NMC Code Section 21: Uphold Your Position as a Nurse

Section 21 of the Code is the integrity standard.

“Uphold your position as a registered nurse, midwife or nursing associate.”

Sub-clauses:

• 21.1 Refuse all but the most trivial gifts, favours or hospitality as accepting them could be interpreted as an attempt to gain preferential treatment.
• 21.2 Never ask for or accept loans from anyone in your care or anyone close to them.
• 21.3 Act with honesty and integrity in any financial dealings you have with everyone you have a professional relationship with.
• 21.4 Make sure that any advertisements, publications or published material you produce or have produced for your professional services are accurate, responsible, ethical, do not mislead or exploit vulnerabilities and accurately reflect your relevant skills, experience and qualifications.
• 21.5 Never use your professional status to promote causes that are not related to health.
• 21.6 Cooperate with the media only in ways that do not breach the other provisions of this Code, in particular by maintaining the confidentiality of people in your care.

Section 21 is shorter than Section 20 but more specific. It covers conduct around money, gifts, advertising and public profile.

What it means in practice

Three operating principles:

Don’t profit improperly. No loans from patients, no significant gifts, no commercial arrangements that exploit the professional relationship.

Don’t misrepresent. Advertising of independent practice should accurately reflect qualifications, scope and likely outcomes. The Advertising Standards Authority has published guidance on healthcare claims.

Don’t use the position for unrelated causes. Wearing uniform to political rallies, or promoting non-health-related products by citing nursing credentials, are Section 21 issues.

Common breaches

• Accepting significant gifts from patients or families.
• Selling products to patients: supplements, devices, books, especially via independent practice.
• Misleading advertising of private nursing services.
• Inappropriate media engagement: sharing identifiable case detail with journalists, using the uniform in non-nursing public contexts.
• Inheritance from patients: being named in a will, especially after recent care.

The gift threshold varies by trust. Most NHS trusts publish a value above which gifts must be declared.

CPD that maps to Section 21

• Anti-fraud and bribery training (mandatory in NHS trusts).
• Conflicts of interest declarations and policy.
• Professional ethics modules.
• Independent practice business standards (for those running private practice).

Common reflective account themes

Section 21 reflections are less common than other Pillar 4 sections but can describe:

• A gift situation you navigated.
• A commercial offer (often from a supplier) you declined.
• A media request you handled appropriately.

Where Section 21 connects to other sections

• Section 20 (uphold reputation): overlap on positional conduct.
• Section 22 (registration requirements): financial integrity issues can affect registration.

The next chapter covers Code Section 22 on fulfilling registration requirements.