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Code of Ethics for Registered Nurses

In Nova Scotia, all RNs and NPs are accountable to practise nursing based on the 2017 Code of Ethics for Registered Nurses developed by the Canadian Nurses Association. As a nurse, the Code of Ethics is a resource to assist you in practising ethically and working through ethical challenges that may arise in your practice setting with individuals, clients, families, communities and the health system.



The Code of Ethics

Providing Safe, Compassionate, Competent and Ethical Care

Nurses provide safe, compassionate, competent and ethical care.

Ethical responsibilities:

  1. Nurses have a responsibility to conduct themselves according to the ethical responsibilities outlined in this document and in practice standards in what they do and how they interact with persons receiving care and other members of the health-care team.
  2. Nurses engage in compassionate care through their speech and body language and through their efforts to understand and care about others’ health-care needs.
  3. Nurses build trustworthy relationships with persons receiving care as the foundation of meaningful communication, recognizing that building these relationships involves a conscious effort. Such relationships are critical to understanding people’s needs and concerns.
  4. Nurses question, intervene, report and address unsafe, non-compassionate, unethical or incompetent practice or conditions that interfere with their ability to provide safe, compassionate, competent and ethical care; and they support those who do the same (see Appendix B).
  5. Nurses are honest and take all necessary actions to prevent or minimize patient safety incidents. They learn from near misses and work with others to reduce the potential for future risks and preventable harms.
  6. Nurses practise “within their own level of competence and seek [appropriate] direction and guidance . . . when aspects of the care required are beyond their individual competence” (Licensed Practical Nurses Association of Prince Edward Island [LPNAPEI], Association of Registered Nurses of Prince Edward Island, & Prince Edward Island Health Sector Council, 2014, p. 3).
  7. When resources are not available to provide appropriate or safe care, nurses collaborate with others to adjust priorities and minimize harm. Nurses keep persons receiving care informed about potential and actual plans regarding the delivery of care. They inform employers about potential threats to the safety and quality of health care.
  8. Nurses planning to take job action or practising in environments where job action occurs take steps to safeguard the health and safety of persons receiving care during the course of the job action.
  9. During a natural or human-made disaster, including a communicable disease outbreak, nurses provide care using appropriate safety precautions in accordance with legislation, regulations and guidelines provided by government, regulatory bodies, employers, unions and professional associations.
  10. Nurses support, use and engage in research and other activities that promote safe, competent, compassionate and ethical care, and they use guidelines for ethical research that are in keeping with nursing values.
  11. Nurses who are involved in research respect the well-being of persons receiving care above all other objectives, including the search for knowledge. They pay attention to the safety of persons receiving care and to informed consent, the risk-benefit balance, the privacy and confidentiality of data and the monitoring of research.
  12. Nurses foster a safe, quality practice environment (CNA & Canadian Federation of Nurses Unions [CFNU], 2015).
  13. Nurses work toward preventing and minimizing all forms of violence by anticipating and assessing the risk of violent situations and by collaborating with others to establish preventive measures. When violence cannot be anticipated or prevented, nurses take action to minimize risk and to protect others and themselves (CNA, 2016a; CNA & CFNU, 2015; Canadian Nursing Students’ Association, 2014).
  14. When differences among members of the health-care team affect care, nurses seek constructive and collaborative approaches to resolving them and commit to conflict resolution and a person-centred approach to care.
  15. Nurses support each other in providing person-centred care.

Promoting Health and Well-Being

Nurses work with persons who have health-care needs or are receiving care to enable them to attain their highest possible level of health and well-being.

