Code of Professional Conduct and Ethics

for Registered Nurses and

Registered Midwives

Incorporating the Scope of Practice

and Professional Guidance

The Code of Professional Conduct and Ethics for Registered Nurses and

Registered Midwives comes into effect on 14 February 2025, replacing the

previous editions published in May 2021 and December 2014.

The Code also replaces the Scope of Nursing and Midwifery Practice

Framework (2015); Ethical Conduct in Research (2015); Recording Clinical

Practice (2015) and Social Media and Social Networking (2013).

Contents

Introduction 2

About NMBI 2

About the Code 3

Purpose of the Code 4

Who Should Use the Code? 5

Section 1: Values and Ethics 6

Section 2: The Principles of the Code 8

Principle 1: Respect 11

Principle 2: Accountability 13

Principle 3: Competence 16

Principle 4: Trust 19

Principle 5: Collaboration 21

Principle 6: Leadership 23
Section 3: Scope of Practice 25

Determining your Scope of Practice 26

Decision-making framework 30

Section 4: Professional Guidance on Record Keeping 31

Section 5: Professional Guidance on Social Media 35

Section 6: Professional Guidance on Research 37

Section 7: Explanatory Notes 40

Section 8: Complaints 58

Resources 61

References 62

Bibliography 64

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives2

Introduction

About NMBI

Protecting patients, individuals, service users and other members of

the public is at the heart of what we do at the Nursing and Midwifery

Board of Ireland (NMBI). We are committed to fulfilling this objective by

supporting registered nurses and registered midwives in their provision

of the highest standard of care.

NMBI has a statutory responsibility to protect the public and protect the

integrity of the professions under the Nurses and Midwives Act 2011, as

amended1.

Among our core functions we:

D maintain the Register of Nurses and Midwives and a Candidate

Register for student nurses and midwives

D set the standards for the education and training of nurses and

midwives

D approve programmes of education necessary for registration and

monitoring these programmes on an ongoing basis

D support registrants by providing appropriate guidance on

professional conduct and ethics for both registered nurses and

midwives, and

D investigate and consider complaints against nurses and midwives.

The Code applies to all nurses and midwives registered in Ireland and will

assist them in their practice.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives3

About the Code

The Code applies to all settings where a registered nurse or registered

midwife provides healthcare, whether in person, virtually or through other

platforms. It outlines the professional conduct expected of a registered

nurse or registered midwife.

NMBI has revised the Code to reflect changes within the professions, the

healthcare system and broader society, to ensure registered nurses and

registered midwives practice safely while upholding the integrity of the

professions.

The Code incorporates and replaces the following documents:

D The Code of Professional Conduct and Ethics for Registered Nurses

and Registered Midwives (2021)2

D The Scope of Nursing and Midwifery Practice Framework (2015)3

D Ethical Conduct in Research (2015)4

D Recording Clinical Practice (2015)5

D Social Media and Social Networking (2013)6

The Code is substantially different to the previous edition and now contains

six principles, a value statement for each of the principles and standards

of conduct that taken together signify what good practice by registered

nurses and registered midwives looks like.

On joining the Register of Nurses and Midwives, and when renewing

registration, all registered nurses and registered midwives must commit to

upholding the principles, values and standards of the Code. They should

make sure that they are using the most up to date version of the Code.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives4

Purpose of the Code

The purpose of the Code is to:

D support and guide you in your ethical clinical decision-making

D support and guide you in your ongoing professional development

D emphasise your obligations to recognise and respond to the needs

of patients, clients, service-users, families and women receiving

maternity care

D ensure you uphold the values of the professions and that your

practice reflects the highest standards of safe, effective and

compassionate care

D inform the individual, the public, employers and professional bodies

of the standards of professional conduct and behaviour that they can

expect from registered nurses and midwives

D provide a benchmark to evaluate the professional conduct and

behaviour of nurses and midwives.

All registered nurses and registered midwives must be aware that a breach

or breaches of the Code could result in a complaint being made against

them and being brought before a fitness to practise inquiry. For further

information, please see Section 8: Complaints.

In addition to complying with the Code, registered nurses and registered

midwives have a duty to keep up to date with new or amended laws that

affect their practice. The Code includes references to law and policies

that apply at the date of publication, to explain the legal and ethical

implications for a registered nurse and registered midwife.

In this document a registered nurse and a registered midwife is referred to

as practitioner. Patients, service users, children, women etc., are referred to

as individuals.

The Code is not intended to give detailed professional advice on specific

activities or issues related to personal practice.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives5

Who Should Use the Code?

The Code should be used by anyone responsible for informing, influencing,

delivering, and providing nursing and midwifery care.

Registered nurses and registered midwives: must comply with the Code in

their day-to-day practice. This involves providing direct care to individuals,

groups or communities, or using their professional knowledge and exercising

their professional judgement to inform nursing and midwifery practice.

Educators: registered nurse and registered midwife educators should

use the Code to teach preregistration and post-registration students to

understand the conduct and behaviours expected of them as it lays the

foundation for their professional practice.

Leaders: all registered nurses and registered midwives have leadership

qualities and should model the Code in the course of their work to ensure

that the integrity of nursing and midwifery is evident.

Employers: have a responsibility to support registered nurses and registered

midwives in developing their practice to uphold the Code and provide safe,

high-quality care.

Section

Values

and Ethics

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives7

Values and ethics are foundational in nursing and midwifery, shaping

professional integrity and quality of care. The core values — Compassion,

Care, and Commitment — underpin ethical principles to ensure respectful,

person-centred care that is free from discrimination.

Key ethical principles that inform the Code

D Autonomy: Respecting individuals’ rights to make informed decisions.

D Beneficence: Acknowledging individuals’ will and preference.

D Non-maleficence: Avoiding harm and prioritising safety.

D Justice: Ensuring fairness and advocating for vulnerable individuals.

D Fidelity: Maintaining trust and honouring commitments.

D Veracity: Being truthful in all communications.

D Privacy: Respecting individuals’ right to privacy.

D Confidentiality: Protecting individuals’ information.

Professionalism in nursing and midwifery

D Competence: Maintaining the necessary skills and knowledge.

D Respect: Treating all individuals with respect.

D Ethical practice: Adhering to ethical standards and prioritising public

safety.

D Dignity: Respecting the inherent worth and autonomy of all

individuals.

D Collaboration: Working effectively with other professionals.

D Integrity: Upholding honesty and ethics.

D Leadership: Influencing positive change.

D Empathy: Providing sensitive, respectful care that is tailored to

individual needs. Together, these values, ethics and professional

standards ensure high-quality, compassionate care that inform the

principles of the Code.

D Accountability: Being responsible for one’s actions.

D Advocacy: Supporting individuals in expressing their will and

preferences.

D Compassion: Providing care with kindness and understanding.

Section
The Principles

of the Code

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives9

The Principles of the Code

The Code is based on

six principles:

The Code’s six principles uphold high standards, prioritising individuals at

the centre of care. Each principle is equally important, guiding safe, ethical

practice, supporting decision-making, ensuring safety of the individual,

and fostering professionalism and accountability. This guidance helps

practitioners integrate the principles daily, enhancing public trust and

quality of care.

Competence

Trust

Collaboration

Leadership

Respect

Accountability

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives10

Terms used in the Code

D ‘You must’ is used where there is an absolute duty to comply with the

principle and standard.

D ‘You must not’ is used as an absolute prohibition.

D ‘You should’ is used to describe the course of action that is generally

best practice while acknowledging that another approach may be

appropriate in certain circumstances, or that there may be factors

outside your control that affect your ability to comply.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives11

Principle 1: Respect

To achieve this, you must:

1. respect individuals regardless of their age, gender, race, religion,

civil status, family status, ethnic background, sexual orientation,

disability (physical, mental or intellectual), or membership of the

Traveller community.

2. respect diversity, promote inclusion and avoid bias, discrimination

and racism towards individuals.

3. treat individuals with kindness, respect and compassion.

4. respect and maintain the dignity of human life.

5. prioritise individuals health and wellbeing.

6. make sure that you get informed consent and document it before

carrying out care.

7. respect and uphold an individual’s human rights, including

supporting and documenting their right to refuse care or

treatment and their right to have an advance healthcare

directive, considering all relevant laws about capacity7.

8. prioritise the safety of individuals receiving care, including raising

safety concerns, irrespective of the source of those concerns.

Values

Respect is a foundational value, significantly impacting both individual care

and professional relationships. Practitioners respect and maintain their

dignity and that of individuals in their care, where respect is mutual. They

make sure that those receiving care are treated with respect, dignity and

compassion, and their rights are upheld.

Standard of conduct

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives12

You should:

12. provide end-of-life care to support individuals to die with dignity

and comfort, ensuring respect for the cultural norms, beliefs and

values that an individual holds about death and dying.

