ANA Nursing Code of Ethics: 9 Provisions Plus Examples
The American Nurses Association (ANA) Code of Ethics is more than a professional guideline. It shapes how nurses make difficult decisions, advocate for patients, navigate workplace pressures, and protect their professional integrity throughout their careers.
Whether you’re a nursing student preparing for the NCLEX, a bedside RN managing competing priorities, or a nurse practitioner balancing clinical autonomy with patient expectations, ethical decision-making affects nearly every shift.
The challenge is that ethical situations rarely appear in black and white. You may face unsafe staffing ratios, conflicting family wishes, telehealth concerns, documentation pressures, or workplace policies that feel at odds with patient care.
The ANA Nursing Code of Ethics provides a framework for navigating those moments.
In this guide, we’ll explain:
- What the ANA Nursing Code of Ethics is
- The 9 provisions and how they apply in practice
- Common ethical dilemmas nurses face
- The difference between ethics violations and legal violations
- How ethics can affect malpractice claims and licensure
- Ethical considerations in telehealth, AI, and modern nursing practice
- Frequently asked questions nurses have about the Code
Table of Contents
- What Is the ANA Nursing Code of Ethics?
- Why the Code of Ethics Matters
- The 9 Provisions Explained with Examples
- Common Ethical Dilemmas Nurses Face
- Ethics vs. Law in Nursing
- Can Ethics Violations Affect Your License or Malpractice Claims?
- Modern Ethical Challenges: Telehealth, AI, and Social Media
- Frequently Asked Questions
What Is the ANA Nursing Code of Ethics?
The ANA Nursing Code of Ethics is the primary ethical framework guiding nursing practice in the United States. Originally adopted in 1950 and updated periodically, the most recent revision was released in 2025 to reflect evolving healthcare challenges and societal expectations.
The Code establishes expectations for:
- Patient advocacy
- Professional conduct
- Accountability
- Respect for human dignity
- Workplace ethics
- Collaboration
- Equity and social justice
- Professional growth
- Protecting public trust
The Code consists of:
9 Provisions: Broad ethical responsibilities nurses must uphold
35 Interpretive Statements: Additional guidance explaining how provisions apply in practice
Think of the provisions as principles and the interpretive statements as examples of how those principles work in real healthcare environments.
Why the ANA Code of Ethics Matters for Nurses
Many nurses assume ethics only becomes important during major dilemmas. In reality, ethical decision-making influences routine activities like charting, communication, delegation, informed consent, and patient advocacy.
The Code matters because ethical failures can contribute to:
- Employer disciplinary action
- Board of nursing investigations
- Patient complaints
- Workplace conflict
- Increased liability exposure
- Loss of public trust
According to the National Practitioner Data Bank, thousands of adverse actions involving nurses occur annually. Ethical lapses may not automatically result in malpractice claims, but they can increase scrutiny and professional risk.
Ethical Practice Supports:
- Better patient outcomes
- Stronger workplace culture
- Improved documentation habits
- Professional reputation
- Reduced liability exposure
The 9 ANA Code of Ethics Provisions Explained
Provision 1: Respect for Human Dignity
Core principle: Nurses must treat every patient with compassion and respect regardless of background or circumstances.
This provision emphasizes that nurses must practice with compassion and respect for the inherent dignity, worth, and unique characteristics of every individual. It reinforces the importance of equitable care, cultural sensitivity, and treating all patients with respect regardless of background, beliefs, identity, or health condition.
Examples:
- Providing equitable care regardless of socioeconomic status
- Respecting cultural beliefs during treatment
- Using preferred pronouns
- Supporting patients with stigmatized conditions
Real-world scenario:
- A patient refuses treatment based on religious beliefs.
Ethical questions:
- How should nurses balance autonomy and medical recommendations?
- What documentation is necessary?
- When should escalation occur?
Provision 2: Commitment to the Patient
Provision 2 establishes that a nurse’s primary responsibility is to the patient, whether caring for individuals, families, groups, or communities. Nurses are expected to prioritize patient well-being and advocate for their needs, even when institutional pressures or competing interests exist.
Examples:
- Advocating for additional evaluation
- Questioning unsafe discharge plans
- Escalating concerns
Scenario:
- A patient appears medically unstable before discharge, but bed shortages increase pressure to release them.
