On 31 January 2015 the NMC published its revised Code of Conduct (“the Code”) for nurses and midwives. The last time revisions were made to the Code was in 2008. As a result, some say that the changes are long overdue, whilst others believe that the revisions to the Code only serve to place a more onerous burden on already over-worked nurses and midwives.
Given that nurses and midwives may find themselves before an NMC Conduct and Competence Committee hearing as a result of allegedly breaching the Code, in this article, we take a look at the main changes to the Code to enable those we defend at Burton Copeland LLP to gain a fuller understanding of their new obligations and responsibilities.
The new Code comes into effect on 31 March 2015 and until then the former Code remains in force.
The new Code seeks to build on the principles and obligations set out in the former Code by adding six new requirements.
- The Fundamentals of Care
Nurses and Midwives will now be expected to ensure that they deliver ‘the fundamentals of care’ effectively.
The NMC define “the fundamentals of care” as including, but not being limited to:
- bladder and bowel care
- physical handling
- ensuring that patients are kept in clean and hygienic conditions.
- ensuring that patients have adequate access to nutrition and hydration
- ensuring that nurses and midwives provide help to those who are not able to feed themselves or drink fluid unaided.
Whilst it may be the case that the public would already expect a nurse/midwife looking after members of the public to ensure that the above fundamentals of care are delivered effectively, it may be the case that some nurses and midwives, for example, those who qualified overseas, are used to different standards of care and may therefore find themselves in breach of this aspect of the Code purely because of training differences in overseas countries.
Whilst this change to the code obviously places a more onerous burden on nurses and midwives practising in the UK, all such registered professionals should be aware of it and should seek to do their best to adhere to it. If a nurse or midwife is struggling with one or more of the fundamentals of care, he/she should not be afraid to seek further training from their employers to ensure that they are able to carry out the fundamentals of care effectively and to the highest standards. However, if the worst should happen and allegations are made against a nurse/midwife in this regard, we can assist.
- The duty of candour
In an ever increasingly litigious society, this duty has been a fundamental part of guidance for other professionals for some time.
The NMC take a dim view of those registered who fail in this regard and many fitness to practise hearings are held across all of the regulated professions when it is alleged that a regulated professional has fallen short of similar standards.
The new Code states that the duty of candour concerns openness and honesty when things go wrong and a joint statement from the Chief Executives of statutory regulators of healthcare professionals has been issued stating that “Every healthcare professional must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm or distress.”
Whilst this is the ideal situation, it is understandable that nurses and midwives may find it extremely difficult to be honest and open when mistakes have been made. As a result, this new requirement could be perceived to be fairly onerous but there is no doubt that it is the best way forward, not least because nurses and midwives are often judged more harshly at NMC Conduct and Competence Committee hearings if they have not been honest and open about a mistake or a wrong doing as the Committees may believe that this shows a lack of insight on the part of the nurse/midwife. In short, therefore, nurses and midwives should always try to be honest and open from the start to avoid allegations of dishonesty or breach of the duty of candour in the longer term.
- Raising concerns
This new requirement forms part of the Code in relation to nurses and midwives acting without delay if they think there may be a risk to patient safety or public protection and includes not only raising and escalating concerns where they believe patient care is at risk but also where they believe that they are being asked to practise beyond their role or training or outwith the scope of the Code or other national standards. It also obligates nurses and midwives to act on concerns raised to them by others and to ensure that anyone who wishes to make a complaint or raise a concern is not victimised, obstructed or intimidated because they wish to make such a complaint. It also obligates nurses and midwives to protect anyone for whom they have management responsibility from harm, victimisation or unwarranted treatment after a concern is raised.
The Code also requires nurses and midwives to raise concerns immediately if they believe that a person is vulnerable or at risk and is in need of support and protection.
It would appear therefore that this new requirement places much responsibility on the shoulders of our nurses and midwives but, in truth, much of this is common sense. If a concern is raised about a nurse/midwife, they should ensure that they do not seek to speak to the person who raised the concern as this may lead to that person complaining that the nurse or midwife has harassed them or tried to obstruct the complaint. Instead, the best advice for that nurse or midwife is to contact a defence solicitor who can advise them on the next steps to be taken.
If a concern about someone else becomes apparent, the nurse or midwife should try to ensure that he/she escalates this concern as quickly as possible. Whilst this may be difficult where the nurse/midwife does not want to raise such a concern, if he/she does not do so, this could now be seen as a breach of the Code and could lead to both disciplinary action by the employer and to a Conduct and Competence Committee hearing at the NMC.
- Delegation and Accountability
The Code now obligates nurses and midwives not only to ensure that they delegate duties where it is appropriate to do so but also that the people to whom they delegate their duties carry out these duties to the required standard.
According to the new Code, nurses and midwives must now delegate tasks to those competent to carry out the tasks and make sure that that person understands the instructions given.
It also requires nurses and midwives to ensure that those to whom duties are delegated are adequately supervised and supported.
Finally, the nurse or midwife is now duty bound to confirm that the delegated task has been completed to the required standard.
There is an argument to suggest that healthcare professionals have enough to do without having to ‘supervise’ staff to whom they delegate duties. However, the new Code is clear on this and if nurses and midwives do not delegate appropriately and ensure that duties have been carried out to the required standard by those to whom they have delegated tasks, they could find themselves facing allegations for breaching the Code.
- The professional duty to take action in an emergency
This places a new requirement on nurses and midwives to take action in an emergency even when they are off duty but they must only take action if such action is within their competence and if their own safety and those of others around them is not compromised. If safety is compromised then the nurse or midwife must take account of the availability of other options for providing care.
This new requirement is probably the easiest one to fulfil in so much as it is assumed that most nurses or midwives would assist in an emergency even if off duty, as any other member of the public would.
As a result, it is not likely that this requirement will cause problems for nurses and midwives registered with the NMC.
- Social media use
More and more we see companies taking a stronger line in terms of their employees use of social media and this is no exception.
In a world that revolves around Information Technology, the NMC now place a duty on nurses and midwives to use social media responsibly and in line with the NMC’s own guidance.
Whilst most of the NMC’s guidance on social media is common sense, there is the possibility that a nurse/midwife will ‘post’ something offensive on social media websites without thinking of the consequences or by making the mistake of thinking that social media websites are totally separate from the environment in which they work.
The NMC is now obligating nurses and midwives to ensure that they do not make the mistake of thinking that their personal views, if made public, will not be criticised purely because such views were not demonstrated in a work environment.
We expect this new requirement to cause many problems for nurses and midwives as the transition is made from believing that work and personal lives are separate to the blurred lines of communication via social media.
We do hope that this article has assisted those who needed a better understanding of the new Code and what new requirements have been implemented.
However, should you or any of your colleagues find yourself in any difficulty with the NMC, please do not hesitate to contact Ms Charlotte Ellis on 0161 827 9500 as we can provide advice and assistance in relation to a wide range of issues.
Please see our website for more details www.burtoncopeland.com under the heading Professional Discipline.