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Code of Ethics for Registered Nurses

The Canadian Nurses Association’s Code of Ethics for Registered Nurses is the code of ethics for all RNs and NPs in Nova Scotia. It is developed by registered nurses for registered nurses and 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. It’s to be used in all contexts, practice settings and levels of decision making.

The Canadian Nurses Association (CNA) has released a new Code of Ethics for Registered Nurses. On September 27, the CRNNS Council will consider adopting this document for all RNs and NPs in Nova Scotia. Until then, the current Code of Ethics (2008) remains in effect. For more information, please visit CNA’s website and stay tuned for a website update from our team on September 27. 

The Code of Ethics

Providing Safe, Compassionate, Competent and Ethical Care

Nurses provide safe, compassionate, competent and ethical care.

  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 as well as with families, communities, groups, populations 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 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 and intervene to address unsafe, non-compassionate, unethical or incompetent practice or conditions that interfere with their ability to provide safe, compassionate, competent and ethical care to those to whom they are providing care, and they support those who do the same.
  5. Nurses admit mistakes and take all necessary actions to prevent or minimize harm arising from an adverse event. They work with others to reduce the potential for future risks and preventable harms.
  6. When resources are not available to provide ideal care, nurses collaborate with others to adjust priorities and minimize harm. Nurses keep persons receiving care, families and employers informed about potential and actual changes to delivery of care. They inform employers about potential threats to safety.
  7. Nurses planning to take job action or practising in environments where job action occurs take steps to safeguard the health and safety of people during the course of the job action.
  8. During a natural or human-made disaster, including a communicable disease outbreak, nurses have a duty to provide care using appropriate safety precautions.
  9. 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.
  10. Nurses work to prevent and minimize 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 to protect others and themselves.

Promoting Health and Well-Being

Nurses work with people to enable them to attain their highest possible level of health and well-being.

  1. Nurses provide care directed first and foremost toward the health and well-being of the person, family or community in their care.
  2. When a community health intervention interferes with the individual rights of persons receiving care, nurses use and advocate for the use of the least restrictive measures possible for those in their care.
  3. Nurses collaborate with other health-care providers and other interested parties to maximize health benefits to persons receiving care and those with health-care needs, recognizing and respecting the knowledge, skills and perspectives of all.

Promoting and Respecting Informed Decision-Making

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

  1. Nurses, to the extent possible, provide persons in their care with the information they need to make informed decisions related to their health and well-being. They also work to ensure that health information is given to individuals, families, groups, populations and communities in their care in an open, accurate and transparent manner.
  2. Nurses respect the wishes of capable persons to decline to receive information about their health condition.
  3. Nurses recognize that capable persons may place a different weight on individualism and may choose to defer to family or community values in decision-making.
  4. 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.
  5. Nurses are sensitive to the inherent power differentials between care providers and those receiving care. They do not misuse that power to influence decision-making.
  6. Nurses advocate for persons in their care if they believe that the health of those persons is being compromised by factors beyond their control, including the decision-making of others.
  7. When family members disagree with the decisions made by a person with health-care needs, nurses assist families in gaining an understanding of the person’s decisions.
  8. Nurses respect the informed decision-making of capable persons, including choice of lifestyles or treatment not conducive to good health.
  9. When illness or other factors reduce a person’s capacity for making choices, nurses assist or support that person’s participation in making choices appropriate to their capability.
  10. If a person receiving care is clearly incapable of consent, the nurse respects the law on capacity assessment and substitute decisionmaking in his or her jurisdiction (Canadian Nurses Protective Society, 2004).
  11. Nurses, along with other health-care professionals and with substitute decision-makers, consider and respect the best interests of the person receiving care and any previously known wishes or advance directives that apply in the situation (Canadian Nurses Protective Society, 2004).

Preserving Dignity

Nurses recognize and respect the intrinsic worth of each person.

  1. Nurses, in their professional capacity, relate to all persons with respect.
  2. Nurses support the person, family, group, population or community 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, including families, groups, populations and communities, to take into account their unique values, customs and spiritual beliefs, as well as their social and economic circumstances.
  4. Nurses intervene, and report when necessary,9 when others fail to respect the dignity of a person receiving care, recognizing that to be silent and passive is to condone the behaviour.
  5. Nurses respect the physical privacy of persons by providing care in a discreet manner and by minimizing intrusions.
  6. When providing care, nurses utilize practice standards, best practice guidelines and policies concerning restraint usage.
  7. Nurses maintain appropriate professional boundaries and ensure their relationships are always for the benefit of the persons they serve. They recognize the potential vulnerability of persons 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 in their care.
  8. In all practice settings, nurses work to relieve pain and suffering, including appropriate and effective symptom and pain management, to allow persons to live with dignity.
  9. When a person receiving care is terminally ill or dying, nurses foster comfort, alleviate suffering, advocate for adequate relief of discomfort and pain and support a dignified and peaceful death. This includes support for the family during and following the death, and care of the person’s body after death.
  10. Nurses treat each other, colleagues, students and other healthcare workers in a respectful manner, recognizing the power differentials among those in formal leadership positions, staff and students. They work with others to resolve differences in a constructive way.

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 relationship.

  1. Nurses respect the right of people to have control over the collection, use, access and disclosure of their 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 individual, family or community.
  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 appropriate.
  6. Nurses advocate for persons in their care to receive 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 people’s privacy, including security safeguards in information technology.
  8. Nurses do not abuse their access to information by accessing health-care records, including their own, a family member’s or any other person’s, for purposes inconsistent with their professional obligations.
  9. Nurses do not use photo or other technology to intrude into the privacy of a person receiving care.
  10. Nurses intervene if others inappropriately access or disclose personal or health information of persons receiving care.

Promoting Justice

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

  1. When providing care, nurses do not discriminate on the basis of a person’s race, ethnicity, culture, political and spiritual beliefs, social or marital status, gender, sexual orientation, age, health status, place of origin, lifestyle, mental or physical ability or socio-economic status or any other attribute.
  2. Nurses refrain from judging, labelling, demeaning, stigmatizing and humiliating behaviours toward persons receiving care, other health-care professionals and each other.
  3. 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.
  4. Nurses make fair decisions about the allocation of resources under their control based on the needs of persons, groups or communities to whom they are providing care. They advocate for fair treatment and for fair distribution of resources for those in their care.
  5. Nurses support a climate of trust that sponsors openness, encourages questioning the status quo and supports those who speak out to address concerns in good faith (e.g., whistle-blowing).

Being Accountable

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

1. Nurses, as members of a self-regulating profession, practise according to the values and responsibilities in the Code of Ethics for Registered Nurses 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.

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, seek help from 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 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 or, if they are self-employed, arranging that someone else attend to
their clients’ health-care needs. Nurses then take the necessary steps to regain their fitness to practise.

5. Nurses are attentive to signs that a colleague is unable, for whatever reason, to perform his or her duties. In such a case, nurses will take the necessary steps to protect the safety of persons receiving care.

6. Nurses clearly and accurately represent themselves with respect to their name, title and role.

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. If nurses can anticipate a conflict with their conscience, they have an obligation to notify their employers or, if the nurse is self-employed, persons receiving care in advance so that alternative arrangements can be made.

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 persons receiving care.

9. Nurses share their knowledge and provide feedback, mentorship and guidance for the professional development of nursing students, novice nurses and other health-care team members.