Justice in Nursing: Nursing Code of Ethics Breakdown

• Continuing NCC’s Nursing Code of Ethics Breakdown, Nurse Perkins explores the role of justice in nursing.
• Learn about the ethical provisions that guide nurses and how these provisions can help guide your decision-making with patients.
• Understand the definition of justice and how you can incorporate it into your decision-making while caring for a patient.

Ethics and ethical values are central to how you conduct yourself as a nurse and should be used as a guide to produce integrity as a healthcare professional. Moral values indicate fairness and the idea of treating all patients equally regardless of age, ethnicity, socioeconomic status, sexual orientation, or religion.  

As a nurse for 20 years, I have faced this notion almost daily in my patient interactions. As a charge nurse, it is essential to be fair and impartial when assigning patients and prioritizing patient care.   

A VIP patient does not take priority over a Medicare patient in the triage and vice versa because of who they are. Patient priority is based on understanding because that is how you treat patients fairly. 

I have had many conversations with patients’ families because they felt that they should be seen first because they work at the hospital, and that is not the case. I remind them that if their loved one had a medical emergency, they would want to be seen first because it is in the patient’s best interest.  

Nursing Code of Ethics 

The Nursing Code of Ethics was developed to guide nurses in making ethical decisions. The following nine provisions will guide your professional career: 

• Provision 1: “Nurses must practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person.” 
• Provision 2: “The nurse’s primary commitment is to the patient, whether an individual, a family, group, community, or population.” 
• Provision 3: “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” 
• Provision 4: “The nurse has the authority, accountability, and responsibility for nursing practice, makes decisions, and takes action consistent with the obligation to promote health and to provide optimal care.” 
• Provision 5: “The nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth.” 
• Provision 6: “The nurse, through continual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and ensures that the conditions of employment are conducive to safe, quality health care.” 
• Provision 7: “The nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy.” 
• Provision 8: “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities.” 
• Provision 9: “The profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy.”  

As a nurse, you must understand ethical principles because you are in one of the most honest and ethical fields, according to some Gallop polls. In addition to these provisions, there are seven moral obligations that you as a nurse must center your care around: 

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

Justice Defined 

Justice in nursing means treating all patients equally and fairly. Patients should not be judged unfairly or treated any differently based on their race, religion, sexual orientation, socioeconomic status, or religion.  

As a nurse, you swore to uphold this ethical principle and the others to provide quality patient care. It’s vital to advocate for your patient without judgment in all circumstances.  

Maleficence is another moral principle that means doing all you can to prevent harmful effects from happening to your patient, thus providing safe care. An example is to provide needed medication to your patient by saying, “I would appreciate it if you could give it to the patient when it is due, not when you get around to it.” It could also mean reporting broken equipment or removing it from circulation to prevent a patient from using it and becoming injured. 

As you have probably heard, “IF YOU SEE SOMETHING, SPEAK UP.” It is everyone’s responsibility to ensure patient safety. 

Justice Examples 

• A “frequent flyer” (someone who comes to the hospital ER so often that the staff remembers them) comes in and has a new complaint. This patient is viewed as a nuisance by many of the staff, but you decide to treat the patient in a non-judgmental manner and discover that this time, the patient does have a medical emergency. 
• A patient comes in, and you recognize them from the news as being accused of a hate crime against a group of transgender friends who were innocent bystanders. The thought of this crime disgusts you, but you have been assigned to care for the patient.  What do you do? You take a deep breath, remember why you became a nurse, and greet the patient as you would do anyone else and assess their concerns—tough, right? Of course, it is for anyone. This is to get you to think about how justice can impact you as a nurse every day. 

The Bottom Line

As a healthcare provider, justice is vital to the Nursing Code of Ethics. As the nurse, you must focus on the patient’s chief complaints and not their race, religion, age, socioeconomic status, sexual orientation, whether they have insurance, what they may be accused of, or how important they believe they are.  

To successfully uphold this ethical principle, you must set aside your biases. Every time you interact with your patients, it is an opportunity to learn something new about justice and how to handle this situation best the next time you encounter it. 

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