The nursing code of ethics in the United States is the Code of Ethics for Nurses with Interpretive Statements, published by the American Nurses Association. The current edition was adopted in 2015 and contains nine provisions, each followed by numbered Interpretive Statements that elaborate the commitment into language a state board of nursing or hospital ethics committee can apply. The document is the moral standard for the profession in the United States and is the source most nursing programs use to teach and assess ethical practice.
How the document came to exist: from the 1893 Nightingale Pledge to the 1950 first formal code
The American profession's ethical self-understanding did not begin with the American Nurses Association. It began in 1893 in Detroit, when Lystra Gretter, an instructor at the Farrand Training School for Nurses connected to Harper Hospital, drafted what came to be called the Nightingale Pledge. Gretter modeled the pledge on the Hippocratic Oath and named it for Florence Nightingale, although Nightingale herself had no part in writing it. It became, for half a century, the closest thing the profession had to a written statement of nursing ethics.
The Nightingale Pledge was a graduation ritual, not a regulatory document. As nursing professionalized in the early twentieth century, the gap became visible. State licensing began in 1903 with North Carolina, public health nursing emerged, and nurses found themselves making choices about confidentiality, advocacy, and obedience to physicians that the pledge did not address. A formal code became necessary.
The American Nurses Association, founded in 1896 and renamed in 1911, took up the task. In 1926 the ANA published a Tentative Code in the American Journal of Nursing. It floated the idea, listed draft principles, and invited the membership to react. In 1940 the ANA published a Suggested Code, again not formally adopted but more developed than the 1926 draft.
The first formally adopted nursing code of ethics in the United States is the 1950 Code for Professional Nurses, ratified by the ANA House of Delegates that year. It contained seventeen provisions and was strongly oriented toward the bedside and the doctor-nurse relationship as it existed at mid-century. The 1950 code reads as a list of duties, but every later edition is a revision of this baseline.
From 1960 through 2015: the revisions that produced the modern document
The 1950 code did not survive long in its original form. In 1960 the ANA published the first revision, condensing the seventeen provisions and updating language to reflect the postwar expansion of hospital nursing. A 1968 revision followed, shortening the document and removing references that had begun to feel paternalistic toward patients.
The 1976 edition is the first to take a form recognizable to today's reader. In 1976 the ANA added what it called Interpretive Statements: short elaborations attached to each provision that explained what the provision meant in practice. A provision might state that the nurse safeguards the patient's right to privacy, but the Interpretive Statements specified what privacy meant when records were shared and when research consent was sought. This is the structural innovation that defines the modern nursing code of ethics: a brief provision paired with a longer Interpretive Statement.
The 1985 edition kept the 1976 structure and refreshed the Interpretive Statements to reflect changes in informed consent law, advance directives, and the emerging role of the nurse in research ethics. By the 1990s, however, healthcare itself had changed in ways the document did not address. Managed care had reshaped clinical decision making, end-of-life care had become a public debate, and nurses were increasingly working in administrative and policy roles where the bedside framing of earlier editions did not fit.
The 2001 revision was a major rewrite of the nursing code of ethics. The ANA reduced the number of provisions to nine, the count that remains today, and broadened the scope beyond the nurse-patient encounter. The 2001 edition introduced systems-level advocacy, addressed the ethics of cost containment, and treated the nurse as a participant in shaping the practice environment. Provisions on the duty to self, on the integrity of the profession, and on the responsibility for the practice environment were added or substantially expanded.
The current edition, published in 2015 and titled Code of Ethics for Nurses with Interpretive Statements, builds on the 2001 framework. The 2015 edition keeps the nine-provision structure but adds explicit emphasis on social justice, global health, and the nurse's role in reducing health disparities. Provision 8 was sharpened to commit nurses to collaboration in protecting human rights and reducing disparities. Provision 9 was expanded to include integration of social justice into nursing and health policy. These additions reflect the ANA's recognition that nursing ethics in the twenty-first century cannot be confined to the individual encounter.
Why ANA, and why "with Interpretive Statements"
Two structural features of the document deserve attention before walking through the provisions. The first is sponsorship: the document is published by the American Nurses Association, the professional membership organization for registered nurses in the United States. The ANA is not a government body and cannot license or revoke licenses; that authority belongs to state Boards of Nursing. But the ANA is the professional voice of nursing in the United States, and the nursing code of ethics it publishes is the document the profession itself has agreed represents its ethical commitments. State Boards of Nursing, hospital ethics committees, and nursing schools accept the ANA Code as authoritative.
