Last month we began our review of the new 2025 Code of Ethics for Nurses published by the American Nurses Association with Provision 1. In this post, we will discuss Provision 2: A nurse’s primary commitment is to the recipient(s) of nursing care, whether an individual, family, group, community or population.

Provision 2:  A nurse’s primary commitment is to the recipient(s) of nursing care, whether an individual, family, group, community, or population.

2.1. Primary Commitment to Recipients of Nursing Care

Nurses prioritize patient care over institutional interests, upholding dignity, rights, and informed decision-making. They support patient participation in care planning, ensuring access to all treatment options, even those unavailable at their institution. Nurses provide honest, non-directive discussions within their scope of practice and advocate for patient values and preferences, mediating conflicts when necessary. They escalate concerns when systemic barriers limit care, particularly for marginalized groups. Ultimately, nurses remain committed to preserving life and promoting health based on the patient’s needs and choices.

2.2. Conflicts of Interest and Conflicts of Commitment in Nursing.

 Nurses may face conflicts of interest or commitment in their practice and must recognize and manage them following professional guidelines. Conflicts arise when personal, financial, or institutional pressures interfere with patient care. Dual agency, such as working in correctional or military settings, can create ethical dilemmas. Conflicts of commitment occur when a nurse’s attention is diverted from patient care. Nurses must disclose conflicts and seek guidance, whether through second opinions, referrals, leadership escalation, or professional consultation, ensuring patient care remains the priority while maintaining ethical and professional standards.

2.3. Professional Boundaries

The nursing therapeutic relationship is  personal, and through it the nurse seeks to address illness and injury through the promotion, protection and restoration of health, including the alleviation of pain and suffering. Nurses establish professional boundaries to protect patients and manage power dynamics. They must monitor their actions to avoid over-involvement or under-involvement in their therapeutic relationships. Recognizing and addressing behaviors that compromise boundaries with patients, colleagues, or decision-makers is essential. Nurses must restore boundaries when threatened and seek support when necessary. Adhering to institutional policies, they use appropriate communication channels and handle patient gratitude with professionalism. In the correctional environment, accepting gifts, even something as small/insignificant as a sketch from an artistic incarcerated individual, is prohibited.  Maintaining ethical and professional integrity ensures patient-centered care remains the priority, and your position as the nurse is not compromised.

2.4 Issues of Safety in the Nurse-Patient Relationship

This section acknowledges that the nurse-patient relationship may be negatively impacted by a lack of safety or safety measures in each environment or situation. No where is this truer than in corrections, but we also have our custody colleagues to monitor patient behavior and help keep the nurse safe, which many of our nursing colleagues don’t have.  Nurses must be aware of safety concerns in every interaction, considering physiological (e.g., infectious diseases), physical (e.g., acts of violence), psychological (e.g., acts of verbal abuse), and emotional (e.g., acts of intimidation) threats to the nurse, the recipients of care, or others. Unsafe behaviors or actions must not be tolerated and must be addressed in a timely manner to restore safety and to help the patient safely participate in healthcare encounters.

In our next ethics post, we will discuss Provision 3:  Advocating for Persons Who Receive Nursing Care.

Please share your thoughts about Provision 2 in the comments below.