Do No Harm In Nursing: Nonmaleficence Explained With Examples

Nursing isn’t only about skills and procedures—it’s also about ethics. One of the most important is nonmaleficence, the principle of “do no harm.” For nurses, this means preventing avoidable harm, protecting dignity, and making choices that put patient safety first.

In this article, we’ll explore nonmaleficence examples in nursing and show how this principle guides everyday care. You’ll learn what nonmaleficence means, why it matters, and how it connects with beneficence. We’ll cover real-world examples across different specialties, case tutorials with scripts and charting tips, a nurse’s safety checklist, and the consequences of ignoring this duty. Finally, we’ll answer common questions and leave you with practical takeaways you can use right away.

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What Is Nonmaleficence in Nursing?

Nonmaleficence means the duty to avoid causing harm. For nurses, it’s not just about preventing mistakes—it’s about acting with intention and care in every decision. It asks you to pause and think: Could this harm my patient?

Key points to remember:

Preventive by nature. Nurses stop harm before it happens.
Covers all harm. Physical injuries, emotional pain, and psychological distress all count.
Balances beneficence. Doing good is important, but never at the cost of harm.
Protects patient rights. Informed consent, honoring DNR orders, and respecting end-of-life choices all reflect nonmaleficence.

In short, nonmaleficence is the foundation of safe, ethical care. It ensures that every action—no matter how small—is guided by the principle of “do no harm.”

Everyday Examples of Nonmaleficence in Nursing

Theory becomes real when applied at the bedside. Here are 15 everyday examples of nonmaleficence in nursing, grouped by specialty. Each scenario shows how nurses translate “do no harm” into practice.

1. Medication Allergy Check (Medical-Surgical)

Situation: A patient is prescribed penicillin for an infection.
Risk of Harm: The patient’s chart shows a penicillin allergy. Giving the drug could cause anaphylaxis.
Nonmaleficence Decision: The nurse calls the provider to request an alternative antibiotic.
Nurse Script: “I noticed this patient has a penicillin allergy. Would you like me to request a different antibiotic?”
Charting Language: “Penicillin allergy noted. Provider notified. Awaiting alternative order.”

2. Blood Transfusion Safety (Medical-Surgical)

Situation: A patient needs a blood transfusion.
Risk of Harm: Giving the wrong blood type could cause a severe reaction.
Nonmaleficence Decision: The nurse double-checks blood compatibility with another RN before starting the transfusion.
Nurse Script: “Let’s verify this unit together before hanging it.”
Charting Language: “Blood type and unit verified with RN Smith prior to transfusion. No reaction noted.”

3. Preventing Falls (Medical-Surgical)

Situation: An elderly patient is weak after surgery.
Risk of Harm: Attempting to walk alone may lead to a fall and injury.
Nonmaleficence Decision: The nurse activates the bed alarm, lowers the bed, and reminds the patient to call before getting up.
Nurse Script: “Please use the call light when you need to get up. I’ll be right here to help.”
Charting Language: “Fall precautions in place: bed alarm activated, call light within reach, patient reminded to call for assistance.”

4. Ventilator Safety (ICU)

Situation: A patient on a ventilator is due for routine suctioning.
Risk of Harm: Incorrect settings or prolonged suctioning can cause hypoxia.
Nonmaleficence Decision: The nurse checks ventilator settings and oxygenates the patient before suctioning.
Nurse Script: “I’m going to suction your airway now. I’ll keep it brief to help you breathe easier.”
Charting Language: “Pre-oxygenated prior to suctioning. Suction performed x2. Patient tolerated well. O2 saturation remained stable.”

5. Central Line Infection Prevention (ICU)

Situation: A central line needs a dressing change.
Risk of Harm: Breaks in sterile technique could cause infection.
Nonmaleficence Decision: The nurse performs the procedure using strict sterile technique.
Nurse Script: “I’ll change your line dressing now. This will help prevent infection.”
Charting Language: “Central line dressing changed using sterile technique. Site clean, dry, and intact.”

6. Managing Sedation Safely (ICU)

Situation: A ventilated patient requires sedation for comfort.
Risk of Harm: Too much sedation can suppress breathing; too little may cause distress.
Nonmaleficence Decision: The nurse titrates sedation to balance comfort and safety, monitoring vital signs closely.
Nurse Script: “I’m adjusting your sedation so you’re comfortable but still safe. I’ll keep monitoring your breathing.”
Charting Language: “Sedation titrated per protocol. RR 16, SpO₂ 97%, patient calm and responsive to stimulation.”

7. Avoiding Unnecessary Invasive Tests (Pediatrics)

Situation: A child with mild dehydration is ordered for a CT scan.
Risk of Harm: Radiation exposure is unnecessary when hydration status can be monitored non-invasively.
Nonmaleficence Decision: The nurse advocates for oral rehydration and reassessment before invasive imaging.
Nurse Script: “Could we trial oral fluids first? The child is stable, and this may avoid radiation exposure.”
Charting Language: “Discussed with provider: plan to initiate oral rehydration before considering imaging. Vitals stable.”

