Nursing care
Beneficence vs nonmaleficence: doing good versus avoiding harm in nursing decisions
Written and reviewed by Dana Whitfield, RN, MSN · 4 min read · Updated October 2026
Short answer
Beneficence is a positive duty to act for the patient's benefit: promote wellbeing, prevent harm and help. Nonmaleficence is a negative duty not to cause harm: avoid injury, unnecessary pain or burden. Ask whether the nurse in the stem is actively doing good, or refraining from or preventing an act that would hurt. Most real decisions weigh both.
Spot the verb: acting to help or refraining from harm
Beneficence asks the nurse to take positive steps for the patient: turning an immobile patient, teaching how to prevent complications, advocating for pain relief, or helping someone who cannot help themselves. Nonmaleficence asks the nurse not to inflict harm: refusing to give a medicine that is clearly wrong for the patient, not continuing a procedure that is causing injury, avoiding careless practice.
Ethicists describe nonmaleficence as a prohibition that applies to everyone equally, and beneficence as a set of positive requirements that can be more demanding. In NCLEX items, the giveaway is often in the action. Adding something good points to beneficence; stopping, withholding or avoiding something harmful points to nonmaleficence.
Short scenarios that separate the two
Beneficence examples: a nurse stays to help a frightened patient fill in a meal menu, arranges an interpreter so the patient understands discharge teaching, or encourages early mobilisation to prevent pneumonia. In each case the nurse adds a benefit. A tempting distractor is autonomy, but the focus here is the patient's welfare, not their right to decide.
Nonmaleficence examples: a nurse questions a prescribed dose that would be dangerous for the patient's kidney function, removes trip hazards, or stops a dressing change and reassesses when it causes severe pain. Here the nurse prevents or avoids harm. Reporting an impaired colleague also fits, because it protects patients from injury caused by unsafe practice.
Where the principles overlap or pull against each other
Many treatments both help and harm. Starting an IV line hurts but delivers needed fluids, and clinical ethics accepts that benefit can justify a burden when the balance favours the patient. Opioids for severe pain carry side effects, but relieving suffering is the intended effect. Decisions weigh expected benefit against harm rather than applying one principle in isolation.
Conflicts also involve autonomy and justice. A capable patient may refuse a beneficial treatment, and respecting that refusal is not a breach of beneficence. Questions may describe overly burdensome treatment at the end of life; withholding it can reflect nonmaleficence. When options seem to fit both principles, decide whether the core action is adding good or avoiding injury.
How the two principles show up in everyday nursing duties
Many routine nursing duties express beneficence: health teaching, early warning of deterioration, advocacy when a patient's needs are overlooked, and comfort measures for distressing symptoms. These go beyond avoiding mistakes to actively improving the patient's situation. When an exam option describes the nurse doing something extra to promote recovery or wellbeing, beneficence is usually the intended principle.
Safety practices largely express nonmaleficence: medication rights, infection prevention, fall precautions, questioning unclear or unsafe orders, and refusing tasks outside competence. Each one is about not causing harm through care. In practice these principles work alongside autonomy and justice, so the best nursing answer often respects the patient's choice while protecting them from avoidable injury.
Apply it to a hypothetical exam item
A nurse is asked to give a sedative that the patient's records show caused a serious reaction last month. The nurse holds the dose and contacts the prescriber. Which principle is the nurse primarily upholding? Options: autonomy, beneficence, justice, nonmaleficence. Nonmaleficence is best because the core action is preventing harm by withholding a risky medicine.
Change the stem: the nurse notices a patient has not been turned all shift and repositions him, checks pressure areas and sets reminders. Now beneficence fits best because the nurse is actively promoting welfare. The pairing shows why reading the verb matters. In practice the nurse also documents the concern and follows local reporting policy.
Sources and further reading
PMC: Principles of clinical ethics and their application to practice. Definitions of beneficence and nonmaleficence, examples, weighing benefits against burdens, and the doctrine of double effect.
Stanford Encyclopedia of Philosophy: The principle of beneficence in applied ethics. Beneficence as positive requirements of action versus nonmaleficence as negative prohibitions applied impartially.
The next step on this is the same as on everything else here: answer questions and read the rationales. Our safe and effective care practice questions are the closest set to what this page covers.
One question from the safe and effective care set
A nurse on a medical unit receives report on four clients. Which client should the nurse assess first?
Rationale
Prioritization items are airway, breathing, circulation, in that order — the ranking survives every rewording. Audible gurgling around a fresh tracheostomy is a partially obstructed airway and it is the only option that can kill the client in the next few minutes. Fever, post-op pain, and a glucose of 232 are all real problems that need the nurse, just not first.
Answer: C
Common questions
Is preventing harm beneficence or nonmaleficence?
Both frameworks touch it. Not causing harm yourself is nonmaleficence; actively stepping in to protect a patient from a hazard is often described as beneficence. Read whether the nurse is refraining or acting.
Does a painful procedure violate nonmaleficence?
Not if the expected benefit outweighs the burden and the patient consents. The principle targets unjustified harm, not every discomfort linked to needed care.
How is beneficence different from paternalism?
Beneficence aims at the patient's good while respecting their choices. Paternalism overrides a capable patient's decision in the name of their good, which conflicts with autonomy.
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