A plain-English breakdown of all four themes of the NMC Code — what each one requires and how it applies to everyday nursing and midwifery practice
The NMC Code — formally titled The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates — is the single most important document in a registered nurse or midwife's professional life. It defines what patients have the right to expect, sets the standard against which all fitness to practise concerns are assessed, and underpins every NMC revalidation reflective account. This guide explains what each part of the Code actually means in practice.
The Code is not optional guidance or a list of aspirational values. It is the regulatory standard that every NMC registrant is required to meet throughout their career. When a complaint is raised about a nurse or midwife, the NMC assesses the conduct or practice in question against the Code. A breach of the Code can trigger a fitness to practise investigation. In legal proceedings, the Code is routinely cited as the benchmark for what a competent nurse or midwife should do.
Understanding the Code therefore matters not just for revalidation or regulatory proceedings but for everyday practice. Knowing what the Code requires helps you recognise ethical dilemmas, make defensible decisions, and practise with confidence.
All five NMC revalidation reflective accounts must link to a specific part of the Code. Knowing the four themes and their sub-sections lets you write targeted, meaningful reflections rather than vague references to "professional standards."
The Code is structured around four overarching themes, each containing a set of specific standards. Together they cover every dimension of professional nursing and midwifery practice.
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This theme requires nurses and midwives to put the interests, needs, and wellbeing of patients and service users at the centre of all care. It covers dignity, respect, consent, shared decision-making, and the right of patients to be fully involved in decisions about their own care.
Key requirements under this theme include: treating every person as an individual with the right to make their own decisions; recognising and responding to any signs that someone is at risk of harm or abuse; respecting patients' privacy and dignity at all times; making sure you get properly informed consent before undertaking any care or treatment; and maintaining professional boundaries in all care relationships.
Fitness to practise cases involving breaches of this theme typically concern failures of consent, undignified treatment, inappropriate relationships with patients, or failures to act when abuse was suspected. The guide to NMC insight and remediation explains how these concerns are assessed in fitness to practise proceedings.
This theme requires nurses and midwives to apply their knowledge and skills competently, to keep their practice up to date, to communicate clearly, to maintain accurate records, and to work effectively within teams and with other professionals.
Key requirements under this theme include: always completing records accurately, promptly, and in a way that could be understood by others; communicating clearly with patients, families, and colleagues; delegating tasks responsibly and only to those with the skills to carry them out safely; keeping your knowledge and skills up to date through CPD; and working collaboratively and contributing positively to team environments.
Poor record-keeping, inadequate communication, and unsafe delegation are among the most common themes in NMC fitness to practise cases that engage this section of the Code. The guide to NMC CPD evidence explains how CPD demonstrating compliance with this theme is assessed in proceedings.
This theme requires nurses and midwives to recognise and act on any risk to patient safety, to raise concerns when they arise, and to work within the limits of their competence. It also includes obligations around medicines management and the duty to escalate when situations exceed a registrant's skills or capacity.
Key requirements under this theme include: raising concerns immediately if you believe patient safety is at risk; working within the limits of your competence at all times; being open and honest when something goes wrong — the duty of candour; advising your manager or employer if patient safety may be compromised by workload or staffing; and handling medicines safely and in accordance with relevant legislation and local policies.
The duty to raise concerns is not discretionary. The Code is explicit that concerns about patient safety must be escalated regardless of any pressure — real or perceived — from employers, colleagues, or managers not to do so. The guide to NMC sanctions explains how safety-related concerns are assessed in fitness to practise proceedings.
This theme requires nurses and midwives to uphold the reputation of the profession — through honesty, probity, appropriate behaviour on social media, and conduct outside of work that does not undermine public confidence in registered nurses and midwives.
Key requirements under this theme include: being honest and trustworthy at all times, including in written records and communications; not using your professional position to obtain personal benefit; behaving in a way, both in work and outside work, that does not damage the reputation of the nursing or midwifery professions; using social media responsibly and not posting content that could be seen as unprofessional or offensive; and cooperating with the NMC and other appropriate authorities in any investigation.
Dishonesty, probity failures, and conduct outside of clinical settings that reflects poorly on the profession are assessed under this theme in fitness to practise proceedings. The guide to how to write an NMC reflective statement explains how engagement with this theme is demonstrated in the remediation evidence file.
