In 1896, a group of Canadian and American nurses formed the "Nurses Association Alumnae"- an organization whose first purpose was to develop a formal code of ethics for the nursing profession. Prior to that time, the Nightingale Pledge provided ethical underpinnings for the practice of nursing work.1 In 1911, this small organization of nurses became the American Nurses Association (ANA), and formally adopted the first code of ethics in 1950. To this day, the ANA maintains the code of ethics that has been revised approximately every decade, although it has been 14 years since the last revision.

Between 2010 and 2014, a steering committee appointed by the ANA solicited online feedback about the 2001 Code of Ethics (the most recent revision prior to 2015), which contains 9 provisions with interpretive statements. An initial survey generated 7800 comments from 2700 nurses. The draft of the new revision was then posted, and more than 1500 comments from about 1000 nurses in the United States and abroad were received.1 The steering committee incorporated this feedback to make the 2015 revision fully relevant to the complexities of current nursing environments and to respond to advances in health care. Through the lens of relationship, this document serves as nursing's "nonnegotiable ethical standard"1^(pviii) in any setting, whether paid or volunteer, and reflects the values, obligations, and duties of every nurse in the workplace (many of which extend into our personal lives), as well as articulating nursing's commitments to society.

New to this revision is a glossary of terms, including social justice, compassion fatigue, collaboration, eco-justice, environmental degradation, environmental justice, culturally sensitive, health diplomacy, evidence-informed practice, just culture, health diplomacy, self-regarding duty, social determinants of health, and social media. These terms hint at the priorities and values of concern to nurses reflected in the newly revised code. The committee proposes that "this revision invites and supports nurses in meeting the key challenges of the 21st century that include achieving true global awareness of the human condition; the sociopolitical, economic, interdependent, and environmental context of all humanity; and the universal need for health care."1

Some states have embedded these provisions into Nurse Practice Acts, thus making them legally binding. Some hospitals have incorporated them into performance appraisals (used to raise awareness as a part of the review process rather than in an evaluative capacity). This underscores the importance of nurses becoming familiar with the code that is available online in a read-only version at http://www.nursingworld.org. Nurse educators can incorporate this content using case studies to make the code come alive, socializing student nurses into understanding the importance and fine points of ethical practice. Administrators can support nurses in using these codes to support reflective, empowered holistic practice.

Ethical decision making among nurses should be based on specific provisions that the nurse can identify and articulate when providing rationales for chosen actions and decisions. This gives one pause when considering Provision 5 of the code which, like the Holistic Nursing Core Value 5, speaks to self-care and self-awareness: "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 interpretive statements with this provision clearly link the personal choices nurses make with professional performance. Could a nurse who does not practice self-care put a client at risk? And if so, would a patient have legal recourse against this nurse if a breach in safety or quality occurred?

In keeping with Nightingale's concerns for the environment's influence on health, this revision calls for the extension of social justice to include eco-justice, noting the deleterious effects that assaults on the environment pose to health of the poor and all of humanity. Through policies, programs, and practices, nurses ought to advocate for sustaining and repairing the natural world. Indeed, the final message of the revised code is lofty and compelling: "As nursing seeks to promote and restore health, prevent illness and injury, and alleviate pain and suffering, it does so within the holistic concept of healing the world."1^(p54) The ANA has identified 2015 as the "Year of Ethics," so take a look at the newly revised code of ethics for nurses. You are sure to find catalysts for reflection among the thoughtfully crafted interpretive statements.

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