UNIT 2 :NURSES’ CODE OF CONDUCT
Key Unit CompetenceApply the nursing code of conduct
2.0 Introductory activity
Observe the above picture and discuss about the following:
M.E is an enrolled nurse working in district hospital for 3 years. Colleagues and
Unit manager had noticed that the clients assigned to M.E, were not cared for,
wet bed sheets were unchanged and urine bottles not emptied, vital signs not
monitored. M arrived always late also spending a lot of time at the nurses’ station
and on phone while her clients were left without assistance. Her unit manager
and his /her colleagues and care givers raised complaint.
After receiving advice form colleagues and manger, she attends the unit on
time, collaborates with clients and gives care to each client and advocates for
clients’ needs. She becomes a respectful nurse for the clients, improves the
communication and collaboration with unit manager and colleagues and all
assigned clients were cared as required. After reading the above scenario,
analyze the nurse general attitude in the work place and answer to the following
question.
a. Who are the people in the above picture?
b. Show bad behavior of a nurse that are displayed in this scenario?
c. List 3 qualities of a good professional nurse displayed in the scenario
2.1. Introduction to the code of conduct
Learning activity 2.1
Mrs. K. is a registered nurse working in the unit where admitted patient are after
surgical operations. She attends the work always on time, when she arrived in
the morning, she puts on her clear uniform, greets clients and observe overall
situation of t them to identify if there is no emergent situation. She is respectful for
colleagues and clients of all ages. She is kind to everybody in the work even out
of the work, she provides care to all assigned client in safe and timely manner.
Before accomplishing any nursing tasks, she firstly obtains the client consent
and treat them with kindness and respect.
Read the above scenario and answer to the following question
1. Identify the 4 positive professional nurse requirements included in the scenario2. List 2 behaviors that should be respected in the nursing code of conduct
Key Concepts of code and conduct
A code: the Code of Professional Conduct for Nurses is a set of expected national
standards of nursing conduct for nurses and midwives to be respect during the
exercise of the profession
The Code is not intended to give detailed professional advice on specific issues
and areas of practice; rather, it identifies the minimum requirements for conduct in
the profession. A breach of the Code may constitute professional misconduct or
unprofessional conduct (ANA, 2021)
The code of profession conduct will help to address many issues and promote
client and nursing satisfaction.
A conduct: the manner in which a person behaves, especially in a particular place
or situation. Professional conduct refers to the manner in which a person behaves
while acting in a professional capacity.
It is generally accepted that when performing their duties and conducting their
affairs professionals will uphold exemplary standards of conduct.
Specific issues concerning professional practice will be considered when they arise
and may be the subject of professional practice guidelines
Ethics: Ethics refers to moral principles, values that governs a person’s behaviour
or a manner of conducting or accomplishing activities. Ethics deals with principles
or morality and what is right or wrong, it is also concerned with motives and attitudes
and relationship of these attitudes to the good of individuals (Basavanthappa, 2006).
Ethics refers to well-founded standards of right and wrong that prescribe what
humans ought to do, usually in terms of rights, obligations, benefits to society,
justice, or specific qualities.
A code of ethics is a set of guiding principles that all members of a profession
accept. It is a collective statement about the group’s expectations and standards of
behavior. Codes serve as guidelines to assist professional groups when questions
arise about correct practice or behavior. (Poter and Perry Fundamentals of Nursing,
8th edition, Elsevier, 2017).
