(Nursing and Midwifery Council, November 2004) As a registered nurse, midwife, or specialist community public health nurse [health visitor], you are personally accountable for your practice. In caring for patients and clients, you must:
• respect the patient or client as an individualYou must recognise and respect the role of patients and clients as partners in their care and recognise the contribution they can make to it. This involves identifying their preferences regarding care and respecting these within the limits of professional practice, existing legislation, resources and the goals of the therapeutic relationship. You are personally accountable for ensuring that you promote and protect the interests and dignity of patients and clients, irrespective of gender, age, race, ability, sexuality, economic status, lifestyle, culture and religious or political beliefs. You must at all times maintain appropriate professional boundaries in the relationships you have with patients and clients. You must ensure that all aspects of the relationship focus exclusively upon the needs of the patient or the client. You must promote the interests of patients and clients. This includes helping individuals and groups to gain access to health and social care, information and support relevant to their needs. You must report to a relevant person or authority, at the earliest possible time, any conscientious objection that may be relevant to your professional practice. You must continue to provide care to the best of your ability until alternative arrangements are implemented.
• obtain consent before you give any treatment or careAll patients have the right to receive information about their condition. You must be sensitive to their needs and respect the wishes of those who refuse or are unable to receive information about their condition. Information should be accurate, truthful and presented in such a way as to make it easily understood. You may need to seek legal or professional advice or guidance from your employer, in relation to the giving or withholding of consent. You must respect patients' and clients' autonomy - their right to decide whether or not to undergo any health intervention - even where arefusal may result in harm or death to themselves or a fetus, unless a court of law orders to the contrary. This right is protected in law, although in circumstances where the health of the fetus would be severely compromised by any refusal to give consent, it would be appropriate to discuss this matter fully within the team and with a supervisor of midwives, and possibly seek external advice and guidance. When obtaining valid consent, you must ensure that it is given by a legally competent person, given voluntarily and it is informed. You should presume that every patient and client is legally competent unless otherwise assessed by a suitably qualified practitioner. A patient or client who is legally competent can understand and retain treatment information and can retain it to make an informed choice. Those who are legally competent may give consent in writing, orally or by cooperation. They may also refuse consent. You must ensure that all your discussions and associated decisions relating to obtaining consent are documented in the patients' or clients' health care records. When patients or clients are no longer legally competent and thus have lost the capacity to consent to or refuse treatment and care, you should try to find out whether they have previously indicated preferences in an advance statement. You must respect any refusal of treatment or care given when they legally competent, provided that the decision is clearly applicable to the present circumstances and that there is no reason to believe that they have changed their minds. When such a statement is not available, the patient's or client's wishes, if known, should be taken into account. If these wishes are not known, the criteria for treatment must be that it is in their best interests. The principles of obtaining consent apply equally to those people who have a mental illness. Whilst you should be involved in their assessment, it will also be necessary to involve relevant people close to them; this may include a psychiatrist. When patients and clients are detained under statutory powers, you must ensure that you know the circumstances and safeguards needed for providing treatment and care without consent. In emergencies where treatment is necessary to preserve life, you may provide care without consent, if a patient or client is unable to give it, provided you can demonstrate that you are acting in their best interests. No-one has the right to give consent on the behalf of another competent adult. In relation to obtaining consent for a child, the involvement of those with parental responsibility in the consent procedure is usually necessary, but will depend on the age and understanding of the child. If the child is under 16 in England and Wales, 12 in Scotland and 17 in Northern Ireland, you must be aware of legislation and local protocols relating to consent. Usually the individual performing the procedure should be the person to obtain the patient's or client's consent. In certain circumstances, you may seek consent on the behalf of colleagues if you have been specially trained for that specific area of practice. You must ensure that the use of complementary or alternative therapies is safe and in the interests of patients and clients. This must be discussed with the team as part of the therapeutic process and the patient or client must consent to their use.
• co-operate with others in the teamThe team includes the patient or client, the patient's or client's family, informal carers and health and social care professionals in the National Health Service, independent and voluntary sectors. You are expected to work co-operatively with teams and to respect the skills, expertise and contributions of your colleagues. You must treat them fairly and without discrimination. You must communicate effectively and share your knowledge, skill and expertise with other members of the team as required for the benefit of patients and clients. Health care records are a tool of communication within the team. You must ensure that the health care record for the patient or client is an accurate account of treatment, care planning and delivery. It should be consecutive, written with the involvement of the patient or client wherever practicable and completed as soon as possible after an event has occurred. It should provide clear evidence of the care planned, the decision made, the care delivered and the information shared. When working as a member of a team, you remain accountable for your professional conduct, any care you provide and any omission on your part. You may be expected to delegate care delivery to others who are not registered nurses or midwives. Such delegation must not compromise existing care but must be directed to meeting the needs and serving the interests of patients and clients. You remain accountable for the appropriateness of the delegation, for ensuring that the person who does the work is able to do it and that adequate supervision or support is provided. You have a duty to co-operate with internal and external investigations.
• protect confidential informationYou must treat information about patients and clients as confidential and use it only for the purposes for which it was given. As it is impractical to obtain consent every time you need to share information with others, you should ensure that patients and clients understand that some information may be made available to other members of the team involved in the delivery of care. You must guard against breaches of confidentiality by protecting information from improper disclosure at all times. You should seek patients' and clients' wishes regarding the sharing of information with their family and others. When a patient or client is considered incapable of giving permission, you should consult relevant colleagues. If you are required to disclose information outside the team that will have personal consequences for patients or clients, you must obtain their consent. If the patient or client withholds consent, or if consent cannot be obtained for whatever reason, disclosures may be made only where they can be justified in the public interest (usually where disclosure is essential to protect the patient or client or someone else from the risk of significant harm) or where they are required by law or by order of a court. Where there is an issue of child protection, you must act at all times in accordance with national and local policies.
• maintain your professional knowledge and competenceYou must keep your skills and knowledge up to date throughout your working life. In particular, you should take part regularly in learning activities that develop your competence and performance. To practice competently, you must possess the knowledge, skills and abilities required for lawful, safe and effective practice without direct supervision. You must acknowledge the limits of your professional competence and only undertake practice and accept responsibilities for those activities in which you are competent. If an aspect of practice is beyond your level of competence or outside your area of registration, you must obtain help and supervision from a competent practitioner until you and your employer consider that you have acquired the requisite knowledge and skill. You have a duty to facilitate students of nursing, midwifery and specialist community public health nursing and others to develop their competence. You have a responsibility to deliver care based on current evidence, best practice and, where acceptable, validated research when it is available.
• be trustworthyYou must behave in such a way that upholds the reputation of the professions. Behaviour that compromises this reputation may call your registration into question even if it is not directly connected to your professional practice. You must ensure that your registration status is not used in the promotion of commercial products or services declare any financial or other interests in relevant organisations providing such goods or services, and ensure that your professional judgement is not influenced by any financial considerations. When providing advice regarding any product or service relating to your professional role or area of practice, you must be aware of the risk that, on account of your professional title or qualification, you could be perceived by the patient or the client as endorsing the product. You should fully explain the advantages and disadvantages of alternative products so that the patient or client can make an informed choice. Where you recommend a specific product, you must ensure that your advice is based on evidence and is not for your own commercial gain. You must refuse any gift, favour or hospitality that may be interpreted, now or in the future, as an attempt to obtain preferential consideration. You must neither ask for nor accept loans from patients, clients or their relatives and friends.
• act to identify and minimise the risk to patients and clientsYou must work with other members of the team to promote health care environments that are conducive to safe, therapeutic and ethical practice. You must act quickly to protect patients and clients from risk if you have good reason to believe that you or a colleague, from your own or another profession, may not be fit to practice for reasons of conduct, health or competence. You should be aware of the terms of legislation that offer protection for people who raise concerns about health and safety issues. Where you cannot remedy circumstances in the environment of care that jeopardise standards of practice, you must report them to a senior person with sufficient authority to manage them and also, in the case of midwifery, to the supervisor of midwives. This must be supported by a written record. When working as a manager, you have a duty towards patients and clients, colleagues, the wider community and the organisation in which you and your colleagues work. When facing professional dilemmas, your first consideration in all activities must be the interests and safety of patients and clients. In an emergency, in or outside the work setting, you have a professional duty to provide care. The care provided would be judged against what would be reasonably expected from someone with your knowledge, skills and abilities when placed in those particular circumstances.
The NMC recommends that a registered nurse, midwife or specialist community public health nurse, in advising, treating and caring for patients/clients, has professional indemnity insurance. This is in the interests of clients, patients and registrants in the event of claims of professional negligence. Some employers accept vicarious liability for the negligent acts and/or omissions of their employees. Such cover does not normally extend to activities undertaken outside the registrant's employment. Independent practice would not normally be covered by vicarious liability, while agency work may not. It is the individual registrant's responsibility to establish their insurance status and take appropriate action. In situations where employers do not accept vicarious liability, the NMC recommends that registrants obtain adequate professional indemnity insurance. If unable to secure professional indemnity insurance, a registrant will need to demonstrate that all their clients/patients are fully informed of this fact and the implications this might have in the event of a claim for professional negligence.
This code is currently (November 2007) under revision, having undergone a process of consultation and review; it will be published in 2008. While continuing to be a standard for conduct, performance, and ethics, the revised code will be reorganized into four sections that refer to relationships with people in areas of care, relationships with colleagues, core standards, and personal and professional standards. It is intended to be a simplified, more user-friendly, version of the 2004 code, emphasizing the NMC's continuing commitment to professional responsibility and self-regulation in nursing and midwifery.
From A Dictionary of Nursing in Oxford Reference.
Subjects: Medicine and Health.