NPAA submission: Review of the Codes of conduct for nurses and midwives

Nurses and midwives want a code of conduct that protects patients. That means clear clinical and ethical standards, and the freedom to use professional judgement and speak up when something is unsafe.

Nursing once held itself to a pledge of about a hundred words. Today the Code of conduct for nurses runs to almost 8,000 words, with more than a hundred separate obligations, a 2,000-word glossary and tests that depend on how others feel rather than what a nurse did. The words “do no harm” do not appear in it once.

NPAA put AHPRA’s own scoping questions, word for word, to our membership of more than 20,000 nurses and midwives, along with the issues we have raised with AHPRA for years. This submission answers each AHPRA question with what our members told us.

What our members told us

• Good care means involving patients in decisions (87%), clear and honest communication (85%) and treating people with respect (83%).
• The top priority for the update is respectful care for all people (85%), followed by communication and consent (67%).
• 87% want the codes grounded in core medical ethics: “first, do no harm” and respect for patient autonomy.
• 55% have held back a professional opinion for fear of a complaint or regulatory action. Only half feel safe raising a clinical concern.
• Only 30% named unprofessional behaviour online as a top concern, the second-lowest of all options.

What we asked for

We ask AHPRA and the NMBA to return the codes to a short, clear, clinical standard built on patient safety, honesty, consent and “first, do no harm”, and to protect the nurses who speak up for their patients. Our ten recommendations are below.

Our ten recommendations

1. A short, clinical code. 
2. First, do no harm. 
3. Objective tests. 
4. Regulation limited to clinical practice. 
5. Speaking up.
6. Valid informed consent.
7. Clinical judgement. 
8. Conscience. 
9. Equal care. 
10. Consultation. 

Further details of these recommendations are in the letter below.