The meta ethics of regulation and guidance

The UK professional Code for nursing has recently undergone further iteration and has grown significantly since it first appeared in 1983. Unlike the previous version the new Code does not have the word ‘ethics’ in its title and only once in its text, in relation to advertisements. This is correct because the code it is not an ethical code but a quasi-legal one, separating unacceptable practice from the just acceptable. The code makes it clear that the values and principles set out are neither negotiable nor discretionary, and yet also states that ‘The code contains a series of statements that taken together signify what good nursing and midwifery practice looks like’. These statements demonstrate conceptual confusion about what the code and associated standards are and what they are for, because they suggest that a nurse acting within the code is a good nurse. I argue that a good nurse is much more than that.
Wording in code and associated standards documentation demonstrate the difference between quasi-legal and ethical injunctions. The NMC website makes it clear that standards use the forceful ‘must’ while guidance uses the normative ‘should’. The distinction is set out much more overtly in corresponding documents from the General medical Council.
This presentation examines the use of the words ‘must’ and ‘should’ in regulatory documents from the NMC and argues that the distinction between them is important for practitioners and educators because they help explain what is required of all nurses and how nurses can aspire to become good nurses. The misuse of these words impedes this function, offering, in places, contradictory, unrealistic and virtually meaningless injunctions likely to result in the standards failing to meet their regulatory and educative function.