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Introduction
This article outlines the Nursing and Midwifery Council (NMC) standards and guidance for nurses and midwives practising in the UK, along with medical ethics principles and relevant UK legislation. All healthcare professionals must uphold the values of their profession and act within boundaries set by their regulatory bodies and the law.
Professionals sitting the NMC Test of Competence (ToC) are expected to be familiar with the NMC Code and guidance, and will need to demonstrate these values during their exam. For further information, see the Geeky Medics guides to the ToC and the ToC OSCE.
The Nursing and Midwifery Council
The NMC is the independent regulator for nurses and midwives in the UK and nursing associates in England. Their role is to maintain a register of nurses and midwives, and to set and ensure standards for the profession.1
Each qualified nurse and midwife who has reached the expected standard receives a unique Professional Identification Number (PIN). Their details are held on the NMC register, which is accessible to the public online. It is illegal to practise as a nurse or midwife in the UK without being on the register.
In addition to maintaining the register, the NMC sets the expected standards for nurses and midwives working in the UK. This includes education and training standards, expected clinical proficiencies of newly qualified nurses, and outlines the professional guidelines of conduct for nurses and midwives in the UK.
Nurses and midwives who do not practice within these standards and guidelines may be referred to the NMC for investigation. Persons found to have impaired fitness to practice may be removed from the nursing register and therefore no longer be able to work as a registered nurse or midwife.
The NMC Code
The NMC Code, also known as The Code, is a document outlining the professional standards of practice and conduct expected of UK nurses, midwives, and nursing associates in England.2 All professionals registered with the NMC are expected to be familiar with and uphold these principles. The Code is accessible in full on the NMC website.
The Code has four main themes:
- Prioritise people
- Practise effectively
- Preserve safety
- Promote professionalism and trust
These principles are explored in detail in The Code. A summary of the main numbered points of the Code is listed below.2
Prioritise people
1. Treat people as individuals and uphold their dignity
2. Listen to people and respond to their preferences and concerns
3. Make sure that people’s physical, social and psychological needs are assessed and responded to
4. Act in the best interests of people at all times
5. Respect people’s right to privacy and confidentiality
Practise effectively
6. Always practise in line with the best available evidence
7. Communicate clearly
8. Work co-operatively
9. Share your skills, knowledge and experience for the benefit of people receiving care and your colleagues
10. Keep clear and accurate records relevant to your practice
11. Be accountable for your decisions to delegate tasks and duties to other people
12. Have in place an indemnity arrangement which provides appropriate cover for any practice you take on as a nurse, midwife or nursing associate in the United Kingdom
Preserve safety
13. Recognise and work within the limits of your competence
14. Be open and candid with all service users about all aspects of care and treatment, including when any mistakes or harm have taken place
15. Always offer help if an emergency arises in your practice setting or anywhere else
16. Act without delay if you believe that there is a risk to patient safety or public protection
17. Raise concerns immediately if you believe a person is vulnerable or at risk and needs extra support and protection
18. Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations
19. Be aware of, and reduce as far as possible, any potential for harm associated with your practice
Promote professionalism and trust
20. Uphold the reputation of your profession at all times
21. Uphold your position as a registered nurse, midwife or nursing associate
22. Fulfil all registration requirements
23. Cooperate with all investigations and audits
24. Respond to any complaints made against you professionally
25. Provide leadership to make sure people’s wellbeing is protected and to improve their experiences of the health and care system
The above principles are explored in more detail in The Code. Nurses, midwives and nursing associates should be familiar with the above principles and how to apply them to their own practice.
Additional NMC guidance
The NMC has multiple published standards, including education and revalidation guidelines.3 There are numerous detailed and practical guidance documents relevant to nursing and midwifery practice, including guidance on raising concerns, social media use, and the duty of candour.
Guidance on raising concerns
The NMC guidance on raising concerns includes advice about reporting concerning work and practices, safeguarding, and whistleblowing.4 As per The Code, registered professionals have a duty to raise concerns where there is a perceived risk to patient safety, or the health or wellbeing of patients. This risk may be due to any number of things, including environment, conduct of staff members, equipment, or financial conduct.
Concerns should be raised with the appropriate person, such as a line manager or supervisor. If a registered nurse, midwife or nursing associate fails to report concerns, this may bring their fitness to practise into question and put their registration at risk. This guidance outlines in detail the steps to take when concerns are noted, as well as relevant legislation, including whistleblower protection laws.
Guidance on social media use
The NMC have provided specific guidance on how registered professionals should approach social media use.5 The Code sets out expected values and behaviours for professionals, including item 20.10, which states to “use all forms of spoken, written and digital communication (including social media and networking sites) responsibly.” 2
Nurses and midwives should always act in a lawful and professional manner on social media. Registered professionals are expected to be mindful of patient confidentiality, i.e. not sharing any patient details online without the patient’s consent.
