NMC Code Section 6: Use Best Available Evidence

Section 6 opens Pillar 2 (Practise Effectively) with the evidence-based practice obligation.

“Always practise in line with the best available evidence.”

Sub-clauses:

• 6.1 Make sure that any information or advice given is evidence-based, including information relating to the use of any health and care products or services.
• 6.2 Maintain the knowledge and skills you need for safe and effective practice.

The section is shorter than most but its reach is wide. Almost every clinical decision is a Section 6 decision: what intervention to recommend, what guideline to follow, what advice to give a patient.

What it means in practice

“Best available evidence” is a hierarchy, not a single thing:

1. High-quality research evidence: randomised controlled trials, systematic reviews. The foundation when available.
2. Clinical guidelines: NICE in England, SIGN in Scotland, NICE-adopted in Wales and Northern Ireland. These synthesise evidence into recommendations.
3. Professional consensus: Royal College guidance, specialist society standards.
4. Clinical experience and patient preference: the application layer where the evidence meets the individual.

In daily practice you usually start with the guideline. NICE’s app and website are the standard UK reference. For a community nurse covering hypertension, NICE NG136 is the guideline. For a midwife covering postnatal care, NICE NG194. The guidelines are deliberately accessible, written for direct clinical use.

Common breaches

Section 6 breaches in fitness-to-practise cases:

• Practice contrary to current guidelines: using an outdated protocol after a guideline update.
• Advice based on personal preference rather than evidence (especially common in patient education).
• Failure to update knowledge: recommending interventions that have since been retracted.
• Recommending products without an evidence base, particularly relevant where there’s a commercial relationship.

The pattern is usually drift: a nurse who learned a practice 15 years ago and never reviewed the evidence as the guideline changed. The CPD requirement is the mechanism that’s supposed to prevent this.

CPD that maps to Section 6

• Critical appraisal skills, short courses widely available.
• NICE guideline updates in your area of practice (NICE publishes update alerts).
• Research methods, for understanding the evidence you’re reading.
• Evidence-based practice frameworks (PICO question framing, hierarchy of evidence).
• Journal clubs, participatory and effective.
• Clinical guideline reviews: when your trust updates protocols, the review process itself is CPD.

The most efficient CPD for Section 6 is subscribing to update alerts for the NICE guidelines that apply to your area of practice. Half an hour reviewing each update as it lands is more useful than a study day.

Common reflective account themes

Strong Section 6 accounts describe:

• A guideline change you adapted to, and how the change in your practice followed.
• A piece of patient education where you realised your advice was outdated and you updated it.
• A clinical decision where you balanced research evidence against the specific patient’s circumstances.
• An audit or review you contributed to that compared current practice against the current evidence.

The accounts that work show the registrant actively engaging with evidence, not just passively receiving training.

Where Section 6 connects to other sections

• Section 13 (limits of competence): evidence often reveals what you don’t yet know.
• Section 19 (reduce risk of harm): most safety improvements are evidence-based.
• Section 25 (provide leadership): supporting team adoption of evidence is a leadership act.

The next chapter covers Code Section 7: communicating clearly.