Draft Revised Code V0.5

Draft revised Code v0.5

Foreword

Introductory notes

Patient and public expectations

‘The Code’

Glossary

NMC standards and guidance

Standards and guidance published by other healthcare organisations

Index

About us

The Nursing and Midwifery Council (NMC) is the nursing and midwifery regulator for England, Wales, Scotland, and Northern Ireland. We exist to protect the public. We do this by setting standards of education, training, conduct and performance so that nurses and midwives can deliver high quality healthcare consistently throughout their careers. We also have clear and transparent processes to investigate and take action against nurses and midwives who fall short of our standards.Foreword

(To be completed)

Introductory notes

The Code is the key Nursing and Midwifery Council (NMC) publication that underpins our regulatory functions and the revalidation process. Nurses and midwives’ fitness to practise is measured against the requirements of the Code. From December 2015, all nurses and midwives will revalidate against the requirements of the Code. These requirements can be found on pages 8 - 20 of this document.

Nurses and midwives work across many practice settings and perform a range of tasks and duties. The Code should therefore be read by individual nurses and midwives in the context of their own scope of practice. It is possible that for some nurses and midwives, certain elements of the Code will not apply to all areas of their practice. However, you must abide by any item in the Code that affects your scope of practice to be regarded as fit to practise and to remain on our register.

Student nurses and midwives should abide by the Code in so far as it applies to them and their setting. They should be aware of the fact that they will have to show that they meet the requirements of the Code in order to be admitted to the register. They will also have to adhere to the requirements of the Code at all times to stay on the register post-qualification.

The Code should be read along with the standards and guidance that underpin it. A breach of those standards or guidance will have the same implications as a breach of the Code itself. This applies not only to our standards and guidance but also national standards of other healthcare-related bodies that apply to your area and country of practice. A guide to our standards and guidance and other national standards can be found at the end of this document.

References in the Code to ‘people’ or ‘people in your care’ should be read to include not only those in your direct care but also others such as:

· parents – for example, when caring for a child

· family members

· carers

· others who have taken on responsibilities for care and decision making – for example, in cases where the person concerned lacks mental capacity, or

· anyone else who has been identified as important to the person in your care.

This Code should be considered together with our rules, standards and guidance available from www.nmc-uk.org/publications.

Patient and public expectations

What can people in your care and the public expect of nurses and midwives?

Putting the interests of people in your care first

People in your care and the public expect you to:

· Make the care and safety of those in your care your primary concern.

· Provide personalised and person-centred care.

· Treat them with dignity, respect, consideration and compassion.

· Never discriminate against people in any way, even if they refuse the care offered to them or make a complaint about the care you have provided.

· Act as advocates on behalf of those in your care and ensure that their rights are upheld.

Communication and collaboration

People in your care and the public expect you to:

· Communicate effectively, sensitively and clearly.

· Respect confidentiality and act with integrity if information about an individual has to be shared for any reason.

· Explain when their information is being shared, with whom and why.

· Listen to and act sympathetically upon their concerns and preferences.

· Support those in your care in caring for themselves and recognise the contribution that they can make to their own care and wellbeing.

· Make arrangements to meet their language and communication needs where possible.

· Gain appropriate consent before you begin any treatment or care.

Treatment, assessment and evaluation

People in your care and the public expect you to:

· Administer any treatment or give assistance as required without undue delay.

· Involve them fully in decisions about their care. After giving them the information they need to make these decisions and confirming their understanding of the consequences, you should respect their right to accept or decline treatment or care.

· Recognise and work within your level of competence.

· Act in the best interests of the people in your care at all times.

· Recommend care based on the best available evidence.

· Ensure that any advice you give is evidence based and in the best interests of them.

Teamwork

People in your care and the public expect you to:

· Work cooperatively and effectively as part of a team.

· Refer or delegate care to another practitioner when it is in their best interests, ensuring that those to whom care is referred or delegated are competent to undertake the tasks required of them.

· Ensure that all records are noted as soon as possible and are kept clearly, accurately and securely.

Raising concerns and handling complaints

People in your care and the public expect you to:

· Act without delay if you believe that you, a colleague or anyone else may be putting someone at risk or if the requirements of the Code are not being met.

· Raise concerns if you believe a person in your care is vulnerable or at risk and in need of extra support and protection, taking all reasonable steps to protect them from neglect or abuse.

· Respond constructively and honestly to anyone who complains about the care they have received, and escalate their concern where appropriate.

· 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.

Professionalism

People in your care and the public expect you to:

· Keep your skills and knowledge up to date.

· Maintain clear professional boundaries.

· Acknowledge your position of trust and uphold the reputation of your profession at all times through high standards of personal conduct.

· Be open and honest and act with integrity at all times.

· Minimise any health risk you may pose to them or your colleagues.

· Inspire confidence.

· Recognise and implement the concepts of equality and diversity.

· Abide by the Code at all times.

The Code: Standards of conduct, performance and ethics for good nursing and midwifery practice

The people in your care must be able to trust you with their health and wellbeing

As a nurse or midwife, your principal and overriding duty is to do no deliberate or avoidable harm to those in your care.

That duty is underpinned by five fundamental aspirations that support the principal duty.

To justify their trust, you must:

· uphold the reputation of your profession

· make the care and safety of people in your care your first concern

· work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community, including colleagues

· provide the highest standard of practice and person-centred care possible at all times, and

· be open and honest and act with integrity.

