Standards of conduct, performance and ethics for nurses and midwives Our response to the Nursing and Midwifery Council's consultation

In our response to the consultation we welcomed the changes the NMC had made to bring the Code up-to-date and provide more detail on the professional obligations of registered nurses and midwives.

Person-centred care

We particularly welcomed the NMC’s acknowledgement that nurses and midwives should work in partnership with people to manage their care in a person-centred way. However, we felt that the Code could be strengthened by making these duties much clearer.

In our response, we argued that the NMC use the following four principles to define person-centred care and clearly describe these respective duties for nurses and midwives in one place within the Code. The four principles of person-centred care are:

• dignity, compassion and respect
• coordinated care and support
• personalised care
• enabling.

We feel that enabling people to develop the knowledge, skills and confidence to manage their own health and make decisions about their care should be a professional obligation of all nurses and midwives.

While the Code requires nurses and midwives to uphold people's right to be involved in their care, we felt that it did not capture the essence of shared decision making and reinforced the idea that people have a passive role in their care.

We recommended an explicit duty is included for nurses and midwives to support individuals to share decisions about their health and healthcare. We feel shared decision making is central to nurses and midwives being able to truly engage in partnership working with patients and should underpin everything they do. The advantages of this well illustrated by work carried out in a nurse-led urology clinic as part of our Magic programme.

Duty of confidentiality

We recommended that the NMC make clear that boundaries of confidentiality only apply to family members and carers, not individual patients or service users.

Quality improvement

We recommended that all nurses and midwives should have a duty to actively engage in the quality improvement process. In particular, we felt that the Code should include a statement underlining the importance of nurses and midwives taking responsibility for contributing to individual and organisational learning from safety incidents, near misses and risks as well as indicators or measures of safety (eg case note reviews).

Duty of Candour

We recommended that the duty of nurses and midwives to be open and honest should be clearer in the Code, as it otherwise risks reinforcing a belief that this duty is limited to responding to complaints.

Raising concerns and managing risk

As well as suggesting the NMC bring together duties for nurses and midwives to act when they see failure clearly in one place, we felt the duties could be strengthened to acknowledge the importance of listening to patients and acting on their concerns about safety. We have done a lot of work on patient involvement in safety and argued that patients are in a unique position, at the centre of the treatment process, to identify safety issues.