Professional Values Lecture: Nursing and the NMC Code (2024)

Introduction

This chapter explores the professional standards of nursing practice, as defined in the NMC Code (2015). It isvital that all nurses practising in the UK adhere to the standards and responsibilities presented in thisdocument, in order to ensure safe, fair and ethical patient treatment. This chapter will provide a detailedoverview of the core features of the NMC Code (2015), with a focused analysis of the expectations andresponsibilities of nurses in the UK. Concepts such as accountability, mentorship and delegation will bediscussed and related to practice in order to provide students and nurses with a clear insight into how the NMCCode (2015) relates to their practice setting and daily experiences.

The NMC Code

As noted in the previous chapter, the NMC Code (2015) is the most recent version of the professional practicesand standards for nurses and midwives practising in the UK. The publication details the duties andresponsibilities of nurses in routine practice and illustrates the professional attitudes and actions thatshould be carried out to achieve good patient care. Although the ethical dimensions of nursing practice werediscussed in the previous chapter, the NMC Code (2015) also focuses on professional and practical aspects ofnursing care.

The scope of the NMC Code is not limited to direct patient care, but also encompasses a range of activities thatnurses are engaged in during routine practice. These activities include interactions with groups or communities,education, leadership, and research. The application of the values and principles noted within the Code may beinterpreted and analysed with respect to each of these activities. However, although interpretation is advised,the values and standards noted in the Code are not optional or negotiable, but rather form an essential set ofcomponents that are demanded of contemporary nurses. These components will be the focus of the present chapter.

The NMC Code (2015) is divided into four different sections, based on the core professional values of nursing.These are as follows:

1. Prioritise people
2. Practise effectively
3. Preserve safety
4. Promote professionalism and trust (NMC, 2015).

Each of these domains will be considered separately to provide an insight into their value and implications forthe nursing profession.

Prioritise people

The ability to prioritise people is key to being an effective nurse and involves putting the interests ofservice users first. Ethical and professional treatment of service users (patients) is necessary to maintaindignity and ensure that the needs of the individual are recognised, assessed, and managed appropriately.Treating patients with respect is a key aspect of the care process and the rights of patients should be upheldabove all else. This means that nurses should not be discriminatory, judgemental or disrespectful to patients,regardless of personal views or patient behaviour.

Practise effectively

The ability to practise as a nurse in an effective manner relies on a multitude of factors. These factorsinclude the ability to assess the needs of patients, interpret results of tests, advise on treatment courses,and to adhere to the evidence base. Furthermore, nurses need to be able to deliver optimal care within a swifttimeframe, while clearly communicating with patients and maintaining professional standards of record keepingand knowledge sharing. The NMC Code outlines a number of aspects of practice that should be adhered to in orderto be an effective nurse.

Preserve safety

In addition to delivering swift and effective care to patients, the NMC Code recognises that patient safety mustbe at the heart of all nurse decision-making. Ensuring the safety of an individual patient, group of patients,or the broader population requires nurses to understand multiple facets of their role. Firstly, you must beaware of your limitations and skill set, knowing when you are out of your depth and require help when deliveringpatient care. Attempting to manage patients when you are doubtful or lack the necessary skills or knowledge isnot safe. You must also be aware of the care processes of others and be alert to the possibility of lapses insafe care, which may otherwise have adverse effects on patient wellbeing. Not only do nurses need to be able toidentify safe and unsafe practice, but they should also be confident in reporting and addressing safety concernsin a timely manner.

Promote professionalism and trust

The final domain of the NMC Code (2015) is the promotion of professionalism and trust. The reputation of nursesneeds to be defended, and from a professional perspective, an individual must uphold the values of theprofession to ensure that nurses remain respected and valuable members of the healthcare team. As a nurse, youshould adopt all of the necessary behaviours and attitudes that are outlined in the NMC Code and lead byexample. By ensuring professionalism in everyday practice, patients are more likely to trust you and will bemore confident in your abilities.

What is expected of nurses?

Nurses are an important professional group in the healthcare system of the UK. They provide fundamental care andassistance to patients in primary, secondary and tertiary care settings, and the nurse role has becomeincreasingly diverse over time. Contemporary nurses have a wide range of clinical duties and may specialise inspecific care areas, driving expertise and evidence-based care. Along with the development of the role of thenurse in healthcare, the expectations of nurses have also changed over time. Patients have high expectations ofnurses and demand excellence from nursing care. These expectations include representing the best interests ofthe patient, professional conduct at all times, caring and compassionate interactions, and advocacy on behalf ofthe patient.

Within the NMC Code (2015), it is apparent that the expectations of nurses do not just fall within the domain ofproviding patient care. Nurses are increasingly expected to engage in other professional activities intended topromote knowledge, optimal practice and societal values. This means that nurses are expected to act as leaders,educators and researchers, as well as care providers. All of these roles demand individual skillsets andknowledge, but at the same time there is some overlap between the roles. It is essential that nurses act asleaders in order to advocate for the needs of their patients, while this advocacy demonstrates a caring role atthe same time. Nurses who discuss treatment options with patients and then decide on a mutually agreeable courseof action serve as both carers and educators. Therefore, although distinct, multiple roles are often fulfilledby nurses unintentionally during a single episode of care.