13. protect and promote an individual’s autonomy.

14. where possible, make sure that any treatment, assistance, care, or

advice that you are responsible for delivering is provided without

undue delay.

15. not take advantage of an individual’s vulnerability or cause them

unnecessary upset or distress.

You must not:

9. use your professional position to form a relationship of a sexual,

emotional or exploitative nature with an individual in your care.

10. exploit or discriminate against an individual receiving care or

condone discrimination by others.

11. discuss, comment or post anything on social media that could be

considered discriminatory, does not preserve the dignity of the

individual receiving care, is unlawful or otherwise breaches the

Code.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives13

Principle 2: Accountability

Values

Accountability means being responsible for one’s professional judgments,

actions, and omissions, and being able to explain these decisions. It

involves maintaining competence, ensuring quality care, and maintaining

professional standards. Practitioners must always uphold the reputation

of their professions and demonstrate accountability and professional

responsibility, personal and professional integrity, autonomy, and advocacy.

Standard of conduct

To achieve this, you must:

1. comply with the Code and other relevant NMBI guidance

documents.

2. work within and keep up to date with the law, regulations and

PPPGs relevant to your practice.

3. be accountable for your own decisions, actions, omissions, and

related outcomes.

4. accept responsibility for errors and learn from them.

5. act immediately and report any error, unsafe behaviour or

unethical conduct, whether or not harm has occurred to relevant

individuals.

6. comply with relevant laws and national policies relating to open

disclosure.8

7. act as an advocate on behalf of an individual who requires you to

do so to ensure their rights and interests are protected.

8. act as an advocate for the vulnerable, challenge poor practice,

and discriminatory attitudes and behaviour relating to care.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives14

You should:

13. be responsible and accountable for your own health and

wellbeing.

14. seek help from your employer if you become aware that your

physical or mental health is affecting your ability to practise

safely.

15. co-operate with any investigation or formal inquiries into

your professional conduct, the professional conduct of other

practitioners, or provision of care or services.

9. empower individuals to be involved in the decision-making

process by providing them with information they can

understand (health literacy).

10. tell your manager or colleagues if you have a conscientious

objection to a procedure or treatment. You may refuse to provide

care or to participate in a procedure or treatment which conflicts

with your ethical or moral standards, but you must make sure a
qualified colleague takes over the care of that person.

11. be aware that conscientious objection does not absolve you of

your responsibility to an individual in emergency circumstances.

12. maintain professional boundaries with an individual in your care,

their families and carers.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives15

Comply with your registration responsibilities to practise as a registered

nurse or registered midwife.

Standard of conduct

Regulatory requirements

To achieve this, you must:

16. inform your employer and NMBI if you have any conditions

attached to your registration from another regulatory body.

You should:

20. adhere to your employer’s policy about accepting and reporting

gifts.

21. make sure that if you are responsible for educational activities

in your workplace or organisation, you should ensure that

any funding from commercial enterprises is directed through

unrestricted education and development funds and managed

independently, without any influence from the commercial

enterprise.

22. be responsible for ensuring that you have adequate professional

indemnity insurance to cover your scope of practice.

You must not:

17. steal, misuse, abuse or improperly destroy the property of

individuals receiving care, the healthcare team or employers.

18. ask for or accept loans of money from individuals receiving care

or anyone close to them.

19. accept incentives, financial or otherwise, that could reasonably

be perceived as affecting your professional judgement.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives16

Principle 3: Competence

To achieve this, you must:

1. be competent to practise safely within your scope of practice.

2. make sure that your knowledge, skills and performance are of a

high standard, up to date and relevant to your practice.

3. regularly take part in appropriate continuing professional

development to maintain and develop your professional

competence.

4. practise only in areas in which you have relevant knowledge,

skills, competence and experience.

5. acknowledge any limitations within your scope of practice

and take measures to address them so that you can develop

competence, where appropriate.

6. participate in and advocate for improving the quality of your

practice to support safe person-centred care.

Values
Competence is the integration of knowledge, professional judgment, skills,

ethical values and attitudes necessary for safe, accountable and effective

practice. Individuals have a right to receive safe, high-quality care from

competent practitioners who work within their scope of practice, adhering

to their level of education, experience, knowledge, skills and judgment to

deliver safe and competent care.

Standard of conduct

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives17

You should:

7. only delegate to a person who you believe has the knowledge,

skills, competence and experience to carry out the activity safely

and effectively, or delegate to a person who is appropriately

supervised.

8. make sure that, by delegating a particular role or activity, it does

not harm the interests of the individual in your care.

9. make sure that the individual you are delegating to understand

the activity and the boundaries of their own competence.

10. make sure that the individual you are delegating to is clear about

the circumstances in which they must refer to you.

11. make sure you take reasonable steps to identify any risks

associated with delegation and whether supervision might be

necessary.

12. take reasonable steps to monitor the outcome of the delegated

task.
Delegation

You must:

13. engage in safe medication practices, having the required

knowledge, skills, and judgement to make evidence-based

decisions.

14. comply with NMBI guidance on medications9 and other relevant

policies, procedures, protocols and guidance, and regulations,

within the limits of your scope of practice, training, competence

and legislation.

Medication safety

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives18

You must:

15. follow risk assessment policies, procedures, protocols and

guidelines (PPPGs) to assess potential risks in the workplace and

your areas of practice.

16. escalate risks you identify to an appropriate authority and take

reasonable steps to minimise or reduce the identified risks.

17. respond courteously and honestly to anyone who complains

about the care, treatment, or other services they have received in

line with relevant laws and policies.10

18. acknowledge and act on all concerns raised to you, investigating,

escalating, or dealing with, and following up on those concerns

where it is appropriate for you to do so.

19. inform an appropriate person or authority if you are aware of

systems or service structures that may lead to unsafe practices

which puts an individual, yourself or others at risk.11

20. take appropriate action to protect people if the safety or

wellbeing of an individual or colleague is affected or put at risk by

another colleague’s actions, omissions, or incompetence.

Risk management

You should:

22. deliver the best possible safe and competent practice based on

the best available evidence and guidance.

You must not:

21. obstruct, intimidate, victimise, or hinder a colleague, member of

staff, individual you are caring for or member of the public who

wants to raise a concern.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives19

Principle 4: Trust

To achieve this, you must:

1. act with honesty and trustworthiness in your professional

interactions with individuals and colleagues.

2. behave in a way that supports and strengthens the public’s trust

and confidence in the integrity of the professions.

3. provide honest, accurate and balanced information based on

the best available evidence, ensuring it is shared sensitively and

in a way the individual can understand, addressing their specific

health, care and treatment needs.

4. be aware that confidentiality covers all forms of record

management including all physical and electronic data.

You should:

5. respect and uphold an individual’s expectation that their personal

information will remain private and confidential.

6. use your professional judgment and act responsibly when you

must disclose and share information.

Values

Trust is a core professional value, influencing the quality of care and the

therapeutic relationship between practitioners and individuals. Open,

honest and compassionate professional relationships are based on trust,

and follow obligations about privacy and confidentiality.

Confidentiality is an expression of the trust inherent in the therapeutic

relationship with an individual.

Standard of conduct

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives20

To achieve this, you must:

7. respect and uphold an individual’s right to confidentiality in all

aspects of their care.

8. obtain the consent of an individual before discussing confidential

information with their family, carers or other professionals

involved in their care and document it12.

9. where appropriate inform individuals if you intend to share

confidential information about them with other healthcare

colleagues and the reason for sharing their information.

10. make sure to know the circumstances when confidential

information may be disclosed in the absence of consent if it is:

D required by law to do so

D to protect individual’s interests

D to protect public interest, or

D to protect the interests of other people.

In these circumstances, you must only disclose the minimum

amount of information necessary to the appropriate person.

11. use all forms of spoken, written and digital communication with

individuals responsibly, always respecting their right to privacy

and confidentiality.

Values

Practitioners engage with individuals respectfully, promoting open, honest,

and compassionate professional relationships and ensuring confidentiality.

Standard of conduct

Confidentiality

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives21

Principle 5: Collaboration

To achieve this, you must:

1. communicate sensitively, effectively, honestly and appropriately,

considering the needs of the individual you are caring for.

2. communicate clearly and effectively with members of the team

caring for an individual to ensure safety and continuity of care.

3. treat colleagues with respect, working with them in a

professional, collaborative and cooperative manner while

recognising that others have a right to hold different opinions.

4. deal with differences of professional opinion by discussion and

informed debate, respecting views and opinions, and always

behaving in a professional way.

5. promote professional relationships with individuals, their

caregivers, advocates, and members of the healthcare team

by managing and resolving conflict through negotiation or

consensus, where appropriate.

6. if needed, refer or transfer an individual’s care to the appropriate

healthcare team for further treatment promptly to maintain

continuity of care and always get the individual’s consent first.

