Ethical and Legal Basis of Nursing Practice

Imagine standing at the heart of a busy hospital, where every decision you make carries not just the weight of responsibility but also the invisible threads of ethics and law guiding your hands and heart. Welcome to the Ethical and Legal Basis of Nursing Practice — the very foundation that transforms compassionate care into professional excellence.

Ethics and law are not distant, complicated theories reserved for classrooms or courtrooms. In nursing, they live and breathe in every patient interaction, every medication administered, and every choice made under pressure. They shape the trust patients place in us, the rights they are entitled to, and the dignity we fiercely protect.

Ethics remind us why we care — to honor humanity, respect autonomy, and advocate for justice. Law reminds us how we must care — following clear rules that ensure safety, fairness, and accountability. Together, they serve as a nurse’s invisible armor, protecting not just our patients, but also our profession and ourselves.

This journey into the ethical and legal world of nursing will empower you to:

• Make decisions confidently, even in morally complex situations.
• Protect your patients’ rights and your own professional standing.
• Become a strong advocate, a trustworthy caregiver, and a role model in healthcare settings.

Let’s dive deep into real-world scenarios, memory-boosting tricks, and practical wisdom that will not just prepare you for exams, but prepare you for the true heart of nursing practice.

Nursing Ethics and Values

Nursing ethics are the moral principles that guide a nurse’s behaviors and decision-making processes. Values are the deeply held beliefs that influence ethical behavior. Together, ethics and values form the moral compass that nurses rely on to provide compassionate, safe, and respectful care.

Key Ethical Principles in Nursing:

Autonomy: Respecting a patient’s right to make their own healthcare decisions, even when those decisions differ from what healthcare providers might recommend. Nurses must ensure patients are fully informed and supported without coercion.

• Example 1: A patient chooses to leave the hospital against medical advice, and the nurse facilitates a safe discharge plan.
• Example 2: A teenage patient decides to refuse a blood transfusion based on religious beliefs; the nurse respects this decision and informs the care team.
• Example 3: A patient declines a recommended vaccination; the nurse educates but does not force the decision.

Beneficence: Acting in the best interest of the patient by promoting good, preventing harm, and creating a positive healthcare experience. Nurses advocate for treatments and interventions that will benefit the patient’s health and well-being.

• Example 1: Repositioning a bedridden patient every two hours to prevent pressure ulcers.
• Example 2: Scheduling a mental health consult for a patient showing signs of depression.
• Example 3: Encouraging a hesitant patient to attend physical therapy to regain mobility.

Nonmaleficence: The commitment to avoid causing harm to patients. Nurses must carefully assess risks, double-check procedures, and act to prevent errors.

• Example 1: Verifying a patient’s identity before administering medications to avoid wrong-patient errors.
• Example 2: Refusing to participate in a treatment known to be experimental without patient consent.
• Example 3: Reporting faulty medical equipment to prevent patient injury.

Justice: Ensuring fairness in care delivery, resource distribution, and decision-making, without discrimination based on gender, race, income, or insurance status.

• Example 1: Providing equal pain management interventions to all patients regardless of socioeconomic status.
• Example 2: Following an organ transplant waiting list protocol strictly, regardless of celebrity or wealth status.
• Example 3: Ensuring all patients in the waiting room are triaged based on medical need, not personal biases.

Fidelity: Being loyal, truthful, and keeping promises to patients. Building trust requires consistency and reliability in following through with commitments.

• Example 1: Returning with water for a patient as promised.
• Example 2: Following through on a patient’s request for a clergy visit.
• Example 3: Advocating for a patient’s pain management needs as previously agreed.

Veracity: Telling the truth to patients and providing complete information so they can make informed decisions. Honesty is crucial to maintaining trust.

• Example 1: Informing a patient about an unexpected side effect even if it might alarm them.
• Example 2: Clarifying that a procedure carries certain risks instead of minimizing concerns.
• Example 3: Admitting an error immediately if a mistake occurs during care.

Core Nursing Values:

Altruism: Demonstrating selflessness by prioritizing the needs and well-being of patients and colleagues.