Nursing responsibilities

Having considered the expectations placed on the nursing profession, it is also important to consider how theseexpectations translate into responsibilities. Nursing responsibilities can be defined as a set of actions orbehaviours that should be completed in order to promote professional practice specific to the nursingprofession. The responsibilities you have as a nurse are varied and are covered within the four main domains ofthe NMC Code (2015). However, it is worth considering specific responsibilities that nurses have in relation topatients, colleagues, their profession and their organisation. The following sections will focus on some of themost important responsibilities of nurses in all care contexts.

Accountability

Accountability is important for both patient care and professionalism in nursing, and is defined as a state ofaccepting responsibility for one's actions (Royal College of Nursing, 2016). A nurse is accountable only whenthey fulfil three conditions: the ability to perform an activity of intervention; accepting responsibility forthe activity; and, having the authority to perform the activity (RCN, 2016). Therefore, accountability inpractice not only means that one should only engage in activities one is qualified to perform, but also thatnurses have been suitably delegated to perform the task and accept responsibility during task completion(Griffith, 2015).

Accountability can apply at multiple levels, as a nurse has to be accountable to him or herself, as well ascolleagues, professional bodies and criminal or civil courts (NMC, 2015). Nurses must be accountable for theiractions - even when performing the smallest tasks, as the implications of mistakes in practice may be vast. Whenyou are not confident in completing a task, it is necessary to contact a senior member of staff or consult localguidelines and policies to determine the suitability of the task for your skill set and knowledge base.

Delegation

Delegation of tasks is an important part of managing a busy workload and ensuring that patient care can bedelivered in a timely and effective manner. Nurses have a duty to ensure quality care to patients and thereforeit is crucial to ensure appropriate delegation of tasks to junior colleagues or associated healthcareprofessionals (RCN, 2016). Nurses should be accountable for delegation decisions made in practice and should beable to justify the suitability of the individual for the task, based on policies, guidelines and experience.When delegating, the skill set of the individual should be carefully considered and support provided whennecessary. It is not acceptable to delegate tasks to another person where they are not trained to perform thosetasks. Ultimately, the person who delegates the task needs to justify their decision and remains partlyaccountable for the outcomes of any intervention.

Multidisciplinary working

Managing a patient is a complex process, often involving more than one healthcare professional. Patients mayhave complex needs, where nurses, doctors, physiotherapists and allied healthcare professionals work together tomeet those needs. This is called multidisciplinary working, and is a fundamental form of teamwork that underpinsthe values of the National Health Service (NHS, 2015). By addressing the needs of the patient in a collaborativeand cooperative way, the chances for patient recovery are maximised (Scaria, 2016).

Multidisciplinary working has been shown to be effective in managing patients and therefore it is a professionalduty of nurses to engage successfully with other health professionals when delivering patient care. Thisinvolves recognising the need for input from other professions, communicating effectively with thoseprofessionals, and making joint decisions on the care processes affecting the patient. If nurses do not workwell within a team, then patient care can be disjointed, leading to poorer patient outcomes. Therefore,multidisciplinary working is a key ethical and professional responsibility of the nurse.

Leadership

In order for nurses to work successfully in a multidisciplinary team, they should be able to demonstratequalities of leadership. Leadership in nursing is an important concept that describes the ways nurses motivateothers to achieve a common goal (Sherring, 2012; NMC, 2015). Nurses can provide leadership in many differentways, including by advocating for the patient's point of view, by leading the multidisciplinary team, or byguiding junior members of staff. Regardless of the way leadership is put into action, nurses have a professionalduty to take control of their profession and provide leadership in patient care, including the delivery ofethical and professional practice.

Leadership is also considered an important feature of nursing when considering processes outside of patientcare, including the professional regulation of the nursing profession and the research setting. Nurses should beable to govern their own profession by contributing to the development of policy and providing strong leadershipto other nurses. When engaging in research, strong leadership can focus investigations on specific clinicaltopics or areas. Leadership is also seen in educating other members of staff and supporting the use of policiesand practices on the ward. Therefore, nurses should be able to engage with others, justify their own opinions,and guide the course of clinical practice.

Record keeping

When nurses interact with patients, they often do so verbally - either seeking the permission of the patient toact or making joint decisions regarding care processes. Talking to patients and colleagues is an effective wayof imparting and gathering information, but this is not the only way that communication occurs in the healthcaresetting. Nurses also have the responsibility to provide a more permanent record of the patient care process,through accurate and detailed record keeping. Record keeping may incorporate a number of resources and tools,including patient notes (both physical and electronic), letters, interprofessional correspondence, and theresults of interventions or investigations. All of these documents illustrate the care decisions that have beenmade for a specific patient and provide a record of the outcomes of those decisions. Therefore, nurses shouldmaintain these documents and ensure their accuracy to guarantee that care is being performed appropriately (NMC,2009).

