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Nursing and Midwifery Council
Fitness to Practise Committee
Substantive Hearing
16 September 2019 - 20 September 2019
Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ
Name of registrant: Fatimah Akinwande NMC PIN: 00I4898E Parts of the register: Registered Nurse – Sub part 1 September 2003 Area of registered address: England Type of case: Misconduct Panel members: David Crompton (Chair, Lay member)
Paul Webb (Registrant member) Linda Redford (Lay member)
Legal Assessor: Sanjay Lal Panel Secretary: Deepan Jaddoo Ms Akinwande: Present and represented by Adewuyi Oyegoke Nursing and Midwifery Council: Sophie Stannard, Case Presenter Facts proved: 1 (in its entirety)
2 (solely in relation to Patient A) Fitness to practise: Impaired Sanction: Caution order – 1 year
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Details of charge
That you, a registered nurse:
1) On 10 March 2017 drew an incorrect dose of oral medication into a syringe.
2) On 4 July 2017 did not respond adequately when informed that Patient A and/or
Patient B appeared distressed and/or required PRN medication in that you;
a) Asked Colleague 1 and/or Colleague 2 if Patient A and/or Patient B could wait
until after handover or words to that effect.
b) Did not attend Patient A and/or Patient B to assess them.
c) Did not assist Colleague 1 and/or Colleague 2 to find the keys for the medication
cabinet.
d) Did not ask another registered nurse to administer the PRN medication to Patient
A and/or Patient B.
e) Did not escalate Patient A and/or Patient B to the nurse in charge.
AND in light of the above, your fitness to practise is impaired by reason of your
misconduct.
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Background
You qualified as a registered nurse in September 2003. On 21 July 2017 the NMC
received a referral from North East London NHS Foundation Trust (“the Trust”). You
commenced employment with the Trust in February 2004 as a Band 5 Mental Health
Nurse. In December 2015 you were transferred to the Ward and placed on a
Performance Improvement Plan (PIP).
At the time of the alleged incidents, you were working as a Band 5 Staff Nurse on the
Brookside Acute Inpatients Unit (“the Unit”) at Goodmayes Hospital (“the Hospital”). Due
the requirements in your PIP, you were unable to administer medication without
supervision.
The Unit is a general acute mental health inpatient ward for young people who were
deemed too high risk to be managed safely in the community. Patients on the Unit have
a range of mental health issues which include anxiety, depression, self-harm, psychosis
and neurodevelopmental disorders.
It is first alleged that on 10 March 2017, whilst you were working in accordance with
your PIP and under the supervision of Colleague 3, Registered Nurse and Manager of
the Unit, you drew an incorrect dose of oral medication into a syringe. It is alleged that
despite correctly calculating the amount of medication to be drawn up, the amount
which you drew was significantly incorrect.
The second set of allegations refer to an incident which occurred on 4 July 2017. It is
recorded that on this date, Colleagues 1 and 2, both of whom are Health Care
Assistants (HCA’s) became aware of two young patients, Patient A and Patient B, who
were displaying signs of distress between 20:00 and 21:00.
Handover on the Unit occurs between 20:00 and 21:00. At the time, Colleague 4, the
only other Registered Nurse on shift, was completing handover to the night nursing
staff.
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Colleague 1 is recorded to have noticed Patient B rolled into a ball on the floor in the
corridor. Patient B was deemed as ‘high risk’ due to her history of self-harm. Colleague
1 records that at the time she was trying to dig her finger nails into her arm.
Patient A is recorded to have been seen banging his head against the wall.
Colleague 1 records that he attended Patient A immediately after both he and you were
informed of this by another patient on the Unit. Colleague 1 records that he took Patient
A back to his room and that he was finding it difficult to engage with Patient A due to
him being distressed. Colleague 2 records that he went to the nurses’ office and
informed you about both patients and requested that you assist him by talking to both
Patient A and B and administering PRN medication to them. It is alleged that Colleague
1 also went back to the nurses’ office and requested you to administer PRN medication
to Patient A.
It is recorded that both Colleague 1 and 2 approached you at different times regarding
obtaining keys to access the PRN medication, and that you provided similar responses
to both colleagues who spoke to you at different times by saying that you did not have
the keys and directing them to speak to the nurse in charge (Colleague 4).