In striving to uphold and achieve those aspirations, you must always remember that:

· as a professional nurse or midwife, you are personally accountable for actions and omissions in your practice, including those tasks you delegate to other people

· you must always be able to justify your decisions and actions

· you must always act lawfully, whether those laws relate to your professional practice or personal life

· you must ensure that you remain up to date with developments in healthcare and the law that shape your work, and where appropriate those that shape the work of other health and social care professionals that you work with, and

· failure to comply with the Code and other national healthcare standards, whether published by us or another healthcare organisation, will bring your fitness to practise into question and may endanger your registration as a result.

It is illegal to practise as a nurse or midwife in the UK if you are not on our register.

Uphold the reputation of your profession

Abiding by the Code

You must uphold the reputation of your profession at all times.
You must abide by the Code at all times.
You must uphold the standards and values set out in and embodied by the Code at all times.

The Duty of Candour

You must exercise your professional duty of candour and give a constructive and honest response to anyone who complains about the care they have received, including an apology where appropriate.

Provide leadership and manage time, resources and risk

You must provide leadership through driving quality improvement and service development to ensure people’s wellbeing and to improve their experiences of the healthcare system.
You must provide leadership through the effective management of any staff (including other nurses and midwives) you have responsibility for, ensuring that at all times the needs of people in your and their care are put first.
You must identify priorities, manage time and resources effectively and manage risk to ensure the quality of care is maintained or enhanced.
You must flag concerns in line with our guidance and local working practices as part of your responsibilities for identifying and managing risk.
You must investigate and act to address concerns raised to you, whether raised by people in your care, members of the public or staff that you have managerial responsibility for (including those on our register or regulated by another healthcare professional regulator).
Those with management or leadership responsibilities must ensure that those they are responsible for are: enabled and supported to comply with the Code at all times; have the knowledge, skills and competence for safe practice; and understand how to raise any concerns linked to potential or actual breaches of the Code.

Make the care and safety of people your first concern

Treat people as individuals

You must treat people as individuals and respect their dignity.
You must treat people kindly, respectfully and compassionately, avoiding assumptions, supporting social inclusion and recognising diversity and individual choice.
You must treat people equally and not discriminate in any way against those in your care.
You must challenge discriminatory attitudes or behaviours.
You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support when they request it.
You must support the development of capacity in people you are caring for, empowering them to make their own decisions regarding their needs and treatment.
You must act as an advocate for the vulnerable, challenging poor practice and unacceptable attitudes and behaviours relating to their care.
You must administer any treatment or render any assistance or care as may be required without undue delay.
You must recognise when people are anxious or in distress and respond accordingly, effectively and courteously.

Respect confidentiality

You must respect people’s right to confidentiality. This includes respecting that a person’s right to confidentiality continues after they have died.
You must ensure that people are informed about how and why information is used and shared by those who will be providing their care.
You must disclose information if you believe someone may be at risk of harm, appropriately and in line with the law regarding disclosure of information for the country in which you are practising.
You must share information appropriately with others when the interests of patient safety and public protection override the need for confidentiality, providing the necessary consent has been obtained.

Work constructively with those in your care

You must listen to the people in your care and respond to their concerns and preferences, working in partnership with them to ensure effective delivery of care.
You must assess and respond to the physical, social and psychological needs of people in your care, paying special attention to changing health needs during different life stages (including those who are dying or in the last days of life) and signs of normal or deteriorating mental and physical health.
You must ensure that those for whom you are responsible have adequate access to nutrition and hydration, providing assistance to those who are unable to feed themselves or drink liquids unaided where appropriate.
You must ensure that the fundamentals of basic care are adhered to and delivered effectively and compassionately, ensuring that those in your care are kept in clean and hygienic conditions, and are physically handled and moved appropriately.
You must support people in caring for themselves where this is appropriate in order to improve and maintain their own health, wellbeing and independence.
You must recognise and respect the contribution that people make to their own care and wellbeing, encouraging and empowering them to take responsibility for this where appropriate.
You must be able to communicate clearly in the English language, using terms that people in your care can understand.
You must make arrangements to meet people’s language and communication needs where possible, using the full range of verbal and non-verbal communication methods in order to better understand their clinical and personal needs and to respond to them accordingly.
You must put aside your own personal and cultural preferences when considering the needs of those in your care.
You must share with people, their families and their carers, as far as the boundaries of confidentiality allow, the information they want or need to know about their health and ongoing treatment sensitively and in a way they can understand.
You must inform and explain to colleagues, your manager and people in your care if you have a conscientious objection to a particular procedure and arrange for a suitably qualified colleague to take over responsibility for this person’s care.

Ensure you gain consent

You must ensure that you gain appropriate and properly informed consent before you begin any treatment or care, ensuring that consent is documented where appropriate.
You must respect and support a person’s right to accept or decline treatment and care.
You must uphold a person’s right to be fully involved in decisions about their care, and respect those decisions.
You must have knowledge of the relevant legislation regarding mental capacity that applies in the country in which you are practising, ensuring that the best interests of people who lack capacity remain at the centre of the decision-making process and that their rights are protected.
You must be able to demonstrate that you have acted in someone’s best interests at all times.

Maintain clear professional boundaries

You must refuse any gifts, favours or hospitality that might be interpreted as an attempt to gain preferential treatment.
You must refuse any loans from anyone in your care or anyone close to them.
You must maintain clear professional boundaries (including sexual, personal and emotional boundaries) at all times with people in your care, their families and carers. (This requirement would not apply in circumstances where you need to administer emergency care or treatment to an individual with whom you already have a personal or familial relationship.)
You must end the professional relationship with a person in your care when it becomes clear that the bond of trust that should exist between you and the person in your care has permanently broken down to the extent that it is no longer possible for you to administer good and safe clinical care to them.

Work with others to protect and promote the health and wellbeing of those in your care, their families and carers, and the wider community

Draft Revised Code V0.5