Ethical responsibility:
- Patient safety takes precedence.
Provision 3: Advocacy and Protection
This provision focuses on the nurse’s responsibility to protect patient rights, safety, privacy, and access to informed decision-making. Advocacy is a central part of nursing practice and may include speaking up about unsafe conditions, safeguarding confidentiality, or ensuring patients understand treatment options.
Examples include:
- Reporting abuse
- Preventing unsafe care
- Addressing consent issues
Provision 4: Accountability and Responsibility
Provision 4 reinforces that nurses are accountable for their clinical decisions, actions, and professional judgment. It highlights the importance of maintaining competence, practicing within scope, and taking responsibility when mistakes or adverse events occur.
Examples:
- Accurate documentation
- Reporting medication errors
- Accepting responsibility
Scenario:
A medication dosage error occurs.
Ethical response:
- Prioritize patient safety
- Report immediately
- Document accurately
- Participate in corrective measures
Attempting to conceal errors often creates larger ethical and legal problems.
Provision 5: Duty to Self and Others
This provision recognizes that nurses have ethical responsibilities not only to patients, but also to themselves. Maintaining physical and mental well-being, pursuing professional development, and preserving personal integrity are considered essential components of ethical nursing practice.
- Mental health
- Burnout prevention
- Continuing education
- Professional boundaries
Chronic exhaustion can impair judgment and patient care.
Self-care is not separate from ethical nursing practice.
Provision 6: Ethical Work Environments
Provision 6 encourages nurses to help create and maintain workplaces that support ethical practice, patient safety, and respectful collaboration. This may include addressing unsafe staffing concerns, workplace bullying, or systems that negatively impact care quality.
Examples:
- Addressing unsafe staffing
- Reporting bullying
- Supporting respectful workplaces
Scenario:
- You consistently receive unsafe patient loads.
Ethical considerations:
- Documentation
- Escalation pathways
- Patient safety concerns
- Professional obligations
Provision 7: Advancement of the Profession
This provision highlights the responsibility nurses have to contribute to the growth and improvement of the profession through education, research, mentorship, and evidence-based practice. Supporting future nurses and promoting continual learning strengthens nursing as a whole.
Provision 8: Collaboration for Human Rights
Provision 8 emphasizes collaboration to advance health equity, reduce disparities, and support broader public health goals. Nurses play an important role in advocating for communities, addressing social determinants of health, and promoting access to quality care.
Examples:
- Community health initiatives
- Public health advocacy
- Access improvement
Provision 9: Integrity of the Profession
The final provision focuses on preserving public trust and maintaining the ethical integrity of nursing as a profession. Nurses collectively contribute to shaping professional standards, promoting social justice, and ensuring nursing values remain central as healthcare evolves.
Nursing remains one of America’s most trusted professions because ethical expectations remain high.
Common Ethical Dilemmas Nurses Face
Ethics become difficult when values, responsibilities, and patient needs conflict. Many ethical dilemmas in nursing do not have obvious answers, which is why understanding the ANA Code of Ethics can help guide decision-making in complex situations.
Examples include:
End-of-life decisions
End-of-life care often requires nurses to balance patient autonomy, family wishes, and medical recommendations. Ethical questions may arise around aggressive treatment versus comfort-focused care, especially when patients and family members disagree about the appropriate course of action.
Documentation pressure
Documentation shortcuts, delayed charting, or incomplete records can create ethical concerns and increase professional risk. Accurate documentation supports continuity of care, protects patients, and may become important evidence if questions arise about treatment decisions.
Unsafe staffing
Balancing heavy workloads with patient safety is one of the most common ethical challenges nurses face. Unsafe staffing situations may force difficult decisions about prioritization, escalation of concerns, and advocacy for both patients and healthcare teams.
Workplace bullying
Workplace bullying, intimidation, or hostile environments can undermine ethical practice and negatively impact patient care. Nurses have a responsibility to contribute to professional, respectful work environments where concerns can be raised without fear of retaliation.
Social media use
Social media creates new ethical challenges for healthcare professionals, particularly around confidentiality and professional boundaries. Sharing patient information, workplace experiences, or even seemingly harmless stories can sometimes violate ethical standards or patient privacy expectations.
Nursing Ethics vs Nursing Law: What’s the Difference?
