Nursing and Midwifery Council Code of Conduct: Complete Training Guide 2026 July

The nursing and midwifery council code of conduct is the foundational professional framework that every registered nurse and midwife in the United Kingdom must understand, internalize, and demonstrate in daily practice. Published by the nursing and midwifery council, this document — formally titled "The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates" — sets out the non-negotiable expectations that define safe, effective, and person-centered care across all healthcare settings in the UK.

For nursing students, newly qualified practitioners, and internationally educated nurses (IENs) seeking registration with the NMC, understanding the Code is not optional. The NMC uses the Code as the benchmark against which all fitness-to-practise investigations are measured. If a complaint or concern is raised about a registrant's conduct, the regulator will assess the situation directly against the four pillars of the Code. Demonstrating that you can apply these standards in real clinical scenarios is essential for both passing the NMC OSCE and maintaining your registration throughout your career.

The Code was last updated in 2018 and is structured around four overarching themes: prioritising people, practising effectively, preserving safety, and promoting professionalism and trust. Each theme contains specific commitments — 25 statements in total — that nurses and midwives are expected to uphold. These commitments are detailed, action-oriented, and grounded in evidence-based practice. They cover everything from obtaining informed consent and maintaining accurate records to raising concerns about unsafe environments and working within your scope of competence.

Internationally, the nursing and midwifery council model has influenced professional regulation worldwide. Organizations like the nursing and midwifery council of nigeria have developed their own codes that parallel many of the same ethical commitments, reflecting a global consensus on what professional nursing conduct looks like. However, the UK NMC Code remains one of the most rigorously enforced and widely cited regulatory frameworks in the world, and understanding it in depth is critical for anyone seeking to practise nursing or midwifery in the United Kingdom.

Many candidates preparing for NMC assessments — including the Computer-Based Test (CBT) and the Objective Structured Clinical Examination (OSCE) — find that questions about professional accountability, ethical decision-making, and the Code's specific commitments appear frequently. Knowing not just what the Code says but why each principle exists and how it applies in complex, real-world situations will give you a significant advantage in both your assessments and your clinical practice.

This training guide breaks down every major element of the nursing and midwifery council code of conduct, explains how it applies to day-to-day nursing decisions, and shows you how to demonstrate competence in each area when it matters most. Whether you are a student nurse, an internationally educated professional navigating the NMC registration process, or an experienced practitioner seeking a refresher, this guide provides the depth and clarity you need to succeed.

Throughout this article, you will find structured breakdowns of each Code pillar, practical tips for applying the standards in clinical settings, common misconceptions that lead candidates astray in assessments, and targeted practice questions to test your knowledge. By the end, you will have a thorough, exam-ready understanding of one of the most important documents in UK nursing and midwifery regulation.

Understanding how the nursing and midwifery council code of conduct translates from abstract principles into concrete daily actions is where many candidates — and indeed many experienced practitioners — struggle. The Code is not a checklist to be ticked off once a year during appraisal; it is a living framework that should shape every interaction you have with patients, families, and colleagues. Let's walk through how each pillar manifests in real clinical situations and why this matters for both your NMC assessments and your practice.

Under the "Prioritise People" pillar, one of the most frequently tested commitments is the requirement to obtain valid, informed consent before any procedure or intervention. Valid consent under the NMC Code must be voluntary, informed, and given by a person with the mental capacity to make that decision.

This means you cannot simply document "consent obtained" — you must ensure the patient understood the risks, benefits, and alternatives, had sufficient time to consider their decision, and was not under any form of coercion. In assessments, scenarios involving patients who lack capacity require candidates to demonstrate knowledge of the Mental Capacity Act 2005 alongside the Code.

The "Practise Effectively" pillar places a strong emphasis on record-keeping standards that are often underestimated by candidates. The NMC expects records to be clear, accurate, and completed as close to the time of care as possible. Records must never be falsified, backdated, or altered without a clear and dated correction.