The second structural feature is the phrase "with Interpretive Statements." Each of the nine provisions is short, often a single sentence. The Interpretive Statements that follow are numbered (1.1, 1.2, 1.3, and so on) and elaborate the provision into specific ethical obligations. The provision is the headline; the Interpretive Statement is the substance.
This structure matters because the provisions alone are too brief to be enforceable. A provision stating that the nurse protects the rights, health, and safety of the patient does not by itself tell anyone what to do when a colleague is suspected of impaired practice. The Interpretive Statement under that provision does. When a state Board of Nursing references the Code in disciplinary proceedings, or when a hospital ethics committee invokes it in adjudicating a conflict, the citation is almost always to a specific Interpretive Statement number. Nursing students writing ethics papers should learn the same habit: cite Provision 3.5, not "the third provision."
Provision 1: respect for human dignity
The first provision of the nursing code of ethics commits the nurse to practice with compassion and respect for the inherent dignity, worth, and unique attributes of every person. It is the foundational commitment from which the rest of the document descends, and the ANA placed it first deliberately. Without respect for human dignity, the rest of the nursing code of ethics loses its grounding.
The Interpretive Statements under Provision 1 unfold the commitment in five parts. Provision 1.1 declares that the worth of the person is not diminished by social or economic status, by personal attributes, or by the nature of the health problem. Provision 1.2 covers relationships with patients, requiring that care be planned and delivered with attention to the individual's needs and values. Provision 1.3 addresses the nature of health, framing it broadly to include physical, mental, social, and spiritual well-being. Provision 1.4 establishes the right to self-determination, the basis of informed consent. Provision 1.5 covers relationships with colleagues, extending the duty of respect to coworkers, students, and the broader healthcare team.
An applied case sharpens what Provision 1 requires. Consider a patient admitted for elective surgery whose religious tradition prohibits blood transfusion. Provision 1.4 requires the nurse to recognize the patient's right to self-determination, including the right to refuse intervention. Provision 1.2 requires that care be planned around the patient's values. The nurse must ensure the patient understands the medical implications, document the informed refusal carefully, and advocate for alternatives such as bloodless surgical techniques. The provision requires the nurse to honor the autonomy expressed, not to talk the patient out of the refusal.
Provision 2: primary commitment to the patient
The second provision of the nursing code of ethics states that the nurse's primary commitment is to the patient, whether an individual, family, group, community, or population. It addresses the question of where the nurse's loyalty lies when interests conflict, and it answers clearly: the patient comes first. The provision recognizes that nurses serve many constituencies, employers, physicians, payers, and the institution among them, but it makes the patient primary among them.
Provision 2 is elaborated through four Interpretive Statements. Provision 2.1 establishes the primacy of the patient's interests in the planning and delivery of care. Provision 2.2 addresses conflict of interest, a category that has expanded to include institutional conflicts and incentive structures, not only personal financial conflicts. Provision 2.3 covers collaboration, recognizing that the patient's interests are usually best served when the nurse works with rather than around the rest of the team. Provision 2.4 addresses professional boundaries when the nurse-patient relationship drifts toward the personal, requiring the nurse to act to restore the boundary.
Consider an applied case. A nurse on a busy medical unit is told that, because the unit is short staffed, she should skip the morning head-to-toe assessment on stable patients and document it as performed. Provision 2.1 makes this request unethical regardless of staffing pressure. The patient's interest in being assessed accurately is primary, and the nurse who falsifies an assessment violates that interest. Provision 2.2 makes the institutional pressure a conflict of interest the nurse must refuse to act on. The proper path is to perform abbreviated but truthful assessments, document accurately, and escalate the staffing concern.
Provision 3: protection of patient rights, health, and safety
The third provision of the nursing code of ethics commits the nurse to promote, advocate for, and protect the rights, health, and safety of the patient. Where Provision 1 establishes respect for the patient and Provision 2 establishes primary loyalty to the patient, Provision 3 establishes the nurse's active duty to defend the patient against threats. It is the most operational of the early provisions and the one most often invoked in disciplinary proceedings.
Provision 3 is unfolded in six Interpretive Statements, more than any other provision. Provision 3.1 addresses privacy, which the nurse safeguards in clinical communication, documentation, and electronic records. Provision 3.2 addresses confidentiality, naming the limited circumstances in which information may be shared. Provision 3.3 covers protection of participants in research, requiring the nurse to ensure informed consent. Provision 3.4 addresses performance standards and review mechanisms. Provision 3.5 is one of the most cited statements in the entire nursing code of ethics: protection of patient health and safety by acting on questionable practice. Provision 3.6 covers patient protection and impaired practice, addressing colleagues whose performance has been compromised by substance use, illness, or fatigue.
Consider an applied case under Provisions 3.5 and 3.6. A nurse working night shift notices that a colleague has been making frequent, unaccompanied trips to the medication room, and the unit's controlled-substance reconciliation has shown persistent discrepancies for the past month. The nurse suspects diversion of opioids. Provision 3.5 obligates the nurse to act on questionable practice, and Provision 3.6 specifies that protection of the patient extends to recognizing impaired practice in colleagues. The provision does not authorize the nurse to confront the colleague directly or to stage an intervention. It requires the nurse to report the concern through institutional channels, typically to the nursing supervisor or pharmacy director, and to document observations factually. The duty under Provision 3 runs first to the patients whose pain medication may be compromised.
Provision 4: authority, accountability, and responsibility for nursing practice
The fourth provision of the nursing code of ethics addresses the structural ethics of nursing practice itself: who has the authority to make nursing decisions, who is accountable for them, and how delegation works in a profession that operates across multiple license levels. Provision 4 is shorter than Provision 3 in its Interpretive Statements but no less consequential, because it defines the boundaries of the nurse's own scope of action.
The provision is elaborated in four parts. Provision 4.1 locates the authority for nursing practice in the registered nurse's license and the standards of the profession. Provision 4.2 establishes accountability, the principle that the nurse is answerable for the consequences of nursing judgments and actions. Provision 4.3 addresses responsibility for delegation and supervision, specifying that the delegating nurse retains accountability for the outcome even when the task is performed by another. Provision 4.4 covers the responsibility for the nursing judgments that compose practice, including the duty to refuse assignments that exceed competence or that endanger patients.
An applied case under Provision 4.3 illustrates the provision. An LPN on a long-term care unit is told by a supervising RN to delegate the administration of an IV-push antibiotic to a CNA. IV-push administration is outside the CNA's scope of practice in every state. Provision 4.3 specifies that the delegating nurse retains accountability for the outcome, which means the LPN cannot offload the legal responsibility. Provision 4.4 obligates the LPN to refuse the delegation, because acceding would compose practice out of judgments she is not authorized to delegate and the CNA is not authorized to perform.
Provision 5: duties to self and to colleagues
The fifth provision is one of the most distinctive in the nursing code of ethics and is often the one nursing students underestimate when first encountering the document. It states that the nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. The provision is what distinguishes the modern Code from earlier formulations that treated the nurse as purely self-sacrificing.
Provision 5 is elaborated in six Interpretive Statements, the most of any provision other than Provision 3. Provision 5.1 establishes the duty to oneself and others, anchoring the symmetry between the two. Provision 5.2 addresses promotion of personal health, safety, and well-being. Provision 5.3 covers preservation of wholeness of character, the moral integrity that allows the nurse to act consistently across professional and personal life. Provision 5.4 addresses preservation of integrity, particularly when the nurse is asked to participate in acts that violate her conscience. Provision 5.5 covers maintenance of competence and continuation of professional growth. Provision 5.6 addresses continuation of personal growth as part of professional development.
Consider an applied case. A staff nurse is asked by her manager to pick up a third consecutive twelve-hour shift because two colleagues have called out, making it her thirty-sixth hour of work in three days. Fatigue at this level is a documented patient-safety hazard. Provision 5.2 establishes her duty to her own health and safety, and Provision 5.1 makes this duty equivalent in weight to her duty to patients. The provision does not require martyrdom; it forbids it. The nurse's appropriate response is to decline the additional shift and to recognize that working past safe limits is itself a violation of her professional ethic, not a fulfillment of it. The case also raises Provision 6 territory, because repeated reliance on unsafe overtime is a feature of the practice environment, not only of individual choice.
