1. Fowler, Marsha D.

Article Content

In the beginning of modern nursing in the United States, there was ethics. As noted in the October/December 2018 column, from the 1800s to 1965, there were approximately 100 nursing ethics textbooks and editions were published. At any given time, two to 11 of these textbooks were in print. In addition, between the 1890s and 1965, hundreds of journal articles principally devoted to ethics, appeared in the Trained Nurse and Hospital Review (TNHR), the American Journal of Nursing (AJN), and other early nursing journals. In 1889, Harriet Camp wrote a six-article series for TNHR, "The Ethics of Nursing," in which she divided nursing ethics into seven "classes" (relationships) and then discussed the duties of each relationship in the article series. No author was listed for the article, only that the author was a female superintendent of a school of nursing in Brooklyn, New York. Camp was superintendent at the time. She writes,

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For convenience's sake, I will divide the duties of a nurse into seven classes: 1st. Those she owes to the family. 2nd. Those she owes to the doctor. 3rd. Those owing the family, friends, and servants of the patient. 4th. To herself. 5th. To her own friends. 6th. To her own hospital or school. 7th. To other nurses. (p. 179)


Over the century since, those seven classes of relationships were reconfigured, recombined, and reduced in number to: nurse to patient, nurse to other healthcare professionals, nurse to profession, nurse to self, and nursing to society. This relational motif remains imbedded in the current Code of Ethics for Nurses (American Nurses Association [ANA], 2015), moving from the patient to society.


Early nursing ethics focused on the moral character of the nurse, that is, on virtue. Nursing education was seen as equally moral formation and nursing formation, to the degree that there was as much ethics content in the curriculum as there was medical-surgical content. In other words, ethics was not the "frosting on the cake"; it was much of the cake itself. Moral character was particularly important because early nursing was principally exercised as private duty nursing in patient homes; nursing students had to be prepared morally for independent practice. In an 1888 article in the Nursing Record (UK), Miss Mollett (1888) identifies six essential characteristics of the nurse: honor, purity, courage, discipline, culture, and love. (At some point, sympathy was substituted for love.) Many other lists would follow, but this is the earliest in a nursing journal.


The early ethics literature was aimed at school and hospital superintendents and educators concerned with ethics education. It includes textbooks, ANA and National League for Nursing convention papers, graduation addresses, lectures, and more. An additional body of ethics literature is aimed at practicing graduate nurses. This includes the Nightingale Pledge by Lystra Gretter, the ANA Code of Ethics in its successive revisions, and the question and answer columns that were published in AJN.


The ANA Committee on Ethical Standards published a Suggested Code in 1926 and a Tentative Code in 1940. Neither was adopted. The first adopted code of ethics was approved by the 1950 ANA House of Delegates. There have been subsequent revisions, approximately every 10 years, to the present 2015 Code of Ethics with Interpretive Statements (Code). There are many points of contact between the ANA Code and the Christian faith, and no conflicts; the Code makes space for a range of beliefs that nurses may have.




* Like the early nurses, do I know as much about nursing ethics as I do about nursing practice?


* What do I find to be affirming points of contact between the ANA Code of Ethics with Interpretive Statements and my understanding of the Christian faith?



American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author. [Context Link]


Mollett W. J. (1888). Honour. The Nursing Record, 1(4), 40-41. [Context Link]


The ethics of nursing: Talks of a superintendent with her graduating class. (1889). Trained Nurse and Hospital Review, 2(5), 179.