6 Ethics in Nursing Practice

Ethical principles in practice

Ethical nursing practice balances a client’s choices, clinical risk, professional duties, and the needs of the care team. It respects the person while providing safe, competent care within professional standards, workplace policy, and applicable law. Key responsibilities include protecting dignity, advocating for clients, promoting safety, and meeting obligations to patients, colleagues, and society.

Principles that can conflict

• Autonomy: Respect the client’s right to make informed choices, including refusing recommended care.

• Beneficence: Act to promote the client’s well-being.

• Nonmaleficence: Avoid or reduce preventable harm.

• Justice: Provide fair, nondiscriminatory care and use resources responsibly.

• Fidelity and veracity: Keep professional commitments and communicate honestly.

These principles may point in different directions. For example, a client may refuse treatment that the team believes would reduce serious risk. The nurse should neither coerce the client nor accept the refusal without discussion. Instead, explore the client’s concerns, provide or obtain understandable information, assess immediate safety, communicate with the responsible clinician, and document the discussion and plan.

Client rights and consent

Hospital patients have rights to participate in care planning, receive information, make informed decisions, and request or refuse treatment. They also have rights to privacy, confidentiality, and care in a safe setting. Applicable requirements depend on the care setting and state law.

Supporting informed decisions

Informed consent is a communication process, not merely a signed form. The client should receive relevant information about the proposed intervention, including expected benefits and risks, alternatives, and the option of no treatment. The client should have an opportunity to ask questions and make a voluntary decision.

The clinician proposing the intervention is generally responsible for explaining it. The nurse supports the process by checking whether the client has questions or appears confused, arranging qualified language assistance when needed, and promptly referring unanswered questions to the responsible clinician. Follow local law and policy about the nurse’s role in witnessing consent.

Responding to refusal

When a client refuses care, explain foreseeable consequences within your role, assess and communicate relevant changes or urgent risks, notify the appropriate clinician, and document the client’s stated choice, information provided, notifications, and follow-up. Disagreement, disability, or a choice that seems unwise does not alone mean the client lacks decision-making capacity. If capacity or the identity of a legally authorized surrogate is in question, escalate for appropriate assessment and follow applicable law and policy. In an emergency, follow governing law and organizational procedures.

For example, if a client declines a fall-prevention measure, ask what matters to the client and what concerns them, explain the specific risk in plain language, explore acceptable alternatives, involve the care team as appropriate, and document the agreed plan. Safety concerns call for assessment and mitigation, not automatic disregard of the client’s preferences.

Prioritization and delegation

Prioritization is ongoing and depends on changing client needs. First identify immediate threats to life or safety, such as airway or breathing problems, new severe symptoms, acute deterioration, or an unsafe environment. Then consider acuity, changes from baseline, time-sensitive treatments, and which actions can prevent harm. Reassess when a client’s condition changes and reprioritize; a fixed checklist cannot replace clinical judgment.

Delegating safely

Delegation does not transfer the nurse’s professional responsibility to use sound judgment, choose appropriate work, give clear directions, and provide supervision. Before delegating, consider the Five Rights of Delegation: the right task, circumstances, person, directions or communication, and supervision.

Confirm that the task is allowed by the jurisdiction’s nursing practice rules and organizational policy, and that the delegatee is competent. Tasks requiring nursing assessment, clinical judgment, care planning, or evaluation should not be delegated where rules or standards reserve them to a licensed nurse. The nurse remains responsible for evaluating the client’s response and following up. Delegation rules vary by jurisdiction.

A stable client’s routine ambulation may be appropriate to delegate to a trained assistant if policy and scope rules permit it, with clear instructions about assistance and when to report symptoms. A new report of chest pressure requires prompt nursing assessment and escalation, not delegation as a routine task.

Continuity and teamwork

Care is safer when essential information and responsibility are clearly transferred during shift changes, referrals, and transitions between settings. A useful handoff communicates the client’s current condition, recent changes, immediate concerns, pending actions, and contingency plans. The receiver should have an opportunity to clarify or confirm the information.

Interdisciplinary care brings together the client, chosen support people when appropriate, nurses, prescribers, pharmacists, therapists, social workers, and other relevant professionals. Share necessary information through appropriate channels, clarify roles, and raise disagreements respectfully. The team’s plan should incorporate the client’s goals and preferences while addressing safety and clinical needs.

If a concern remains unresolved, use the communication chain, supervisor, ethics consultation, or patient-safety reporting process available in the setting.

Responding to an ethical dilemma

Use a deliberate process to respond when a client’s wishes, safety, and team recommendations conflict:

1. Recognize the conflict: identify the choice, harm, right, or professional duty at stake.

2. Gather facts: assess the client, urgency, expressed wishes, relevant orders, and applicable policy or law.

3. Listen and explain: seek the client’s perspective and provide accurate, understandable information without pressure.

4. Consult and collaborate: communicate with the responsible clinician and relevant team members; escalate urgent safety concerns.

5. Agree on and carry out a plan: respect the client’s rights while taking appropriate steps to reduce risk.

6. Document and reassess: record objective findings, discussions, decisions, notifications, and follow-up; revisit the plan as circumstances change.

Ethical nursing practice combines respect for client autonomy with advocacy, safety, fairness, and professional accountability. Support informed consent and refusal, prioritize according to changing risk, delegate only within applicable rules and with appropriate oversight, and protect continuity through clear handoffs and teamwork. When concerns conflict or remain unresolved, communicate openly, seek guidance, document, and keep the client’s rights and well-being central.