m e uastiedine column
New Code of Professional Conduct: how it affects you George Castledine, University of Central England in Birmingham
Having considered this possible change it was then decided to under take a major review and update some of the clauses and language. Clause 10 emphasizes increased patient privacy by stating that all nurses, midwives and health visitors must:
evising the C ode o f Professional Conduct (U K C C , 1984) has many similarities to the difficulties involved in revising or tampering with the L ord ’s Prayer. There are those who like the version they grew up with and therefore do not wish to see it changed. On the other hand, there are others who are more rad ical and responsive to current trends and wish to change with the times. I must admit that on this occasion I was on the side of the radicals at the U K CC . The original impetus to revise the Code came from criticism of its failure to express equal oppor tunities and prevent discrimination. This led to the newly revised clause 7 which states that in the exercise of professional accountability, nurses, rr)idwives and health visitors must:
R
‘recognize and respect the uniqueness and dignity of each patient and client, and respond to their need for care, irrespec tive of their origin, religious be liefs, personal attributes, the na ture of their health problems or any other factor’. Professor Castledine is Head of the Department of Nursing and Community Health, at the University of Central England in Birmingham, Perry Barr, Birmingham B42 2SU
296
‘protect all confidential informa tion concerning patients and cli ents obtained in the course of professional practice and make disclosures only with consent, where required by the order of a court or where you can justify disclosure in the wider public in terest.’
There has been criticism that some of the wording in the new clauses, particularly the emphasis on report ing rather than the former obligation of taking appropriate action, is ‘passive and anachronistic’ (Nursing Times, 1992). However, it is import ant to remember that the wording in clauses 1 and 2 should leave the nurse in no doubt about the import ance of taking action.
Wellbeing The first clause stresses the import ance of acting ‘. . . always in such a manner as to promote and safeguard the interest and well-being of pa tients and clients’; the second of en suring ‘. . . that no action or omission on your part, or within your sphere of responsibility, is det rimental to the interests, condition or safety of patients and clients’. Far from dilution, the lead-in phrase and paragraph to the revised Code still maintain and strengthen their overall appeal and importance. The Code appears to defy rigid im plementation in some cases, but I think it would be impossible to pro duce a watertight wording that would be seen as all embracing and ethically and legally acceptable. After all, the Code is only a bench
mark or guide on which to base our professional behaviour and nursing practice. It should be general and flexible enough to allow us to use our professional judgements and clear enough to give us some idea of what to do when faced with our difficulties. The final responsibility and accountability remains with us. This latter point is further ex panded and emphasized in the U K C C ’s new document The Scope o f Professional Practice (U K C C, 1992). Now this position statement really has an exciting and potentially controversial message. In its intro duction it makes the point that nurs ing practice must be: ‘. . . sensitive, relevant and re sponsive to the needs of individ ual patients and clients and have the capacity to adjust, where and when appropriate, to changing circumstances’.
The rapid advance of biomedical knowledge in the last three decades has created much broader horizons for all health professionals and in creased the expectations of our pa tients and clients. Nurses are now being expected to adjust their roles and change along with other health professionals. In the past, the terms ‘extended’ and ‘expanded’ roles have been used to describe some of these changes in nursing activity. There has also been a proliferation of specialist nurses taking over traditional medical tasks; indeed many GPs see their practice nurses in this vein. The new nurses’ act relating to prescribing simple medicines is possibly another attempt to per suade nurses that traditional nursing is inferior to playing handmaiden to medical mythology and machines. Medical knowledge and skills, no matter how relevant to medical prac tice and health care, are not substiBritish Journal of Nursing, 1992, Voi l,N o 6
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 16, 2019.
New Code of Professional Conduct: how it affects you
Code of Professional Conduct Each registered nurse, m idw ife and health visitor shall act, a t all times, in such a m anner as to:
• safeguard and promote the interests of individ ual patients and clients; •
serve the interests of society;
8. report to an appropriate person or authority, at the earliest possible time, any conscientious objection which may be relevant to your professional practice; 9. avoid any abuse of your privileged relationship with patients and clients and of the privileged access allowed to their person, property, residence or workplace;
• justify public trust and confidence and •
uphold and enhance the good standing and reputation of the professions.