Documentation should be as detailed as possible and should record all of the necessary factual information for acare decision. This includes noting observations and vital signs of patients on a routine basis, as suddenchanges that are not recorded may lead to poor outcomes. This also includes maintaining a record of writtenconsent for procedures and documentation of discussions of these procedures with the patient. Records not onlyprovide a clear outline of the patient's care plan to other professionals, but may also provide legal protectionagainst wrongdoing. When a patient complains, or dies as a result of a specific course of treatment, recordsshould be able to show the logic and reasoning behind the decisions that went into their care. If records arepoorly kept or incomplete, then nurses are liable to being professionally or legally investigated, even if theyperformed care in an ethical and professional manner. Therefore, you should get into a habit of documentingevery conversation and decision made with a patient in their notes from an early stage of your career to avoidsuch situations in the future. Unless it is written down formally, there is no evidence that a conversation tookplace!

Student-mentor relationship

One of the responsibilities of the nurse is to guide junior members of staff and provide mentorship in theclinical setting. A mentor is a senior staff member who can provide support to students and trainees, includingeducation support and psychological support (Butterworth & Faugier, 2013). It is important that nursesengage in mentorship in order to promote the learning experiences of junior staff members. The skillset andknowledge base of the entire clinical team depend on a process of information sharing and critical feedback toensure standards are met consistently.

The nature of the relationship between student and mentor should be considered fundamental to promotingeducation in nursing. Patience, understanding and guidance are all needed in order to be an effective mentor andto ensure that students have the chance to learn in a safe and nurturing environment. All nurses are expected tobe able to provide mentorship to others and it is a professional responsibility for nurses to support thelearning and training of their colleagues.

Professional development and research

A key component of the NMC Code (2015) is the wide range of responsibilities that nurses have in practice. Allof these responsibilities reflect areas of professional expertise requiring specific knowledge and skills.Professional development, and continuing professional development (CPD) in particular, are terms widely used todescribe the constant need for nurses to not only maintain their knowledge and skills, but also to engage in alifelong process of learning (Royal College of Nursing, 2014). New discoveries are always being made, leading tonew drug treatments, while the evidence base for some interventions may change on an annual basis. Unless nursesare able to keep up with these changes, they risk their own professionalism by engaging in out-dated or unsafepractices. It is a professional duty of the nurse to review research, local guidelines and national guidelinesin order to make sure that they are up-to-date with the most current evidence. Furthermore, nurses need tocontinually reflect on their skillset and practice techniques to make sure that they can demonstrate competencyin performing procedures ranging from patient lifting/handling to basic life support.

Finally, the need for nurses to become involved in the research setting is being recognised as increasinglyimportant (Parahoo, 2014). Research is the foundation of knowledge gathering, and all scientific studies aim toincrease knowledge and expertise in a given field. Nurses can utilise published research to guide their practiceby appraising evidence and critically analysing how this may apply to their care setting. However, it is of theutmost importance that nurses are also actively involved in research in order to ensure that nursing prioritiesare addressed in the research setting, and to allow for further skill development. By becoming involved inresearch at any level, nurses expose themselves to the principles of critical analysis and can develop a deeperunderstanding of clinical topics. As a nurse, you are encouraged to develop your research interests andcontribute to the expansion of the knowledge base for yourself and others.

Conclusion

This chapter has provided an overview of the professional standards of nursing, as noted in the NMC Code (2015).Four key domains have been evaluated: prioritise people, practise effectively, preserve safety, and promoteprofessionalism and trust. The details of each of these domains reflect the need for nurses to meet thechallenges of performing multiple roles and having many responsibilities in the care setting. Nurses must act aseducators, care providers, counsellors, researchers and leaders in modern practice. By using professionalguidance and ensuring that you meet the criteria for effective professional nursing, all of these areas can befulfilled in your own practice and future practice. It is vital that you utilise evidence and experience tocontinue to develop your knowledge and skills over time to meet the professional standards of the nursingprofession.

Reference list

Butterworth, T., & Faugier, J. (2013). Clinical supervision and mentorship in nursing. London:Springer.

Griffith, R. (2015). Accountability in district nursing practice: key concepts. British Journal of CommunityNursing, 20(3), 146-149

NHS (2015). About the NHS: NHS core principles. Available at: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhscoreprinciples.aspx[accessed 6th November 2016]

Nursing and Midwifery Council (2009). Record keeping: guidance for nurses and midwives. London: NMC

Nursing and Midwifery Council (2015). The codes for nurses and midwives. London: NMC

Parahoo, K. (2014). Nursing research: principles, process and issues. London: Palgrave Macmillan.

Royal College of Nursing (2014). RCN factsheet: continuing professional development (CPD) for nurses workingin the United Kingdom (UK). London: RCN

Royal College of Nursing (2016). Accountability and delegation. Available at: https://www.rcn.org.uk/professional-development/accountability-and-delegation[accessed 6th November 2016]

Scaria, M. K. (2016). Role of care pathways in interprofessional teamwork. Nursing Standard,30(52), 42-47.

Sherring, S. (2012). Nursing leadership within the NHS: An evolutionary perspective. British Journal ofNursing, 21(8), 491-494