One
of the first actions of the newly formed Nursing and Midwifery Council was to
introduce the updated Code of Professional Conduct. Below, each of the sections
is explained with its particular relevance to occupational health, by Greta
Thornbory
The
Nursing and Midwifery Council (NMC) is the new regulatory body for nurses under
the Nursing and Midwifery Order 2001, which took over from the UKCC in April
this year. It was created at the same time as the Health Professions Council
(HPC), which replaces the Council for Professions Supplementary to Medicine –
the body responsible for regulating 12 of the professions (www.hpcuk.org).
Some
think that the intention is to embrace all healthcare professions under one
regulatory umbrella and that the creation of the NMC brings the nursing
profession in line with the medical, dental and opticians’ bodies of the GMC,
GDC and GOC respectively, each of which has a similar code.
One
of the first actions of the newly formed NMC was to introduce the updated Code of
Professional Conduct,1 which had been under consultation with the UKCC for the
past few years.
In
June 2002 the new code replaced the previous three codes: Code of Professional
Conduct; Scope of Professional Practice and Guidelines for Professional
Practice into one single document. According to the NMC the new code identified
with the shared values of all the UK healthcare regulatory bodies (see box).
It
is important to remember that the main function of these regulatory bodies is
to protect the public, and that codes of practice are there to inform both the
profession and the public of the standards of professional conduct that are
expected from the practitioner.
This
article explores each section of the NMC Code of Professional Conduct in turn,
highlighting its relevance to occupational health nursing practice. In an
article in Nursing Standard, Scott2 says that the language of the new code is
stronger than before. It now states that nurses are personally accountable for
their practice and this is reinforced throughout the code.
Respect
the patient and client as an individual
This
section is particularly relevant to occupational health practice because the OH
nurse may be acting as client advocate, either individually or collectively, in
dealings with management.
We
live and work in a multicultural society in the UK and we should all support
equal opportunities in all aspects of the workplace. When setting the health
requirements for specific types of work and deciding who is deemed ‘fit’, this
point is especially relevant.
We
must remember that each person should be judged as an individual, and that some
blanket restrictions on work, such as age or gender, may be unsuitable if we
are to respect individuality.
One
clause in this section that is very useful for the occupational health nurse
is: "You must promote the interests of patients and clients and this
includes helping individuals and groups to gain access to health and social
care, information and support relevant to their needs." This is supportive
of the health promotion role of the occupational health nurse and may help with
persuading management of the broad remit occupational health nurses could have
in the workplace.
Obtain
consent before you give any treatment or care
This
section is not new and no OH nurse would wish to force a member of staff to
receive treatment against that person’s will. However, this section could lead
to some ethical problems.
There
may be specific requirements for a job, or certain immunisations or surveillance
procedures may be needed. However, there may be religious or cultural reasons
why a client does not want to have an immunisation, which is required under
company policy, and one cannot give an immunisation against the wishes of the
client.
For
example, people working in the NHS who have patient contact are required to
demonstrate immunity to tuberculosis. If they refuse to be tested one cannot test under any other guise – but
this raises the ethical problem of confidentiality: should management be
informed that the person has not demonstrated immunity. It may then be
necessary for the OH nurse to seek legal advice from their professional
organisation.
Protect
confidential information
Dorothy
Ferguson explored this section of the code in her article in the September
issue of Occupational Health.3 She highlighted that the new code allows for the
sharing of confidential information within the healthcare team. She also says
that OH practitioners need to clarify who they consider to be members of this
team. I suggest that it should only be other healthcare professionals who are
subject to regulation under the HPC or one of the other regulatory bodies
identified and mentioned by the HPC. However, in occupational health practice
this is an area for debate.
Co-operate
with others in the team
In
OH one is tempted to say, first define your team. The code only mentions other
healthcare professionals yet many OH nurses are members of a broader team,
which may include safety officers, occupational hygienists, ergonomists, etc.
It is difficult to share with them confidential information and yet, according
to the code, OH nurses remain accountable even in a team. The code also states
that the OH nurse may be expected to "delegate care delivery to others who
are not registered nurses". Perhaps this is one way for the safety officer
to be answerable to the OH nurse, rather than the other way round, which can be
the more usual situation. It is also something that OH nurses do when
delegating emergency care to trained and qualified first-aiders.