7. complete records at the time of, or as soon as possible after

providing care, recording if the notes are written sometime after

the event.

Values

Collaboration takes a multi-disciplinary approach to care. Teamwork

ensures consistent standards, improving individual experiences and health

outcomes while maintaining accountability and safety. Practitioners

communicate with individuals, healthcare professionals, colleagues and

students. Effective communication enhances wellbeing, and proper record-

keeping is vital for safety and continuity of care.

Standard of conduct

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives22

You should:

16. take reasonable steps to meet an individual’s language and

communication needs, and if possible, aid those who need help to

communicate their own or others’ needs.

17. use terms that individuals can understand recognising health

literacy issues.

You must not:

13. share your personal views, such as religious, political or moral

beliefs, with individuals in a way that is inappropriate for a

professional setting.

14. document false or misleading information about individuals, the

care given or to be given.

15. use unapproved abbreviations, jargon or speculation in records.

8. keep clear and accurate records relevant to your practice.

9. make sure that all paper or electronic records are clearly

documented and include your name, the date and time of the

entry, and your signature or log entry with your NMBI PIN number.

Using a signature bank is acceptable. For digital records, ensure

they are traceable to the practitioner who provided the care.

10. take immediate and appropriate action if you are aware that

someone has not completed records correctly. This must be raised

with the individual and if necessary, the employer.

11. cooperate with audits of training records or other relevant audits

that may be carried out relevant to your role.

12. collect, store and use records according to data protection law.13

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives23

Principle 6: Leadership

To achieve this, you must:

1. uphold and promote high standards of evidenced based care.

2. be aware of how your behaviour can affect and influence the

behaviour of other colleagues, students, and members of staff

and individuals.

3. support colleagues to follow the principles of the Code.

4. stop unsafe, incompetent, unethical or unlawful practice.

5. promote person-centred care.

6. manage time, staff, and resources efficiently, considering

environmental, social and economic factors.

7. take all reasonable steps to protect team members you are

responsible for from harm, detriment and victimisation.

8. take all reasonable steps to protect team members you are

responsible for from unwarranted treatment after a concern is

raised.

9. teach, supervise and assess students fairly and respectfully using

approved criteria.

10. support and encourage students and colleagues, to help them

develop their knowledge, skills and competence through clinical

supervision, reflection and evaluation.

Value
Leadership in nursing and midwifery means inspiring and guiding others to

achieve goals, building trust among individuals, colleagues and the public.

Practitioners demonstrate professionalism, adaptability, promote dignity,

and support all colleagues, fostering effective teamwork and positive

change.

Standard of conduct

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives24

You should:

13. support, preceptor, mentor and teach colleagues, non-registered

staff, and other members of the healthcare team, especially

those who are less experienced in providing care, considering the

resources you have available.

14. promote teamwork and collaboration within and between

professions through shared learning opportunities.

15. be supportive of colleagues who have health or performance

problems, ensuring that such supports do not compromise an

individual’s safety.

16. not ignore, engage in or excuse behaviour that could be

perceived as bullying or harassment, in compliance with relevant

policies.

17. recognise and encourage leadership and value the work of your

colleagues.

18. encourage independent, innovative nursing and midwifery

practices based on evidence.

19. take part in approved research or support the research of others,

where possible.

11. provide constructive and timely feedback in your assessment of

students.

12. promote good professional behaviour for students, newly

qualified practitioners and team members.

Section

Scope of

Practice

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives26

Determining your scope of

practice

Scope of practice is the range of roles, functions, responsibilities and

activities which a registered nurse or registered midwife is educated,

competent, and has authority to perform. Your scope of practice is fully

linked to the Code, which are the overarching principles that guides you

in your professional practice.

The scope of practice should be flexible and adaptable, responding to

evolving healthcare needs, advancements in knowledge and technological

progress. An individual practitioner’s scope of practice is shaped by various

factors, including the healthcare setting, the specific needs of individuals,

the practitioner’s own competence and the guidelines of the service they

work in. As practitioners acquire new skills and knowledge, their personal
scope of practice expands and evolves. Practitioners who expand their

practice must be accountable for their role and associated responsibility in

accordance with the Code.

The scope of practice of an individual practitioner is influenced by

several factors including:

D Education preparation, professional practice and competence

Your initial education sets the foundation for your scope of practice.

Additional education and practice experience further develops your

knowledge and skills that may broaden the range of activities you

are competent to undertake.

D Guidelines, policies and evidence-based research

Local, national and international practice policies, procedures,

protocols and guidelines, and evidence-based research inform and

guides your practice. Adhering to these helps ensure your practice

aligns with legal and ethical requirements, and reflect current best

practices in healthcare.

D Practice setting

Your workplace environment, whether in the acute, community or

other practice settings affects your scope of practice. Each setting

may require distinct skills, knowledge, influencing the specific

competencies required.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives27

D Collaborative practice

This involves shared responsibilities, interprofessional learning and a

holistic approach to care. It involves practitioners working with other

professionals to provide comprehensive, person-centred care.

When considering your scope as a regulated professional, you must think

of your role and responsibilities in providing safe, quality person-centred

care. You should review your own scope of practice on an ongoing basis

to ensure that it is up to date to meet the needs of individuals and the

environment you are working in.

The Scope of Practice Framework is designed to support you in making

decisions about your role and responsibilities.

The framework has several functions and is:

D an empowering resource for practitioners to practice high quality

safe care

D a framework to support decision-making related to practice

D help for practitioners to identify professional development needs

D an enabling framework that allows practitioners to develop their

roles, and

D a framework to encourage reflective practice, improve learning and

provide safe, quality healthcare.

You are accountable for your professional actions. If you identify a

competence deficit, you should, with the support of your employer, take

appropriate measures to gain competence, where appropriate.

Making decisions regarding the scope of practice are based on the

following principles:

D Your practice must be for the benefit and needs of the individual in

line with the Code.

D When determining your scope of practice, you must make a balanced

judgement about your competence to carry out a role or activity

guided by all the principles in the Code. Further education and

training may be required to gain competence in a particular area.

You are reminded that in accordance with the Code, you are accountable

for your own decisions, actions, omissions and related outcomes.

In compliance with the Code, ask yourself these questions relating to the

decision you must make.

1. Identify need/benefit

D Has there been a comprehensive assessment to establish the

individual’s health and cultural needs?

D Has there been appropriate consultation with, and consent by, the

individual receiving care?

D Does the activity consider the will and preference of the individual

receiving care?

2. Reflect on scope of practice

D Do you have the necessary knowledge skills and competence to carry

out this activity?

D Have legislative requirements been met?

D Does your practice comply with the Code?

3. Consider context of practice

D Is the activity/practice/delegation supported by the organisation?

D Is the activity supported by local or national Policies, Procedures,

Protocols and Guidelines (PPPGs)?

D If this is a new practice is there a system for ongoing education and

maintenance of competence in place?Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives

28

Take Action:

D Perform the activity, reconfirm

consent from the individual

receiving care

and

D document the decision and

the actions

and

D evaluate outcome.

(see corresponding algorithm)

Take Action:

D You must make sure that the

individual’s needs are met, this

may be through collaboration,

delegation or referral to other

healthcare professional

D You must discuss with your line

manager/supervisor what you

need to do to take measures

to develop and maintain your

professional competence

D If appropriate, consider what

needs to happen to put the

necessary policies, procedure

protocols and guidelines

in place to enable practice

changes, if appropriate and

document such considerations

as per algorithm

and

D document the decisions and

the actions.

(see corresponding algorithm)

If you answered YES

to ALL of the above

If you answered NO

to ANY of the aboveCode of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives

29

The Scope of Practice Decision Making-FrameworkCode of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives

30

YOU MUST

make sure that

the individual’s

needs are

met, this may

be through

collaboration,

delegation

or referral to

another HCP

YOU MUST

discuss with your

line manager/

supervisor what

you need to do

to develop and

maintain your

competence

Discuss with your

line manager

If appropriate,

plan to enable

practice

changes by

developing and

implementing

policies,

procedures,

protocols and

guidelines
(PPPGs) as

appropriate

PROCEED

D perform the

activity

D document

the decision

actions and

D evaluate

outcome

Is the activity

supported in

your practice

setting? (Eg.

legislation/

evidence PPPGs)

YES

Have you the

necessary

competence to

carry out this

activity?

YES

Unsure

/No
NO

STOP

Consider what

you must do

Decision making

starts here

YOU MUST make sure that

the individual’s needs are

met, this may be through

collaboration, delegation or

referral to another HCP

YOU MUST discuss with your

line manager/supervisor

what you need to do to

develop and maintain your

competence

Discuss with your line

manager

If appropriate, plan to

enable practice changes (by

developing and implementing

policies, procedures,

protocols and guidelines

(PPPGs)as appropriate

Professional
Guidance on

Record Keeping

Section

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives32

Record keeping

All practitioners are responsible for maintaining clear, accurate and up-

to-date records, whether in written or electronic form. This duty applies to

all records relevant to your scope of practice, including but not limited to

individuals’ health records.

