Care Registration: Code of Conduct

    1. Introduction

      Welcome to this code of conduct for support workers in health care. As a health-care worker, you play a vital role in:

      • protecting patients from harm and
      • valuing all aspects of equality and diversity.

      What you do has a big impact on the quality of health care for people who use the service.

      This code of conduct is necessary because the work you do as a member of the health-care team is very important. The code is a list of statements that set the standard for how you should work on a day-to-day basis. It is based on the basic principle of protecting the public, and mirrors what is required of all ‘regulated’ health-care professionals you work with.

      You can use the code to check that you are ‘working to standard’. Your employer can use it to make sure that the service is meeting the standards and that both the public and the patients’ safety is assured. Employers can also use it to help them understand what kind of service they can expect from you and your colleagues.

      The statements are based on existing good practice. You’ll probably find you are already working to standard in most, if not all of them. If not, the code will show you how you can change the way you work to make sure you are working to standard.

      The term ‘patient’ is used throughout the code. However, in practice you may hear patients being referred to as  ‘service users’, ‘clients’ or ‘residents’. Basically, the term means any person that you come into contact with who needs care.

    2. Working ‘to standard’

      2.1. — As a Health care worker, you are expected to work to a certain standard. You need to be able to do your job properly, behave properly, and do the right thing at all times. This is essential to protect patients and others from harm. Patients and their relatives, your employer and your colleagues all expect this, and you should expect this of yourself.

      2.2. — But what does this mean on a day-to-day basis? It means that in your work, you should always be of ‘good character’ 2. This means that you should always display the characteristics outlined below.

      2.3. — ‘Good character’ is defined as: ‘someone who is capable of safe and effective practice at all times’.  It is important that healthcare workers can provide safe and effective care at all times.  To assess good character, employers will take up character references and check for a satisfactory criminal records check.

    3. Good character

      3.1. — Accountability
      Making sure that you can always ‘answer’ for your actions or omissions.

      Make sure you are happy with the things you do (actions) and the things you don’t do (omissions) in your daily work and that you can justify them to patients, your supervisor, your employer and others.

      How will I know if I’m ‘working to standard’ on accountability?

      When you are working to standard on accountability, you may be asked to explain anything that you do or do not do with, or for, the patient.  So, you need good reasons for the way you have acted.  Your employers will draw on the knowledge and skills you have used when they judge your actions.  Make sure that you record your actions in line with your employer’s procedures.  By taking part in ongoing monitoring of your performance, you are showing you are aware of your accountability.

    4. 3.2. — Awareness
      Being honest with yourself and others about what you can do.

      Know yourself, what you can do and what you can’t do.  The safety of your patients is your first priority. Always ask colleagues for help if you have any worries or concerns about your abilities.

      How will I know if I’m ‘working to standard’ on awareness?

      When you’re working to standard on awareness, you’ll know yourself well enough to know what you can do.   You’ll show you understand that some procedures can only be carried out by people who have had special training, and that, in certain circumstances, you need permission from qualified staff before you do certain things with patients. If you feel you’re being asked to do something you haven’t been trained to do, and that you don’t have the skills to do it, you will speak up

      3.3. — Integrity
      Always do what is right to protect the patient.

      Always do your best to make sure nothing you or anyone else does, or does not do, will harm the patient’s mental or physical health or delay their recovery.

      How will I know if I’m ‘working to standard’ on integrity?

      When you’re working to standard on integrity, you will be protecting patients every way you can, taking into account all aspects of equality and diversity.  You should be prepared to report issues that cause you to worry.

      3.4. — Advocacy
      Doing your best for patients and their relatives.

      This means being responsible for promoting and protecting the interests of patients, many of whom may not be able to protect their own interests.  This could involve speaking up for patients to make sure that what is best for each individual is always taken into account.

      How will I know if I’m ‘working to standard’ on advocacy?

      When you’re working to standard on advocacy, you’ll be putting patients’ interests first at all times and making sure that you are meeting their wants and needs. All patients are individuals with different likes and dislikes, and you must acknowledge their equality and diversity to make sure that you treat them equally and fairly.

