What is the NMC Code?
The Code is the Nursing and Midwifery Council's statement of the standards of practice and behaviour expected of everyone on its register. It was published in 2015 and updated in 2018. It applies whatever your role, setting or seniority, and it covers your conduct outside work too, because how you behave affects public trust in the professions.
The Code is not a list of clinical procedures. It describes values and behaviours. Employers use it to set expectations, the NMC uses it when deciding whether someone's fitness to practise is impaired, and you use it in revalidation, where each written reflective account must link to it.
| Theme | In short | Typical everyday examples |
|---|---|---|
| Prioritise people | Put the interests of people using services first | Dignity in personal care, consent, respecting refusals, listening, person-centred language |
| Practise effectively | Use evidence, communicate well, work as a team, keep good records | Using interpreters, speaking up on ward rounds, clear contemporaneous notes, keeping up to date |
| Preserve safety | Work within your competence and act on risks | Saying when you are not trained, safe delegation, escalating deterioration, raising concerns, duty of candour |
| Promote professionalism and trust | Uphold the reputation of the professions | Honesty, professional boundaries, responsible social media use, cooperating with investigations |
Theme 1: Prioritise people
This theme asks you to treat people with kindness, dignity and respect, listen to them, respect their choices and act in their best interests. For many internationally educated nurses the biggest shift is that adults in the UK are presumed to make their own decisions, even when professionals or family disagree.
Consent and capacity in practice
- Valid consent is voluntary, informed and given by someone with capacity for that decision.
- It can be verbal, written or implied (holding out an arm), but you still explain what you are doing.
- A person can withdraw consent at any time.
- A relative cannot consent for an adult unless they hold a relevant legal authority, such as a lasting power of attorney for health and welfare, or a court appointment.
- In England and Wales the Mental Capacity Act 2005 applies: assume capacity, support people to decide, an unwise decision is not proof of incapacity, act in best interests, and choose the least restrictive option. Scotland and Northern Ireland have their own laws with similar principles.
An 80-year-old woman with capacity refuses a urinary catheter. Her son insists she must have it. Under the Code and the law, her decision stands. Explore her reasons, explain risks and alternatives, document the discussion, inform the team and keep offering care. Do not insert the catheter because her son asks you to.
Prioritising people also means small daily things: asking how someone likes to be addressed, protecting privacy during personal care, respecting cultural and religious needs, helping with food and drink, and never labelling people as 'non-compliant' or 'difficult'.
Theme 2: Practise effectively
This theme covers using the best available evidence, communicating clearly, working cooperatively and keeping clear, accurate records. UK teams expect nurses to contribute as autonomous professionals: to share their assessment on ward rounds, ask a doctor to explain a plan, and say when they think a plan is not right for the patient.
- Use plain English with patients and check they have understood.
- Use a professional interpreter when English is limited. Do not rely on family, and never on children, for clinical information.
- Adapt communication for people with hearing loss, learning disabilities or dementia.
- Keep your knowledge and skills up to date.
Record keeping
Records should be completed at the time or as soon as possible afterwards, be accurate and free of jargon and speculation, identify risks and the action taken, and never be falsified. In a complaint or investigation, your notes are your evidence.
Pt unsettled overnight. Obs ok. Given meds. Family aware.
03:15. Woke distressed, calling for her husband. Reoriented and settled after a drink and reassurance. RR 16, SpO2 97% on air, BP 132/78, pulse 82, temp 36.8, alert but disorientated to time, which is new since handover. NEWS2 3 (3 for new confusion). Escalated to on-call doctor 03:25, who will review. Paracetamol 1 g oral at 03:30 for headache, as prescribed. Daughter updated by phone at 08:00 with patient's consent. [Name, RN]
The strong entry gives times, values, the change from baseline, the escalation and who was told. New confusion alone scores 3 in NEWS2, which is why it was escalated.
Theme 3: Preserve safety
This theme asks you to work within your competence, act on concerns about safety, be open when things go wrong, manage medicines safely and protect people from harm.
Working within your competence
As a new UK nurse you will meet unfamiliar equipment, systems and procedures. Saying 'I have not been trained to do this here, can someone show me or do it with me?' is professional, not weak. Many trusts require local sign-off for skills such as intravenous drug administration, even for experienced nurses.
Delegation
You may delegate only tasks within the other person's competence, make sure they understand, check the outcome, and you remain accountable for the decision to delegate.
Raising concerns and candour
- Raise it locally first if you can: Speak to the nurse in charge or your manager, factually.
- Write it down: If the concern is serious or not resolved, record what you saw, with dates, and keep a copy.
- Use other routes: Most NHS organisations have a Freedom to Speak Up guardian. Your union or professional body can advise.
- Go external if needed: If internal routes fail or the concern is very serious, you can raise it with a regulator such as the CQC or the NMC.
When something goes wrong that causes or could cause harm, the professional duty of candour means telling the person, apologising, explaining what happened and what will be done, and recording it. An apology is not an admission of legal liability.
Theme 4: Promote professionalism and trust
This theme covers honesty and integrity, professional boundaries, behaviour online and outside work, and cooperation with investigations.
- Gifts: follow your employer's policy. Small tokens for the team are usually fine; money or valuable gifts are not.
- Relationships: never pursue a sexual or improper emotional relationship with someone in your care, or their family.
- Personal details: be careful about sharing contact details or social media accounts with patients.
- Money: never borrow from, lend to or get involved in the finances of people in your care.