While keeping accurate and clear records can be challenging in a busy

work environment, it is a crucial part of your role as a practitioner. The

quality of the records you maintain reflects the quality of care you provide.

Practitioners are both professionally and legally accountable for the

standard of care they deliver and contribute to. Effective record-keeping is

an essential component of high-quality practice.

Guidelines for completing records (written and electronic)

1. Records should be accurate and created according to legal, ethical,

and professional standards. Records should be legible, clear and

permanent, ensuring they can be easily photocopied if needed.

2. Records should be completed as close to the time that care is given and

include the date and time (24-hour clock).

3. Records should clearly reflect evidence of the care planning process,

the delivery of care and the evaluation of that care.

4. All care provided must be accurately documented to ensure continuity

of care.

5. Record the ongoing holistic assessment of an individual, including

the perspectives and observations of family members, when relevant.

Ensure that records are specific, current, factual and clear.

6. Avoid using jargon or disrespectful remarks.

7. Only use your initials to sign charts in designated signature areas. For

example, on a drug administration record, ensure you record or log both

your full signature and initials with your NMBI PIN number. The use of a

signature bank is essential. Include practitioner’s role or title, such as

Registered General Nurse (RGN) or Clinical Midwife Specialist (CMS)

when signing records. An individual’s care record should be documented

in chronological order. If this order is not followed, the reason for the

deviation (such as in an emergency) must be clearly explained.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives33

8. Late entries are allowed if they are clearly indicated as such.

Practitioners must not make or backdate entries before the event has

occurred.

9. Practitioners must not rewrite or discard original entries, even for simple

reasons like a torn page or spilled drink.

10. Always record the date and time if requesting attendance from medical

or other healthcare staff, or when calling for assistance in an emergency.

11. When referring or consulting with another healthcare team member,

always include the person’s name in the record. Phrases like “seen by
doctor” or “doctor informed” are not allowed. If another professional

sees the individual, they must keep their own records. Any information

or advice given over the phone must be accurately recorded by the

practitioner who received the call, with the caller’s identity clearly

noted.

12. Only use abbreviations that are approved by your healthcare

organisation. It is advisable for healthcare facilities to maintain an

approved list of abbreviations which should be reviewed and updated

as necessary.

13. Only use an accepted official grading system.

D +++, <> should be avoided unless it is part of an accepted grading

system

D upward or downward arrows to show changes in physiology or

other vital signs should not be used.

14. If an entry is made in error, it should be bracketed and a single line

drawn through it, ensuring the original text remains legible. The error

must be signed and dated.

15. Any decision to delay action and review the situation later must be

clearly documented.

16. Any information, instructions or advice provided by a practitioner to an

individual, including discharge instructions, should be recorded.

17. Do not create or maintain more than one record for an individual.

18. The individual’s name and identifying details should be included on

every page of the record, ensuring their identity is always clear to the

reader.
Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives34

19. Practitioners should not record care on behalf of someone else. If it is

necessary, such as when a practitioner calls while off duty to report

missed documentation, it should be clearly stated in the record.

20. Students must be taught the importance of recording care delivery

and management. This includes instruction, practice, supervision and a

countersignature by a practitioner.

21. Practitioners supervising students or practitioners (candidates) in

practice before registration should monitor the quality of their record-

keeping.

22. A practitioner should only countersign records if they have witnessed

the activity or can confirm that it occurred.

23. If a supervised individual needs to amend an entry, they should follow

the proper procedure for correcting errors in the record.

24. Practitioners who take records outside of their organisation must take

all reasonable steps to ensure the records remain safe and secure. They

should return the records to the appropriate storage facility as soon as

possible after use.

25. Regular audits of record-keeping should be conducted as an essential

part of ensuring the quality of records.

26. It is recommended that local policies should be available to support

practitioners in following best practices for record-keeping.

Section

5
Professional

Guidance on

Social Media

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives36

Use all forms of spoken, written and digital communication

responsibly (including social media and networking sites).

D Social media connects people, fosters conversation, supports others

and enables sharing. It is a valuable tool for learning, entertainment,

research, news promotion and engaging in current discussions. Social

media extends beyond major platforms to include blogs, forums,

messaging apps and other tools for sharing information.

D Before using social media, familiarise yourself with the platform’s

rules and practices, and learn how to set and manage your privacy

settings. Understand key concepts such as privacy, confidentiality,

defamation, cyberbullying and copyright, as well as the benefits

and risks associated with social media. Keep your personal

and professional lives separate online to maintain appropriate

boundaries.

D Use social media responsibly, adhering to the same professional

standards as other forms of communication. Always consider the

potential impact on individuals before posting material, and respect

both professional and personal boundaries, including privacy and

confidentiality. Sharing confidential information online can be more

harmful than sharing it verbally because of the rapid speed at which

it can spread and the large potential audience.

D Clearly state in your profile that your views are personal and

ensure that retweets or comments do not imply endorsement.

Think about the information you share, including your professional

identity and workplace location. Even the strictest privacy settings

have limitations. Once something is online, it can be copied and

redistributed.

D Maintain professional boundaries and respect the legal rights of

others.

D If tagged in inappropriate content, promptly request its removal and

report any illegal or unprofessional behaviour. Additionally, report

any inappropriate content you encounter, both online and within

your organisation, to your manager and in accordance with your

organisation’s policy.

D Do not take photos or videos in the workplace unless part of

approved professional training or education. Avoid airing grievances

or discussing work situations with colleagues or individuals online.

D If you are unsure whether something you post online could harm your

professionalism or reputation, pause to consider if the information

reflects your professional values and how it might affect your

obligation to follow the Code.

Section

Professional

Guidance on
Research

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives38

Research

Research is crucial for improving healthcare practices and achieving

the best possible outcomes. In nursing and midwifery, research covers

areas such as clinical practice, management, education and informatics.

Practitioner-led research, especially within multidisciplinary teams, drives

meaningful change by generating evidence that shapes professional

practice. This evidence informs policy, guides professional decision-making

and supports high-quality, evidence-based care.

Ethical approval

Research ethics define guidelines to ensure that research is conducted

responsibly and with respect for participants. These principles are essential

to protecting the dignity, rights and wellbeing of those involved. The

Declaration of Helsinki14 outlines core ethical standards for research with

human participants, requiring independent ethical review.

Any research involving human participants must be reviewed by an ethics

committee to ensure compliance with ethical standards, relevant national

policies and legislation.

Before beginning a research project, researchers must understand the

ethical considerations, guidelines, policies and procedures relevant to their

study. Ethical approval must be obtained from the appropriate healthcare

services, institutions or educational bodies. Research practices should

also be monitored, audited and evaluated regularly. Many healthcare and

educational institutions have research ethics committees that enforce strict

standards for research and clinical trials to ensure compliance with ethical

and regulatory requirements.

Informed consent in research

If you are responsible for, or involved in, planning or conducting nursing

or midwifery research, you must be familiar with and adhere to the

appropriate requirements for obtaining consent from participants.

Consent for research is the informed, voluntary and explicit agreement of a

potential participant to take part in a research study. This consent must be

recorded and kept in accordance with Irish data protection laws13.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives39

It involves the clear, freely given and unambiguous agreement of the

participant to engage in specific research activities, and/or to allow

the processing of their personal data, following a thorough process

of communication and information sharing. If you are the practitioner

responsible for the care of potential participants, you should consider

having someone else involved in the research consent process to avoid any

potential conflict of interest. Consent to participate in research must always

be explicitly obtained, it should never be assumed.

Participants have the right to withdraw from a research study at any time,

without facing any negative consequences or affecting their care. This right

to withdraw should be clearly explained to participants at the start of the

research process, during recruitment.

Healthcare records in research

When individuals’ records are used in research, they must be treated

with the same ethical considerations as any other research data. The

principles of privacy, confidentiality and anonymity must always be upheld.

Researchers should follow relevant policies regarding record-keeping and

comply with the Data Protection Act (2018)13 and GDPR (2018).

Research integrity

Research integrity is essential to maintaining the trustworthiness of both the

research process and its outcomes.

Good research practices are grounded in key principles of integrity

D Reliability: ensuring the quality of research through sound design,

methodology, analysis and appropriate use of resources.

D Honesty: conducting, reviewing, reporting, and communicating

research in a transparent, fair, complete and unbiased manner.

D Respect: demonstrating respect for colleagues, participants, research

subjects, society, ecosystems, cultural heritage and the environment.

D Accountability: taking responsibility for the entire research

process—from the initial idea to publication, including management,

organisation, training, supervision and mentoring, as well as

considering the broader societal impact of the research.