      3.5. — Sensitivity
      Respecting the patient.

      Every patient is an individual with real feelings and emotions. When working with patients, think about how they may be feeling and what is the most appropriate response to their situation.

      How will I know if I’m ‘working to standard’ on sensitivity?

      When you’re working to standard on sensitivity, you’ll be treating patients and their relatives politely while being aware of the situation they are in and their reactions to it.  For example, they may be feeling confused, angry or frustrated. It is important that you are sensitive to this and do not take their reactions personally.

      3.6. — Objectivity
      Treating all patients in the same way.

      It is the duty of public bodies and their employees to promote equality.  Personal feelings about patients must not interfere with the standard of your work.  By law, you must provide all patients with high-quality care which reflects their individual needs, whatever their race, sex, sexuality, age, religious belief or disability3.  This means that you owe patients a ‘duty of care’ and they can expect a ‘reasonable’ standard of care from all workers.

      And, it is important to maintain clear boundaries when caring for patients.  This means that you should always have a ‘professional’ relationship with your patients. If you have any strong feelings about a patient’s religious, social or cultural beliefs, you should tell your manager as soon as possible so they can take appropriate action.

      How will I know if I’m ‘working to standard’ on objectivity?

      When you’re working to standard on objectivity, you’ll be working to the same high standard with every patient you work with. It should not matter to you what the patient is like as an individual, what colour or religion they are or how they live their life.  You will see all patients as worthy of your respect and best efforts.

      3.7. — Consideration and respect
      Making sure that patients are always treated with dignity.

      Consider and respect patients’ privacy to make sure that neither you nor they are ever placed in an embarrassing situation.

      How will I know if I’m ‘working to standard’ on consideration and respect?

      When you’re working to standard on consideration, you’ll always show thoughtfulness for patients’ feelings and needs.  You’ll protect patients to make sure that they are never unnecessarily exposed to embarrassing situations — whether in front of relatives, fellow patients or healthcare workers.

      The Disability Discrimination Act 1995 states you must make sure that disabled patients receive the same quality of service as all other patients.  You should be aware that this may mean you have to treat disabled patients more favourably than you treat others to deliver an equal level of care.

      3.8. — Consent
      Telling patients what you intend to do and listening carefully to what they say about it.

      Working in partnership with the patient at all times is a basic principle that you must keep to at all times.  Always explain to patients what you intend to do with them, even when it is basic care or routine procedures, and only continue with your planned work once the patient agrees to it.  You must check that this agreement is written in the patient records, and you should report any concerns that the patient or a relative has to your supervisor.

      How will I know if I’m ‘working to standard’ on consent?

      When you’re working to standard on consent, you’ll be demonstrating  that you will always make sure that the patient knows what you are planning to do and is happy with it.  If the patient cannot give consent for themselves, because of their age or condition, you must always check with a relative or a senior member of staff. If the patient or relative has not agreed to what you plan to do, you must not do it.  Always check with a senior member of staff if you are in any doubt.

      3.9. — Confidentiality
      Protecting the patient’s privacy.

      Confidentiality is essential to protect the interests of patients. It is a main feature of any code of conduct and of most terms and conditions of service in a health-care environment.  So you must make sure that you don’t give out personal information about patients, or about their condition or treatment, to anyone other than colleagues in the team who need to know the information to help in the patient’s care.  If you do not protect the patient’s right to confidentiality, you may be breaking data-protection laws.  If you feel that a patient is at risk of harm, and that you need to speak out, you should tell your supervisor.  You should not discuss patients with anyone out of work.

      How will I know if I’m ‘working to standard’ on confidentiality?

      When you’re working to standard on confidentiality, you’ll maintain a professional attitude at all times when handling patient information and you won’t ‘gossip’ about patients to anyone at any time. When you do pass on information to a colleague as part of your job, you will take care to be accurate and clear in what you say or write.

      3.10. — Co-operation
      Working effectively with your colleagues as part of a team.

