Freedom of expression and Fitness to Practise

When expressing your views you should be particularly mindful of the need to

• treat people with kindness, respect and compassion (1.1);
• listen to people and respond to their preferences and concerns (2);
• deal with differences of professional opinion with colleagues by discussion and informed debate, respecting their views and opinions and behaving in a professional way at all times (9.3).
• act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment (20.2);
• be aware at all times of how your behaviour can affect and influence the behaviour of other people (20.3);
• make sure you do not express your personal beliefs (including political, religious or moral beliefs) to people in an inappropriate way (20.7);
• act as a role model of professional behaviour for students and newly qualified nurses, midwives and nursing associates to aspire to (20.8);
• use all forms of spoken, written and digital communication (including social media and networking sites) responsibly, respecting the right to privacy of others at all times (20.10).

A midwife discusses their work with friends in a restaurant. They express very vocal support for a specific political party and claim that government action is destroying the service and profession they work in; they go on to criticise their line manager and say they are part of the problem.

Registered professionals are entitled to hold and express opinions about their work and politics, including in public, provided they do not act contrary to the Code. Sometimes such expression can be heated and passionate. In this scenario there is no evidence of behaviour contrary to the Code, such as racism, discrimination, harassment or breach of confidentiality, so we won’t take regulatory action here. Had the professional, for example, described their manager using a racial slur or indicated that they would treat patients differently based on their political views or other characteristics, then we would be likely to take action

A registered nurse has a conversation with a member of the public they meet on the train. The member of the public mentions their cancer diagnosis. The nurse refers to their registered status, discourages the member of the public from seeking medical help and suggests that extensive prayer will assist.

We are likely to take regulatory action against this professional. Regardless of the nature of any underlying beliefs, the professional’s words create risk to the public and are likely to fundamentally call into question their practice or the knowledge expected of a registered professional. The advice is public, given to someone aware of the nurse’s registered status and there is no evidence that the nurse has made reasonable qualifications to what they have said.

A registered nurse posts a public tweet comparing medical professionals delivering a vaccine to ‘angels of death’ and explaining that vaccination is ‘a plan to kill off the elderly’.

We are likely to take regulatory action against this professional. A registered professional should be aware of how their behaviour can affect and influence the behaviour of others, as well as undermine public confidence in their registered profession. The language used is inflammatory and abusive, their speech is public and goes far beyond a reasoned debate on the pros and cons of vaccination.

A nursing associate, knowing a colleague is transgender, persistently makes comments to them to “accept the body they are in” and recommends they should undertake therapy to deal with “their issue”. They raise the subject persistently and make jokes about trans rights and transphobic slurs whenever there is the opportunity.

We are likely to take action against this professional. They have targeted their colleague in a discriminatory and harassing manner. Their conduct could undermine confidence in the profession as well as raise public protection concerns. Even if the nursing associate could demonstrate that the underlying beliefs that motivated their conduct are themselves protected, that protection does not give them licence to harass others or to discriminate against them.⁸

A registered nurse deliberately misgenders a transgender person attending a diabetes clinic, despite that person repeatedly asking them to refer to them using the correct gender. The transgender person makes a formal complaint to the nurse’s employer. When challenged about her behaviour, the nurse says that she was acting in accordance with her belief that human beings cannot change their sex or gender.

We are likely to take action against this nurse. Persistently and deliberately misgendering a trans person is contrary to the requirements of the Code to treat people with kindness and respect. The nurse’s beliefs do not justify a clear departure from the provisions of the Code. Although gender-critical beliefs are protected under the Equality Act, this does not mean that those with gender-critical beliefs can ‘misgender’ trans persons with impunity.⁹

Whilst chatting during a lunch break, a midwife mentions to a colleague that they are opposed to recent proposals to reform legislation to make it easier for someone to change their legal gender. They believe that sex is binary and cannot be changed. They do not consider that the law should be changed to allow people to change their legal sex based solely on how they self-identify. The midwife’s colleague disagrees with this stance and worries that it will impact the midwife’s practice.

We are unlikely to take action on the basis of these facts alone. The Employment Appeal Tribunal has decided that Gender-critical views are capable of being protected beliefs.¹⁰ We will not take action against professionals unless the way their beliefs are expressed fundamentally calls into question a nurse, midwife or nursing associate’s practice or professionalism. Though the nurse’s beliefs may cause offense to others, there is no evidence in this example that they have expressed them in a way that could undermine public confidence in the profession. Nor is there any indication that the professional’s belief is affecting their ability to practise safely and according to the Code – for example, that the midwife in this example has failed to treat a transgender patient with kindness and respect or has harassed or discriminated against trans people.

A nurse has doubts about the efficacy or safety of a vaccine that is being widely administered as part of a nationwide public health campaign. They refuse to be vaccinated on this basis and tell colleagues about their misgivings.

There is no evidence at any point that the nurse has acted contrary to the Code.

While on duty a nurse tries to persuade parents to remove their consent to have their child vaccinated as child vaccination runs contrary to the nurse's ethical beliefs.

We are likely to take action in these circumstances. Even if the nurse’s underlying beliefs were protected, by seeking to actively interfere with treatment on that basis they are acting contrary to the Code. This conduct is likely to impact on care and public health, as well as undermine confidence in the profession.