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PURPOSE/OBJECTIVES: To describe the perceptions of nurses regarding the importance of each action skill listed in the Ethical Assessment Framework (EAF) to their ethical decision-making process and how prepared they were to undertake each action when confronted by moral dilemmas in clinical practice, and to identify general genetic ethical issues of concern and frequency encountered. DESIGN: Descriptive, exploratory. SAMPLE AND SETTINGS: Members of the Oncology Nursing Society's Cancer Genetics Special Interest Group (n = 34) and the International Society of Nurses in Genetics (n = 101). METHODS: Participants completed the Ethical Assessment Skills Survey and Genetic Ethical Issues Survey. MAIN RESEARCH VARIABLES: Perceptions of level of importance and preparation for each action skill in the EAF and level of concern and frequency encountered regarding ethical issues in clinical practice. FINDINGS: Each ethical action skill listed in the EAF was rated as important to the ethical decision-making process, although minimal skill level was reported in 60% of the steps. Nurses reported major concerns about the frequently encountered issues of confidentiality, managed care, and informed consent. CONCLUSIONS: The EAF proposes action skills that can assist nurses in developing expertise in ethical decision making and offers a model for addressing genetic ethical issues in clinical practice. Protection of patient confidentiality was the number one ethical concern of nurses surveyed. IMPLICATIONS FOR NURSING: Nurses are challenged to have comprehensive and current genetic knowledge, which is necessary to advocate for, educate, counsel, and support patients and families confronting difficult genetic healthcare decisions. Nurses will be able to effectively translate genetic information to patients by developing and using ethical decision-making and counseling skills. Effective measures to protect confidentiality of patient data are important to ensure that genetic information is safeguarded.