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CODE FOR NURSES

with Interpretive State­ments

American Nurses’ Association

Copyright © 1976, 1985

PREAMBLE

A code of ethics makes explicit the primary goals and values of the profession.  When indi­viduals become nurses, they make a moral commitment to uphold the values and special moral obligations expressed in their code.  The Code for Nurses is based on a be­lief about the nature of individuals, nursing, health, and so­ciety.  Nursing encompasses the protection, promotion, and restoration of health; the pre­vention of illness; and the al­leviation of suffer­ing in the care of clients, including individuals, families, groups, and communities.  In the con­text of these func­tions, nursing is defined as the diagnosis and treatment of human re­sponses to actual or potential health problems.

Since clients themselves are the primary de­ci­sion makers in matters concerning their own health, treatment, and well-being, the goal of nursing actions is to support and en­hance the client’s responsibility and self-de­termination to the greatest extent possible.  In this context, health is not necessarily an end in itself, but rather a means to a life that is meaningful from the client’s perspective.

When making clinical judgments, nurses base their decisions on consideration of con­se­quences and of universal moral principles, both of which prescribe and justify nursing ac­tions.  The most fundamental of these princi­ples is respect for persons.  Other prin­ciples stemming from this basic principle are auton­omy (self-determination), beneficence (doing good), nonmaleficence (avoiding harm), verac­ity (truth-telling), confidential­ity (respecting privileged information), fi­delity (keeping promises), and justice (treating people fairly).

In brief, then, the statements of the code and their interpretation provide guidance for con­duct and relationships in carrying out nursing responsibilities consistent with the ethical obligations of the profession and with high quality in nursing care.

INTRODUCTION

A code of ethics indicates a profession’s ac­cep­tance of the responsibility and trust with which it has been invested by society.  Under the terms of the implicit contract between so­ciety and the nursing profession, society grants the profession considerable autonomy and authority to func­tion in the conduct of its affairs.  The development of a code of ethics is an essential activity of a profession and pro­vides one means for the exercise of profes­sional self-regulation.

Upon entering the profession, each nurse in­herits a measure of both the responsibility and the trust that have accrued to nursing over the years, as well as the corresponding obligation to ad­here to the profession’s code of conduct and relationships for ethical prac­tice.  The Code for Nurses with Interpretive Statements is thus more a collective expres­sion of nursing conscience and philosophy than a set of exter­nal rules imposed upon an individual practi­tioner of nursing.  Personal and professional integrity can be assured only if an individual is committed to the pro­fession’s code of con­duct.

A code of ethical conduct offers general prin­ciples to guide and evaluate nursing actions.  It does not assure the virtues required for pro­fessional practice within the character of each nurse.  In particular situations, the justifica­tion of behavior as ethical must sat­isfy not only the individual nurse acting as a moral agent but also the standards for pro­fessional peer review.

The Code for Nurses was adopted by the American Nurses’ Association in 1950 and has been re­vised periodically.  It serves to in­form both the nurse and society of the pro­fession’s expectations and requirements in ethical mat­ters.  The code and the interpre­tive statements together provide a frame­work within which nurses can make ethical decisions and dis­charge their responsibilities to the public, to other members of the health team, and to the profession.

Although a particular situation by its nature may determine the use of specific moral prin­ciples, the basic philosophic values, direc­tives, and suggestions provided here are widely ap­plicable to situations encountered in clinical practice.  The Code for Nurses is not open to negotiation in employment set­tings, nor is it permissible for individuals or groups of nurses to adapt or change the lan­guage of this code.

The requirements of the code may often ex­ceed those of the law.  Violations of the law may sub­ject the nurse to civil or criminal li­ability.  The state nurses’ associations, in ful­filling the profes­sion’s duty to society, may discipline their members for violations of the code.  Loss of the respect and confidence of society and of one’s colleagues is a serious sanction resulting from violation of the code.  In addition, every nurse has a personal obli­gation to uphold and adhere to the code and to ensure that nursing colleagues do like­wise.

Guidance and assistance in applying the code to local situations may be obtained from the American Nurses’ Association and the con­stituent state nurses’ associations.

