The ANA Code of Ethics: A New Playbook for Nursing Negligence Litigation

 Disclaimer

This article contains information based on my education, professional knowledge, and clinical experience. I am not an attorney; this content is for informational purposes only and should not be construed as legal advice.

I do not represent the American Nurses Association (ANA) in any capacity. The following analysis and opinions are my independent thoughts based solely on my professional experience and understanding of the ANA Code of Ethics. This article should not be interpreted as an official position or interpretation endorsed by the ANA.

Lastly, all case studies and deposition dialogues presented in this article are fictional and were created for educational purposes only. They do not represent actual legal proceedings or real individuals. These illustrative scenarios were developed with the assistance of artificial intelligence to demonstrate potential applications of the ANA Code of Ethics in legal contexts. The specific scenarios, characters, and conversations are entirely fictional and should not be interpreted as representing actual cases or establishing legal precedent.

Understanding Legal Authority and Evidence in Nursing Negligence

To appreciate the role of the ANA Code of Ethics in nursing negligence cases, it's essential to understand the distinctions between different types of legal authority and evidence.

Mandatory authority, or binding authority, refers to laws, regulations, and court decisions that courts must follow in a particular jurisdiction. For nurses, the primary source of mandatory authority is the Nurse Practice Act in their state of licensure. These practice acts define the legal scope of nursing practice, establish licensing requirements, and outline prohibited conduct. Courts and licensing boards must adhere to these statutory provisions when determining whether a nurse's actions constitute negligence or professional misconduct.

Persuasive authority, by contrast, refers to legal sources that courts may consider but are not obligated to follow. These include scholarly treatises, law review articles, and court decisions from other jurisdictions. While not binding, persuasive authority can influence judicial reasoning when mandatory authority does not directly address the issue.

The ANA Code of Ethics falls into a third category: evidentiary support. Unlike legal authorities that guide the interpretation of the law, evidentiary support helps establish facts relevant to elements of a claim. In nursing negligence cases, the Code serves as evidence of nationally recognized standards for nursing practice. Attorneys introduce the Code to demonstrate whether a nurse's actions aligned with or deviated from these established professional standards.

The Code's evidentiary value derives from its development by the profession's leading organization and its widespread acceptance among nursing professionals. Courts often give significant weight to the Code when determining the standard of care in negligence cases precisely because it represents the profession's consensus on ethical practice expectations.

In nursing negligence litigation, attorneys must prove four elements: duty, breach of duty, causation, and damages. The Code of Ethics primarily helps establish the first two elements—it defines aspects of the nurse's duty and provides benchmarks against which to measure potential breaches. Expert witnesses frequently reference the Code when testifying whether a nurse's actions met the professional standard of care in specific clinical situations.

Development and Evolution of the ANA Code of Ethics

The American Nurses Association Code of Ethics has deep historical roots extending back to the late 1880s, coinciding with the foundation of the ANA itself. The nursing profession's ethical tradition emerged from early ethics literature in modern nursing, culminating in the first formal adoption of a professional ethics code by the ANA in 1950. Over the past 75 years, this Code has undergone multiple revisions to remain responsive to nursing's evolution and societal changes.

The revision process follows formal procedures established by the ANA, with the Code typically updated on a ten-year cycle. This deliberate timeline allows thoughtful consideration of changing practice environments while maintaining ethical continuity. Each revision includes a public comment period, as seen before the 2025 publication, where practicing nurses, nursing organizations, and stakeholders can provide input that shapes the final document. This collaborative approach ensures the Code reflects the collective wisdom and concerns of the profession.

The most recent 2025 revision retains the structural integrity of the previous 2015 version while incorporating necessary changes to address contemporary challenges. The 2025 Code maintains nine provisions from the 2015 version (with appropriate edits) and adds a tenth provision focusing on global ethical issues. Each provision includes interpretive statements that provide specific practice guidance. Together, these components form a comprehensive ethical framework organized around six reciprocal relationships: nurse-to-patient (Provisions 1-3), nurse-to-nurse (Provisions 4 and 6), nurse-to-self (Provision 5), nurse-to-profession (Provision 7), nurse-to-others (Provision 8), nurse/nursing-to-society (Provision 9), and nursing-to-global community (Provision 10).

