Explore leadership standards in the NMC Code for nurses and midwives including accountability, delegation, supervision and professional responsibilities.
Written by Laura Bouttell • Mon 5th January 2026
The Nursing and Midwifery Council Code explicitly requires registered nurses and midwives to "be a model of integrity and leadership for others to aspire to," establishing leadership not as optional aspiration but as fundamental professional obligation for all registrants regardless of role or seniority. This framing represents profound shift from traditional views treating leadership as specialist function reserved for senior positions—the NMC Code positions every registered professional as leader responsible for protecting wellbeing, improving experiences, and upholding standards within their sphere of influence.
For the 760,000+ nurses, midwives, and nursing associates registered with the NMC across the United Kingdom, understanding the Code's leadership requirements proves essential for professional practice, regulatory compliance, and career development. The Code's four themes—prioritise people, practise effectively, preserve safety, and promote professionalism and trust—each contain leadership dimensions addressing how professionals influence colleagues, shape cultures, delegate responsibilities, and champion quality improvement.
This guide examines leadership within the NMC Code comprehensively: the Code's structure and evolution, specific leadership standards and their practical application, accountability and delegation requirements, professional responsibility frameworks, and how Code requirements inform both daily practice and structured leadership roles. Whether you're registered professional understanding obligations, aspiring clinical leader planning development, or healthcare manager supporting nursing staff, grasping the Code's leadership expectations provides essential foundation.
The NMC Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates provides regulatory framework governing professional conduct for all UK-registered nursing and midwifery professionals. Originally published January 2015 and updated October 2018 to include nursing associates, the Code establishes legally enforceable standards that registrants must uphold throughout their careers.
The Code organises 25 standards into four overarching themes reflecting fundamental professional values and practice expectations. This thematic structure enables coherent understanding of how individual standards interconnect whilst providing clear framework for education, revalidation, fitness-to-practice proceedings, and daily decision-making.
Prioritise People encompasses standards ensuring person-centred care delivery. This theme requires treating people with kindness and respect, understanding limitations of professional competence and role, acting as advocate for vulnerable people, maintaining clear professional boundaries, and raising concerns immediately when safety or wellbeing is at risk. The prioritise people theme establishes patient welfare as paramount consideration overriding all other pressures—operational targets, resource constraints, or organisational convenience cannot justify compromising patient-centred care.
Practise Effectively addresses professional competence, continuous development, and collaborative working. Standards within this theme require maintaining knowledge and skills, understanding and applying research and evidence to practice, keeping clear and accurate records, communicating effectively, working cooperatively with colleagues, and sharing skills and experience for the benefit of the public. This theme recognises that effective practice demands both individual excellence and collective capability building through knowledge sharing and collaboration.
Preserve Safety focuses on risk management, safeguarding, and creating safe care environments. Standards mandate recognising and working within limits of competence, raising concerns about care safety immediately, advising on and supporting safe composition and skill mix of teams, acting without delay if patient safety is at risk, and taking necessary action to protect patients from harm. The preserve safety theme establishes proactive risk identification and mitigation as core professional responsibility rather than reactive problem-solving after harm occurs.
Promote Professionalism and Trust requires upholding public confidence in nursing and midwifery through integrity, honesty, and professional behaviour. Standards within this theme mandate acting with honesty and integrity, upholding reputation of professions, demonstrating commitment to Code standards, being a model of integrity and leadership, displaying professional commitment through development and support of students, and responding to National Institution for Health and Care Excellence guidance appropriately. This theme recognises that public trust in professions depends on individual members' conduct both within and beyond clinical practice.
The NMC Code carries regulatory force under the Nursing and Midwifery Order 2001. Failure to comply with Code standards can result in fitness-to-practice proceedings potentially leading to conditions on practice, suspension, or removal from the professional register. This regulatory power distinguishes the Code from aspirational guidance—adherence proves mandatory rather than discretionary.
