Nurse Base

Nurses value and advocate for quality practice environments that have the organizational
structures and resources necessary to ensure safety, support and respect for all persons in
the work setting.
1. Nurses must advocate, to the extent possible within the circumstances, for sufficient
human and material resources to provide safe and competent care.
2. Nurses, individually or in partnership with others, must take preventive as well as
corrective action to protect persons from incompetent, unethical or unsafe care.
3. If working short staffed, nurses must set priorities reflecting the allocation of
resources. In such cases, nurses must endeavour to keep patients, families and
employers informed about potential and actual changes to usual routines (CRNM,
2000).
4. Nurses must support a climate of trust that sponsors openness, encourages
questioning the status quo and supports those who speak out publicly in good faith
(e.g., whistle blowing). It is expected that nurses who engage in responsible reporting
of incompetent, unsafe or unethical care or circumstances will be supported by their
professional association.
5. Nurses must advocate for work environments in which nurses and other health
workers are treated with respect and support when they raise questions or intervene to
address unsafe or incompetent practice.
6. Nurses must seek constructive and collaborative approaches to resolve differences
impacting upon care amongst members of the health-care team and commit to
compromise and conflict resolution.
7. Nurses are justified in using reasonable means to protect against violence when,
following an informed assessment, they anticipate acts of violence toward
themselves, others or property. In times when violence cannot be prevented or
anticipated, nurses are justified in taking self-protective action.
8. Nurse managers/administrators must strive to provide adequate staff to meet the
requirements for nursing care as part of their fundamental responsibility to promote
practice environments where fitness to practise and safe care can be maintained
(CARNA, 2004b). With their staff, they should work towards the development of a
moral community.7
9. As part of a moral community, nurses acknowledge their responsibility in
contributing to quality practice settings that are positive, healthy working
environments.
10. Nurses should collaborate with nursing colleagues and other members of the health
team to advocate for health-care environments conducive to ethical practice and to
the health and well-being of clients and others in the setting. They do this in ways
that are consistent with their professional role and responsibilities.

Nurses are answerable for their practice, and they act in a manner consistent with their
professional responsibilities and standards of practice.
1. Nurses must respect and practise according to the values and responsibilities in this
Code of Ethics for Registered Nurses and in keeping with the professional standards,
laws and regulations supporting ethical practice. They should use opportunities to
help nursing colleagues be aware of this code and other professional standards.
2. Nurses have the responsibility to conduct themselves with honesty and to protect their
own integrity in all of their professional interactions.
3. Nurses, in clinical, administrative, research or educational practice, have professional
responsibilities and accountabilities toward safe-guarding the quality of nursing care
persons receive. These responsibilities vary, but all must be oriented to the expected
outcome of safe, competent and ethical nursing practice.
4. Nurses should share their knowledge and provide mentorship and guidance for the
professional development of nursing students and other colleagues/health-care team
members.
5. Nurse educators, to the extent possible, must ensure that students will possess the
required knowledge, skills and competencies in order to graduate from nursing
programs (ANA, 2001).
6. Nurse administrators/managers, to the extent possible, must ensure that only those
nurses possessing the required knowledge, skills and competencies work in their
practice areas.
7. Nurses should provide timely and accurate feedback to other nurses and colleagues in
other disciplines and students about their practice, so as to support and recognize safe
and competent practice, contribute to ongoing learning and improve care.
8. If nurses determine that they do not have the necessary physical, mental or emotional
well-being to provide safe and competent care to persons, they may withdraw from
the provision of care or decline to engage in care. However, they must first give
reasonable notice to the employer, or if self-employed to their patients, and take
reasonable action to ensure that appropriate action has been taken to replace them
(Registered Nurses Association of British Columbia, 2001).
9. Nurses planning to participate in job action or who practice in environments where
job action occurs, must take steps (see Appendix A) to safeguard the health and
safety of people during the course of the job action.
10. Nurses must give primary consideration to the welfare of the people they serve and to
any possibility of harm in future care situations when they are pondering taking
action with regard to suspected unethical conduct or incompetent or unsafe care.
When nurses have reasonable grounds for concern about the behaviour of colleagues
or about the safety of conditions in the care setting, they must carefully review the
situation and take steps, individually or in partnership with others, to resolve the
problem (see Appendix A).
11. Nurses should advocate for discussion of ethical issues among health team members,
patients and families.
12. Nurses should advocate for changes to policy, legislation or regulations in concert
with other colleagues and their professional associations or colleges, when there is
agreement that these directives are unethical.

Nurses uphold principles of equity and fairness to assist persons in receiving a share of
health services and resources proportionate to their needs and promoting social justice.
1. Nurses must not discriminate in the provision of nursing care based on a person’s
race, ethnicity, culture, spiritual beliefs, social or marital status, sex, sexual
orientation, age, health status, lifestyle, mental or physical disability, and/or ability to
pay.
2. Nurses must strive to make fair decisions about the allocation of resources under their
control based upon the individual needs of persons in their care.
3. Nurses should put forward, and advocate for, the interests of all persons in their care.
This includes helping individuals and groups gain access to appropriate health care
that is of their choosing.
4. Nurses should promote appropriate and ethical care at the organizational/agency and
community levels by participating in the development, implementation and ongoing
review of policies and procedures designed to provide the best care for persons with
the best use of available resources given current knowledge and research.
5. Nurses should advocate for health policies and decision-making procedures that are
consistent with current knowledge and practice.
6. Nurses should advocate for fairness and inclusiveness in health resource allocation,
including policies and programs addressing determinants of health, along with
research based technology and palliative approaches to health care.
7. Nurses should be aware of broader health concerns such as environmental pollution,
violations of human rights, world hunger, homelessness, violence, etc. and are
encouraged to the extent possible in their personal circumstances to work individually
as citizens or collectively for policies and procedures to bring about social change,
keeping in mind the needs of future generations (ANA, 2001).

Nurses safeguard information learned in the context of a professional relationship and
ensure it is shared outside the health-care team only with the person’s informed consent,
or as may be legally required, or where the failure to disclose would cause significant
harm.
1. Nurses must respect the right of each person to informational privacy, that is, the
individual’s control over the use, access, disclosure and collection of their
information.
2. Nurses must advocate for persons requesting access to their health record subject to
legal requirements.
3. Nurses must protect the confidentiality of all information gained in the context of the
professional relationship, and practise within relevant laws governing privacy and
confidentiality of personal health information.
4. Nurses must intervene if other participants in the health-care delivery system fail to
maintain their duty of confidentiality.
5. Nurses must disclose a person’s health information only as authorized by that person,
unless there is substantial risk of serious harm to the person or to other persons or a
legal obligation to disclose. Where disclosure is warranted, information provided
must be limited to the minimum amount of information necessary to accomplish the
purpose for which it has been disclosed. Further the number of people informed must
be restricted to the minimum necessary.
6. Nurses should inform the persons in their care that their health information will be
shared with the health-care team for the purposes of providing care. In some
circumstances nurses are legally required to disclose confidential information without
consent. When this occurs nurses should attempt to inform individuals about what
information will be disclosed, to whom and for what reason(s).
7. When nurses are required to disclose health information about persons, with or
without the person’s informed consent, they must do so in ways that do not stigmatize
individuals, families or communities. They must provide information in a way that
minimizes identification as much as possible.
8. Nurses must advocate for and respect policies and safeguards to protect and preserve
the person’s privacy.

Nurses recognize and respect the inherent worth of each person and advocate for
respectful treatment of all persons.
1. Nurses must relate to all persons receiving care as persons worthy of respect and
endeavour in all their actions to preserve and demonstrate respect for the dignity and
rights of each individual.
2. Nurses must be sensitive to an individual’s needs, values and choices.
3. Nurses should take into account the biological, psychological, social, cultural and
spiritual needs of persons in health care.
4. Nurses must recognize the vulnerability of persons and must not exploit their
vulnerabilities for the nurse’s own interest or in a way that might compromise the
therapeutic relationship. Nurses must maintain professional boundaries to ensure their
professional relationships are for the benefit of the person they serve. For example,
they must avoid sexual intimacy with patients, avoid exploiting the trust and
dependency of persons in their care and must not use their professional relationships
for personal or financial gain.
5. Nurses must respect the physical privacy of persons when care is given, by providing
care in a discreet manner and by minimizing unwanted intrusions.
6. Nurses must intervene if others fail to respect the dignity of persons in care.
7. Nurses must advocate for appropriate use of interventions in order to minimize
unnecessary and unwanted procedures that may increase suffering.
8. Nurses must seek out and honour persons’ wishes regarding how they want to live the
remainder of their life. Decision-making about life sustaining treatment is guided by
these considerations.
9. Nurses should advocate for health and social conditions that allow persons to live and
die with dignity.
10. Nurses must avoid engaging in any form of punishment, unusual treatment or action
that is inhuman or degrading towards the persons in their care and must avoid
complicity in such behaviours.

Nurses respect and promote the autonomy of persons and help them to express their
health needs and values and also to obtain desired information and services so that they
can make informed decisions.
1. Nurses must be committed to building trusting relations as the foundation of
meaningful communication, recognizing that building this relationship takes effort.
Such relationships are critical to ensure that a person’s choice is understood,
expressed and advocated.
2. Nurses should provide the desired information and support required so people are
enabled to act on their own behalf in meeting their health and health-care needs to the
greatest extent possible.
3. Nurses should be active in assisting person’s to obtain the best current knowledge
about their health condition.
4. Nurses must respect the wishes of those who refuse, or are not ready, to receive
information about their health condition. They should be sensitive to the timing of
information given and how the information is presented.
5. Nurses must ensure that nursing care is provided with the person’s informed consent.
Nurses must also recognize that persons have the right to refuse or withdraw consent
for care or treatment at any time.
6. Nurses must respect the informed choices of those with decisional capacity to be
independent, to choose lifestyles not conducive to good health and to direct their own
care as they see fit. However, nurses are not obligated to comply with a person’s
wishes when this is contrary to the law.
7. Nurses must continue to provide opportunities for people to make choices and
maintain their capacity to make decisions, even when illness or other factors reduce
the person’s capacity for self-determination. Nurses should seek assent of the person
when consent is not possible.
8. If nursing care is requested that is contrary to the nurse’s personal values, the nurse
must provide appropriate care until alternative care arrangements are in place to meet
the person’s desires.
9. Nurses must be sensitive to their position of relative power in professional
relationships with persons. Nurses must also identify and minimize (and discuss with
the health team) sources of coercion.
10. Nurses must respect a person’s advance directives about present and future healthcare
choices that have been given or written by a person prior to loss of decisional
capacity.
11. When a person lacks decisional capacity, nurses must obtain consent for nursing care
from a substitute decision-maker, subject to the laws in their jurisdiction. When prior
wishes for treatment and care of an incompetent person are not known or are unclear,
nurses’ decisions must be made based on what the person would have wanted as far
as is known, or failing that, decisions must be made in the best interest of the person
in consultation with the family and other health-care providers.
12. Nurses should respect a person’s method of decision-making, recognizing that
different cultures place different weight on individualism and often choose to defer to
family and community values in decision-making (American Nurses Association
[ANA], 2001). However, nurses should also advocate for the individual if that
person’s well-being is compromised by family, community or other health
professionals.

Nurses value health promotion and well-being and assisting persons to achieve their
optimum level of health in situations of normal health, illness, injury, disability or at the
end of life.
1. Nurses must provide care directed first and foremost toward the health and well-being
of the person, family or community in their care.
2. Nurses must recognize that health is more than the absence of disease or infirmity and
must work in partnership with people to achieve their goals of maximum health and
well-being.
3. Nurses should provide care addressing the well-being of the person in the context of
that person’s relationships with their family and community.
4. Nurses must foster comfort and well-being when persons are terminally ill and dying
to alleviate suffering and support a dignified and peaceful death.
5. Nurses should provide the best care that circumstances permit even when the need
arises in an emergency outside an employment situation.
6. Nurses should respect and value the knowledge, skills and perspectives of the persons
in their care and must recognize, value and respect these while planning for and
implementing care.
7. In providing care, nurses should also respect and value the knowledge and
perspectives of other health providers. They should actively collaborate and where
possible seek appropriate consultations and referrals to other health team members in
order to maximum health benefits to people.
8. Nurses should recognize the need to address organizational, social, economic and
political factors influencing health. They should participate with their colleagues,
professional associations, colleges and other groups to present nursing views in ways
that are consistent with their professional role, responsibilities and capabilities and
which are in the interests of the public.
9. Nurses should recognize the need for a full continuum of accessible health services,
including health promotion and disease prevention initiatives, as well as diagnostic,
restorative, rehabilitative and palliative care services.
10. Nurses should seek ways to improve access to health care that enhances, not replaces,
care by utilizing new research based technologies, such as telehealth (e.g., telephone
assessment and support).
11. Nurses should continue to contribute to and support procedurally and ethically
rigorous research and other activities that foster the ongoing development of nursing
knowledge.
12. Nurses who conduct or assist in the conduct of research must observe the nursing
profession’s guidelines, as well as other guidelines, for ethical research.6

