A Brief History of the Code of Ethics for Nurses

The first formal code of ethics for nurses was adopted in 1950 (Fowler, 1997). However, a need for ethical guidance was recognized soon after modern nursing began to formalize in the mid-1800s. Although in 1896, one of the initial goals of the newly established American Nurses Association was to write a code of ethics, urgent issues such as nurse registration, the welfare of nurses, and accreditation processes for nursing schools took precedence (Fowler, 1997). Thus, for many years, nurses had no formalized code of ethics and used Gretter’s Nightingale Pledge, akin to medicine’s Hippocratic Oath, to guide their practice (ANA, n.d.).

In the early 1900s, Isabel Hampton Robb’s text, Nursing's Ethics for Hospital and Private Use described the obligations of the nurse to the patient, physician, institution, self, and profession and the creativity needed to find solutions to problems and provide good nursing care (Robb, 1926). In 1926, the ANA published a “suggested” code which provided the first outline of ethical behavior for nurses (ANA, 1926). The provisions were framed in terms of the various relationships between the nurse and patient; the nurse and medicine; and nurses and their profession.  For example, the relation of the nurse to the patient involved “bringing all of the knowledge, skill, and devotion” to the work (ANA, 1926, p. 600).

At the same time as the suggested code, ethics was on the minds of nurse faculty and administrators in terms of training and educating nursing students and practicing nurses (Crawford, 1926; Ethical Problems, 1926; Ethical Problems, 1933; Fowler, 1997). Their work highlights the thinking of the time, that is, that character was a significant factor in determining right action. Ms. Beulah Crawford’s article, How and What to Teach in Nursing Ethics stated, “…in the end, it is the character of the nurse which makes her; if she has the right principles she will not go far wrong in the minor matters” (Crawford, 1926, p. 211) and included nursing etiquette or rules of conduct in the hospital setting. The article provided direction about which aspects of character and living help a nurse “steer her craft safely on the stormy seas” (p. 212), such as accepting authority, being adaptable to difficult situations, being industrious, and using “judgment in the use of the tongue” (p. 212).

A “Tentative Code” in 1940 (ANA, 1940) described nursing as a profession and outlined many provisions similar to those in the 1926 suggested code, including framing the provisions in terms of relationships to patient, colleagues, and profession. The first formal Code for Professional Nurses was adopted in 1950 and was edited slightly before being revised in 1960 (Fowler, 1997). The 1960 Code for Professional Nurses outlined 17 provisions beginning with the “fundamental responsibility…to conserve life, to alleviate suffering, and to promote health” and extending to accountability for practice and conduct, participation in research and “action on matters of legislation affecting nurses” (ANA, 1960, p. 1287) .

...the Code has been revised over time to introduce obligations to advance the profession and build and maintain a healthy work environment. The 1968 revision of the Code included several significant changes (ANA, 1968). First, prior to this revision, the provisions were simply listed with little, if any, interpretation. The new code provided brief interpretations which helped the nurse see how the provision might be applied. Second, the provisions were reduced from 17 to a more manageable 10. Finally, there was a fundamental shift in language in the 1968 revision. The obligations of the nurse changed from generalized responsibilities to “conserve life, alleviate suffering and promote health” (ANA, 1960, p 1287) to a deeper, more duty-based obligation to “respect the dignity of man, unrestricted by considerations of nationality, race, creed, color, or status” and to “safeguard the individual’s right to privacy” (ANA, 1968, p. 2582). With changes in the level of practice independence; advances in technology; societal changes; and expansion of nursing practice into advanced practice roles, research, education, health policy, and administration, the Code has been revised over time to introduce obligations to advance the profession and build and maintain a healthy work environment (ANA, 1976; ANA, 1985; ANA, 2001; ANA, 2015b).

Reference:
http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-20-2015/No2-May-2015/The-Nursing-Code-of-Ethics-Its-Value-Its-History.html#History