Colleague 1 records that he did this and returned back to you, informing you that
Colleague 4 did not have the keys, and that you remained seated and did not assist.
Colleague 2 records that he also did this and that upon returning back to you, you told
him that the patients would have to wait until handover was completed when the night
staff were able to assist.
Following this, Colleague 1 found the medication keys in the door of the medicine
cabinet and handed them to you. Colleague 1 records that he immediately returned to
Patient A, and waited for you to attend, however you did not.
The night staff attended both Patient A and Patient B following the completion of
handover and following an alarm being raised due to Patient B being found ligaturing
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with wire. Colleague 1 and other staff members were able to remove the wire around
Patient B’s neck and take him to the treatment room.
The NMC therefore allege that you did not respond adequately when informed that
Patient A and/or Patient B appeared distressed and/or required PRN medication, in that
you:
Asked Colleague 1 and/or Colleague 2 if Patient A and/or Patient B could wait
until after handover or words to that effect.
Did not attend Patient A and/or Patient B to assess them.
Did not assist Colleague 1 and/or Colleague 2 to find the keys for the medication
cabinet.
Did not ask another registered nurse to administer the PRN medication to Patient
A and/or Patient B.
Did not escalate Patient A and/or Patient B to the nurse in charge.
Admissions
At the outset of this hearing, Mr Oyegoke, on your behalf, with the assistance of Ms
Stannard on behalf of the NMC, prepared a document outlining your partial admissions
to the charges.
Decision on the findings on facts and reasons
In reaching its decision on the charges, the panel considered all of the evidence
adduced in this case together with the submissions made by Mr Oyegoke and Ms
Stannard.
The panel accepted the advice of the legal assessor.
The panel was aware that the burden of proof rests on the NMC, and that the standard
of proof is the civil standard, namely the balance of probabilities. This means that the
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facts will be proved if the panel is satisfied that it was more likely than not that the
incidents occurred as alleged.
The NMC’s live witness evidence came from:
Colleague 1, HCA;
Colleague 3, Modern Matron on the Unit and Manager of the Unit at the time;
Colleague 2, HCA;
Colleague 4, Band 6 Mental Health Nurse;
The panel also considered the written statement and documentary evidence covering
accounts of events given by Colleague 5.
You also gave evidence under affirmation.
The panel considered Colleague 1’s evidence. The panel found him to be a
straightforward witness who tried to assist the panel. The panel found that Colleague 1
was clear when he could remember details and clear when he could not. Colleague 1’s
evidence was consistent.
The panel considered Colleague 3’s evidence. Colleague 3 was clear, logical and
professional. She was able to address areas of confusion within the NMC’s evidence
and was convincing in her explanations to the panel. Colleague 3 tried her best to assist
the panel despite having some issues of recall which she accepted.
The panel considered Colleague 2’s evidence. The panel found Colleague 2 to be a
credible, straight forward witness and that his oral evidence remained consistent with
his witness statement. However, the panel noted that, by his own admission, he had
limitations to his memory due to the passage of time which impacted upon the clarity of
his evidence. Nonetheless, Colleague 2 had a good grasp of the issues involved in the
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case and the panel found that he was able to comment on the incident in detail. The
panel found him to be a credible witness.
The panel considered Colleague 4’s evidence. The panel noted that Colleague 4
presented as a nervous witness who provided minimal responses to questions. She was
unable to expand upon her answers in any detail and appeared guarded during
questioning. Nonetheless, the panel found that she tried her best to assist where she
was able.
The panel considered your oral evidence. You presented as a clear witness who tried to
assist the panel. You provided detailed explanations and a rationale for your actions at
the time and accepted that you had made some mistakes. In particular, the panel noted
that you admitted to an allegation which you could have quite easily denied based on
earlier information provided to the panel. The panel noted that there were some minor
inconsistencies in your evidence but also noted that you remained consistent in your
denial in relation to the allegations surrounding Patient B, which added to your overall
credibility.
The panel considered the following charges.
Charge 1
1) On 10 March 2017 drew an incorrect dose of oral medication into a syringe.
This charge is found PROVED.