As a registered nurse, midwife or health visitor you are personally accountable for your practice and, in the exercise of your professional account ability, must: 1. act always in such a manner as to promote and safe guard the interests and well-being of patients and clients; 2. ensure that no action or omission on your part, or within your sphere o f responsibility, is detrimental to the interests, condition or safety of patients and clients; 3. maintain and improve your professional knowledge and competence; 4. acknowledge any limitations in your knowledge and competence and decline any duties or responsibilities unless able to perform them in a safe and skilled manner; 5. w ork in an open and co-operative manner with pa tients, clients and their families, foster their indepen dence and recognize and respect their involvement in the planning and delivery of care; 6. w ork in a collaborative and co-operative manner with healthcare professionals and others involved in providing care, and recognize and respect their par ticular contributions within the care team; 7. recognize and respect the uniqueness and dignity of each patient and client, and respond to their need for care, irrespective of their ethnic origin, religious beliefs, personal attributes, the nature of their health problems or any other factor;
10. protect all confidential information concerning pa tients and clients obtained in the course of profes sional practice and make disclosures only with con sent, where required by the order of a court or where you can justify disclosure in the wider public interest; 11. report to an appropriate person or authority, having regard to the physical, psychological and social effects on patients and clients, any circumstances in the envi ronment of care which could jeopardise standards of practice; 12. report to an appropriate person or authority any circumstances in which safe and appropriate care for patients and clients cannot be provided; 13. report to an appropriate person or authority where it appears that the health o r safety of colleagues is at risk, as such circumstances may compromise stan dards of practice and care; 14. assist professional colleagues, in the context of your own knowledge, experience and sphere of responsi bility, to develop their professional competence, and assist others in the care team, including informal carers, to contribute safely and to a degree appropri ate to their roles; 15. refuse any gift, favour or hospitality from patients or clients currently in your care which might be in terpreted as seeking to exert influence to obtain preferential consideration and 16. ensure that your registration status is not used in the promotion of commercial products or services, declare any financial or other interests in relevant organisations providing such goods or services and ensure that your professional judgement is not influ enced by any commercial considerations.
Source: Code o f Professional Conduct (U K C C , 1992).
British Journal of Nursing, 1992, Voi l,N o 6
297
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 16, 2019.
New Code of Professional Conduct: how it affects you
tutes for the development of nursing knowledge and skills. It is important to bear this in mind when reading The Scope o f Professional Practice document. There are those (and I have al ready heard many doctors express their joy at the appearance of this document) who say: ‘It should give us the chance to get on with more important aspects of medicine and research.’ O f equal concern was a comment by a GP who saw the document as an opportunity to de velop ‘physicians’ assistants’.
W aste To attempt to recruit professionally educated nurses out of nursing, and even more flagrantly, to propose that they function at a lower level in the field of medicine, represents an extraordinary human and intel lectual waste, as well as an effort to deny society a knowledgeable nurs ing service. Martha Rogers (1972) once said: ‘The nursing profession does not exist to serve the ends of any other profession, nor does one profession delegate anything to another profession. Each profes sion must determine its own boundaries within the context of social need.’ This is certainly the intended mess age in The Scope o f Professional Practice paper. It emphasizes the im portance of education and experi ence related to the range of responsi bilities the nurse should adopt. The barriers that inhibit the extension of the scope of nursing practice should be bridged through education and training. Casual acceptance of duties or responsibilities is dangerous prac tice and should not be taken on until the individual nurse feels safe and se cure in her/his performance. In paragraph 6 of the Scope docu ment there is an important cross ref erence to the number of explicit clauses in the revised C ode o f Profes sional Conduct — this reminds us that the Code provides the firm basis upon which decisions can be made. The principles which should govern adjustments to an individual’s scope of professional practice are covered in paragraph 9 (Table 1). It is pleas British Journal of Nursing. 1992, Vol I , No 6
Table I. The principles governing nurses’ scope of profes sional practice 9
The registered nurse, midwife or health visitor:
_________________
9.1 must be satisfied that each aspect of practice is directed to meeting
the needs and serving the interests of the patient or client;_________ 9.2 must endeavour always to achieve, maintain and develop knowledge,
skill and competence to respond to those needs and interests;_______ 9.3 must honestly acknowledge any limits of personal knowledge and skill
and take steps to remedy any relevant deficits in order effectively and appropriately to meet the needs of patients and clients;____________ 9.4 must ensure that any enlargement o r adjustment of the scope of per
sonal professional practice must be achieved without compromising or fragmenting existing aspects of professional practice and care and that the requirements of the Council’s Code o f Professional Conduct are satisfied throughout the whole area of practice;___________________ 9.5 must recognize and honour the direct o r indirect personal accountability
borne fo r all aspects of professional practice and__________________ 9.6 must, in serving the interests of patients and clients and the wider
interests of society, avoid any inappropriate delegation to others which compromise those interests._______________________ ___________ Source: The Scope o f Professional Practice (U K C C , 1992)
ing to see the emphasis on nursing as a collaborative profession which, along with medicine, is indispens able in providing society with high quality healthcare. The U K C C considers that the terms ‘extended’ or ‘extending’ roles are no longer suitable, nor is the wide variety of certificates that have approved such tasks. The emphasis should be on giving holistic and total nursing care to patients. The number of extended roles performed by nurses on a regular basis varies from hospital to hospi tal. Also, some health authorities do not accept other health authorities’ extended role certificates. The em phasis for such certification had come from such documents as The Extending R ole o f the Nurse (DHSS, 1989). It is to be hoped that such recommendations will now be with drawn in favour of those in the Scope paper. I am sure nurses want some sort of nationally recognized extended role certification. This will now be incorporated into the individual’s professional profile, thus reducing unnecessary wastage of scarce re sources from duplication of training. Paragraphs 20 and 21 of the Scope document are particularly contro
versial as they refer to registered nurses who are employed in non nursing or residential care settings. Paragraph 20 states: ‘Registered nurses who are em ployed in this sector, whether in homes or in the provision of other services, remain account able to the Council and subject to the Council’s Code of Profes sional Conduct, even if their posts do not require nursing qualifications.’ In this regard, as explained in para graph 5 of this paper, the position of such nurses is the same as that of nurses engaged in direct profes sional nursing practice. Paragraph 21 states: ‘The Council requires that regis tered nurses employed in such circumstances will use their judgement and discretion to identify the nursing needs of residents and others for whom they may have responsibility, and will comply with any re quirements of the Council. The Council expects that employers will recognise the advantages to the personal social services and residential care sector which re sult from the employment of registered nurses.’
299
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 16, 2019.
New Code of Professional Conduct: how it affects you
Table 2. The Council’s definitions of the role of health care assistants 23
The Council’s position in relation to support roles is as follows:
23.1 health care assistants to registered nurses, midwives and health visitors must w o rk under the direction and supervision of those registered practitioners: 23.2 registered nurses, midwives and health visitors must remain account able fo r assessment, planning and standards of care and for determining the activity of their support staff;______________________________ 23.3 health care assistants must not be allowed to w ork beyond their level of competence; 23.4 continuity of care and appropriate skill/staff mix is important, so health care assistants should be integral members of the caring team; 23.5 standards of care must be safeguarded and the need for patients and clients across the spectrum of health care, to receive skilled profes sional nursing, midwifery and health visiting assessment and care must be recognized as of primary importance; 23.6 health care assistants w ith the desire and ability to progress to profes sional education should be encouraged to obtain vocational qualifi cations, some of which may be approved by the Council as acceptable entry criteria into programmes of professional education and 23.7 registered nurses, midwives and health visitors should be involved in these developments so that the support role can be designed to ensure that professional skills are used most appropriately for the benefit of patients and clients. Source: The Scope o f Professional Practice (U K C C , 1992)
Finally, in paragraph 23 the docu ment acknowledges the impact and development of healthcare assistants and the important role the registered nurse plays in supporting and super vising them (T able 2). There is no doubt that many reg istered nurses today are not practis ing at their highest potential, nor re ceiving the training, education or ex perience that would enable them to extend the scope of their practice. This document, along with the PREPP proposals (U K C C , 1990) should give every registered nurse the opportunity of reviewing their situation in a new and refreshing light. j^ I DH SS (1989) The Extending R ole o f the Nurse. Health circular Pl/CM O (89)7 PL/CBO(89)10 H M SO , London Nursing Times (1992) Diluting the Code? Editorial. Nurs Times 88 (25):3 Rogers M E (1992) Nursing: to be or not to be? Nurs O utlook 20:42-6 U K C C (1984) C o d e o f Professional Conduct f o r th e Nurse, M idw ife an d H ealth Visi tor. U K C C , London U K C C (1990) The Report o f the Post-regis tration Education an d Practice Project. U K C C , London U K C C (1992) The Scope o f Professional Prac tice. U K C C , London U K C C (1992) C ode o f Professional Conduct. U K C C , London
Instructions to authors for care studies All care studies submitted lo r publication should be sent to Joy Notter/Paula McGee, Nursing Research Unit, Uni versity of Central England in Birmingham, Perry Barr, Birmingham B42 2SU. Studies should be typewritten on A4 paper, double spaced with reasonable margins on one side of the pa per only. Please send three copies.