Nursing ethics and nursing law often overlap, but they are not the same. Ethical standards help guide how nurses should act in situations involving patient care, advocacy, integrity, and professional judgment, while laws establish the legal requirements nurses must follow to maintain compliance and protect patient safety. Understanding the difference matters because some actions may raise ethical concerns without breaking the law, while others can lead to disciplinary action, licensure issues, or legal consequences. The table below highlights how nursing ethics and nursing law differ, and where they often intersect in everyday practice.
| Nursing Ethics | Nursing Law |
| Professional expectations | Legal requirements |
| Based on values | Based on statutes/regulations |
| Violations may trigger discipline | Violations may trigger lawsuits |
| Governed by professional standards | Governed by state/federal law |
Example: Documentation Errors and Ethical vs Legal Violations
A documentation shortcut may raise ethical concerns before it becomes a legal issue. For example, a nurse who copies forward chart notes without verifying current patient status, delays documentation until the end of a shift, or omits relevant details may be acting inconsistently with ethical expectations around honesty, accountability, and patient advocacy. Even if no immediate patient harm occurs, these behaviors can compromise continuity of care and undermine trust within the healthcare team.
However, if inaccurate or incomplete documentation contributes to patient harm, a medication error, delayed treatment, or miscommunication between providers, the issue may move beyond ethics into legal territory. In those situations, documentation practices could become part of a malpractice claim, licensing board investigation, employer disciplinary action, or regulatory review.
Some actions violate both ethical standards and legal requirements. For example, intentionally falsifying records, documenting care that was never provided, or altering chart entries after an adverse event may breach professional ethical obligations while also creating serious legal consequences. Ethical lapses do not always become legal issues, but repeated poor documentation habits can increase professional risk over time.
In short: Ethics asks, “Was this the right professional decision?” while law asks, “Did this violate a regulation, standard of care, or legal requirement?” In nursing, the two often overlap.
Can Ethics Violations Affect Malpractice Claims?
Ethics violations do not automatically create malpractice claims.
However, ethical concerns may contribute to:
- Documentation issues
- Patient complaints
- Board investigations
- Increased scrutiny
- Liability allegations
Common examples:
Inadequate Documentation
Incomplete, delayed, or inaccurate documentation can create challenges long before a malpractice claim occurs. Poor records may make it harder to demonstrate appropriate clinical judgment, explain decision-making, or defend the care provided during investigations, patient complaints, or legal proceedings.
Boundary Violations
Professional boundaries exist to protect both patients and healthcare providers by maintaining trust and preserving therapeutic relationships. Boundary violations, whether involving inappropriate communication, dual relationships, or oversharing personal information, can raise ethical concerns and in some cases lead to disciplinary action or complaints.
Failure to Advocate
Patient advocacy is a core ethical responsibility in nursing, particularly when safety concerns, communication breakdowns, or questionable treatment decisions arise. Ignoring concerns, failing to escalate issues, or remaining silent in unsafe situations may later become relevant during employer reviews, licensing investigations, or malpractice claims.
Does Malpractice Insurance Cover Ethics Investigations?
Coverage depends on policy terms and circumstances.
Professional liability insurance may help with:
- Legal defense costs
- Licensing board matters
- Covered malpractice allegations
This is one reason many nurses maintain individual malpractice coverage even when employer coverage exists.
Ethical Challenges in Modern Nursing Practice
Healthcare has changed significantly over the past decade, creating new ethical considerations that extend beyond traditional bedside care. As telehealth, artificial intelligence, and digital communication become more common, nurses must apply ethical principles to situations that previous generations of providers may not have encountered.
Telehealth
The growth of telehealth has expanded access to care, but it has also introduced new ethical responsibilities for nurses and nurse practitioners. Questions may arise around practicing across state lines, maintaining patient privacy during virtual visits, obtaining informed consent, and ensuring documentation remains accurate and complete in remote care settings.
Even when care is delivered virtually, nurses remain responsible for providing services within their licensed scope of practice and complying with state-specific regulations.
Artificial Intelligence and Documentation Tools
AI-assisted documentation and charting tools are becoming more common in healthcare environments, offering opportunities to improve efficiency and reduce administrative burden. However, these tools also raise ethical questions around accuracy, oversight, bias, and accountability if information is incomplete or incorrect.
Technology may assist with documentation, but nurses remain ethically and professionally responsible for reviewing records and ensuring patient information is accurate.