Courts may reference the Code when determining professional negligence cases, establishing expected standards of care against which actual practice is measured. Employers incorporate Code requirements into policies, job descriptions, and performance frameworks, creating organisational expectations aligned with regulatory obligations. Professional indemnity insurers may assess Code compliance when evaluating coverage or claims.
Registrants bear personal responsibility for understanding and applying Code standards regardless of employer policies, resource constraints, or management pressures. The principle "I was following orders" or "my employer told me to" provides no defence against Code breaches—professional accountability remains individual even when working within organisational hierarchies.
Whilst the entire Code contains leadership implications, several standards explicitly address leadership responsibilities, establishing expectations for how registered professionals influence others, drive improvement, and shape practice environments.
Standard 25 states: "Provide leadership to make sure people's wellbeing is protected and to improve their experiences of the healthcare system." This standard establishes clear leadership obligation applicable to all registrants regardless of whether they hold formal leadership positions.
The standard's sub-requirements specify that registrants must:
25.1 Identify priorities, manage time, staff and resources effectively and deal with risk to make sure that the quality of care or service you deliver is maintained and improved, putting the needs of those receiving care or services first. This requirement addresses leadership's operational dimension—effective prioritisation, resource stewardship, and risk management ensuring quality maintenance and enhancement. The explicit emphasis on putting recipients of care first establishes that leadership serves patient welfare rather than organisational or professional convenience.
25.2 Support any staff you may be responsible for to follow the Code at all times. They must have the knowledge, skills and competence for safe practice; and understand how to raise any concerns linked to any circumstances where the Code has, or could be, broken. This requirement creates cascade accountability—leaders must ensure those they supervise understand and comply with Code standards whilst feeling empowered to raise concerns about potential breaches. This protective function proves essential for creating psychologically safe environments where staff report problems rather than concealing them.
The leadership standard's positioning as final Code requirement (Standard 25) reflects its integrative nature—effective leadership synthesises and operationalises all preceding standards rather than representing discrete additional obligation. Leaders who prioritise people, practise effectively, preserve safety, and promote professionalism create conditions enabling others to do likewise.
Standard 20.8 requires registrants to "be a model of integrity and leadership for others to aspire to." This aspiration standard establishes that all registrants—not merely those in designated leadership positions—should demonstrate exemplary conduct inspiring colleagues, students, and the public.
Modelling integrity and leadership manifests through multiple behaviours:
The standard recognises that professionals model whether consciously intending to or not—junior staff observe how experienced colleagues behave under pressure, students learn professional norms through watching registered practitioners, and public forms impressions of professions through individual members' conduct. Being intentional about positive modelling proves essential.
Standard 9 establishes that registered professionals "are accountable for your decisions to delegate tasks and duties to other people." This accountability standard creates leadership framework for managing teams, delegating appropriately, and maintaining ultimate responsibility for care quality even when specific tasks are performed by others.
Accountability means that professionals must:
The accountability framework applies regardless of hierarchical position—newly qualified nurses bear accountability for their practice equally to ward managers or directors of nursing, though the scope and complexity of accountable decisions differs. This universal accountability creates professional responsibility culture rather than depending on managerial oversight alone.
Delegation represents critical leadership capability directly addressed in the NMC Code through multiple standards establishing when, how, and to whom tasks may be delegated whilst maintaining accountability for outcomes. Understanding delegation requirements proves essential for any registered professional supervising others.
The NMC defines delegation as "the transfer to a competent individual, of the authority to perform a specific task in a specified situation." This definition contains several important elements: delegation transfers authority (not merely asks someone to help), requires recipient competence for the specific task, and operates within particular situational context rather than as blanket permission.
