Code of Professional Conduct for Nurses: principles, duties and sanctions

The Code of Professional Conduct sets out the rights and duties of all nurses, regardless of their place or mode of practice. It governs the relationship with the patient, confidentiality, relations between colleagues, professional communication and private practice. This guide presents the essential rules, article by article where necessary, and explains what you risk in the event of a breach.

What is the Code of Professional Conduct for Nurses?

The Code of Professional Conduct for Nurses stems from Decree No. 2016-1605 of 25 November 2016, published in the Journal officiel on 27 November 2016. It is set out in the Public Health Code, in articles R4312-1 to R4312-92. Prepared by the Conseil national de l'Ordre infirmier, it contains more than ninety articles.

It was amended by Decree No. 2020-1660 of 22 December 2020, which relaxed the rules on public information and advertising. The Order also publishes an annotated code that clarifies the application of each article.

Who is the Code of Professional Conduct binding on?

Under article R4312-1, the code applies to:

• all nurses registered on the Order's roll, whether employed or in private practice;
• nurses practising in France under the conditions laid down by law;
• nursing students.

Upon registration, you confirm to the departmental council that you have read the code and you undertake, under oath and in writing, to comply with it (article R4312-2). The procedures are set out in our guide on registration with the Order of Nurses.

What are the general principles of the code?

• Respect for the person: human life, dignity and privacy of the patient (R4312-3).
• Morality, integrity, loyalty and humanity in all circumstances (R4312-4).
• Professional independence: the nurse cannot surrender it in any form (R4312-6).
• Assistance: faced with a patient or injured person in danger, the nurse provides assistance or ensures they receive the necessary care (R4312-7).
• Contribution to public authorities in the event of emergency or disaster (R4312-8).
• Dignity of the profession: refrain from any act likely to bring it into disrepute (R4312-9).

What are the nurse's duties towards patients?

Providing care without discrimination and with competence

The nurse provides conscientious, attentive care based on established scientific knowledge (R4312-10). They care for all people with equal conscientiousness, without discrimination (R4312-11). They keep their skills up to date and comply with their obligation of continuous professional development (R4312-46).

Informing and obtaining consent

The patient has the right to honest, appropriate and intelligible information about their state of health and the care proposed; only emergency or impossibility exempts from this obligation (R4312-13). No care is provided without free and informed consent. If a patient refuses care after being informed of the consequences, the nurse respects this refusal (R4312-14). These rules align with those detailed in our guide on patients' rights.

Ensuring continuity of care

Except in an emergency, the nurse may refuse to provide care for a professional or personal reason. They must then explain their reasons to the patient, without causing them harm, and direct them to a colleague. Care that has been accepted must be continued regularly (R4312-12). For the Order, an arbitrary refusal without justification constitutes a breach.

Protecting the most vulnerable

Faced with a person who is a victim of abuse or ill-treatment, the nurse implements with prudence the most appropriate means to protect them. If it is a minor or vulnerable person, they alert the competent authorities (R4312-18). They relieve pain (R4312-19) and support the patient at the end of life, never deliberately causing death (R4312-20 and R4312-21).

What does the code say about professional confidentiality?

Confidentiality is binding on all nurses under the conditions established by law, and the nurse must instruct their staff on this (R4312-5). Within the same care team, professionals may exchange information strictly necessary for coordination or continuity of care (article L1110-4 of the Public Health Code). Outside the care team, sharing requires the patient's prior consent.

Point of caution: breach of professional confidentiality is also a criminal offence. Article 226-13 of the Criminal Code punishes it with one year's imprisonment and a fine of €15,000, independently of disciplinary sanctions.

What rules apply to collegiality between nurses?

Nurses maintain relations of good collegiality with one another. They are forbidden to slander a colleague, speak ill of them or relay remarks likely to harm them. In the event of a dispute, reconciliation should be sought, if necessary through the departmental council of the Order (R4312-25).

• Poaching of patients: poaching and attempted poaching are prohibited (R4312-61).
• After a locum: the locum ceases all activity with the patients of the colleague they replaced. After a locum of more than three months, they may not set up practice for two years in a place where they would be in direct competition with them, except with agreement (R4312-87).
• Other healthcare professionals: the nurse maintains good working relationships with other healthcare professionals (R4312-28).

Commissions, industry, conflicts of interest: what is prohibited?

• any commission for a professional act and any collusion, that is to say an agreement detrimental to the patient, for example with a supplier or an establishment (R4312-29);
• the sharing of fees, except where provided for (R4312-30);
• benefits offered by health product sector companies (R4312-52);
• any public communication without declaration of conflicts of interest (R4312-51).

Employed nurse: what particular rules apply?

The code applies in full to employees. An employed nurse cannot accept that their remuneration depends on productivity or performance standards (R4312-64). They retain their independence and remain bound by confidentiality, regardless of their employer (R4312-63). Their practice is governed by a written contract, in both private and public settings (R4312-65 and R4312-66). The Order exercises its disciplinary control alongside the employer's disciplinary authority.

Advertising and communication: what can a nurse do?

Since the decree of 22 December 2020, a nurse may communicate to the public, by any means including the internet, information about their skills and practices. This communication must be honest and truthful, must not include comparisons with other nurses, must not encourage unnecessary recourse to care and must not undermine the dignity of the profession (R4312-68-1).

What the Order permits

• a website presenting your skills and professional background in an objective manner;
• a presence on social media that respects professional ethics;
• a discreet nameplate indicating name, forenames, telephone number, consultation days and hours (R4312-70);
• an announcement in the press upon setting up practice, within the month following (R4312-71);
• business cards provided at the patient's request.

Good to know: the Order has published detailed recommendations on professional communication. Consult them before launching a website, a social media page or business cards.

What the Order prohibits

• the distribution of leaflets outside the practice;
• public advertising on vehicles;
• illuminated signs and commercial window displays;
• the promotion of patient reviews for self-promotion purposes;
• in general, any practice that treats the profession as a commercial activity (R4312-76).

What rules apply to private practice?

Several articles specifically target private practitioners. Fees are set with discretion and moderation, and any public information must mention the fees charged (R4312-80). Locum work is temporary: a nurse without a practice must hold an authorisation from the departmental council and cannot replace more than two nurses at the same time (R4312-83). Any change in conditions of practice or any cessation of activity must be reported without delay to the departmental council (R4312-89).

What sanctions apply for breach of the code of ethics?

A breach exposes the nurse to disciplinary proceedings, without prejudice to any possible criminal proceedings (R4312-1).

1. The complaint is filed with the departmental or inter-departmental council of the place where the nurse practises, by any person with a legitimate interest.
2. Conciliation, which is free of charge, is arranged within one month of the complaint being registered.
3. The first instance disciplinary chamber, chaired by an administrative judge, is seized in the event of conciliation failing.
4. An appeal is possible before the national disciplinary chamber within thirty days of notification.
5. An application for judicial review before the Council of State must be made within two months.

The sanctions provided for in article L4124-6 of the Public Health Code are warning, censure, a temporary or permanent ban on exercising certain functions, a temporary ban on practising (for a maximum of three years, with or without suspension of sentence) and removal from the register of the register. A training obligation may be imposed in the event of professional inadequacy. You may be assisted by a lawyer, although this is not mandatory. The relationship with civil and criminal liability is developed in our guide on the nurse's liability.

Official sources

• National Council of Nurses: Code of Ethics for Nurses, text of the code of ethics, annotated code of ethics
• National Council of Nurses: Advertising and communication, best practice, Legal brief on professional confidentiality
• National Council of Nurses: How to lodge a disciplinary complaint against a nurse, Complaint filing guide