CNA Code of Ethics for Registered Nurses 2024: Best safety guide

CNA Code of Ethics for Registered nurses provide guidance for nurses working through ethical challenges that arise in practice with persons receiving care and with colleagues in nursing and other fields of health-care provision

Access the CNA Code of Ethics for Registered Nurses:

The CNA Code of Ethics for Registered Nurses (2017) serves as a declaration of the ethical principles upheld by registered nurses and nurses in extended roles like nurse practitioners. It reflects nurses’ dedication to individuals with healthcare requirements and those under their care.

The Canadian Nurses Association (CNA) Code of Ethics for Registered Nurses (herein called the Code) is a statement of the ethical values of nurses and of nurses’ commitments to persons with healthcare needs and
persons receiving care

This Code serves a dual purpose:

1. It serves as an aspirational guide, delineating the ethical values, responsibilities, and objectives of nurses for all stakeholders.
2. It functions as a regulatory instrument. Nursing in Canada operates under self-regulation, meaning nurses are obligated to adhere to a code of ethics as part of a regulatory framework aimed at safeguarding the public’s interests.

The CNA Code of ethics are organized into two parts:

Part I. Nursing Values and Ethical Responsibilities:

It describes the ethical responsibilities central to ethical nursing practice articulated through seven primary values and responsibility statements. These statements are grounded in nurses’ professional relationships with persons receiving care as well as with students, nursing colleagues and other health-care providers. The seven primary values are:
A. Providing safe, compassionate, competent and ethical care
B. Promoting health and well-being
C. Promoting and respecting informed decision-making
D. Honoring dignity
E. Maintaining privacy and confidentiality
F. Promoting justice
G. Being accountable

1. Providing safe, compassionate, competent and ethical care:
   • When resources are not available to provide appropriate or safe care, nurses collaborate with others to adjust priorities and minimize harm. Nurses keep persons receiving care informed about potential and actual plans regarding the delivery of care. They inform employers about potential threats to the safety and quality of health care.
2. Promoting health and well-being:
   • Nurses recognize the social determinants of health in their assessments, diagnoses, outcomes planning, implementations and evaluations with individuals, families and communities, collaborating with others in and outside of the health sector
3. Promoting and respecting informed decision-making:
   • Nurses are sensitive to the inherent power differentials between care providers and persons receiving care. They do not misuse that power to influence decision making.
4. Honoring dignity
   • In health-care decision-making, in treatment and in care, nurses work with persons receiving care to take into account their values, customs and spiritual beliefs, as well as their social and economic circumstances without judgment or bias.
5. Maintaining privacy and confidentiality
   • In the use of social media, nurses safeguard the privacy and confidentiality of persons and other colleagues
   • When nurses are required to disclose information for a particular purpose, they disclose only the amount of information necessary for that purpose and inform only those necessary. They attempt to do so in ways that minimize any potential harm to the persons receiving care or colleagues
6. Promoting justice
   • Nurses uphold principles of justice by safeguarding human rights, equity and fairness and by promoting the public good.
   • Nurses do not discriminate on the basis of a person’s race, ethnicity, culture, political and spiritual beliefs, social or marital status, gender, gender identity, gender expression, sexual orientation, age, health status, place of origin, lifestyle, mental or physical ability, socio-economic status, or any other attribute.
7. Being accountable
   • Nurses are accountable for their actions and answerable for their practice
   • Nurses maintain their fitness to practice
   • Nurses identify and address conflicts of interest.

Part II. Ethical Endeavors Related to Broad Societal Issues:

It describes activities nurses can undertake to address social inequities. Ethical nursing practice
involves endeavoring to address broad aspects of social justice that are associated
with health and well-being.

Framework for Ethical Decision-Making (Code of Ethics for Registered Nurses):

1. Developed by Michael McDonald with additions provided by Patricia Rodney and Rosalie Starzomski in 2001)
2. It provides detailed questions to consider in ethical decision-making. This framework uses ethical principles to develop questions, but the principles may give deeper meaning to the nature of the questions.

Using ethical resources to evaluate alternatives: Principles/concepts

• Autonomy: What does the person want? How well has the person been informed and/or supported? What explicit or implicit promises have been made to the person?
• Non-maleficence: Will this harm the person? Others?
• Beneficence: Will this benefit the person? Others?
• Justice: Consider the interests of all those involved who have to be taken into account (including the person). Are biases about the person or family affecting your decision-making? Treat like decisions alike.
• Fidelity: Are you fostering trust in the person/family/team relationships?
• Care: Will the person and family be supported as they deal with loss, grief and uncertainty? What about any moral distress of team members? What principles of the palliative care approach can be incorporated into the alternatives?
• Relational autonomy: What relationships and structures are affecting the various individuals involved in the situation? How can these relationships and social structures be used to enable support of the person, family members and health-care providers?

Principles/concepts of code of ethics.

Applying the Code of Ethics for Registered Nurses in Selected Circumstances:

A. Ethical Considerations for Nurses in a Natural or Human-Made Disaster, Communicable Disease Outbreak or Pandemic:

During a natural or human-made disaster, including a communicable disease outbreak, nurses provide care using appropriate safety precautions in accordance with legislation, regulations and guidelines provided by government, regulatory bodies, employers, unions and professional associations

A duty to provide care refers to a nurse’s professional obligation to provide persons receiving care with safe, competent, compassionate and ethical care.

Nurses carefully consider their professional role, their duty to provide care and other competing obligations to their own health, to family and to friends

B. Responding Ethically to Incompetent, Non-Compassionate, Unsafe or Unethical Care:

1. Nurses question, intervene, report and address unsafe, non-compassionate, unethical or incompetent practice or conditions that interfere with their ability to provide safe, compassionate, competent and ethical care; and they support those who do the same.
2. Some examples of appropriate immediate steps in cases of actual or imminent harm could include, but are not limited to, speaking up if a potential error in drug calculations is detected, questioning an unclear order, intervening to prevent unsafe restraint practices, protecting patients when a colleague’s performance appears to be impaired for any reason (see CRNNS, 2017) or intervening in a serious breach of confidentiality involving people with sexually transmitted infections.

C. Ethical Considerations in Addressing Expectations That Are in Conflict with One’s Conscience:

1. Nurses may not abandon those in need of nursing care. However, nurses may sometimes be opposed to certain procedures and practices in health care and find it difficult to willingly participate in providing care that others have judged to be morally acceptable.
2. Such situations include, but are not limited to, blood transfusions, abortion, suicide attempts, refusal of treatment and medical assistance in dying. The nurse’s right to follow their conscience in such situations is recognized in the Code’s provision for conscientious objection

COMMON ETHICAL ISSUES YOU MUST BE AWARE OF:

1. Patient Confidentiality:
   • Example: A nurse inadvertently shares patient information in a public setting.
   • Solution: Always discuss patient information in private and secure areas and adhere strictly to confidentiality policies as outlined by the Canadian Nurses Association (CNA).
2. Informed Consent:
   • Example: A patient undergoes a procedure without fully understanding the risks involved.
   • Solution: Ensure that patients are fully informed about procedures and have given their explicit consent. Nurses should verify that consent is obtained appropriately and documented correctly.
3. Scope of Practice:
   • Example: A nurse performs a task that is beyond their professional scope, such as administering a medication they are not trained for.
   • Solution: Understand and work within the defined scope of practice for your nursing level. Consult the provincial regulatory body’s guidelines and seek supervision when necessary.
4. Documentation:
   • Example: Inaccurate or incomplete patient records that lead to a medical error.
   • Solution: Ensure thorough, accurate, and timely documentation of all patient interactions, treatments, and observations. Proper documentation is crucial for patient safety and legal protection.
5. Professional Boundaries:
   • Example: Developing a personal relationship with a patient or their family.
   • Solution: Maintain professional boundaries to avoid conflicts of interest and ensure objectivity in patient care. Follow the guidelines set by the CNA and your provincial regulatory body.
6. Medication Administration:
   • Example: Administering the wrong medication or dosage due to a lack of verification.
   • Solution: Follow the “five rights” of medication administration (right patient, right drug, right dose, right route, right time) to minimize errors. Double-check all medications with another nurse if possible.
7. Workplace Safety:
   • Example: A nurse is injured due to unsafe working conditions.
   • Solution: Adhere to workplace safety protocols and report any hazards to management immediately. Engage in continuous education on safe practice standards and use protective equipment as required.
8. End-of-Life Care and Euthanasia:
   • Example: Navigating the complexities of assisted dying laws in Canada.
   • Solution: Stay informed about the current legislation regarding Medical Assistance in Dying (MAiD) and ensure compliance with legal requirements. Provide compassionate care and support to patients and families.
9. Cultural Competence:
   • Example: Misunderstanding a patient’s cultural beliefs leads to a breakdown in communication.
   • Solution: Engage in cultural competence training and seek to understand and respect the diverse backgrounds of patients. Use interpreters and cultural liaisons when necessary to ensure clear communication.
10. Reporting and Accountability:
    • Example: Failing to report a colleague’s unethical or unsafe practice.
    • Solution: Familiarize yourself with the reporting procedures for unethical or unsafe practices. Report any concerns to the appropriate authorities to ensure patient safety and uphold professional standards.

Few terms related to Code of Ethics for Registered Nurses:

1. Patient Confidentiality: Upholding patient privacy is paramount. Discuss sensitive information in secure settings and follow institutional privacy policies.
2. Informed Consent: Obtain and document clear consent after explaining all procedure aspects to the patient.
3. Scope of Practice: Understand your professional boundaries and seek guidance or additional training when necessary.
4. Documentation: Keep detailed, accurate records of all patient interactions and treatments.
5. Professional Boundaries: Maintain a professional distance from patients and their families to prevent conflicts of interest.
6. Medication Administration: Verify all aspects of medication administration to prevent errors.
7. Workplace Safety: Follow safety protocols and report unsafe conditions to prevent injuries.
8. End-of-Life Care and Euthanasia: Stay informed about MAiD laws and provide compassionate care within legal boundaries.
9. Cultural Competence: Respect and understand cultural differences in healthcare practices and communication.
10. Reporting and Accountability: Report unethical behavior or unsafe practices through proper channels to maintain patient safety and professional integrity.

Resources of Code of Ethics for Registered Nurses:

• Canadian Nurses Association (CNA): Provides guidelines and resources on ethical and professional standards.
• Provincial Regulatory Bodies: Offer detailed information on scope of practice, legal responsibilities, and reporting procedures specific to each province.
• Workplace Safety Protocols: Institutional guidelines on maintaining a safe work environment.

Ethics – Canadian Nurses Association (cna-aiic.ca)

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