The Code is not a document you consult only when something goes wrong. Its principles apply in every patient interaction, every entry in a clinical record, every conversation with a colleague, and every decision about escalating a concern. The four themes provide a framework for thinking through ethical and professional dilemmas in real time: which patient interests are at stake, am I working within my competence, is there a safety concern I need to raise, am I behaving in a way that maintains trust in my profession?
When facing any professional dilemma, ask yourself: would a reasonable nurse or midwife, acting in accordance with the NMC Code, make the same decision I am about to make? If the answer is uncertain, consult a colleague or your line manager before proceeding. The guide to how to save your NMC registration covers the broader evidence framework for demonstrating Code compliance in fitness to practise proceedings.
UK-registered nurses and midwives can access professional ethics training through Healthcare Ethics Courses.
Nurses with connections to Australia can consult ethics training in Australia.
Those with connections to New Zealand can review professional development in New Zealand.
10 CPD-certified courses for £500. CPD directly linked to all four themes of the NMC Code — supporting revalidation reflective accounts and fitness to practise remediation.
Bulk Buy 10 Courses →The NMC Code is not a statute but it is a binding professional standard. Breaches can result in fitness to practise proceedings leading to conditions, suspension, or removal from the register. Courts also reference the Code as the benchmark for competent nursing and midwifery practice.
Yes. The NMC Code applies to all registrants on the NMC register — registered nurses, midwives, and nursing associates. All are held to the same professional standards set out in the Code.
A breach may trigger a fitness to practise investigation. Depending on severity, outcomes range from advice or a warning through to conditions, suspension, or removal from the NMC register. The NMC considers the seriousness of the breach, the context, and whether the registrant has shown genuine insight and remediation.
Every NMC revalidation reflective account must link to a specific part of the Code. Understanding the Code's four themes and individual provisions allows nurses and midwives to write specific, meaningful reflective accounts that genuinely reflect their practice.
The four themes are: 1. Prioritise People — putting patient interests, dignity, consent, and wellbeing at the centre of care. 2. Practise Effectively — applying knowledge and skills competently, keeping records, communicating clearly, and maintaining CPD. 3. Preserve Safety — raising concerns, working within competence, the duty of candour, and medicines management. 4. Promote Professionalism and Trust — honesty, probity, appropriate social media use, and conduct that maintains public confidence in the profession.
Any conduct or practice that may amount to a breach of the Code can trigger an NMC fitness to practise investigation. Common triggers include failures of consent, poor record-keeping, unsafe delegation, failure to raise concerns, dishonesty, and conduct outside work that undermines trust in the profession.
Under the Prioritise People theme, the Code requires nurses and midwives to make sure they get properly informed consent before undertaking any care or treatment. This means ensuring the patient has the information they need to make a voluntary, capacitous decision — not just obtaining a signature.
Under the Preserve Safety theme, the Code requires nurses and midwives to be open and honest when something goes wrong — telling patients or their families what has happened, apologising, explaining the implications, and describing what will be done to address the situation.
Yes. Under the Promote Professionalism and Trust theme, the Code requires nurses and midwives to use social media responsibly and not to post content that could be seen as unprofessional, offensive, or damaging to the reputation of the profession.
Under the Preserve Safety theme, the Code is explicit that concerns about patient safety must be escalated regardless of any pressure — real or perceived — from employers, colleagues, or managers not to do so. The duty to raise concerns is not discretionary.
Under the Practise Effectively theme, the Code requires nurses and midwives to keep their knowledge and skills up to date through CPD. This is also a revalidation requirement. CPD that addresses specific Code provisions provides evidence of active engagement with professional standards.
Yes. Courts routinely reference the NMC Code as the benchmark for what a competent nurse or midwife should do in given circumstances. The Code can be cited as evidence of the standard expected of a reasonable registrant.
Under the Prioritise People theme, the Code requires nurses and midwives to maintain professional boundaries in all care relationships. This prohibits sexual or inappropriate personal conduct with patients, and any conduct that exploits the inherent professional relationship.
This guide is for educational purposes only and does not constitute legal or regulatory advice. For specific advice about your NMC registration or a fitness to practise matter, contact the NMC directly or seek guidance from your professional defence organisation.