The development and revision process intentionally considers language choices to ensure inclusivity and precision. For example, the term "patient" is retained for universal intelligibility while acknowledging that "recipient(s) of [nursing] care" provides important nuances for those served outside established healthcare systems. Similarly, terms like "ought," "should," and "must" are deliberately chosen to express different levels of obligation and moral imperative.

According to the ANA Code of Ethics preface, the Code serves multiple functions simultaneously. It is described as "both a normative framework and an aspirational guide" that establishes ethical obligations while pointing toward professional ideals. The preface states that the Code articulates "the primary obligations, values, and ideals of the profession" and is meant to "inform every aspect of the nurse's life." The document acknowledges that while nursing seeks to realize its moral values and ideals, there are instances where the profession falls short, necessitating reflection and correction. Throughout its development, the Code has maintained connections with international nursing ethics documents, including those from the United Nations, World Health Organization, and International Council of Nurses, while addressing contexts specific to American healthcare.

The Subsequent 2025 Revision: A Significant Shift in Language

The ANA released the 2025 Nursing Code of Ethics Revision on January 29th, 2025. However, just one month later, on February 28th, 2025, the organization took an unusual step. The ANA emailed nurses who had purchased the revised code and provided an errata sheet containing five full pages of edits. Most notably, these edits systematically replaced compulsory language such as "must" with more permissive terminology such as “ought to” throughout the document.

This substantial post-publication revision raises significant questions for the legal community. The original publication remains in circulation and can be obtained by attorneys in nursing negligence cases. The existence of two versions—the original with compulsory, more directive language and the revised version with softened imperatives—creates the potential for conflicting interpretations of nursing's ethical obligations.

The timing and nature of these changes invite scrutiny. Why did the ANA initially publish a Code with mandatory language, only to quickly retreat to more permissive phrasing? One possibility is that the organization received pushback from nursing stakeholders concerned about establishing overly rigid standards that could increase legal vulnerability.

This situation creates strategic opportunities and challenges for attorneys involved in nursing negligence litigation. Plaintiffs' attorneys may seek to introduce the original, more directive version as evidence of nursing's self-defined obligations, arguing that the subsequent revisions attempt to shield nurses from accountability rather than a genuine correction of the profession's ethical standards. They might contend that the first published version accurately reflects nursing's ethical commitments.

Defense attorneys, meanwhile, may argue that the rapid issuance of corrections demonstrates the ANA's commitment to precision and accuracy in articulating nursing's ethical obligations. They could position the errata sheet as evidence that the organization recognized the need for nuance in ethical guidance, acknowledging the contextual nature of nursing practice and the importance of professional judgment.

Expert witnesses will inevitably face questions about these competing versions. Their interpretation of which version better represents nursing's ethical standard—and why the changes were made—could significantly influence case outcomes. This situation underscores the complex relationship between professional ethics and legal standards of care, highlighting how subtle linguistic shifts can have substantial implications in negligence proceedings.

The Conspicuous Silence: ANA's Lack of Public Explanation

To the author’s knowledge, the ANA has issued no public statement explaining the extensive changes in the errata sheet or clarifying why its position shifted dramatically just one month after publication. This silence is particularly notable given the significance of the Code of Ethics to the nursing profession and the substantial nature of the modifications.

Easily found through a simple internet search, the errata sheet contains only the specific textual changes without context or rationale. This lack of transparency creates a vacuum that will inevitably be filled by speculation from various stakeholders, including attorneys, nursing professionals, healthcare organizations, and patient advocates.

The absence of a clear explanation from the profession's leading organization presents several challenges in the legal context. Without official clarification, courts must determine which version more accurately represents the profession's ethical standards. Expert witnesses lack official guidance on interpreting the changes when establishing the standard of care in negligence cases. This ambiguity may lead to inconsistent applications of the Code across different jurisdictions and cases.

From an evidentiary perspective, the absence of an official explanation may strengthen plaintiffs' positions in some circumstances. Plaintiffs' attorneys could argue that the lack of transparency suggests the changes were motivated by liability concerns rather than a genuine reassessment of nursing's ethical obligations. They might contend that the original, more stringent language represents the profession's authentic, ethical position, with the subsequent modifications reflecting political or legal considerations rather than ethical ones.

This silence challenges the defense in explaining the modifications to judges and juries. Without an authoritative explanation from the ANA, defense experts must develop their interpretations of why the changes were necessary and appropriate. These explanations may lack the credibility of an official statement from the organization itself.

This situation highlights a broader issue in professional ethics: the tension between establishing clear, enforceable standards and providing flexibility for professional judgment. The ANA's decision to modify its language and not to explain those modifications publicly reflects this tension and raises important questions about the relationship between ethical code and legal liability in healthcare professions.

Case Study: Ethical Language and Reproductive Healthcare Access

Case Narrative: Garcia v. Heartland Medical Center

Maria Garcia filed a lawsuit against Heartland Medical Center and nurse practitioner Jordan Taylor, APRN. Garcia, who was 11 weeks pregnant with a diagnosis of severe fetal anomalies incompatible with life, sought information about termination options. The medical center is located in a state that had recently enacted strict abortion limitations with narrow exceptions for medical emergencies but not for fetal anomalies.

Garcia alleges that Taylor failed to adequately inform her about all healthcare options, including the possibility of seeking care in neighboring states where the procedure remained legal. Taylor documented discussing "available options within state guidelines" but did not document discussing out-of-state referrals. Garcia ultimately miscarried at 16 weeks after experiencing significant psychological distress.

Both versions of the 2025 ANA Code of Ethics became central to questioning ethical obligations regarding patient rights and state restrictions during the deposition.

Deposition Excerpt: Plaintiff’s Attorney Questioning Nurse Taylor

Attorney: Ms. Taylor, are you familiar with the ANA Code of Ethics for Nurses?

Taylor: Yes, I am.

Attorney: I'm showing you two documents. Exhibit A is the ANA Code of Ethics published in January 2025. Exhibit B contains the February 2025 errata sheet showing language changes. Have you seen both versions?

Taylor: Yes. I reviewed the original when it was published and later received the updates.

Attorney: I'd like to direct your attention to a specific passage. The original January version states, "The limitation of individual rights must be considered a serious departure from the standard of care, justified only when there are no less-restrictive means to preserve the rights of others and protect the public." Do you see that?

Taylor: [Takes time to locate and read] I do.

Attorney: Please look at the same section in the revised version. It now reads, "The limitation of individual rights is considered a serious departure from the standard of care, justified only when there are no less-restrictive means to preserve the rights of others and protect the public." Do you see that the phrase "must be" was changed to "is"?

Taylor: Yes, I see that change. Before we discuss this further, I'd like to request a moment to read the full context surrounding this statement in both versions.

Attorney: [Somewhat impatiently] The change is straightforward but take your time.

Taylor: [After carefully reading] Thank you. I've reviewed the full context now.

Attorney: Would you agree that the original language with "must be considered" creates a stronger ethical obligation than the revised "is considered" language?

Taylor: The original language uses more imperative phrasing, while the revised version uses more descriptive phrasing. However, both versions still identify limiting individual rights as a serious departure from the standard of care.

Attorney: In your care of Ms. Garcia, which version of the Code were you following?

Taylor: The revised version had been published when I treated Ms. Garcia. However, I would emphasize that both versions maintain the principle that limiting individual rights is a serious matter requiring substantial justification.

Attorney: Let's apply this to Ms. Garcia's situation. She had a constitutional right to travel to another state for legal healthcare services. Would you agree that not informing her about options in neighboring states effectively limited her individual rights?

Taylor: I informed Ms. Garcia of the options available under our state's laws and the care we could provide. I followed our institution's policies regarding counseling patients.