Demonstrating behaviours that are against the expected values of the profession, such as bullying, encouraging violence, or inciting hatred, would be considered a fitness to practice concern. Nurses and midwives are expected to report their concerns if they witness colleagues behaving in an unprofessional manner on social media.
Guidance on the professional duty of candour
The NMC has issued joint guidance with the General Medical Council (GMC) exploring duty of candour.6 When mistakes are made or something goes wrong with the delivery of care, all healthcare professionals have a duty of candour. The duty of candour is an expectation to be honest and open not only with the affected patient(s) and their families, but also with colleagues, and where relevant, employers and regulators.
This guideline advises that professionals should disclose the error, apologise, offer a remedy or solution, and explain the short or long-term effects of the error. Lessons should be learnt in cases where care has gone wrong. The document provides practical advice on how to structure an apology and reminds readers that, under UK legislation, an apology does not amount to admitting to legal liability.
Medical ethics
All healthcare professionals are expected to act and practise in an ethical manner. Medical ethics refers to the morals and principles underpinning healthcare decisions and behaviours. The NMC Code is built upon the four pillars of medical ethics:
- Autonomy (the right to choose): the patient’s right to make their own decisions about their healthcare, including the right to refuse healthcare
- Beneficence (doing good): acting in the patient’s best interests
- Non-maleficence (do no harm): avoiding causing harm to the patient
- Justice (fairness): the principle of equality of access to healthcare regardless of background or circumstances
Principles in UK legislation
There are numerous laws relevant to healthcare professionals in the UK, ranging from the Human Rights Act 1998 to more specific legislation. The NMC Code has been written with these underpinning laws in mind. Nurses and midwives should be aware of the following legal principles, which are outlined briefly below.
Confidentiality
Patients have a right to confidentiality, i.e. privacy. All healthcare professionals have a duty to protect the patient’s confidentiality, including their healthcare records. This is an important consideration in standards such as The Code and is also established in UK law.
Broadly speaking, patient information must be kept secure and shared only with the patient’s consent, when legally required, or where it is in the public’s best interest. NHS Trusts and other bodies are also legally required to protect patient confidentiality.
Relevant legislation includes the Common Law Duty of Confidentiality, General Data Protection Regulation (GDPR) (under which patients have the right to a copy of their records), the Data Protection Act 2018, and Section 251 of the National Health Service Act 2006.
Capacity
Capacity, or the ability to make one’s own decisions about healthcare, is defined in the Mental Capacity Act (MCA) 2005. All patients over the age of 16 should be presumed to have capacity in the first instance.7
When capacity is questioned, the patient should be assessed within the framework of the MCA. To have the capacity to make a specific decision, an individual must demonstrate the following capabilities:
- Understand information
- Retain information
- Use the information to make a decision
- Communicate their decision
In circumstances where patients lack capacity, healthcare professionals are expected to act in their best interests at all times.
Medical record-keeping
Medical records are often considered legal documents and must be completed accurately and objectively. Falsifying medical records is a serious fitness to practice concern. It can also be considered a criminal offence when falsifying records is done with the intent to deceive. This principle is set out in the Health and Care Act 2014.
Nursing and Midwifery Order 2001
The Nursing and Midwifery Order 2001 grants regulatory power to the NMC and outlines the NMC’s duties and responsibilities. The NMC has the power to investigate and take action against nurses and midwives who fail to uphold the expected standards.
Children
There are numerous laws outlining the responsibilities of healthcare services and professionals to individuals aged under 16, many of which emphasise the welfare needs of children. These include the Children Act 1989 and 2004, and the Health and Care Act 2022.
A key aspect of delivering care to children is their capacity to consent to their own medical treatment, also known as Gillick Competence. Children aged 16 and under can consent to their medical treatment if they are deemed ‘Gillick competent’, i.e. they have the competence and understanding to make an informed decision.
Professionalism in the Test of Competence
Candidates sitting the ToC will be expected to demonstrate NMC values throughout the OSCE. This includes behaving professionally and compassionately in all stations, and also demonstrating their understanding of the NMC Code and relevant legislation in the written professional values station.
Summary
Nurses and midwives in the UK are expected to uphold a code of conduct and values as outlined in The NMC Code. Healthcare professionals should also be familiar with guidance and legislation relevant to their practice, including advice about raising concerns, social media use, duty of candour, and the principles of confidentiality and capacity. Nurses and midwives who fail to uphold expected standards and behaviours may be putting their registration at risk.
Editor
Dr Jamie Scriven
References
- NMC. Who we are and what we do. 2025. Available from: [LINK].
- NMC. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. 2018. Available from: [LINK].
- NMC. Standards. 2025. Available from: [LINK].
- NMC. Raising concerns: Guidance for nurses, midwives and nursing associates. 2019. Available from: [LINK].
- NMC. Guidance on using social media responsibly. 2019. Available from: [LINK].
- NMC and GMC. Openness and honesty when things go wrong: The professional duty of candour. 2024. Available from: [LINK].
- UK Public General Acts. Mental Capacity Act 2005, c. 9. Available from: [LINK].
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