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NMC code to be changed to reflect Francis report

Nurses could in future be struck off if they breach new fundamental standards of care for NHS patients, the Nursing and Midwifery Council has warned in its formal response to the Francis report.

The regulator is reviewing the nursing and midwifery code of conduct to ensure it is aligned with key recommendations from Robert Francis QC’s report into failings at Mid Staffordshire Foundation Trust.

The NMC said last week that it backed Mr Francis’s idea of introducing new fundamental standards of care. Such standards are likely to include rules on patient nutrition and hydration, patients receiving the correct medication and patients not being left in their own faeces or urine, according to the Care Quality Commission.

The NMC said the code would also be changed to reflect a focus on complaints, communication, older people, delegation and a duty of candour.

But it has rejected a key recommendation from Mr Francis that it should proactively launch its own investigations into hospitals where nurses may be guilty of breaching the code.

NMC chief executive and registrar Jackie Smith told Nursing Times: “We will of course deal with individuals, but we don’t have the power to go in [to a trust] and investigate systemic issues. We want to work closer with system regulators.”

She said the NMC will worker closer with the CQC and employers to share information, tackle serious issues and prepare for nurse revalidation in 2015. It will also seek improvements to its wider profile and awareness of its public protection role.

In addition, the regulator is looking to develop better links with trusts to ensure managers identify which cases should be resolved locally from those that require regulatory action. As previously reported by Nursing Times, one of the approaches being considered is attaching NMC liaison officers to trusts.

Speaking at a press conference last week, Ms Smith said the NMC did not believe it needed extra funds to meet the aims of its response to the Francis report, though she said the registration fee would be reviewed in March 2014.

“We take Robert Francis’ report and recommendations extremely seriously and what he said about us we accept unreservedly,” she said.

Ms Smith also defended the NMC’s record on fitness to practise decisions, which she said could be reviewed by the Professional Standards Authority.

However, she acknowledged there was still an issue around fitness to practise panels making judgements based on a nurses’ behaviour up to the day of their hearing, rather than purely on the day of the incident that the hearing related to.

“I accept the longer it takes us to investigate something there is an issue around the point at which someone turns up at a hearing and says they have learned from their mistake etc, but that is the law,” she told Nursing Times.

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Readers' comments (24)

  • Let's get a regulatory body that is fit for purpose. Disband the current organisation, get rid of the incompetent cronies and start from scratch building a regulatory body for nurses that is robust, competent, fair and relevant.

    A hundred knicker a year for a circus run by a bunch of clowns, set to rise in 2014 ("....she said the registration fee would be reviewed in March 2014. My *rse!!). Poor value for money .

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  • Francis is a lawyer not a nurse WTF do they know about nursing or the standard of care? any commission should be made up of doctors nurses and care astistants and patients, its all bull when you have some fancy commission telling us what should happen when the NHS executives tell us what to do or loose or jobs.

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  • It just gets worse and worse. No wonder we are so short of nurses, and have to go to other countries to employ..the kids here do not want to do nursing, instead get an IT qualification that pay much better......

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  • Agree...it is time that nurses really took a STANCE and OBJECTED BIG TIME !!!!!...be very interesting if the majority of nurses had a mysterious virus, and had to call sick on the same day !!!!

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  • Nurses should take a stance and be counted. Four years ago when my daughter started university I asked her what made her choose chemistry when I believe she would have made a good nurse. she said mum you are always tired being told there are enough staff with a bad morale at work.
    she wants to be seen to make a difference.
    I still try after 30yrs!!
    the problem is the private sector is also about money I dont know where they dreamt up so called patient to carer ratios from either!!!!!!!!

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  • I work in the private sector..it is all about form filling..endless..and if you miss a spot check for a bed rail..disciplined !!!!.....NURSING is about working under stress in fear of reprisal.....I have to pay mortgage which is high through a job that I now hate !!!

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  • This again is being being directed at the clinical nurse.

    S/he can only achieve so much in a day !

    Most of the clinical nurses time is spent on idiotic paper work !

    Lets get real!

    Who reduces RN staffing levels ?

    Who employs hordes of unskilled and untrained "care assistants "

    Who pretends that RN staffing levels are "safe"

    I will tell you !

    It is so called "Directors of Nursing"

    These people have no regard for "junior" nurses or patients !

    It is these "Directors" who should be struck off the register !

    A prediction !

    Someone will say I am a nasty person and defend the "directors" !





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  • michael stone

    '... patients receiving the correct medication and patients not being left in their own faeces or urine ...'

    It isn't clear to me, why knowingly allowing that to happen without a very good reason, isn't already behaviour which could lead to being de-registered.

