The ICN Code of Ethics for Nurses

Revised 2021

LEGEND
- ORIGINAL TEXT FROM 2012 CODE

- NEW ADDED TEXT

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Copyright © 2021 by ICN - International Council of Nurses,

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ISBN: …………………..
THE ICN CODE OF ETHICS FOR NURSES
An international code of ethics for nurses was first adopted by the International
Council of Nurses (ICN) in 1953. It has been revised and reaffirmed at various
times since, most recently with this review and revision completed in 2021.

PURPOSE OF THE CODE

The ICN Code of Ethics for Nurses is a statement of the ethical values,
responsibilities and professional standards of nurses. It guides everyday ethical
nursing practice and can serve as a regulatory tool to guide and define ethical
nursing practice.

The ICN Code of Ethics for Nurses provides ethical guidance in relation to nurses’
roles, responsibilities, behaviours, decision-making and relationships with patients
and people who are receiving nursing care. It is to be used in combination with the
laws, regulations and professional standards of countries that govern nurses’
practice. The values and obligations expressed in this Code apply to nurses in all
settings, roles and domains of practice, and should be aspired to by all nursing
students.

PREAMBLE

From the origins of organised nursing in the mid-1800s, nurses have consistently
recognised four fundamental nursing responsibilities: to promote health, to prevent
illness, to restore health, and to alleviate suffering. The need for nursing is universal.

Inherent in nursing is a respect for human rights, including cultural rights, the right to
life and choice, to dignity and to be treated with respect. Nursing care is respectful of
and unrestricted by considerations of age, colour, culture, disability or illness, gender,
sexual orientation, nationality, politics, race, religious or spiritual beliefs, legal,
economic or social status.

Nurses render health services to the individual, the family, community and
populations and coordinate their services with those of other health care
professionals and related groups.

THE ICN CODE

The ICN Code of Ethics for Nurses has four principal elements that outline the
standards of ethical conduct. These four elements, nurses and patients or people
requiring care, nurses and practice, nurses and the profession, and nurses and
global health, give a framework for the standards of ethical conduct.

APPLYING THE ELEMENTS OF THE CODE

The charts that follow the description of each element of the Code are intended to
assist nurses to translate the standards into action. Note, these charts present
examples of the main tenets included in the elements of the Code and are not
intended to be an exhaustive or complete list of concepts.

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ELEMENTS OF THE CODE

1. NURSES AND PATIENTS OR PEOPLE REQUIRING CARE1

1.1 Nurses’ primary professional responsibility is to people requiring nursing care

whether individuals, families, communities or populations (hereinafter referred
to as either ‘patients’ or ‘people requiring care’).

1.2 Nurses promote an environment in which the human rights, values, customs,
religious and spiritual beliefs of the individual, family and community are
respected and promoted by everyone.

1.3 Nurses ensure that the individual receives accurate, sufficient and timely
information in a culturally appropriate manner on which to base consent for
care and related treatment.

1.4 Nurses hold in confidence personal information and respect the privacy,
confidentiality and interests of patients in the lawful collection, use, access,
transmission, storage and disclosure of this information.

1.5 Nurses respect the privacy and confidentiality of colleagues and people
requiring care and uphold the integrity of the nursing profession in person and
in all media, including social media.

1.6 Nurses share with society the responsibility for initiating and supporting action
to meet the health and social needs of all people.

1.7 Nurses advocate for equity and social justice in resource allocation, access to
health care and other social and economic services.

1.8 Nurses demonstrate professional values such as respect, justice,

responsiveness, compassion, empathy, trustworthiness and integrity.

1.9 Nurses provide evidence-informed, person-centred care, recognising and

using the values and principles of primary health care and health promotion.

1.10 Nurses encourage a culture of safe health care and raise any concerns
regarding the safety of people and health services.

1.11 Nurses support and protect the right to self-determination of all patients and
other health care professionals.

1.12 Nurses ensure that use of technology and scientific advances are compatible
with the safety, dignity and rights of people. In the case of devices, such as
robots, nurses ensure that care remains person-centred and that such
devices support and do not replace human relationships.

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The two terms ‘patients’ and ‘people requiring care’ are used interchangeably. The two
terms refer to the patient, family, community and populations requiring care.

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Applying the Elements of the Code #1: NURSES AND PATIENTS OR PEOPLE REQUIRING
CARE

Nurses and Nurse

Educators and National Nurses
Managers
Researchers Associations
Provide patient focused, In curricula, include content Develop position statements,
culturally appropriate, care on cultural norms, human standards of practice and
that respects human rights rights, equity, justice, guidelines that support
and is sensitive to the values, disparities and solidarity as human rights and ethical
customs and beliefs of the basis for access to standards.
people without prejudice or healthcare. Design studies to
unjust discrimination. explore human rights issues.
Participate in continuing Design curricula and provide Establish standards for
education on ethical issues, teaching and learning ethics education and provide
ethical reasoning and ethical opportunities for ethical continuing ethics education
conduct. Encourage open issues, ethical principles and for nurses.
dialogue among all reasoning, and ethical
stakeholders. decision making. This
includes respect for
autonomy, nonmaleficence,
beneficence, and justice.
Ensure informed consent for Educate about respect for Provide guidelines for human
nursing and/or medical care. autonomy, informed consent, participants in research,
This includes the right to privacy, and confidentiality. position statements, relevant
choose or refuse treatments. Respect research documentation and
participants’ right to refuse to continuing education related
participate in studies without to informed consent for
prejudice. nursing and medical care.
Use judgement in the use of In curricula, include accuracy, Prepare guidelines and
information, health records confidentiality and privacy on standards of practice on
and reporting systems, the use of media, reporting appropriate use of
whether electronic or paper- and recording systems, information and reporting
based, to ensure protection whether images, recordings, systems that ensure
of human rights, or comments. Be familiar with protection of human rights,
confidentiality and privacy in the use of required reporting confidentiality, privacy, and
accord with patient for extreme emergencies. mandated reporting
preferences and community mechanisms for public health
safety and in compliance with outbreaks or extreme
any laws. emergencies.
Report to appropriate Teach attributes, risk factors Advocate for healthy and
supervisors and/or authorities and skills to ensure practice safe workplaces for nurses
any risks, inappropriate environments that are safe and other healthcare
behaviours or misuse of for everyone in the workers. Provide guidelines
technologies that threaten healthcare setting. that guarantee a safe
patient safety and are environment.
factually supported.
Meet nurses’ ethical In curricula, include Express the values and
obligations and professional values and ideals of nursing in their
responsibilities and actively ideals, and ethical foundational documents.
affirm the values and ideals responsibilities and Incorporate moral obligations
of the profession. obligations. into national codes of ethics
for nurses.

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Develop and monitor Teach students the elements Define and articulate
environmental safety in the of an environmentally methods for nurses to create
workplace. healthy, safe and sustainable healthy communities.
work setting.

2. NURSES AND PRACTICE

2.1. Nurses carry personal responsibility and accountability for nursing practice, and
for maintaining competence by continual learning. They engage in continuous
professional development and lifelong learning.

2.2 Nurses maintain fitness to practice so as not to compromise the ability to

provide care.

2.3 Nurses practise within the limits of their individual competence and use
judgement when accepting and delegating responsibility.

2.4 Nurses value their own dignity, well-being and health. They know that positive
practice environments, characterised by professional recognition, education,
support structures, adequate resourcing, management practices and
occupational health and safety, are pivotal to achieve them.

2.5 Nurses, at all times maintain standards of personal conduct which reflect well
on the profession and enhance its image and public confidence. In their
professional role, nurses recognise and maintain personal relationship
boundaries.

2.6 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.

2.7 Nurses foster and maintain a practice culture that promotes ethical behaviour
and open dialogue.

2.8 Nurses may conscientiously object to participating in a particular medical

procedure or research study but must ensure that people receive care.

2.9 Nurses maintain a person’s right to give and withdraw informed consent to
access their genetic information, including activities linked to genetic and
genomic-based research. They protect the use, privacy and confidentiality of
genetic information and human genome materials. They also foster the
equitable access to genomic technologies.

2.10 Nurses develop and sustain collaborative and respectful relationships with
colleagues and other members of the health care team. They recognise and
respect their knowledge, skills and perspectives.

2.11 Nurses take appropriate actions to safeguard individuals, families and

communities when their health is endangered by a co-worker, any other
person, policy, practice or misuse of technology.

2.12 Nurses are active participants in the promotion of patient safety. They promote
ethical conduct when errors or near misses occur, speak up when patient
safety is threatened, and work with others to reduce the potential of errors.

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Applying the Elements of the Code #2: NURSES AND PRACTICE

National Nurses
Nurses and Nurse Educators and
Associations
Managers Researchers
Pursue professional Teach the value and Develop a range of
development through reading obligation of lifelong learning continuing education
and study. Request and and competence for practice. opportunities through
participate in continuing Explore current concepts and journals, media,
education to enhance novel teaching methods for conferences, and distance
knowledge and skills. theory and practice. education, that reflect
advances in nursing practice.
Initiate continuing education Conduct and disseminate Promote national policies for
and participate in workplace research that explores links high quality nurse education
governance, systems for between continual learning and educational
professional performance, and competence to practice. requirements for continued
appraisal and systematic authorisation to practice.
renewal of licensure to
practice. Monitor, promote
and evaluate fitness to
practice of nursing staff.
Seek a work-life balance, Teach obligations to self as Set healthy lifestyle
ongoing personal growth, and well as obligations to patients standards for nurses and
maintain a healthy lifestyle. and the importance of fitness incorporate work-life balance
to practice. into national codes of ethics.
Foster collaboration for Teach methods of situational Inform other disciplines and
managing conflict and assessment and conflict the public about the roles of
interdisciplinary tensions. management as well as the nurses and the values of the
Promote an environment of roles and values of other nursing profession. Promote
shared ethical values. healthcare disciplines. a positive image of nursing.
Develop appropriate personal Maintain and teach Set standards for
relationships with patients professional boundaries and professional boundaries and
and colleagues; decline gifts skills to maintain them. Teach establish processes for the
or bribes and avoid conflicts identification of and methods expression of recognition
of interest. to avoid conflicts of interest. and gratitude.
Assure continuity of care for Encourage self-reflection and Develop standards and
the patient when exercising teach frameworks and guidelines for refusal of
conscientious objection processes of conscientious participation in specific
where an action may cause objection. medical procedures.
harm or is morally Include guidance on
objectionable to the nurse. conscientious objection in
national codes of ethics.

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3. NURSES AND THE PROFESSION

3.1 Nurses assume the major role in determining and implementing acceptable
standards of clinical nursing practice, management, research and education.

3.2 Nurses are active in developing a core of research-based, updated

professional knowledge that supports evidence-informed practice.

3.3 Nurses are active in developing and sustaining a core of professional values.

3.4 Nurses, through their professional organisations, participate in creating a

positive practice environment that supports individual practice and ensures
safe quality care, and maintains safe, equitable social and economic working
conditions for nurses.

3.5 Nurses contribute to positive and ethical organisational environments and

challenge unethical practices and settings.

3.6 Nurses engage in the creation, dissemination and use of research.

3.7 Nurses prepare for and respond to emergencies, disasters, conflicts, epidemics
and conditions of scarce resources.

Applying the Elements of the Code #3: NURSES AND THE PROFESSION

National Nurses
Nurses and Nurse
Educators and Researchers Associations
Managers
Collaborate with colleagues Teach research methodology, Develop position statements,
to support the conduct, ethics and evaluation. guidelines, policy and
dissemination and use of Conduct, disseminate, utilise standards informed by
research related to patient and evaluate research to study nursing research and
care, nursing and health. and advance nursing scholarly inquiry.
knowledge.

Promote participation in Emphasise to learners the Communicate the importance

national nurses’ nature, function and of membership in
associations to create importance of professional professional nursing
solidarity and cooperation nursing associations and organisations and promote
to promote favourable international nursing participation in national
socioeconomic conditions collaboration. nurses’ associations.
for nurses.
Practice ethical behaviours Prepare students for local Collaborate globally to
and develop strategies to response to global issues with address current and
deal with moral distress a broader vision of the emergent social justice
during emergent crises, common good. Include health issues.
such as pandemics. disparities, particularly for
infants, frail elderly, prisoners,
economically disadvantaged,
trafficked, displaced persons
and refugees.
Develop guidelines for Teach identification of Advocate and negotiate for

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workplace issues, such as unhealthy work environments fair and decent working
bullying, violence, sexual and skills to develop healthy conditions. Develop position
harassment, fatigue, safety, workplace communities. statements and guidelines to
and incident management. Conduct research on ethical address workplace issues.
Participate in studies workplace issues across the
regarding ethics and ethical profession.
workplace issues in every
setting.
Prepare for and respond to Ensure that curricula include Advocate and lobby
emergencies, disasters, essential elements of caring for governments and health
conflicts, epidemics and people and populations in high organisations to prioritise.
conditions of scarce risk, challenging environments. and protect the health, safety
resources. and wellbeing of healthcare
workers during the response
to health emergencies.

4. NURSES AND GLOBAL HEALTH

4.1 Nurses value access to health care as a human right, affirming the need for
universal health coverage.

4.2 Nurses uphold the dignity, freedom and worth of all human beings and oppose
all forms of exploitation, such as human trafficking and child labour.

4.3 Nurses lead or contribute to health policy development.

4.4 Nurses support and work towards the achievement of the United Nations
Sustainable Development Goals.

4.5 Nurses recognise the significance of the social determinants of health. They
contribute to, and advocate for, policies and programmes that address them.

4.6 Nurses collaborate and practise to preserve, sustain and protect the natural
environment and are aware of its consequences on health. They advocate for
initiatives that reduce environmentally harmful practices in order to promote
health and well-being.

4.7 Nurses collaborate with other health professions and the public to uphold
principles of justice by promoting responsibility in human rights, equity and
fairness and by promoting the public good and a healthy planet.

Applying the Elements of the Code #4: NURSES AND GLOBAL HEALTH

National Nurses
Nurses and Nurse Educators and
Associations
Managers Researchers
Participate in human rights Ensure that curricula include Collaborate with nursing
efforts, such as trafficking human rights, universal regulatory bodies, voluntary
prevention and detection, access to care, culturally organisations, and global
helping vulnerable appropriate care, civic agencies to develop position
populations, providing responsibility, equity, and statements and guidelines

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universal education, and social and environmental that support human rights
mitigating hunger and justice. and environmental justice.
poverty.
Educate oneself and Seek opportunities to Contribute to legislation and
colleagues about global evaluate the short and long- policies on the ethical use of
health, including current and term ethical consequences of technology and scientific
emergent technologies. the use of diverse advances adapted to the
Advocate for the ethical use technologies and emerging norms and context of the
of technology and scientific practices, including country.
advances compatible with innovative equipment,
safety, dignity, privacy, robotics, genetics and
confidentiality and human genomics, stem cell
rights. technologies and organ
donation.
Acquire and disseminate Teach about the facts and Participate in the
knowledge about the consequences of climate development of legislation to
negative effects of climate change on health and the reduce the impact of the
change on people's health many opportunities nurses healthcare industry on the
and on the planet. have to support climate environment and address
health: reduce carbon climate changes that
footprint, recycle, choose negatively affect the health of
reusable supplies. populations.
Support the ethical and Participate in developing, Update knowledge and
proficient use of social media implementing and evaluating increase awareness about
and technologies to improve new and emerging the United Nation’s
population health consistent technologies for prevention Sustainable Development
with the values of the nursing initiatives, public health Goals for population health
profession. education, and the health and and actively strategise
well-being of populations. nursing’s participation
in achieving these goals.
Act on local and global issues Educate about socio-political Collaborate with other
that affect health, such as and economic issues that international nursing
poverty, food security, affect health, including organisations to formulate
shelter, immigration, gender, gender, race, inequality and policies and legislation that
class. race, environmental discrimination. Research address the socio-political
health, dignified work, and socio-political factors that causes of illness.
education. contribute to individual and
population health and illness.
Participate in peace Educate and research for Collaborate with global
diplomacy and peace building peace diplomacy and peace nursing agencies to further
activities. building in communities and the ends of global peace and
globally. justice and ameliorate the
causes of illness.

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SUGGESTIONS FOR USE
of the ICN Code of Ethics for Nurses

The ICN Code of Ethics for Nurses is a guide for action based on social values and
needs. It will have meaning only as a living document if applied to the realities of
nursing and health care in all settings in which nursing care is delivered.

To achieve its purpose the Code must be understood, internalised and used by
nurses in all aspects of their work. It must be available to students and nurses
throughout their study and work lives.

Nurses and nursing students can therefore:

• Study the standards under each element of the Code.

• Reflect on what each standard means to you. Think about how you can
apply ethics in your nursing domain: practice, education, research or
management.
• Discuss the Code with co-workers and others.
• Use a specific example from experience to identify ethical dilemmas and
standards of conduct as outlined in the Code. Identify how you would
resolve the dilemmas.
• Work in groups to clarify ethical decision making and reach a consensus
on standards of ethical conduct.

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 • Collaborate with your National Nurses Association, co-workers, and
others in the continuous application of ethical standards in nursing
practice, education, management, research and policy.

DISSEMINATION
of the ICN Code of Ethics for Nurses

To be effective the ICN Code of Ethics for Nurses must be familiar to nurses. We
encourage you to help with its dissemination to schools of nursing, practising nurses, the
nursing press and other mass media. The Code should also be disseminated to other
health professions, the general public, consumer and policy-making groups, human rights
organisations and employers of nurses.

GLOSSARY OF TERMS USED

in the ICN Code of Ethics for Nurses

Advocate Actively supporting a right and good cause; supporting

others in speaking for themselves or speaking on behalf of
others who cannot speak for themselves.
Competence The integrated knowledge, skills, judgement and attributes
required of a nurse to practise safely and ethically in a
designated role and setting.
Confidentiality As a legal term, ’confidentiality’ refers to a duty of an
individual to refrain from sharing confidential information
with others, except with the express consent of the other
party and/or in special circumstances regulated by
legislation.
Conscientious objection A situation in which a nurse informs their employer about a
conflict of conscience and the need to refrain from
providing care because a practice or procedure conflicts
with the nurses’ moral beliefs.
Co-worker Other nurses and other health and non-health related
workers and professionals.
Environmental Justice The fair treatment and meaningful involvement of all
people, regardless of race, colour, national origin, or
income, with respect to the development, implementation
and enforcement of environmental laws, regulations and
policies to reduce environmental, health, economic and
racial disparities. (US-EPA; Milman 2018)
Equity In healthcare, the fulfilment of each individual’s needs as
well as the individual’s opportunity to reach full potential as
a human being.
Ethics A branch of philosophy that deals with questions of right
and wrong and of ought and ought not in interactions with
others.
Evidence-informed Use the results of a wide range of research approaches
and expertise from clinical practice to reflect on the
practice, valuing the characteristics of the patient, such as
cultural and religious beliefs, and other personal
preferences.
Family A social unit composed of members connected through
blood, kinship, emotional or legal relationships.