The panel noted that you admit this charge on the basis that the oral medication used
was Lactulose.
The panel noted that the evidence in support of this charge came solely from Colleague
3 who, in her oral evidence to the panel, was of the view that the oral medication used
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was probably Fluoxetine. Colleague 3 provided a rationale as to why she believed this,
stating that if the medication had been Lactulose she would not have been as
concerned as she was at the time. Colleague 3 described how “shocked” she was at
how significantly incorrect the medication drawn up was, and told the panel that
Lactulose would never be administered via a syringe.
The panel took into account that there was no documentary evidence to support
Colleague 3’s assertion that the medication used was in fact Fluoxetine. However, it
noted that in your internal interview you made reference to a dose of Lactulose being
prepared. There was no evidence provided by the NMC of any challenge by the Trust at
the time or subsequently after your interview.
Given that there was no other independent evidence to refute your assertion that the
medication used was Lactulose, the panel preferred your evidence.
Accordingly, the panel determined that on balance, it was more likely than not that the
medication used at the time was in fact Lactulose. The panel found this charge proved.
Charge 2(a)
2) On 4 July 2017 did not respond adequately when informed that Patient A and/or
Patient B appeared distressed and/or required PRN medication in that you;
a) Asked Colleague 1 and/or Colleague 2 if Patient A and/or Patient B could wait
until after handover or words to that effect.
This charge is found PROVED.
The panel noted that you admit this charge on the basis that you only asked Colleague
1 if Patient A could wait until after handover or words to that effect.
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The panel therefore accepted this admission, solely in relation to Colleague 1 and in
relation to Patient A. It then went on to consider the remaining aspect of the charge,
namely, whether you asked Colleague 2 if Patient A and/or Patient B could wait until
after handover or words to that effect.
The panel considered the evidence of Colleague 2. In his NMC statement, Colleague 2
states:
“I went to the nursing office, where the Registrant was sitting at the computer doing
work. I informed her that there were two young patients in distress and requested that
she attend the patients to assist with the situation by talking to them and helping to calm
them down. I also requested that the Registrant administer PRN medication to the
patients.”
The panel noted that you deny that such a conversation with Colleague 2 took place. In
your written statement provided to the panel, you stated “I was not contacted by
Colleague 2 concerning Patient B”. You reaffirmed and stood by this in your oral
evidence to the panel. On balance the panel is satisfied that the NMC have not
discharged the evidential burden of demonstrating that Colleague 2 had this
conversation with you. This is because there was no reference by Colleague 1, in both
his written and oral evidence to Patient B nor was there any relevant contemporaneous
evidence in support of Colleague 2’s oral evidence, for example in the local
investigation.
Accordingly, the panel found this charge proved solely on the basis and rationale which
you admitted to the allegation, as outlined above.
Charge 2(b)
b) Did not attend Patient A and/or Patient B to assess them.
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This charge is found PROVED.
The panel noted that you accept this charge on the basis that you did not attend to
Patient A. The panel noted that the remaining part of the charge falls given its earlier
finding in charge 2(a), namely you could not have failed to assess Patient B as you had
not been informed of their condition.
Accordingly, this charge is found proved.
Charge 2(c)
c) Did not assist Colleague 1 and/or Colleague 2 to find the keys for the medication
cabinet.
This charge is found PROVED.
The panel noted that you accept this charge on the basis that you did not assist
Colleague 1 in the sense that you did not physically go with Colleague 1 to look for the
keys. Whilst the panel noted that it was your evidence that you got out up from your
seat to look within the office for the keys, it had no other evidence to support or refute
this. In the panel’s view, this was to some extent irrelevant given your admission to the
charge.
The panel noted that the remaining part of the charge falls given its earlier finding in
charge 2(a).
Accordingly, this charge is found proved.
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Charge 2(d) and (e)
d) Did not ask another registered nurse to administer the PRN medication to Patient
A and/or Patient B.
e) Did not escalate Patient A and/or Patient B to the nurse in charge.
These charges are found PROVED.
The panel noted that you accept both charges on the basis that you did not ask another
registered nurse to administer the PRN medication to Patient A, nor did you escalate
Patient A to another nurse on duty.
The panel noted that there was only one other registered nurse on duty, namely
Colleague 4. It also noted that it was not disputed that you did not speak to Colleague 4,
nor was in dispute that you did not escalate Patient A to Colleague 4.
The panel noted that the remaining part of the charge falls, in so far as it relates to
Patient B, given its earlier finding in charge 2(a).
Accordingly, these charges are found proved.
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Determination on misconduct and impairment:
Having announced its finding on all the facts, the panel then moved on to consider
whether the facts found proved amount to misconduct and, if so, whether your fitness to
practise is currently impaired. The NMC has defined fitness to practise as a registrant’s
suitability to remain on the register unrestricted.
Ms Stannard referred the panel to her written submissions. She referred the panel to the
case of Roylance v General Medical Council (no. 2) [2000] 1 AC 311 in which Lord
Clyde defined misconduct “as a word of general effect, involving some act or omission
which falls short of what would be proper in the circumstances. The standard of
propriety may often be found by reference to the rules and standards ordinarily required
to be followed by a practitioner in the [relevant field]. Such falling short as is established
should be serious.”
Ms Stannard submitted that this case engages both public protection and public interest
considerations. She reminded the panel that there is no burden of proof at this stage
and the decision on misconduct is for the panel’s independent judgment.
Ms Stannard invited the panel to take the view that your actions amount to a breach of
‘The Code: Professional standards of practice and behaviour for nurses and midwives
(2015), (the Code). She then drew the panel’s attention to specific paragraphs and
identified where, in the NMC’s view, your actions amounted to misconduct.
She then moved on to the issue of impairment, and addressed the panel on the need to
have regard to protecting the public and the wider public interest. Ms Stannard referred
the panel to the case of Council for Healthcare Regulatory Excellence v (1) Nursing and
Midwifery Council (2) Grant [2011] EWHC 927 (Admin).
Ms Stannard submitted that the following limbs are engaged:
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a. has in the past acted and/or is liable in the future to act so as to put a patient or
patients at unwarranted risk of harm; and/or
b. has in the past brought and/or is liable in the future to bring the medical
profession into disrepute; and or
c. has in the past breached and/or is liable in the future to breach one of the
fundamental tenets of the medical profession;
d. […]
Ms Stannard submitted that the allegations found proved relate to two separate
incidents which occurred on different dates, namely 10 March 2017 and 4 July 2017.
She told the panel that your failings relate to the following areas of nursing practice:
medication administration, assisting staff members, providing safe care to vulnerable
patients under your care and escalating concern. Ms Stannard submitted that these
were all fundamental areas of nursing and that your actions, in relation to both incidents
had the potential to place the patients under your care at unwarranted risk of harm. She
further submitted that by your actions, you had brought the reputation of the nursing
profession into disrepute and breached fundamental tenets of the nursing profession.
Ms Stannard reminded the panel that, in order to assess whether you would put patients
at risk of harm in the future, it should determine to what extent you have shown
remorse, demonstrated insight and/or remedied any misconduct. Ms Stannard
submitted that in light of you having brought the profession into disrepute and placed
patients at unwarranted risk of harm, a finding of impairment is necessary on both public
protection and public interest grounds in order to uphold proper professional standards
and uphold public confidence in the NMC as a regulator.
Mr Oyegoke submitted that your fitness to practise is not currently impaired.
Mr Oyegoke submitted that these were one off incidents and that this is the first time
you have been brought before your regulator. Mr Oyegoke noted the mitigating
circumstances in your case as outlined previously in his submissions on facts. These
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included staff shortages on the Unit and two family bereavements which may have
impacted upon your judgment and practice at the time.
Mr Oyegoke next referred the panel to a bundle of documentation containing training
certificates and references which attest to your good practice and good character. Mr
Oyegoke referred the panel to a reference from your current employer who is aware of
your referral to the NMC and your fitness to practise case and continues to support you
in your role as the Unit Manager.
Mr Oyegoke submitted that, since these incidents, you have displayed remorse and
undertaken training courses to remedy your past shortcomings. He explained that a
number of these training courses were face to face, and some were online. He indicated
to the panel which courses were mandatory and provided by your employer, and which
were independently arranged and privately funded by you.
