Defined as “a set of conventional principles and expectations that are considered binding on any person who is a member of a particular group” (Code of Conduct, 2012, online), code of conduct is considered to be an effective tool to encourage or even reinforce particular pattern of behaviour.
Code of conduct in health care settings in particular can be described as normative. In other words, they are “concerned with describing what should be done and how you should behave; i.e. the moral principles, rules and values that should guide your actions” (Hendrick, 2004, p.63).
This article represents a critical review of a code of professional conduct for nursing and midwifery developed by Nursing and Midwifery Council (NMC) that has been introduced in 2004 and revised in 2008. Revisions relate to the additions of new principles that have increased the total numbers of principles in the code from 54 to 61. The article critically evaluates both, the structure and content of the code and addresses the core principles within the code in a detailed manner.
Analysis of NMC Code of Professional Conduct
NMC code of conduct is based on four following core principles:
The first core principle: taking care of individuals concerned, treating them as individuals, and respecting their dignity at all times. This core principle consists of 20 individual principles that address a range of relevant issues such as treatment of people as individual, respecting of confidentiality of people, maintaining collaboration with those in care, and ensuring that consent has been gained.
The principles of treating people as individuals (principles 1 to 4) require nurses and midwife to treat people with great level of care and consideration, not to discriminate against anyone and avoid stereotyping those in care due to their illnesses and possible disabilities.
Discrimination can be defined as “the unjust or prejudicial treatment if different categories, especially on the grounds of race, age and sex” (Oxford Dictionaries, 2012, online) and the mentioning of this serious issue as an initial principle in the code contributes to its value and effectiveness.
Principles related to confidentiality issues (principles 5 to 7) require the respect for the right to confidentiality, and informing individuals in care regarding the reasons and manner in which their information is shared with others. It has to be noted that while principle 5 requires nurses and midwifes to respect the right of patients to confidentiality, the code fails to accommodate several other elements of Data Protection Act (1998) and this can be specified as inefficiency associated with the code.
The next set of principles in the code (principles 8 to 12) require nurses and midwifes to collaborate with individuals in their care by listening to their concerns and preferences, making arrangements to accommodate specific communication needs, and sharing necessary information.
According to principles of obtaining consent (principles 13 to 17), it has to be gained prior to the commencement of treatment and the right to acceptance and decline need to be met with understanding and respect. Moreover, people’s rights to be involved in taking decisions regarding their care and effective demonstration of acting in their best interest are also covered within the scope of these principles
The last set of principles (principles 18 to 20) within the first core principle involve the preservation of clear professional boundaries in terms of in terms of refusing any gifts, favours, and loans from individuals in care or their close people. Moreover, clear sexual boundaries are also imposed between nurses and midwife and people in their care, the members of their families and carers.
Discussing difficulties associated with the reinforcement of principle 20 (maintaining sexual boundaries), Minchin (2010) mentions a case in ‘Little Ted’ nursery in UK, where staff member Vanessa George sexually abusing youngsters has been unnoticed for a long period of time.
The second core principle: to protect and promote health and wellbeing for individuals concerned and wider community through working with others. Consisting of 14 individual principles the second core principle is aimed to regulate the issues of sharing information with co-workers, being an effective team-member, and engaging in work delegation in an effective manner.
According to principles 21 to 23, nurses and midwifes have to keep their co-workers informed when the care is being shared with others and the development of competencies of students and colleagues need to be effectively facilitated.
Issues of operating effectively as a team member are covered within the principles 24 to 28. Specifically, NMC code of professional conduct requires nurses and midwifes to respect their co-workers, treat them without discrimination, share knowledge, experience and skills, and commit to referring to another practitioner if it is in the best interests of individuals in care. Knowledge sharing has a paramount importance in healthcare due to the highly dynamic nature of the sector fuelled by technological developments (Barrick, 2009) this the inclusion of these principle in the code is justified.
The issues of delegation are covered within the principles 29 to 31 and they involve ensuring that co-workers are able to perform tasks delegated to them, the outcome of tasks delegated are up to standards, and necessary monitoring measures are in place.
Principles 32 to 34 relate to risk management and require nurses and midwife to be acting without delay in instances where colleagues or others are subjected to risk, informing relevant authorities regarding the problems, and reporting the problems in writing where the source of risk relate to the environment of care.
The third core principle: providing practice and care of high standard at all times. 13 separate principles have been developed by NMC in order to facilitate the adherence to this core principle. Specifically, these principles address the issues of using the best available evidence, maintaining personal skills, competencies, and knowledge updated, keeping records.
Clarifying the guidance on the usage of the best available resources, principles 35 to 37 in the code state that care has to be delivered on the basis of best available evidence and best practice and any complimentary or alternative treatments offered are safe and are in the best interests of individuals in care.
Principles 38 to 41 deal with skills and knowledge of nurses and midwife clarify such requirements as accepting the tasks within the limits of own competence, constantly maintaining knowledge and competencies updated.
Williams et al. (2009) find the principle 39 that requires nurses and midwife to accept tasks within the limits of own competence to be ambiguous and incomplete. The authors convincingly argue that there are no specific techniques available that can be objectively used to determine such limit.
Principles related to record keeping (principles 42 to 47) represent the last set of rules within the third core principle and according to them completing records need to be implemented in an objective and timely manner, they need to be signed, dated and timed in an appropriate way and kept securely.
The fourth core principle: to operate in an open and honest manner maintaining the high reputation of the profession. The facilitation of this last NMC core principle of professional conduct is aided by the formulation of 14 sub-principles that clarify the guidance on acting with integrity, dealing with various issues, being impartial, and sustaining the reputation of nursery and midwifery at high levels.
Acting with integrity for nurses and midwifes, according to principles 48 to 51 require demonstration of a high level of commitment to equality and diversity. Moreover, practitioners are required to abide the government laws and inform NMC any cases of criminal offence.
The issues of commitment to equality and diversity is particularly important for healthcare organisation, taking into account a high level of vulnerability of customers in some occasions (Greener, 2008). From this viewpoint, the adoption of equality and diversity as behavioural priorities in the code of conduct contributes to it weight.
Guidance for dealing with problems are provided through principles 52 to 56 that call for providing constructive and honest response to individuals complaining about the care and cooperating with internal and external investigations.
Principles 57 and 58 demand nurses and midwife not to abuse their privileged positions, and safeguard their professional judgement against the influence of any commercial considerations, whereas principles 59 to 61 serve to deal with sustaining the reputation of the profession.
NMC code of professional conduct is effectively structured in a logical manner. The code covers a wide range of aspects of nursing and midwife practice and guidance is provided in relation to specific issues with clear formulations.
However, there are minor inefficiencies associated with the code as it has been discussed above that need to be addressed in order to increase the level of its effectiveness. Specifically, principles 5 and 39 have been found as vague and incomplete.
Nevertheless, it is faire to state that comprehensive guidance in relation to a wide range of important issues has been provided in the code of professional conduct devised for nurses and midwife this code can be justly specified as one of the most effective patterns available along a wide range of industries.
Barrick, I.J. (2009) “Transforming health care management: integrating technology strategies” Jones and Bartlett Learning
Greener, I. (2008) “Healthcare in the UK: Understanding Continuity and Change” The Policy Press
Hendrick, J. (2004) “Law and Ethics” Nelson Thornes
Code of conduct (2012) Available at: http://www.thefreedictionary.com/code+of+conduct Accessed May 17, 2012
Discrimination (2012) Oxford Dictionaries, Available at: http://oxforddictionaries.com/definition/discrimination Accessed May 17, 2012
Minchin, R. (2010) “Nursery culture blamed for sex abuse” Independent
Williams, C., Firn, M. & Wharne, S. (2011) “Assertive Outreach in Mental Healthcare: Current Perspectives” John Wiley & Sons