A Blueprint for 21st Century Nursing Ethics: Report of the National Nursing Summit

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Nursing Ethics for the 21st Century

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In August 2014, 50 nursing leaders came together in Baltimore for a summit meeting on Nursing Ethics for the 21st Century. They had set for themselves an ambitious agenda that could culminate in changing the nation’s health care culture so that it more strongly supports basic ethics principles and more effectively enables nurses to practice more ethically. That long-term process starts with changing work environments for nurses across the board.

For many reasons, the environments in which nurses work are changing rapidly, yet one core principle holds constant: nurses’ desire to serve their patients, families, and communities while fulfilling nursing values. These systemic changes create new opportunities for organizational arrangements and work designs that enhance the practice of nursing and ensure that the next generation of nurses can have meaningful careers in service to others.

While many observers of U.S. health care lament what is broken about our system, the summit participants concentrated on describing ways in which nursing as a profession could have a positive influence in four critical domains: clinical practice, education, research, and public policy. They laid out a specific blueprint and identified initial steps, which can be found on this website. And they made commitments to carry on this work—to themselves, to each other, and to the profession they revere.

Click for a printable summary of the report on this website.

The goals of the “Nursing Ethics for the 21st Century” national summit were to identify the strategic nursing ethics priorities for the profession and create a blueprint for the future that key individuals and professional organizations will adopt and implement to build capacity within nursing; create and support ethically principled, healthy, sustainable work environments; and contribute to the best possible patient, family, and community outcomes.

Fifty national leaders in the fields of nursing ethics, education, and research attended the summit, sponsored by the Johns Hopkins School of Nursing and the Johns Hopkins Berman Institute of Bioethics. The Summit and its follow-on activities have a growing list of collaborating partners.

Click below to join in making the vision a reality.



Ruth Faden, Director, Johns Hopkins Berman Institute of Bioethics


Patricia Davidson, Dean, Johns Hopkins University School of Nursing

Dialogue norms were proposed that included respect, non-attribution of specific comments to individuals or groups, and communication of the content of the Summit in an organized, deliberate way.

“There is a river flowing now very fast. It is so great and swift, that there are those who will be afraid. They will try to hold on to the shore. They will feel they are being torn apart and will suffer greatly.

Know the river has its destination. The elders say we must let go of the shore, push off into the middle of the river, keep our eyes open, and our heads above the water. And I say, see who is in there with you and celebrate. At this time in history, we are to take nothing personally. Least of all, ourselves. For the moment that we do, our spiritual growth and journey comes to a halt.

The time of the lone wolf is over. Gather yourselves! Banish the word struggle from your attitude and your vocabulary. All that we do now must be done in a sacred manner and in celebration.

We are the ones we’ve been waiting for.”

-Oraibi, Arizona, Hopi Nation

Click here for Shaping Nursing Ethics for the Future, recent article in nursezone.com.

Eight Key Assumptions

  1. In all settings in which nurses work, ethical challenges are embedded in everyday practice
  2. The need to strengthen the ethical foundation of nursing is urgent, particularly in light of pressures that threaten the integrity of individual nurses, the profession, and the people they serve
  3. The ANA Code of Ethics is foundational to understanding the ethical landscape for nurses, and serves as an invaluable resource and guide for how nurses carry out their professional ethical obligations
  4. Many ethical pressures arise more from disparities in the human resources, social capital, and financial resources available across the system (many of which result from resource allocation decisions and waste, rather than from resource scarcity) and contribute to persistent problems in access to care
  5. Moral distress is a pervasive reality for nurses when they are unable to translate their moral choices into action because barriers prevent them from practicing in accord with their values
  6. Nurses must define the boundaries of their professional responsibility with inter-professional colleagues in the environments where they practice
  7. Nurses are ideally situated to lead and contribute to contemporary models of care delivery, policy, research, and education [see The Future of Nursing: Leading Change, Advancing Health]
  8. Efforts to improve the ethical environment for nurses have a direct impact on the quality of care provided to patients and families and the sustainability of the health care system


Photo credit: World Health Organization Photo Library

All illustrations on this site were created at the National Nursing Ethics Summit by
Graphic Recorder Greg Gersch.

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