patient
care ethics, quality, and safety. Nurses who participate
on these committees and boards “are obligated to
actively engage in, and contribute to, the decisions that
are made” (p. 16). Inclusion of Keisha and/or Kyle on
the hospital’s Ethics Committee may have sensitized
them to the issues surrounding confidentiality.

Interpretative statement four addresses the “assign-
ment and delegation of nursing activities or tasks.” The
revised Code specifically indicates nurses may not dele-
gate nursing process duties of assessment and evalua-
tion, and “employer policies do not relieve the nurse of
responsibility for making assignment or delegation deci-
sions” (p. 17). This statement also focuses specifically on
the importance of managers in facilitating appropriate
assignment and delegation. In addition, this statement
expands on the obligations of nurses functioning in
educator or preceptor roles. As the revised Code states,
“It is imperative that the knowledge and skill of the
nurse or nursing student be sufficient to provide the
assigned nursing care under appropriate supervision”
(p. 17). There is nothing in this interpretative statement
relevant to the case situation.

When the Code (ANA, 2001) was written, few contrib-

utors could have envisioned the current health care envi-
ronment. These revised provisions and interpretive state-
ments were developed with an eye toward the future and
a foot well-grounded in knowledge gained from the past.
This updated version provides nurses with clarity on
terms through a glossary, links to foundational docu-
ments on the ANA website, and improved clarity
through editing of the first four provisions. Through the

addition of interpretative statement 3.6, “protection of
patient health and safety by acting on questionable prac-
tice,” the importance of the role of the professional nurse
in the patient safety is expressed.

American Nurses Association (ANA). (2001). Code of ethics for nurses

with interpretive statements. Silver Spring, MD: Author.
American Nurses Association (ANA). (2015). Code of ethics for nurses

with interpretive statements. Silver Spring, MD: Author.
Gallup. (2014). Americans rate nurses highest on honesty, ethical stan-

dards. Retrieved from

Fowler, M. (2015). Guide to the code of ethics for nurses with interpreta-
tive statements: Development, interpretation, and application.
Silver Spring, MD: American Nurses Association.

OnCourse Learning Corporation. (2015). The ANA’s “year of ethics”
kicks off with the release of revised code of ethics. Retrieved from

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