According to the American Nurses Association (ANA), the nursing code of ethics
and profession conduct is a guide for “carrying out nursing responsibilities in a
manner consistent with quality in nursing care and the ethical obligations of the
profession.” Ethics, in general, are the moral principles that dictate how a personwill conduct (ANA, 2021
Self-assessment 2.1
included in the code of conduct used in Rwanda
1. According to the above definition of nursing code of conduct and aspects
Explain 2 roles of the code of conduct in nursing practice2. Using an example, illustrate how you should honor the nursing profession
2.2. The nursing code of conduct
Learning activity 2.2
Mrs. J. is associate nurse in Internal Medicine and the team of this unit is few
as it comprises only 6 persons for days and night duties Her colleague Mrs.T.
was sick and she was not able to attend to accomplish all assigned task as she
was weak and pregnant. The morning medical round have also ordered taking
blood sample for many clients the even other drugs have been prescribed to
be given before noon. She feels stressed but do her best to accomplish the
assigned tasks. Her colleague Mrs.J. passes in the Mrs.T. subunit observe the
state of T and the assigned tasks; she decides to perform some procedures like
withdrawing blood samples as she is well skilled in puncture of the vein. The unit
manager was very happy and congratulates the nurse.
According to the above scenario,
1. What do you think about the origin of the stress for the nurse T?
2. Identify the professional behaviors of these nurses?
3. What would be the consequences on the clients if the nurse has a bigburden?
Nurses are currently facing various personal, interpersonal, professional, and in
stitutional even socio- cultural challenges in their professional practice and to deal
with them may not be always clear. The lack of one correct approach or attitude
in addressing different issues may lead to ethical issue or a difficult to choose in
different options to resolve them.
Rwandan regulatory body Nursing Council of Nurses and midwives (NCNM)
adopted by the constitution of the Republic of Rwanda of 04 June, 2003 and
the Law no 25/2008of 25/7/2008 establishing the National Council of Nurses and
Midwives and adopted by the cabinet in its session of 09/07/2010. The Code of
Professional Conduct for Nurses and Midwives is supported by Rwanda National
Council for Nurses and Midwives.
2.2.1. Role of nurse‘s code of conduct:
A code of conduct provides structure and guidance for workplace values and
principles. A respected code is important to the nursing profession to help prevent
inappropriate and incompetent behavior and as a guide for nursing performance.
The Code guides nurses and midwives in their day-to-day practice and helps them
to understand their responsibilities in caring for service users in a safe, ethical and
effective way.
The Code supports ethical and clinical decision-making, on-going reflection and
professional self-development. The code informs the general public about the
professional care they can expect from nurses and midwives.
The code also emphasizes the importance of the obligations of nurses and midwives
to recognize and respond to the needs of service users and families (Georges et
al , 2012).
The code of conduct sets standards for the regulation, monitoring and enforcement
of professional conduct
The code of conduct is used in conjunction with the code of ethics as ethics and
professional conduct can’t be separated.
2.2.2. Standards of professional code of conduct:
According to the code of conduct of Nurses and Midwifes provided by the regulatory
body National Council of Nurses and Midwives (NCNM); the standards of nurse’s
code of conduct is summarized as follow:
a. Conduct of a nurse towards patients
Respect for human rights and values
Without prejudices to provision of particular laws that specify the rights of a patientin Rwanda, the nurse / midwife shall:
Promote the respect of human rights, human dignity, culture and spiritual beliefs of
the individual, family and community
Ensure that the individual receives written and sufficient information on which to
base his/her consent for care and related treatment
Keep confidential any information related to an individual and shall share this
information with colleagues advisedly
Collaboration in promoting health activities
A nurse / midwife shall collaborate with members of the community in initiating and
supporting actions to meet the health and social needs
A nurse / midwife shall also collaborate with others in conserving the environment
Refusal to act for lack of capacity and competence: a nurse or midwife is required
to refuse any instructions to perform any activity that is outside his/ her scope of
competence or one for which he/ she lacks sufficient knowledge. However, in case,
in the case, he/ she shall inform his/her supervisor or the person what gave him/her such instructions.