Standard 11 addresses delegation directly: "Only delegate tasks and duties that are within the other person's scope of competence, making sure that they fully understand your instructions." This requirement establishes several obligations:
Assessing competence before delegation requires understanding what the task involves, what knowledge and skills it demands, and whether the potential delegate possesses these capabilities. Competence assessment cannot rely merely on job titles or assumed training—delegating nurses must verify actual capability, perhaps through observing performance, reviewing credentials, or discussing the person's experience with similar tasks.
Ensuring understanding means confirming the delegate comprehends what they're being asked to do, why it matters, what standards apply, what to do if problems arise, and when/how to report outcomes. Effective delegation involves checking understanding rather than assuming it—asking the delegate to explain the task back demonstrates comprehension more reliably than asking "do you understand?"
Specifying the situation acknowledges that competence proves context-dependent. A healthcare assistant may competently perform basic observations on stable patients but lack capability for complex post-operative monitoring. Delegation must match not just task to person but task-in-this-situation to person's demonstrated capability in similar circumstances.
Standard 11.1 requires: "Make sure that everyone you delegate tasks to is adequately supervised and supported so they can provide safe and compassionate care." This supervision requirement establishes that delegation doesn't mean abandonment—delegating professionals retain responsibility for ensuring adequate oversight and assistance.
Adequate supervision varies based on delegate competence, task complexity, patient risk factors, and environmental context. Newly trained staff performing unfamiliar tasks require close proximity supervision with registered professional immediately available. Experienced staff handling routine tasks in stable situations need less intensive oversight, though regular checking and availability for questions remain essential.
Support provision includes ensuring delegates have necessary equipment, information, and resources; being available to answer questions or provide guidance; creating psychologically safe environment where asking for help is encouraged rather than stigmatised; and providing feedback helping delegates develop capability over time.
Standard 11.2 specifies: "Confirm that the outcome of any task you have delegated to someone else meets the required standard." This outcome confirmation requires checking that delegated tasks were completed satisfactorily, not merely assuming everything proceeded appropriately because no one raised concerns. Confirmation might involve directly observing outcomes (checking vital signs recorded match patient's current state), reviewing documentation, or discussing task completion with delegate.
The NMC makes clear that "accountability for the overall care of the patient remains with the registered nurse, midwife or nursing associate" even when specific tasks are delegated. This principle means delegating professionals cannot absolve themselves of responsibility by claiming "I delegated that task so it's not my fault if it went wrong."
Retained accountability creates several implications:
This accountability retention reflects delegation's fundamental nature: transferring task execution whilst maintaining responsibility for ensuring appropriate execution. True delegation involves calculated risk-taking—determining that allowing another to perform the task, with appropriate safeguards, serves patients better than registered professional performing everything personally.
The NMC Code establishes clear professional duty to raise concerns when patient safety, dignity, or wellbeing is compromised—a duty reflecting leadership's protective function and creating expectation that all registrants champion quality improvement and safety.
Standard 16 requires: "Act without delay if you believe that there is a risk to patient safety or public protection." The "without delay" language establishes immediacy obligation—concerns cannot be deferred until convenient, appropriate, or politically expedient. Patient safety trumps all other considerations.
Standard 16.2 specifies raising concerns immediately if patient dignity or safety is compromised, taking necessary action to address difficulties where possible, making sure concerns are dealt with promptly by escalating through appropriate channels, and following up to confirm action has been taken.
Concerns warranting immediate escalation include:
The Code rejects any suggestion that "it's not my problem" or "someone else will handle it"—every registrant bears responsibility for raising concerns within their awareness.
Standard 16.4 requires: "Acknowledge and act on all concerns raised to you, investigating, escalating or dealing with those concerns where it is appropriate for you to do so." This reciprocal requirement means leaders receiving concerns must take them seriously rather than dismissing, ignoring, or punishing those who raise issues.
UK law provides protections for whistleblowers through the Public Interest Disclosure Act 1998, prohibiting detriment or dismissal for protected disclosures made in good faith. The NMC reinforces these protections by establishing that victimising colleagues who raise legitimate concerns constitutes professional misconduct potentially resulting in fitness-to-practice action.