- Social media: never post anything that could identify a patient, even without a name, and remember private groups can be shared.
- Honesty: be truthful in your CV, timesheets, sickness records, revalidation and anything you tell the NMC. Tell the NMC if you are charged with or convicted of an offence or receive a caution, as its guidance sets out.
Applying the Code: two practical examples
Rosa has been on a surgical ward for three months. A doctor phones asking her to give an extra intravenous morphine dose, saying he will write it up later. The patient is drowsy with a respiratory rate of 10. Under Preserve safety, Rosa should not give it. She tells the doctor what she has observed, asks for an urgent review, follows local guidance for reduced breathing after opioids and escalates to the nurse in charge. Local medicines policies generally do not accept verbal orders for controlled drugs. Questioning an unsafe instruction is exactly what the Code expects.
Dev, newly arrived, hears a senior nurse call an incontinent older patient 'disgusting'. Others seem to accept it, and he worries about his job. Under Prioritise people and Preserve safety, he should note what he saw and heard with dates and speak to the ward manager, or the Freedom to Speak Up guardian if he cannot. NHS organisations have policies to protect staff who raise concerns in good faith.
I saw a nurse being rude to a patient. I didn't say anything because she was senior. I learned that the Code says to treat people with dignity.
I saw a senior colleague speak to an older patient in a humiliating way. At first I said nothing because I was new and anxious. On reflection, this conflicted with Prioritise people, especially treating people with kindness and respect, and with my duty under Preserve safety to raise concerns. I wrote down what I had seen and discussed it with my ward manager, who acted. I have since read our speaking-up policy and know who our guardian is. In future I will raise concerns promptly and protect the patient's dignity at the time, for example by stepping in to offer care.
How do I use the Code in revalidation?
NMC revalidation every three years includes five written reflective accounts, each linked to the Code, and a reflective discussion with another NMC registrant. Linking experiences to the Code from your first week makes this far easier.
- After a difficult shift, ask which part of the Code was most relevant.
- When you get feedback, note which theme it relates to.
- When you complete CPD, record the part of the Code it supports.
- Use the Code to frame dilemmas in supervision or preceptorship.
This guide summarises the Code but does not replace it; read the full text on the NMC website. Our course The NMC Code for New UK Nurses works through each theme with UK examples and a reflection you can use for revalidation. NMC Registration for Internationally Educated Nurses and NMC CBT Preparation (Test of Competence Part 1) are useful if you are still joining the register, since the CBT tests the Code heavily.
Frequently asked questions
What are the four themes of the NMC Code?
Prioritise people; practise effectively; preserve safety; and promote professionalism and trust. Each theme contains numbered standards with more detailed statements. Together they describe how a nurse, midwife or nursing associate should behave towards patients, colleagues and the public, both at work and outside it.
Who does the NMC Code apply to?
Every nurse, midwife and nursing associate on the NMC register in the UK, in any role, including those not in direct patient care such as managers, educators and researchers. It also applies to your conduct outside work. Nursing and midwifery students are expected to follow it as part of their training.
Is the NMC Code legally binding?
The Code is a professional standard rather than a law, but it carries real weight. The NMC uses it when deciding whether a registrant's fitness to practise is impaired, and serious or repeated breaches can lead to sanctions affecting your registration. Employers also use it to set expectations. Separate laws, such as the Mental Capacity Act, also apply.
What does 'prioritise people' mean in practice?
It means putting the interests of the people in your care first: treating them with dignity and respect, listening, respecting their choices, getting valid consent, recognising their physical, social and psychological needs and acting in their best interests. It includes respecting an adult's decision to refuse care, even if family disagree.
Is the NMC Code changing?
The NMC announced in July 2026 that it would consult from September to December 2026 on a new draft Code and on changes to revalidation. Proposed areas include anti-discrimination, digital technology and AI, and working cultures. Until any new Code is published and in force, the current Code applies. Check the NMC website for updates.
Do I have to report a colleague under the NMC Code?
The Code requires you to raise and, if necessary, escalate concerns about patient safety or public protection, including unsafe practice by colleagues. Usually you start with your line manager or the nurse in charge. You must not obstruct others from raising concerns. Your organisation's speaking-up policy and your union can guide you.
How many reflective accounts must link to the Code for revalidation?
Five written reflective accounts per three-year revalidation cycle, each explaining what you learned, how you changed or improved your practice, and how it relates to the Code. You then discuss them with another NMC registrant in a reflective discussion. Use the NMC's official forms.
Related courses
The NMC Code for New UK Nurses
This course explains the NMC Code and shows how to apply it in everyday UK nursing and midwifery practice. It works through each of the four themes…
NMC Registration for Internationally Educated Nurses
This course walks internationally educated nurses and midwives through each stage of joining the NMC register, from checking you are ready to…
NMC CBT Preparation (Test of Competence Part 1)
This course prepares internationally educated nurses for Part 1 of the NMC Test of Competence, the computer-based test. It explains the structure of…
Sources and further reading
- The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- NMC to launch landmark consultation on new Code and revalidation process (July 2026). Nursing and Midwifery Council.
- Raising concerns: guidance for nurses, midwives and nursing associates. Nursing and Midwifery Council.
- Openness and honesty when things go wrong: the professional duty of candour. General Medical Council and Nursing and Midwifery Council.
- Guidance on using social media responsibly. Nursing and Midwifery Council.
- Mental Capacity Act 2005 Code of Practice. Office of the Public Guardian.
Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.
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