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Nurses Bill of Rights

More than 4 million registered nurses comprise the largest group of health care professionals in the United States. And the American public has consistently ranked nursing the most honest and ethical professional in an annual Gallup poll. Bringing vast knowledge and expertise to every health care setting across a wide range of specialties, nurses serve their patients and communities throughout the continuum of life and care. Nurses provide mental and physical health care and wellness services while maintaining respect for human dignity and delivering equitable, patient-centered care regardless of race, origin, or background. It is vitally important to acknowledge and respect the rigor of nursing practice as both an art and science. To that end, and for their indisputable contributions to society, education, public health, science, and the health of all communities, the following rights are non-negotiable for all nurses to meet the increasing complexities of care delivery:

  1. Full authority for nurses to practice at the top of their license, credentials, and professional standards without barriers, and in a manner that fulfills their obligations to society, patients, and communities.
  2. Continuous access to training, education, professional development, as well as pathways for nurses to be recognized as leaders and in roles to direct shared decision-making on nursing practice, resources, staffing concerns and patient safety issues.  
  3. Work and practice in environments that ensure respect, inclusivity, diversity, and equity with leaders who are committed to dismantling systemic racism and addressing racist behaviors that negatively impact nurses of color.
  4. Just care settings that facilitate ethical nursing practice, standards, and care in accordance with the Code of Ethics for Nurses with Interpretive Statements.
  5. Safe work environments that prioritize and protect nurses’ well-being and provide support, resources, and tools to stay psychologically and physically whole. 
  6. Freedom for nurses to advocate for their patients and raise legitimate concerns about their own personal safety without the fear of retribution, retaliation, intimidation, termination, and ostracization.
  7. Competitive compensation consistent with nurses’ clinical knowledge, experience, and professional responsibilities and that recognizes the value and rigor of nursing practice.
  8. Collective and individual rights for nurses to negotiate terms, wages, and work conditions of their employment in all practice settings.

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How can the Bill of Rights help a registered nurse?

As nurses go about their daily practice, they cite factors in the workplace that make it difficult for them to do their jobs, or to feel safe and respected as professionals. There are several tools that can facilitate discussions about workplace concerns. As one of those tools, the Bill of Rights for Registered Nurses sets forth seven premises concerning workplace expectations and environments that nurses from across the United States recognize are necessary for sound professional nursing practice.

Does the Bill of Rights offer nurses any protections at work?

The Bill of Rights is a statement of professional rights, not a legal document. It can help guide development of organizational policy or focus discussions between nurses and employers regarding employment contracts and work agreements. The Bill of Rights supplements other tools such as the Code of Ethics for Nurses with Interpretive Statements (2001), Nursing’s Social Policy Statement, (2003) and Nursing: Scope and Standards of Practice (2004) – all available from the American Nurses Association (See Below and right). All of these documents have been developed by expert nurses and approved by a representative national body of practicing nurses.

In addition to these tools, all nurses and employers must be familiar with the nurse practice act and the regulations for their individual states, which do spell out essential legal requirements related to practice.

What are some examples of situations where nurses might use the Bill of Rights to work through problems at work?

As nurses approach employers with patient care or health and safety concerns in the workplace, nationally-recognized consensus documents can lend credibility to their discussions. The Bill of Rights was conceived to support nurses in an array of workplace situations including unsafe staffing, mandatory overtime and health and safety issues such as needlestick injuries, workplace violence, and latex allergies. Nurses realize that bringing these issues to the attention of employers is essential in meeting their responsibilities to their patients – and to themselves.

What other ways can the Bill of Rights for Registered Nurses be used?

Employers can refer to the document to help them understand what nurses need in their places of work to fulfill professional responsibilities. As a document developed and approved by practicing nurses, the Bill of Rights can be a reliable basis for dialogue to resolve concerns nurses may have about ensuring work environments that support professional practice.

Nurse educators can use the Bill of Rights when addressing nursing issues and trends and professional practice topics, in certain aspects of discussion about clinical practice, or in an introductory nursing course.