CODE FOR NURSES

1    The nurse provides services with re­spect for human dignity and the uniqueness of the client, unre­stricted by considera­tions of social or eco­nomic status, per­sonal at­tributes, or the na­ture of health problems.

2    The nurse safeguards the client’s right to privacy by judiciously pro­tecting in­forma­tion of a confiden­tial nature.

3    The nurse acts to safeguard the client and the public when health care and safety are af­fected by the incompetent, unethi­cal, or illegal practice of any per­son.

4    The nurse assumes responsibility and ac­countability for individual nursing judg­ments and actions.

5    The nurse maintains competence in nurs­ing.

6    The nurse exercises informed judg­ment and uses individual com­pe­tency and qual­i­fications as crite­ria in seeking consulta­tion, accept­ing re­sponsibilities, and dele­gating nursing activities to others.

7    The nurse participates in activities that contribute to the ongoing de­vel­opment of the profes­sion’s body of knowledge.

8    The nurse participates in the pro­fes­sion’s efforts to implement and im­prove stan­dards of nursing.

9    The nurse participates in the pro­fes­sion’s efforts to establish and main­tain condi­tions of em­ployment con­ducive to high quality nursing care.

10    The nurse participates in the pro­fes­sion’s effort to protect the public from misinfor­mation and misrepre­sentation and to maintain the in­tegrity of nursing.

11    The nurse collaborates with mem­bers of the health professions and other citizens in promot­ing com­mu­nity and national ef­forts to meet the health needs of the pub­lic.

CODE FOR NURSES 

WITH INTERPRETIVE 

STATE­MENTS

1    The nurse provides services with re­spect for human dignity and the uniqueness of the client, unre­stricted by considera­tions of social or eco­nomic status, per­sonal at­tributes, or the na­ture of health problems.

1.1    Respect for Human Dignity

The fundamental principle of nursing practice is respect for the inherent dignity and worth of ev­ery client.  Nurses are morally obligated to respect human existence and the individ­uality of all persons who are the recipients of nursing actions.  Nurses therefore must take all rea­sonable means to protect and preserve human life when there is hope of recovery or reason­able hope of benefit from life-prolong­ing treatment.

Truth telling and the process of reaching in­formed choice underlie the exercise of self-de­termina­tion, which is basic to respect for per­sons.  Clients should be as fully involved as possible in the planning and implementation of their own health care.  Clients have the moral right to deter­mine what will be done with their own person; to be given accurate in­formation, and all the in­formation neces­sary for making informed judgments; to be assisted with weighing the benefits and bur­dens of op­tions in their treatment; to accept, refuse, or terminate treatment without coer­cion; and to be given necessary emotional support.  Each nurse has an obligation to be knowl­edgeable about the moral and legal rights of all clients and to protect and sup­port those rights.  In situations in which the client lacks the capac­ity to  make a decision, a surrogate decision maker should be desig­nated.

Individuals are interdependent members of the community.  Taking into account both in­dividual rights and the interdependence of persons in decision making, the nurse recog­nizes those situa­tions in which individual rights to autonomy in health care may tem­porarily be overridden to preserve the life of the human community; for example, when a disaster demands triage or when an individ­ual presents a direct danger to others.  The many variables involved make it impera­tive that each case be considered with full awareness of the need to preserve the rights and re­sponsi­bilities of clients and the de­mands of justice.  The suspension of individ­ual rights must al­ways be considered a devi­ation to be tolerated as briefly as possible.

1.2    Status and Attributes of Clients

The need for health care is universal, tran­scending all national, ethnic, racial, reli­gious, cultural, political, educational, eco­nomic, de­velopmental, personality, role, and sexual dif­ferences.  Nursing care is delivered without prejudicial behavior.  Individual value systems and life-styles should be con­sidered in the planning of health care with and for each client.  Attributes of clients in­fluence nursing practice to the extent that they represent fac­tors the nurse must under­stand, consider, and respect in tailoring care to personal needs and in maintaining the in­dividual’s self-respect and dignity.

1.3    The Nature of Health Problems

The nurse’s respect for the worth and dignity of the individual human being applies, irre­spective of the nature of the health problem.  It is reflected in care given the person who is disabled as well as one without disability, the person with long-term illness as well as one with acute illness, the recovering patient as well as one in the last phase of life.  This re­spect extends to all who re­quire the ser­vices of the nurse for the promotion of health, the pre­vention of illness, the restora­tion of health, the alleviation of suffering, and the provision of supportive care of the dying.  The nurse does not act deliberately to terminate the life of any person.

The nurse’s concern for human dignity and for the provision of high quality nursing care is not limited by personal attitudes or beliefs.  If ethically opposed to interventions in a par­ticu­lar case because of the procedures to be used, the nurse is justified in refusing to participate.  Such re­fusal should be made known in ad­vance and in time for other ap­propriate ar­rangements to be made for the client’s nursing care.  If the nurse becomes involved in such a case and the client’s life is in jeopardy, the nurse is obliged to provide for the client’s safety, to avoid abandonment, and to with­draw only when assured that al­ternative sources of nursing care are avail­able to the client.

The measures nurses take to care for the dy­ing client and the client’s family emphasize hu­man contact.  They enable the client to live with as much physical, emotional, and spiri­tual com­fort as possible, and they max­imize the values the client has treasured in life. Nursing care is directed toward the pre­vention and relief of the suffering commonly associated with the dying process.  The nurse may pro­vide inter­ventions to relieve symp­toms of the dying client even when the in­ter­ventions en­tail sub­stantial risks of hastening death.

1.4    The Setting for Health Care

The nurse adheres to the principle of nondis­criminatory, nonprejudicial care in every sit­u­ation and endeavors to promote its accep­tance by others.  The setting shall not deter­mine the nurse’s readiness to respect clients and to ren­der or obtain needed services.

2      The nurse safeguards the client’s right to privacy by judiciously pro­tecting in­for­ma­tion of a confiden­tial nature.

2.1    The Client’s right to Privacy

The right to privacy is an inalienable human right.  The client trusts the nurse to hold all in­for­mation in confidence.  This trust could be destroyed and the client’s welfare jeopar­dized by inju­di­cious disclosure of information pro­vided in confidence.  The duty of confiden­tial­ity, however, is not absolute when inno­cent parties are in direct jeopardy.

2.2    Protection of Information

The rights, well-being, and safety of the in­di­vidual client should be the determining factors in ar­riving at any professional judg­ment con­cerning the disposition of confiden­tial infor­ma­tion re­ceived from the client rele­vant to his or her treatment.  The standards of nursing practice and the nursing responsi­bility to pro­vide high quality health services require that relevant data be shared with members of the health team.  Only informa­tion pertinent to a client’s treatment and welfare is disclosed, and it is disclosed only to those directly concerned with the client’s care.

Information documenting the appropriate­ness, necessity, and quality of care required for the purposes of peer review, third-party payment, and other quality assurance mech­anisms must be disclosed only under defined policies, man­dates, or protocols.  These writ­ten guidelines must as­sure that the rights, well-being, and safety of the client are main­tained.

2.3    Access to Records

If in the course of providing care there is a need for the nurse to have access to the records of persons not under the nurse’s care, the persons affected should be notified and, whenever possi­ble, permission should be ob­tained first.  Although records belong to the agency where the data are collected, the in­di­vidual maintains the right of control over the information in the record.  Similarly, pro­fes­sionals may exercise the right of control over information they have generated in the course of health care.

If the nurse wishes to use a client’s treat­ment record for research or nonclinical pur­poses in which anonymity cannot be guaran­teed, the client’s consent must be obtained first.  Ethi­cally, this ensures the client’s right to pri­vacy; legally, it protects the client against un­lawful invasion of privacy.

3      The nurse acts to safeguard the client and the public when health care and safety are affected by in­competent, un­ethical, or illegal prac­tice by any person.

3.1    Safeguarding the Health and Safety of the Client

The nurse’s primary commitment is to the health, welfare, and safety of the client.  As an advo­cate for the client, the nurse must be alert to and take appropriate action regard­ing any in­stances of incompetent, unethical, or illegal practice by any member of the health care team or the health care system, or any action on the part of others that places the rights or best interests of the client in jeopardy.  To function effectively in this role, nurses must be aware of the em­ploy­ing institution’s policies and procedures, nursing standards of practice, the Code for Nurses, and laws governing nurs­ing and health care practice with regard to in­compe­tent, unethical, or illegal practice.

3.2    Acting on Questionable Practice

When the nurse is aware of inappropriate or questionable practice in the provision of health care, concern should be expressed to the per­son carrying out the questionable practice and attention called to the possible detrimental ef­fect upon the client’s welfare.  When factors in the health care delivery sys­tem threaten the welfare of the client, simi­lar action should be directed to the re­sponsi­ble administrative per­son.  If indicated, the practice should then be reported to the ap­pro­priate authority within the institution, agency, or larger system.

There should be an established process for the reporting and handling of incompetent, uneth­ical, or illegal practice within the em­ployment setting so that such reporting can go through official channels without causing fear of reprisal.  The nurse should be knowl­edgeable about the process and be prepared to use it if necessary.  When questions are raised about the practices of individ­ual practitioners or of health care systems, writ­ten documentation of the observed practices or behaviors must be available to the appro­priate authorities.  State nurses’ associations should be prepared to provide assistance and support in the devel­opment and evaluation of such processes and in reporting procedures.

When incompetent, unethical, or illegal prac­tice on the part of anyone concerned with the client’s care is not corrected within the em­ployment setting and continues to jeopardize the client’s wel­fare and safety, the problem should be reported to other appro­priate au­thorities such as practice commit­tees of the pertinent professional organiza­tions or the legally constituted bodies con­cerned with li­censing of specific categories of health workers or professional practitioners.  Some situa­tions may warrant the concern and involvement of all such groups.  Accurate reporting and doc­umentation un­dergird all actions.

3.3    Review Mechanisms

The nurse should participate in the planning, establishment, implementation, and evalua­tion of review mechanisms that serve to safe­guard clients, such as duly constituted peer review pro­cesses or committees and ethics committees.  Such ongoing review mechanisms are based on es­tablished crite­ria, have stated purposes, include a process for making rec­ommendations, and fa­cilitate improved deliv­ery of nursing and other health services to clients wherever nursing ser­vices are provided.

4    The nurse assumes responsibility and accountability for individual nursing judg­ments and actions.

4.1    Acceptance of Responsibility and Ac­countability

The recipients of professional nursing ser­vices are entitled to high quality nursing care.  Indi­vid­ual professional licensure is the protective mechanism legislated by the pub­lic to ensure the basic and minimum compe­tencies of the professional nurse.  Beyond that, society has accorded to the nursing pro­fession the right to regulate its own practice.  The regulation and control of nursing prac­tice by nurses demand that individual practi­tioners of professional nursing must bear pri­mary responsibility for the nursing care clients receive and must be individually ac­countable for their own practice.

4.2    Responsibility for Nursing Judg­ment and Action

Responsibility refers to the carrying out of du­ties associated with a particular role as­sumed by the nurse.  Nursing obligations are re­flected in the ANA publications Nursing: A So­cial Policy Statement and Standards of Nurs­ing Practice. In recognizing the rights of clients, the standards describe a collabora­tive relationship between the nurse and the client through use of the nursing process.  Nursing responsibilities include data collec­tion and as­sessment of the health status of the client; formation of nursing diagnoses de­rived from client assessment; development of a nurs­ing care plan that is directed toward designated goals, assists the client in maxi­mizing his or her health capabilities, and provides for the client’s participation in pro­moting, maintain­ing, and restoring his or her health; evaluation of the effectiveness of nursing care in achiev­ing goals as deter­mined by the client and the nurse; and sub­sequent reassessment and revi­sion of the nurs­ing care plan as warranted.  In the pro­cess of assuming these responsibilities, the nurse is held ac­countable for them.

4.3    Accountability for Nursing Judg­ment and Action

Accountability refers to being answerable to someone for something one has done.  It means pro­viding an explanation or rationale to oneself, to clients, to peers, to the nursing pro­fession, and to society.  In order to be ac­count­able, nurses act under a code of ethical conduct that is grounded in the moral princi­ples of fi­delity and respect for the dignity, worth, and self-determination of clients.

