2.3 Ethical Principles & Nursing Code of Conduct

2.3 Ethical Principles & Nursing Code of Conduct

Key Takeaway for Internationally Qualified Nurses (IQNs): Nursing ethics in Aotearoa New Zealand provides the moral compass for professional practice. Registered Nurses must ground their daily practice in the Nursing Council of New Zealand (NCNZ) Code of Conduct's 8 core principles while applying classical biomedical ethical principles to navigate complex clinical dilemmas.

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1. The NCNZ Code of Conduct for Nurses

The Code of Conduct for Nurses published by NCNZ sets out the standards of ethical conduct and professional behaviour expected of all registered nurses, enrolled nurses, and nurse practitioners in New Zealand. The Code acts as a legal and ethical benchmark; failure to adhere to the Code can form the basis of a competence investigation or professional disciplinary charge before the Health Practitioners Disciplinary Tribunal (HPDT).

The 8 Core Principles of the NCNZ Code of Conduct

Principle 1: Respect Consumer Dignity & Individuality
Principle 2: Respect Cultural Needs & Values
Principle 3: Work in Partnership to Promote Well-Being
Principle 4: Maintain Trust through Safe & Competent Care
Principle 5: Respect Privacy & Confidentiality
Principle 6: Support Informed Decision-Making
Principle 7: Promote & Protect Health & Safety
Principle 8: Maintain Professional Integrity & Public Trust

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2. Fundamental Ethical Principles in Nursing

Biomedical ethics provides the theoretical framework for evaluating moral duties and resolving conflicts in patient care.

1. Autonomy (Self-Determination)

Autonomy asserts that individuals have the moral right to make independent decisions regarding their own body, health, and healthcare interventions. Respecting autonomy requires nurses to:

• Support informed consent and respect informed refusal of treatment by competent adults.
• Honor advance directives and enduring powers of attorney (EPOA).
• Refrain from paternalism (overriding a consumer's autonomous choice simply because the nurse disagrees with their decision).

2. Beneficence (Doing Good)

Beneficence imposes a moral obligation to act for the benefit of others, promoting health consumer well-being, preventing harm, and removing harmful conditions.

• Clinical Example: Administering prescribed pain management promptly, advocating for necessary surgical interventions, and providing comfort measures.

3. Non-Maleficence (Do No Harm)

Non-maleficence dictates that nurses must avoid inflicting harm, risk, or injury on health consumers. Where interventions carry inherent risk, the nurse must ensure benefits substantially outweigh risks.

• Clinical Example: Double-checking high-alert medication dosages prior to administration, maintaining strict aseptic technique to prevent healthcare-associated infections.

4. Justice (Fairness & Equity)

Justice demands that health consumers be treated fairly, equitably, and without discrimination, regardless of socio-economic status, ethnicity, age, or gender. It involves the equitable distribution of scarce health resources.

• Clinical Example: Triage in emergency departments based strictly on clinical urgency rather than social status or insurance coverage.

5. Fidelity (Faithfulness & Promise-Keeping)

Fidelity requires loyalty, truthfulness to commitments, keeping promises, and upholding professional duties within the nurse-consumer relationship.

• Clinical Example: Following through when telling a patient you will return in 10 minutes to reassess their pain.

6. Veracity (Truthfulness)

Veracity is the obligation to tell the truth and provide accurate, honest information to health consumers without deception or misleading omissions.

• Clinical Example: Disclosing medication errors transparently to patients and clinical leads during open disclosure processes.

| Ethical Principle | Core Meaning | Common Clinical Conflict | | :--- | :--- | | Autonomy | Self-determination & choice | Patient refusing life-saving blood transfusion (Jehovah's Witness) | | Beneficence | Duty to do good & benefit patient | Administering painful chemotherapy to prolong survival | | Non-Maleficence | Duty to prevent harm | Restraining an agitated consumer vs risk of fall injury | | Justice | Fair allocation & non-discrimination | Allocating limited ICU beds during pandemic surge | | Fidelity | Faithfulness & keeping promises | Balancing loyalty to a colleague vs reporting their error | | Veracity | Truthfulness & honest disclosure | Family requesting nurse withhold terminal cancer diagnosis from patient |

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3. Resolving Clinical Ethical Dilemmas

An ethical dilemma arises when a nurse is faced with two or more moral imperatives that conflict, and adhering to one principle results in violating another.

Systematic Ethical Decision-Making Model

1. Assess the Context: Gather comprehensive clinical, social, and cultural data.
2. Identify the Ethical Conflict: Articulate which specific principles (e.g., Autonomy vs Beneficence) are in opposition.
3. Explore Options & Stakeholder Perspectives: Include the consumer, whānau, interprofessional team, and cultural advisors.
4. Apply Moral & Legal Frameworks: Review NCNZ Code of Conduct, HDC Rights, Te Tiriti obligations, and institutional policies.
5. Select & Implement Action: Execute the ethically justified decision with clear documentation.
6. Evaluate Outcomes: Reflect on the process and outcome to inform future practice.