Editorial

Are we failing to prepare nurses in the UK and Australia to practice by the codes of conduct?

Sharon Andrew
Department of Acute Care, Faculty of Health and Social Care, Anglia Ruskin University, Chelmsford, United Kingdom

PP: 148 - 150

Article Text

Nursing pre-registration curricula in the United Kingdom (UK) and Australia (Aust.) are underpinned by codes of conduct which will guide their everyday practice when they complete their program and register as a nurse. These codes are prescribed by national registration organisations - the Nurses and Midwives Council UK (NMC UK) and the Nursing and Midwifery Board of Australia (NMB Aust.). In the UK the code is called 'Standards of conduct, performance and ethics for nurses and midwives' (NMC UK, 2008) and the Australia equivalent is the 'Code of professional conduct for nurses in Australia' (ANMC, 2008a). There is separate code in Australia for midwifery (ANMC, 2008b). While variations exist, overall, as would be expected, there is a significant similarity between the UK and Australian codes.

The code is generally woven into the content of nursing curricula and the assessment of nursing students' during clinical placements is often based directly on the code. By the end of their academic program nursing students should be fully informed about and have practical experience of working with the code that will guide them for the remainder of their time in the nursing profession. In other words after 3-4 years of constant reference to the code they should be very familiar with the code, know it 'inside out' and have already had experience of applying it to their practice during clinical placements.

In the last 18 months the NMC UK and NMB Aust. have released documents and initiatives on their websites that seem to be an adjunct or reworking of aspects of the code. This includes the areas such as safeguarding including dignity (NMC UK, 2009, 2010b, n.d.), raising and escalating concerns (NMC UK, 2010a), and professional boundaries (ANMC, 2010). When I read the documents I became concerned about whether the profession is experiencing serious problems with the codes for the professional conduct of nurses. Are there aspects of the codes that are not clear?, are they being ignored?, are nurses forgetting the key elements of the code?, or are our curricula failing to teach students in a way that they understand these key fundamentals of our profession nursing? I don't have the answers but my instinctive feelings are telling me that something is awry in the profession. Let me introduce you to some of these documents/initiatives in this paper.

Try reading the 'A nurse's guide to professional boundaries' (ANMC, 2010) document as a registered nurse and you will understand why I have concerns. Professional boundaries are clearly stated in UK and Australian codes. This adjunct document spells out in detail what is meant by crossing the professional boundary. What? I need to be told that that sexual misconduct means that I have crossed the professional boundary? If I do need to be told then I haven't been adequately prepared for my role as a registered nurse. Experienced or newly qualified nurses should be fully aware of these boundaries. I worked with a colleague who when telling you something she felt that you were probably already familiar with, would preface the content with an apology if she was telling you 'how to suck eggs'. This expression, based on a very old saying 'Don't try to teach your grandma to suck eggs', has the underlying meaning 'don't presume to offer advice to an expert' (Quinion, 1999). As an experienced registered nurse I felt in this document that they are telling me to 'suck eggs'.

The document 'Raising and escalating concerns' is about whistle-blowing and encourages nurses to safeguard those under their care from abuse, to raise concerns and thereby 'prevent minor issues becoming serious ones, thus protecting the public from harm and improving standards of care' (NMC UK, 2010a, p. 2). The general principles underpinning raising concerns are contained in the code. The document (NMC UK, 2010a) is to be commended for including a section about students and the responsibilities of clinical leaders in relation to this topic. While the document gives the stages for raising and escalating concerns it doesn't address the realities involved in being a whistleblower or a bystander to a whistle-blowing event. Research has shown that being a whistleblower or bystander can bring repercussions from peers and leaders and result in personal, physical and emotional implications (Jackson et al., 2010a; 2010b) and this needs to be made clear in the documents.

The 'Safeguarding' initiative appears to have been initially linked to the area of raising concerns in that is used the key terms 'harm' and 'abuse' but also includes the concepts 'providing effective and safe care to patients'. The safeguarding initiative, however, seems to have expanded and now seems to be so broad that it encompasses all aspects of the code of practice. I refer you to the NMC UK (2009) document 'Guidance for the care of older people'. This document would make an excellent teaching resource in pre-registration programs. Quotes directly from the code are given and examples for determining competency around a code statement are provided. In the document I am informed, for example, that to deliver safe, effective, quality care I must ensure older people are given fluids and assistance with eating, hygiene, toileting and pain relief. Read carefully I have to be told to do this if I am nursing an older person. I was astounded and my first instinct when reading the document was to feel indignant and that they were telling me to 'suck eggs'. I mulled over the document and then started to feel concern. These are fundamental principles in the code and those that guide my actions as a nurse. Yet there must be a need to state the obvious. One can ask what is happening. If we commence practice as a registered nurse with this knowledge and with predetermined minimum level practical skills why do we need to re-state the obvious? Again I reflected on our pre-registration programs and to question what are we teaching about the core essence of the nursing profession. Are we failing to provide examples of what nursing means? Are students not seeing the code applied to practice? I don't have the answers but I do know that we need to revisit our curricula and look carefully at how we are teaching the essence and practice of our discipline nursing. If we have to teach RNs to 'suck eggs' then we need to rethink the process of how they got there and re-evaluate their preparation for practice.

So I challenge you. Go to your national registration organisations' website. You need to! Be prepared to feel indignant but if you do feel they are telling you to 'suck eggs' you can give a sigh of relief - you are at least aware of the code under which you are practising as a nurse (and I anticipate applying it to your practice). If you don't feel indignant then you need to read the documents carefully and reflect on why you need to be told. Those developing curricula for pre-registration programs need to look carefully to see if what they are teaching is rhetoric or are they truly teaching the applications of the code to practice. While reviewing the code consider including, assertiveness training, principles of leadership and counselling strategies in your curricula as these will be required to complement the implementation of nursing care in current practice today.

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