2.1 SNB Code for Nurses and Midwives & Ethical Principles
Key Takeaways
The April 2018 SNB Code has four provisions—People, practice, profession and co-workers—and ten principles. Autonomy, beneficence, non-maleficence and justice are a separate, widely used bioethical framework.
Professional accountability requires nurses in Singapore to practice within their defined scope under the Nurses and Midwives Act (Cap. 209) and report unsafe practices immediately.
Maintain professional boundaries and follow institutional policies on gifts and money. Avoid personal gain, improper influence and relationships that compromise safe, objective care.
SNB’s Complaints Committee reports to the Board; the Board may exercise the applicable statutory powers.
2.1 SNB Code for Nurses and Midwives & Ethical Principles
The Singapore Nursing Board (SNB) is the regulatory authority established under the Nurses and Midwives Act (Cap. 209) to oversee the registration, licensing, and professional conduct of nurses and midwives in Singapore. Nursing practice is guided by the SNB Code for Nurses and Midwives (April 2018), which sets the standards for professional practice, ethical behavior, and clinical accountability. Nurses in Singapore must uphold these standards to maintain public trust, deliver high-quality care, and fulfill their professional legal duties across public healthcare clusters (SingHealth, National Healthcare Group, National University Health System) and private institutions.
Core Bioethical Principles in Clinical Nursing
Autonomy, beneficence, non-maleficence and justice are four widely used bioethical principles for clinical decision-making. They help analyse patient choices, benefits, harms and fairness; they are distinct from the SNB Code’s own four provisions and ten principles.
| Ethical Principle | Definition | Clinical Nursing Application in Singapore |
|---|---|---|
| Autonomy | Respecting an individual's right to self-determination and independent decision-making. | Obtaining voluntary informed consent, respecting refusal of treatment, honoring Advance Medical Directives (AMD). |
| Beneficence | Acting in the best interest of the patient to promote health and well-being. | Implementing evidence-based MOH Clinical Practice Guidelines, advocating for pain management, providing compassionate care. |
| Non-Maleficence | The obligation to do no harm (primum non nocere) and minimize risk of injury. | Checking medication administration against the applicable policy, following infection-prevention procedures, and preventing pressure injury. |
| Justice | Ensuring fair, equitable, and non-discriminatory distribution of healthcare resources. | Triage prioritization in emergency departments, providing non-judgmental care regardless of nationality, race, or socio-economic status. |
The Four Provisions and Ten Principles of the SNB Code
The SNB Code for Nurses and Midwives (April 2018) groups its ten principles into four provisions:
1. Nurses/Midwives and People
Principles 1–4 address respect for people’s values, needs and rights; autonomy and self-determination; privacy and confidentiality; and advocacy in people’s best interests. Care should reflect the person’s individual needs and choices without unfair discrimination.
2. Nurses/Midwives and Their Practice
Principles 5–7 address responsible and accountable practice, maintaining competence, and clear and accurate records. Nurses must work within their scope and competence, escalate concerns about unsafe practice, and keep complete, accurate and timely documentation.
SNB’s RN target is 15 CPE points per qualifying period (1 September to 31 August). During the transition towards mandatory CPE, SNB’s notice updated 21 July 2026 allows nurses and midwives with insufficient points for the current period to renew their PC for 2027, while asking them to continue earning points for 1 September 2026–31 August 2027. APNs have separate mandatory requirements of 30 CPE points per qualifying period. For the PC2027 renewal cycle, SNB’s notice updated 7 October 2026 says a late fee applies after 3 December 2026 and the current PC expires on 31 December 2026. These are cycle-specific dates; a valid PC is always required to practise.
3. Nurses/Midwives and Their Profession
Principles 8–9 address professionalism and public trust, and self-regulation. Nurses must maintain appropriate professional boundaries, communicate responsibly, keep a valid PC and maintain fitness and competence to practise.
4. Nurses/Midwives and Co-workers
Principle 10 addresses collaboration with all members of the healthcare team through respectful interactions, clear and timely communication, mutual support and safe ethical care.
Source: SNB Code for Nurses and Midwives (April 2018), printed pages 2 and 4–13. The edition date is distinct from the date on which SNB’s website is updated.
Professional Boundaries, Gifts and Money
A therapeutic relationship must focus on the person receiving care. The SNB Code’s Principle 8 requires following institutional policies when gifts or money are offered; where there is no policy, nurses must avoid becoming beholden or inviting allegations of impropriety. Its professional-boundaries appendix warns against personal or business relationships that compromise the therapeutic relationship and against sexual misconduct.
Check the institution’s actual policy, disclose concerns through the appropriate channel and avoid using a professional position for personal gain. Evaluate the offer under the institution’s policy, the therapeutic relationship and professional responsibilities.
Scope, Competence and Delegation
RNs and ENs must work within the scope and competence applicable to their registration or enrolment. Delegating an activity requires an appropriate decision about the recipient’s competence, instructions, supervision and follow-up; the recipient also remains accountable for their own practice. Consider the delegating nurse’s decisions and the recipient’s own actions and competence when assessing accountability.
APN expanded practice depends on education, certification and legislative, regulatory and institutional requirements. Prescribing or ordering under a collaborative-prescribing arrangement additionally requires the relevant qualification and training, programme completion, collaborative practice agreement and institutional approval described by MOH.
SNB Complaints and Board Decisions
SNB’s current public complaints guidance describes this process:
- A written complaint identifies the practitioner, allegations and supporting evidence.
- The Board may appoint a Complaints Committee to investigate relevant convictions, misconduct/negligence or physical/mental fitness. The committee may conduct a formal inquiry and submits a report and recommendations to the Board.
- Under section 19(2), the Board may cancel registration/enrolment, suspend it for not more than two years, impose conditions, impose a financial penalty of not more than S$2,000, censure the practitioner or issue a written warning.
The Board considers the applicable powers in each case; a complaint does not automatically determine a particular sanction. Consult current SNB guidance for the decision and review procedures.
Source: SNB complaints guidance, updated 24 June 2025.
Clinical Scenario: Applying an Institution’s Gift Policy
Hypothetical case: A ward’s written policy requires staff to decline personal cash gifts. A grateful patient’s family offers a nurse an envelope containing S$500.
The nurse should politely decline under that stated policy, explain the professional boundary and suggest a thank-you note or the institution’s recognition process. The Code supports compliance with institutional gift policies; the case does not establish a universal statutory cash-gift rule for all institutions.
A ward’s written policy requires staff to decline personal cash gifts. A patient’s family offers a nurse S$200. Which response follows that policy and maintains professional boundaries?
Accept the money but donate it immediately to a ward charity fund without reporting it.
Politely decline the cash gift, explain the professional boundary policy, and suggest a written thank-you note.
Accept the cash gift as long as it was offered voluntarily after patient discharge.
Divide the cash equally among all shift nurses on duty without informing the nurse manager.
A Registered Nurse performs a routine nasogastric tube insertion on a competent adult patient who explicitly verbally refused the procedure. Which core bioethical principle has the nurse directly violated?
Autonomy
Beneficence
Justice
Fidelity
According to SNB’s published complaints guidance, which body may cancel a nurse’s registration under the applicable section 19(2) powers?
Ministry of Health (MOH) Legal Counsel Department
Singapore Nursing Association (SNA) Executive Board
The Singapore Nursing Board
Hospital Quality Management and Peer Review Board
Sections you finish are checked off in the contents.