Critical Discussion of the Code of Professional Conduct for Nursing Practice

This essay aims to provide a critical discussion on the code of professional conduct and examine how it acts to promote professional values and guide professional nursing practice. The code of professional practice and behaviour for nurses, midwives and nursing associates was published in January 2015 but updated in October 2018 by the Nursing and Midwifery Council (NMC) (2018). The code has four main themes, which are prioritising people, practice effectively, preserve the safety and promote professionalism and trust, and these themes contain statements that guide practice and inform nurses of their responsibilities.

The first theme focuses on the core principle of nursing, which is prioritising people, and this theme is divided into five sub-themes which inform nurses of their responsibilities for providing patient-centred care. Carter (2006) noted that patient-centred care should be safe and effective, emphasise on promoting health and well-being, integrated and seamless, informing and empowering and timely and convenient. However, NMC (2018) pointed out that the main issue is ensuring that patients’ safety is the primary concern for the nurse, their dignity is preserved, and their needs are recognised, assessed and met. These needs are identified as physical, social and psychological, and even though the nurse might not be skilled to meet all the needs of patients, the code allows for nurses to act as advocates for their care. This always means acting in the best interests of patients in terms of their care (NMC, 2018). The issue of dignity is a priority for nursing practice as the Social Care Institute for Excellence (SCIE) (2013) identified eight main factors that promote dignity in care and they include choice and control, communication, eating and nutritional care, pain management, personal hygiene, practical assistance, privacy and social inclusion. All these activities and factors are within the remits of nursing practice. Hence, the code of conduct guides nurses prioritising patients and carrying out their patient-centred responsibilities.

The next domain is ‘practise effectively’, and this theme is concerned with nurses utilising the best available evidence as the bedrock of their practice as well as improve their skills, knowledge and professional experience. Craig and Smith (2012) pointed out that evidence-based practice is the use of the best available evidence for clinical situations that results in more good than harm. This is a critical aspect of nursing practise that requires nurses to undergo a university degree that combines both theoretical learning with placement practice. According to Maginnis and Croxon (2010), there is a need to align taught learning and experiential learning to ensure safe practice for nursing practice. The interaction between the two forms of nursing learning makes the nurse competent, and this is one of six values essential to compassionate nursing care. The six values include care, compassion, competence, communication, courage and commitment (Department of Health, DH, 2012) and they represent ways in which compassionate care can be delivered to the patient. One of the values is communication, and the NMC (2018) inform nurses to communicate clearly and effectively. While the DH (2012) defines communication as mainly listening to patients, developing caring relationships and facilitating effective team working, the NMC (2018) provide specific guidance for achieving effective communication. The code of practice also defines what it means to facilitate effective team working with seven points. The detail provided by the NMC (2018) is therefore useful in instructing the nurse of how to practise effectively as it covers all aspects of practice, including accountability and the need for indemnity arrangement.

The next mandate is preserving the safety of patients, and this theme has seven sub-themes that cover various aspects of the nurses’ competence to risk management for the patient. The code of conduct, therefore, identifies a professional value that is vital for modern nursing practice and expand the meaning to include risk-averse practice. Competence is identified by the DH (2012 p.13) as the ability of professionals to “understand individual health and social needs as well as the expertise, clinical and technical knowledge to deliver effective care and treatments”. The preservation of safety is, therefore, hinged on competence but also risk management. Hence, the NMC (2018) point out that nurses’ must work within the limits of their competence, communicate freely with patients about their care and treatment, raise concerns for vulnerable or at-risk patients and be aware of and reduce any potential harm associated with their practice. The instructions presented by the NMC for the preservation of safety is an extended mandate for nurses to practice safely and ensure that patients in their care are safe. This is important because NHS Improvement (2018) reported 508,409 patient incidents in England between October to December 2017, and this number indicates an increasing trend of patient incidents in the country. There is, therefore, a mandate for nurses to practise safely as nurses have more contact with patients than any other healthcare professional (Murray, 2017).

The last domain is the promotion of professionalism and trust, and this theme focuses on the need for nurses to display a personal commitment to the standards of practice set out in the code (NMC, 2018). Professionalism is a vital factor for nursing practice as it shows the embodiment of commitment to patients and the vision of healthcare. The DH (2012) connotes professional commitment as the obligation to improve the care and experience of patients and the execution of actions that make healthcare strategy and vision a reality. Hall and Ritchie (2013) pointed out that professional values for nurses requires practice that is holistic, non-judgement, avoids assumptions, supports social inclusion and acknowledges diversity. The domain of professionalism and trust mandate nurses to not only focus on delivering quality healthcare for patients but also uphold their registration requirements and negotiate their work experience within the scope of the legal and ethical requirements.

By providing guidance for how nurses can navigate the challenges to professional practice, NMC (2018) provides nurses with knowledge and information on how to cooperate with audits as well as how to respond to any professional complaints. This is possible because the nurse can relate their personal values and morals to the guidance for nursing practice and reflectively adjust aspects that do not align (Carvalho et al., 2011). The NMC (2018) code of conduct promoted critical professional values and guides nursing practice.

References 

• Carter, R. (2007) Quality and Clinical Governance. In: Brown, J., and Libberton, P. (eds), Principles of Professional Studies in Nursing. Basingstoke: Palgrave Macmillan.
• Carvalho, S., Reeves, M., and Orford, J. (2011) Fundamental Aspects of Legal, Ethical and Professional Issues in Nursing. 2^nd Edition. London: Quay Books Division.
• Craig, J.V., and Stevens., K.R. (2012) Evidence-based practice in nursing. In: Craig, J.V., and Smyth, R.L. (eds), The Evidence-Based Practice Manual for Nurses. 3^rd Edition. Churchill Livingstone Elsevier.
• Department of Health (2012) Compassion in Practice. Crown Copyright.
• Hall. C., and Ritchie, D. (2011) What is Nursing? Exploring Theory and Practice. 2^nd Edition. Exeter: Learning Matters.
• Maginnis, C., and Croxon, l. (2010) Transfer of learning to the nursing clinical practice setting. Rural Remote Health, 10 (2), 1313. [Online]. Available from http://www.rrh.org.au (Accessed 16 August 2019).
• Murray, R. (2017) Falling number of nurses in the NHS paints a worrying picture. The Kings Fund. Available at https://www.kingsfund.org.uk/blog/2017/10/falling-number-nurses-nhs-paints-worrying-picture (Accessed 16 August 2019).
• NHS Improvement (2018) NRLS national patient safety incident reports: commentary. London: NHS Improvement.
• Nursing and Midwifery Council (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: NMC.
• Social Care Institute for Excellence (SCIE) (2013) The Dignity Factors. Available at https://www.scie.org.uk/publications/guides/guide15/factors/ (Accessed 16 August 2019).