Competent genetic and genomic nursing practice requires the incorporation of various ethical approaches, or tools, into patient decision making. Using different decision-making approaches, which converge to answer an ethical issue, nurses can be confident that their judgment is justified. A lack of convergence can signal a need to reexamine the nurse’s ethical decision-making skills. This article describes four approaches that nurses can use to facilitate ethical decision making, which is a skill that must be learned and practiced; these will then be applied to a genomic case study.