• Example 1: Volunteering for overtime during a hospital staffing crisis.
• Example 2: Taking extra time to emotionally support a grieving family member.
• Example 3: Helping a new nurse orient to a stressful unit without expecting recognition.

Human Dignity: Respecting the intrinsic worth of every patient regardless of their background or situation.

• Example 1: Providing courteous care to incarcerated patients.
• Example 2: Protecting a patient’s modesty during procedures.
• Example 3: Addressing elderly patients respectfully, using preferred names or titles.

Integrity: Acting consistently with professional values, being honest, and adhering to moral and ethical standards even when difficult.

• Example 1: Admitting to a documentation error even if it risks professional embarrassment.
• Example 2: Refusing to cover up a colleague’s mistake that could harm a patient.
• Example 3: Upholding patient confidentiality in conversations even outside of work.

Social Justice: Advocating for fairness and equality, especially for underserved or marginalized populations.

• Example 1: Supporting policies that expand healthcare access to low-income communities.
• Example 2: Educating coworkers about unconscious bias and its impact on patient care.
• Example 3: Assisting a non-English-speaking patient in accessing interpreter services.

Memory Trick (Mnemonic): All Big Nurses Juggle Faithfully Values

• Autonomy
• Beneficence
• Nonmaleficence
• Justice
• Fidelity
• Veracity

Real-World Connection: Imagine you are caring for a patient who refuses a lifesaving treatment. Even if you believe the treatment is necessary (beneficence), respecting their choice (autonomy) is essential — this is nursing ethics in action.

Ethical Decision-Making

Ethical decision-making in nursing involves a structured, thoughtful process that helps nurses resolve dilemmas where there is no clear “right” answer. This approach ensures that patient care respects moral principles, legal standards, and professional guidelines.

Steps in Ethical Decision-Making:

1. Recognize the Ethical Issue: Identify whether a situation poses a moral conflict. Not all challenges are ethical issues, but anything involving patient rights, safety, or dignity often is.
2. Gather Information: Collect all relevant facts, including medical facts, patient wishes, cultural influences, and legal policies.
3. Examine Personal Values: Reflect on your own beliefs and biases to ensure they do not improperly influence the patient’s care.
4. Identify the Ethical Principles Involved: Pinpoint principles such as autonomy, beneficence, or justice that are at play.
5. Explore Options: List possible courses of action, considering their ethical implications and consequences.
6. Make a Decision: Choose the best option that aligns most closely with ethical standards and patient-centered care.
7. Act and Evaluate: Implement the decision and monitor the outcomes, being open to adjusting if needed.

Example 1:

• Scenario: A terminally ill patient refuses further treatment.
• Application: The nurse gathers information, respects the patient’s autonomy, and supports palliative care options.

Example 2:

• Scenario: A nurse discovers a colleague diverting narcotics.
• Application: The nurse recognizes the ethical duty to protect patients (nonmaleficence) and reports the misconduct through appropriate channels.

Example 3:

• Scenario: A family insists on aggressive treatment for a patient in a vegetative state.
• Application: The nurse considers patient dignity (human dignity), weighs beneficence versus nonmaleficence, and advocates for ethical end-of-life care.

Example 4:

• Scenario: A patient requests to use alternative therapies not approved by the hospital.
• Application: The nurse respects the patient’s autonomy while ensuring that any alternative therapy does not compromise safety.

Example 5:

• Scenario: An unconscious patient’s advance directive indicates no resuscitation, but the family demands CPR.
• Application: The nurse honors the patient’s documented wishes (fidelity and autonomy) despite family pressure, ensuring ethical and legal compliance.

Memory Trick for Steps (Mnemonic): Respect Gathering Ethics Identify Evaluate Move

• Recognize Issue
• Gather Information
• Examine Values
• Identify Principles
• Explore Options
• Make Decision and Evaluate

Legal Aspects of Nursing: Scope of Practice, Negligence, Malpractice

Understanding the legal aspects of nursing is critical to safeguarding both the patient’s well-being and the nurse’s professional career. Nurses must operate within legal boundaries to maintain patient trust and protect their licenses.

Scope of Practice: Scope of practice defines the procedures, actions, and processes that a nurse is permitted to undertake based on their professional license and state regulations. It outlines what nurses can and cannot do legally.

• Example 1: An RN administering IV medications according to hospital policy and their training.
• Example 2: A licensed practical nurse (LPN) assisting with wound care but not prescribing medications.
• Example 3: A nurse practitioner independently diagnosing and treating illnesses within their state laws.
• Example 4: A registered nurse delegating tasks to nursing assistants appropriately.
• Example 5: A nurse refraining from performing surgical procedures, as it falls outside their licensed role.

Negligence: Negligence occurs when a nurse fails to act as a reasonably prudent nurse would, resulting in harm to a patient. It is an unintentional breach of duty that leads to injury.

• Example 1: Forgetting to lower a patient’s bed and causing a fall.
• Example 2: Not reporting a significant change in a patient’s condition to the healthcare provider.
• Example 3: Administering medication late without documenting or informing the physician.
• Example 4: Failing to ensure a patient has assistance before ambulating post-surgery.
• Example 5: Not verifying a patient’s identity before administering a blood transfusion.

Malpractice: Malpractice is professional negligence — when a licensed healthcare provider’s actions fall below accepted standards, causing harm. Malpractice implies a greater degree of responsibility because it involves specialized knowledge and skill.

• Example 1: A nurse inserting a urinary catheter without sterile technique, leading to a severe infection.
• Example 2: Ignoring a patient’s allergy information and administering a contraindicated drug.
• Example 3: Failure to follow up on critical lab results.
• Example 4: A nurse acting outside their training, such as performing a procedure they are not authorized for.
• Example 5: Improper delegation of tasks to unqualified personnel resulting in patient injury.

Liability: Liability in nursing means being legally responsible for one’s actions or inactions. If a nurse’s behavior results in harm to a patient, they can be held personally accountable. Liability ensures that nurses uphold the expected standards of care and act in a manner consistent with their training and professional code.

• Example 1: A nurse is liable if they fail to monitor a postoperative patient properly, leading to complications.
• Example 2: A nurse who administers the wrong medication and causes harm may face personal and professional liability.
• Example 3: A nurse is held liable for not following hospital protocols during a patient emergency.
• Example 4: Documenting falsely in patient records can lead to both civil and criminal liability.
• Example 5: A nurse ignoring infection control procedures resulting in a hospital-acquired infection.

Confidentiality: Confidentiality means safeguarding a patient’s private health information and only sharing it with individuals directly involved in their care. It protects the patient’s dignity and privacy and is both an ethical duty and a legal requirement under laws such as HIPAA (Health Insurance Portability and Accountability Act).

• Example 1: Discussing a patient’s diagnosis only with the healthcare team members involved in the patient’s care.
• Example 2: Keeping medical records secured and accessible only to authorized personnel.
• Example 3: Not discussing patient details in public areas like hallways, elevators, or cafeterias.
• Example 4: Avoiding social media posts that could reveal patient information, even indirectly.
• Example 5: Following the correct procedures when a patient requests copies of their own medical records.

Memory Trick for Legal Concepts (Mnemonic): Smart Nurses Make Legal Choices

• Scope of Practice
• Negligence
• Malpractice
• Liability
• Confidentiality

Patient Rights (e.g., Informed Consent, HIPAA)

Respecting patient rights is a core ethical and legal obligation for all nurses. Patient rights are protections and entitlements that ensure individuals receive safe, respectful, and dignified care.

Informed Consent: Informed consent means that patients have the right to receive all necessary information regarding their treatment options, including the benefits, risks, and alternatives, so they can make voluntary and knowledgeable decisions about their care.

• Example 1: Before surgery, the nurse ensures the patient understands the procedure, risks, and options and signs the consent form.
• Example 2: A nurse explains the potential side effects of a new medication and documents the patient’s consent to proceed.
• Example 3: Ensuring a patient understands they have the right to refuse treatment, even after signing consent.
• Example 4: Clarifying complex medical terms to the patient to guarantee true comprehension before consenting.
• Example 5: Advocating for a patient who feels pressured to consent without fully understanding the procedure.

