On 31 March 2015, the new NMC Code of professional standards for nurses and midwives came into force. The new Code puts patients and service users at the heart of practice with the intention of better protecting the public.
The Code is structured around four broad themes: prioritising people; practising effectively; preserving safety; and promoting professionalism and trust. The revised Code includes greater focus on compassionate care, team work, record keeping, delegation and trust, accountability, raising concerns and co-operating with investigations and audits.
Why was a new Code needed?
The previous version had been in force since 2008 and the new Code is therefore designed to reflect the changes in healthcare and society which have developed in the intervening period.
The failings in care at Mid Staffordshire NHS Foundation Trust were well publicised, and the Francis Inquiry into these failings recommended sweeping changes as a result. These included, amongst others, culture change, putting patients first, fundamental standards of behaviour and openness, transparency and candour.
New offences relating to ill-treatment and wilful neglect, and the duty of candour, have since come into force. The latter offence applies only to healthcare providers, rather than to individual healthcare professionals, with the professional regulators being given responsibility for policing the professional duty of candour for individuals.
The revised Code has been introduced in response to these developments.
What are the new requirements?
The revised Code contains six new requirements which did not feature in the previous version. These are:
Fundamentals of care
The Code now includes a requirement to deliver the 'fundamentals of care' effectively, in order to treat people as individuals and uphold their dignity (paragraph 1.2). The Code states that:
'The fundamentals of care include, but are not limited to, nutrition, hydration, bladder and bowel care, physical handling and making sure that those receiving care are kept in clean and hygienic conditions. It includes making sure that those receiving care have adequate access to nutrition and hydration, and making sure that you provide help to those who are not able to feed themselves or drink fluid unaided.'
Duty of Candour
The Code provides that 'the professional duty of candour is about openness and honesty when things go wrong" and paragraph 14 requires nurses and midwives to "be open and candid with all service users about all aspects of care and treatment, including when any mistakes or harm have taken place'. The Code includes an extract from the joint statement from the Chief Executives of statutory regulators of healthcare professionals:
'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.'
Social media use
The Code includes a provision that social media must be used responsibly, respecting others' right to privacy and upholding the reputation of the profession. Separate guidance has also been produced by the NMC on social media use.
Raising concerns
The Code sets out the responsibility of nurses and midwives to raise concerns about patient safety and to act on concerns raised to them. The Public Interest Disclosure Act enables nurses and midwives to make protected disclosures to the NMC and other organisations, protecting them from retaliation or victimisation when they raise concerns. As of 6 April 2015, this protection has been extended to student nurses and midwives. In light of the revised Code coming into force, the NMC has updated its guidance on raising concerns, which is considered later in this article.
Delegation and accountability
Paragraph 11 requires nurses and midwives to be accountable for their decisions to delegate tasks and duties to other people, ensuring that delegated tasks and duties are within the other person's scope of competence, that they are appropriately supervised and that the task is completed to the required standard.
Professional duty to assist in an emergency
Paragraph 15 of the revised Code reintroduces the duty to offer help in an emergency, within the limits of knowledge and competency, and to arrange for access to and the prompt provision of emergency care, wherever possible, whilst having regard to personal safety, the safety of others and the availability of other options for providing care.
The new guidance
Raising concerns
This guidance sets out the processes to follow to raise a concern and the legislation in place to protect individuals who raise concerns. It also includes details of where to get confidential support and advice. The guidance sets out broad principles to assist individuals to think through issues and take appropriate action in the public interest. It also details the role of the nurse or midwife in raising concerns, with express reference to the relevant provisions of the Code. It acknowledges that reporting concerns is not always easy, but emphasises the professional duty to put the interests of people in your care first and to act to protect them if you consider them to be at risk.
Social media
This guidance sets out broad principles to enable nurses and midwives to think through issues and act professionally, at all times ensuring public protection. The guidance acknowledges the benefits of social media, but its wide ranging influence is reflected in the number of areas of the Code listed in the guidance which will be affected by social media use. Nurses and midwives could put their registration in jeopardy if they use social media unprofessionally or unlawfully. The guidance includes some examples of inappropriate actions, as well as advice on how to use social media responsibly. The guidance reminds nurses and midwives of their duty to report concerns about patient or public safety, including the inappropriate use of social media by others.
Comment
Raising concerns and the duty of candour are hot topics at the moment and it is important that, by updating codes of practice, the NMC and other regulators are sending a strong message that these are essential components for responsible practice.
Jane Lang, partner, BLM