Attorney: That's not what I asked. Did withholding information about legal options in neighboring states limit Ms. Garcia's individual rights?

Taylor: I need to be clear about the full clinical context. My documentation shows that I discussed "available options" with Ms. Garcia. Our conversation included an acknowledgment that different states have different laws. I didn't specifically document discussing out-of-state referrals.

Attorney: Under the original Code language stating limitations of rights "must be considered" a serious departure from the standard of care, would you have had a stronger ethical obligation to ensure Ms. Garcia knew about all options, including those requiring travel to other states?

Taylor: Both versions of the Code establish that respect for patient autonomy and informed decision-making are central to nursing ethics. Changing from "must be considered" to "is considered" doesn't fundamentally alter the ethical principle that limiting individual rights is a serious matter.

Attorney: But you personally felt more comfortable limiting information after the Code language was softened, correct?

Taylor: No, that's not accurate. This wording change didn't influence my approach to patient education. I aim to provide comprehensive care within my practice's legal and policy framework.

Attorney: Are you aware that other providers in similar circumstances have interpreted the original "must be considered" language as creating an ethical obligation to inform patients about all legal options, even those requiring travel to other states?

Taylor: I can't speak to other providers' interpretations. I can only explain my understanding that both versions of the Code emphasize respect for patient autonomy while acknowledging the complex legal and ethical landscape in which we practice.

Attorney: In your professional judgment, which version of the Code better protects patients' rights to full information about their healthcare options?

Taylor: Both versions uphold the core ethical principles of nursing, including respect for human dignity, patient autonomy, and the nurse's responsibility to promote health. The language change doesn't alter these fundamental principles. Ethical nursing practice requires considering the whole Code, not just isolated phrases or word changes.

The Code of Ethics in Nursing Negligence Cases

Applying the ANA Code of Ethics in nursing negligence litigation represents a strategic opportunity for attorneys on both sides. As evidentiary support, the Code can significantly influence how courts and juries evaluate nursing conduct and determine whether actions meet the professional standard of care.

For plaintiffs' attorneys, the Code provides a clear, authoritative framework for establishing nursing obligations that transcend specific workplace policies or individual practice settings. When a nurse's actions contradict ethical provisions, plaintiffs can argue that these contradictions represent deviations from the profession's established standards. The Code's explicit language regarding patient advocacy, competence, and professional responsibility creates benchmarks against which alleged negligence can be measured.

Conversely, defense attorneys can use the Code to demonstrate a nurse's alignment with professional ethical standards. They might highlight provisions that acknowledge the complex, contextual nature of nursing judgment or recognize institutional constraints on nursing practice. The Code's emphasis on professional discretion and its recognition of systems factors can support arguments that a nurse made reasonable decisions given the circumstances, even if adverse outcomes occurred.

Expert witnesses in nursing negligence cases frequently cite the Code when establishing the standard of care. Their testimony often involves interpreting how the Code's provisions apply to the specific clinical situation. This interpretation helps contextualize nursing actions within the profession's ethical framework, potentially influencing how jurors evaluate the reasonableness of those actions.

The Code's evidentiary power is particularly evident in cases involving:

1. Patient advocacy disputes, where nurses face conflicts between institutional policies and patient needs

2. Documentation issues, where the Code's emphasis on accurate record-keeping becomes relevant

3. Delegation and supervision scenarios, where the Code establishes clear parameters for appropriate oversight

4. Informed consent situations, where ethical obligations regarding patient autonomy apply

5. End-of-life care, where the Code provides guidance on balancing complex ethical considerations

Case Study: The Plaintiff's Perspective on Provision 3.4

Case Narrative: Evans v. Metropolitan Medical Center

Jacob Evans, a 67-year-old patient, was admitted to Metropolitan Medical Center for routine gallbladder surgery. Following surgery, he developed symptoms consistent with a surgical site infection, including increased pain, redness, and elevated temperature. Sarah Johnson, RN, noticed these symptoms during her evening shift assessment and documented them in the patient's chart.

