Professionalism, Professional Values, Ethics & Legal Aspects of Nursing
Key Takeaways
The core ethical principles of nursing are autonomy, beneficence, non-maleficence, justice, veracity, fidelity and confidentiality.
The 2021 ICN Code of Ethics for Nurses has four elements: nurses and patients or other people requiring care, nurses and practice, nurses and the profession, and nurses and global health.
Negligence requires four elements: a duty of care, breach of that duty, causation, and resulting harm.
The National Nursing and Midwifery Commission Act, 2023 replaces the Indian Nursing Council Act, 1947, but the Indian Nursing Council continued to function because the commission had not been constituted by mid-2026.
In Common Cause v. Union of India (2018) the Supreme Court recognised advance medical directives (living wills), and it simplified the procedure in 2023.
Nursing is a profession, not just an occupation, because nurses are accountable for judgements that affect patients' lives. This subject tests professional values, ethical reasoning and the legal duties of a Nursing Officer in a government hospital.
1. Nursing as a Profession
Characteristics of a profession (from Abraham Flexner's 1915 criteria and later writers):
- A specialised body of knowledge learned through prolonged education.
- Service to society as the main motive (altruism).
- Autonomy and self-regulation through a professional council.
- A code of ethics.
- A professional organisation and lifelong learning.
Florence Nightingale founded modern nursing: Crimean War service (1854), Notes on Nursing (1859), and the Nightingale Training School at St Thomas' Hospital, London (1860). Her birthday, 12 May, is International Nurses Day. The Nightingale Pledge (1893) was written by Lystra Gretter.
Professional organisations: International Council of Nurses (ICN, founded 1899); Trained Nurses' Association of India (TNAI, founded 1908); Indian Nursing Council (INC).
Core professional values
| Value | What it looks like on the ward |
|---|---|
| Altruism | Putting the patient's welfare first |
| Autonomy | Respecting the patient's right to decide |
| Human dignity | Privacy, respect, non-discrimination |
| Integrity | Honest documentation; admitting errors |
| Social justice | Equal care regardless of caste, religion, gender, income or HIV status |
| Accountability | Answering for one's own actions and omissions |
2. Ethical Principles
| Principle | Meaning | Example |
|---|---|---|
| Autonomy | Respect a competent person's right to make decisions | Accepting an informed refusal of surgery |
| Beneficence | Do good; act in the patient's best interest | Turning an immobile patient two-hourly |
| Non-maleficence | Do no harm | Checking for allergies before a drug |
| Justice | Fair distribution of care and resources | Triage by need, not status |
| Veracity | Tell the truth | Honest answers within one's scope |
| Fidelity | Keep promises; be faithful to commitments | Returning to give the analgesic as promised |
| Confidentiality | Protect patient information | Not discussing a patient's HIV status with visitors |
An ethical dilemma arises when two principles conflict—for example, autonomy (a patient refuses a blood transfusion) versus beneficence (the transfusion would save life). Nurses work through it by gathering facts, identifying the principles in conflict, considering options and consequences, consulting the team or ethics committee, acting, and evaluating.
3. Codes of Ethics
- ICN Code of Ethics for Nurses (first adopted 1953; revised 2021). Its four elements are: nurses and patients or other people requiring care or services; nurses and practice; nurses and the profession; and nurses and global health (the last added in the post-COVID revision).
- Indian Nursing Council Code of Ethics and Code of Professional Conduct: respect for persons and their dignity, safe and competent practice, confidentiality, honesty, working collaboratively, and continuous learning.
4. Nursing Regulation in India
- The Indian Nursing Council Act, 1947 created the INC to set uniform standards of nursing education and maintain the Indian Nurses' Register.
- The National Nursing and Midwifery Commission (NNMC) Act, 2023 (passed by Parliament in August 2023; in force from 2024) replaces the INC Act. By mid-2026 the commission had not been constituted, so the INC continued to discharge regulatory functions.
- State Nursing Councils register nurses and midwives. OSSSC requires valid registration with the Nursing Council of the State of Odisha at the time of application.
- Practising without valid registration, or beyond one's scope, can lead to disciplinary action.
5. Legal Terms Every Nurse Must Know
| Term | Meaning |
|---|---|
| Negligence | Failure to exercise the care a reasonably prudent nurse would exercise. Four elements: duty, breach, causation, damage (harm) |
| Malpractice | Professional negligence by a licensed practitioner |
| Assault | Threat or attempt to touch without consent |
| Battery | Actual touching without consent (e.g., giving an injection a competent patient has refused) |
| False imprisonment | Unjustified restraint or detention of a patient |
| Defamation | Damaging someone's reputation—libel (written) or slander (spoken) |
| Invasion of privacy | Unauthorised disclosure, photographs, or exposure |
| Res ipsa loquitur | "The thing speaks for itself"—e.g., a swab left in the abdomen |
| Vicarious liability | The employer is liable for the acts of employees in the course of duty |
Consent
- Informed consent: the person understands the nature, purpose, risks, benefits and alternatives and agrees voluntarily. The doctor or person doing the procedure explains; the nurse may witness the signature and must report if the patient does not understand.
- Implied consent: shown by conduct (holding out an arm for a blood sample).
- Express consent: spoken or written.
- Minors (under 18 years in India) and persons without capacity: consent is given by a parent or legal guardian, except in emergencies where life-saving treatment cannot wait.
- A competent adult may refuse treatment; document the refusal and inform the doctor.
Documentation and medico-legal cases
- Records are legal documents: write factually, legibly and promptly; never alter or back-date entries.
- Medico-legal cases (MLCs) such as road accidents, assaults, burns, poisoning and suspected abuse must be registered and the police informed; preserve evidence (clothing, samples) and maintain the chain of custody.
- Since 1 July 2024, new criminal laws have replaced the IPC, CrPC and Indian Evidence Act: the Bharatiya Nyaya Sanhita (BNS), the Bharatiya Nagarik Suraksha Sanhita (BNSS) and the Bharatiya Sakshya Adhiniyam (BSA).
Consumer protection
The Supreme Court brought medical services under consumer law in Indian Medical Association v. V. P. Shantha (1995). Patients can now seek compensation for deficient service under the Consumer Protection Act, 2019.
6. Patients' Rights and End-of-Life Decisions
- The Charter of Patients' Rights (prepared by the National Human Rights Commission and circulated by the Health Ministry in 2019) includes the rights to information, records, emergency care, informed consent, confidentiality, dignity, a second opinion, non-discrimination, and grievance redressal.
- Advance medical directives (living wills): the Supreme Court recognised the right to die with dignity and permitted passive euthanasia with safeguards in Common Cause v. Union of India (2018), and simplified the procedure in 2023. Active euthanasia remains illegal.
- Mental Healthcare Act, 2017: advance directives and nominated representatives for mental illness (see the mental health chapter).
- Transplantation of Human Organs and Tissues Act, 1994: regulates organ donation and bans commercial dealing.
A nurse gives an intramuscular injection to a competent adult who had clearly refused it. Which legal wrong has been committed?
Defamation
Battery
Invasion of privacy
False imprisonment
Which set lists the four elements that must be proved in a claim of nursing negligence?
Assault, battery, injury and compensation
Duty, breach of duty, causation and damage
Consent, documentation, supervision and harm
Intent, motive, opportunity and harm
Which element was added to the ICN Code of Ethics for Nurses in its 2021 revision?
Nurses and the profession
Nurses and co-workers
Nurses and practice
Nurses and global health
Sections you finish are checked off in the contents.