The updated NMC code addresses concerns about recent care failings and requirements of the revalidation system to be introduced at the end of 2015
From 31 March, all nurses and midwives must comply with the Nursing and Midwifery Council’s new code. This sets out the standards and behaviour that all registrants, not just those providing hands-on care, should make central to their practice. This includes ensuring practice is safe and effective, putting the interests of patients and service users first, and promoting trust through professionalism. The new code is part of the NMC’s response to several key reports, and will play a key role in the regulator’s revalidation process being piloted this year.
Citation: Dix A (2015) Changes introduced into the revised NMC code. Nursing Times; 111: 6, 22-23.
Author: Ann Dix is a freelance editor and writer.
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A new professional code published by the Nursing and Midwifery Council sets out expected standards of good practice and behaviour that all registered nurses and midwives must uphold in their daily practice (NMC, 2015).
The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives, contains the standards that everyone, including patients and the public, can expect from a nurse or midwife. The standards include ensuring practice is safe and effective, putting the interests of patients and service users first, and promoting trust through professionalism.
The new code builds on and strengthens the NMC’s previous code to reflect best practice from other regulators, patient and public expectations and recommendations in the following key reports:
- The Francis report into care failings at Mid Staffordshire Foundation Trust (Francis, 2013);
- The Clwyd and Hart (2013) report into the NHS hospitals complaints system;
- The Neuberger review of the Liverpool Care Pathway, which sets out standards for end-of-life care (Neuberger, 2013).
In December, the NMC told Nursing Times the new code was more than a fitness to practise tool but a “live” document that all nurses and midwives should make central to daily practice (Merrifield, 2014).
The code states that standards must be upheld by all registrants across all settings and scopes of practice, including by those in leadership, education and research roles, as well as those giving direct care. It can also be used by patients, service users and carers to help them provide feedback, by employers to support staff in upholding the standards, and by educators.
The new code will play a key part in the NMC’s roles, including registration, fitness to practise and a revalidation process that is being piloted this year and is due to come into effect from 31 December 2015. Through revalidation and appraisal, nurses and midwives will regularly use the code to demonstrate their expertise and professionalism.
Box 1. The new code’s key themes
Nurses and midwives must:
- Treat people with compassion and ensure their physical, social and psychological needs are assessed
- Exercise candour when errors or harm occur
- Intervene professionally if an emergency occurs outside the workplace
- Follow detailed new standards if they want to raise a concern
- Use social media and all other communications responsibly
An extensive two-stage consultation on revalidation and the code was used to gather the views of nurses and midwives, employers, patients and the public. This included five stakeholder summits across the UK involving more than 1,000 nurses and midwives, as well as online consultation, events, social media and programme boards involving more than 18,400 practitioners and their organisations (NMC, 2014). A review of the evidence resulted in a code based on four themes that builds on its predecessor (Box 1) and differs from the lengthier draft version. The themes are:
- Prioritise people;
- Practise effectively;
- Preserve safety;
- Promote professionalism and trust.
Each theme contains 5-7 sub-themes outlining the standards and what is required to meet them. Patient and public expectations are included. Later this year the NMC will detail what patients and the public can expect from registrants. The new code is summarised below.
Nurses and midwives must put the interests of people needing their services first, make care and safety their primary concern, and ensure people’s dignity is preserved and their needs are recognised, assessed and responded to. They must ensure people are treated with respect, their rights are upheld and discriminatory attitudes and behaviour are challenged. This includes treating people with kindness and “compassion”, and recognising when they are anxious or in distress.
Staff must meet “fundamental care needs” without undue delay, and provide hygienic conditions, access to nutrition and hydration and help those unable to eat or drink unaided; both the Francis (2013) and Neuberger (2013) reports say this must be central to practice. Staff must listen and respond to preferences and concerns; they should encourage and empower people to share in decisions about treatment and care as far as they wish and support and document their right to accept or decline this.
