What Is Nonmaleficence in Nursing?
A nurse stands at a patient’s bedside, holding a syringe of pain medication. The patient is in clear distress, but their blood pressure has dropped to a dangerously low level. Administering the drug could ease their pain — but it might also worsen their condition. This moment of hesitation reflects a core principle: nonmaleficence. In nursing, this term means “do no harm,” a commitment that requires nurses to constantly balance the benefits of an intervention against its potential risks.
Putting nonmaleficence into practice is key to delivering safe, effective care. In this article, we’ll take a closer look at what this ethical principle really means, why it matters, and how you can incorporate it into your nursing practice.
Definition of Nonmaleficence in Nursing
Nonmaleficence is one of the seven core ethical principles in nursing, and it centers on a simple but powerful idea: do no harm. In practice, this means avoiding actions that could cause pain, injury, disability, or emotional distress, or take away anything that supports a patient’s dignity, independence, or quality of life.
While the idea may sound simple, implementing it in a real-world healthcare system is anything but. Should you go ahead with a life-saving treatment that also brings nausea, confusion, or pain? Is it ethical to perform an expensive nonessential procedure on someone, knowing it could leave them in serious debt? Should you administer opioid pain medication to a patient in agony due to a leg fracture — even if they’ve just admitted to a history of opioid abuse and say the last time they took it, it triggered a relapse? These difficult choices highlight just how nuanced this ethical principle can be.
You can think of nonmaleficence as a threshold for treatment decisions. If a treatment is likely to do more harm than good, it’s not worth considering. If the benefits far outweigh the risks, then go ahead with it. This delicate balance is often referred to as the doctrine of double effect, which aims for a net benefit over harm.
Examples of Nonmaleficence in Nursing
Healthcare professionals deal with tough decisions every day — ones that involve both medical facts and ethical judgment. Both of these elements help nurses avoid harming the patient while making care decisions.
Here are some real-world examples of how nonmaleficence shows up in practice:
| Example | Description |
|---|---|
| Administering medications | A post-surgery patient needs blood thinners to prevent clots but has a history of bleeding issues. Nonmaleficence means checking their history and lab results before administering the drug to ensure the treatment is safe. |
| Monitoring a patient on a ventilator | A nurse receives a new order to adjust the ventilator settings, but the prescribed level seems too high and could potentially cause lung damage. Nonmaleficence means the nurse will confirm with the doctor before making any adjustments, ensuring the patient is not harmed. |
| Monitoring a post-surgery patient for infection | A patient recovering from surgery asks for corticosteroids to relieve itching. Nonmaleficence means checking for signs of infection first, since corticosteroids can suppress the immune response and worsen infections. |
The Origin of Nonmaleficence
The idea of doing no harm has deep roots in the history of medicine, dating all the way back to the Hippocratic Oath. In nursing, this commitment is formally reflected in the Nightingale Pledge, often referred to as nursing’s version of the Hippocratic Oath. First adopted in 1893, the pledge includes a promise to “abstain from whatever is deleterious and mischievous” and “not take or knowingly administer any harmful drug,” a clear reference to nonmaleficence.
Professional standards are essential to turning ideals like nonmaleficence into everyday practice. The American Nurses Association (ANA) outlines these expectations in its Code of Ethics for Nurses, which serves as a guide for ethical decision-making in all areas of nursing.
To reflect ongoing changes in healthcare, the ANA updates the Code of Ethics for Nurses every 10 years. The latest revision was released in 2025, updating the previous 2015 version. These regular updates help nurses keep pace with changing professional standards and the evolving needs of society.
Importance of Nonmaleficence in Nursing
Nurses may not mean to cause harm, but in a high-stress healthcare environment, it’s still a genuine possibility. With issues like short staffing and burnout on the rise, the margin for error can get thinner. But in nursing, a mistake isn’t just an oversight — it can mean real harm to a real person. Nonmaleficence is the ethical anchor that keeps nurses focused on preventing harm, no matter how hectic or demanding things get.
Nonmaleficence also supports a culture of safety. When nurses prioritize harm prevention, it encourages teams to speak up, collaborate, and hold each other accountable. It empowers nurses to advocate for their patients — even when it’s uncomfortable or inconvenient — because safety always comes first.
Nonmaleficence in Nursing: FAQ
What is the meaning of nonmaleficence in nursing ethics?
Nonmaleficence refers to the ethical principle of avoiding causing harm. It is one of the seven core ethical principles outlined in the Code of Ethics for Nurses and plays a vital role in guiding nursing practice.
How is nonmaleficence different from beneficence?
Nonmaleficence is about the obligation to do no harm, meaning nurses must avoid actions that could cause injury, pain, or suffering to their patients. Its focus is on preventing negative outcomes. On the other hand, beneficence in nursing is the promise to do good, which involves taking proactive steps to help patients recover.
What are some challenges nurses face when applying nonmaleficence?
One challenge nurses may face with nonmaleficence is the fear of seeming annoying when questioning or clarifying orders. Nurses may feel hesitant to call a doctor to confirm a potentially harmful prescription and worry about overstepping boundaries. However, nonmaleficence encourages nurses to prioritize patient safety, even if it means taking difficult steps to prevent harm.
What happens when nonmaleficence is breached in nursing?
Breaching nonmaleficence in nursing means causing harm to a patient through an action or oversight. An example of nonmaleficence in nursing being breached could be when a nurse administers the wrong dosage of medication, resulting in adverse effects on the patient.
The consequences of breaching nonmaleficence can vary depending on the situation, but typically, they can include:
- Patient harm: This can manifest as worsened health conditions, complications, new injuries, or even death, depending on the severity of the breach.
- Legal consequences: Nurses may face legal actions, such as malpractice suits, which could result in financial penalties, loss of licensure, or other professional consequences.
- Loss of trust: Patients or their families may feel anger or disappointment, potentially leading to complaints or a reluctance to seek care in the future.
- Emotional consequences: Nurses may experience guilt, stress, and a loss of confidence after realizing they’ve caused harm.
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