Johnson also observed that the surgical dressing had not been changed according to protocol and contained an unusual amount of yellowish drainage. Although hospital policy required reporting such concerns to the charge nurse and attending physician, Johnson hesitated. The surgeon, Dr. Williams, had previously responded harshly to nurses who questioned his post-operative care. Johnson had personally witnessed a colleague being reprimanded for raising similar concerns.

Johnson documented the symptoms but did not escalate her concerns to the charge nurse or the surgeon. Over the next 24 hours, Evans developed sepsis, requiring transfer to intensive care, where he suffered cardiac arrest and sustained permanent brain damage. The family later sued the hospital and the nursing staff, alleging failure to provide appropriate post-operative care and timely intervention.

Deposition Excerpt: Plaintiff's Attorney Questioning Nurse Johnson

Attorney: Ms. Johnson, you documented Mr. Evans' increased pain, redness at the surgical site, and elevated temperature at 8:45 PM on October 15th, correct?

Johnson: Yes, that's correct.

Attorney: And you also noted, quote, "moderate amount of yellow drainage on surgical dressing," end quote. Is that accurate?

Johnson: Yes.

Attorney: These are all signs of a potential surgical site infection, aren't they?

Johnson: They can be, yes.

Attorney: Yet you didn't notify Dr. Williams or even the charge nurse about these findings, did you?

Johnson: No, I documented them in the chart.

Attorney: Ms. Johnson, are you familiar with the American Nurses Association Code of Ethics?

Johnson: Yes, we covered it in nursing school, and it was part of our hospital orientation.

Attorney: I'd like to direct your attention to Provision 3.4 of the Code. [Hands document] Please read the highlighted sentence.

Johnson: [Reading] "Reporting practice concerns, even when done appropriately, may present a substantial risk to the nurse; however, such risk does not eliminate the obligation to address threats to patient safety."

Attorney: Thank you. You mentioned earlier that you were hesitant to report your concerns because Dr. Williams had previously responded negatively to nurses questioning his care. Is that correct?

Johnson: Yes. He had a reputation for being... difficult with nursing staff.

Attorney: So, were you concerned about potential professional risk to yourself?

Johnson: I was concerned about conflict, yes.

Attorney: But according to the ethical standards of your profession, as we just read, does that concern about personal risk eliminate your obligation to address threats to patient safety?

Johnson: No, it doesn't.

Attorney: Would you agree that signs of a potential surgical site infection threaten patient safety?

Johnson: Yes.

Attorney: In your professional judgment, would notifying the physician or charge nurse about these symptoms have been appropriate to address that threat?

Johnson: Yes, looking back, I should have reported it.

Attorney: And if you had reported these signs promptly, treatment could have been initiated earlier, potentially preventing Mr. Evans' sepsis and subsequent cardiac arrest, correct?

Defense Attorney: Objection to the form. You can answer if you think you understand the question.

Attorney: I'll rephrase. Based on your nursing education and experience, is early intervention important in treating surgical site infections?

Johnson: Yes, early intervention is important.

Attorney: And according to your profession's ethical standards, despite any personal risk, you had an obligation to report your observations that evening, didn't you?

Johnson: Yes.

Case Study: The Defense Perspective on Provision 2.1

Case Narrative: Torres v. Riverside Community Hospital

During a hectic night shift at Riverside Community Hospital, the emergency department was severely understaffed, with nurse-to-patient ratios far exceeding recommended guidelines. Lisa Torres, RN, was assigned six high-acuity patients, including two critical cardiac cases, when a typical assignment in this emergency department was four patients per nurse.

Among Torres's patients was 58-year-old Robert Winters, who had presented with chest pain and shortness of breath. The hospital's protocol required all chest pain patients to receive an ECG within 10 minutes of arrival. However, due to the overwhelming patient load, Torres could not perform Winters' ECG until 22 minutes after his arrival.

When Torres finally conducted the ECG, she immediately recognized signs of an acute myocardial infarction. She contacted the attending physician and activated the cardiac response team. Winters was rushed to the catheterization lab, where an intervention was performed. Though the procedure was successful, Winters suffered moderate cardiac damage.