HIPAA (Health Insurance Portability and Accountability Act): HIPAA is a U.S. law designed to protect patients’ health information from being disclosed without their consent or knowledge. It mandates strict standards for confidentiality, access, and sharing of medical data.

• Example 1: Logging out of electronic health records when stepping away from a computer.
• Example 2: Speaking about patient cases only in private areas.
• Example 3: Releasing patient information only with proper written authorization.
• Example 4: Keeping printed charts and records secured and inaccessible to unauthorized individuals.
• Example 5: Educating patients about their rights under HIPAA, such as the right to access and amend their medical records.

Memory Trick for Patient Rights (Mnemonic): Informed Health Protection Always Applies

• Informed Consent
• HIPAA
• Patient Autonomy
• Access to Information
• Advocacy by Healthcare Providers

Professional Accountability

Professional accountability in nursing means taking responsibility for one’s actions, decisions, and the outcomes of patient care. It reflects a commitment to providing safe, ethical, and high-quality care and maintaining trust within the healthcare team and community.

Nurses are expected to:

• Practice within their scope and competence.
• Follow legal and ethical standards.
• Engage in continuous learning and professional development.
• Report and address errors and unsafe practices.
• Advocate for the best interest of their patients.

Examples of Professional Accountability:

• Example 1: A nurse reports a medication error immediately and participates in efforts to prevent future errors.
• Example 2: Pursuing continuing education to stay updated with evidence-based practices.
• Example 3: Documenting patient care accurately, thoroughly, and truthfully.
• Example 4: Refusing to perform a task that the nurse is not trained or licensed to do.
• Example 5: Advocating for necessary resources or interventions when a patient’s safety is at risk.

Memory Trick for Accountability (Mnemonic): Responsibility Always Improves Safe Environments

• Report Errors
• Advance Learning
• Integrity in Documentation
• Scope Awareness
• Enhance Patient Safety

Interactive Worksheet

Reflective Questions:

1. List three examples where respecting patient autonomy can create an ethical dilemma.
2. Describe a situation where a nurse’s negligence could turn into malpractice.
3. How would you explain the concept of informed consent to a patient who has limited medical knowledge?
4. Provide a real or imagined example where confidentiality could be unintentionally breached. How would you prevent it?
5. What actions can you take to demonstrate professional accountability in your clinical practice?

Scenario-Based Questions:

1. A patient refuses a lifesaving procedure. What ethical principle is involved, and what should you do?
2. A colleague repeatedly arrives late for medication passes. What professional responsibility do you have?
3. A patient’s lab results indicate a critical value, but the doctor is unavailable. What is your next step?
4. How would you handle a situation where a patient’s family demands to override a DNR order?
5. You overhear nurses discussing a patient’s condition in the cafeteria. What should you do?

Concise Memory Trick Recap

FAQ Section

Q1: What is the difference between negligence and malpractice in nursing?

• Negligence is failing to act with reasonable care, while malpractice involves professional misconduct where specialized knowledge and skill are improperly used.

Q2: What happens if a nurse violates patient confidentiality?

• Violating confidentiality can result in disciplinary action, legal penalties, and loss of trust from patients and employers.

Q3: Can a patient refuse treatment after signing an informed consent form?

• Yes, patients can withdraw consent at any time before or during treatment.

Q4: How can nurses stay updated with their scope of practice?

• By reviewing state nursing board regulations, hospital policies, attending continuing education, and consulting professional guidelines.

Q5: What should a nurse do if they witness unsafe or unethical practices?

• Nurses must report unsafe or unethical practices to appropriate supervisors or regulatory bodies to protect patient safety.

References

• American Nurses Association (ANA). (2015). Code of Ethics for Nurses with Interpretive Statements.
• Pozgar, G. D. (2020). Legal and Ethical Issues for Health Professionals (5th ed.). Jones & Bartlett Learning.
• Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2021). Fundamentals of Nursing (10th ed.). Elsevier.
• Guido, G. W. (2018). Legal and Ethical Issues in Nursing (7th ed.). Pearson.
• U.S. Department of Health and Human Services. (n.d.). Health Information Privacy (HIPAA). Retrieved from https://www.hhs.gov/hipaa/index.html