Professional Values & Accountability

A nurse witnesses a colleague administer the wrong dose of a medicine to a patient. According to the NMC Code, what is the most appropriate immediate action?

• ACheck the patient is safe, then report the error openly and document it✓
• BKeep it to yourself so that the colleague does not get into trouble over it
• CCorrect the records so the error is not visible
• DWait until the end of the shift to mention it informally

Answer: The NMC Code requires nurses to act in the patient's best interests and be open and honest when something goes wrong, known as the duty of candour. Patient safety is assessed first, then the error is reported and accurately documented.

Under the NMC Code, what does professional accountability primarily mean for a registered nurse?

• AFollowing a doctor's instruction so the doctor bears the responsibility
• BDeferring responsibility for decisions to the ward manager
• CHolding current NMC registration and paying the annual fee
• DBeing answerable for one's own decisions, actions and omissions✓

Answer: Accountability means a registered nurse is answerable for their own decisions, actions and omissions and can justify them. This applies regardless of who gave an instruction.

A patient asks a nurse not to share their diagnosis with their visiting relatives. What should the nurse do?

• ARespect the patient's wishes and keep the information confidential✓
• BRecord in the notes that the patient is being difficult about their relatives
• CTell the relatives the diagnosis anyway, because they are close family members
• DShare the diagnosis only with the closest relative and no one else in the family

Answer: The NMC Code requires nurses to respect a person's right to confidentiality and to share information only with consent or where there is a lawful reason. A competent adult's decision about who is told their diagnosis must be respected.

A nurse is asked to undertake a clinical task they have not been trained to perform. What is the correct response under the NMC Code?

• APerform the task anyway, but record in the notes that they were unsure of it
• BDecline and explain they lack the competence, seeking support or training✓
• CAttempt the task to appear competent and helpful
• DDelegate the task straight away to a healthcare assistant working on the ward

Answer: The NMC Code requires nurses to recognise and work within the limits of their competence. They must not undertake tasks they are not trained or competent to perform and should seek appropriate support or training.

Which of the following best reflects the NMC requirement to revalidate?

• ASitting a written NMC examination once every five years in order to stay on the register
• BRenewing registration once each year by paying the annual fee, with no other requirements
• CSubmitting an enhanced criminal record check to the NMC every three years and nothing else
• DCompleting practice hours, CPD, reflective accounts and feedback every three years✓

Answer: NMC revalidation occurs every three years and requires evidence including 450 practice hours, 35 hours of CPD, practice-related feedback, reflective accounts and confirmation. It demonstrates continued fitness to practise.

Which of these is one of the four themes of the NMC Code?

• AProtect the employer
• BPrevent complaints
• CPromote efficiency
• DPreserve safety✓

Answer: The Code is structured around four themes: prioritise people, practise effectively, preserve safety, and promote professionalism and trust.

How often must NMC registrants revalidate?

• AEvery 5 years
• BEvery 3 years✓
• CEvery year
• DEvery 2 years

Answer: Nurses, midwives and nursing associates must revalidate every three years to stay on the NMC register.

How many practice hours must a nurse with a single registration complete over the three years before revalidation?

• A450 hours✓
• B900 hours
• C750 hours
• D300 hours

Answer: The NMC requires 450 practice hours over the three years for a single registration, and 900 hours for those revalidating as both a nurse and a midwife.

What are the continuing professional development requirements for NMC revalidation?

• A20 hours, including 10 hours of participatory learning
• B35 hours, including 20 hours of participatory learning✓
• C35 hours, all of which may be completed by private reading
• D50 hours, including 35 hours of classroom teaching

Answer: Registrants must complete 35 hours of CPD over the three years, of which at least 20 hours must include participatory learning with other people.

How many written reflective accounts are required for NMC revalidation?

• AFive✓
• BTwo
• CTen
• DThree

Answer: The NMC requires five written reflective accounts, which must then be discussed with another NMC registrant in a reflective discussion.

A patient is harmed by an error in their care. What does the professional duty of candour require?

• ARecord the incident, but share details only if the patient asks directly
• BTell the patient, apologise, explain the effects and offer to put it right✓
• CWait until the incident investigation is complete before telling the patient
• DTell only the patient's relatives, so that the patient is not distressed

Answer: NMC and GMC joint guidance on openness says that when something goes wrong professionals must tell the person, apologise, offer an appropriate remedy or support, and explain fully the short- and long-term effects.

A grateful patient offers you £50 as a thank-you when they are discharged. What should you do?

• AAccept it and share the money with the rest of the team
• BAccept it, provided nobody else on the ward sees it
• CPolitely decline, as only trivial gifts are acceptable✓
• DAccept it, as refusing could cause offence to the patient

Answer: The Code says registrants should refuse all but the most trivial gifts, favours or hospitality, as accepting them could be seen as trying to gain preferential treatment. Follow local policy.