Short Introduction/Abstract This should be approximately 50-100 words and should give a precis of the background to the study, the pa tient’s history, family support and the clinical setting in which the study occurred.
Main text The main emphasis should be on the nursing care of the patient(s) and not on the disease process, the surgery carried out, the investigations conducted and/or the drugs used. These should be mentioned where appropri ate but should not dominate the study. The study should present a comprehensive account of each stage of care: a clear assessment of the patient; the aims and plan of care; a critical evaluation of the
300
effectiveness of the care given and recommendations for future care (where appropriate). Other disciplines, e.g. psychology should be included if pertinent as should any specific physiological details. Where a specific model of nursing is used a brief out line of the model should be included (a diagrammatic representation may be helpful) together with a short evaluation including its advantages/disadvantages.
Confidentiality You must ensure that whatever other information is in cluded you do n o t identify the patient(s), his/her family, home or place of work.
Overall presentation Headings should be used where appropriate, and the study should be approximately 2,000 words in length. Photographs, charts, tables and/or diagrams should be used to illustrate the main points. Clear indication of where these fit into the text is essential.
Reproduction permissions
You must gain the necessary permission to reproduce figures/tables/artwork from other journals or books be fore submitting your care study.
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 16, 2019. British Journal of Nursing, 1992, Voi l,N o 6
New Code of Professional Conduct: how it affects you George Castledine, University of Central England in Birmingham
Having considered this possible change it was then decided to under take a major review and update some of the clauses and language. Clause 10 emphasizes increased patient privacy by stating that all nurses, midwives and health visitors must:
evising the C ode o f Professional Conduct (U K C C , 1984) has many similarities to the difficulties involved in revising or tampering with the L ord ’s Prayer. There are those who like the version they grew up with and therefore do not wish to see it changed. On the other hand, there are others who are more rad ical and responsive to current trends and wish to change with the times. I must admit that on this occasion I was on the side of the radicals at the U K CC . The original impetus to revise the Code came from criticism of its failure to express equal oppor tunities and prevent discrimination. This led to the newly revised clause 7 which states that in the exercise of professional accountability, nurses, rr)idwives and health visitors must:
R
‘recognize and respect the uniqueness and dignity of each patient and client, and respond to their need for care, irrespec tive of their origin, religious be liefs, personal attributes, the na ture of their health problems or any other factor’. Professor Castledine is Head of the Department of Nursing and Community Health, at the University of Central England in Birmingham, Perry Barr, Birmingham B42 2SU
296
‘protect all confidential informa tion concerning patients and cli ents obtained in the course of professional practice and make disclosures only with consent, where required by the order of a court or where you can justify disclosure in the wider public in terest.’
There has been criticism that some of the wording in the new clauses, particularly the emphasis on report ing rather than the former obligation of taking appropriate action, is ‘passive and anachronistic’ (Nursing Times, 1992). However, it is import ant to remember that the wording in clauses 1 and 2 should leave the nurse in no doubt about the import ance of taking action.
