All nurses are bound by a professional code of ethics, such as Code of Ethics for Nurses with Interpretive Statements (2001) and ICN Code of Ethics for Nurses (ICN 2006). Codes of ethics for nurses serve to provide a guiding framework for carrying out the practice of nursing outlined in the scope and standards of practice. Ethics codes give a framework for nurses’ standards of conduct and assist nurses in translating standards into action (ICN 2006). They also help translate ethical principles such as autonomy, beneficence, confidentiality, fidelity, informed consent, justice, privacy, and veracity into behaviors expected of nurses as they practice nursing.

An ethical code offers an ordered series of key principles to guide practitioners, put forth by an authoritative professional organization (Olick 2004). Codes of ethics make explicit the goals and values of the profession and serve as moral principles that guide nurses’ behavior and decisions (ANA 2004). Ethical codes provide a framework to set the ethical standards for the profession and serve as a tool for nurses to use in ethical analysis and decision-making (ANA 2004).

The core of ANA‘s Code for Nurses with Interpretive Statements are nine fundamental ethical provisions to guide ethical behavior and decision making for professional nurses. Each principle has several subcategories with one or more paragraphs that serve as interpretive statements, which describe how nurses can implement these principles. ICN Code of Ethics for Nurses is a briefer document listing four categories under which general standards of ethical conduct are organized: Nurses and People, Nurses and Practice, Nurses and the Profession, and Nurses and Co-Workers. For example, “The nurse ensures that the individual receives sufficient information on
which to base consent for care and related treatment” is one of the principles listed under “Nurses and People” (ICN 2006, 4). There are no interpretive statements, and this document is much more general. The ANA document is much more specific and comprehensive, and includes the integration and application of ethical principles such as respect for human dignity, protecting confidentiality, self-determination, informed consent, and safeguarding privacy. In genetics nursing the ANA code of ethics may be more useful for the practicing nurse because of the additional content. For example:

Standard setting and the accompanying self-regulation are primary attributes of a profession. Professional standards of practice for nursing help measure competency and provide definition and structure to the practice of nursing (Townes and Cook 2001). According to the American Nurses Association, “standards are authoritative statements by which the nursing profession describes the responsibilities for which its practitioners are accountable” (ANA 2004, 1).

Standards of practice also have legal implications which nurses need to understand. When standards for acceptable professional behavior are defined, nurses who do not meet these standards are potentially liable for negligence (Powell 2003). In medical negligence litigation the courts decide whether or not a healthcare professional’s conduct in a particular instance falls below an acceptable “professional standard of care” (Rosenbaum 2003). Scope and standards of nursing practice are documents by which nurses can be judged in a court of law. Nurses also need to be aware of legislation affecting standards of nursing practice because Federal law supersedes both state law and professional standards. For example, standards or no standards, nurses have a legal obligation under federal law to follow the HIPAA (Health Insurance Portability and Accountability Act, enacted by Congress in 1996) privacy requirements (45CFR46) before sharing or discussing protected health information (PHI) with a family member, even a spouse (Muller and Flarey 2004).

Professional standards need to be broad to encompass a wide range of activities, and flexible enough to still be applicable as the profession evolves and changes over time (C. Bickford, personal communication, January 19, 2005). Standards are “living guidelines” (Muller and Flarey 2004, 255) and need to take into account the changing nature of health care and nursing practice so that the document remains applicable to changing practice and does not become easily outdated. The leadership of a profession is responsible for regularly examining, questioning, revisiting, and revising standards of practice (Muller and Flarey 2004).

The scope of nursing practice describes “the who, what, where, when, why, and how of nursing practice” and provides the boundaries of nursing practice and who can practice it (ANA 2004, 1). The International Society of Nurses in Genetics (ISONG) scope of practice refers to “a range of nursing functions and abilities that are differentiated according to level of practice, role of the nurse, and work setting” (ISONG and ANA, 1998, 97). According to the International Council of Nurses, “scope of practice is defined within a legislative regulatory framework, and communicates to others the roles, competencies, and the professional accountability of the nurse” (ICN 2000). The scope of practice parameters are a framework to guide nursing practice and are complemented by professional codes of ethics, nursing practice standards, and the legislative or regulatory framework in which the nurse practices. For example, in the United States the nurse practice act for each state influences what activities or functions the nurse is allowed to perform in that state. Similarly, different countries have regulations defining the scope of nursing practice. Scope and standards of nursing practice flow from the definition of nursing practice and represent the essence of what nurses do. “Ethics guide scope through an individual ability to accept and manage consequences, in accordance with safe standards of practice” (Klein 2005).

Nurses have been involved in genetic counseling and education since the 1960s, when nurses provided services to children with genetic disorders and their families. In 1984 a small group of nurses practicing in genetics formed the Genetics Nursing Network, which later became ISONG. In 1988, ISONG was incorporated as a nursing specialty organization dedicated to fostering the scientific and professional growth of nurses in human genetics worldwide (ISONG 2007). ISONG is the official professional organization of nurses in genetics in the United States and also
represents genetics nurses worldwide. In 1997 ISONG worked with ANA to establish genetics nursing as an official specialty of nursing practice. This was followed by the publication of the scope and standards of clinical genetics nursing practice as a collaborative effort between the ANA and ISONG (ISONG and ANA, 1998). See Table 2-1 for this timeline.