An Open Letter – Cost of the Code of Ethics for Registered Nurses – 2017 Edition

August 2 2017
Mike Villeneuve, Chief Executive Officer, Canadian Nurses Association
Barb Shellian, President, Canadian Nurses Association
Claire Betker, President-Elect, Canadian Nurses Association

An Open Letter – Cost of the Code of Ethics for Registered Nurses – 2017 Edition

Dear Mr. Villeneuve, Ms. Shellian, and Ms. Betker,

On August 1, 2017, CNA released its refreshed Code of Ethics for Registered Nurses, to replace the existing code that had been in place since 2008. As professors responsible for the ethics education of nursing students, we rely on the Code as vital resource in our teaching practice. And so we eagerly and enthusiastically anticipated its release. However, in the same moment that the new Code was released, we were surprised and saddened to learn that individual copies, whether print or online, may only be available at a financial cost to individuals. This was not the case with the previous version of the Code, which was publicly available online as a PDF download. We have since been told that there will be a “flip book” available online, but we remain concerned that it will not be possible to download, save, and share the Code in this format. By changing its access policy, the CNA will create a situation in which all Canadian nurses, nursing students, as well as interprofessional colleagues and members of the general public, must pay out of pocket if they are to have ready access to what the Code says about the ethics of nursing practice.

We believe that requiring people to pay to have access to the Code contradicts the mission of fostering ethical nursing practice in our country. This mission is why we have a Code in the first place. Below are four main reasons that we feel the Code of Ethics for Registered Nurses should be publicly available to anyone and everyone, online and free of charge.

  1. The Code of Ethics is an aspirational document that communicates the moral foundations of our profession. It defines the scope of nursing’s responsibility toward all stakeholders with whom nurses work: people, families, and communities. The Canadian public needs to have access to this document in order to understand who nurses are, what we value, and what we take responsibility for. Such understanding enables us to earn and keep the public trust, and in turn maintain our social relevance.
  2. Many nursing innovations have been important beyond their direct relevance for nursing practice, by inspiring practice changes in other disciplines. Canadian nursing can better exercise interprofessional leadership in promoting practice innovation by having the key statement of the profession’s moral foundations freely accessible.
  3. The Code is an essential resource to all nurses in their navigation of ethical concerns that are inherent in contemporary health care practice. Today’s landscapes of nursing care are rife with moral complexity and ambiguity. Every day, nurses in all spheres of practice face a multitude of forces (relational, institutional, and socio-political) that challenge their ability to deliver care that is good, right, and just. The Code is both a moral anchor and a moral compass in the face of such challenges. It assists nurses to become sensitive to the ethical issues at stake in their work, and provides practical guidance to help them analyze and work through difficult situations. In short, the Code is an essential tool that supports nurses’ capacity for ethical decision-making and advocacy. This capacity is undermined if nurses cannot access the Code, wherever and whenever necessary.
  4. In certain Canadian provinces, in addition to being an aspirational, values-based resource, the Code is a regulatory document. This means that the Code defines the standards of professional practice to which nurses are held accountable. When these standards are not met, nurses can face disciplinary and punitive procedures, which typically involve temporary or permanent suspension of the right to practice, and payment of fees associated with disciplinary proceedings. It is not logical that nurses should be subjected to such quasi-judicial processes without first being provided full and open access to the standards they are expected to follow.

As professors of nursing ethics, we each have our own personal stories of what the CNA’s Code of Ethics has meant to us and our work. The Code is an important source of understanding how nursing ethics relates to, but is different from, fields of bioethics and medical ethics. It coherently articulates a vision for nursing practice that promotes health, human dignity, and social justice. We are grateful for the tremendous work that CNA has invested over the years in producing a compelling and inspirational document that is firmly based in philosophy, in theory, and in research evidence. Finally, the Code is a source of professional pride for us and for our students, in that it faithfully reflects the uniqueness and complexity of nurses’ moral practice.

We urge you to reconsider your decision regarding the availability of this document for nurses, nursing students, interprofessional colleagues, and members of the general public.


David K Wright, RN, PhD, University of Ottawa
Marilou Gagnon, RN, PhD, University of Ottawa
Jean-Daniel Jacob, RN, PhD, University of Ottawa
Franco A Carnevale, RN, PhD, McGill University
Marianne Sofronas, RN, Doctoral student, McGill University
Patricia (Paddy) Rodney, RN, PhD, University of British Columbia
Jan Storch, RN, PhD, University of Victoria

Original letter: Open Letter – Cost of Code of Ethics

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