Provision 2 of the ANA Code of Ethics for Nurses

"Provision 2: A nurse's primary commitment is to the recipient(s) of nursing care, whether an individual, family, group, community, or population" (ANA, 2025, p. 5). 

ANA Code of Ethics for Nurses

According to the 2025 edition of the Code of Ethics for Nurses, this provision includes four areas: a primary commitment to recipients of nursing care; conflicts of interest and conflicts of commitment in nursing; professional boundaries; and issues of safety in the nurse-patient relationship (pp. 5-7).

My dissertation, The experience of accelerated nursing program graduates utilizing ethics in their nursing practice 

Reading through this provision made me think of an example from my doctoral research. As written in my dissertation (McLaughlin, 2016) on pages 62-63:  

Catherine mentioned breaches in integrity such as students cheating in her accelerated program to achieve good grades, and a clinical faculty member breaking technique.  This faculty member broke sterile technique when placing a Foley but continued to use that kit and finish the insertion.  This faculty member did report it to the patient’s nurse.  To this, Catherine commented, “I guess she was trying to set an ethical standard by saying, ‘Look I told, it’s OK, I told someone.’”  She added, “I thought it was interesting that you would break technique, say it’s OK, and then say it’s even more OK because you told someone about it.”  This faculty member was eventually fired from the school for unknown reasons, but instead of using this incident as a teachable moment, the school never discussed it again.  After this incident, Catherine felt that students worried about reporting errors were less likely to report errors in the future.  To support this, Catherine told the following story:

     They always talk about whenever you make a mistake, admit to it.  Own up to it.  We can’t fix problems unless people admit their mistakes.  But then this person makes a mistake and is fired instantly.  And it was done in such a hush-hush way; it was all rumor mills for all the other students and none of the professors would talk about it; a lot of people were really confused about the message of, “If I admit if I give a med wrong, am I going to be fired instantly too?”

 

Alignment of this example with the ANA Provision 2 of the Code of Ethics for Nurses (2025)

I feel the example provided highlights this area of Provision 2: issues of safety in the nurse-patient relationship. 

As the ANA (2025) states on page 7 of The Code:

The nurse-patient relationship may be negatively impacted by a lack of safety or safety measures in a given environment or situation. Nurse must evaluate safety 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. 

I really feel this example pertains to the physiological threats to the patient. By breaking sterile technique, it put the patient at risk for an infectious process. The instructor knowingly proceeded with placing the Foley catheter despite a break in sterile technique. One may also argue that the instructor exercised an emotional threat to the nursing students as well. It could be said that their actions were an act of intimidation.  The nursing student did not feel comfortable going against the instructor and speaking up on behalf of the patient. 

The Siciliano-McLaughlin Model of Ethics

This example also aligns with my Model of Ethics. It speaks to advocacy since the student did not advocate on behalf of the patient. The student probably felt as if they could not advocate here without being reprimanded from the instructor. It also addresses dignity and humanity by completing a task that may be a physical threat to the patient (setting up an infectious process). This situation also demonstrates a lack of integrity especially on the part of the instructor (she chose to do the wrong thing). The instructor is not demonstrating appropriate leadership to the student or staff nurse as well. Overall, this instructor lacked authenticity in this situation. 

Do you have any examples that align with Provision 2 or my Model of Ethics? As always, I would love to hear from others. Feel free to leave a comment. 

References

American Nurses Association (ANA). (2025). Code of ethics for nurses. Silver Spring, MD: Nursesbooks.org. 

McLaughlin, M. A. S. (2016). The experience of accelerated nursing program graduates utilizing ethics in their nursing practice (Publication No. 10195870) [Doctoral dissertation, Columbia University]. ProQuest Dissertations and Theses Global.