8. Safe Medication Dosing Education (Pediatrics)

Situation: A parent is about to give their child adult-dose acetaminophen.
Risk of Harm: Overdose can cause liver toxicity.
Nonmaleficence Decision: The nurse educates the parent on correct pediatric dosing.
Nurse Script: “Your child’s dose is smaller than an adult’s. Let’s measure it together to be safe.”
Charting Language: “Provided education on weight-based acetaminophen dosing. Parent demonstrated correct dose using syringe.”

9. Vaccine Safety Screening (Pediatrics)

Situation: A child is scheduled for a flu vaccine.
Risk of Harm: Previous severe egg allergy could trigger a reaction.
Nonmaleficence Decision: The nurse screens for contraindications before administering.
Nurse Script: “Before the shot, I want to double-check allergies and past reactions to vaccines.”
Charting Language: “Screened for contraindications prior to influenza vaccine. No adverse reactions reported. Vaccine administered.”

10. Avoiding Unnecessary Restraints (Behavioral Health)

Situation: A patient is agitated and pacing.
Risk of Harm: Immediate restraint could cause injury or trauma.
Nonmaleficence Decision: The nurse uses verbal de-escalation before considering restraints.
Nurse Script: “I can see you’re upset. Let’s sit down and talk about what’s bothering you.”
Charting Language: “Patient agitated. Verbal de-escalation used. Patient calm after 10 minutes. No restraints required.”

11. Using De-escalation Before Medications (Behavioral Health)

Situation: A patient shouts angrily during group therapy.
Risk of Harm: Immediate medication may sedate unnecessarily.
Nonmaleficence Decision: The nurse attempts calm communication before PRN medication.
Nurse Script: “I hear your frustration. Let’s step outside and talk privately.”
Charting Language: “Patient escalated during group session. Redirected to private setting. De-escalation successful, no PRN required.”

12. Protecting Dignity During Evaluation (Behavioral Health)

Situation: A patient is asked sensitive questions during intake.
Risk of Harm: Asking in front of others could breach privacy and cause distress.
Nonmaleficence Decision: The nurse ensures privacy before continuing the assessment.
Nurse Script: “Let’s move to a private room so you feel comfortable sharing.”
Charting Language: “Completed psychosocial intake in private room. Patient expressed comfort with setting.”

13. Providing Pain Relief at End-of-Life (Palliative Care)

Situation: A terminally ill patient requests stronger pain medication.
Risk of Harm: Higher doses may suppress breathing.
Nonmaleficence Decision: The nurse administers medication per protocol, prioritizing comfort while monitoring.
Nurse Script: “This may make you more relaxed and ease your pain. I’ll stay with you and monitor closely.”
Charting Language: “Morphine administered per protocol. Patient resting comfortably. RR 14, SpO₂ 96%.”

14. Respecting Do Not Resuscitate (DNR) Orders (End-of-Life Care)

Situation: A patient with a DNR collapses in the hospital.
Risk of Harm: Ignoring the order could cause unnecessary suffering.
Nonmaleficence Decision: The nurse honors the DNR, providing comfort measures only.
Nurse Script: “We will keep you comfortable and follow your wishes.”
Charting Language: “Patient collapsed. DNR honored. Comfort care provided. Family notified and present at bedside.”

15. Avoiding Futile Interventions (End-of-Life Care)

Situation: A patient with multi-organ failure is declining.
Risk of Harm: Aggressive interventions would prolong suffering without benefit.
Nonmaleficence Decision: The nurse advocates for palliative measures and communicates with the care team.
Nurse Script: “Given the patient’s decline, would you like to focus on comfort-focused care instead of aggressive treatment?”
Charting Language: “Discussed prognosis with provider. Palliative measures initiated. Family updated and in agreement.”

Why Nonmaleficence Matters in Nursing

Nonmaleficence is more than a theory—it’s the backbone of safe nursing care. Every action a nurse takes has consequences. Some heal, but others can unintentionally cause harm. This principle reminds nurses to pause, weigh the risks, and act carefully.

Here’s why it matters:

Patient safety comes first. Even minor errors—like a wrong dose or a missed allergy—can have lasting effects. Nonmaleficence builds a safety-first mindset.
It builds trust. Patients place their lives in nurses’ hands. Protecting them from harm strengthens that trust.
It guides tough choices. When decisions feel unclear, “do no harm” provides a steady compass.
It balances beneficence. Doing good is important, but it must never come at the cost of hidden risks.

Example: A strong pain medication may ease suffering (beneficence) but could lower blood pressure or slow breathing. Nonmaleficence asks: Is the relief worth the risk?

By practicing nonmaleficence, nurses protect both safety and dignity. It’s what turns technical skill into ethical, trustworthy care.

Tutorials: Case Scenarios of Nonmaleficence in Action

Case scenarios make ethics practical. Here are three common situations where “do no harm” guides the nurse’s response.

1. Medication Error Prevention

A nurse is about to give insulin but notices the vial label doesn’t match the order.

Stop and verify with the provider
Use the five rights of medication safety
Document and educate the patient

Takeaway: Double-checking prevents life-threatening errors and keeps patient safety at the center.

2. Informed Consent

A patient is scheduled for surgery but doesn’t understand the risks. The surgeon is unavailable, and the nurse is asked to get the consent form signed.

Pause the process until the provider explains fully
Ensure the patient’s questions are answered
Document the delay and reasoning

Takeaway: Rushing consent may seem efficient but violates patient rights and risks harm. Nonmaleficence protects dignity and autonomy.

3. Doctrine of Double Effect

An end-of-life patient is in severe pain. High-dose morphine could shorten life but offers comfort.

Advocate for pain relief as part of palliative care
Monitor side effects closely
Communicate openly with family and provider

Takeaway: Sometimes harm cannot be fully avoided. The goal is to minimize it while prioritizing comfort and respect.

Nurse’s Checklist for Practicing Nonmaleficence

Nursing shifts are busy and fast-paced. This simple checklist helps keep “do no harm” at the center of care.

Before you act, ask yourself:

Is this intervention necessary?
- Avoid unnecessary tests, procedures, or medications.
Have I verified accuracy?
- Double-check medication, patient ID, allergies, and orders.
Could this cause unintended harm?
- Weigh risks, side effects, and complications before proceeding.
Am I protecting dignity?
- Respect privacy, cultural values, and emotional well-being.
Does the patient understand?
- Ensure informed consent and clear explanations.
Am I documenting correctly?
- Accurate notes prevent confusion and safeguard patients.
Have I spoken up for safety?
- Raise concerns when you see unsafe practices, even if it’s hard.

Tip: Think of this as a pocket guide. With practice, these steps become second nature and keep care aligned with nonmaleficence every time.

Consequences of Neglecting Nonmaleficence

When “do no harm” is ignored, the results can be serious for both patients and nurses.

1. Patient Harm

Physical injury from falls, infections, or medication errors
Emotional harm such as fear, trauma, or loss of trust
Prolonged suffering from unnecessary treatments

2. Legal and Professional Risks

Malpractice lawsuits and liability claims
Disciplinary action from boards of nursing
Suspension or loss of license in severe cases

3. Ethical Breach

Violating the ANA Code of Ethics
Breaking the trust between patient and provider
Weakening the credibility of the profession

4. Emotional Toll on Nurses

Moral distress and guilt when harm occurs
Burnout from repeated ethical conflicts
Reduced confidence in clinical decision-making

Example: If a nurse fails to report a medication error, the patient may suffer harm, legal action may follow, and the nurse could carry long-lasting guilt.

Takeaway: Nonmaleficence is protection for everyone. It shields patients from harm and nurses from ethical, legal, and emotional consequences.

FAQs on Nonmaleficence in Nursing

1. What is a simple example of nonmaleficence in nursing?
Checking a patient’s allergy list before giving a new medication. That one step prevents harm and shows a safety-first mindset.

2. How is nonmaleficence different from beneficence?

Nonmaleficence: Avoiding harm or injury.
Beneficence: Actively promoting good and well-being.
Nurses often balance both in daily practice.

3. What happens if a nurse breaks nonmaleficence?
Patients may be harmed, and nurses may face lawsuits, discipline from the board, or even lose their license. It can also leave nurses with guilt and moral distress.

4. Is nonmaleficence part of the ANA Code of Ethics?
Yes. The 2025 ANA Code of Ethics highlights nonmaleficence as a key duty, reminding nurses to prevent physical, emotional, and psychological harm.

5. How can new nurses apply nonmaleficence every day?

Ask questions when unsure
Verify orders and medications carefully
Explain care clearly to patients
Speak up about unsafe practices
Respect patient dignity in all situations

Final Thoughts

Nonmaleficence—the principle of “do no harm”—isn’t just an ethical rule. It’s a daily promise that shapes every decision a nurse makes. From double-checking a medication label to protecting a patient’s dignity, small actions build trust and safeguard lives.

By practicing nonmaleficence, nurses:

Reduce risks and prevent errors
Strengthen patient trust and confidence
Uphold professional and ethical standards

When paired with beneficence, nonmaleficence ensures that nursing care is both safe and compassionate. It reminds us that good care isn’t only about doing more—it’s about doing what’s right, wise, and respectful for every patient, every time.

Key takeaway: Nonmaleficence turns knowledge into trustworthy care. Every pause to check, every act of advocacy, and every step to prevent harm keeps patients safe and nursing honorable.

Nonmaleficence in Nursing Practice: Real Examples, Case Scenarios, and a Nurse’s Guide to Safe Care