We have begun our review of the new 2025 Code of Ethics for Nurses published by the American Nurses Association with a review of Provision 1, 2 and 3. In this post, we will discuss Provision 4.

Provision 4: Nurses have authority over nursing practice and are responsible and accountable for their practice consistent with their obligations to promote health, prevent illness, and provide optimal care.

4.1. Responsibility and Accountability for Nursing Practice

Nurses are responsible for delivering ethical, competent, and compassionate care within their scope of practice. Accountability is inseparable from nursing, requiring sound judgment and adherence to professional standards, even when systems or technologies fail. Nurses must base role acceptance on education, competence, and patient safety risks. They advocate for ethical deliberation, seek resources for complex issues, and combat health misinformation. Staying informed on regulations, engaging in professional development, and contributing to quality care initiatives ensure nurses uphold their responsibilities to patients, colleagues, and the profession.

4.2. Addressing Barriers to Exercising Nursing Practice Authority

 Nurses face various barriers to exercising their authority, including hierarchical structures, economic constraints, and inadequate resources. Workplace violence, evolving technologies like AI, and system pressures can further limit nursing practice. To maintain authority, nurses must address these challenges, engage in decision-making, and advocate for supportive environments. Leadership plays a key role in empowering nurses to voice concerns. When institutional constraints persist, nurses seek guidance from ethics experts, literature, and professional organizations. Ensuring nurses have a meaningful role in healthcare decisions is essential for improving patient care and fostering a healthy work environment.

4.3 Ethical Awareness, Discernment, and Judgment

Ethical awareness in nursing means recognizing that all actions have moral implications. Nurses internalize values, virtues, and obligations, shaping their ethical identity through education and practice. Ethical judgment is inseparable from clinical expertise, guiding responses to patient needs and societal health challenges. Nurses advocate for social change, addressing systemic issues that impact health. Ethical discernment is present in everyday interactions, not just conflicts, ensuring compassionate, patient-centered care. In dilemmas, nurses rely on ethics resources and professional collaboration to make informed decisions, always striving to promote individual well-being and the common good.

4.4. Assignment and Delegation

Nurses are responsible for assigning and delegating tasks while ensuring adherence to nursing standards and policies. They must assess the competence of individuals receiving delegated tasks, considering their skills, experience, and patient needs. Nurses oversee delegated care, ensuring quality outcomes, and must only assign assessment and evaluation to qualified nurses. Leadership plays a key role in fostering safe, ethical environments with proper staffing, training, and open communication. Nurses also supervise student nurses, ensuring they receive appropriate support while maintaining patient safety. Employer policies do not absolve nurses of their accountability in delegation decisions.

In our next ethics post, we will discuss Provision 5:  The nurse has moral duties to self as a person of inherent dignity and worth, including an expectation of a safe place to work that fosters flourishing, authenticity of self at work, and self- respect through integrity and professional competence.

Please share your thoughts about Provision 4 in the comments below.