Example: If a medical doctor asks to the nurse to withdraw excess of fluid in the
peritoneal cavity (Ascites), this is a medical task and is beyond the nurse scope of
competence and he/ she must inform the medical doctor that he/ she is not able toperform that procedure
Quality and continuing professional development: the nurse or midwife shall
be obliged to fulfil his/her duties. He/ she shall regularly demonstrate continual use
of technical knowledge and always be trained on modern techniques: the Nursingacts changes as the Medicine also undergo evolution
Obligation to care her/ his personal health: a nurse or a midwife shall be obliged
to take care of his/her personal health so that his/ her responsibility of providingcare is not compromised
Discretion on duty: a nurse or midwife shall ensure that no action or omission on
his/ her part that may be harmful to health
Safe use of science and technology: a nurse or midwife shall ensure that use of
science and technology on duty is compatible with the safety, dignity and people’srights
E.g., use of suctioning machine if not well used can traumatize upper respiratorytract.
Activities contrary to moral and professional conviction: A nurse shall have
right to refuse to participate in activities contrary to his/ her personal moral and
professional convictions. However, such rights shall not contravene his/herresponsibilities towards patients and those who require his/her services
b. Conduct of a nurse or a midwife in performing his/her duties
• Abide by law and regulation in the country in particular those relevant to
his/her nursing profession
• Maintain professional honor: the nurse shall demonstrate all times a
personal conduct that honors the profession and enhance public confidence
in nursing and midwifery staff. The conduct of a nurse must be integral and
even a model in the society
• Participation in designing and implementation of professional regulations:
a nurse or midwife shall participate in designing and implementing guiding
principles of nursing, midwifery management, research in matters regarding
professional practice or duties of a nurse and a midwife
• Participation in developing professional skills; a nurse or midwife shall be
active in developing a core of research based professional skills
• Role in enhancing better working conditions: a nurse or a midwife, acting
through professional federation or association in which he/she is a member,
shall participate in creating and maintaining safe, equitable social and
economic working conditions in nursing or midwifery practice respectively
• Safe management of resources: a nurse or a midwife shall safely manage
and maintain assets under his/her control as well as public resources, use
effectively the available materials
c. Relations between a nurse, a midwife and colleagues
• Interdisciplinary collaboration : a nurse or midwife shall sustain
collaboration with colleagues and workers in the multidisciplinary team inorder to promote the health and well-being of each client.
• Appropriate measures to protect people: a nurse or a midwife shall take
appropriate measures in order to preserve the health of individual. Families
and the public when endangered by a colleague or any other person• An incompetent nurse can lead to harmful nursing care
• Sharing and exchanging expertise/ experience: a nurse or midwife shall
share expertise and knowledge with colleagues and exchange views on
various professional issues that may arise in their profession. They have toshare experience in order to better care the clients and resolve raised issues
• Non evasion of responsibilities: a nurse or a midwife shall avoid to
relinquish his/her duties and to overburden his/her colleagues in order to
evade responsibilities. Each nurse must accomplish his/her responsibilitiesand let the assigned to tasks to colleagues
Self-assessment 2.2
After understanding how the nurse shall behave with collegues and duties
1. Explain briefly the importance of collaboration between nurses in caring
patients
2. Explain briefly 2 standards of nurse’s conduct between a nurse and a
client
2.3. Purpose of the professional code of conductLearning activity 2.3
Look at the following video on;
Look also at this picture below and guess what is happening during the nurseand client interactions during the provision of nursing care
1. Is the client looks like well-prepared before nursing intervention? Is the
client relaxed and ready to collaborate with the nurse?
2. Identify at least 3 attitudes of the nurse that a client may depreciate during
the nurse client relationship3. Explain the importance of nurse conduct/ behavior in front of the client
The code of ethics aims to :
• Sets standards for the regulation, monitoring and enforcement of professional
conduct,
• Inform the public about the minimum standards of profession
• Help them understand professional nursing conduct,
• Outline the major ethical considerations of the profession and guides the
profession in self regulation.
• Acts as a non-negotiable standard and reminder of nurses’ commitment to
society.
• The code requires nurses to continue with their learning and evidence-basedpractice
Example of a professional code of ethics: American nurses’ association.(ANA) professional code of ethics
A nurse, in all professional relationships, practices with compassion and respect
for the inherent dignity, worth, and uniqueness of every individual, without consid
erations of social or economic status, the nature of health problems.