Provision 6: shaping the practice environment
The sixth provision of the nursing code of ethics marks a shift in the document's orientation. Provisions 1 through 5 address the nurse's commitments to patients, to practice, and to self. Provision 6 turns outward, requiring the nurse to take responsibility for the environment in which care is delivered. It states that the nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality healthcare. The provision is the ANA's recognition that nursing ethics cannot be reduced to individual virtue when systemic conditions shape what is possible.
The provision is elaborated in three Interpretive Statements. Provision 6.1 addresses the environment and moral virtue, recognizing that ethical practice is harder in some environments than in others. Provision 6.2 covers the environment and ethical obligation, establishing that the nurse has a duty to work toward conditions that support ethical practice. Provision 6.3 addresses responsibility for the healthcare environment, including engagement with policy, leadership, and organizational change.
An applied case under Provision 6 takes a familiar form. A medical-surgical unit has nurse-to-patient ratios that exceed safe staffing recommendations, and adverse events have increased over the last quarter. Individual nurses have raised the issue informally without effect. Provision 6.2 obligates the nurses, individually and collectively, to work toward changing the conditions, not only to do their best within them. Provision 6.3 names the responsibility for the broader environment, including engagement with hospital leadership, the nursing council, and state-level staffing-ratio advocacy. Working harder is not an ethical solution to systemic understaffing; changing the system is.
Provision 7: advancement of the profession
The seventh provision of the nursing code of ethics states that the nurse, in all roles and settings, advances the profession through research and scholarly inquiry, professional standards development, and the generation of both nursing and health policy. The provision treats every nurse, not only academics or administrators, as a contributor to the profession's growth. The expectation is graded by role: the bedside nurse is not expected to publish in Nursing Research, but is expected to participate in evidence-based practice, contribute to standards on her unit, and engage with policy as it affects nursing.
Provision 7 is unfolded in three Interpretive Statements. Provision 7.1 covers contributions through research and scholarly inquiry, including participation in research, application of research findings to practice, and dissemination of knowledge. Provision 7.2 addresses contributions through development, evaluation, and application of professional standards in practice, education, and administration. Provision 7.3 covers contributions through nursing and health policy development, recognizing that nurses bring clinical expertise to policy debates that often lack it.
An applied case under Provision 7.2 shows what the provision asks of a staff nurse. A unit has been using a fall-prevention protocol last revised four years ago, and recent literature has identified a more effective bundle. A staff nurse joins the unit's evidence-based practice committee, helps draft a revised protocol, and participates in the rollout and evaluation. Provision 7.2 makes contributions to the development and evaluation of professional standards a part of practice itself, and underwrites participation in journal clubs and quality-improvement projects.
Provision 8: collaboration to protect human rights and reduce health disparities
The eighth provision of the nursing code of ethics is the one most clearly shaped by the 2015 revision. It states that the nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities. The provision was present in earlier editions in less explicit form, but the 2015 rewrite made the commitment to social justice and global health central rather than peripheral. It is also the provision that most directly connects American nursing to the international tradition.
Provision 8 is elaborated in four Interpretive Statements. Provision 8.1 declares that health is a universal right, anchoring the rest of the provision in a rights framework rather than only a charitable one. Provision 8.2 addresses collaboration for health, human rights, and health diplomacy. Provision 8.3 establishes the obligation to advance health and human rights and to reduce disparities, naming the reduction of disparities as a duty rather than a preference. Provision 8.4 covers collaboration in complex, extreme, or extraordinary practice settings, including disaster, conflict, and migration contexts.
An applied case under Provision 8.3 makes the abstraction concrete. A community-health nurse works in a clinic serving undocumented immigrants who lack health insurance and are reluctant to engage with the formal healthcare system because of fears about immigration enforcement. Provision 8.1 makes the health of these patients an ethical concern equal in weight to that of insured patients in the same community. Provision 8.3 obligates the nurse to advance their access to care and to reduce the disparity, not to treat the disparity as a regrettable feature of policy. In practice this means ensuring language-appropriate care, advocating with local public-health authorities for vaccination and prenatal access, and participating in professional advocacy.