Wellbeing The first clause stresses the import ance of acting ‘. . . always in such a manner as to promote and safeguard the interest and well-being of pa tients and clients’; the second of en suring ‘. . . that no action or omission on your part, or within your sphere of responsibility, is det rimental to the interests, condition or safety of patients and clients’. Far from dilution, the lead-in phrase and paragraph to the revised Code still maintain and strengthen their overall appeal and importance. The Code appears to defy rigid im plementation in some cases, but I think it would be impossible to pro duce a watertight wording that would be seen as all embracing and ethically and legally acceptable. After all, the Code is only a bench
mark or guide on which to base our professional behaviour and nursing practice. It should be general and flexible enough to allow us to use our professional judgements and clear enough to give us some idea of what to do when faced with our difficulties. The final responsibility and accountability remains with us. This latter point is further ex panded and emphasized in the U K C C ’s new document The Scope o f Professional Practice (U K C C, 1992). Now this position statement really has an exciting and potentially controversial message. In its intro duction it makes the point that nurs ing practice must be: ‘. . . sensitive, relevant and re sponsive to the needs of individ ual patients and clients and have the capacity to adjust, where and when appropriate, to changing circumstances’.
The rapid advance of biomedical knowledge in the last three decades has created much broader horizons for all health professionals and in creased the expectations of our pa tients and clients. Nurses are now being expected to adjust their roles and change along with other health professionals. In the past, the terms ‘extended’ and ‘expanded’ roles have been used to describe some of these changes in nursing activity. There has also been a proliferation of specialist nurses taking over traditional medical tasks; indeed many GPs see their practice nurses in this vein. The new nurses’ act relating to prescribing simple medicines is possibly another attempt to per suade nurses that traditional nursing is inferior to playing handmaiden to medical mythology and machines. Medical knowledge and skills, no matter how relevant to medical prac tice and health care, are not substiBritish Journal of Nursing, 1992, Voi l,N o 6
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 16, 2019.
New Code of Professional Conduct: how it affects you
Code of Professional Conduct Each registered nurse, m idw ife and health visitor shall act, a t all times, in such a m anner as to:
• safeguard and promote the interests of individ ual patients and clients; •
serve the interests of society;
8. report to an appropriate person or authority, at the earliest possible time, any conscientious objection which may be relevant to your professional practice; 9. avoid any abuse of your privileged relationship with patients and clients and of the privileged access allowed to their person, property, residence or workplace;
• justify public trust and confidence and •
uphold and enhance the good standing and reputation of the professions.
As a registered nurse, midwife or health visitor you are personally accountable for your practice and, in the exercise of your professional account ability, must: 1. act always in such a manner as to promote and safe guard the interests and well-being of patients and clients; 2. ensure that no action or omission on your part, or within your sphere o f responsibility, is detrimental to the interests, condition or safety of patients and clients; 3. maintain and improve your professional knowledge and competence; 4. acknowledge any limitations in your knowledge and competence and decline any duties or responsibilities unless able to perform them in a safe and skilled manner; 5. w ork in an open and co-operative manner with pa tients, clients and their families, foster their indepen dence and recognize and respect their involvement in the planning and delivery of care; 6. w ork in a collaborative and co-operative manner with healthcare professionals and others involved in providing care, and recognize and respect their par ticular contributions within the care team; 7. recognize and respect the uniqueness and dignity of each patient and client, and respond to their need for care, irrespective of their ethnic origin, religious beliefs, personal attributes, the nature of their health problems or any other factor;
10. protect all confidential information concerning pa tients and clients obtained in the course of profes sional practice and make disclosures only with con sent, where required by the order of a court or where you can justify disclosure in the wider public interest; 11. report to an appropriate person or authority, having regard to the physical, psychological and social effects on patients and clients, any circumstances in the envi ronment of care which could jeopardise standards of practice; 12. report to an appropriate person or authority any circumstances in which safe and appropriate care for patients and clients cannot be provided; 13. report to an appropriate person or authority where it appears that the health o r safety of colleagues is at risk, as such circumstances may compromise stan dards of practice and care; 14. assist professional colleagues, in the context of your own knowledge, experience and sphere of responsi bility, to develop their professional competence, and assist others in the care team, including informal carers, to contribute safely and to a degree appropri ate to their roles; 15. refuse any gift, favour or hospitality from patients or clients currently in your care which might be in terpreted as seeking to exert influence to obtain preferential consideration and 16. ensure that your registration status is not used in the promotion of commercial products or services, declare any financial or other interests in relevant organisations providing such goods or services and ensure that your professional judgement is not influ enced by any commercial considerations.
Source: Code o f Professional Conduct (U K C C , 1992).
British Journal of Nursing, 1992, Voi l,N o 6
297
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 16, 2019.