      Value the part you play in the team and respect the part played by other members of the team.

      How will I know if I’m ‘working to standard’ on co-operation?

      When you’re working to standard on co-operation, the contribution you make to the team will be valued.  You’ll be communicating effectively, sharing information and working to meet the team’s shared goals in the best interests of the patient.

      3.11. — Protection
      Making sure you don’t put patients and colleagues at risk of harm.

      Make sure patients, visitors and colleagues are protected from dangers and risks and that nothing you do, or don’t do, results in harm or risk to others.

      How will I know if I’m ‘working to standard on protection’?

      When you’re working to standard on protection, you’ll know the dangers patients and colleagues face at work and will do what you can to reduce risks of accidents or harm.  You will also make sure you report any concerns you have to a supervisor to reduce risks in the future.

      3.12. — Development
      Trying to increase your own knowledge and skills by talking to patients and colleagues and looking for opportunities to learn.

      If you are interested in your work and feel comfortable using the knowledge you need to carry out your job, you will be able to offer a better service to patients and you should feel more motivated as a result.

      How will I know if I’m ‘working to standard’ on development?

      When you’re working to standard on development, you’ll be taking every chance you can to protect patient safety by improving the way you work.  This could be by attending a course, shadowing a colleague or listening to feedback from patients. You’ll continually monitor, evaluate and reflect on what you do at work and try to do it to the best of your ability.

      3.13. — Alertness
      Observing any changes that could affect a patient’s needs or progress.

      Always try to notice when a patient isn’t doing what you expect of them and report your observations to an appropriate person.

      How will I know if I’m ‘working to standard’ on alertness?

      When you’re working to standard on alertness, you will notice when patients are ‘just not right’. You’ll notice, for instance, when the patient can’t move as well as usual or perhaps hasn’t eaten their meal.   Reporting these observations will be in the best interests of the patient.

    5. What this means for you

      4.1. — The code of conduct means that, as a health-care worker, you have a responsibility to work to standard. This means that you must do the following.

      4.1.1. — If you do something, or accept an instruction from another healthcare worker to do something, that isn’t within your level of skill, you could be putting the safety of the patient at risk and you could be disciplined.  Let your manager or supervisor know if you feel you are being asked to do something you don’t know how to.

      4.1.2. — It is within the code of conduct of all health-care professionals not to delegate tasks unless they are sure that the person they are delegating to has the skills and is happy to perform the task.  The person who delegates will remain professionally accountable for delegating the task.  However, if you accept the task, you will be accountable for how well you perform it.

      4.1.3. — Make sure that you always follow the standard procedures for carrying out tasks and duties.

      4.1.4. — Follow the rules on ‘duty to care’ (see paragraph 3.2.6). This means you must always make sure patients and colleagues don’t come to harm because of something you’ve done or something you have not done, or because you’ve been careless or taken risks.

      4.1.5. — Making notes and keeping patients records up to date and accurate is an essential part of care.  You should only write down information relevant to the care you have given to patients and get an appropriate person to sign the record in line with policy.  If you are not sure, ask for advice.  As you are accountable for anything you write, no matter how informal it might seem, what you write can be used as evidence in any enquiry by your employer or the courts in the future.

      4.1.6. — Raise issues you are concerned about with your line manager where these relate to:

      • how care is delivered
      • the personal health, safety and security of patients or
      • harm and abuse of patients.
    6. Want to know more?

      5.1. — If you’d like to find out more about the issues in this code of conduct, talk to your manager, supervisor, trade union representative or a member of your relevant professional association. You could also have a look at the following sources.

      • Blowing the Whistle – advice from the Royal College of Nursing on how to speak up if you feel something is seriously wrong in your workplace.
      • The Duty of Care – a UNISON handbook to help health care staff to carry out their duty of care to patients, colleagues and themselves.
      • The Nursing & Midwifery Council’s (and other professional regulators) guidelines on records and record keeping. (See www.workinginhealth.com/standards for information on links to the different regulatory organisations’ websites)
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