It
is this part of the code that mentions record keeping and it identifies records
as a tool of communication within the team. It is interesting to note that the
GMC also mentions record keeping and team communication in its standards for
practice5. The GMC also highlights the importance of identifying who is
responsible for each aspect of care and making sure each member of the team is
aware of the others’ roles. This is an important point for OH nurses to note
for the occasions when conflict arises with medical colleagues. In their
guidelines for records and record keeping, the UKCC states: "Good record
keeping is a mark of a skilled and safe practitioner."6
Maintain
professional knowledge and competence
Here
it is quite clear that nurses must keep up to date and regularly take part in
learning activities in order to practice competently and without direct
supervision. It puts the onus on the nurse, not the employer.
However,
the code goes on to say that one must acknowledge the limits of professional
competence and only undertake work at which one is competent. It is therefore
the responsibility of individual nurses to inform employers or managers if they
feel they are not competent to undertake work requested of them. Nurses working
in OH who are not OH trained may find this helpful in supporting a request to
management for training in specialist practice.
The
code also identifies for the first time the duty of practitioners to facilitate
students of nursing and others to develop their competence. In OH this could
cover a number of areas but not least, student nurses, OH students, general
medical practitioners without specialist qualification, first-aiders etc., as
well as empowering clients.
Lastly
this section of the code highlights ‘evidence-based practice’ and the need to
deliver care based on best practice and validated research. This whole section
clarifies and puts in writing what has been accepted good practice for some
time, but which has been fought against by certain factions of the profession,
even though it was in previous codes of practice in a milder form.
Be
trustworthy
It
is under this section that endorsement and commercial influence are dealt with.
This is an area that may have relevance for the OH nurse who works for and is
answerable to a commercial organisation. It may also relate to the increasing
number of OH practitioners who work as independent consultants.
All
nurses have a duty to ensure that they put professional considerations before
financial gain – would we rather (a) carry out DSE assessments on every member
of the workforce, (b) train key workers at a one-off session to do it, or (c)
even suggest that a company purchase an intranet product that enables workers
to do their own? The latter two suggestions would not earn the same
professional fee as the former, but nurses can always be trusted to give the
best professional advice. In fact, this may be where we can be more successful
than other health and safety professionals who do not have to follow such a
strict code of practice.
Act
to identify and minimise risk to patients and clients
The
entire remit of the work of occupational health and the OH nurse is about risk
assessment and minimising risk to protect, maintain and even promote the health
of the workforce. This section states that where you cannot remedy
circumstances in the environment of care that could jeopardise standards of
practice, you must report them, supported by a written record.Â
This
may be useful for the OH nurse when there are obvious health risks in the
workplace. Nurses may make a verbal report, but fail to back this up with a
written record. This could leave the practitioner open to criticism if a
written record of the incident is not kept.
This
section also deals with ‘whistle blowing’ in order to protect patients and
clients. It places a duty on nurses to report colleagues (from their own or
another profession) who are not fit to practice for reasons of "conduct,
health or competence". This may be a difficult situation, but nurses are
as accountable for their omissions as much as their actions, according to the
code.
Emergency
care
Lastly,
for the first time the code outlines the nurse’s professional duty to provide
care outside the work setting in an emergency. It is therefore important for
all nurses to keep up to date with first aid and emergency procedures. When
people know you are a nurse, at social functions, for example, they will expect
you to be able to deal with an emergency situation.
This
year, at RCN Congress, a motion was carried that all nurses should be trained
in first aid. Luckily, most OH nurses are conversant with first aid in the
workplace, but it is important for those whose role has taken them away from
clients and into management still maintain the relevant knowledge and skills
for emergency care.
This
is a new code of conduct for a new century, a new registration body and a
dynamic profession. It will be interesting to see its application over time.
Greta
Thornbory, MSC RGN OHNC DipNOH PGCEA MIOSH is an education and occupational
health consultant
References
1.
Nursing & Midwifery Council (2002) Code of Professional Conduct, London:
NMC.
3.
Scott G (2002) Code breaker. Nursing Standard, 16(26) March 13.
4.
Ferguson D (2002) Seal of secrecy, Occupational Health, 54: 9.
5.
General Medical Council (2001) Standards for Practice, London: GMC
6.
UKCC (1998) Guidelines for Records and Record Keeping, London, UKCC
Your
Guide to the Health Professions Council 2002 – www.hpcuk.org
Code
of Professional Conduct
As
a registered nurse or midwife, you are personally accountable for your
practice.
In
caring for patients and clients you must:
–
Respect the patient or client as an individual
–
Obtain consent before giving any treatment or care
–
Protect confidential information
–
Co-operate with other members of the team
–
Maintain your professional knowledge and competence
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–
Be trustworthy
–
Act to identify and minimise risks to patients and clients