Despite legal and professional protections, whistleblowing often proves professionally costly. Research demonstrates whistleblowers frequently experience career damage, ostracism, stress-related illness, and forced departure from organisations. Effective leaders create cultures where concerns are welcomed early, addressed transparently, and responded to constructively—making formal whistleblowing unnecessary because problems are identified and resolved through normal channels.
Standard 25.2 requires leaders to support staff "to understand how to raise any concerns linked to any circumstances where the Code has, or could be, broken." This support obligation means leaders must educate staff about raising concerns processes, create psychologically safe environments encouraging early problem identification, respond constructively to concerns rather than defensively, and protect those who speak up from retaliation.
Practical support mechanisms include:
Leaders who create speak-up cultures benefit through early problem detection, staff engagement, and reduced risk of serious incidents. Those who suppress concerns through intimidation, dismissiveness, or inaction create ticking time bombs where problems fester until catastrophic failure occurs.
The Code applies to all registered professionals "whether they are providing direct care to individuals, groups or communities or bringing their professional knowledge to bear on nursing and midwifery practice in other roles, such as leadership, education or research." This breadth establishes that Code obligations extend beyond bedside nursing into management, education, policy, research, and commercial roles.
Registered professionals in formal leadership positions—ward managers, matrons, directors of nursing, chief executives—remain bound by Code standards whilst exercising managerial authority. This dual accountability means leadership decisions must align with professional values and obligations, not merely organisational interests or financial pressures.
Tensions arise when organisational and professional obligations conflict: budget holders pressed to reduce staffing below safe levels, managers directed to implement policies compromising patient-centred care, executives balancing competing stakeholder demands with patient welfare. The Code provides clear guidance—professional obligations supersede organisational pressures. Leaders who compromise Code standards due to management pressures remain professionally accountable regardless of hierarchical instructions received.
This professional primacy creates difficult situations for nurse leaders within organisational hierarchies. Effective navigation requires:
Registered nurses and midwives in education roles bear particular leadership responsibility for developing next generation of professionals. Standard 21 requires displaying professional commitment through development and support of students and colleagues, giving constructive feedback, and raising concerns immediately when standards of care, teaching, or supervision compromise patient safety.
Educator leadership manifests through:
The educator role's influence extends beyond immediate students into future professional workforce. Poor educators who pass incompetent students, model substandard practice, or create toxic learning environments compromise entire profession's future capability and reputation.
Registered professionals conducting research or developing policy continue serving public through different mechanisms than direct care. Code standards adapt to these contexts:
Policy-focused nurses and midwives apply professional expertise toward system-level improvement, regulatory development, or service design. Their leadership influence operates through shaping environments within which clinical colleagues practice rather than through direct patient care. Code compliance requires ensuring policies promote rather than compromise safe, effective, person-centred care.
The NMC Code (full title: "The Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates") is the regulatory framework establishing professional conduct standards for all UK-registered nurses, midwives, and nursing associates. Originally published January 2015 and updated October 2018, the Code comprises 25 standards organised into four themes: prioritise people, practise effectively, preserve safety, and promote professionalism and trust. The Code applies legally to all registrants regardless of role, with breaches potentially resulting in fitness-to-practice proceedings leading to practice restrictions, suspension, or registration removal.
The NMC Code establishes leadership as fundamental professional obligation through several standards. Standard 25 requires providing leadership to protect wellbeing and improve healthcare experiences by identifying priorities, managing resources effectively, and supporting staff to follow the Code. Standard 20.8 requires being a model of integrity and leadership for others to aspire to. Standard 9 creates accountability for delegation decisions. The Code frames every registrant as leader responsible for championing quality, raising concerns, supporting colleagues, and demonstrating exemplary professional conduct regardless of hierarchical position.
