How NSW nurses and midwives regard the Code of Conduct

A new study by Cowin et al in the International Nursing Review explored Australian nurses’ and midwives’ familiarity with the newly revised Codes of Conduct (2018) for nurses and for midwives and what it means to them.

A total of 136 nurses and midwives from an acute care hospital in Sydney responded to the research survey, which was designed to discover their understanding, relevance and use of the latest Code of Conduct in their clinical work.

The research sample is small and we acknowledge the results might not necessarily apply to the wider population of nurses and midwives in NSW; however, the study may prompt refection on whether the results are relevant to your workplace.


Knowing the Code

The study found that 59% of participants were aware of the Codes. Most participants understood that the Codes were important but reported that they weren’t familiar with them. Most felt it was a good referral document, noting it “embodies the spirit of nursing as a trustworthy, person centred profession. The new version of the code is simple and explicit.”

The study results showed that the principle rated highest for importance and familiarity by the nurses and midwives was 4: “Nurses/midwives embody integrity, honesty, respect and compassion.”

Those who found it very relevant noted two features, its foundation as a guide to practise and its patient-centeredness.

A large proportion of the nurses and midwives surveyed (41%) weren’t aware of the new version of the Code or hadn’t read it. This is surprising given all nurses and midwives agree to uphold the Codes of Conduct at registration and annual renewal.

The Codes and professional standards are tools that provide principles of behaviour. These can be used by managers, team leaders and colleagues to identify expected standards within a unit.

The four domains in the Codes are:

  • Practise legally
  • Practise safely, effectively and collaboratively
  • Act with professional integrity
  • Promote health and wellbeing

Challenges with the Code

A few participants felt the Codes were not specific enough to guide them and that examples are needed for each principle. There were also times when participants felt the Code was difficult to live up to, such as when staffing was low and patient ratios were high.

A strategy that may help with applying the Codes in complex and diverse health care environments is to use staff meetings and huddles to identify and discuss the specific essential safe behaviours required in the unit which align with the principles identified in the Codes and practice standards. The unit staff can than agree together on their expected behaviour, with all staff accountable individually and to each other for maintaining the principles and behaviours that ensure that patients in the unit are receiving safe person-centred care.

In complex health settings such as these, it’s highly likely that a variety of unexpected risks could occur that, at times, may require different-than-usual ways of working. Such changes should be made in an informed way, planned and documented to ensure risk is minimised. The changes should be only temporary, such as when you’re short of staff and must determine the most important things to do for safety. Maintaining such changes when the risk is no longer present may actually decrease safety over time, so once conditions return to normal, usual practise must be re-established to ensure standards don’t slip. When the same risks occur regularly, then system or resource changes are required.

Near the end of this article we provide more tips on how to apply the Codes in daily practise. The Clinical Excellence Commission also provides resources for monitoring key priorities for safe care and quality improvement.


How the Code gets breached

Study participants were asked if they had faced a situation that breached the code; 47% said yes. The most common themes of code violations were bullying, lack of collegiality (unwillingness to teach) and managing misconduct. Other violations included inappropriate conduct (rudeness and aggression), unprofessional behaviour, and violation of privacy and confidentiality.

It is critical that bullying and professional misunderstandings are addressed early and appropriately to build trust. Teaching and supervising is a critical element in this, and all nurses and midwives have this responsibility as described in the Codes. It’s also important for nurses and midwives to acknowledge feedback and reflect on areas they may be able to improve.   


Where to from here?

Most participants reported that they believe the Code of Conduct is a good guide for professional behaviour.

The Code’s effectiveness depends on nurses and midwives actively interpreting and applying it, and by the agreed adoption of it within a unit or work group. Here are some ideas on how to achieve this:

1. Increase awareness of the Code by:

  1. Establishing visibility of the codes and standards within the unit
  2. Providing and reviewing the codes and standards at orientation
  3. Managers and supervisors modelling the expected behaviour (Leadership and the establishment of trust is essential for developing a safety culture.)  

2. Increase understanding and application of the Code by:

  1. Discussing and seeking agreement to set expectations about how the code applies within the context in which the team works, with an understanding that members of the team hold themselves and others accountable
  2. Reviewing and reflecting on performance when incidents occur and things didn’t go as expected
  3. Correcting and coaching when lapses occur
  4. Identifying areas of focus for professional development
  5. Reflecting the Code in performance management plans
  6. Developing and evaluating policies and procedures to align with the Code
  7. Developing job interview questions related to the Code

3. Reinforce the Code by:

  1. Identifying, measuring and providing feedback on key elements that are essential to safety
  2. Providing performance review and mentoring related to Code behaviours
  3. Adopting a transparent, non-punitive approach to reporting and learning from adverse events
  4. Implementing a feedback loop so staff know that actions are being taken to address or fix the identified issue
  5. Acknowledge and celebrate positive behaviours and good practice

How do you apply the Code?

We would love to hear how you think about the Code of Conduct and how you apply it in your everyday practice. If you’re happy to share your reflections in an upcoming newsletter, please send your comments to us at

Study citation:

COWIN L.S., RILEY T.K, HEILER J. & GREGORY L.R. (2019). The relevance of nurses and midwives code of conduct in Australia. International Nursing Review 00, 1–9