New instructions concern assessing and responding to physical, social and psychological needs, including promoting wellbeing, preventing ill health and meeting challenging needs. This includes recognising and responding compassionately to the needs of people at the end of life, in line with the Neuberger recommendations (Neuberger, 2013).
Practitioners must also: help with access to care, information and support, and act as an advocate for vulnerable people; ensure informed consent, while balancing the rights and best interests of people who lack capacity; and tell people about their care, ensuring information about them is shared appropriately.
All nurses and midwives must provide treatment, advice or assistance based on best evidence and best practice, without undue delay and to the best of their abilities. They must ensure effective communication, record keeping and sharing of knowledge and experience to help colleagues and people receiving care, and use feedback to improve practice. This includes making sure they have the knowledge and skills required, and meeting people’s communication needs using a range of clear verbal and non-verbal methods.
Other instructions centre around: team working, including the use of constructive feedback and informed discussion to improve individual and team performance; keeping clear, up-to-date, accurate records, including on risks and problems and how they are addressed; and being accountable for decisions to delegate tasks and duties and ensuring they are carried out to required standards.
Nurses and midwives must work within the limits of their competence, exercise their professional duty of candour and immediately raise concerns and act if a patient or public safety is put at risk. Where errors or harm have occurred, they must explain to those affected what has happened and the likely effects, offer a full, prompt apology, and act immediately to remedy matters. All events must be documented and escalated so they can be acted on quickly.
Practitioners must act without delay where there is any risk to patient safety or public protection. This includes raising concerns if asked to practise beyond their competence, not obstructing, intimidating or victimising anyone wishing to raise a concern, and protecting their own staff who raise concerns from reprisals.
The code reinstates a previous requirement for nurses and midwives to intervene in emergencies outside work. Often known as good samaritan acts, these include offering professional assistance within their scope of competence and arranging for emergency care. Other instructions centre around practitioners recognising and working within their competency; raising concerns if people are vulnerable or at risk; minimising the potential for harm in their practice; and medicines management.
Promote professionalism and trust
Nurses and midwives must uphold the reputation of their profession at all times, showing a personal commitment to the code’s standards. They must show integrity and leadership that others can aspire to and which inspires trust and confidence in the profession. This includes:
- Maintaining objectivity and clear professional boundaries with patients, former patients, families and carers;
- Not exploiting vulnerability or causing distress;
- Refraining from expressing personal beliefs in an inappropriate way;
- Ensuring complaints do not prejudice care, but are used for reflection and learning.
The code also stresses responsible use of social media and networking sites. A prohibition in the draft code on mentioning colleagues or employers on social media has been removed in favour of responsible use. A paragraph on refusing gifts, favours or hospitality now allows staff to accept gifts of a “trivial nature”.
The code will come into effect on 31 March, and be a key part of the revalidation pilot. Revalidation and appraisal will allow nurses and midwives to reflect on the code, their continued professional development and feedback from patients, students and colleagues to improve practice and show they are meeting the standards.
- As well as strengthening existing standards, the new code for nurses and midwives looks at behaviour
- Registrants must make the code central to daily practice
- Nurses and midwives should refer to the code regularly to ensure they meet the standards
- The code will play a key role in a revalidation process being piloted this year
- Registrants must treat people with compassion, ensure their needs are assessed, and exercise candour if errors or harm occur
Clwyd A, Hart T (2013) A Review of the NHS Hospitals Complaints System Putting Patients Back in the Picture.
Francis R (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry.
Merrifield N (2014) NMC rubber stamps new code of conduct for nurses and midwives. nursingtimes.net; 5 December.
Neuberger J (2013) More Care, Less Pathway: a Review of the Liverpool Care Pathway. London: DH.
Nursing and Midwifery Council (2015) The Code: Professional Standards of Practice and Behaviour for Nurses and Midwives.
Nursing and Midwifery Council (2014) Code Evidence Report.