What is the foundation for each of the seven rights included in the Bill of Rights for Registered Nurses?

  1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care.
    Nurses have always expressed a strong commitment to serving society. In ANA’s Nursing’s Social Policy Statement, 2nd Edition (2003), the profession clearly articulates that the authority for the practice of nursing is based on a social contract that acknowledges professional rights and responsibilities as well as mechanisms for public accountability (p.3). ANA’s Code of Ethics for Nurses with Interpretive Statements (2001) serves the following purposes: "it is a succinct statement of the ethical obligations and duties of every individual who enters the nursing profession; it is the professions' nonnegotiable ethical standard; and, it is an expression of nursing’s own understanding of its commitment to society" (p. 5).
  2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice. 
    The ANA has published 
    Nursing: Scope and Standards of Practice (2004), which sets forth the professional standards that apply to the practice of all professional nurses. The ANA also has published or endorsed standards for specialty nurse practice. 
    In addition, the nurse practice act of each state governs the practice of nursing. Each nurse should have a copy of the practice act, the regulations, and any other official documents governing nursing practice for each state where he or she is employed. All of these documents define the legal scope of nursing practice and guide and protect nurses in performing their duties.
  3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with Code of Ethics for Nurses with Interpretive Statements.
    Code of Ethics for Nurses (2001) and its interpretive statements establish the ethical standards for the profession and help nurses determine whether or not their work environments support ethical practice.
  4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution.
    The Code of Ethics for Nurses (2001) asserts that the nurse promotes, advocates for and strives to protect the health, safety, and rights of the patient, as one of its non-negotiable tenets. Unfortunately, nurses have experienced adverse consequences for stepping forward to advocate for patients’ safety and informed decision-making. Some states have enacted whistle-blower legislation to protect employees who report unsafe or unethical situations, but there are no federal whistleblower protections. In addition, state nurse practice acts, as well as state human service laws, include mandatory reporting provisions that hold nurses accountable for implementing state hospital laws and regulations, as advocates for their patients.
  5. Nurses have the right to fair compensation for their work, consistent with their educational preparation, knowledge, experience and professional responsibilities.
    There are no laws or provisions that define "fair compensation" beyond the minimum wage. Nurses can become informed about current market wages for their region of employment in order to negotiate or seek employment with appropriate compensation. Employers cannot artificially control wages by collaborating with other employers in their region to set salary scales. Doing so may be illegal under state and federal anti-competition laws. Nurses can consult the ANA brochure Guide to Nurses' Rights: Passport to Protection (2000), which outlines specific protections for nurse employees under federal and state laws.
  6. Nurses have the right to a work environment that is safe for themselves and their patients.
    The federal Occupational Safety and Health Act of 1970 requires that an employer provide a workplace free from recognized hazards that could cause harm or death to employees. Some states have additional requirements that exceed federal mandates and address specific issues in each individual state.
  7. Nurses in all practice settings have the right to negotiate, either as individuals or collectively, the conditions of their employment.
    Nurses have the right to negotiate employment terms and conditions, and to have letters of employment that set forth wages, work schedules, how work performance will be evaluated, and orientation information.
    Under the National Labor Relations Act (NLRA,1935;1947;1959), employees may form, join or assist labor organizations, engage in collective bargaining over wages, hours and other terms and conditions of employment. The NLRA also protects non-union employees who, as a group, engage in certain activities related to their employment. While nurses employed in collective bargaining settings are prohibited from individual negotiation, the principles contained in the Bill of Rights for Registered Nurses are applicable to group negotiations.

Where are the other documents noted in this guide available?

  • Visit the Web site of the National Council of State Boards of Nursing listed below for nurse practice acts. Click on "Nursing Regulation".
  • Visit the Web site of the Department of Labor listed below to read the Occupational Health and Safety Act of 1970. Click on "A-Z index;" the law is listed under "O."

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