In this paper we argue that while attention to and acting upon ethical codes of conduct is paramount in professional nursing conduct, a critical antecedent to ethical behaviour is ontological perception, that is, how we view the patient as a person. We argue that the nurse’s perspective of the essence of patients (e.g., are they a means to our ends or ends in themselves?) - will form the groundwork for the quality of ethical care provided. As a foil for our discussion, we use the 2013 case at the Mid Staffordshire General Hospital in the United Kingdom in which unethical practice among staff place patient health, safety, and dignity at risk. We conclude by offering an ontological dimension to a truly ‘patient first’ strategy which places the very essence of the patient as primary.