The duties and prohibitions of the health worker

Distinguish the general duties, the duties towards the patient, the duties in social medicine and the duties of confraternity that Decree 89/354 of 3 March 1989 imposes, and identify the prohibitions whose breach opens the disciplinary route.

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Why this matters

A nurse who cannot say what she owes and what she must refuse has no defence when a decision is questioned. The duties in this section explain why you cannot choose your patient, why consent is not a signature but a conversation, and why a public-health declaration is part of the care you give. The prohibitions explain why some choices end a career in a single shift. Knowing both is what turns personal kindness into a professional obligation that can be named out loud.

What you need to know first

You do not need to memorise a decree. You need to be able to read one article and answer three questions about it: who owes the duty, to whom is it owed, and what happens when it is broken? If you can answer those three questions, the list stops being a list.

Words to know (5)

Duty: What a professional is bound to do, or to refrain from doing, because of the rules of the profession rather than because of personal preference. Providing care to anyone in immediate danger is a duty; the nurse does not first ask whether the person can pay.
Prohibition: An act the professional must never perform, stated absolutely and without a balancing test, so that the single fact of doing it is already a breach. Financially exploiting a patient is prohibited; the nurse cannot justify it by saying the patient agreed.
Confraternity: The mutual duties that members of the same profession owe one another: moral assistance, loyalty, and the courtesy of warning a colleague before you take over the patient he was following. A colleague is accused of negligence on the ward; confraternity requires you to defend him if the accusation is unjust, not to repeat it in the corridor.
Non-discrimination: The rule that care is owed to every individual without regard to origin, sex, age, religion, wealth, illness or personal conduct — including prisoners, migrants and those whose behaviour you dislike. A nurse who leaves an unconscious drunk man in the corridor because of how he behaved earlier has broken the duty of non-discrimination.
Social medicine: The part of professional duty directed at the health of a population rather than at one patient, such as declaring communicable diseases and cooperating with public-health programmes. Declaring a case of cholera to the district public-health service is a duty in social medicine, not an administrative formality.

One idea at a timeIdea 1 / 7

In one sentence Absolute respect for life, care without discrimination, help to anyone in immediate danger and respect for the patient’s free choice apply to everyone you meet.

General duties are owed to every person, not only to the pleasant ones

The general duties come first because they set the floor under every other rule: absolute respect for life, care to any individual without discrimination, help to anyone in immediate danger, respect for the patient’s free choice. With them come the working duties. Provide services safely and ethically, obtain consent, report concerns about a colleague’s conduct, respond to adverse events, adopt standard infection precautions, minimise harm to others if infectious. Comply with privacy laws, keep proper records, display the national code. The list reaches prisoners, migrants, the person whose behaviour disgusts you, and the colleague whose practice worries you.

For example

A man is brought in unconscious after a fight and the staff recognise him as the person who robbed the ward last month. The duty of non-discrimination does not ask whether he deserves care; it requires the same assessment, the same monitoring and the same respect as for anyone else.

Pause and check yourself

A nurse stops a colleague from giving a patient an injection after the colleague admits she has been drinking. Is the nurse breaking confraternity?

Show the answer

No. Confraternity never outranks the duty to protect the patient. Stopping the injection, then reporting the matter through the proper channel, is the conduct the code requires.

Read detailed explanations

What happens after the breach: two routes and who bears the damage: A prohibition is only a prohibition if something follows it, and in the Cameroonian public hospital the consequence takes two shapes at once. A public servant who is a member of the medical corps is subject to administrative discipline in addition to the professional discipline of the order, and the two are not alternatives: they run side by side, each before its own authority. The administrative route belongs to the civil-service hierarchy of the public hospital, and its measures are graded by gravity. The professional route belongs to the council of the order sitting as a disciplinary chamber, and its referral is initiated by the order of the medical professionals of Cameroon and by the Ministry of Public Health; that route before the order is independent of the employer, who cannot close it by an agreement or an internal arrangement. The second shape is financial. The hospital also answers financially for the damage its staff cause in the service, and the institution’s liability — who may claim, and what it does to the worker’s file — is set out in 5.3. The lesson for practice is that one act can produce two files that answer different questions: one asks whether the professional standard was respected, the other asks who must pay for the damage. A resignation does not extinguish a criminal or a civil liability already incurred, and it does not answer the professional body in the place of the person who committed the act.
Who opens a disciplinary file, and the name of the national instrument: The route from an act to a sanction is institutional. Any breach of the code of ethics of the health professions may result in sanctions, and the council of the order, constituted as a disciplinary chamber according to the law, is the body whose jurisdiction can be seized. The initiative of the referral belongs to the order of the medical professionals of Cameroon and to the Ministry of Public Health. One detail in the sequence is worth learning: a complaint made against a medical doctor must first be investigated by the disciplinary board before it produces its effects, and the investigation is not a formality that a busy service can skip. A word is also needed about the name of the instrument, because the notes are correct on this point and a student should not be told otherwise. The heading of the notes calls the text the code of the medico-sanitary professions; the body of the notes already identifies Decree 89/354 of 3 March 1989 and names its three professions — nurse, midwife and medical technician — with the medical profession governed separately. No correction of the notes is needed on this point. The one correction that is needed concerns the oath, and it is treated in the next topic.
The 1893 pledge, the self-imposed oath and the ICN’s three responsibilities: The pledge studied in this course has a history that the notes leave implicit, and that history changes how a student should read it. The text is not a letter written by Florence Nightingale. It is a professional pledge composed for nursing graduates in 1893 — thirty years after Nightingale’s own work — and it was cast as an ideal for the nurse rather than as her personal text; the notes describe the senior nursing oath as the oath of Florence Nightingale, and that attribution is the one correction this chapter needs. The origin matters because it shows that the profession chose its own standard at the moment when it was organising itself, and not merely that a famous reformer inspired it. The second thing the pledge adds is a mechanism of enforcement. A code of ethics is enforced against a professional by an institution: a complaint, an investigation, a sanction. An oath is enforced by the professional against himself, which is why the notes insist on the psychological repercussions of a violation in addition to the legal ones, and why the candidate is asked to meditate and to withdraw if he cannot keep the promise. That exit clause is what makes the oath a decision rather than a ceremony. The pledge can also be read beside the international code the profession adopted later. The 1953 International Council of Nurses code, adopted at São Paulo, states three responsibilities — keep life, relieve suffering, promote health — and adds a rule of conscience: the nurse carries out medical prescriptions intelligently and loyally, but must refuse to take part in acts that ethics condemns. Read together, the personal promise and the professional code cover the same ground from two directions: the oath states the standard as a value the nurse adopts, and the code states it as a rule the profession applies. The second half of this course — secrecy, responsibility, civil liability — is the legal translation of that value, and it is easier to accept once the value has been named.

Explore the diagram

Look at the whole drawing first. Then select one numbered part and connect it to the idea you just read.

The duties and prohibitions of the health worker

The code of 3 March 1989 states one body of duties in four directions — general, towards the patient, in social medicine, towards colleagues — then a short list of absolute prohibitions. A breach opens two routes at once: the administrative route of the public hospital, graded in four groups, and the professional route of the council of the order sitting as a disciplinary chamber.

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01 / 8Decree 89/354 of 3 March 1989

If the drawing is wider than this panel, scroll it sideways. Labels stay readable; the numbered explanations below show the same ideas.

Decree 89/354 of 3 March 1989

This is the instrument that gives the duties their legal force. It was signed by the President of the Republic on 3 March 1989 and it governs the professions of nurse, midwife and medical technician; the medical profession is covered by a separate text. Read the whole plate from here, because every list below is a clause of this one decree and not a collection of good advice. The lecture notes attribute the general duties to this text; naming the decree and its date is what allows you to find the article instead of arguing from memory.

Teaching schematic, not a legal procedure. The plate shows how the decree is organised and how a breach is routed; the four administrative groups and the disciplinary route are drawn side by side because a single act can engage both, and article numbers are not reproduced here.

Key points to remember

The general duties are owed to every person without discrimination: absolute respect for life, help in immediate danger, respect for free choice, safe and ethical services, consent, appropriate conduct, standard infection precautions, reports of a colleague’s conduct, and confidential, well-kept records.
The duties towards the patient govern the care relationship: provide all necessary care, act with correction, be meticulous in diagnosis, verify the execution of treatment, give prophylaxis, advise hygiene, stay out of family affairs; and consent is the hinge, required from the patient before care, because the information belongs to the patient.
Social medicine and confraternity extend the duty beyond the bed: declare communicable diseases and assist public health, and among colleagues give moral assistance, defend the unjustly accused, warn before taking over a patient and avoid direct competition.
The prohibitions are absolute and one act is enough: no false claim to cure serious illness, no misinformation, no practice under the influence or while impaired, no financial or sexual exploitation, no refusal to help a colleague with a patient, no ostracism.
The Nightingale oath makes the code a personal promise: a life of integrity, faithful observance of the code, abstention from anything harmful or criminal, no deliberate administration of a dangerous remedy, continuing competence, and professional secrecy — with the freedom to withdraw before swearing.

Go deeper

Worked example

The colleague who drinks before the night shift. At 21:40 a nurse smells alcohol on the breath of a colleague who has just come on duty in the intensive care unit. The colleague is due to manage two ventilated patients and a morphine infusion. He is popular, has twenty years of service, and says he had one beer at a family gathering two hours ago and is perfectly fine.

Name the duty that decides the case. It is not confraternity, and it is not loyalty. The prohibition on providing care while under the influence of alcohol, or while suffering from any condition likely to place clients at risk, is stated absolutely. A prohibited act is not measured, so “one beer” and “twenty years of service” are not quantities in the calculation.
Act before arguing. The immediate duty is that the colleague does not take charge of the ventilated patients or the morphine infusion. The nurse arranges cover with the senior on duty first, because a patient must never be left without a competent person during a professional disagreement.
Separate the person from the act. The obligation to report concerns about the conduct of other health care workers is a general duty, but it is not a duty to humiliate. The report is written, factual and addressed to the person who can decide: time, observation, and what was and was not done — not a diagnosis of a colleague’s character.
Apply the duties of confraternity in the right direction. Confraternity requires moral assistance and the defence of a colleague who is unjustly attacked. Here the colleague is not attacked unjustly; he is protected from a decision that could destroy both a patient and his own career, and he is offered help, because the code names the obligation to assist a confrere and to take timely measures to minimise harm.
Record and follow up. The incident is documented, the colleague is referred for support, and the head of department confirms the following shift’s staffing. A conscientious objection by other staff, a silent rearrangement of the roster, or a note in the corridor would each leave the same risk in place for the next night.

The colleague does not take charge of the patients, the nurse does not shame him, and the event is written down and followed up. Three duties all pointed the same way — the prohibition on impaired practice, the general duty to report concerns about a colleague’s conduct, and the duty of confraternity to offer moral assistance — and only a false idea of loyalty suggested the opposite.

Common misconception

Beginners often read a code of ethics as a list of prohibitions, so the duties look like decoration and the prohibitions look like the real content. The opposite is true, and the order of the text shows it: the code begins with duties because they tell you what to do all day, and the prohibitions are the small set of acts that sit outside practice altogether. A second and more damaging mistake is to treat confraternity as a duty of silence. It is a duty of loyalty and mutual assistance, which includes defending a colleague against an unjust accusation — and never includes covering an act that puts a patient at risk. When the two readings conflict, the patient wins, because the general duties are owed to every person and no professional duty outranks them.

Check your reasoning

Think of a rule at your clinical placement that everyone follows without being able to explain why. Ask the three questions of a duty: who owes it, to whom, and what follows if it is broken? Then ask whether the rule is written in the code or is only a ward habit — and what you would do the day a senior colleague asks you to skip it.

Reveal an answer

Most ward rules turn out to be habits whose origin nobody remembers, and the three questions usually expose the difference. When the rule is in the code, breaking it is a disciplinary matter with a named route: a report, an investigation by the disciplinary chamber, and a sanction that may reach dismissal from the civil service. When it is only a habit, breaking it costs social approval but nothing legal — and the habit may itself be wrong. The professional answer in both cases is the same: say the duty out loud, write down what you did and why, and let the record, not the corridor, carry the decision.

Where this comes from

BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey) · Chapter on the duties of nurses under the code of ethics of 3 March 1989 of the medico-sanitary professions in Cameroon: general duties, duties towards the patient, duties in social medicine, duties of confraternity, duties towards other health professionals, prohibitions and disciplinary procedure; together with the chapter on the moral qualities of a nurse and the analysis of the national Florence Nightingale oath
Republic of Cameroon, Decree No. 89/354 of 3 March 1989 on the code of ethics of the professions of nurse, midwife and medical technician · the notes attribute the general duty list to the decree without giving its articles; the vicarious liability of the public hospital and the coexistence of the administrative and professional routes are stated in the notes’ chapter on professional secrecy and are reused here as the consequence of a breach
International Council of Nurses, Code of Ethics (São Paulo 1953; revised Mexico 1973) · used to show that the obligations the oath states personally are the same obligations the professional code states for the profession
World Medical Association, Declaration on the Rights of the Patient · the modern position on the patient’s right to information, cited to correct the notes’ suggestion that a serious prognosis may be concealed from the patient while consent is still required

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About this course and its sources

Bilingual lessons organised from the supplied BMS 115 Health Care Ethics lecture notes (Mme Bakume Jessey, St Louis University Institute Douala) and the international texts those notes reproduce — the Universal Declaration of Human Rights 1948, Pacem in terris 1963, the African Charter on Human and Peoples’ Rights (drafting launched at Monrovia in 1979 by Decision 155; adopted 1981; in force 21 October 1986), the 1959 Declaration of the Rights of the Child, the ICN codes of 1953 and 1973, and the Cameroon code of ethics of 3 March 1989. The short guided notes and the longer “Read detailed explanations” panels are written as two different jobs: the notes state one idea plainly, and the detailed panels add mechanism, vocabulary and worked judgement that the notes do not contain. Diagrams are original teaching schematics. Ethics, nursing and French-language review are pending.