New Code of Professional Conduct: how it affects you
tutes for the development of nursing knowledge and skills. It is important to bear this in mind when reading The Scope o f Professional Practice document. There are those (and I have al ready heard many doctors express their joy at the appearance of this document) who say: ‘It should give us the chance to get on with more important aspects of medicine and research.’ O f equal concern was a comment by a GP who saw the document as an opportunity to de velop ‘physicians’ assistants’.
W aste To attempt to recruit professionally educated nurses out of nursing, and even more flagrantly, to propose that they function at a lower level in the field of medicine, represents an extraordinary human and intel lectual waste, as well as an effort to deny society a knowledgeable nurs ing service. Martha Rogers (1972) once said: ‘The nursing profession does not exist to serve the ends of any other profession, nor does one profession delegate anything to another profession. Each profes sion must determine its own boundaries within the context of social need.’ This is certainly the intended mess age in The Scope o f Professional Practice paper. It emphasizes the im portance of education and experi ence related to the range of responsi bilities the nurse should adopt. The barriers that inhibit the extension of the scope of nursing practice should be bridged through education and training. Casual acceptance of duties or responsibilities is dangerous prac tice and should not be taken on until the individual nurse feels safe and se cure in her/his performance. In paragraph 6 of the Scope docu ment there is an important cross ref erence to the number of explicit clauses in the revised C ode o f Profes sional Conduct — this reminds us that the Code provides the firm basis upon which decisions can be made. The principles which should govern adjustments to an individual’s scope of professional practice are covered in paragraph 9 (Table 1). It is pleas British Journal of Nursing. 1992, Vol I , No 6
Table I. The principles governing nurses’ scope of profes sional practice 9
The registered nurse, midwife or health visitor:
_________________
9.1 must be satisfied that each aspect of practice is directed to meeting
the needs and serving the interests of the patient or client;_________ 9.2 must endeavour always to achieve, maintain and develop knowledge,
skill and competence to respond to those needs and interests;_______ 9.3 must honestly acknowledge any limits of personal knowledge and skill
and take steps to remedy any relevant deficits in order effectively and appropriately to meet the needs of patients and clients;____________ 9.4 must ensure that any enlargement o r adjustment of the scope of per
sonal professional practice must be achieved without compromising or fragmenting existing aspects of professional practice and care and that the requirements of the Council’s Code o f Professional Conduct are satisfied throughout the whole area of practice;___________________ 9.5 must recognize and honour the direct o r indirect personal accountability
borne fo r all aspects of professional practice and__________________ 9.6 must, in serving the interests of patients and clients and the wider
interests of society, avoid any inappropriate delegation to others which compromise those interests._______________________ ___________ Source: The Scope o f Professional Practice (U K C C , 1992)
ing to see the emphasis on nursing as a collaborative profession which, along with medicine, is indispens able in providing society with high quality healthcare. The U K C C considers that the terms ‘extended’ or ‘extending’ roles are no longer suitable, nor is the wide variety of certificates that have approved such tasks. The emphasis should be on giving holistic and total nursing care to patients. The number of extended roles performed by nurses on a regular basis varies from hospital to hospi tal. Also, some health authorities do not accept other health authorities’ extended role certificates. The em phasis for such certification had come from such documents as The Extending R ole o f the Nurse (DHSS, 1989). It is to be hoped that such recommendations will now be with drawn in favour of those in the Scope paper. I am sure nurses want some sort of nationally recognized extended role certification. This will now be incorporated into the individual’s professional profile, thus reducing unnecessary wastage of scarce re sources from duplication of training. Paragraphs 20 and 21 of the Scope document are particularly contro
versial as they refer to registered nurses who are employed in non nursing or residential care settings. Paragraph 20 states: ‘Registered nurses who are em ployed in this sector, whether in homes or in the provision of other services, remain account able to the Council and subject to the Council’s Code of Profes sional Conduct, even if their posts do not require nursing qualifications.’ In this regard, as explained in para graph 5 of this paper, the position of such nurses is the same as that of nurses engaged in direct profes sional nursing practice. Paragraph 21 states: ‘The Council requires that regis tered nurses employed in such circumstances will use their judgement and discretion to identify the nursing needs of residents and others for whom they may have responsibility, and will comply with any re quirements of the Council. The Council expects that employers will recognise the advantages to the personal social services and residential care sector which re sult from the employment of registered nurses.’