Social Media Ethics
Social media creates ethical challenges related to patient confidentiality, professional boundaries, and public trust in healthcare professionals. Sharing workplace experiences, patient stories, or opinions online, even without identifying details, may unintentionally violate ethical expectations or create privacy concerns.
Maintaining professionalism online is increasingly viewed as an extension of professional conduct within clinical settings.
How Nursing Students Use the ANA Code
Many nurses first encounter the ANA Code of Ethics during nursing school, where ethical principles are integrated into coursework, clinical rotations, simulations, and discussions around patient care. Students learn to apply ethical reasoning to scenarios involving informed consent, advocacy, confidentiality, and difficult treatment decisions.
Ethics also appears within NCLEX competency areas, making a foundational understanding important for licensure preparation. Developing ethical decision-making skills early helps support stronger clinical judgment and confidence as students transition into professional practice.
Frequently Asked Questions About the ANA Nursing Code of Ethics
What are the 9 provisions of the ANA Code of Ethics?
The 9 provisions of the ANA Code of Ethics establish ethical expectations related to patient dignity, advocacy, accountability, professional growth, workplace ethics, collaboration, and maintaining the integrity of the nursing profession. Together, they provide a framework that helps nurses make ethical decisions across a wide range of clinical situations.
Is the ANA Code of Ethics legally binding?
The ANA Code of Ethics is not a law and does not carry legal penalties on its own. However, ethical violations may influence employer disciplinary actions, licensing board investigations, professional reputation, or become relevant during malpractice claims and regulatory reviews.
How often is the ANA Code updated?
The ANA periodically revises the Code of Ethics to reflect changes in healthcare practice, technology, and societal expectations. The most recent update was released in 2025 and includes expanded considerations around health equity, social justice, and emerging healthcare challenges.
Does the ANA Code apply to nurse practitioners?
Yes, the ANA Code of Ethics applies broadly across the nursing profession, including registered nurses, nurse practitioners, nursing students, educators, and leaders. Ethical responsibilities remain important regardless of specialty, practice setting, or level of autonomy.
Is the ANA Code tested on NCLEX?
Ethical principles are integrated throughout NCLEX competency areas rather than appearing as a single dedicated section. Nursing students are expected to demonstrate ethical decision-making skills related to patient advocacy, confidentiality, informed consent, safety, and professional accountability.
Does the ANA Code apply to telehealth nursing?
Yes, ethical responsibilities apply regardless of whether care is delivered in person or through telehealth. Nurses providing virtual care must still uphold standards related to patient privacy, informed consent, documentation accuracy, advocacy, and practicing within their licensed scope and applicable state regulations.
What happens if a nurse violates the ANA Code of Ethics?
Violating ethical standards does not automatically result in legal action, but it may lead to employer discipline, professional consequences, or licensing board investigations depending on the circumstances. Repeated or serious ethical violations may also increase scrutiny during malpractice claims or affect a nurse’s professional reputation.
Does the ANA Code of Ethics affect malpractice insurance claims?
Ethics violations do not automatically create malpractice claims, but issues such as poor documentation, boundary concerns, or failures in patient advocacy may become relevant during investigations or legal proceedings. Maintaining ethical practice can help reduce professional risk and support stronger defense if allegations arise.
The ANA Code of Ethics Is More Than a Guideline
The ANA Nursing Code of Ethics helps nurses navigate difficult decisions, advocate for patients, maintain integrity, and strengthen trust in the profession.
Ethical practice is not simply about avoiding mistakes. It supports safer care, stronger judgment, and long-term professional protection.
As healthcare evolves through staffing challenges, telehealth, AI, and changing patient expectations, the ability to apply ethical principles in real-world situations may become even more important.
Strong Ethics and Career Protection
For nurses and nurse practitioners, protecting your professional future means combining ethical practice with appropriate liability protection. You need insurance for times when you have acted within the ethics code but something goes wrong.
NOW Insurance offers professional liability coverage designed specifically for nurses and nurse practitioners, with fast online quotes and policies built around modern healthcare risks. Many nurses can get coverage in minutes with instant proof of insurance.
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Sources:
American Nurses Association Code of Ethics (2025)
Gallup Poll: Most Trusted Professions
NCSBN NCLEX-RN Test Plan