The NMC code: conduct, performance and ethics
Nurses and midwives can use the NMC code to guide and support daily practice
In this article…
- How the NMC code aims to safeguard the health and wellbeing of the public
- How nurses and midwives should use the code to guide their daily practice
- How the code, alongside other NMC standards, guidance and advice, can be used as a tool to support development
Jan Goldsmith is assistant director, standards (nursing) at the Nursing and midwifery Council.
Goldsmith J (2011) The NMC code: conduct, performance and ethics. Nursing Times; 107: 37, early online publication.
The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives is a set of key principles that should underpin the practice of all nurses and midwives, and remind them of their professional responsibilities. It is not just a tool used in fitness-to-practise cases – it should be used to guide daily practice for all nurses and midwives. Alongside other standards, guidance and advice from the NMC, the code should be used to support professional development.
Keywords: NMC Code, Standards, Guidance
- This article has been double-blind peer reviewed
- Figures and tables can be seen in the attached print-friendly PDF file of the complete article
5 key points
- The NMC code is key to safeguarding the health and wellbeing of the public
- It is not just a mechanism used in fitness to practise cases
- It should form a key part of guiding nurses’ and midwives’ daily practice
- Nurses and midwives should refer to the key principles of the code frequently
- Alongside other NMC standards, guidance and advice, the code is an important tool for supporting professional development
Like any profession, nursing must have clear regulatory principles so that registered nurses know what is required of them. These principles are set down in The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives (Nursing and Midwifery Council, 2008), which is a key tool in safeguarding the health and wellbeing of the public.
The code provides the foundation upon which all other NMC standards, guidance and advice are based. It also provides the benchmark against which individual nurses’ or midwives’ fitness to practise is judged if it is called into question; this is often the main feature that people associate with the code. Fewer than 1% of the total number of nurses and midwives on the NMC’s register are referred to the fitness to practise department but, in spite of this, all nurses and midwives need to think more broadly about how the code can support them in their everyday work.
The code should be seen as a set of key principles that underpin the practice of all nurses and midwives and remind them of their professional responsibilities. It should also be used as a tool to support decision-making, reflection and learning and development.
This article explores the ways in which nurses and midwives can use the code on an ongoing basis to support and improve their practice.
The key principles
When working in busy environments, it is easy for nurses to lose sight of what the code requires of them. It is, therefore, important that all nurses refer to it frequently, to remind themselves of the key principles set out in its different sections.
The people in your care must be able to trust you with their health and wellbeing
This is the code’s overarching principle. As a nurse, you must always be able to justify that trust and never forget what a privilege it is to care for someone. This could be giving help with personal care or to eat a meal, listening to a person who is disclosing their deepest concerns and anxieties to you, or caring for a baby who a parent has handed to you. It is sometimes easy to forget the magnitude of this responsibility.
Make the care of people your first concern, treating them as individuals and respecting their dignity
Sadly, recent high-profile reports and inquiries into failings in the delivery of healthcare continue to show that there are far too many incidences where people are simply not being treated with the dignity and respect they deserve. You need to continually remind yourself that often it is the simplest things that are important in maintaining the dignity of the people you care for and work with.
Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community
It is vital to remember the principles of effective teamworking, which are set out in this section of the code. Many nurses now lead teams from very early in their careers and so need to be effective leaders. In leadership and management roles, it is crucial that you are absolutely clear about your accountability in relation to delegating care safely and effectively, and managing risk.
Provide a high standard of practice and care at all times
Nurses have a responsibility to strive for excellence and aim to deliver the highest possible standard of practice wherever they work. This can be difficult when resources are limited, but is important. You need to ensure you are using the best available evidence to support practice and that you keep your knowledge and skills up to date.
Be open and honest, act with integrity and uphold the reputation of your profession
As a nurse you have a responsibility to uphold the reputation of the profession at all times. This applies equally whether you work directly with patients and service users or in other environments such as education, research or policy development. It also applies to your behaviour and conduct outside the workplace.
Additional guidance and advice
As the code sets out fundamental principles, it cannot cover all the circumstances or ethical situations nurses and midwives may encounter. The NMC therefore provides a wide range of additional guidance and advice to support aspects of the code. This is frequently updated, so it is important to check the NMC website regularly for new material.
Some examples of recent areas of development are set out below.
Paper and electronic records
Record Keeping: Guidance for Nurses and Midwives (NMC, 2010a) elaborates on the section in the code that addresses record-keeping. It explains in detail what the NMC expects from nurses and midwives in relation to paper and electronic records.
In view of evidence that poor record-keeping continues to be a problem across nursing and midwifery, the NMC is about to begin a review of this document. Its aim is to develop a new standard that will address the wider processes of critical thinking, decision-making, assessment and diagnosis that is undertaken by nurses and midwives and determines the care they provide, and the subsequent content of their records.
