ICN Revised Code of Ethics for Nurses

A revised Code of Ethics for Nurses was launched by the International Council of Nurses on International Ethics Day on October 20. The extensively revised Code addresses many of the challenges and ethical dilemmas which were brought to the forefront by the COVID-19 pandemic. This is most evident in the new section on Nurses and Global Health.

Purpose of the ICN Code of Ethics for Nurses

Since it was first adopted in 1953 the ICN Code of Nursing Ethics has guided nursing practice across the globe. Since then it has been revised regularly in response to changes in nurses’ roles and responsibilities, health care, and society as a whole.

The Code is a statement of the professional values, responsibilities, and accountabilities of nurses with the purpose of guiding ethical nursing practice. It serves as a framework for resolving the ethical dilemmas faced by nurses irrespective of their role or the setting in which they practice.  

Furthermore, the Code lays a foundation that can be built on by the law, regulations, and professional standards which govern nursing practice in a particular country.

Review for the new 2021 ICN Code of Ethics for Nurses started in 2019. The work was done by an Expert Steering Group, ICN Board members which represent all ICN member countries, and ICN Staff.  Besides the English version, the document is also available in Spanish, French, and German.

Changes to the ICN Code of Ethics for Nurses

The revised edition is divided into four sections representing the principal elements for ethical conduct:

• nurses and patients or other people requiring services
• nurses and practice
• nurses and the profession
• nurses and global health. 

The previous edition also had four sections, namely nurses and people, nurses and practice, nurses and the profession, and nurses and co-workers. 

From the above, it is clear that the major change in the revised edition is the addition of the section on global health. This element focuses on nurses’ advocacy role in addressing inequities in health care, which have been so starkly highlighted by the COVID-19 pandemic.

The revised code also addresses new issues like the digital explosion, including social media; artificial intelligence in health care settings; human genome technology; population health and the Sustainable Development Goals; and the consequences of environmental and climate change.

Furthermore, as stated by, President of the ICN at the time of the launch, “Used as a guide by nurses in everyday choices, the revised Code highlights the need to protect and support nurses and ensure they have the appropriate education, training, and resources to provide the highest quality of care to all patients.”

Code of Nursing Ethics – a living document

To help nurses translate the code into action, each section has a list of standards followed by a chart with examples of how it is applied in practice.

THE ICN CODE OF ETHICS FOR NURSES

 An international code of ethics for nurses was first adopted by the International Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various times since, most recently with this review and revision completed in 2012.

Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering.

The need for nursing is universal. Inherent in nursing is a respect for human rights, including cultural rights, the right to life and choice, to dignity and to be treated with respect. Nursing care is respectful of and unrestricted by considerations of age, colour, creed, culture, disability or illness, gender, sexual orientation, nationality, politics, race or social status.

Nurses render health services to the individual, the family and the community and coordinate their services with those of related groups.

The ICN Code of Ethics for Nurses has four principal elements that outline the standards of ethical conduct.

ELEMENTS OF THE Code of Ethics for Nurses

Nurses and people

Nurses and the people: ICN Code of Ethics for Nurses

The nurse’s primary professional responsibility is to people requiring nursing care. In providing care, the nurse promotes an environment in which the human rights, values, customs and spiritual beliefs of the individual, family and community are respected. The nurse ensures that the individual receives accurate, sufficient and timely information in a culturally appropriate manner on which to base consent for care and related treatment.

The nurse holds in confidence personal information and uses judgment in sharing this information. The nurse shares with society the responsibility for initiating and supporting action to meet the health and social needs of the public, in particular those of vulnerable populations. The nurse advocates for equity and social justice in resource allocation, access to health care and other social and economic services. The nurse demonstrates professional values such as respectfulness, responsiveness, compassion, trustworthiness and integrity.

Nurses and practice

Nurses and Practice: ICN Code of Ethics for Nurses

The nurse carries personal responsibility and accountability for nursing practice, and for maintaining competence by continual learning. The nurse maintains a standard of personal health such that the ability to provide care is not compromised. The nurse uses judgement regarding individual competence when accepting and delegating responsibility. The nurse at all times maintains standards of personal conduct which reflect well on the profession and enhance its image and public confidence. The nurse, in providing care, ensures that use of technology and scientific advances are compatible with the safety, dignity and rights of people. The nurse strives to foster and maintain a practice culture promoting ethical behaviour and open dialogue.

Nurses and the profession

Nurses and the Profession: ICN Code of Ethics for Nurses

The nurse assumes the major role in determining and implementing acceptable standards of clinical nursing practice, management, research and education. The nurse is active in developing a core of research-based professional knowledge that supports evidence-based practice.

The nurse is active in developing and sustaining a core of professional values. The nurse, acting through the professional organisation, participates in creating a positive practice environment and maintaining safe, equitable social and economic working conditions in nursing. 3 The nurse practices to sustain and protect the natural environment and is aware of its consequences on health. The nurse contributes to an ethical organisational environment and challenges unethical practices and settings.

Nurses and co-workers

Nurses and Co-workers: ICN Code of Ethics for Nurses

The nurse sustains a collaborative and respectful relationship with co-workers in nursing and other fields. The nurse takes appropriate action to safeguard individuals, families and communities when their health is endangered by a co-worker or any other person. The nurse takes appropriate action to support and guide co-workers to advance ethical conduct.

The ICN Code of Ethics for Nurses is a guide for action based on social values and needs. It will have meaning only as a living document if applied to the realities of nursing and health care in a changing society. To achieve its purpose the Code must be understood, internalised and used by nurses in all aspects of their work. It must be available to students and nurses throughout their study and work lives.

APPLYING THE ELEMENTS OF THE ICN CODE OF ETHICS FOR NURSES

The four elements of the ICN Code of Ethics for Nurses: nurses and people, nurses and practice, nurses and the profession, and nurses and co-workers, give a framework for the standards of conduct.

Nurses and nursing students can therefore:

• 1. Study the standards under each element of the Code.
• 2. Reflect on what each standard means to you. Think about how you can apply ethics in your nursing domain: practice, education, research or management.
• 3. Discuss the Code with co-workers and others.
• 4. Use a specific example from experience to identify ethical dilemmas and standards of conduct as outlined in the Code. Identify how you would resolve the dilemmas.
• 5. Work in groups to clarify ethical decision making and reach a consensus on standards of ethical conduct.
• 6. Collaborate with your National Nurses Association, co-workers, and others in the continuous application of ethical standards in nursing practice, education, management and research.