    And if you know it is happening because there are too few staff, surely there is already a powerful professional duty to push vigorously for more staff to be provided - which gets us back to the 'bullying of staff who raise concerns' issues.

    The NMC has never investigated 'bad care' or 'bad procedures' in any general sense, and has only ever investigated complaints against individual nurses - I see it has no desire to change that position:

    'But it has rejected a key recommendation from Mr Francis that it should proactively launch its own investigations into hospitals where nurses may be guilty of breaching the code.'

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  • Can I ask a really silly question?
    Whose side is the NMC on?
    The patients, good nurses, or its own?

    Question: How many nurses at Mid Staffs that spoke out were victimised and appeared in front of the NMC and had their registration thrown out?

    Question: Does the NMC ask questions about hospitals that have more than average nurse referrals?

    I may be being really silly here as I am not a nurse but being here I have learnt nurses cannot defend themselves and are very easily victimised and are easy to bully.

    Nurses must tell the public what is going on and get a voice.

    LOVE
    PDaveANGEL

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  • The NMC really have no clue about nursing or what nurses do.
    They had a medication code, all nurses know what that is.
    All nurses know that patients shouldn't be left in faeces or urine, how does that work though if you have 10 incontinent patients and only 1 member of staff to look after them all at the same time?
    The NMC should be concentrating their efforts on safe staffing levels, training and registration of HCAs (as staff nurses are we really prepared to get disciplined if an HCA offers poor care, I don't think so, times are a-changing my friends).
    It is time that nurse managers faced the NMC.

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  • michael stone

    Anonymous | 21-Jul-2013 11:51 am

    In all honesty, I think that in theory safe staffing levels is more one for the CQC.

    The problem, is that the more 'responsibilty of regulators is compatmentalised' (presumably to reduce overlap and introduce efficiency') the more some things keep slipping through the gaps between different regulators.

    As for:

    'All nurses know that patients shouldn't be left in faeces or urine, how does that work though if you have 10 incontinent patients and only 1 member of staff to look after them all at the same time?'

    well, I think we all know, it frequently doesn't work, full stop !

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  • It saddens me so much that the individual nurse is still going to be targetted for staff shortages due to budget cutting. The NMC does not feel it neccessary to look at systemic issues within a hospital / unit - who will then? I agree with Michael Stone - how on earth can one, two or even 3 nurses change 3 incontinent patients all at the same and give their meds etc etc. Is everyone forgetting that with the increasing number of patients being discharged home early or avoiding admission in the first place the patients in the beds will be very unwell and very needy - WE NEED MORE NURSES NOT LESS!!! From a reader 34 years in nursing and getting the resignation letter ready - sadly!

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  • A correction by anonymous above 1.21 pm - meant to say 10 patients as Michael Stone had!

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  • Surely the current Code already covers all of the above mentioned issues? Isn't leaving people in their own faeces/urine a matter if denying them their dignity?

    This smacks of a regulator who is not fit for purpose rehashing their code to look as if they're doing something.. easy fix.. job done.. time for tea & scones in their lovely offices.. whilst frontline staff bear the brunt of staff shortages & criticism..

    Sadly wondering why I do my job anymore & becoming more disheartened by the day.

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  • tinkerbell

    Anonymous | 21-Jul-2013 3:50 pm

    same here. It's all just becoming a paper exercise and lip service without any ACTION from all the penpushers.

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  • I agree with the two comments above. the current code is similar or based on the International Code for Nurses and is also similar to some other national codes. why is there a need to change it? soon what little is left of nurses' professional autonomy, authority and responsibility will all be taken away although perhaps such rigid rules are in preparation for when there is a predominance of less qualified personnel providing 'care'.

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  • NMC needs to be part of HEE or GMC. This report proves there is not enough of a role to support a stand alone regulator which is not in touch with its membership or employers or anyone. Sorry NMC but your days seem to be numbered.

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  • Anonymous | 22-Jul-2013 10:01 am

    "Sorry NMC but your days seem to be numbered."

    Actually. I don't think they are. More's the pity.

    Why should a regulatory body for nurses be "a part" of any other organisation? That would only reinforce the 'subservient' nature of the profession. Are we so lacking in aspiration and ability that we cannot have an independent, fair regulatory body which stands alone?

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  • tinkerbell

    PDave Angel | 21-Jul-2013 8:59 am

    Can I ask a really silly question?
    Whose side is the NMC on?
    The patients, good nurses, or its own?

    Their own! Hob nobs all round and the best hotels.

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  • NHS! NHS! NHS!
    All nurses Private Care, Non NHS and NHS should be targeted equally.

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