The Nursing and Midwifery Board of Ireland (NMBI) has published a new edition of its Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (new Code) which is now in effect. The new Code replaces the earlier edition which had been in place since December 2014. The NMBI is the regulator of the nursing and midwifery professions in Ireland. One aim of the NMBI is the protection of the public in its dealing with nurses and midwives.
The new Code deals with changes to nursing and midwifery practice in light of legislation enacted since the previous Code was released. Key changes include those brought about by the Assisted Decision-Making (Capacity) Act 2015, the Health (Regulation of Termination of Pregnancy) Act 2018, and the Data Protection Act 2018. Further supporting guidance for registrants in their day-to-day work is now provided, particularly in relation to issues of conscientious objection and capacity.
The Code addresses the interactions of nurses and midwives with patients, colleagues, and the public under five principles:
• Principle 1: Respect for the dignity of the person
• Principle 2: Professional responsibility and accountability
• Principle 3: Quality of practice
• Principle 4: Trust and confidentiality
• Principle 5: Collaboration with others
The most significant changes in the new Code relate to Principles 1 and 2. Principle 4 has been updated to include reference to the Data Protection Act 2018. However, other than this change, its content has remained the same.
The Code has been expanded in light of the Health (Regulation of Termination of Pregnancy) Act 2018. It now addresses the obligation of nurses and midwives to respect a woman’s legal right to a termination of pregnancy within the provisions of this Act. However, where a nurse or midwife has a conscientious objection to the provision of terminations, they may refuse to provide care. This refusal to provide care applies to the provision of any medical service.
The Code does however require that, where a nurse or midwife cannot personally provide appropriate care to a patient due to their conscientious objection, arrangements should be made, where necessary, for the patient to receive care elsewhere. Where a termination is sought, the nurse or midwife is legally obliged to make these arrangements.
However, even where a nurse or midwife has a conscientious objection, it remains enshrined in the new Code that they must provide care to a patient “in an emergency where there is a risk to the patient’s life”.
The Code now also expressly states that where a doctor determines that a person lacks capacity, the nurse or midwife involved in their care must ensure that their rights and best interests “are at the centre of the decision-making process concerning their care and welfare.”
This further develops the obligations on nurses and midwives to ensure that valid consent is obtained for the treatment and care of patients. This is the case except for in emergency situations. Nurses and midwives are guided to empower patients in making decisions concerning their care, and to take into consideration previously expressed wishes where a patient cannot make a decision in relation to their care at that time.
The new Code addresses the duty of nurses and midwives to “protect the health of [their] patient, [their] own health and safety and that of the wider community.” The Code places a duty on registrants to, where necessary, “make difficult decisions quickly to preserve the safety of the patient, your own personal safety and the safety of the others”. This is required in circumstances where “adequate and sufficient protective clothing is not available … in extreme infectious clinical situations.” These obligations accord with the expectations on each nurse and midwife as part of a team providing “safe, quality care.”
A breach of the Code is a ground for the making of a complaint about a nurse or midwife to the NMBI under section 55 of the Act. It is also a ground on which the Preliminary Proceedings Committee can refer a registrant to the Fitness to Practise Committee for an inquiry into their fitness to practise. Where a registrant is found to have breached an aspect, or aspects of the Code beyond a reasonable doubt, they can be subject to sanction by the Board of the NMBI under Part 8 of the Act.
It is important that registered nurses and registered midwives are familiar with their obligations under the new Code. They should seek further guidance as necessary, to ensure the highest standards of patient care and professional practice.
For more information, contact a member of our Public, Regulatory and Investigations team.
The content of this article is provided for information purposes only and does not constitute legal or other advice.