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Understanding the Legal and Ethical Factors that Influence Nursing Practice

A nurse holding a patient's hand Description automatically generated with low confidence


Recent innovations and developments in the healthcare industry have revolutionized nursing practice. However, as the nursing field changes, nurses face new ethical and legal challenges and dilemmas. Therefore, there is a need for healthcare professionals to understand the legal and ethical factors influencing their practice.

This article will give you a detailed insight into the legal and ethical issues in nursing practice.

What are the differences between legal and ethical factors in nursing practice?

The healthcare industry is governed by sets of legal and ethical standards. Legal standards are designed to protect nurses when making decisions about their nursing practice. They also set out the roles and functions of nursing professionals. However, legal and ethical standards are different. For instance, while legal standards are designed by state or governmental laws, ethical standards don’t necessarily include a legal basis.

Legal standards are essential because they help nurses to understand what they are not supposed (allowed) to do. On the other hand, ethical standards are based on human principles of wrong and right. With legal factors, authorities can enforce rules and take action when a nurse does something illegal. On the other hand, ethical aspects do not have regulations.

Moreover, legal and ethical factors in nursing practice are different in how they are applied. For instance, legal principles apply to any healthcare professional within a healthcare facility or country that implements that specific rule or law. Conversely, ethical principles are considered personal and voluntary acts based on the individual’s perception of wrong or right.

Ethical issues in nursing practice

While there are many potential ethical considerations or issues in nursing practice, here are the nine ethical factors that significantly influence nursing practice.


Autonomy, the right of patients to make independent decisions about their healthcare based on cultural and personal belief systems, is a prime ethical factor influencing nursing practice.

Nurses should tell patients the truth about their health condition and inform them about the benefits and risks of treatment. Under the law, adult patients have the right to refuse procedures, medications or treatments, even if it conflicts with recommendations made by nurses. However, nurses should still respect the patient’s decision.

In the past, paternalistic physicians had the authority to make healthcare decisions. However, this has evolved over the years to allow patients to participate in making their own healthcare decisions.



In nursing ethics, beneficence refers to the act of taking action in the patient’s best interests. As Peter Ellis states, providing care that benefits patients entails facilitating their wellbeing by offering quality and safe care.

Sometimes, ethical dilemmas may arise while applying the principle of beneficence and autonomy – for instance, a decision has to be made on whether the nurse should respect the patient’s autonomy when offering the best healthcare. In such a situation, Chadwick recommends that nurses consider the patient’s health benefits rather than their autonomy.


You have probably heard of this principle, which means not doing harm. As Debra J. Hain states, nurses should create a safe environment to minimize or eliminate harm to patients.

For example, some patients may choose to hasten death due to too much pain. Although the choice to ‘die with dignity’ is an ideal manifestation of patient autonomy, it is hard for a nurse to accept death when there are many viable options.

Here, we see two conflicting principles (autonomy and nonmaleficence). Therefore, nurses should give patients enough information needed to make informed about the courses of action available to them. However, you should note that going against the patient’s wishes can result in more subsequent harm and mental anguish.



In some instances, nurses ought to communicate unpleasant information to their patients. Therefore, veracity is a nursing ethical principle that requires completely honesty and openness with patients, even if the truth can cause harm or distress.

Therefore, velocity helps in establishing and strengthening patient-nurse relationships. It also strengthens patient autonomy, as patients are able to make informed healthcare decisions based on factual and relevant information.

However, there are times when professional ethics and legal systems agree that veracity can be daunting and detrimental to the patient’s wellbeing. Therefore, nurses are sometimes recommended to withhold information.



Fidelity refers to the special relationship established between nurses and their patients. For instance, each owes the other faithfulness and loyalty. The greater fidelity burden is on healthcare providers. However, patients must assume some fidelity responsibilities.

Generally, fidelity always results in a conundrum because a nurse’s commitment to a particular patient may not transform into the best outcome for that patient. Fidelity is based on the importance of being true to your word or keeping a promise. However, some nurses and/or patients see this differently. For instance, some nurses can set aside their fidelity if an action could be detrimental to the patient, while others promote fidelity at all costs.



Justice plays a crucial role in the nursing practice code of ethics. For instance, every nurse is responsible for making healthcare decisions based only on facts and not on other factors, such as the patient’s sexual orientation, socioeconomic status, religion, ethnicity and age.

To uphold justice in nursing practice, you should act as an impartial and fair healthcare-giver. This helps your patients to feel more valued. For instance, treating your patients impartially, regardless of their situation, is vital in ensuring that they participate and accept their own care. As a result, this usually leads to optimal patient outcomes.



