NMC Code Section 2: Listen and Respond to Concerns

Section 2 of the Code asks for active engagement with what patients and their families say.

“Listen to people and respond to their preferences and concerns.”

Sub-clauses cover:

• 2.1 Work in partnership with people to make sure you deliver care effectively.
• 2.2 Recognise and respect the contribution people make to their own care.
• 2.3 Encourage and empower people to share decisions about their treatment and care.
• 2.4 Respect the level to which people receiving care want to be involved in decisions about their own health, wellbeing and care.
• 2.5 Respect, support and document a person’s right to accept or refuse care and treatment.
• 2.6 Recognise when people are anxious or in distress and respond compassionately and politely.

Section 2 is heavier on rights (particularly the right to refuse) than Section 1. Most Section 2 reflections involve a moment where what the patient wanted didn’t match what the system was set up to deliver.

What it means in practice

Active listening means visibly hearing, not just allowing speech. The classic test: can you summarise what the patient just said back to them in a way they recognise? If yes, you listened. If no, you waited for them to stop talking.

Shared decision-making (the focus of 2.3) is more than informing the patient and asking them to agree. It’s offering genuine options where they exist, explaining the trade-offs, and giving the patient real influence over the choice. NICE’s guideline NG197 sets the standard for what this looks like in practice.

The right to refuse (2.5) is the section’s hardest clause for many nurses. A patient with capacity refusing recommended treatment can be difficult to support. The Code is clear: capacity makes the refusal valid, and the nursing role is to document the refusal and continue providing care for what the patient does accept.

Common breaches

Section 2 breaches tend to be quieter than Section 1 breaches. They show up in fitness-to-practise cases as:

• Failure to record discussions of preferences and concerns, especially around end-of-life choices.
• Pushing through care that the patient was resisting, particularly with patients who had capacity but were assumed not to.
• Failure to recognise distress, where a patient becoming withdrawn or anxious is not responded to until the issue escalates.
• Family input ignored when the family had information about the patient’s typical wishes or behaviour.

The pattern is often busyness rather than malice. A nurse short on time defaults to the standard care pathway without checking whether the standard pathway is what this particular patient wants.

CPD that maps to Section 2

Useful CPD for Section 2 reflections:

• Active listening training, short, often included in communication modules.
• Shared decision-making courses (NICE has aligned resources).
• Mental Capacity Act updates, especially relevant given 2.5.
• Motivational interviewing, for behaviour change conversations.
• Communication with people in distress, including de-escalation training and mental health awareness.
• Complaints handling, often where Section 2 failures get formalised.

The Section 2 competencies (active listening, shared decision-making, recognising distress) overlap heavily with the communication competencies recruiters interview for at band 6+ nursing roles, so CPD here doubles as interview prep.

For 2.6 specifically (responding to anxiety and distress), trauma-informed care training is increasingly available and counts.

Common reflective account themes

Section 2 accounts often describe a moment when a patient’s voice changed the plan:

• A patient near end of life asking for fewer interventions than the medical team had planned, and how you advocated for the patient’s preference.
• A family member raising a concern about a patient’s deterioration that hadn’t been heard by other staff, and how you escalated the concern.
• A patient refusing a medication, and the conversation that worked through whether the refusal was informed.
• A distressed patient whose behaviour was being treated as challenging until you recognised the underlying anxiety.

The reflective accounts that work are honest about the moments when you almost missed something. The ones that don’t work present the nurse as already perfect and the patient as the recipient of that perfection.

Where Section 2 connects to other sections

• Section 4 (act in best interests): the bridge when a patient lacks capacity.
• Section 7 (communicate clearly): listening is half of communication.
• Section 14 (duty of candour): when something goes wrong, Section 2 requires you to hear the patient’s account before deciding what to disclose.

The next chapter covers Code Section 3: assessing physical, social and psychological needs.