Q I work in the obstetrics department of a community hospital. Our patients include immigrants and refugees who don’t speak English and have cultural practices and beliefs that impact how we provide healthcare. Recently, a patient’s cultural beliefs allowed for only female clinicians to care for her. Fortunately, we were able to abide by her wishes, although it took thinking outside the box and last-minute staffing and schedule changes to ensure an entirely female team. Does the Code of Ethics for Nurses offer guidance on how to support advocacy and health equity for our immigrant and refugee patients? How can we prepare to care for all patients?

A Provision 8 of the Code of Ethics for Nurses (Code) highlights how nurses build collaborative relationships with nurse colleagues, multidisciplinary/interprofessional teams, and communities to protect patients’ human rights, mitigate health disparities, and achieve health equity (codeofethics.ana.org/provisions). As nurses, we engage in both leadership and collaboration to support patient outcomes, which can prove useful to consider in relation to your question.

The situation you described isn’t uncommon but it took effort, leadership, and collaboration across the healthcare team to effectively act on your patient’s values, beliefs, and needs to ensure acknowledgement of and respect for her rights and cultural customs. Thank you for bringing to the forefront a difficult and ethically challenging situation and offering your innovative thinking and approach.

According to the Code, “Nurses are uniquely positioned to elicit patients’ values, beliefs, and wishes, and communicate them to the team.” Ideally, a well-developed procedure would address cultural or religious beliefs, provide efficient delivery of care, and be simple to implement for both patients and clinicians. Nurses can take a leading role in developing such a procedure by, for example, recognizing scenarios likely to occur in a particular healthcare setting, identifying key stakeholders, engaging in drafting the procedure, and collaborating with team members to finalize it.

As members of the procedure development team, nurses actively listen, bring their own voices, and amplify the voices of everyone on the team as well as those of patients, families, and communities. Nurses bring a sense of curiosity and interest in learning, trustworthiness, and transparency to decision-making.

A nurse’s role extends well beyond their place of employment to form alliances for actions that advocate for patients and empower others to advocate for themselves. In the situation of the laboring woman who requested only female staff members, the nurse could engage in opportunities to learn about this patient’s cultural beliefs. The nurse might then identify community resources and work to develop a lasting collaboration that supports these cultural practices while also maintaining safe, high-quality care. Such efforts enable the team to develop creative yet ethical, equitable, and respectful solutions. Once a procedure has been tested and refined, disseminating it to others through professional conferences or publications offers a productive approach to collaborating across healthcare organizations and professions.

—Response by Annmarie Muñana, DNP, MSN, MJ, RN, and Beth Epstein, PhD, RN, HEC-C, FAAN, Code of Ethics Revision Panel contributors

American Nurse Journal. 2025; 20(9). Doi: 10.51256/ANJ092537