Explanatory

Notes

Section

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives41

Accountability: refers to the responsibility that practitioners have for their

actions, inactions, decisions and the care they provide to individuals. It

involves being answerable for one’s professional conduct, adhering to

ethical standards, and complying with legal and regulatory requirements.

Practitioners are accountable for ensuring safety of individuals, delivering

evidence-based care, maintaining confidentiality and acting within

the scope of their practice. This accountability extends to professional

development, as practitioners must continuously update their knowledge

and skills. They are expected to collaborate with other healthcare team

members, ensuring the best outcomes for patients and service users while

advocating for their rights and wellbeing.

Practitioners are accountable to the individual, the public, the NMBI, their

employer and any relevant supervisory authority. There are three main

considerations: organisational, team and personal accountability.

Advance healthcare directives: a capable individual has the right to refuse

treatment.

An advance healthcare directive should be respected on condition

that:

D the individual made an informed choice at the time of making the

advanced healthcare directive

D the decision in the directive covers the situation that has now arisen,

and

D there is no indication that the individual has changed their mind since

the advance healthcare directive or plan was made.

The Advance Healthcare Directive must comply with the provisions of the
Assisted Decision Making (Capacity)(Amendment) Act, 2022.7 This is a legal

framework that supports individuals who lack or may be deemed to lack

capacity. It uses a functional approach to decision-making and places

the obligation on all those working in healthcare to support an individual

whose capacity may be in question to ensure they are part of the decision-

making process. This includes advance healthcare directives. A cognitive

impairment is relevant in this context only if it affects capacity.

Advocacy: in nursing and midwifery is a crucial aspect of both professions,

emphasising the role of practitioners as advocates. This involves promoting

and protecting the rights, needs and preferences of individuals while

ensuring they receive appropriate care.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives42

Practitioners advocate for individuals by listening to their concerns,

respecting their values and ensuring their voices are included in decision-

making. They provide education about health conditions, treatment

options and possible outcomes, empowering patients and service users

to make informed choices. Advocacy also involves collaborating with

other healthcare professionals to deliver comprehensive care that meets

individual needs.

Artificial Intelligence (AI):

AI is emerging in healthcare and has the potential for significant

transformation of care. Some examples of the use of AI include,

monitoring vital signs via wearable devices, alerting practitioners to

urgent changes and analysing medical histories to identify individuals

at risk for complications. AI systems may also provide evidence-based

recommendations for treatment and streamline administrative tasks like

scheduling. Practitioners should be cautious about the interpretation of

AI recommendations, as they must retain assessment and judgment, and

ultimate accountability for their actions and omissions.

Authority: refers to the recognised responsibility granted to practitioners

through their education, training, experience and professional standards. It

enables them to make decisions, provide care, and lead within their scope

of practice, supported by legal, ethical and organisational frameworks to

ensure accountability and prioritise person-centred care.

Autonomy: refers to the ability of practitioners to make independent

decisions and take actions based on their professional judgment. While

professionals have decision-making power, they remain accountable to

ethical guidelines, legislation, PPPGs and the public. This autonomy fosters

trust in their expertise and allows for high standards of practice. This can

empower them to advocate for individuals, assess and manage care,

and respond swiftly to changes in the individuals’ conditions. Autonomy

fosters accountability and encourages collaboration with other healthcare

professionals. Ultimately, it plays a crucial role in providing high-quality,

person-centred care.

Capacity and informed consent: it is essential to presume that individuals

have the capacity to make their own decisions unless there is a good

reason to doubt it. Every adult with capacity has the right to refuse

care or treatment, and their decision must be respected, even if there is

disagreement7. Documentation of the refusal and the explanation provided

should be clear in the individual’s records.

Before any treatment or intervention, informed consent must be obtained

to respect the individual’s autonomy and right to control their own life.

Effective communication is crucial; individuals should receive information in

an understandable manner, potentially using translation services if needed.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives43

Closed loop communication: where individuals repeat the information

back to the individual to ensure they understand. Sometimes, an individual’s

health may prevent them from participating in the consent process. In such

cases, assess their capacity based on relevant laws and regulations, while

taking steps to support their decision-making. To determine capacity,

consider whether the individual can understand, retain and communicate

information about the decision at hand.

Capacity is specific to each decision; lacking capacity for one decision

does not mean they lack it for other decisions. If someone cannot decide,

consult with a legally authorised representative.

The information provided should be tailored to the individual’s needs,

including their beliefs and culture. Always allow enough time for questions

and decision-making, while keeping them informed about any changes to

their condition or treatment options.

In emergencies, treatment can proceed without consent if it is necessary

to save a life or prevent significant health deterioration. When using digital

health technologies, explicit consent must be obtained for processing health

data. Any withdrawal of consent should lead to the deletion of personal

data.

Clinical indemnity insurance: practitioners are legally accountable

for ensuring they have appropriate professional indemnity insurance.

Individuals expect practitioners to hold insurance in case there is a

substantiated claim of professional negligence against them. If you are

employed in the public health service or in certain voluntary organisations,

you are indemnified by the Clinical Indemnity Scheme (CIS). If you are

working in the private sector, you may be covered by your employer’s

insurance.

In the interest of an individual’s safety and protecting the public, you must

ensure that you have professional indemnity insurance if you are working in

private or independent practice.

Competence: refers to the ability of practitioners to consistently

demonstrate the necessary skills, knowledge, judgement and attitudes

required to provide safe, effective and ethical care. This includes not only

technical proficiency in clinical tasks but also the capacity to assess and

respond to the physical, emotional and psychological needs of individuals.

Competence involves ongoing professional development, adherence to

established PPPGs, and the ability to make informed decisions in complex

and dynamic healthcare settings. Ultimately, competence ensures that

practitioners can deliver high-quality care that meets the needs of

individuals and communities while promoting safety and wellbeing.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives44

Concerns about colleagues or systems: if you have concerns about a

colleague’s conduct or competence, you should talk to the individual initially

to highlight your concerns. If the conduct or competence concern continues,

you should inform your manager. In a situation where you have concern

about potentially unsafe systems, you must act to prevent any immediate

risk to an individual’s safety by taking appropriate steps to notify the

relevant person or authority about your concerns as soon as possible. If you

are unsure who you should report your concern to, ask a senior colleague

for advice.

If you are concerned about a colleague’s health or professional competence

due to alcohol or drug misuse, a physical or psychological disorder or other

factors, you have an overriding duty to make sure that individuals are

protected. The best way to support a colleague in these circumstances, is to

advise them to seek professional help in line with the principles of the Code.

However, if there is a serious risk to an individual’s safety, you should inform

senior management of your concerns immediately, in accordance with local

policy and inform NMBI, if required.

Confidentiality and privacy: confidentiality is central to the practitioner

and individual’s relationship. Each individual needs to be confident that

their personal information and their basic dignity will be protected by you.

Relationships are built on trust. Any improper breach of this trust, even if

accidental, damages the relationship and the general trust worthiness of

the professions of nursing and midwifery.

Conscientious objection: refers to a practitioner’s strong moral or religious

objection to providing, or participating in certain healthcare services or

interventions. This may arise in various contexts, such as refusing to be

involved in procedures like abortions or certain treatments that conflict with

the practitioner’s deeply held beliefs. While practitioners have the right to

refuse participation based on their convictions, it is essential that they do

so responsibly. This includes informing their employers and ensuring that

individuals are directed to alternative providers who can meet their needs

without delay. Conscientious objection must be balanced with the duty to

provide care, and practitioners are encouraged to communicate openly

with individuals about their limitations. Conscientious objection requires

careful consideration of both the rights of practitioners and the rights of

individuals to receive comprehensive care.

Culturally safe and respectful practice: culturally safe and respectful

practice requires having knowledge of, and insight into how culture, values,

attitudes, assumptions and beliefs influence interactions with an individual,

families and colleagues. To ensure culturally safe and respectful practice, it

is important to acknowledge that only the individual and/or their family can

determine whether care is culturally safe and respectful.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives45

It is important to establish a relationship of trust with each individual by

being honest, acting consistently, and delivering safe and competent care.

Adopt practices that respect diversity, avoid bias, discrimination and

racism, and challenge belief based upon assumption (for example, based

on gender, disability, race, ethnicity, religion, socioeconomics, sexuality,

age or political beliefs). By developing and promoting actions such as

raising awareness, challenging discrimination, and encouraging attitude

and behaviour changes towards a more inclusive culture, a positive and

culturally safe work environment can be created through role modelling and

supporting the rights, dignity, and safety of others, including both individuals

and colleagues.

Data Protection Officer (DPO): is a designated individual within an

organisation responsible for overseeing data protection strategies and

ensuring compliance with relevant data protection laws and regulations,

such as the General Data Protection Regulation (GDPR). They play a crucial

role in safeguarding personal data, which is particularly important in

sectors like healthcare, where sensitive information about individuals is

routinely handled.