Provision 9: articulation and integrity of the profession
The ninth and final provision of the nursing code of ethics states that the profession of nursing, collectively through its professional organizations, must articulate nursing values, maintain the integrity of the profession, and integrate principles of social justice into nursing and health policy. The provision is the only one written primarily in collective rather than individual voice, and it closes the loop between the individual practitioner and the profession as a whole. The provisions that precede it speak in the voice of the nurse; Provision 9 speaks in the voice of nursing.
Provision 9 is unfolded in four Interpretive Statements. Provision 9.1 addresses articulation and assertion of values, the active expression of the profession's commitments in public discourse. Provision 9.2 covers integrity of the profession, including the responsibility of nursing organizations to speak with credibility. Provision 9.3 addresses integrating social justice into nursing and health policy. Provision 9.4 covers social justice in nursing and health policy, the operational expression of that commitment.
An applied case under Provision 9 takes a recognizable form. A state legislature is considering a bill on medical aid in dying, and the state's nurses association is debating whether and how to weigh in. The nursing code of ethics does not tell the association what position to take on the underlying question, which remains genuinely contested within the profession. But Provision 9 does require the association to articulate the profession's values in the debate, to speak with integrity, and to bring the perspective of bedside nurses who would implement whatever policy is enacted. Silence is not an option Provision 9 endorses, because silence in a debate that affects nursing practice fails the duty of articulation.
How the Code interacts with state nurse practice acts and hospital ethics committees
The legal status of the nursing code of ethics is sometimes misunderstood by students writing their first paper on nursing ethics. The Code is published by a professional association, and the ANA cannot license or discipline nurses. State Boards of Nursing license nurses, and state Nurse Practice Acts define the legal scope of nursing practice. The Code lives in a layered relationship with both.
Many state Nurse Practice Acts reference the ANA nursing code of ethics by name or incorporate its core principles into their statement of professional standards. Where this has occurred, a violation of the Code can become evidence in a disciplinary proceeding before the Board of Nursing. The Board may suspend or revoke a license for unprofessional conduct, and conduct that violates a specific Interpretive Statement, particularly under Provisions 3, 4, or 5, can be cited as the basis. In states where the Code is not directly incorporated, it still functions as evidence of the professional standard of care, and Boards routinely consider it.
Hospital ethics committees relate to the Code differently. An ethics committee is not a disciplinary body. It convenes to deliberate on specific clinical conflicts: a family disagreement over goals of care, a nurse's conscientious objection to a procedure, a question about disclosure to a patient. The Code is one of the resources the committee draws on, alongside hospital policy, applicable law, and the broader bioethics literature. An ethics consultation is consultative, not binding, and is distinct from a legal consultation. The ethics committee asks what is right; legal counsel asks what is allowed.
The nursing code of ethics also interacts with broader frameworks nurses encounter in clinical and academic work, including the ANA standards of nursing practice, the diagnostic vocabulary expressed through NANDA-I terminology, and the theoretical traditions that shape how nurses think about caring relationships, including Watson's caring science. Standards of practice operationalize what competent care looks like; the Code tells the nurse what ethical care requires. Diagnostic terminology supports the assessment that Provisions 2 and 4 expect. Theory frames the relational ethic that Provision 1 makes foundational.
How nursing students cite the Code in academic papers
Nursing students writing on nursing ethics, concept analyses, and clinical reflections cite the nursing code of ethics regularly, and most programs expect a specific form of citation. The current edition is the 2015 ANA Code of Ethics for Nurses with Interpretive Statements, and that is the title that should appear in the reference list. The publishing body is the American Nurses Association, and the place of publication is Silver Spring, Maryland. Students who cite the older 2001 edition without checking are citing a superseded document, and most reviewers will catch it.
Citations within the body of the paper should distinguish between the provision and the Interpretive Statement. A student writing on confidentiality should cite Provision 3.2, the relevant Interpretive Statement, not "Provision 3" alone. The same applies to delegation (Provision 4.3), to fatigue and self-care (Provision 5.2), and to staffing (Provision 6.2). Specificity signals that the student has read the document, not only the headlines. Treat the Interpretive Statements as you would any cited source: paraphrase carefully, use direct quotation when the exact wording matters, and never copy long passages verbatim.