Winters later sued the hospital and Torres, claiming the delay in performing the ECG caused unnecessary heart damage. The plaintiff's attorney argued that Torres failed to follow hospital protocol regarding timely ECG assessment.

Before the incident, Torres had repeatedly notified the hospital administration about unsafe

staffing levels through proper channels. She had explicitly requested additional nursing support that night but was told no staff was available. Torres documented her concerns about patient safety in the hospital's incident reporting system and the prioritization decisions she made given the understaffing situation.

Deposition Excerpt: Defense Attorney Questioning Nurse Torres

Defense Attorney: Ms. Torres, can you describe the staffing situation in the emergency department on the night Mr. Winters arrived?

Torres: The department was severely understaffed. I was assigned six high-acuity patients, including two cardiac cases requiring continuous monitoring. A typical assignment in our emergency department is four patients per nurse.

Defense Attorney: Have you raised concerns about this staffing situation?

Torres: Yes. I notified my charge nurse and the nursing supervisor at the beginning of the shift. I formally requested additional staff but was told none were available. I documented my concerns in the hospital's incident reporting system.

Defense Attorney: When Mr. Winters arrived, what were you doing?

Torres: I was administering critical cardiac medications to another patient whose condition had suddenly deteriorated. This required my immediate attention to prevent a potentially fatal outcome.

Defense Attorney: So, you faced a situation where you had to prioritize multiple urgent patient needs?

Torres: Yes. Based on their conditions, I had to make clinical judgments about which patients needed my immediate attention.

Defense Attorney: Ms. Torres, are you familiar with the American Nurses Association Code of Ethics?

Torres: Yes, I am. It guides my practice daily.

Defense Attorney: I'd like to direct your attention to Provision 2.1. [Hands document] Please read the highlighted portion.

Torres: [Reading] "Within the context of nursing practice, the nurse prioritizes recipients of nursing care, placing them over institutions."

Defense Attorney: How does this ethical principle relate to your decisions that night?

Torres: This provision recognizes that my primary obligation is to my patients, not institutional policies or metrics. When faced with impossible demands, I prioritized direct patient care over strictly adhering to timeframe policies. I made decisions based on clinical assessment of which patients were most critically in need at each moment.

Plaintiff's Attorney: But Ms. Torres, the hospital has a clear protocol stating chest pain patients must receive an ECG within 10 minutes. You failed to meet that standard, correct?

Torres: I was unable to perform the ECG within that timeframe because I was providing life-saving care to another critical patient. The Code of Ethics directs me to prioritize patient care needs over institutional requirements when such conflicts arise.

Defense Attorney: In your professional judgment, if you had left your critical cardiac patient to perform Mr. Winters' ECG within the 10-minute window, what might have happened?

Torres: The other patient could have suffered serious harm or possibly died. I had to make a clinical judgment about which situation presented the most immediate threat to life.

Defense Attorney: Did you document your clinical reasoning and the circumstances affecting your care decisions?

Torres: Yes. I documented the staffing situation, prioritization decisions, and the care I provided each patient. I also completed an incident report highlighting the unsafe conditions and how they impacted patient care.

Defense Attorney: Ms. Torres, would you say your actions that night were guided by what was best for your patients, given the circumstances?

Torres: Absolutely. I did everything possible to provide safe care to all my patients while working under extremely difficult conditions. I made decisions based on clinical priorities, not convenience or institutional metrics. The ethical guidance in our Code directed me to place patient needs first, even when I couldn't meet every institutional timeframe requirement.

Strategy for the Nurse Witness: Contextualizing the Code of Ethics

After reviewing these case studies, it becomes clear that attorneys may strategically isolate specific lines from the ANA Code of Ethics to advance their arguments. As a nurse witness, understanding how to respond to these tactics is crucial for providing accurate and contextual testimony.