Ethical responsibilities:

  1. Nurses provide care directed first and foremost toward the health and well- being of persons receiving care, recognizing and using the values and principles of primary health care.
  2. Nurses work with persons receiving care to explore the range of health-care choices available to them, recognizing that some have limited choices because of social, economic, geographic or other factors that lead to inequities (Registered Nurses’ Association of Ontario [RNAO], 2011). Nurses recognize the social determinants of health in their assessments, diagnoses, outcomes planning, implementations and evaluations with individuals, families and communities, collaborating with others in and outside of the health sector (CNA, 2013).
  3. When a community health intervention interferes with the individual rights of persons, nurses use and advocate for the use of the least restrictive measures possible for those in their care (CNA, 2008).
  4. Nurses collaborate with other health-care providers and others to maximize health benefits to persons receiving care and with health-care needs and concerns, recognizing and respecting the knowledge, skills and perspectives of all.
  5. When the integrity of nurses is compromised by patterns of institutional behaviour or professional practice that erode the ethical environment and the safety of persons receiving care (generating moral distress), nurses express and report their concern individually or collectively to the appropriate authority or committee (American Nurses Association [ANA], 2015).

Promoting and Respecting Informed Decision-Making

Nurses recognize, respect and promote a person’s right to be informed and make decisions.

Ethical responsibilities:

  1. Nurses provide persons receiving care with the information they need to make informed and autonomous decisions related to their health and well-being. They also work to ensure that health information is given to those persons in an open, accurate, understandable and transparent manner.
  2. Nurses respect the wishes of capable persons receiving care to decline to receive information about their health condition.
  3. Nurses ensure that nursing care is provided with the person’s informed consent. Nurses recognize and support a capable person’s right to refuse or withdraw consent for care or treatment at any time (College of Registered Nurses of British Columbia [CRNBC], 2017a). Nurses recognize that capable persons receiving care may place a different weight on individualism and may choose to defer to family, cultural expectations or community values in decision-making while complying with the law of consent.
  4. Nurses are sensitive to the inherent power differentials between care providers and persons receiving care. They do not misuse that power to influence decision- making.
  5. Nurses advocate for persons receiving care if they believe the health of those persons is being compromised by factors beyond their control, including the decision-making of others.
  6. Nurses provide education to support the informed decision-making of capable persons. They respect the decisions a person makes, including choice of lifestyles or treatment that are not conducive to good health, and continue to provide care in a non-judgmental manner.
  7. When family members disagree with the decisions made by a person receiving care, nurses assist families in gaining an understanding of the person’s decisions.
  8. If a person receiving care is clearly incapable of consent, the nurse respects the law on capacity assessment and substitute decision-making in the nurse’s jurisdiction (Canadian Nurses Protective Society [CNPS], 2009).
  9. For any person that is considered incapable of consenting to care, nurses promote that person’s participation in discussions and decisions regarding their care in a manner that is adapted to the person’s capabilities.
  10. Nurses, along with other health-care providers and substitute decision- makers, consider and respect the best interests of the person receiving care and any previously known wishes or advance care planning that applies in the situation (CNPS, 2009).

Honouring Dignity

Nurses recognize and respect the intrinsic worth of each person.

Ethical responsibilities:

  1. Nurses, in their professional capacity, relate to all persons receiving care with respect.
  2. Nurses support persons receiving care in maintaining their dignity and integrity.
  3. In health-care decision-making, in treatment and in care, nurses work with persons receiving care to take into account their values, customs and spiritual beliefs, as well as their social and economic circumstances without judgment or bias.
  4. Nurses intervene, and report when necessary, when others fail to respect the dignity of a person they are caring for or a colleague (including students), recognizing that to be silent and passive is to condone the behaviour. They speak up, facilitate conversation and adjudicate disputes, as appropriate/required.
  5. Nurses respect the privacy of persons receiving care by providing care in a discreet manner and by minimizing intrusions.
  6. Nurses utilize practice standards, best practice guidelines, policies and research to minimize risk and maximize safety, well-being and/or dignity for persons receiving care.
  7. Nurses maintain appropriate professional boundaries and ensure their relationships are always for the benefit of the person. They recognize the potential vulnerability of persons receiving care and do not exploit their trust and dependency in a way that might compromise the therapeutic relationship. They do not abuse their relationship for personal or financial gain and do not enter into personal relationships (romantic, sexual or other) with persons receiving care.
  8. In all practice settings where nurses are present, they work to relieve pain and suffering, including appropriate and effective symptom management, to allow persons receiving care to live and die with dignity.
  9. Nurses encourage persons receiving care at the end of their life to be clear about what they want. They listen to a person’s stories to gain greater clarity about their goals and wishes.
  10. Nurses document a person’s wishes regarding end-of-life care in order to make their wishes and decisions clear and known to other caregivers (College of Registered Nurses of Manitoba [CRNM], College of Licensed Practical Nurses of Manitoba [CLPNM], & College of Registered Psychiatric Nurses of Manitoba [CRPNM], 2016; College of Registered Nurses of Nova Scotia [CRNNS] & College of Licensed Practical Nurses of Nova Scotia [CLPNNS], 2016).
  11. When a person receiving care is terminally ill or dying, nurses foster comfort, alleviate suffering, advocate for adequate relief of discomfort and pain, and assist people in meeting their goals of culturally and spiritually appropriate care. This includes providing a palliative approach to care for the people they interact with across the lifespan and the continuum of care, support for the family during and following the death, and care of the person’s body after death.
  12. Nurses understand the law so as to consider how they will respond to medical assistance in dying and their particular beliefs and values about such assistance. If they believe they would conscientiously object to being involved with persons receiving care who have requested such assistance, they discuss this with their supervisors in advance (see Appendix B; Canada, Parliament, 2016; College of Nurses of Ontario [CNO], 2017b; CRNM et al., 2016; CNA, 2015a).
  13. Nurses treat each other, colleagues, students and other health-care providers in a respectful manner, recognizing the power differentials among formal leaders, colleagues and students. They work with others to honour dignity and resolve differences in a constructive way.
  14. Nurses foster a moral community in which ethical values and challenges can be openly discussed and supported.

Maintaining Privacy and Confidentiality

Nurses recognize the importance of privacy and confidentiality and safeguard personal, family and community information obtained in the context of a professional relationships.

Ethical responsibilities:

  1. Nurses respect the interests of persons receiving care in the lawful collection, use, access and disclosure of personal information.
  2. When nurses are conversing with persons receiving care, they take reasonable measures to prevent confidential information in the conversation from being overheard.
  3. Nurses collect, use and disclose health information on a need-to-know basis with the highest degree of anonymity possible in the circumstances and in accordance with privacy laws.
  4. When nurses are required to disclose information for a particular purpose, they disclose only the amount of information necessary for that purpose and inform only those necessary. They attempt to do so in ways that minimize any potential harm to the persons receiving care or colleagues.
  5. When nurses engage in any form of communication, including verbal or electronic, involving a discussion of clinical cases, they ensure that their discussion of persons receiving care is respectful and does not identify those persons unless necessary and appropriate (CNA, 2012).
  6. Nurses advocate for persons receiving care to have access to their own health- care records through a timely and affordable process when such access is requested.
  7. Nurses respect policies that protect and preserve the privacy of persons receiving care, including security safeguards in information technology.
  8. Nurses do not abuse their access to information by accessing health-care records, including those of a family member or any other person, for purposes inconsistent with their professional obligations. When using photo, video or other technology for assessment, diagnosis, planning, implementation and evaluation of persons receiving care, nurses obtain their consent and do not intrude into their privacy. They handle photos or videos with care to maintain the confidentiality of the persons involved, including colleagues and students.
  9. Nurses intervene if others inappropriately access or disclose the personal or health information of persons who are receiving or have previously received care.
  10. In the use of social media, nurses safeguard the privacy and confidentiality of persons and other colleagues (CNA, 2012).
  11. In all areas of practice, nurses safeguard the impact new and emerging technologies can have on patient privacy and confidentiality, professional boundaries, and the professional image of individual nurses and the organizations in which they work (CNA, 2012). They are also sensitive to ethical conduct in their use of electronic records, ensuring accurate data entry and avoiding the falsification or alteration of documentation.

Promoting Justice

Nurses uphold principles by safeguarding human rights, equity and fairness and by promoting the public good.