In clinical practice, poor documentation is one of the most common triggers for fitness-to-practise referrals. The nursing and midwifery council portal provides access to guidance documents and revalidation resources that support registrants in meeting these standards, and practitioners are encouraged to review these materials regularly to ensure their practice remains current.

The "Preserve Safety" pillar introduces one of the most ethically complex aspects of nursing practice: the duty to raise concerns. The Code is explicit — if you believe a patient is at risk, or that a colleague is practising in a way that may cause harm, you have a professional obligation to report this through appropriate channels.

This is not a discretionary act; it is a mandatory professional duty. Many candidates find this difficult to navigate in scenario-based questions because it can seem to conflict with team loyalty or hierarchical structures. However, the NMC is unequivocal: patient safety supersedes professional courtesy in all circumstances.

The duty of candour, contained within the "Promote Professionalism and Trust" pillar, requires nurses and midwives to be open and honest when things go wrong. If a patient is harmed — or if there is a near-miss — the Code requires you to apologise, explain what happened, and support the patient to understand the situation. Importantly, the duty of candour is not an admission of guilt; it is a professional obligation to be transparent. This distinction is critical in NMC assessments, where candidates who conflate candour with liability are likely to give incorrect responses to scenario questions.

Another key practical application of the Code involves delegation and supervision. When you delegate care tasks to healthcare assistants or nursing associates, you retain accountability for ensuring the task is carried out safely and competently. You cannot delegate a task that falls outside the competence of the person you are delegating to, and you cannot use delegation as a mechanism to avoid clinical responsibility. The Code is clear that registered nurses are accountable for their decisions to delegate, and this accountability does not transfer when tasks are assigned to others.

Revalidation is the process by which NMC registrants demonstrate to their regulator that they continue to meet the standards of the Code every three years. This involves completing a minimum of 450 practice hours, 35 hours of continuing professional development (CPD), five written reflective accounts linked to the Code, and receiving a confirmatory conversation from a line manager or other NMC registrant. Understanding revalidation requirements is essential for all registered practitioners and is frequently tested in professional standards assessments at both pre-registration and post-registration levels.

Fitness-to-practise investigations represent one of the most serious professional situations any nurse or midwife can face, and understanding how the NMC Code of Conduct underpins every aspect of the regulatory process is essential for practitioners at all career stages. The NMC receives approximately 6,000 fitness-to-practise referrals every year, and while many of these result in no further action, a significant proportion proceed to formal hearings that can result in suspension or removal from the register. Knowing how the Code protects both patients and practitioners is the first step toward avoiding the situations that lead to referral.

The NMC's fitness-to-practise framework identifies three main grounds for investigation: misconduct, lack of competence, and impaired fitness to practise due to health conditions. Misconduct is by far the most common ground for referral, and it encompasses a very wide range of behaviours — from serious incidents like patient abuse or falsification of records, to subtler but equally serious issues like boundary violations, dishonesty in professional communications, or failure to raise concerns about a colleague's unsafe practice. In every case, the NMC evaluates the conduct against the specific standards set out in the Code.

One area that generates significant confusion among both students and experienced practitioners is the concept of professional boundaries. The Code's commitment to maintaining appropriate relationships with people in your care goes beyond the obvious prohibitions on romantic or sexual relationships with patients. Professional boundaries also cover accepting gifts, maintaining confidentiality even after a patient's death, using social media to discuss patients, and the appropriate limits of therapeutic relationships. The NMC has published supplementary guidance on professional boundaries that expands on the Code's requirements, and this guidance is frequently referenced in fitness-to-practise proceedings.

Honesty and integrity are themes that run through all four pillars of the Code, but they become particularly acute in the context of fitness-to-practise proceedings. The NMC expects registrants to be honest with their employer, their patients, and the regulator itself.

Attempting to conceal an incident, providing misleading information during an investigation, or failing to disclose a caution or conviction to the NMC are all serious aggravating factors that can turn what might have been a minor regulatory matter into a case that results in removal from the register. Proactive transparency, even when it is uncomfortable, is almost always the better professional choice.