The NMC Code addresses delegation through Standard 11, defining delegation as "transfer to a competent individual, of the authority to perform a specific task in a specified situation." The Code requires only delegating tasks within the delegate's competence, ensuring they understand instructions, providing adequate supervision and support, and confirming outcomes meet required standards. Critically, the Code establishes that ultimate accountability for patient care remains with the registered professional even when tasks are delegated—delegating doesn't transfer accountability, only task execution authority.
Failure to comply with NMC Code standards can result in fitness-to-practice proceedings potentially leading to conditions on practice, suspension, or removal from the professional register. The NMC investigates concerns about registrants through formal processes assessing whether conduct falls below Code standards. Serious breaches—patient harm, dishonesty, criminal convictions, persistent failure to meet standards—may result in registration loss ending nursing or midwifery careers. Less serious concerns might result in warnings or undertakings. Additionally, employers may take disciplinary action, and courts may reference Code standards when assessing professional negligence claims.
Yes, Standard 16 creates clear professional duty to raise concerns immediately when you believe risks to patient safety or public protection exist. The Code requires acting without delay if patient dignity or safety is compromised, making sure concerns are dealt with promptly through appropriate escalation, and following up to confirm action has been taken. Failing to raise legitimate safety concerns when aware of them constitutes professional accountability failure potentially resulting in fitness-to-practice action. The duty applies regardless of potential career consequences, organisational pressures discouraging concern-raising, or fears about whistleblowing repercussions.
The NMC Code applies to all registered professionals regardless of role, explicitly including those in "leadership, education or research" rather than direct patient care. Registrants in management positions remain professionally accountable for ensuring decisions align with Code standards, not merely organisational interests. Educators must model excellent practice, provide honest feedback, and raise concerns about teaching quality or student fitness. Researchers must protect participant welfare and conduct studies with integrity. Policy developers must ensure system designs promote safe, effective, person-centred care. The Code's principles adapt to context whilst maintaining core professional obligations.
No, professional accountability remains individual—you cannot use "my employer told me to" as defence against Code breaches. Standard 20.2 requires acting without delay if being asked to practise in a way that is beyond your scope of competence, inconsistent with Code standards, or would otherwise be unsafe or inappropriate. If employers pressure you to compromise Code standards, you must document concerns, escalate through appropriate channels (including potentially to NMC or CQC), and ultimately be prepared to refuse instructions fundamentally incompatible with professional obligations. Professional registration carries personal accountability transcending employment relationships.
The NMC Code's leadership framing represents fundamental shift from treating leadership as specialist function to establishing it as universal professional obligation. By requiring all registrants to provide leadership protecting wellbeing and improving experiences, model integrity and leadership for others, support colleagues to follow Code standards, and raise concerns about safety and quality, the Code positions every registered nurse, midwife, and nursing associate as leader within their sphere of influence.
This democratisation of leadership proves essential for healthcare's complexity. Problems often surface first at frontline, requiring staff delivering direct care to identify risks and champion improvements rather than waiting for senior leaders to notice issues. Cultural safety depends on everyone feeling empowered and obligated to speak up, not merely those in designated leadership positions. Quality improvement emerges from thousands of daily decisions by individual practitioners choosing excellence over convenience, not solely from strategic initiatives by executives.
For registered professionals, embracing leadership responsibility means moving beyond minimum compliance toward excellence aspiration. It involves asking not "what can I get away with?" but "what does exemplary practice look like in this situation?" It requires courage to raise difficult concerns, integrity to admit mistakes, generosity to support struggling colleagues, and continuous improvement orientation toward perpetual development. These leadership behaviours prove demanding but essential.
The Code's leadership standards create accountability framework supporting public protection and professional excellence. Understanding these requirements proves foundational for registered practice, whether you're newly qualified professional establishing good habits, experienced practitioner considering formal leadership roles, or senior leader supporting others' development. By meeting the Code's leadership expectations consistently across your career, you contribute to nursing and midwifery's collective credibility, capability, and public trust.
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