Summary Lessons

Investigations and Audits

The NMC has recently introduced changes to the code to address as nurses not wanting to get involved in investigations and audits. This in part stems from numerous abuse inquiries which highlighted that nurses either did not want to get involved or ignored what was happening around them. In order to address this NMC have introduced parts to the code to improve matters.

The NMC Code (2015) states that nurses are now required to cooperate with all investigations and audits:‘This includes investigations or audits either against you or relating to others, whether individuals or organisations. It also includes cooperating with requests to act as a witness in any hearing that forms part of an investigation, even after you have left the register’.

Person-centred care

Person-centred care is about treating people who use health and social care services as equals in all aspects of care planning. Professionals work closely with the individual to get a better understanding of their wishes in terms of assessing, planning, developing and evaluating their care. It differs from traditional nursing models in that the person is at the centre and most importantly feel they are in control of their own destiny.

In the past when patients were in receipt of services they were expected to fit into the routines and cultures of the service provider. We have learnt this can be very disempowering and people can lose a sense of control and thus experience increased stress. It is very much about working with the individual and their family rather than doing things to them. Person-centred care is advocated as an approach for planning care for most vulnerable adult groups such as older people, people with learning disabilities and those with mental health needs.

Safeguarding

The NMC states that it is everyone’s responsibility to safeguard patients wherever they are cared for. They encourage nurses to reflect on their everyday personal and team practice in order to prioritise safeguarding and make the necessary changes to protect patients from harm.

Privacy and Confidentiality

The NMC Code Section 5 states that you must respect people’s right to privacy and confidentiality and that as a nurse or midwife, you owe a duty of confidentiality to all those who are receiving care. This includes making sure that they are informed about their care and that information about them is shared appropriately. The Code states that to achieve this, you must (5.1) respect a person’s right to privacy in all aspects of their care. However, you must also (5.4) share necessary information with other healthcare professionals and agencies only when the interests of patient safety and public protection override the need for confidentiality.

In this situation the patient has indicated a threat to her life and therefore her safety is at risk, so it would be expected as a professional that you breach confidentiality in order to ensure patient safety. You should discuss this with the patient as they need to know you are acting in their best interest. This is identified in the Code Section 5.5 which states that you must share with people, their families and their carers, as far as the law allows, the information they want or need to know about their health, care and ongoing treatment, sensitively and in a way they can understand.

 Revalidation

Revalidation is the process that all nurses and midwives in the UK need to follow to maintain their registration with the NMC. As part of the requirement for this, you must be able to demonstrate you have undertaken 450 hours of practice as a nurse. Revalidation is straightforward and will help you demonstrate that you practise safely and effectively. It will encourage you to reflect on the role of the Code in your practice and demonstrate that you are 'living' the standards set out within it.

The NMC’s (2015) ‘The Code - Professional standards of practice and behaviour for nurses and midwives’ states that registered nurses must keep knowledge and skills up to date, taking part in appropriate and regular learning and professional development activities that aim to maintain and develop competence and improve performance. Each registered nurse is required to demonstrate how they have achieved this by the process of revalidation, which takes place every three years.

These require you to fulfil all registration requirements (Section 22).‘To achieve this, you must:

22.1 meet any reasonable requests so we can oversee the registration process

22.2 keep to our prescribed hours of practice and carry out continuing professional development activities,

and22.3 keep your knowledge and skills up to date, taking part in appropriate and regular learning and professional development activities that aim to maintain and develop your competence and improve your performance.’

 The four themes of the Code

• Prioritise people

As a nurse, you must put the interests of people using or needing nursing or midwifery services first. You must make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed and responded to. You must make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.

• Practise effectively

As a nurse, you must assess need and deliver or advise on treatment, or give help (including preventative or rehabilitative care) without too much delay and to the best of your abilities, on the basis of the best evidence available and best practice. You must communicate effectively, keeping clear and accurate records and sharing skills, knowledge and experience where appropriate. You must reflect and act on any feedback you receive to improve your practice.

• Preserve safety

As a nurse, you must make sure that patient and public safety is protected. You must work within the limits of your competence, exercising your professional ‘duty of candour’ and raising concerns immediately whenever you come across situations that put patients or public safety at risk. You must take the necessary action to deal with any concerns where appropriate

• Promote professionalism and trust

As a nurse you must uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the Code. You should be a model of integrity and leadership for others to aspire to.

Clear and accurate records

The Nursing and Midwifery Council Code (2015) requires that nurses keep clear and accurate records relevant to their practice and documented at the time or as soon as possible after an event (10.1). The record left with an individual who is receiving care must be marked to indicate that they remain the property of the issuing organisation. Organisations must be able to produce a record of their work, including services delivered in the home. Upon termination of treatment where the records are the sole evidence of the course of treatment/care, they must be recovered and returned to the issuing organisation.