What are the 4 pillars of NMC? A guide to the core principles and advanced practice

September 23, 2025 •

4 min read

The Nursing and Midwifery Council (NMC) regulates over 780,000 professionals in the UK, making its standards fundamental to safe care. The question, What are the 4 pillars of NMC?, is vital for both new and experienced practitioners seeking to uphold the highest standards of care. It's important to recognise that the term 'pillars' can refer to different frameworks depending on the context.

Quick Summary

The NMC uses different frameworks depending on the context; 'the four pillars' can refer to the four core themes of The Code that apply to all registrants or the four advanced practice pillars for specialised roles. Both sets of principles are crucial for delivering high-quality, professional care in the UK.

Key Points

Two Frameworks: The term '4 pillars of NMC' can refer to the four themes of The Code or the four pillars of advanced practice.
The Code's Themes: The Code's pillars are Prioritise people, Practise effectively, Preserve safety, and Promote professionalism and trust, applying to all registrants.
Advanced Practice Pillars: The pillars for advanced practice roles are Clinical practice, Leadership and management, Education, and Research.
Ethical Foundation: The NMC's principles are underpinned by ethical concepts like autonomy, beneficence, non-maleficence, and justice.
Promoting Safety and Trust: Both frameworks are designed to protect the public, ensure high standards of care, and build confidence in the nursing and midwifery professions.
Context is Key: Understanding the specific context—whether it refers to The Code or advanced roles—is necessary to define the correct set of 'pillars'.

Understanding the 'Pillars' of the NMC

When discussing the 'four pillars' of the Nursing and Midwifery Council (NMC), it is crucial to clarify which framework is being referenced. The term can refer to the four broad themes of the NMC's professional 'Code' that govern all registrants, or it can refer to the four pillars of advanced practice, which apply specifically to those working at a higher level of expertise.

The Four Themes of the NMC Code

The NMC Code is the foundation of good nursing and midwifery practice, and its four core themes are mandatory for all registered professionals. These themes define the professional standards and behaviours expected to protect the public and promote confidence in the professions. Adherence to The Code is a fundamental requirement for maintaining registration.

1. Prioritise people

This theme is all about putting the individual at the centre of care. It requires professionals to:

Treat people with kindness, respect, and compassion.
Uphold people's dignity and human rights.
Listen to people and respect their preferences, concerns, and choices.
Advocate for vulnerable individuals and challenge poor practice.

2. Practise effectively

This theme focuses on the competence and effectiveness of the care provided. It mandates that professionals must:

Base their practice on evidence and best-available knowledge.
Be accountable for their decisions and actions.
Maintain the necessary knowledge and skills for safe practice.
Work cooperatively within the wider healthcare team.

3. Preserve safety

This pillar highlights the essential responsibility to protect the public from harm. It includes the duty to:

Recognise and minimise any potential for harm.
Work with colleagues to create and maintain a safe environment.
Raise concerns immediately if a person's safety or dignity is at risk.
Follow all relevant safety procedures and protocols.

4. Promote professionalism and trust

This theme is about acting with integrity and upholding the reputation of the profession. Professionals are expected to:

Be open and honest, admitting when mistakes are made.
Maintain appropriate professional boundaries.
Use social media responsibly and professionally.
Uphold the public's confidence in the professions.

The Four Pillars of Advanced Practice

For nurses and midwives working at an advanced level, a different set of four pillars is used to define their roles and competencies. These pillars, also supported by the NMC, describe a higher level of expertise achieved through additional education and experience. This framework distinguishes advanced practice from standard or experienced practice.

1. Clinical Practice

This is the pillar of direct, expert care. Advanced practitioners are expected to demonstrate comprehensive, specialised clinical knowledge and skills. This involves a high degree of autonomy in complex decision-making, diagnosis, treatment, and management of patients with complex needs.

2. Leadership and Management

Advanced practitioners play a key leadership role, not only within their teams but also in shaping service delivery. This includes managing resources, supervising other staff, acting as a role model, and influencing policy to improve care.

3. Education

Advanced roles involve a significant educational component, both formally and informally. This includes teaching and mentoring students and other staff, contributing to curriculum development, and using their expertise to inform others' professional development.

4. Research

This pillar involves engaging with and using research to improve practice. Advanced practitioners must be able to critically appraise evidence, lead research projects, and ensure care is based on the latest findings. This drives innovation and quality improvement across healthcare.

Comparison: Code Themes vs. Advanced Practice Pillars


Aspect	NMC Code Themes	Advanced Practice Pillars
Application	Mandatory for all nurses and midwives on the register.	Framework for those working at an advanced, specialised level.
Focus	Defines the core ethical and behavioural standards for professional practice.	Describes a higher level of expertise and expanded scope of practice.
Scope	Foundational principles for all care interactions and professional conduct.	Encompasses advanced clinical skills, leadership, education, and research.
Example	Treating a patient with respect and kindness regardless of their background.	An advanced nurse practitioner leading a research project to improve patient outcomes in a specialist area.

Ethical Underpinnings: Autonomy, Beneficence, Non-maleficence, and Justice

While not explicit 'pillars' of the NMC in the same way as the Code's themes or the advanced practice framework, the principles of biomedical ethics form a critical foundation for nursing practice. These are woven into the very fabric of The Code and advanced practice principles, guiding professionals in their decision-making and patient interactions. They are often learned during training and revisited throughout a nurse's career.

Autonomy: Respecting the patient's right to make their own decisions about their care.
Beneficence: Acting in the best interests of the patient and promoting their well-being.
Non-maleficence: The obligation to 'do no harm' and to minimise potential harm to the patient.
Justice: Ensuring fairness, equal access to healthcare, and a fair distribution of resources.

Why these Frameworks are Essential

The NMC's frameworks, whether the Code's themes or the advanced practice pillars, serve as essential guides for professional practice. They ensure consistency, quality, and public safety across the nursing and midwifery professions. By clearly defining expectations, they provide a robust foundation for accountability and continuous professional development. Adherence to these standards is not just a requirement but a commitment to excellence and the well-being of the people in their care.

For more detailed information on the professional standards, visit the official NMC website at https://www.nmc.org.uk/standards/code/.

Conclusion: The Pillars of Professional Excellence

In summary, the term 'four pillars of NMC' can refer to two distinct but equally vital frameworks. For all registered nurses, midwives, and nursing associates, the pillars are the four themes of The Code: prioritise people, practise effectively, preserve safety, and promote professionalism and trust. For those pursuing or working in advanced roles, the pillars are clinical practice, leadership, education, and research. Both frameworks, supported by core ethical principles, are designed to ensure the highest standards of care and maintain public confidence in the professions.

Frequently Asked Questions

The NMC Code's four themes (Prioritise people, Practise effectively, Preserve safety, Promote professionalism and trust) are foundational standards that apply to all registered nurses, midwives, and nursing associates. The four advanced practice pillars (Clinical, Leadership, Education, Research) are a separate framework that outlines the higher level of expertise and expanded scope expected of those in advanced, specialised roles.

The 'Preserve safety' theme directly addresses this by mandating that professionals must recognise and minimise harm, work with colleagues to ensure a safe environment, and raise concerns immediately. Other themes also contribute, for instance, by promoting effective, evidence-based practice.

While not formally named as 'pillars' in the same way, these ethical principles are foundational to the NMC's frameworks. They are integral to the themes of The Code, particularly in areas like 'Prioritise people', and guide professionals' decision-making in their day-to-day practice.

This framework applies to nurses and midwives who work at an advanced level of practice, demonstrating a higher level of expertise, autonomy, and decision-making capabilities. This is achieved through additional education and substantial experience beyond initial registration.

The NMC ensures compliance through several mechanisms. These include the initial registration process, mandatory revalidation cycles where professionals must demonstrate they are meeting standards, and a robust fitness to practise process for when serious concerns arise about a professional's conduct or practice.

Research is a key pillar because advanced practitioners are expected to be leaders in evidence-based practice. This involves critically evaluating research to ensure care is of the highest quality, and in many cases, leading research initiatives themselves to improve patient outcomes and service delivery.

The 'Prioritise people' theme means that professionals must place the individual at the centre of their care. This involves treating people with respect and compassion, upholding their dignity and human rights, and ensuring their preferences and concerns are heard and addressed.