Delegation: refers to the process by which practitioners assign specific

tasks or responsibilities to other healthcare team members, such as students,

regulated and unregulated staff, while maintaining overall accountability

for the individual’s care. Delegation involves clear communication, ensuring

that the designated individual has the appropriate skills, knowledge

and authority to perform the task safely and effectively. It also requires

the delegating practitioner to monitor and evaluate the outcome of the

delegated tasks to ensure safety and quality of care are maintained. The

practitioner who is delegating is accountable for the decision to delegate.

The practitioner, student or regulated/unregulated healthcare worker is

responsible for carrying out the delegated role or activity in an appropriate

manner and is accountable for the appropriate performance of that role or

activity. Employers and managers must support practitioners in delegation

and supervision of students or regulated/unregulated staff by providing

appropriate organisational policy and resources.

Disclosure of information outside the healthcare team without consent:

in limited situations, information can be disclosed without consent when

required by law or if it is in the public interest. Individuals involved should be

informed of such disclosure unless doing so would compromise the purpose

of the disclosure.10

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives46

You must disclose information when required by law, including:

D when a judge issues a court order

D when requested by a tribunal or a body formed by legislative act

D under relevant legislation (Patient Safety [Notifiable Incidents and

Open Disclosure] Act 202310)

D according to infectious diseases regulations, or

D if a crime, such as sexual assault or violence, is suspected against

a child or a vulnerable individual (Criminal Justice [Withholding of

Information on Offences against Children and Vulnerable Persons]

Act 201215)

Disclosure may be in the public interest when the benefit to others or

society outweighs the duty of confidentiality, for example to prevent harm

from serious diseases or crime. This requires balancing individual rights

with public interest, and legal guidance may be required. Only necessary

information should be shared with relevant authorities.

Diversity, equality and inclusion (DEI): embracing diversity means

recognising and valuing the unique backgrounds, experiences, and

perspectives of individuals and healthcare providers. This includes

considerations of race, ethnicity, gender, sexual orientation, age, disability

and socioeconomic status.

Equality emphasises the importance of providing fair treatment and access

to healthcare services for all individuals, regardless of their background.

Practitioners should strive to eliminate disparities in healthcare outcomes,

and ensure that all patients and service users receive the same quality of

care. This commitment to equality helps build trust within communities and

improves overall public health. NMBI supports the avoidance of language

which implies that there are only two genders.

Evidence-based practice (EBP): involves integrating the best available

research evidence with the practitioner’s expertise, and the individual

patient’s values and preferences to guide healthcare decisions. This

approach ensures that care is informed by the latest scientific findings,

which can lead to improved outcomes and enhanced quality of care.

Practitioners use EBP to evaluate and apply research findings to real-

world situations, considering their own skills and experiences while also

respecting the unique needs and choices of individuals. Actively involving

individuals in the decision-making process and honouring their preferences,

EBP promotes a collaborative and personalised approach to care.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives47

This method not only enhances the effectiveness of interventions but also

empowers individuals, fostering a sense of ownership over their health and

wellbeing. Ultimately, evidence-based practice is essential for delivering

high-quality, effective and person-centred care.

Health Literacy: is the ability to read, understand and use healthcare

information. Practitioners play an important part in improving health

literacy, as incorporating it into practice is essential for delivering high-

quality care. Using terminology that is easy to understand, and offering time

and explanations may help those individuals become better informed about

their health and as a result may lead to improved health outcomes.

Open disclosure and raising concerns: open disclosure is an honest, open,

compassionate and timely approach to communicating with an individual,

and if appropriate, their family/carers, following a patient safety incident.10

This includes acknowledging, apologising and explaining when things

go wrong. Practitioners have legal responsibilities and need to comply

with any mandatory reporting requirements. They have a professional

duty to acknowledge when something has gone wrong and to provide an

honest explanation of what happened. They must prioritise the interests of

individuals in their care and act to protect them if they think there is a risk.11

Practitioners must follow any relevant mandatory reporting laws to protect

groups that are particularly at risk, including reporting obligations relating

to care of older persons, child abuse and neglect. They must remain alert to

other groups who may be vulnerable and at risk of physical harm and sexual

exploitation, and act on welfare concerns where appropriate. Regardless

of the role or location, it is important for practitioners to know how to raise

concerns appropriately.

Professional autonomy: refers to the ability of practitioners to use their

knowledge and expertise critically to deliver safe and high-quality

healthcare to individuals. This autonomy allows practitioners to make

informed decisions based on clinical judgement, evidence-based

practices and an understanding of the needs of individuals. The degree

of autonomy can vary significantly among practitioners, influenced

by legislative frameworks, organisational policies and individual

circumstances. Legislation, regulations and PPPGs may define the scope

of practice for practitioners, outlining what they are authorised to do

within their professional roles. The culture and policies of the healthcare

organisation can either empower or restrict practitioners’ ability to

exercise their autonomy. Individual factors, such as experience, confidence

and education, also play a crucial role in determining how effectively a

practitioner can act autonomously.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives48

Ultimately, fostering professional autonomy is essential for enhancing the

quality of care, as it enables practitioners to respond more effectively to

the complexities of care and adapt their approaches based on the unique

context of each situation.

Protected disclosure:11 a practitioner, in good faith, can report specific

concerns, encouraging healthcare professionals to speak up about serious

issues that could jeopardise safety or the integrity of the healthcare system.

Practitioners can report safety concerns that pose risks to individuals or the

public, such as unsafe practices, inadequate staffing or potential hazards

in clinical environments, thereby ensuring that necessary actions are taken

to protect health and safety. They also have a duty to report violations of
legal obligations, including breaches of health regulations, laws or ethical

standards, which helps maintain the integrity of the healthcare system and

safeguard individuals’ rights. Additionally, concerns about the misuse or

waste of public funds, such as resources allocated for patient care, can be

disclosed, promoting financial accountability, and ensuring that resources

benefit individuals and the community effectively.

When disclosures are made in good faith, practitioners are protected from

adverse consequences like dismissal, disciplinary action or harassment,

fostering a culture of transparency and accountability in healthcare

settings. To qualify for protection, disclosures typically must follow specific

legal frameworks, often requiring reporting to designated individuals or

regulatory bodies. Practitioners are encouraged to adhere to established

protocols to ensure their concerns are handled appropriately while

maintaining confidentiality when needed. Overall, protected disclosure

empowers healthcare professionals to consider the will and preferences

of individuals and the public, contributing to a safer and more ethical

healthcare environment.

Respect for the dignity of the person: the Universal Declaration of Human

Rights (United Nations, 1948) states that freedom, justice and peace are built

on dignity and equality of the person.

The values and standards established for respecting the dignity of the

person are also referenced in:

D The Constitution of Ireland (Government of Ireland, 1937)16

D The European Convention for the Protection of Human Rights and

Fundamental Freedoms (Council of Europe, 1950)17

D The Equal Status Acts (Government of Ireland, 2000–2018)18

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives49

D The United Nations Convention on the Rights of Persons with

Disabilities, 2007 (ratified by the Government of Ireland, 2018)19

D The United Nations Convention on the Rights of the Child (Government

of Ireland 1992, 2002)20

D Charter of Fundamental Rights of the European Union 2012/C 326/02

(Article 1 deals with Human Dignity).21

Responsibility: refers to a practitioner’s obligation to perform competently

at an acceptable level, which is determined by their education, training and

professional standards. This means that registered nurses and registered

midwives are expected to carry out their roles effectively and ethically,

ensuring that their practice aligns with established guidelines and best

practices.

Supervision: practitioners may be required to supervise, delegate to, and

educate students and regulated/unregulated colleagues in providing

safe person-centred care. Supervision enables students to learn and

safely achieve competence and autonomy in their professional role. All

NMBI practitioners can supervise students, serving as role models for safe

and effective practice. Students may be supervised by other registered

healthcare professionals.

The main types of supervision include:

D Direct supervision: involves the practitioner being physically present

while students provide care. The supervisor observes the student’s

actions in real-time, offering immediate feedback and guidance.

D Indirect supervision: the practitioner is not physically present

but is available for consultation and support. Students may work

independently and can seek advice or clarification as needed. This

type of supervision encourages autonomy while still providing safe

learning.

D Remote supervision: With advancements in technology, remote

supervision allows supervisors to oversee student activities from

a distance, often using video conferencing tools. This can be

particularly useful in scenarios where in-person supervision is

not feasible, such as when students are placed in geographically

dispersed locations.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives50

D Peer supervision: In some educational settings, students may

supervise one another under the guidance of a qualified instructor.

This collaborative approach encourages teamwork and critical

thinking, allowing students to learn from each other’s experiences

and insights.