Concept analyses, particularly in Walker and Avant or Rodgers traditions, often draw on the Code for definitional and normative content. The Code is appropriate as a source for the normative attributes of a concept like advocacy, dignity, or accountability. It is less appropriate as the sole source for empirical attributes; for those, the student should reach into the empirical literature. A student who narrates a clinical case and then names which provision was at stake, and which Interpretive Statement specifies the duty, has produced a substantially stronger paper than one who tells the story alone.
Other professional documents commonly intersect with Code citation. The SBAR communication framework supports the duty under Provision 3 to escalate safety concerns clearly, and the mechanics of writing a care plan reflect the planning duties that Provisions 1.2 and 2.3 articulate. Capstone and graduate papers often weave these together, citing the nursing code of ethics for the ethical commitment and framework documents for operational mechanics. If you are working on an ethics paper and the integration feels unwieldy, the EssayFount writing experts can review your draft and tighten the citation structure so the Code's role is clear without overwhelming the analysis.
The International Council of Nurses publishes its own Code of Ethics for Nurses, most recently revised in 2021, which is the equivalent document at the international level. The ICN code is the appropriate reference for international or comparative work, and many graduate-level papers benefit from a brief comparison between the ANA and ICN codes. Do not, however, substitute the ICN code for the ANA code in a paper on United States nursing practice; American Boards of Nursing reference the ANA document.
Reader questions about the nursing code of ethics
What are the 7 codes of ethics in nursing?
The American Nurses Association Code of Ethics for Nurses (2015 revision) is organised around nine provisions, not seven. The seven principles most commonly summarised in licensure-prep texts are autonomy, beneficence, nonmaleficence, justice, fidelity, veracity, and accountability. These are the foundational bioethical principles that the nine ANA provisions operationalise for nursing practice. They are tested in the NCLEX as named principles applied to scenarios; the nine ANA provisions are tested as the formal framework that governs licensed nursing practice in the United States.
What is the code of ethics for nurses?
The American Nurses Association Code of Ethics for Nurses with Interpretive Statements is the formal ethical framework that governs licensed registered nurses in the United States. The current edition (2015, with a 2025 revision underway) contains nine provisions that name the nurse's primary commitment to the patient, the obligation to advocate for and protect the patient, responsibility for individual practice and delegation, and the role in advancing the profession through research, policy, and human-rights work. The International Council of Nurses Code (2021) covers the same ground for international practice.
What is provision 5 of the Code of Ethics for Nurses?
Provision 5 states that the nurse owes the same duties to self as to others, including the responsibility to promote health and safety, preserve wholeness of character and integrity, maintain competence, and continue personal and professional growth. It is the only provision in the nine that turns the ethical lens on the nurse rather than on the patient. Provision 5 is the textual basis for self-care, healthy boundaries, ongoing education, and the refusal to participate in care that violates the nurse's moral integrity.
What are the 10 ethics of nursing?
There is no canonical list of ten ethics in the ANA Code of Ethics; the official document has nine provisions. The ten most often listed in textbook summaries are autonomy, beneficence, nonmaleficence, justice, fidelity, veracity, accountability, advocacy, confidentiality, and informed consent. The first six are bioethical principles, accountability and advocacy are professional duties, and confidentiality and informed consent are legal-ethical obligations codified in HIPAA and the Patient Self-Determination Act. The ANA provisions remain the governing framework even when textbook summaries list ten items.
What are the 7 codes of ethics with examples?
Autonomy: respecting a competent patient's refusal of a blood transfusion. Beneficence: advocating for a pain regimen that improves quality of life. Nonmaleficence: refusing to administer a medication ordered at an unsafe dose. Justice: distributing a limited resource (an isolation room, a one-to-one observer) by clinical need rather than by social status. Fidelity: keeping a promise to the patient that the call light will be answered within five minutes. Veracity: telling a patient the truth about a medication error. Accountability: documenting that error in the chart and notifying the physician.
What are the 10 nursing ethical values?
The ten ethical values most often listed in undergraduate ethics modules are altruism, autonomy, human dignity, integrity, social justice, equality, fidelity, freedom, accountability, and truth-telling. They are framed as the values that underlie the nine ANA provisions and the seven bioethical principles. The American Association of Colleges of Nursing's Essentials documents tie these values to the professional formation domain of baccalaureate education, which is why they appear in concept-analysis papers and reflection assignments more often than in NCLEX-style questions.