The "Preserve Safety" pillar has become increasingly prominent in fitness-to-practise proceedings since the publication of the Francis Report into failings at Mid Staffordshire NHS Foundation Trust. The report highlighted a culture of silence and deference that allowed serious patient harm to continue unchecked, and the NMC responded by strengthening the Code's language around the duty to raise concerns.

Today, a nurse or midwife who knew about unsafe practice and failed to raise it — even if they did not directly cause harm — can face fitness-to-practise action for that failure. This represents a significant shift in how regulatory accountability is understood within the profession.

Registrants who are the subject of a fitness-to-practise referral should seek independent legal or professional union support immediately. The NMC process can be lengthy — investigations sometimes take 18 to 24 months or longer — and the emotional and psychological toll on registrants is substantial even when outcomes are ultimately favourable. The NMC does offer an Employer Link Service and a Registrant Support service to help practitioners navigate the process, but these are not substitutes for professional representation. Understanding your rights and the process from the outset significantly improves your ability to engage constructively with the investigation.

For practitioners seeking to demonstrate their ongoing commitment to the Code's standards — whether as part of revalidation, following a concern, or simply as part of professional development — reflective practice is one of the most powerful tools available. The NMC requires five written reflective accounts per revalidation cycle, each linked to either the Code or other relevant practice standards.

These accounts should demonstrate genuine critical engagement with your practice, not just a description of events. Reflections that show how a challenging situation changed your understanding of a Code commitment are far more valuable than accounts that simply describe what happened and assert that you learned from it.

Preparing effectively for NMC assessments — whether the CBT, OSCE, or the professional values components of pre-registration programmes — requires a strategy that goes well beyond memorising the four pillars of the Code. The most successful candidates are those who can apply the Code's principles fluidly and accurately to novel clinical scenarios, demonstrating not just knowledge but genuine professional judgment. Here is a structured approach to building that kind of deep, exam-ready understanding that will serve you in assessments and throughout your clinical career.

Start by reading the Code in its entirety at least twice before you begin any other preparation. Read it first for familiarity — to understand the scope and structure. Then read it again with a pen in hand, noting every commitment that you find ambiguous, surprising, or difficult to apply in practice.

These are the areas where you need to invest the most preparation time, because they are also the areas that assessment writers are most likely to focus on in scenario-based questions. The NMC publishes the Code for free on its website, and every practitioner should have a copy bookmarked and accessible.

Next, supplement your reading with the NMC's suite of supplementary guidance documents. These include guidance on social media, delegation and accountability, professional boundaries, indemnity arrangements, and the revalidation process. Each of these documents expands on specific Code commitments and provides worked examples that are enormously helpful for understanding how the Code applies in complex situations. The nursing and midwifery council jobs section of the NMC website also provides information about the kinds of professional roles that carry specific Code-based responsibilities, which can be useful context for career planning and assessment preparation.

Practice questions are a non-negotiable part of effective NMC preparation. The CBT includes questions on professional accountability, record-keeping, delegation, raising concerns, and the duty of candour — all of which map directly onto the Code's commitments. The best way to prepare for these questions is to practise with scenario-based questions that require you to identify the most professionally appropriate course of action, not just recall facts. When you get a question wrong, always go back to the relevant Code commitment and ask yourself why the correct answer aligns with the Code and why your initial response did not.

For OSCE preparation, the Code's communication commitments deserve particular attention. Many OSCE stations are fundamentally assessments of whether candidates can demonstrate person-centred communication — explaining procedures clearly, responding compassionately to patients who are distressed or confused, and maintaining dignity and respect throughout clinical interactions. These are not soft skills; they are direct Code requirements. Practising with role-play partners, recording your practice sessions, and seeking feedback on your communication style are all highly effective preparation strategies for the communication-heavy elements of the OSCE.

Understanding how the nursing and midwifery council register works is also important for assessment preparation. The register is a publicly searchable database of all currently registered nurses, midwives, and nursing associates in the UK. Practitioners are responsible for ensuring that their registration is current and that their details are up to date on the NMC Online system.