D Reflective supervision: This type of supervision focuses on the

reflective practice of students. Supervisors encourage students to

think critically about their experiences, decisions, and the care they

provide, facilitating deeper learning and self-awareness.

D Simulation-based supervision: In a controlled environment, students

participate in simulated clinical scenarios where they can practice

their skills and decision-making without risk to real individuals.

Supervisors provide feedback during or after the simulation,

enhancing the learning experience.

Each type of supervision plays a crucial role in developing nursing and

midwifery students’ knowledge, skills and competencies, ensuring they are

well-prepared for their future roles in healthcare. Balancing approaches to

supervision helps to cultivate both practical skills, and independent critical

thinking and decision making.

Sustainability: in healthcare focuses on promoting environmental,

social and economic health. For practitioners, this means incorporating

sustainable practices into daily routines. Key considerations include efficient

resource management (optimising the use of water, energy and supplies

to reduce waste) alongside waste reduction strategies like recycling

and minimising single-use plastics. Practitioners play a vital role in the

care of individuals by encouraging sustainable lifestyle choices through

health education, advocating for organisational policies that promote

sustainability and enhancing knowledge about sustainable practices.

Therapeutic relationships: are vital for providing effective and

compassionate care, built on trust, respect, and a focus on the individual’s

wellbeing. Establishing a safe environment encourages individuals to share

sensitive information, while open and empathetic communication (through

active listening and clear explanations), helps individuals feel understood.

Focusing on individual needs, preferences and values, empowers individuals

to actively participate in their care. Maintaining professional boundaries

protects both the individual and the practitioner, ensuring the focus
remains on health needs. Practitioners also advocate for individuals’ rights

and preferences within the healthcare system, and understanding and

respecting cultural backgrounds enhance trust and address specific health

beliefs. Practitioners should engage in reflection and self-awareness

to recognise their biases and emotions, allowing them to provide non-

judgmental care. Therapeutic relationships can contribute to better health

outcomes by creating a supportive and trusting environment.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives51

Ethical Principles

Traditional

ethical theory Utilitarianism

Ethical

principle

Principle 1 - Respect

Principle 3 – Competence

Principle 4 - Collaboration

Main

concepts

D Emphasises the consequences or outcomes.

D Good outcomes or consequences are those that produce

happiness for the greatest number of people.

D The end justifies the means.

D The test of quality of actions is not the personal motivation

but the results and outcomes.

Demands of

the theory

D Self-sacrifice for the good of many.

D Negative responsibility – equally responsible for actions and

omissions.

Health related

example

D Public health interventions and programmes (for example,

vaccination programmes, smoking cessation)

D Triaging individuals in emergency departments in order to

prioritise those with the highest chance of survival or those

in greatest need.

D Resource allocation where resources are limited healthcare

providers may need to make difficult decisions about

resource allocation.

D When considering treatment options for an individual with

limited prognosis or multiple comorbidities, healthcare

providers may weigh the potential benefits and harms of

various interventions.

Underpinning

values

D Commitment

D Compassion

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives52

Traditional

ethical theory Deontology

Ethical

principle

Principle 1 - Respect

Principle 3 – Competence

Principle 4 - Collaboration

Main

concepts

D There is intrinsic value in making good choices, irrespective

of the consequences.

D Focus is on doing because it is the right thing to do.

D Provides a framework of how we ought to live.

Demands of

the theory

Four rules or duties (the categorical imperative):

(1) Treat others as you want to be treated

(2) Treat people as ends in themselves and not as a means to an

end

(3) Respect others autonomy

(4) Act as you want others to act (rule of universality).

Health related

example

D Relating to the individual and balancing clinical skill,

appropriate treatment, demonstrable care and concern,

and information provision.

D Individualised and person-centred care planning.

D Close adherence to an ethical code and professional

standard which direct duties and responsibilities to

individuals. Such adherence would guide the nurse or

midwife to maintain confidentiality, respect autonomy and

provide care with integrity.

D Truth-telling even when having to delivery bad news.

D A nurse or midwife maintains professional boundaries,

avoiding the disclosure of personal information that may

compromise the therapeutic relationship.

Underpinning

values

D Care

D Commitment

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives53

Traditional

ethical theory Virtue

Ethical

principle

Principle 1 - Respect

Principle 3 – Competence

Principle 4 - Collaboration

Main
concepts

D Virtue ethics emphasises the development of good

character traits.

Demands of

the theory

D Requires the cultivation of key virtues to guide practice.

D Nurses and midwives are expected to demonstrate these

virtues in their interactions with individuals, colleagues, and

the community to provide holistic and compassionate care.

Health related

example

D Care is provided and guided by compassion, empathy,

honesty, integrity and advocacy.

D A midwife communicates openly and honestly with

expectant parents about the risks and benefits of various

birthing options, ensuring they have accurate information to

make informed decisions about their care.

D A nurse or midwife advocates for the rights and needs of

marginalised and vulnerable populations, by addressing

social determinants of health and promoting equitable

access to healthcare services.

Underpinning

values

D Compassion

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives54

Traditional

ethical theory Principlism

Ethical

principle

Principle 1 – Respect

Principle 2 – Accountability

Principle 3 – Competence

Principle 4 – Collaboration

Principle 5 - Leadership

Main

concepts

D Beneficence – acting in the interests of individuals.

D Non-malevolence – acting to avoid causing harm to

individuals.

D Autonomy – acting in a way that shows respect of the

individual’s choices and views.

D Justice – acting in a way that shows individuals are treated

equally and resources are distributed fairly.

Demands of

the theory

D Balancing the principles.

D Incorporates the need for truth telling, confidentiality and

informed consent.

Health related
example

D Autonomy - respect for autonomy involves recognising and

respecting an individual’s rights to make informed decisions

about their own healthcare.

D Beneficence - requires healthcare providers to give effect to

an individual’s will and preferences in order to promote their

wellbeing.

D Non-maleficence – places on obligation on the nurse or

midwife to do no harm to patients and to minimise the risk

of harm wherever possible, (for example, double-checking

drugs for administration).

D Justice - refers to the fair distribution of resources

treatments and access to care.

Underpinning

values

D Care

D Compassion

D Commitment

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives55

Traditional

ethical theory Narrative ethics

Ethical

principle

Principle 1 – Respect
Principle 2 – Accountability

Principle 3 – Competence

Principle 4 – Collaboration

Main

concepts

D Recognises the centrality of the individual’s story.

D Supports the hearing of other voices especially those

immediately involved in trying to resolve a case.

Demands of

the theory

D Recognises that an individual’s narrative can have many

interpretations, but it is the individual’s interpretation that is

the most important.

Health related

example

D Peron-centred care planning ensuring adherence to will and

preference of an individual.

D Family centred care encouraging nurses to listen to the

stories of families, understanding their dynamic, background

and preferences.

D Birth plans that ensure the woman’s preferences and the

reasons for them are understood.

D Emphasis is placed on recognising some clients and service

user’s care may be trauma informed.

D Culturally competent care by actively listening to and

hearing the story of the individual.

D Promotes shared decision-making, through collaboration to

develop care plans that align with will and preferences of

the individual.

D End-of-life care decision-making that focusses on the

individual’s will and preference.

Underpinning

values

D Care

D Compassion

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives56

Traditional

ethical theory Ethic of care

Ethical

principle

Principle 1 – Respect

Principle 2 – Accountability

Principle 3 – Competence

Principle 4 – Collaboration

Main

concepts

D Emphasises the importance of responsibility, concern and

the centrality of relationships.

Demands of
the theory

D Recognises the centrality of relationships and attention as

core tenets of the therapeutic interaction.

Health related

example

D Prioritising the needs and interests of individuals and their

families.

D Advocating for individual’s user rights.

D Providing emotional support.

D Consideration of the social and cultural context of care.

D Recognises the need to provide developmentally

appropriate care in the context of care of children and

young people.

D Recognises the need to respect women’s autonomy and right

to make their bodies and childbirth experiences.

D Recognises the need to build trusting and supportive

relationships with individual user to ensure their autonomy

and right to make decisions about their mental health

treatment is respected.

D Recognises the vulnerability of individual and the potential

for power imbalances in the caregiver-client relationship.

D Recognises the need to adopt trauma-informed approaches

to care, recognising the prevalence and impact of trauma on

mental health and wellbeing.

Underpinning
values

D Care

D Compassion

D Commitment

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives57

Traditional

ethical theory Feminist ethics

Ethical

principle

Principle 1 – Respect

Principle 2 – Accountability

Principle 3 – Competence

Principle 4 – Collaboration

Principle 5 – Leadership

Main

concepts

D Recognises the need for strong advocacy regarding gender

and social equality.

D Provides uniquely feminist arguments and viewpoints that

expose gender concerns in ethical issues.

Demands of

the theory

D Recognition of unique feminist perspective.

