Nursing Ethics and Gun Safety: A Professional Imperative
Nurses have an ethical obligation to counsel patients about firearm safety risks, particularly for vulnerable populations including children, adolescents, persons with dementia, those with mental illness, and individuals with substance use disorders—this is a core professional responsibility grounded in harm prevention and public health advocacy. 1
The Ethical Foundation
The American College of Physicians establishes that the medical profession has a special responsibility to speak out on prevention of firearm-related injuries and deaths, just as healthcare professionals have addressed other public health crises. 1 This ethical duty extends fully to nursing practice, as nurses are often the frontline providers with the most patient contact time and trust.
Core Ethical Principles in Action
Beneficence and Non-maleficence: Nurses must actively work to prevent harm by discussing firearm risks with patients, as proper storage and safety measures can prevent a substantial number of deaths. 2
Patient advocacy: Healthcare professionals should counsel patients on the risk of having firearms in the home, with particular attention to high-risk situations where children, adolescents, people with dementia, people with mental illnesses, people with substance use disorders, or others at increased risk are present. 1
Professional autonomy: State and federal authorities should avoid enactment of mandates that interfere with healthcare provider free speech and the patient-provider relationship—nurses have the right and duty to have these conversations. 1
Risk Assessment Framework
Nurses should systematically identify patients requiring firearm safety counseling using these specific criteria:
- Households with children or adolescents present 1
- Patients with dementia (approximately 60% of persons with dementia own firearms, and only 16.9% store them safely) 1
- Patients with mental illnesses associated with greater risk of self-harm or harm to others 1
- Patients with substance use disorders 1
- Patients with depression (about 40% of persons with dementia experience depression, and more than 90% of firearm injuries in older adults are suicide) 1
- Patients exhibiting combative behavior (about one-third of persons with dementia exhibit this) 1
Evidence-Based Counseling Protocol
The conversation must be standard practice with all patients, not limited to specific subsets, and should be framed without bias against gun ownership to maintain trust and effectiveness. 3
Specific Counseling Components
Discuss storage risks: Unsafely stored and loaded firearms in homes increase the risk of homicide, suicide, and unintentional firearm injury for family members and home healthcare professionals. 1
Recommend best practices: Firearms should be stored unloaded and locked, with ammunition stored separately, ensuring they cannot be accessed by at-risk individuals. 1
Address suicide risk: Having access to firearms increases the likelihood of completed suicide because of the high case fatality rate for suicide attempts with guns—this is particularly critical for older adults. 1
Provide specific mitigation strategies: The National Institute of Occupational Safety and Health recommends home health agencies establish no-weapon policies or safely stored weapons policies in patient homes to minimize risk. 1
Educational Preparation Requirements
Nursing schools, residency programs, and continuing education programs should incorporate firearm violence prevention into their curricula. 1 This addresses the current gap where most healthcare providers feel unprepared to have these conversations despite their ethical obligation. 2
Key Educational Elements
- Training on how to initiate conversations about firearms without appearing judgmental 3
- Understanding of firearm injury epidemiology and prevention evidence 1
- Knowledge of safe storage practices and available resources (such as firearm locks) 4
- Skills in assessing risk factors for firearm-related harm 1
Advocacy Role
Nurses are encouraged, individually and through their professional societies, to advocate for national, state, and local efforts to enact legislation implementing evidence-based policies to reduce preventable firearm injuries and deaths. 1
This includes supporting:
- Universal background check systems 1
- Child access prevention laws that hold firearm owners accountable for safe storage 1
- Reporting requirements for lost or stolen firearms within 72 hours 1
Common Pitfalls to Avoid
Do not limit conversations to "high-risk" patients only—this creates bias and misses opportunities for prevention. The conversation should be standard with all patients. 3
Avoid appearing to disapprove of gun ownership—the discussion must focus solely on safety practices and storage, not ownership itself, to maintain the therapeutic relationship. 3
Do not let concerns about liability prevent counseling—professional guidelines clearly establish this as within the scope of practice and an ethical obligation. 2
Avoid superficial screening without follow-through—if firearms are present, specific counseling on safe storage must occur, not just documentation of presence. 4
Implementation in Clinical Practice
Despite high acceptability of screening (85% of physicians endorse it) and counseling (80% endorse it), these practices are not yet routine, and provision of safety devices like firearm locks remains rare (only 15%). 4 This represents a critical implementation gap that nursing leadership must address through: