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Chapter 2. Nursing and the NMC Code

Learning objectives

By the end of this chapter, you should be able to:

- Understand the purpose and content of the NMC Code (2015)

- Appreciate the value of professional standards in practice

- Identify professional actions and behaviours suitable for nurses

- Critically review your own professional practice compared to national standards

The NMC Code

The NMC Code is the professional practices and standards for nurses and midwives practising in the UK. The publication details the duties and responsibilities of nurses in practice and illustrates the professional attitudes and actions necessary for good patient care. The NMC Code also focuses on professional and practical aspects of nursing care.

The NMC Code pertains to direct patient care, but also covers a range of other activities in nursing practice. These activities include work with groups or communities, education, leadership, and research. The application of the Code's values and principles may be interpreted and analysed with respect to each of these activities. However, these values and standards are not optional or negotiable, but rather form an essential set of components that are demanded of contemporary nurses.

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

  • Prioritise people
  • Practise effectively
  • Preserve safety
  • Promote professionalism and trust.

Prioritise people

Prioritising people is key, and involves putting the interests of service users first. Treating patients with respect is a key aspect of the care process and the rights of patients should be upheld. This means that nurses should not be discriminatory, judgemental or disrespectful to patients, regardless of personal views or patient behaviour.

Practise effectively

Nurses must be able to assess the needs of patients, interpret test results, advise on treatment courses, and to adhere to the evidence base. Furthermore, nurses need to be able to deliver optimal care within a swift timeframe, while clearly communicating with patients and maintaining professional standards of record keeping and knowledge sharing. The NMC Code outlines a number of aspects of practice that should be adhered to in order to be an effective nurse.

Preserve safety

Patient safety must be at the heart of all nurse decision-making. Nurses must be aware of their limitations and skill set, knowing when they are out of their depth and require help. Attempting to manage patients when you are doubtful or lack the necessary skills or knowledge is not safe. You must also be aware of the care processes of others and be alert to the possibility of lapses in safe care. Nurses should be able to identify safe and unsafe practice, and should report and address safety concerns in a timely manner.

Promote professionalism and trust

The final domain of the NMC Code is the promotion of professionalism and trust. The reputation of nurses needs to be defended, and from a professional perspective, an individual must uphold the values of the profession to ensure that nurses remain respected and valuable members of the healthcare team. You should adopt all of the necessary behaviours and attitudes outlined in the Code, and lead by example. By ensuring professionalism in everyday practice, patients are more likely to trust you and will be more confident in your abilities.

What is expected of nurses?

Nurses are an important professional group in the healthcare system of the UK. Patients have high expectations of nurses and demand excellence from nursing care. These expectations include representing the best interests of the patient, professional conduct at all times, caring and compassionate interactions, and advocacy on behalf of the patient.

The expectations of nurses are not limited to providing patient care. Nurses should engage in other professional activities intended to promote knowledge, optimal practice and societal values. Nurses are also expected to act as leaders, educators and researchers.

Nursing responsibilities

Nursing responsibilities are a set of actions or behaviours that should be completed in order to promote professional practice specific to the nursing profession. The responsibilities are varied and are covered within the four main domains of the NMC Code. However, it is worth considering specific responsibilities that nurses have in relation to patients, colleagues, their profession and their organisation.

Accountability

Accountability is important for both patient care and professionalism in nursing, and is defined as a state of accepting responsibility for one's actions. A nurse is accountable only when they fulfil three conditions: the ability to perform an activity of intervention; accepting responsibility it; and, having the authority to perform the activity. Therefore, one should only engage in activities one is qualified to perform, and nurses that have been suitably delegated to perform the task should accept responsibility during task completion.

A nurse has to be accountable to him or herself, as well as colleagues, professional bodies and criminal or civil courts. Nurses must be accountable for their actions - even when performing the smallest tasks. When you are not confident in completing a task, it is necessary to contact a senior member of staff or consult local guidelines and policies to determine your suitability for the task.

Delegation

Delegation is important in managing a workload and providing effective patient care. Nurses should be accountable for delegation decisions and should be able to justify their choices. When delegating, the skill set of the individual should be considered and support provided when necessary. It is not acceptable to delegate tasks to someone not trained to perform those tasks. Ultimately, the person who delegates the task needs to justify their decision and remains partly accountable for the outcome.

Multidisciplinary working

Patients may have complex needs, and nurses, doctors, physiotherapists and allied healthcare professionals work together to meet those needs. This is a fundamental form of teamwork in the NHS. By addressing the needs of the patient in a collaborative and cooperative way, the chances for patient recovery are maximised.

Multidisciplinary working has been shown to be effective; therefore nurses must engage successfully with other health professionals when delivering care. This involves recognising the need for input from other professions, communicating effectively with them, and making joint decisions on the care processes affecting the patient. If nurses do not work well within a team, then patient care can be disjointed.

Leadership

Nurses should be able to demonstrate qualities of leadership. This is how nurses motivate others to achieve a common goal. Nurses' leadership can involve advocating for the patient, leading the multidisciplinary team, or guiding junior members of staff. Nurses have a professional duty to take control and provide leadership in care.

Leadership is also important outside of patient care, including regulation of the nursing profession and the research setting. Nurses should be able to govern their own profession by contributing to the development of policy and providing strong leadership to other nurses. When engaging in research, strong leadership can focus investigations on specific clinical topics or areas. Leadership is also seen in educating other members of staff and supporting the use of policies and practices on the ward. 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. However, nurses must also 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, letters, interprofessional correspondence, and the results of interventions or investigations. These illustrate the care decisions that have been made for a specific patient and provide a record of the outcomes. Nurses should maintain these documents and ensure their accuracy.

Documentation should be as detailed as possible and should record all of the necessary factual information for a care decision. This includes noting observations and vital signs on a routine basis, as well as a record of written consent for procedures, and documentation of discussions of these procedures with the patient. Records may also provide legal protection against wrongdoing. If a patient complains, or dies, records should be able to show the reasoning behind the decisions that went into their care. If records are poorly kept or incomplete, nurses may be professionally or legally investigated, even if they performed care in an ethical and professional manner. Nurses should document every conversation and decision they undertake in care. Without documentation, there is no evidence that a conversation took place.

Student-mentor relationship

One of the responsibilities of the nurse is to guide junior members of staff and provide mentorship. A mentor is a senior staff member who can support students and trainees, including education support and psychological support. Nurses should engage in mentorship in order to promote the learning experiences of junior staff members. The skillset and knowledge base of the entire clinical team depend on a process of information sharing and critical feedback to ensure standards are met consistently.

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

Professional development and research

Nurses have a wide range of responsibilities in practice. All of these responsibilities reflect areas of professional expertise requiring specific knowledge and skills. Professional development, and continuing professional development (CPD) in particular, are terms which describe the constant need for nurses to maintain their knowledge and skills, while engaging in a lifelong process of learning. New discoveries are always being made, and the evidence base for some interventions may change annually. Unless nurses are able to keep up with these changes, they risk their own professionalism by engaging in out-dated or unsafe practices. It is a professional duty of the nurse to review research, local guidelines and national guidelines in order to make sure that they are up-to-date. Furthermore, nurses need to continually reflect on their skillset and practice techniques to make sure that they can demonstrate competency in performing procedures ranging from patient lifting/handling to basic life support.

Finally, it is important for nurses to become involved in the research setting. Research is the foundation of knowledge gathering, and all scientific studies aim to increase knowledge and expertise in a given field. Nurses can utilise published research to guide their practice by appraising evidence and critically analysing how this may apply to their care setting. However, nurses must also be actively involved in research in order to ensure that nursing priorities are addressed in the research setting, and to allow for further skill development. By becoming involved in research at any level, nurses expose themselves to the principles of critical analysis and can develop a deeper understanding of clinical topics. Nurses are encouraged to develop their research interests and contribute to the expansion of the knowledge base.

Conclusion

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


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