Health related
example

D Individualised and person-centred care planning.

D Attending to reproductive needs and choices of women.

D Using gender-inclusive language and practices to create

a welcoming and affirming environments for all individuals

user irrespective of sexual orientation or sexual identity.

D Using intersectional approaches to health which recognise

the intersecting impacts of gender, race, class, sexuality, and

other social identities on health outcomes and wellbeing.

D Promoting woman’s healthcare across the lifespan.

D Supporting communities to understand their needs and

develop culturally responsive healthcare interventions.

D Recognises the importance of listening to and hearing

the perspectives of those individuals often excluded from

discussions about their care and place of care.

Underpinning

values

D Care

D Compassion

Complaints

Section

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives59

Complaints may be made to NMBI against registered nurses and registered

midwives on one or more of the nine grounds listed in the Nurses and

Midwives Act 2011, as amended. These are:

1. Professional misconduct.

2. Poor professional performance.

3. Non-compliance with a code of professional conduct.

4. A relevant medical disability.

5. A failure to comply with a relevant condition.

6. A failure to comply with an undertaking or to take any action specified

in a consent given in response to a request given under section 57A(1) or

65(1).

7. A contravention of a provision of this Act (including a provision of any

regulations made under this Act).

8. An irregularity in relation to the custody, prescription, or supply of a

controlled drug under the Misuse of Drugs Acts 197722 (2017) or another

drug that is likely to be abused.

9. A conviction in the State for an offence triable on indictment or a

conviction outside the State for an offence consisting of acts or

omissions, that if done in the State, would constitute an offence triable

on indictment.

A complaint against a registered nurse or registered midwife is made to

the Preliminary Proceedings Committee (PPC) of NMBI. When a complaint

is received by the PPC, it will be assigned to a case officer. The case officer

assists the PPC to manage the complaint and to carry out any investigations.

The case officer will keep the practitioner updated on any decision made

by the PPC or the Board regarding whether the complaint warrants further
action.

Complaints must be made in writing by email to: [email protected] or

by post to the PPC Division, Fitness to Practise Department, Nursing and

Midwifery Board of Ireland, 18-20 Carysfort Avenue, Blackrock, Co. Dublin.

A breach of the Code could result in a registered nurse or registered midwife

being brought before a fitness to practise inquiry.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives60

In addition to complying with the Code, practitioners have a duty to keep up

to date with legislation or legal developments that affect their professional

nursing or midwifery practice. The Code includes links and references to

legislation and policies as applicable at the date of publication, to help

them understand the legal and ethical implications of their role as a nurse or

midwife.

Further details about NMBI’s complaints process is available on our website:

www.nmbi.ie/complaints.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives61

Resources

NMBI provides guidance and support to nurses and midwives in their clinical

practice.

These include:

D Guidelines for nurses and midwives in relation to professional

practice and standards.

D Standards and requirements for registered nurse and registered

midwife registration education programmes.

D Annual reports, eZines, eLearning programmes and conference

proceedings.

Practitioners should refer to these resources, as necessary, when

determining their individual scope of practice.

Useful websites

www.nmbi.ie Nursing and Midwifery Board of Ireland

www.health.gov.ie Department of Health

www.hiqa.ie Health Information and Quality Authority

www.hse.ie Health Service Executive

www.hseland.ie HSE’s online resource for Learning and

Development

www.irishstatutebook.ie The Irish Statute Book database

www.mhcirl.ie Mental Health Commission

www.patientsafetyfirst.ie Website of the Patient Safety Initiative in

Ireland

www.lenus.ie The Irish Health Repository

Any reference to law contained in this Code, whether a reference to any

enactment or otherwise, should be construed as a reference to such

provision as amended, adapted or extended from time to time.

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives62

References

1. House of Oireachtas, 2011. Nurse and Midwives Act 2011, as amended.

Nurses and Midwives Act 2011

2. Nursing and Midwifery Board of Ireland, 2021. Code of Professional

Conduct and Ethics for Registered Nurses and Registered Midwives.

Dublin

3. Nursing and Midwifery Board of Ireland, 2015. Scope of Nursing And

Midwifery Practice Framework. Dublin

4. Nursing and Midwifery Board of Ireland, 2015. Ethical Conduct in

Research. Dublin

5. Nursing and Midwifery Board of Ireland, 2015. Recording Clinical

Practice. Dublin

6. Nursing and Midwifery Board of Ireland, 2013. Social Media and Social

Networking. Dublin

7. House of the Oireachtas 2022. Assisted Decision-Making (Capacity)

(Amendment) Act 2022. Republic of Ireland. Assisted Decision-Making

(Capacity) (Amendment) Act 2022

8. House of the Oireachtas, 2023. Patient Safety (Notifiable Incidents

and Open Disclosure) Act 2023. Republic of Ireland. Patient Safety

(Notifiable Incidents and Open Disclosure) Act 2023

9. Nursing and Midwifery Board of Ireland, 2020. Guidance for Registered

Nurses and Midwives on Medication Administration. Dublin

Nursing and Midwifery Board of Ireland, 2007. Guidance to Nurses and

Midwives on Medication Management. Dublin

10. House of the Oireachtas, 2023. Patient Safety (Notifiable Incidents and

Open Disclosure) Act 2023. Patient Safety (Notifiable Incidents and

Open Disclosure) Act 2023

11. House of the Oireachtas, 2022. Protected Disclosures (Amendment) Act

2022. Republic of Ireland. Protected Disclosures (Amendment) Act 2022

12. Health Service Executive, (2022). National Consent Policy. Dublin. HSE_

Consent_Policy.pdf

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives63

13. House of the Oireachtas, 2018. The Data Protection Act 2018. Republic of

Ireland. Data Protection Act 2018

14. Lee, H.S., 2022. Ethical issues in clinical research and publication. Kosin

Medical Journal, 37(4), pp.278-282.

15. House of Oireachtas 2012. Criminal Justice (Withholding of Information

on Offences against Children and Vulnerable Persons) Act 2012

(Commencement) Order 2012. Criminal Justice (Withholding of

Information on Offences against Children and Vulnerable Persons) Act

2012 (Commencement) Order 2012.

16. House of the Oireachtas, (1937). Constitution of Ireland. Irish Statute

Book

17. European Court of Human Rights, (1950). European Convention on Human

Rights. www.echr.coe.int

18. Irish Human Rights and Equality Commission (2000-2018) The Equal

Status Acts 2000-2018 (‘the Acts’). Equal Status Acts - IHREC - Irish

Human Rights and Equality Commission

19. Department of Children, Equality, Disability, Integration and Youth, (2018).

United Nations Convention on the Rights of Persons with Disabilities

(UNCPRD) in 2007 and ratified it in March 2018. gov.ie - Ireland and the

UNCRPD
20. Government of Ireland, (1992, 2002). The United Nation’s Convention on

the Rights of the Child (UNCRC). United Nations Convention on the Rights

of the Child

21. European Union (2012). Charter of Fundamental Rights of the European

Union. Charter of Fundamental Rights of the European Union

22. House of the Oireachtas, 2016. Misuse of Drugs Act 1977, Misuse of Drugs

(amendment) Act 2016 Misuse of Drugs (Amendment) Act 2016

Code of Professional Conduct and Ethics for

Registered Nurses and Registered Midwives64

Bibliography

1. House of the Oireachtas 2005. Disability Act 2005. Republic of Ireland.

Disability Act 2005

2. House of the Oireachtas 2018. Health (Regulation of Termination of

Pregnancy) Act. Republic of Ireland. Health (Regulation of Termination of

Pregnancy) Act 2018

3. Department of Health, 2023. National Open Disclosure Framework,

National Patient Safety Office (Advocacy & Legislation).

4. Health Service Executive 2021 National Framework for Governance,

Management and Support of Health Research [Online]. Available:

HSE-Framework-for-the-Governance-Web-Optimised.pdf [Accessed

15/04/2024 20224].

5. Irish Medical Council, 2024. Guide to Professional Conduct and Ethics

for Registered Medical Practitioners, 9th Ed. guide-to-professional-

conduct-and-ethics-for-registered-medical-practitioners-2024.pdf

6. Health Information and Quality Authority, 2023. The Fundamentals

of Advocacy in Health and Social Care [Online]. Available: The

Fundamentals of Advocacy in Health and Social Care [Accessed

02/02/2024 2024].

7. Health Service Executive 2021. HSE Rainbow Badge Practice Guide

for Healthcare Professionals. https://www.hse.ie/eng/services/list/4/

mental-health-services/camhs/linn-dara-inpatient-unit/hse-rainbow-

badge-practice-guide-for-healthcare-professionals.pdf

Nursing and Midwifery Board of Ireland (NMBI)

18/20 Carysfort Avenue | Blackrock | Co. Dublin | A94 R299

T +353(0)1 639 8500 www.nmbi.ie