A colleague posts a photograph of a patient on social media without identifying them by name. What is the correct view?

• AIt is acceptable because the patient is not named
• BThis breaches confidentiality✓
• CIt is acceptable if the account is set to private
• DIt is acceptable if the patient seemed happy

Answer: The NMC's guidance on social media says registrants must not share images or information about people in their care. Patients can be identified from photographs or details even without a name.

When may a nurse share confidential information without the patient's consent?

• AWhen the patient's employer telephones to ask for an update
• BWhen a relative says they have a right to know the diagnosis
• CWhen a colleague on another ward is curious about the case
• DWhen there is a risk of serious harm, or the law requires it✓

Answer: The Code allows disclosure without consent where it is in the public interest, such as a risk of serious harm to the person or others, or where the law requires it. Share only what is necessary.

A registered nurse is charged with a criminal offence. What does the NMC Code require them to do?

• ATell their employer and the NMC as soon as they can✓
• BTell the NMC at the next revalidation, three years on
• CTell their manager, who decides whether the NMC is told
• DTell the NMC only if they are later found guilty

Answer: The Code requires registrants to tell employers and the NMC as soon as they can about any caution or charge against them, or any conviction.

Which of these must every NMC registrant have in place to practise?

• AA university postgraduate nursing qualification
• BMembership of a trade union or professional body
• CAn appropriate professional indemnity arrangement✓
• DA personal accident insurance policy of their own

Answer: The Code and the revalidation requirements say registrants must have an appropriate indemnity arrangement in place for their practice. For employed staff this is usually provided by the employer.

When should nursing records be completed?

• AAt the end of the shift, all together
• BWithin one week of the care being given
• CAs soon as possible after the event✓
• DOnly when something unusual has happened

Answer: The Code says to complete records accurately and without falsification, at the time or as soon as possible after an event, recording if the notes are written some time after.

You notice an error in an entry you made in a paper care record. How should you correct it?

• AScribble over the error so that it cannot be read by anyone
• BTear out the page and rewrite the whole entry on a fresh sheet
• CUse correction fluid over the error and write the right entry on top
• DStrike through once, then sign, date and time the correction✓

Answer: Errors in paper records should be crossed out with a single line so the original remains readable, and the correction signed, dated and timed. Records must never be altered in a way that hides what was written.

In which situations does the NMC Code recognise a right of conscientious objection?

• ATaking part in abortion, or in fertility treatment procedures✓
• BCaring for a patient who has been convicted of a crime
• CCaring for a patient whose lifestyle choices you disagree with
• DGiving blood products to a patient of a different religion

Answer: The Code notes that the law gives a right of conscientious objection only in relation to abortion and to procedures under the Human Fertilisation and Embryology Act. Registrants must still give care in an emergency.

In NHS organisations in England, who can staff contact if they feel unable to raise a patient-safety concern with their line manager?

• AThe local newspaper's health editor
• BThe patient's own GP practice
• CThe hospital's chaplaincy service
• DThe Freedom to Speak Up Guardian✓

Answer: NHS organisations have Freedom to Speak Up Guardians who support staff to raise concerns. Concerns can also be escalated to regulators such as the CQC.

A former patient you cared for last month asks you out on a date. What should you do?

• ADecline and keep clear professional boundaries✓
• BAccept, as the patient has now been discharged
• CAsk your manager to decide on your behalf
• DAccept, provided you meet away from the hospital

Answer: The Code says registrants must keep clear professional boundaries with people in their care and those close to them. A relationship with a recent patient could exploit the trust built during care.

Which of these is one of the NMC revalidation requirements?

• AA written essay on nursing theory and practice
• BA health and character declaration✓
• CAn annual practical skills exam
• DA new English language test at a set level

Answer: The revalidation requirements include practice hours, CPD, practice-related feedback, reflective accounts, a reflective discussion, a health and character declaration, an indemnity arrangement and confirmation.

Who provides the confirmation stage of NMC revalidation?

• AA confirmer, usually the registrant's line manager✓
• BA patient chosen by the registrant for the purpose
• CThe university where the registrant first trained
• DThe NMC's own registration staff, by telephone

Answer: A confirmer, ideally the line manager and preferably an NMC registrant, confirms that the requirements have been met. The reflective discussion must be with an NMC registrant.

What is the overarching purpose of the Nursing and Midwifery Council?

• ATo represent nurses in pay disputes
• BTo protect the public✓
• CTo train student nurses
• DTo run NHS hospitals

Answer: The NMC's overarching objective is the protection of the public. It sets standards, keeps the register and investigates concerns; trade unions, not the NMC, represent members.