The Context Principle: Never Accept Isolated Quotes

The ANA Code of Ethics was designed as an integrated document, with each provision building upon and informing the others. Individual sentences cannot be properly interpreted in isolation from their surrounding context. When faced with an attorney who presents a single sentence and asks for your agreement, employ the following strategy.

First, request to read the entire provision before answering any questions about specific lines. This is not being difficult—it's ensuring your testimony accurately reflects the Code's intent. Clearly state that ethical principles require context for proper interpretation and application to clinical situations.

Second, take your time reviewing the document. Depositions are not races. Attorneys may create an atmosphere of urgency, but you have the right to consider documents presented to you carefully. Remember that your testimony is recorded and may significantly impact the case outcome.

Third, maintain control of your pacing. If you feel rushed or pressured, calmly state that you need additional time to review the material thoughtfully. The transcript will likely not show how quickly you answered. It will only show what you said.

Sample Deposition Strategy in Action

Attorney: Nurse Reynolds, I'm showing you the ANA Code of Ethics. Are you familiar with this document?

Nurse: Yes, I am.

Attorney: Great. Please read line 3 on page 22. [Hands document]

Nurse: Before I read just that line, I'd like to see which provision this is part of and read the entire provision for context.

Attorney: I'm just asking you to read this one sentence. It's a simple request.

Nurse: I understand, but the Code of Ethics provisions work together as a cohesive guide. To interpret any single sentence accurately, I need to understand its context within the provision. I'd be happy to read the line after reviewing the full provision it's part of.

Attorney: Fine. You can read the paragraph.

Nurse: [Takes time to read carefully] Thank you. Now I understand the context. The specific line you're referring to states: "The nurse advocates for the delivery of dignified and humane care." However, this is part of a broader discussion about the nurse's role in maintaining professional boundaries while still providing compassionate care.

Attorney: You agree that nurses must advocate for humane care in all circumstances?

Nurse: The Code directs nurses to advocate for dignified and humane care, but this must be understood within the full context of nursing practice. The same provision also acknowledges that nurses face complex situations requiring professional judgment. It's important not to oversimplify ethical guidance by focusing on isolated statements.

Attorney: Let me be more specific. In Mr. Johnson's case, when his pain medication was delayed by two hours, would you agree that this violated the ethical obligation to provide humane care?

Nurse: I would need to know the full clinical context of that situation before making such a determination. The Code of Ethics recognizes that nursing practice involves balancing multiple ethical considerations. There could be legitimate clinical reasons for medication timing decisions that don't constitute ethical violations.

Attorney: But the Code clearly states nurses must advocate for humane care. A two-hour delay in pain medication doesn't seem humane, does it?

Nurse: The Code guides us to advocate for humane care while using professional judgment in complex situations. I cannot make a blanket statement about whether a medication timing decision meets ethical standards without knowing the specific clinical circumstances, staffing conditions, patient assessment findings, and other relevant factors.

Key Takeaways for Nurse Witnesses

Remember these essential strategies when facing questions about the Code of Ethics during depositions:

1. Insist on reviewing complete provisions, not isolated sentences.

2. Take the time you need to read and comprehend the material thoroughly.

3. Acknowledge the ethical principle but contextualize it within nursing's complex practice environment.

4. Avoid absolute answers about specific clinical scenarios without knowing all relevant factors.

5. Maintain professional composure even when attorneys employ pressure tactics.

By approaching ethical questions with these strategies, nurse witnesses can provide testimony that accurately reflects the letter and spirit of the ANA Code of Ethics rather than allowing it to be mischaracterized through selective quotation.

A Call to Action: Embracing the Code of Ethics as Essential Professional Knowledge

The ANA Code of Ethics is the gold standard for nursing ethical practice regardless of specialty, setting, or organizational membership. Yet many nurses encounter this foundational document only superficially during their education or practice. This limited familiarity creates vulnerability for individual nurses facing litigation and the profession's ethical integrity.

Every practicing nurse, whether an ANA member or not, should thoroughly understand the Code of Ethics. This is not merely an academic exercise but a practical necessity. A well-internalized ethical framework provides crucial guidance when facing ethical dilemmas in clinical practice. When called to account for clinical decisions in legal proceedings, familiarity with the profession's ethical standards allows nurses to articulate their reasoning confidently and clearly.