Accountability is one of the critical ethical factors influencing nursing practice. For instance, every nurse must be responsible for their actions and choices in patient care.

Generally, healthcare providers who hold themselves accountable usually offer higher-quality healthcare services. They will most likely build solid relationships with their patients due to increased trust. Moreover, accountable nurses often adhere to their practice scope and, in most cases, are greatly appreciated by their patients and colleagues.



Patient confidentiality is a significant ethical factor that influences nursing practice. Confidentiality can have serious legal consequences for nursing professionals if not done correctly. For instance, nurses must maintain the patient’s right to privacy and confidentiality to maintain a positive nurse-patient relationship.

While the Health Insurance Portability and Accountability Act (HIPAA) protects the patient’s medical and healthcare information, there are definite guidelines and boundaries for safeguarding the privacy of patients.

Informed consent

Informed consent can also present an ethical dilemma for nurses. For instance, there can be a dilemma when patients and their families do not understand or have not been informed about the treatment, medication and procedures used on the patient.

While most patients find it uncomfortable to ask questions, they find it difficult to give treatment consent without understanding the effects of their treatment. However, nurses can prevent these ethical dilemmas by ensuring that their patients fully understand all the facets of their medication, procedure and treatment plans. This helps patients to obtain informed consent securely.

Legal issues in nursing practice

The legal factors influencing nursing are determined by the scope of practice, law, licensure and expectations of high professional standards. They include the following.

Standards of care

The standards of care are the guidelines that govern nursing practice. They ensure that nurses offer competent and safe healthcare services to patients. The standards of care are determined by the employment healthcare agencies, healthcare professional organizations, and nursing councils or nurse registration boards.

For example, employment healthcare agencies design written protocols and policies that detail how healthcare professionals are expected to perform their roles. Healthcare professional organizations design nursing service standards in policy statements. On the other hand, nursing councils define the nursing practice scope.

Therefore, a nurse should understand the standards of care that they are expected to meet.

Code of conduct and ethics

The code of conduct presents the rules and standards that a nurse must uphold to protect, promote and respect the fundamental rights of patients. The code of conduct outlines the professional boundaries and legal requirements of nurses in the healthcare practice – for example, it provides the standards and guidelines that nurses should follow.

Generally, nurses should always follow the guidelines and standards of the code. Their action should meet the standard of healthcare expected from a registered nurse. They should always make decisions based on importance and priority. They are also expected to provide person-based nursing care.



Battery is an intentional tort. In nursing practice, battery is the deliberate causation of offensive or harmful contact with a patient without their consent. For instance, patients have the right to refuse physical interaction or help and even treatment. They can seek legal intervention if a nurse touches them without their consent.

For example, a hospitalized patient can refuse to take prescribed medication. If a nurse forcibly administers medication without the patient’s consent, they can be sued for battery in a court of law. However, forcible medical administration based on the nurse’s order can be justified in emergency medical circumstances to prevent imminent harm or risks.


Malpractice and negligence

Nurses are often at high risk of being charged with negligence and malpractice. For instance, a patient injured during medical treatment – for example, harmed by a defective medical tool or piece of equipment, or injured due to medical errors – can sue the nurse to recover their loss.

A patient can also sue when a nurse fails to offer a critically needed medical service or treatment. Therefore, because of the ever-present litigation threats, nurses should carefully cover all the bases while providing healthcare services.

Dealing with legal and ethical issues in nursing practice

Nurses require many years of education and clinical experience before they become certified registered nurses. Coping with real legal and ethical dilemmas in nursing is more complex than dealing with hypothetical challenges in textbooks.

However, healthcare professionals can learn to deal with legal and ethical issues in nursing practice by interacting with patients and gaining real-life experience. There are also many non-hospital jobs that can help you deal with ethical and legal dilemmas in nursing. To find out more about jobs for nurses outside the hospital, read Elmhurst University’s blog, linked to here.

You can also benefit by surrounding yourself with experienced nurse managers and well-seasoned nurses. For instance, you can rely on their guidance when dealing with situations that you may not know how to address.

Experienced nurse managers can create an educational environment where they regularly discuss legal and ethical factors faced by nurses in their unit. Through open discussion, you can learn how to approach various legal and ethical challenges and issues in your nursing practice.



Nursing professionals and patients face legal and ethical decisions daily concerning their practice, hospital management, medical treatments, and other matters that arise in the healthcare industry. Therefore, obtaining a degree in healthcare management can help you become aware of ethical and legal issues in nursing practice.


Sean Jacobson

I'm Sean, a former HR and business consultant providing you insights into the business world for Leader to Leader.

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