Step 1 – IDENTIFY THE PROBLEM(S)

• Briefly state the Scenario: A patient has reported to you as the SNCO that a female medic has made an inappropriate sexual remark to a male nurse in front of them.  What actions should you do?  What are the ethical issues?
• List the Issues that arise from the scenario.
• Identify Critical Information required and Assumptions to be made:

This scenario covers the ethics of professional behaviour, promoting professionalism and upholding the reputation of the profession.  It also involves the human rights and dignity that all professionals should expect from fellow professionals in whatever environment they work in and particularly in front of the patient. It also potentially involves disclosure by a SNCO to a higher authority against another registrant regarding the inappropriate sexual behaviour of a colleague and also them challenging that behaviour and not being an inactive bystander.

Step 2 – ANALYSE

Patient: 2 principles of beneficence and non-maleficence apply. The patient has the right to expect that health professionals act with professionalism and trust not only towards them as a patient but also each other.

Clinical: on hearing the remarks this could have caused the patient emotional harm. They may have been upset and distressed over what was said. In addition, the patient may feel that the female nurse has not treated her with kindness, respect and compassion by making such a comment in front of them. There will be an expectation up by the patient that you will deal with this matter appropriately to ensure that this does not happen again.  

Legal: The International Council of Nurses Code of Ethics is at: https://www.icn.ch/sites/default/files/2023-04/ICN_Code-of-Ethics_EN_Web_0_0.pdf . At section 1.2 it says that in order to be ethical nurses ought to promote an environment in which the human rights of the individual are to be upheld and respected. Similarly, at section 1.8. nurses ought to demonstrate professional values such as respect, justice, caring, compassion, empathy, trustworthiness and integrity towards all those they care. This includes not making inappropriate comments in front of the patient or to colleagues.

Societal/Military: To hold ethical values the SNCO should display a personal and professional commitment to the standards of practice and behaviour set out in their regulatory code (of whatever country) and the International code of ethics. The SNCO therefore has a duty to disclose to a higher authority the comments of the female nurse and challenge her on the inappropriateness of them and in particular, made in front of the patient. 

All nurses are bound by a professional code. In the United Kingdom, the Nursing Midwifery Council (NMC) that regulates all nurses, nursing associates and midwives’ states that the professional standards of practice and behaviour of registrants includes; privatising people, practising effectively preserving safety and promoting professionalism and trust. As in all nursing regulatory bodies the primary function is for the protection of the public and the reputation of the profession and such language by the female medic (if a registrant) fails to uphold the dignity of the patient and her colleague. It also damages the reputation of the profession. If the medic is not a regulated healthcare professional then this will warrant reporting through the chain of command for a potential disciplinary investigation.

Step 3 – FUSE

• Summarise conclusions
• Insert citations to key reference sources for your analysis
• Determine the exact Decision(s) to be made

This scenario considers the dignity, respect and compassion of the female medic owed to her colleagues and patients not to make unprofessional and disparaging comments against anyone and particularly of a sexual nature.  As the comments were of as sexual nature this there might also be a discussion about the fitness to practice of the female medic and professional misconduct.

Step 4 – DECIDE

• What is your Decision?
• Why (can you justify it)?
• Residual uncertainly, need for review?

The female SNCO needs to challenge the female medic’s inappropriate comments and report them. The patient needs to be reassured that they will be treated with kindness and compassion.

References and Further Reading

International Council of Nurses (Revised 2021), The ICN Code of Ethics for Nurses at Code. Available at ICN_Code-of-Ethics_EN_Web_0_0.pdf; accessed 24 August 2023

Nursing Midwifery Council: Future nurse: Standards of proficiency for registered nurses. Available at future-nurse-proficiencies.pdf (nmc.org.uk); accessed 24 August 2023

Nursing Midwifery Council. The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Available at The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates - The Nursing and Midwifery Council (nmc.org.uk) accessed 24 August 2023

Nursing and Midwifery Board of Australia. Available at https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx; accessed 24 August 2023

Contributor - Lt Col Janet Kelly VR RGN RM DIpHSM MA (HRM) LLB (Hons) PGHCE PhD. Senior Lecturer in Midwifery, Healthcare Law & Ethics; University of Hull. Chair for the Nursing Midwifery Council's Fitness to Practise Conduct and Competence Committees (2013 to 2021). She has served as a commissioned officer in Queen Alexandra's Royal Army Nursing Corps both as a regular and reservist for over 30 years and is now at the rank of Lieutenant Colonel.