Allowing registration to lapse — even inadvertently — is a serious professional matter that can result in criminal prosecution if you continue to work in a nursing capacity without valid registration. Setting calendar reminders well in advance of your renewal date is a simple but effective strategy for ensuring this never happens.

Finally, building good reflective practice habits from the start of your career is one of the best investments you can make in your professional development. Reflection linked to the Code not only supports your revalidation requirements but actively helps you become a better, more self-aware practitioner. Whether you prefer written journals, structured models like Gibbs' Reflective Cycle, or peer discussion, the key is to make reflection a regular habit rather than a rushed activity completed in the weeks before revalidation. Practitioners who reflect regularly report greater job satisfaction, stronger professional identity, and a more confident relationship with the Code's demands.

Practical day-to-day application of the NMC Code of Conduct is where theory meets reality, and where the strength of a nurse's or midwife's professional foundation is truly tested. Even the most knowledgeable practitioners can find themselves uncertain in the moment — under time pressure, in hierarchical environments, or when caring for patients whose needs conflict with institutional constraints. The following practical tips are drawn from common scenarios that arise in clinical practice and frequently appear in NMC assessments in various forms.

When in doubt in a clinical scenario, always return to the Code's first pillar: prioritise people. Ask yourself what course of action best serves the patient's interests, dignity, and wellbeing. This is not always the easiest option — it may require difficult conversations, formal escalation, or going against the preferences of a senior colleague. But the Code is unambiguous that patient welfare comes first, and this principle should be your compass in any situation where you feel professionally uncertain about the right course of action.

Record-keeping errors are among the most common and most avoidable triggers for fitness-to-practise referrals. Develop a consistent approach to documentation from the very beginning of your career: be specific rather than vague, always include the date and time, never leave blanks in structured records, and always correct errors with a single line through the mistake followed by your initials and the date. In digital record systems, understand how the system logs edits and ensure your practice complies with your employer's documentation policy. Strong record-keeping habits are a form of professional self-protection as well as a patient safety measure.

Social media use is an area where many nurses and midwives underestimate professional risk. The Code's requirements around maintaining public trust apply outside working hours as well as during them. Posting photographs from a clinical setting — even without identifying patient information — can constitute a breach of confidentiality.

Expressing strong opinions about colleagues, employers, or the healthcare system in ways that could undermine public confidence in nursing is similarly a Code-based concern. A useful rule of thumb: before posting anything related to your professional life, ask whether your regulatory body, your employer, or a patient could have reasonable cause for concern about the content.

Working with colleagues from different professional backgrounds is a reality of modern healthcare, and the Code's commitments to effective communication and collaboration are directly relevant to these interdisciplinary contexts. When contributing to multidisciplinary team discussions, you have a professional obligation to share relevant clinical information clearly, to raise concerns if you disagree with a clinical decision, and to document your professional input accurately. The NMC Code does not require you to defer automatically to physicians or other senior clinicians when you have a genuine, evidence-based clinical concern — it requires you to communicate that concern clearly and through appropriate channels.

For nurses and midwives who work in leadership or management roles, the Code carries additional responsibilities around supervision, delegation, and organisational culture. Leaders who create environments where staff are afraid to raise concerns, where documentation is pressured or falsified, or where patient dignity is routinely compromised are themselves in breach of the Code — even if they are not personally delivering direct patient care. The NMC has been increasingly willing to investigate concerns about the professional conduct of nurse leaders and managers where those leaders have contributed to cultures of harm or silence, and this trend is likely to continue.

Finally, remember that the nursing and midwifery council of nigeria and other international nursing regulatory bodies share many of the same core values as the UK NMC Code, even when specific requirements differ. If you trained internationally and are adjusting to the UK regulatory framework, focusing on the underlying ethical principles — patient-centeredness, honesty, accountability, and safety — will help you make sense of the Code's specific requirements more quickly. The values are universal even when the regulatory systems differ in their details.