The nursing profession continues to develop ways to clarify nursing’s accountability to so­ci­ety.  The contract between the profession and society is made explicit through such mecha­nisms as (a) the Code for Nurses, (b) the stan­dards of nursing practice, (c) the de­velopment of nursing theory derived from nursing re­search in order to guide nursing actions, (d) educational requirements for practice, (e) certi­fication, and (f) mechanisms for evaluating the effectiveness of the nurse’s per­formance of nursing responsibilities.

Nurses are accountable for judgments made and actions taken in the course of nursing practice.  Neither physicians’ orders nor the employing agency’s policies relieve the nurse of accountability for actions taken and judg­ments made.

5     The nurse maintains competence in nursing.

5.1    Personal Responsibility for Compe­tence

The profession of nursing is obligated to pro­vide adequate and competent nursing care.  Therefore it is the personal responsibility of each nurse to maintain competency in prac­tice.  For the client’s optimum well-being and for the nurse’s own professional develop­ment, the care of the client reflects and in­corporates new techniques and knowledge in health care as these develop, especially as they relate to the nurse’s particular field of practice.  The nurse must be aware of the need for continued pro­fessional learning and must assume personal responsibility for cur­rency of knowledge and skills.

5.2    Measurement of Competence in Nurs­ing Practice

Evaluation of one’s performance by peers is a hallmark of professionalism and a method by which the profession is held accountable to so­ciety.  Nurses must be willing to have their practice reviewed and evaluated by their peers.  Guidelines for evaluating the scope of practice and the appropriateness, effective­ness, and efficiency of nursing practice are found in nursing practice acts, ANA stan­dards of practice, and other quality assur­ance mech­anisms.  Each nurse is re­sponsible for partici­pating in the development of objec­tive criteria for evaluation.  In addition, the nurse engages in ongoing self-evaluation of clinical compe­tency, decision-making abili­ties, and profes­sional judgments.

5.3    Intraprofessional Responsibility for Competence in Nursing Care

Nurses share responsibility for high quality nursing care.  Nurses are required to have knowl­edge relevant to the current scope of nursing practice, changing issues and con­cerns, and ethical concepts and principles.  Since individual competencies vary, nurses re­fer clients to and consult with other nurses with expertise and recognized competencies in various fields of practice.

6     The nurse exercises informed judg­ment and uses individual com­pe­tency and qual­i­fications as crite­ria in seeking con­sultation, accept­ing re­sponsibilities, and dele­gating nursing activities to others.

6.1    Changing Functions

Nurses are faced with decisions in the con­text of the increased complexity of health care, chang­ing patterns in the delivery of health services, and the development of evolving nursing practice in response to the health needs of clients.  As the scope of nurs­ing prac­tice changes, the nurse must exercise judg­ment in accepting responsibilities, seek­ing consultation, and assigning re­spon­sibili­ties to others who carry out nursing care.

6.2    Accepting Responsibilities

The nurse must not engage in practices pro­hib­ited by law or delegate to others activities prohib­ited by practice acts of other health care personnel or by other laws.  Nurses de­termine the scope of their practice in light of their edu­cation, knowledge, competency, and extent of experience.  If the nurse concludes that he or she lacks competence or is inade­quately pre­pared to carry out a specific func­tion, the nurse has the responsibility to refuse that work and to seek alternative sources of care based on concern for the client’s welfare.  In that refusal, both the client and the nurse are protected.  Inasmuch as the nurse is respon­si­ble for the continuous care of patients in health care settings, the nurse is frequently called upon to carryout components of care delegated by other health professionals as part of the client’s treatment regimen.  The nurse should not ac­cept these interdependent func­tions if they are so extensive as to pre­vent the nurse from fulfill­ing the responsibil­ity to pro­vide appropriate nursing care to clients.

6.3    Consultation and Collaboration

The provision of health and illness care to clients is a complex process that requires a wide range of knowledge, skills, and collabo­ra­tive efforts.  Nurses must be aware of their own individual competencies.  When the needs  of the client are beyond the qualifica­tions and competencies of the nurse, consul­tation and collaboration must be sought from qualified nurses, other health pro­fessionals, or other appropriate sources.  Participation on intradis­ciplinary or interdisciplinary teams is often an effective approach to the provision of high quality total health ser­vices.

