By Stacey Kusterbeck
Every 10 years, the American Nurses Association (ANA) updates its Code of Ethics for Nurses. The much-anticipated 2025 changes have important implications for nurses, ethicists, and other healthcare providers. (To access the revised Code, visit https://codeofethics.ana.org/home.)
“The ethical challenges we face in our profession are not new. But we do have a healthcare landscape that requires us to reexamine the language and guidance we give nurses on how to navigate everyday ethical challenges,” says Kara Curry, MA, RN, senior policy and ethics advisor for the ANA’s Center for Ethics & Human Rights. The Center put together a Revision Panel of 49 experts, tasked with refining the Code to include current relevant issues. The updated Code addresses health disparities, workplace safety, racism, and emerging technologies. “One of our biggest goals during this revision process was to capture the essence of nurses — all nurses. We wanted every nurse to be able to see themselves reflected in the Code somewhere,” says Curry.
Nurses continue to deal with the aftereffects of the pandemic, which exacerbated longstanding ethical issues. “It was necessary to approach this revision with those thoughts at the forefront,” says Curry. The revised Code highlights the relationships nurses have with their patients, colleagues, and society. “We built upon established concepts and widely accepted nursing values and enhanced them further,” says Curry. For example, human dignity has long been a fundamental nursing value in the Code. The updated Code extended this concept to actively condemn dehumanization. Other updates and additions include:
- The Code includes a new term: “recipient(s) of care,” to be synonymous with “patient.” This recognizes that some individuals receive nursing care outside of the established healthcare system, such as persons who are unsheltered or uninsured.
- The Code supports healthcare as a human right. “It advocates for equitable access and outcomes in care, emphasizing that all individuals deserve respect and dignity as whole persons,” says Kathryn Schroeter, PhD, MA-Bioethics, RN, one of the revision panel members and a nurse scientist/ethicist at Froedtert Hospital.
- The Code focuses on the physical and psychological well-being of nurses by addressing workplace violence, hostility, and the broader environments nurses operate in. “We removed the false parallel of ‘duty to self’ and ‘duty to others’ and added the concept of ‘Human Flourishing.’ It was important to keep the focus of ‘duty to self’ as a standalone notion,” says Curry.
- The Code provides guidance on what qualifies as a conscience-based objection and when it might constitute discrimination or restricting patients’ access to care. “We acknowledge the tension between ethics and law. Ethical action may not always align with what is legal, and what is legal may not align with what is ethical. As we experience legislative changes, it can create a great deal of moral distress for nurses as they are forced to make difficult decisions when weighing the ethical and legal implications of their choices. Either decision may come with risks or consequences,” says Curry.
- The Code calls for nurses to actively participate in the development and evaluation of healthcare technologies, such as artificial intelligence. “The goal is to ensure safety, prevent misuse, and address bias,” says Schroeter.
- The Code emphasizes collaboration with colleagues, patients, and communities. “We explicitly address racism and intersectionality, as [they have] been a great contributor to health disparities and health inequities,” adds Curry.
- The Code extends the nurse-to-society relationship to a global context. “This reflects the evolving scope of nursing’s commitment to worldwide health,” says Schroeter.
After a revised Code was drafted, it was posted for public comment. More than 6,300 responses were received. The Revision Panel noted two recurring themes in those responses:
- Individuals wanted the Code to clearly articulate that patients be prioritized over institutions.
- Individuals wanted the Code to be clear that the responsibility and accountability of nurses also extend to the organizations and systems in which nurses are employed.
“The updated Code asks nurses in leadership and administrative roles to be aware of recurring problems, and to encourage their nurses to articulate their concerns and perspectives,” says Curry. Front-line nurses can do this most effectively by familiarizing themselves with the updated Code. “It cannot simply sit on a shelf. We can leverage it if we know what it says. It can be leveraged on our units, in our collegial relationships, and even in our advocacy and policy development,” says Curry.
The Code also is a valuable tool for hospital ethicists, who use various professional codes when consulting on individual cases or developing hospital policies. “There are many situations that arise where there are competing ethical considerations. Professional codes provide guidance in how to navigate those situations,” says Ian Wolfe, PhD, MA, RN, HEC-C, one of the Revision Panel members and director of ethics at Children’s Minnesota.
“Ethicists are not extensions of professional licensure boards. Thus, we are not looking for, nor do we determine if there are any, professional code of ethics violations,” notes Wolfe. “But we can provide our expertise to help clinicians apply their respective professional code of ethics to their practice or to a particular situation.”
Ethicists can use the Code in these ways, Curry suggests:
- when providing ethics education on nursing units;
- during ethics consults, when helping nurses to navigate everyday ethical challenges;
- when helping nurses who are experiencing moral distress;
- when determining what the appropriate parameters are for a nurse exercising conscience-based objection;
- when addressing safety concerns or questions that arise about a colleague who may be impaired.
“We encourage ethicists to embrace the Code as a standard reference for guidance,” emphasizes Curry.
Stacey Kusterbeck is an award-winning contributing author for Relias. She has more than 20 years of medical journalism experience and greatly enjoys keeping on top of constant changes in the healthcare field.
Every 10 years, the American Nurses Association updates its Code of Ethics for Nurses. The much-anticipated 2025 changes have important implications for nurses, ethicists, and other healthcare providers.
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