Nursing schools should recognize the Code of Ethics as an essential curriculum, not peripheral content. Ethics education should extend beyond brief introductory lectures to integrated applications throughout the educational journey. Faculty should incorporate ethical analysis into clinical scenarios, simulation exercises, and case studies. Nursing students should graduate knowing that the Code exists and understanding how it guides decision-making in complex healthcare environments.

Professional development for practicing nurses should include regular refreshers on ethical standards. Healthcare organizations would benefit from incorporating Code of Ethics discussions into unit meetings, continuing education, and institutional policies. Creating a culture where ethical reflection is valued and ethical reasoning is explicitly articulated strengthens patient care and professional practice.

The Code’s legal implications—illustrated throughout this article—underscore its practical importance. Understanding how the Code functions as evidentiary support in litigation is relevant for nurses involved in legal proceedings and everyday clinical practice. The same ethical principles that might one day be scrutinized in a deposition should consciously guide clinical decisions at the bedside.

Ethical literacy becomes valuable and essential as the profession navigates increasingly complex healthcare environments. Challenges related to technology, resource allocation, healthcare disparities, and global health issues demand nurses equipped with robust ethical frameworks. The Code of Ethics provides this foundation only if nurses actively engage with it, internalize its principles, and apply its guidance to their practice.

The time for passive awareness of nursing ethics has passed. Every nurse should actively embrace the Code of Ethics as an integral part of professional identity and practice. Nursing's future and the well-being of those we serve depend on a profession unified by shared ethical commitments and fluency in the language of its own moral standards.

Conclusion: Navigating Ethical Waters in an Evolving Landscape

With its recent 2025 revision and subsequent modifications, the ANA Code of Ethics represents both an anchor and a compass for the nursing profession. It grounds nursing practice in enduring values and consistent ethical principles as an anchor. As a compass, it provides direction through the increasingly complex terrain of modern healthcare.

The Code's role in nursing negligence litigation highlights its practical significance beyond theoretical ethics. As we've seen, the document that guides everyday clinical decisions can become a powerful tool in legal proceedings—whether to establish a breach of duty or defend principled nursing actions. This dual function underscores why a thorough understanding of the Code is essential for every practicing nurse.

The tension between the original 2025 publication and its subsequent revisions reveals something important about nursing ethics: they exist within real-world contexts where clarity and flexibility must coexist. The profession continues to grapple with articulating ethical obligations that are firm enough to provide clear guidance and nuanced enough to accommodate clinical complexity.

For attorneys engaged in nursing negligence litigation, the Code offers a window into nursing's professional self-understanding. Effectively using this document requires appreciating its letter and spirit—recognizing that ethical nursing practice involves thoughtful application of principles rather than rigid rule-following.

For nurses, the Code serves as both protection and challenge. It protects by establishing recognized standards that validate sound clinical judgment. It challenges by setting high expectations for professional conduct even in difficult circumstances. Embracing both aspects is part of nursing's professional maturity.

As the profession progresses, ongoing dialogue about how ethical standards translate into clinical practice remains essential. The Code will continue to evolve, but its fundamental purpose—articulating nursing's moral covenant with society—remains constant.

I invite attorneys, nurses, and healthcare leaders interested in exploring these topics further to contact me for consultation, educational presentations, or case reviews. With experience spanning clinical practice, nursing education, and legal nurse consulting, I offer a unique perspective on the intersection of nursing ethics and legal standards. Visit my website at www.garveyces.com or contact me at matthew.garvey@garveyces.com to discuss how these insights might apply to your situation.

Together, we can work to ensure that nursing's ethical foundations remain strong while adapting to emerging challenges in healthcare delivery and legal accountability.

AI Assistance Disclosure: This article was developed, in part, with the assistance of artificial intelligence tools. The author has reviewed and edited all content to ensure accuracy and alignment with the author's professional expertise and opinions.