6.4    Delegation of Nursing Activities

Inasmuch as the nurse is accountable for the quality of nursing care rendered to clients, nurses are accountable for the delegation of nursing care activity to other health workers.  Therefore, the nurse must assess individual competency in assigning selected components of nursing care to other nursing service per­sonnel.  The nurse should not delegate to any member of the nursing team a function for which that person is not prepared or quali­fied.  Employer policies or direc­tives do not relieve the nurse of accountability for mak­ing judg­ments about the delegation of nurs­ing care ac­tivities.

7    The nurse participates in activities that contribute to the ongoing de­vel­opment of the profession’s body of knowledge.

7.1    The Nurse and Development of Knowledge

Every profession must engage in scholarly in­quiry to identify, verify, and continually en­large the body of knowledge that forms the foundation for its practice.  A unique body of verified knowl­edge provides both framework and direction for the profession in all of its ac­tivities and for the practitioner in the pro­vi­sion of nursing care. The accrual of scien­tific and humanistic knowledge promotes the ad­vancement of practice and the well-being of the profession’s clients.  Ongoing scholarly ac­tivity such as research and the develop­ment of theory is indispensable to the full dis­charge of a profession’s obligations to soci­ety.  Each nurse has a role in this area of professional ac­tivity, whether as an investi­gator in furthering knowledge, as a partici­pant in research, or as a user of theoretical and empirical knowledge.

7.2    Protection of Rights of Human Par­tic­ipants in Research

Individual rights valued by society and by the nursing profession that have particular appli­ca­tion in research include the right of ade­quately informed consent, the right of freedom from risk of injury, and the right of privacy and preservation of dignity.  Inherent in these rights is respect for each individual’s rights to exercise self-determina­tion, to choose to partic­ipate or not, to have full information, and to terminate participa­tion in research without penalty.

It is the duty of the nurse functioning in any research role to maintain vigilance in pro­tect­ing the life, health, and privacy of human sub­jects from both anticipated and unantici­pated risks and in assuring informed con­sent.  Sub­jects’ integrity, privacy, and rights must be es­pecially safe­guarded if the sub­jects are un­able to protect themselves be­cause of incapac­ity or because they are in a dependent rela­tionship to the investigator.  The investigation should be discontinued if its continuance might be harmful to the subject.

7.3    General Guidelines for Participat­ing in Research

Before participating in research conducted by others, the nurse has an obligation to (a) ob­tain in­formation about the intent and the na­ture of the research and (b) ascertain that the study pro­posal is approved by the appro­priate bodies, such as institutional review boards.

Research should be conducted and directed by qualified persons.  The nurse who partici­pates in research in any capacity should be fully in­formed about both the nurse’s and the client’s rights and obligations.

8    The nurse participates in the pro­fes­sion’s efforts to implement and im­prove stan­dards of nursing.

8.1    Responsibility to the Public for Stan­dards

Nursing is responsible and accountable for admitting to the profession only those indi­vid­uals who have demonstrated the knowl­edge, skills, and commitment considered es­sential to profes­sional practice.  Nurse edu­cators have a major responsibility for insur­ing that these competen­cies and a demon­strated commitment to professional practice have been achieved be­fore the en­try of an in­dividual into the practice of professional nursing.

Established standards and guidelines for nursing practice provide guidance for the de­livery of professional nursing care and are a means for evaluating care received by the public.  The nurse has a personal responsibil­ity and commitment to clients for implemen­ta­tion and maintenance of optimal standards of nursing practice.

8.2    Responsibility to the Profession for Standards

Established standards reflect the practice of nursing grounded in ethical commitments and a body of knowledge.  Professional stan­dards or guidelines exist in nursing practice, nursing ser­vice, nursing education, and nurs­ing re­search.  The nurse has the responsibil­ity to monitor these standards in daily prac­tice and to participate actively in the profes­sion’s ongo­ing efforts to foster optimal stan­dards of prac­tice at the local, regional, state, and national levels of the health care system.

