Nonmaleficence in nursing is the ethical duty to do no harm. It requires nurses to avoid causing injury, prevent foreseeable harm, and weigh the risks of every intervention against its benefits. Alongside beneficence, autonomy, and justice, it is one of the four core principles of healthcare ethics, and it guides daily decisions from medication safety to fall prevention.
Key Takeaways
- Nonmaleficence means “do no harm”, including harm from action, inaction, and carelessness.
- It is different from beneficence: nonmaleficence avoids harm, while beneficence actively promotes good.
- Common examples include medication safety checks, fall prevention, infection control, and refusing unsafe assignments.
- When an intervention carries risk, nurses apply the principle of double effect and proportionality.
- The ANA Code of Ethics for Nurses supports nonmaleficence through its focus on patient safety and competent practice.
What Is Nonmaleficence in Nursing?
Nonmaleficence comes from the Latin non maleficere, meaning “not to do harm.” In nursing, it means you must not intentionally harm patients, and you must take reasonable steps to prevent unintentional harm. Harm can be physical, psychological, social, or financial.
The principle covers three duties:
- Do not inflict harm, for example by giving a medication you know is contraindicated.
- Prevent harm, for example by using bed alarms for a patient at high fall risk.
- Remove harmful conditions, for example by reporting broken equipment or unsafe staffing.
Why Is Nonmaleficence Important in Nursing?
Nurses spend more time with patients than any other clinician, so they are often the last safety barrier before an error reaches the bedside. Nonmaleficence matters because it:
- Protects patients from preventable adverse events such as medication errors, pressure injuries, and healthcare-associated infections.
- Builds trust between patients, families, and the care team.
- Supports legal and professional standards of care, which reduces liability.
- Encourages a culture of safety where staff report near misses instead of hiding them.
Examples of Nonmaleficence in Nursing Practice
| Situation | How the Nurse Applies Nonmaleficence |
|---|---|
| Medication administration | Uses the rights of medication administration, checks allergies, and questions unclear orders. |
| Fall risk | Completes a fall risk assessment, lowers the bed, and keeps the call light within reach. |
| Infection prevention | Performs hand hygiene and uses the right PPE for each patient. |
| Pain management | Balances pain relief against sedation and respiratory depression risk. |
| Unsafe assignment | Speaks up when workload or skill mix makes safe care impossible. |
| Impaired colleague | Reports suspected impairment through the proper chain of command. |
Many of these skills are covered in depth in our Medical Error Prevention and Infection Control and Barrier Precautions courses.
Nonmaleficence vs Beneficence: What Is the Difference?
Nonmaleficence is the duty to avoid harm. Beneficence is the duty to act for the patient’s benefit. The two often work together: giving an opioid for severe post-operative pain is beneficent, while monitoring respiratory rate and sedation level honors nonmaleficence. When they conflict, nurses weigh whether the expected benefit justifies the risk.
What Is the Principle of Double Effect?
Some interventions have both good and harmful effects. The principle of double effect holds that an action may be ethical if:
- The action itself is good or morally neutral.
- The nurse intends only the good effect.
- The harmful effect is not the means to the good effect.
- The good effect outweighs the harm.
A common example is palliative sedation or high-dose opioids at the end of life, where the intent is comfort, not hastening death. Our course on Chronic Pain: Assessment and Management explores safe opioid practice in more detail.
Ethical Dilemmas Involving Nonmaleficence
- Chemotherapy: treatment causes serious side effects, but withholding it may cause greater harm.
- Restraints: they may prevent self-injury but can cause injury, distress, and loss of dignity.
- Truth-telling: nurses sometimes worry that bad news will harm a patient, yet withholding information conflicts with veracity in nursing.
- Promises to patients: keeping commitments supports fidelity in nursing, but never at the cost of patient safety.
How Nurses Can Practice Nonmaleficence Every Day
- Stay current through continuing education and evidence-based practice.
- Practice only within your scope and competence, and ask for help when unsure.
- Use safety tools such as barcode scanning, checklists, and structured handoffs.
- Report errors and near misses so systems can improve.
- Protect patient privacy, because disclosure can cause emotional and social harm.
- Care for yourself; fatigue and burnout increase the risk of mistakes.
Want CE hours on safe practice? Explore the California nursing CE course catalog or review California RN license renewal requirements.
Frequently Asked Questions
What is a simple definition of nonmaleficence in nursing?
Nonmaleficence is the nurse’s ethical obligation to do no harm, which includes avoiding injury, preventing foreseeable harm, and removing unsafe conditions.
What is an example of nonmaleficence in nursing?
Checking a patient’s allergies before giving a new antibiotic is an example, because it prevents a harmful allergic reaction.
What is the difference between nonmaleficence and beneficence?
Nonmaleficence means avoiding harm, while beneficence means actively doing good for the patient. Nurses balance both when choosing interventions.
Is nonmaleficence part of the ANA Code of Ethics?
The ANA Code of Ethics for Nurses does not use a single provision titled nonmaleficence, but its commitments to patient safety, competence, and advocacy reflect the duty to do no harm.
Can a nurse violate nonmaleficence through inaction?
Yes. Failing to monitor, report, or intervene when harm is foreseeable can violate nonmaleficence just as much as a harmful action.
Sources and Further Reading
- American Nurses Association, Code of Ethics for Nurses with Interpretive Statements
- Beauchamp TL, Childress JF. Principles of Biomedical Ethics
- Agency for Healthcare Research and Quality (AHRQ), Patient Safety Network
This article was prepared under our Editorial and Review Policy. It is for educational purposes and does not replace official guidance from your licensing board or employer policy.
