Nursing Ethics in Action: Values, Code, and Hard Choices

Heather Murphy

Welcome back, everybody. I’m Professor Murphy and today we’re talking about nursing ethics—basically the everyday choices that shape safe, respectful care. Ethics is not an extra topic; it’s the compass that guides clinical decisions. One of the clearest tools we have is the nursing code of ethics. Put simply, it is the profession’s written statement of its primary goals and values. It tells us, out loud and in writing, what nurses are responsible for and what standards regulate our conduct.

Heather Murphy

Nursing became recognized as a profession by building research, moving education into universities, increasing autonomy, and establishing a code of ethics.

Caitlin Hope

Let's talk about the The American Nurses Association. They published the first official code of ethics for nurses in 1950 and continues to guide updates to it. If I had to do the fast lesson-burst version, the code says a few big things very clearly. First, respect the inherent worth, dignity, and rights of every person. Every person. Not just the easy patient, not just the grateful patient, not just the one who agrees with you. Second, the nurse’s primary responsibility is to the person seeking care.

Heather Murphy

Third, we establish trusting relationships and advocate for recipients of care. Advocacy is not always dramatic. Sometimes it’s clarifying consent. Sometimes it’s saying, “I’m concerned this patient doesn’t understand.” Sometimes it’s pushing for pain control, safer staffing, or another set of eyes in the room. The code also says nurses are responsible for their own ethical practice and must act with integrity.

Caitlin Hope

I’ll add one more that I think gets skipped when people are stressed: nurses should help improve the ethical environment of the workplace. So ethics isn’t just “What would I do?” It’s also “What kind of unit culture are we building?”

Heather Murphy

It also pushes nurses toward collaboration, advancing the profession, promoting social justice, and reducing health inequities.

Caitlin Hope

For senior BSN students, the takeaway is simple: ethics is part of professional nursing identity, and it shapes how we protect dignity and speak up for patients. And from the key points we’re using in class, remember that specifically in Virginia, the Virginia Nurse Practice Act exists to protect the health, safety, and welfare of the public. That means you stay within scope, ask for help if you’re unsure, and request reassignment if needed. If you see falsified documentation, report it. If a colleague appears impaired, you have an ethical responsibility to speak up. And if a patient refuses treatment, respect the refusal, document objectively, and escalate through the chain of command.

Derek Mendoza

So how do we actually make an ethical decision in practice? The good news is there is a process. Nurses constantly make decisions, but ethical decision making is not always neat. Patient care situations often carry moral implications, uncertainty, and conflict.

Caitlin Hope

And the first thing is recognizing that a real problem exists. A problem is basically a gap between the desired state and the current undesirable situation. Some problems are routine. Moral problems are different. They’re more complex and dynamic, with uncertainty and competing concerns.

Karen Whitaker

Sometimes what you feel first is moral uncertainty. You sense something is off, but you’re not sure what the morally correct action is, or which values apply, or even how to define the problem. That’s common. It doesn’t mean you’re bad at ethics. It means you need to slow down and analyze.

Heather Murphy

And sometimes it’s a true ethical dilemma, where the options involve conflicting moral claims. It can feel like every available option has a cost. In those moments, structure helps.

Caitlin Hope

So here’s the practical sequence: recognize the problem, gather data and information, consider all options, weigh the merits of each option, make a decision, and then evaluate the outcome. Honestly, it maps really well onto the nursing process, which is probably why it feels familiar once you use it.

Derek Mendoza

I like the even simpler memory tool from the ethical decision-making model. Five moves: articulate, gather, explore, act, evaluate. Articulate the problem and set a realistic goal. Gather data and identify conflicting moral claims. Explore strategies. Select and implement a strategy. Then evaluate outcomes and revise if needed.

Karen Whitaker

Let’s put that at the bedside. Say a patient seems confused during discharge teaching, the family is rushing, and the team wants the bed. You might articulate the problem like this: “I am concerned the patient does not understand the plan well enough for a safe discharge.” Then gather data: what is the patient actually able to repeat back, what does the chart say, who has decision-making capacity concerns, what are the safety risks?

Caitlin Hope

Then consider the options. Re-teach. Pull in the provider. Involve case management. Delay discharge if needed. Weigh the merits. Which option best protects the patient, respects dignity, and supports safe care? Then decide and do the thing. And after? Evaluate. Did the patient understand? Did the plan actually work?

Derek Mendoza

A few factors can make this harder: uncertainty, context, multiple stakeholders, power imbalance, institutional policy, professional standards, third-party payers, public policy, and urgency. That’s why ethical decisions can feel heavy. There’s a patient in the bed, but there’s also a whole system in the room.

Heather Murphy

And this is where self-awareness matters. You have to examine your core values and understand how they connect with nursing standards and institutional expectations. Emotions have a legitimate role here too. If you feel discomfort, don’t just bulldoze past it. Explore it.

Karen Whitaker

Absolutely. That discomfort may be moral distress, which happens when you know there is a moral problem, believe you know the correct action, but you’re constrained from taking it. It’s more likely in stressful situations and with vulnerable patients, and it can harm both nurses and patients.

Caitlin Hope

Which is why collaborative discussion is huge. Bring in the charge nurse, preceptor, instructor, provider, ethics resources if available, whoever needs to be there. In urgent situations, gather as many participants as possible and discuss the known factors quickly. Don’t carry it alone if you don’t have to.

Derek Mendoza

And keep coming back to the code. Learn it. Use its language. Let it steady you when personalities, hierarchy, or chaos start pulling the decision off course.

Heather Murphy

That’s the episode. Ethics is not separate from bedside nursing; it is bedside nursing. Karen, Caitlin, Derek thanks for talking this through with me. Thanks, everybody. Keep learning, keep asking questions, and we’ll see you next time