Nurse educators have the additional respon­sibility to maintain optimal standards of nursing practice and education in nursing ed­ucation programs and in any other set­tings where planned learning activities for nursing students take place.

9     The nurse participates in the pro­fes­sion’s efforts to establish and main­tain condi­tions of employment con­ducive to high quality nursing care.

9.1    Responsibility for Conditions of Em­ployment

The nurse must be concerned with conditions of employment that (a) enable the nurse to practice in accordance with the standards of nursing practice and (b) provide a care envi­ronment that meets the standards of nursing service.  The provision of high quality nurs­ing care is the respon­sibility of both the indi­vidual nurse and the nursing profession.  Professional autonomy and self-regulation in the control of conditions of practice are nec­essary for imple­menting nursing stan­dards.

9.2    Maintaining Conditions for High Quality Nursing Care

Articulation and control of nursing practice can be accomplished through individual agreement and collective action.  A nurse may enter into an agreement with individu­als or organizations to provide health care.  Nurses may participate in collective actions such as collective bargaining through their state nurs­es’ association to determine the term and con­ditions of employment con­ducive to high qual­ity nursing care.  Such agreements should be consistent with the profession’s standards of practice, the state law regulating nursing practice, and the Code for Nurses.

10    The nurse participates in the pro­fes­sion’s effort to protect the public from misin­formation and misrepre­sentation and to maintain the in­tegrity of nursing.

10.1    Protection from Misinformation and Misrepresentation

Nurses are responsible for advising clients against the use of products that endanger the clients’ safety and welfare.  The nurse shall not use any form of public or profes­sional communication to make claims that are false, fraudulent, misleading, deceptive, or unfair.

The nurse does not give or imply endorse­ment to advertising, promotion, or sale of commer­cial products or services in a manner that may be interpreted as reflecting the opinion or judgment of the profession as a whole.  The nurse may use knowledge of spe­cific services or products in advis­ing an indi­vidual client, since this may contribute to the client’s health and well-being.  In the course of providing in­formation or education to clients or other prac­titioners about commer­cial products or ser­vices, however, a variety of similar products or services should be offered or described so the client or practitioner can make an in­formed choice.

10.2    Maintaining the Integrity of Nurs­ing

The use of the title registered nurse is granted by state governments for the protection of the pub­lic.  Use of that title carries with it the re­sponsibility to act in the public inter­est.  The nurse may use the title R.N. and symbols of academic degrees or other earned or honorary professional symbols of recogni­tion in all ways that are legal and appropri­ate.  The title and other symbols of the pro­fession should not be used, however, for ben­efits unrelated to nurs­ing practice or the pro­fession, or used by those who may seek to ex­ploit them for other pur­poses.

Nurses should refrain from casting a vote in any deliberations involving health care ser­vices or facilities where the nurse has busi­ness or other interests that could be con­strued as a conflict of interest.

11    The nurse collaborates with mem­bers of the health professions and other citizens in promoting com­mu­nity and national efforts to meet the health needs of the pub­lic.

11.1    Collaboration with Others to Meet Health Needs

The availability and accessibility of high qual­ity health services to all people require collab­ora­tive planning at the local, state, na­tional, and international levels that respects the in­terdepen­dence of health professionals and clients in health care systems.  Nursing care is an integral part of high quality health care, and nurses have an obligation to pro­mote equi­table access to nursing and health care for all people.

11.2    Responsibility to the Public

The nursing profession is committed to pro­moting the welfare and safety of all people.  The goals and values of nursing are essential to effective delivery of health services.  For the benefit of the individual client and the public at large, nursing’s goals and commit­ments need adequate repre­sentation.  Nurses should ensure this representation by active partici­pa­tion in decision making in in­stitutional and po­litical arenas to assure a just distribution of health care and nursing re­sources.

11.3    Relationships with Other Disci­plines

The complexity of health care delivery sys­tems requires a multidisciplinary approach to deliv­ery of services that has the strong support and active participation of all the health profes­sions.  Nurses should actively promote the collaborative planning required to ensure the availability and accessibility of high quality health services to all persons whose health needs are unmet.