As a registered nurse it has been ingrained in me that, as a professional, I will be held accountable to an expected set of behaviours. The Nursing and Midwifery Council (NMC) Code (2018) states that:
‘You uphold the reputation of your profession at all times. You should display a personal commitment to the standards of practice and behaviour set out in the Code.’
The NMC has a Fitness to Practise (FTP) Library that shares the policy and guidance for NMC colleagues around decision making (NMC, 2024a). This is publicly available and a resource that I was not aware of until recently.
The NMC regularly updates its guidance, based on learning from cases and current issues of concern in society. Recently, the NMC held some discussions with professionals to consider several revisions to guidance, specifically focused on conduct outside of professional practice. There are several areas that have been clarified that are key for us to understand as professionals and employers.
As part of these updates, the NMC has clarified that conduct outside professional practice could require NMC action on the grounds of either public protection or public interest. This includes when the behaviour indicates deep-seated attitudinal issues that could pose a risk to the public in professional practice or is so serious that it is capable of diminishing public trust and confidence in the profession, or it raises fundamental questions about the nurse, midwife or nursing associate's ability to uphold the values and standards set out in the Code.
The updated guidance (NMC, 2024b) clarifies that, broadly speaking, the following behaviours are more likely to suggest a risk of harm to the public and impair a person's practise, irrespective of whether they occur inside or outside professional practice: discriminatory views or behaviours, sexual misconduct, abuse or neglect of children and/or vulnerable adults, and violence.
The guidance clarifies the approach to take when there is a belief that another organisation might be best placed to respond to concerns raised and when it may be in the public interest to share information with the police or relevant third parties.
In the NMC guidance on criminal convictions and cautions (NMC, 2024c) there is clarification to the central principle that the NMC will almost always have a regulatory interest where a professional:
- Has been convicted of any serious crimes it classifies as specified offences and/or
- Has been given a custodial sentence (including suspended sentences).
The NMC states that each case must be considered on its facts, but offers examples of where action may be taken outside of specified offences. These include coercive control, serious and/or repeated violence against others and stalking or harassment offences and where there is serious and/or repeated mistreatment, and/or the behaviour targets children or vulnerable people. These cases are more likely to identify deepseated attitudes of concern. There may be circumstances where there will be a need to investigate allegations the police have decided not to pursue. For example, where the allegation indicates a potential risk to people receiving care and is serious enough to diminish confidence in the profession.
There are further changes in where the NMC would refer an individual directly to an FTP committee – where there is the adoption of a new definition of hate crime, and a new section referring to ‘serious offences involving children’, which include a wider range of offences. In the ‘How we determine seriousness’ guidance (NMC, 2024b), it is made clear that certain behaviours are particularly serious as they suggest a risk to people receiving care, including:
- Conduct or poor practice that indicates a dangerous attitude to the safety of people receiving care
- Sexual misconduct ■ Discrimination and harassment
- Misconduct otherwise involving cruelty, exploitation or predatory behaviour, such as abuse or neglect of children and/or vulnerable adults.
The guidance explains in more detail the impact these behaviours can have and why conduct outside professional practice will raise fundamental concerns about a person's ability to meet the standards and values set out in the Code. There is also new guidance on making decisions on sexual misconduct, which signposts Crown Prosecution Service guidance so as not to be influenced by common myths and stereotypes surrounding rape and other forms of sexual misconduct (NMC, 2024d).
There is a relatively small number of individuals who meet the threshold that requires FTP processes. However, it is critical that guidance is current and reflective of the issues that are at play in society and may need to be considered.