The nurse’s primary commitment is to the patient, whether an individual, family,
group, or community.
• The nurse promotes, advocates for, and strives to protect the health, safety,
and rights of the patient.
• The nurse is responsible and accountable for individual nursing practice
• The nurse respects the same duties to self as to others, including the
responsibility
• The nurse preserves integrity and safety, maintain competence, and continue
personal and professional growth.
• The nurse participates in establishing, maintaining, and improving health care
environments and conditions of employment conducive to the provision of
quality health care and consistent with the values of the profession through
individual and collective action
• The nurse participates in the advancement of the profession through
contributions to practice, education, administration, and knowledge
development.
• The nurse collaborates with other health professionals and the public in
promoting community, national, and international efforts to meet health needs
• The profession of nursing, as represented by associations and their members,
is responsible for articulating nursing values, for maintaining the integrity of
the profession and its practice.
• The nurse personal conduct promotes the image of institution and the nursingprofession
Self-assessment 2.3
Mrs. J. works in Emergency and the team of this unit is few as it comprises only
8 persons for days and night duties. Her colleague Mrs.L. was sick and she was
not able to attend the planned night duty and asks Jo to replace her and promise
to do the same for him when she will get better. The unit manager agreed but Jo
refuses. The evening J. past the night in the dancing club and the morning, he
comes to work drunk and he fails to provide care to assigned clients and blame
them without any reason . He has forced a patient to get up without support and
due to dizziness, the client falls down hitting the head on the bed
1. According to the above code of ethics and conduct, identify the
unprofessional behaviors of this nurse?
2. Explain 2 purposes of code of ethics3. Enumerate 3 standards of code of ethics for a nurse
End unit assessment
After covering this unit, understanding the Ethics and Nurse’s professional code
of conduct and how to behave in order to promote client health and avoid any
action against nursing practice, answer to the following questions:
1. The nursing profession is recognized worldwide for having a big number
of staff in health facilities. Each nurse has the obligation to act in
respecting ethical principles. One of the following ethical principles is
not important in nursing profession:
a. They are basis for nurse’s decisions on consideration of consequences
of their acts
b. They are universal moral principles when making clinical judgments.
c. They are only applied to the clinical settings while caring different clients
d. They are professional values to be used when interpreting ethical issues
2. client right, it means that:
his/her care
Autonomy is one of the ethical principles in nursing profession even a
a. A patient has to request the health care provider for a care plan about
b. A patient has his own schedule for his health care
c. A patient should always accept nursing care plan for himself
d. A patient has independent to choose and participate in his / her health
care provision
3. Read carefully the following statement and answer by T if it is true or by F
it is false
a. Nurses should always maintain health consumers’ trust by providing
safe and competent care.
b. A right to confidentiality means that the patients should restreint to
reveal thei information to the healthcare professionals
c. A professional nurse must acquire expertise in carrying out nursing
actions.
d. The nurse code of conduct must be applied only in health institutions
4. Case Study
Mm K is a registered nurse working in the unit where admitted clients are after
surgical operations. She attends the work always on time, attends attentively
the morning staff and handover. When she arrived in the morning, she puts on
her clear uniform, greets clients and observe overall situation of them to identify
if there is no emergent situation. She is respectful for colleagues and clients of
all ages. She is kind to everybody in the work even out of the working hours
when necessary to fulfill assigned tasks; she provides care to all assigned clients
in safe and timely manner. Before accomplishing any nursing tasks, she firstly
obtains the client consent and treats them with kindness and respect. All client
is confident in the nurse K and don’ hesitate to give her any information needed
and to ask any question they have
Read the above case study and answer to the following question.
1. Identify 4 professional nurse values included in the scenario
2. Use an example to illustrate the professional benefit of the nurse’s K
behavior on the nursing profession3. Is there any the code conduct of nurse violated in this case?