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Genetics The study of single genes, genetic variation and heredity in
organisms.
Genomics The study of the complete set of a person’s genes, the
genome, to find variations that affect health, drug
response, interactions among genes or with the
environment.
Human rights Human rights are inherent in all human beings, regardless
of race, sex, nationality, ethnicity, language, religion, or
any other status. Human rights include the right to life and
liberty, freedom from slavery and torture, freedom of
opinion and expression, the right to work and education,
and many more. Everyone is entitled to these rights,
without discrimination. (United Nations 2020)
Personal information Information obtained during professional contact that is
private to an individual or family, and which, when
disclosed, may violate the right to privacy, cause
inconvenience, embarrassment, or harm to the individual or
family.
Privacy Physical privacy is the right or interest in controlling or
limiting the access of others to oneself. Informational
privacy is the right of individuals to determine how, when,
with whom and for what purposes any of their personal
information will be shared.
Related groups Other nurses, health care workers or other professionals
providing service to an individual, family or community and
working toward desired goals.
Self-reflection The ability to evaluate one’s own thoughts, plans and
actions in relation to ethical responsibilities and ethical
guidelines.
Social determinants of The conditions in which people are born, grow, live, work
health and age. These circumstances are shaped by the
distribution of money, power and resources at global,
national and local levels. The social determinants of health
are mostly responsible for health inequities, i.e. the unfair
and avoidable differences in health status seen within and
between countries. (World Health Organization 2020)
Social justice The fair distribution of society’s benefits and responsibilities
and their consequences. It focuses on the relative position
of one social group in relation to others in society as well
as on the root causes of disparities and what can be done
to eliminate them (Canadian Nurses Association, 2009).
Social media Social media are “electronic tools that enhance
communication, support collaboration, and enable users
across the globe to generate and share content” (Thielst,
2013, p. 1). The definition will continue to evolve and
change as will the way these social tools are used by the
professions and the public alike (Guidance to nurses and
midwives on social media and social networking – Nursing
and Midwifery Board of Ireland 2013).
Sustainable Development The Sustainable Development Goals are the blueprint to
Goals achieve a better and more sustainable future for all people.
They address the global challenges we face, including
those related to poverty, inequality, climate change,
environmental degradation, peace and justice. The 17

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 Goals are all interconnected and, in order to leave no one
behind, it is important that we achieve them all by 2030.
(United Nations 2020)
Values Values are part of ethics systems that attempt to prescribe
or evaluate moral behaviour (Butts and Rich, 2013).

REFERENCES

Butts J.B., Rich K.L. (2013). Ethics across the curriculum and into practice. Burlington, Jones
and Bartlett.

Canadian Nurses Association (2009). Ethics in practice for registered nurses. Series: Social
justice in practice. Retrieved from https://www.cna-aiic.ca/~/media/cna/page-content/pdf-
en/ethics_in_practice_april_2009_e.pdf?la=en

Milman O (20 Dec 2018), “Robert Bullard: ‘Environmental justice isn’t slang, it’s real”, The
Guardian, Retrieved from: https://www.theguardian.com/commentisfree/2018/dec/20/robert-
bullard-interview-environmental-justice-civil-rights-movement

Nursing and Midwifery Board of Ireland (2013). Guidance to nurses and midwives on social
media and social networking. Ireland.

Thielst, C.B. (2013). Social media in healthcare: Connect, communicate, collaborate.

Chicago, Health Administration Press.

United Nations (2020). Human Rights. Retrieved from:

https://www.un.org/en/sections/issues-depth/human-rights/

United Nations (2020). About the Sustainable Development Goals. Retrieved from:
https://www.un.org/sustainabledevelopment/sustainable-development-goals/

United States Environmental Protection Agency (n.d.), Environmental Justice. Retrieved

from: https://www.epa.gov/environmentaljustice

World Health Organization (2020). Social determinants of health. Retrieved from:

https://www.who.int/social_determinants/sdh_definition/en/

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