Ethical responsibilities:

  1. Nurses do not discriminate on the basis of a person’s race, ethnicity, culture, political and spiritual beliefs, social or marital status, gender, gender identity, gender expression, sexual orientation, age, health status, place of origin, lifestyle, mental or physical ability, socio-economic status, or any other attribute.
  2. Nurses respect the special history and interests of Indigenous Peoples as articulated in the Truth and Reconciliation Commission of Canada’s (TRC) Calls to Action (2012).
  3. Nurses refrain from judging, labelling, stigmatizing and humiliating behaviours toward persons receiving care or toward other health-care providers, students and each other.
  4. Nurses do not engage in any form of lying, punishment or torture or any form of unusual treatment or action that is inhumane or degrading. They refuse to be complicit in such behaviours. They intervene, and they report such behaviours if observed or if reasonable grounds exist to suspect their occurrence.
  5. Nurses provide care for all persons including those seen as victims and/or abusers and refrain from any form of workplace bullying (CNA, 2016a).
  6. Nurses make fair decisions about the allocation of resources under their control based on the needs of persons receiving care. They advocate for fair treatment and fair distribution of resources.
  7. Nurses advocate for evidence-informed decision-making in their practice including, for example, evidence for best practices in staffing and assignment, best care for particular health conditions and best approaches to health promotion.
  8. Nurses work collaboratively to develop a moral community. As part of this community, all nurses acknowledge their responsibility to contribute to positive and healthy practice environments. Nurses support a climate of trust that sponsors openness, encourages the act of questioning the status quo and supports those who speak out in good faith to address concerns (e.g., whistle- blowing). Nurses protect whistle-blowers who have provided reasonable grounds for their concerns.

Being Accountable

Nurses are accountable for their actions and answerable to their practice.

Ethical responsibilities:

  1. Nurses, as members of a self-regulating profession, practise according to the values and responsibilities in the Code and in keeping with the professional standards, laws and regulations supporting ethical practice.
  2. Nurses are honest and practise with integrity in all of their professional interactions. Nurses represent themselves clearly with respect to name, title and role.
  3. Nurses practise within the limits of their competence. When aspects of care are beyond their level of competence, they seek additional information or knowledge, report to their supervisor or a competent practitioner and/or request a different work assignment. In the meantime, nurses remain with the person receiving care until another nurse is available.
  4. Nurses are accountable for their practice and work together as part of teams. When the acuity, complexity or variability of a person’s health condition increases, nurses assist each other (LPNAPEI et al., 2014).
  5. Nurses maintain their fitness to practise. If they are aware that they do not have the necessary physical, mental or emotional capacity to practise safely and competently, they withdraw from the provision of care after consulting with their employer. If they are self-employed, they arrange for someone else to attend to their clients’ health-care needs. Nurses then take the necessary steps to regain their fitness to practise, in consultation with appropriate professional resources.
  6. Nurses are attentive to signs that a colleague is unable, for whatever reason, to perform their duties. In such a case, nurses will take the necessary steps to protect the safety of persons receiving care (see Appendix B).
  7. If nursing care is requested that is in conflict with the nurse’s moral beliefs and values but in keeping with professional practice, the nurse provides safe, compassionate, competent and ethical care until alternative care arrangements are in place to meet the person’s needs or desires. But nothing in the Criminal Code compels an individual to provide or assist in providing medical assistance in dying. If nurses can anticipate a conflict with their conscience, they notify their employers or persons receiving care (if the nurse is self-employed) in advance so alternative arrangements can be made (see Appendix B).
  8. Nurses identify and address conflicts of interest. They disclose actual or potential conflicts of interest that arise in their professional roles and relationships and resolve them in the interest of the needs and concerns of persons receiving care.
  9. Nurses share their knowledge and provide feedback, mentorship and guidance for the professional development of nursing students, novice nurses, other nurses and other health-care providers (see Appendix B).
  10. Nurses advocate for more comprehensive and equitable mental health care services across age groups, socio-cultural backgrounds and geographic regions.