299
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 16, 2019.
New Code of Professional Conduct: how it affects you
Table 2. The Council’s definitions of the role of health care assistants 23
The Council’s position in relation to support roles is as follows:
23.1 health care assistants to registered nurses, midwives and health visitors must w o rk under the direction and supervision of those registered practitioners: 23.2 registered nurses, midwives and health visitors must remain account able fo r assessment, planning and standards of care and for determining the activity of their support staff;______________________________ 23.3 health care assistants must not be allowed to w ork beyond their level of competence; 23.4 continuity of care and appropriate skill/staff mix is important, so health care assistants should be integral members of the caring team; 23.5 standards of care must be safeguarded and the need for patients and clients across the spectrum of health care, to receive skilled profes sional nursing, midwifery and health visiting assessment and care must be recognized as of primary importance; 23.6 health care assistants w ith the desire and ability to progress to profes sional education should be encouraged to obtain vocational qualifi cations, some of which may be approved by the Council as acceptable entry criteria into programmes of professional education and 23.7 registered nurses, midwives and health visitors should be involved in these developments so that the support role can be designed to ensure that professional skills are used most appropriately for the benefit of patients and clients. Source: The Scope o f Professional Practice (U K C C , 1992)
Finally, in paragraph 23 the docu ment acknowledges the impact and development of healthcare assistants and the important role the registered nurse plays in supporting and super vising them (T able 2). There is no doubt that many reg istered nurses today are not practis ing at their highest potential, nor re ceiving the training, education or ex perience that would enable them to extend the scope of their practice. This document, along with the PREPP proposals (U K C C , 1990) should give every registered nurse the opportunity of reviewing their situation in a new and refreshing light. j^ I DH SS (1989) The Extending R ole o f the Nurse. Health circular Pl/CM O (89)7 PL/CBO(89)10 H M SO , London Nursing Times (1992) Diluting the Code? Editorial. Nurs Times 88 (25):3 Rogers M E (1992) Nursing: to be or not to be? Nurs O utlook 20:42-6 U K C C (1984) C o d e o f Professional Conduct f o r th e Nurse, M idw ife an d H ealth Visi tor. U K C C , London U K C C (1990) The Report o f the Post-regis tration Education an d Practice Project. U K C C , London U K C C (1992) The Scope o f Professional Prac tice. U K C C , London U K C C (1992) C ode o f Professional Conduct. U K C C , London
Instructions to authors for care studies All care studies submitted lo r publication should be sent to Joy Notter/Paula McGee, Nursing Research Unit, Uni versity of Central England in Birmingham, Perry Barr, Birmingham B42 2SU. Studies should be typewritten on A4 paper, double spaced with reasonable margins on one side of the pa per only. Please send three copies.
Short Introduction/Abstract This should be approximately 50-100 words and should give a precis of the background to the study, the pa tient’s history, family support and the clinical setting in which the study occurred.
Main text The main emphasis should be on the nursing care of the patient(s) and not on the disease process, the surgery carried out, the investigations conducted and/or the drugs used. These should be mentioned where appropri ate but should not dominate the study. The study should present a comprehensive account of each stage of care: a clear assessment of the patient; the aims and plan of care; a critical evaluation of the
300
effectiveness of the care given and recommendations for future care (where appropriate). Other disciplines, e.g. psychology should be included if pertinent as should any specific physiological details. Where a specific model of nursing is used a brief out line of the model should be included (a diagrammatic representation may be helpful) together with a short evaluation including its advantages/disadvantages.
Confidentiality You must ensure that whatever other information is in cluded you do n o t identify the patient(s), his/her family, home or place of work.
Overall presentation Headings should be used where appropriate, and the study should be approximately 2,000 words in length. Photographs, charts, tables and/or diagrams should be used to illustrate the main points. Clear indication of where these fit into the text is essential.
Reproduction permissions
You must gain the necessary permission to reproduce figures/tables/artwork from other journals or books be fore submitting your care study.
Downloaded from magonlinelibrary.com by 130.237.122.245 on January 16, 2019. British Journal of Nursing, 1992, Voi l,N o 6