Guidance for the Care of Older People (NMC, 2009) uses the code as a framework for identifying a range of principles that should be followed when delivering care to people in this age group. It focuses particularly on maintaining the dignity and autonomy of older people, and respecting their rights and choices. Nurses who work with older people are strongly encouraged to use this resource to further develop services and make improvements in care.
Safeguarding, raising concerns and improving standards of care
The importance of safeguarding people’s rights, choices and maintaining their dignity is highlighted in an innovative collection of materials the NMC has developed. The safeguarding adults resources were launched last year and include a series of short films to enable nurses and midwives to critically reflect on their practice and ensure that safeguarding continues to be a key priority. These resources clearly illustrate the responsibility of nurses and midwives in using the principles enshrined in the code to safeguard the health and wellbeing of the public.
The code clearly directs nurses and midwives to act without delay if they believe someone is being put at risk. Of course, it is not always easy to report concerns and, in recognition of these challenges, the NMC published Raising and Escalating Concerns: Guidance for Nurses and Midwives (NMC, 2010b). This provides a range of information to help nurses and midwives work through a process to ensure that concerns about the safety and wellbeing of people in their care or work environment can be raised and addressed.
It is important to emphasise that raising and escalating concerns is not just about blowing the whistle on dangerous or unsafe practice. Nurses and midwives must be proactive in improving practice and standards of healthcare; this means being able to take a lead in identifying opportunities for innovation and enhancement.
Creating and maximising opportunities to improve services and providing leadership feature strongly in the new Standards for Pre-Registration Nursing Education (NMC, 2010c). The need for students to develop skills in critical thinking, evidence-based practice, and use of technology are also strong themes.
Students will be starting the first programmes approved under these standards this year and will need to see these principles modelled in the workplace when they undertake their practice learning. It is important for all nurses to familiarise themselves with the new standards and ask themselves what they will mean in terms of how they apply the code in their practice.
The NMC also produces a wide range of advice sheets that provide additional support to nurses and midwives in identifying how aspects of the code relate to their practice. These include confidentiality, accountability, delegation and, most recently, responsible use of social networking sites.
It is important to emphasise that nurses and midwives should ensure they are aware of the range of legislation as well as local policies and procedures that affect their practice and keep themselves up to date with any changes.
Supporting professional development
The above information should have highlighted the importance of regularly referring to the code and the range of supporting guidance and advice, both to remind you of the principles that should underpin your practice and to enable you to reflect and consider ways of enhancing and improving practice within your working environment.
Reflection as a tool to help maintain and improve practice should be at the heart of continuing professional development activities that nurses and midwives are required to undertake in order to maintain their NMC registration. Employers also require evidence of learning activity through local appraisal and performance development processes.
The code can, and should, be used as a framework to develop learning objectives throughout your career. It is particularly useful at the beginning and can be incorporated into local preceptorship processes.
As the code applies to all nurses and midwives, irrespective of their field or scope of practice, it is useful to refer to it during induction into any new role. It should be used on an ongoing basis to form part of the learning, development, and performance review cycle. Even if you are at the end of your career or work in a senior role, the code still applies – and it can be easy to forget the fundamentals of high-quality care and practice.
Nurses and midwives all need to remember that they are accountable for adhering to the code, whether they work directly or indirectly with patients and service users, and whether they deliver essential care or delegate it to others. It is good practice to consider and reflect on this responsibility whenever you are thinking about learning and development objectives and activities.
It is important that the code is reviewed on a regular basis to ensure it continues to reflect current nursing and midwifery practice and sufficiently addresses all aspects of conduct, performance and ethics.
The NMC has just begun a review of the code and intends to introduce a revised version early in 2013. The council wants to ensure it continues to relate to nurses and midwives in the increasingly diverse environments in which they practise and will need to engage widely with members of the professions to achieve this. It will be undertaking various events and activities during the coming months, so keep an eye on the NMC website for details of how you can be involved.
Hopefully, this article has shown that the code is more than just a mechanism to implement processes against individuals where fitness to practise has been called into question.
The vast majority of nurses and midwives on the NMC register want to deliver the highest standards of practice possible, and the code is the most valuable tool they have available to them to enable them to do this in conjunction with other NMC standards, guidance and advice.
The code and other NMC standards, guidance and advice, including the safeguarding adults resources, are easily accessible through the NMC’s website at www.nmc-uk.org. Many of the publications can be ordered as hard copies through the publications section of the website.
Future articles will consider how the principles within the code apply to specific areas of practice and include real-life examples from nurses working across a wide range of environments and settings in the UK.
Nursing and Midwifery Council (2010a) Record Keeping: Guidance for Nurses and Midwives.
Nursing and Midwifery Council (2010b) Raising and Escalating Concerns: Guidance for Nurses and Midwives
Nursing and Midwifery Council (2010c) Standards for Pre-Registration Nursing Education.
Nursing and Midwifery Council (2009) Guidance for the Care of Older People.
Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives.