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'We want the code to articulate what it means to be a nurse', says NMC

As revision of the Nursing and Midwifery Council’s code of conduct is under way, Jo Stephenson finds out about the changes and the rationale behind them.

The Nursing and Midwifery Council’s code of conduct may seem somewhat removed from the reality of delivering care at the bedside of a sick patient, yet it is the cornerstone of the nursing profession.

So says the NMC’s director of continued practice Katerina Kolyva, who is leading work to update these key standards of conduct, performance and ethics.

“The code is a tool to enhance professionalism and not just a tool for disciplinary processes, which is how some people have seen it in the past,” she told Nursing Times.

“We want it to be a way for nurses and midwives to articulate clearly to everybody what it means to be a nurse or midwife, and to celebrate and take pride in those standards.”

A new version of the code, which features a total of 115 core standards, is currently out for consultation. It will replace the present version of the code, which was implemented in May 2008.

“We were keen to add this to the code to put the emphasis on the user and the public”

Katerina Kolyva

It covers everything from basic principles of care, prescribing medicines and patient confidentiality to teamwork, managing resources and the use of social media.

The document has been shaped by the NMC’s long-standing desire to strengthen regulation. But it was also heavily influenced by a raft of major reviews into patient safety, the most high profile of which was the Francis report into care failings at Mid Staffordshire Foundation Trust.

For the first time, the draft code sets out what patients and the public can expect from nursing care such as being treated with dignity, respect and compassion.

“We were keen to add this to the code to put the emphasis on the user and the public,” said Ms Kolyva.

“Other regulators have done that differently,” she said. “For example, the General Medical Council has a leaflet for patients, but their code specifically talks to doctors. However, the General Dental Council’s standards talk about what users of dental services can expect and we thought this was a better approach for us.”

Another development is a more explicit emphasis on individual nurses’ duty to raise concerns, if they fear patients are being put at risk, or feel they are being prevented from complying with the code in any way.

This has prompted questions about whether nurses’ registration could be at risk if they raise a concern but are not listened to or no action is taken, especially when it comes to the complex issue of safe staffing levels.

“Our raising concerns guidance clearly identifies the step a nurse or midwife can take in terms of raising concerns and taking things forward,” stated Ms Kolyva.

“If they have escalated it appropriately and are still concerned about patient safety then ultimately they can raise it with us as well,” she said.

The code also stresses that nursing managers and leaders have a responsibility to investigate and address concerns that they are informed about.

Ms Kolyva believes the profession will welcome the fact the document clearly sets out responsibilities for those in senior roles, as well as for those on the frontline.

NMC

Katerina Kolyva

“It is important for us to acknowledge that our register is very diverse and includes frontline nurses but also nurses in very senior positions – from someone who is a sister through to the director of nursing, to a very senior policy person to the chief nurse,” she said.

“All of these people are exactly the same under the code, with exactly the same requirements,” she said.

Another proposed addition to the code deals with “duty of candour”, a nurse’s responsibility to admit mistakes and apologise where appropriate.

The current code already requires nurses to “act immediately to put matters right if someone in your care has suffered harm for any reason”, and to “explain fully and promptly to the person affected what has happened and the likely effects”.

However, the draft extends the duty from incidents that have resulted in actual harm to those that may have done so.

It says patients can expect a nurse to “act immediately to put matters right if someone in your care has suffered harm for any reason or been the victim of a ‘near miss’ and explain promptly to them what has happened and the likely effects”.

The draft document is clear that when it talks about candour it is referring to the definition used by the 2013 Francis report. This definition requires a nurse to volunteer “all relevant information to persons who have or may have been harmed by the provision of services”, whether or not a complaint has been made.

The duty of candour is one of the areas that is very much up for discussion, said Ms Kolyva.

The NMC is currently working on more detailed duty of candour guidance with the GMC, which will set out “what that actually means from a professional’s point of view”, she adds.

Ms Kolyva stressed that the updates to the code were “not a done deal” and were subject to change, depending on the outcome of the consultation process, which is due to end on 11 August.

She said the NMC is keen to hear the views of the nurses and midwives who will be expected to live up to the standards in the new code. So far, she said the regulator had received hundreds of responses each week since the consultation began in May.

“We’re not saying no social media, it’s about appropriate use”

Katerina Kolyva

Ms Kolyva revealed that one area that had prompted an unexpected amount of feedback was the proposed standard on social networking, which would require nurses and midwives to use social media and other forms of electronic communication responsibly.

“Some people have asked if that means they can’t have a LinkedIn profile or engage with social media,” she said. “But we’re not saying no social media, it’s about appropriate use. If we need to change the statement we have at the moment to make that clear, then we will.”

Another hot topic is the draft code’s spelling out of care basics such as the need for nurses to ensure patients get enough to eat and drink and are looked after in clean, hygienic conditions.

This in part brings the code in line with the NMC’s standards for nursing education, which emphasise the need to cover these fundamental principles.

But there was a feeling that some registrants viewed this as an unnecessary emphasis on aspects of care that should be obvious to any nurse, Ms Kolyva said. “If people think this doesn’t need to be there [in the draft code] as strongly as it is, and there is another way of addressing it, then we want to hear about it,” she said.

In addition, she told Nursing Times there had been much discussion about the format of the code. “Some people feel the code should be beefed up – I get that a lot from senior nurses,” said Ms Kolyva. “While others feel the version out for consultation at the moment may be too long, so it is about getting that balance right.”

The NMC Council has moved away from having a shorter code – with a lot of accompanying information and guidance on its website – to a more comprehensive document, which is supported by a single layer of separate guidance that covers topics including revalidation, candour, raising concerns and medicines management.

The aim was to make it less confusing and easier for nurses to access the information, rather than if it was “in three or four places”, explained Ms Kolyva.

Once it is finalised by the NMC Council in December this year, the revised code will be supported by other resources to help ensure all nurses and midwives are aware of the new standards and can easily refer to them while at work.

“It would be good to get the code published in a version that people can use daily,” said Ms Kolyva.

“That could include an app that you can look at on your phone or having it electronically rather than people going around with a little booklet,” she suggested.

* For more information on the consultation go to http://www.nmc-uk.org/Get-involved/Consultations/Consultation-on-revalidation-and-the-revised-Code

* To take part in the consultation on the code of conduct, go to https://research.ipsosinteractive.com/mrIWeb/mrIWeb.dll

Readers' comments (13)

  • There is a universal truth that the more rules and regulations, guidelines and aspect of code you put in, the more holes people will find to slide through! When on earth did it become necessary to have a code that Nurses must comply with that tells them they must make sure patient's nutrition, hydration and hygiene needs are being met. Next when a patient dies due to lack of oxygenation the nurse in question will be able to say that oxygenation needs were not in the code! Think this thing through, broad principles make for better practice.

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  • I agree with the comment above. Overly detailed regulation is often a recipe for endless counter queries, which is the reason why solicitors tend to keep their statements concise, simple, and in few numbers.

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  • As usual, only one person to lose in the endless NMC and court cases that will no doubt be generated: the patient.

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  • these articles get longer and longer. does anybody read them?

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  • I totally agree with the comments made. If the information is too labor intensive to read through and absorb then is it really going to be fit for purpose.

    Broader concepts that should be a mantra for all registered nurses would surely be more effective.

    I don't understand why we have to make everything so complicated today.

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  • these people would be better served volunteering on the front lines in hospital wards to ensure the staff numbers meet the minimum requirements needed to take care of patients properly then there would be no need to mess about with codes which the majority of nurses adhere to the very best of their ability every day the bottom line to most problems is understaffing and the only people able to do anything about that is ................. ??

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  • The present code is absolutely fine, clear and comprehensive. As Alison says, above, the issues which need addressing are not within the control of frontline nurses - we can advise, report and ask managers for adequate staffing, training and infrastructure, but if these are not provided the code will be compromised. 1 nurse cannot adequately or safely carry out the work of 3, no matter how aware they are of the code, or how committed, knowledgeable or hard working.

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  • NMC code: Nurse your patient

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  • 115 Core standards it would seem that it will merely be a tool to use agains nurses rather than support them. Does this go some way to justifying the huge hike in registration fees?

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  • how is anybody going to remember 115 standards at any one time. does that include the six Cs or do they come as extras?

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  • How much are these consultations + revisions costing?
    The more bureaucracy that gets added into any system, the more it costs, and also core messages could become more diluted.

    How much does it cost to maintain a register of nurses and midwives? Then work from there.
    Any registrant who isn't up to scratch should be taken through the courts, and dealt with under existing laws. Such as abuse would come under assault, then it would show up on someone's DBS checks, and cannot work in practice until they have served their time and if appropriate make changes to their practices, before being allowed to deliver any care again.

    Under duty of candour, its been said many times NMC and the government aren't fit for practice, and yet, nothing much seems to change!

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  • why isn't the NMC a member of FEPI

    http://www.fepi.org/

    makes one wonder what they and british nurses have to hide.

    there should be standardised regulation for all nurses and all healthcare serviced to patients throughout the EU. anything falling short of European standards is unacceptable , high risk and potentially dangerous.

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  • It is funny how many of you are stating that it must be obvious what a nurse is required to do and what they should not do. But, look at the Staffordshire scandal, so many nurses failed in their duty of care which resulted in unacceptable care.

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