A new Code of Conduct for nurses
22 August 2012
The Nursing Council has published a new Nurses Code of Conduct setting out the standards of behaviour that nurses are expected to uphold in their professional practice.
The Code both advises nurses and tells the public what they can expect of a nurse in terms of the professional role. It also provides a yardstick for evaluating the conduct of nurses.
While most nurses will have already internalised many of its foundational values and core principles and instinctively treat their patients with respect and build relationships of trust, the Code provides a means to reflect, and to articulate the values and principles at the heart of competent nursing.
The Council has produced the new Code, to replace an outdated Code, in line with its statutory role to protect the health and safety of the public by setting standards of clinical competence, ethical conduct and cultural competence for nurses.
Framed around four core values of respect, trust, partnership and integrity and eight primary principles, the Code is a practical document clearly describing the conduct expected of nurses. With public trust and confidence in the profession critical to enabling individual nurses to fulfil their role effectively, there is inevitably an overlap between the personal and the professional.
is designed to be read alongside the Code as it discusses the sometimes challenging but critical issue of professional boundaries in more detail.
The key message of both documents is that nurses must make the care of patients their first concern and to do this effectively they must maintain professional boundaries.
Nurses are expected to familiarise themselves with the Code and Guidelines and to ensure the standards are incorporated in their practise. Over the next three years, all nurses will be required to complete professional development on the code of conduct and professional boundaries and as part of the continuing competence requirements.
A series of interactive presentations around the country are currently being planned to support nurses in meeting this requirement and to foster examination and discussion of the new principles and guidance. The use of online learning is also being explored to ensure that education is available to all nurse whatever their place or time of work.
Backgrounding the development of the Code and Guidelines
The development of the new Code of Conduct and the guidelines involved a rigorous process of research, analysis and consultation.
As the Code had not been subject to a major review since its initial development in 1994-95, there had been major changes in society, technology, nursing practice and the healthcare and legislative environments that needed to be reflected in a new Code. The project commenced with a review of these changes and an analysis of the former Code of Conduct and competencies for registered nurses against the more recent Codes of Conduct that have been developed by other nursing (UK and Australia), medical (New Zealand and Australia) and midwifery regulators (New Zealand). Information from disciplinary investigations and findings was also examined.
The resulting draft, which was sent out for consultation was a substantial change from the former Code. Four original principles were changed and extended to seven to allow a change in emphasis towards the needs and rights of the health consumer and to make more explicit the values of respect and trust as the foundations of ethical relationships and behaviour. More information was included on privacy and confidentiality, health consumer rights and documentation of care. New areas were included e.g. working with others in the health care team and professional boundaries.
With the Guideline: Professional Boundaries, the Council was involved in a joint project with the Australian Nursing and Midwifery Council to develop a guideline but in the end, we weren’t satisfied that that guideline satisfactorily reflected our specific local context. The decision was made to develop a separate New Zealand guidance document.
As the Guidelines provide additional detailed advice and discussion on professional boundaries, beyond that contained in the Code, it was important that the two documents were aligned and the timing of the two projects was adjusted to allow overlap in the consultation.
Consultation and feedback
Between November 2011 and February 2012, the Council consulted with nurses, the wider health sector, Maori and consumer organisations.
Three focus groups were held with nurses and health consumers. 74 submissions, including 40 from organisations and 34 from individuals were received on the Code. 22 submissions were received on the guidelines with 21 of those from groups and organisations. The Council’s Māori Advisors also provided feedback.
The majority of submissions were positive about the substantial changes to the Code seeing it as a relevant and more useful document. Similarly most submissions on the guidelines were positive. Two submissions thought the guidance on professional boundaries could have been included in the Code.
There was widespread support for the move to making standards of professional behaviour more explicit. Many suggestions were made about rewording and many of these were incorporated in the final draft which went to the Council in April 2012. Particular attention was paid to the wording of the principles to ensure they link to the values.
The most significant change was the addition of a new principle about respecting the cultural needs and values of health consumers. In line with this, a guidance box on working with Māori to improve health outcomes was removed and the contents made more relevant to individual nurses and integrated with the standards under the new principle. Definitions of “culture”, “cultural safety” and “kawa whakaruruhau” now appear in the guidance box on cultural safety. Culture is given a broad definition.
Another change was the removal of a guidance box on social media and the issue addressed under the principles: confidentiality and privacy, and professional boundaries. Advice on social media was added to the guidance box on professional boundaries and included in the Guidelines: Professional Boundaries.
Other smaller changes were made to ensure the standards align with the Code of Health Consumer Rights (1996) and The Code of Rights is now included in the introduction of the document.
Feedback on the Guidelines
Feedback from Māori Advisors indicated that the draft document still did not reflect the context of Aotearoa sufficiently. Further work was undertaken with a Māori Advisor and several sections added as a result including working with Māori consumersand concluding professional relationships.
The focus groups on the Code of Conduct also looked at the guidelines. A clear message from these groups was that many nurses work in small communities where they will have prior relationships with health consumers. Greater attention was given in the final draft to managing boundaries in this situation.
Two sections on touch and over-disclosure were removed in the final version, both to reduce the length of the documents and because it was felt that these matters were covered in undergraduate programmes.
More detailed advice on sexual relationships has been added in response to feedback on both documents and the guidelines were reordered so that “relationship issues” are discussed first ahead of issues related to personal gain and conflict of interest are outlined.
Finally relevant standards from the Draft Code of Conduct for nurses were included and the two documents aligned.