Nurses value the ability to provide safe, competent and ethical care that allows them to
fulfill their ethical and professional obligations to the people they serve.
1. Nurses must strive for the highest quality of care achievable.
2. Nurses must recognize that they have the ability to engage in determining and
expressing their own moral choices. Their moral choices may be influenced by
external factors (e.g., institutional values and constraints).
3. Nurses should be sufficiently clear and reflective about their personal values to
recognize potential value conflicts.
4. Nurses must maintain an acceptable level of health and well-being in order to provide
a competent level of service/care for the people they serve.
5. Nurses must base their practice on relevant research findings and acquire new skills
and knowledge in their area of practice throughout their career.
6. Nurses must practice within their own level of competence. When aspects of care are
beyond their level of competence, they must seek additional information or
knowledge, seek help from their supervisor or a competent practitioner and/or request
a different work assignment. In the meantime, nurses must provide care until another
nurse is available to do so.
7. Nurses seeking professional employment must accurately state their area(s) of
competence. They should seek reasonable assurance that employment conditions will
permit care consistent with the values and responsibilities of the code.
8. Nurses must admit mistakes and take all necessary actions to prevent or minimize
harm arising from an adverse event.
9. Nurses must strive to prevent and minimize adverse events5 in collaboration with
colleagues on the health-care team. When adverse events occur, nurses should utilize
opportunities to improve the system and prevent harm.
10. All nurses must contribute to safe and supportive work environments.
11. Nurse leaders have a particular obligation to strive for safe practice environments that
support ethical practice.
12. Nurses should advocate for ongoing research designed to identify best nursing
practices and for the collection and interpretation of nursing care data at a national
level.

Safe, competent and ethical care
Nurses value the ability to provide safe, competent and ethical care that allows them to
fulfill their ethical and professional obligations to the people they serve.
Health and well-being
Nurses value health promotion and well-being and assisting persons to achieve their
optimum level of health in situations of normal health, illness, injury, disability or at the
end of life.
Choice
Nurses respect and promote the autonomy of persons and help them to express their
health needs and values and also to obtain desired information and services so they can
make informed decisions.
Dignity
Nurses recognize and respect the inherent worth of each person and advocate for
respectful treatment of all persons.
Confidentiality
Nurses safeguard information learned in the context of a professional relationship, and
ensure it is shared outside the health-care team only with the person’s informed consent,
or as may be legally required, or where the failure to disclose would cause significant
harm.
Justice
Nurses uphold principles of equity and fairness to assist persons in receiving a share of
health services and resources proportionate to their needs and in promoting social justice.
Accountability
Nurses are answerable for their practice, and they act in a manner consistent with their
professional responsibilities and standards of practice.
Quality Practice Environments
Nurses value and advocate for practice environments that have the organizational
structures and resources necessary to ensure safety, support and respect for all persons in
the work setting.

The Code of Ethics for Registered Nurses is structured around eight primary values that
are central to ethical nursing practice:
• safe, competent and ethical care
• health and well-being
• choice
• dignity
• confidentiality
• justice
• accountability
• quality practice environments
With each value, specific responsibility statements are provided. Ethical reflection, which
begins with a review of one’s own ethics, and judgment are required to determine how a
particular value or responsibility applies in a particular nursing context. There is room
within the profession for disagreement among nurses about the relative weight of
different ethical values and principles. More than one proposed intervention may be
ethical and reflective of good practice. Discussion and questioning are extremely helpful
in the resolution of ethical issues. As appropriate, persons in care, colleagues in nursing
and other disciplines, professional nurses’ associations, colleges, ethics committees and
other experts should be included in discussions about ethical problems. In addition
legislation, standards of practice, policies and guidelines of professional nurses’
associations, colleges and nurses’ unions may also assist in problem-solving. Further,
models for ethical decision-making, such as those described in CNA’s Everyday Ethics,
can assist nurses in thinking through ethical problems.