Mr Oyegoke submitted that it was clear, through your oral evidence and reflective
statement, that you have shown insight into your previous errors. Given your reflection
and the steps you have taken since these incidents to improve your practise, he invited
the panel to consider that you have fully remedied your past failings to the extent that
your fitness to practise is not currently impaired.
The panel accepted the advice of the legal assessor.
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Decision on misconduct
The panel first considered whether the facts found proved amounted to misconduct.
This is a matter for the panel’s judgement. In considering whether the conduct, as found
proved, amounted to misconduct, the panel reminded itself that not every act falling
short of what would be proper in the circumstances, and not every breach of the Code,
would be sufficiently serious that it could properly be described as misconduct.
The panel has reminded itself that registrants are personally accountable under the
NMC Code for acts and omissions in their practice. The panel had regard to the relevant
version of the NMC Code (2015). The Code contains the underlying principles that
guide the nursing profession and is in place to protect the public and to ensure that
proper standards of the profession are upheld.
1) On 10 March 2017 drew an incorrect dose of oral medication into a syringe.
The panel took into account that, at the time of this incident, you were subject to a PIP
which had been specifically amended in 2016 to improve your medication
administration. The panel heard clear, unchallenged, evidence from Colleague 3 in
relation to this. Given the surrounding context of this medication administration error,
the panel was of the view that a member of the public would be concerned if a nurse
under such a performance plan continued to make errors of a fundamental nature. It
determined that your conduct fell significantly below the standards expected of a
registered nurse and amounted to misconduct.
2) On 4 July 2017 did not respond adequately when informed that Patient A and/or
Patient B appeared distressed and/or required PRN medication in that you;
a) Asked Colleague 1 if Patient A could wait until after handover or words to that
effect.
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b) Did not attend Patient A to assess them.
The panel noted that the incident involving Patient A was first brought to your attention
by a young patient who attended the nurses’ office who informed you that Patient A was
“banging his head” against the corridor wall. Given the risk of harm Patient A posed
towards himself, the panel determined that failing to attend Patient A in order to assess
him fell significantly below the standards expected of a registered nurse. The panel also
considered that, without attending Patient A, there would have been no reasonable way
of making an informed decision to delay administering PRN medication to him until after
handover. Whilst the panel heard evidence that Colleague 1 may not have vocalised
Patient A’s condition or the urgency of Patient A’s situation, the opportunity for you to
ask Colleague 1 about this was not taken, and in the circumstances should have been.
The panel therefore determined that your actions in this regard also fell significantly
below the standards expected of a registered nurse. The panel determined that your
actions in respect of both of the above matters amounted to misconduct.
c) Did not assist Colleague 1 to find the keys for the medication cabinet.
The panel took account of its earlier finding in relation to this charge and noted that you
had made some attempt to assist Colleague 1 in finding the keys for the medication
cabinet. The panel also noted that there were other factors which contributed to the
difficulties in Colleague 1 finding these keys. On that basis, the panel did not consider
your actions to amount to misconduct.
d) Did not ask another registered nurse to administer the PRN medication to Patient
A.
The panel noted that at the time you were unable to administer medication due to the
restrictions on your PIP and that Colleague 4 was the only other member of staff who
was permitted to do this. In the circumstances, the only practical method of ensuring
that Patient A was administered PRN medication would have been to interrupt the
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handover being carried out by Colleague 4 and ask her to administer this medication to
Patient A. You did not do this. Instead you did nothing. In the panel’s view, your failure
to act in a proactive manner fell significantly below the standards expected of a
registered nurse and amounted to misconduct.
e) Did not escalate Patient A to the nurse in charge.
The panel noted that as a consequence of your misconduct in relation to charge 2(b),
you would have been fully unaware of Patient A’s condition at the time and therefore
unable to make an informed decision to escalate Patient A’s condition to the nurse in
charge. In the panel’s view, your earlier omission in relation to charge 2(b) did not
excuse your failure to escalate Patient A’s condition. Furthermore, the panel took into
account that you would have been aware of Patient A’s risk factors due to his previous
attempt of self-harm. The panel determined that your conduct fell significantly below the
standards expected of a registered nurse and amounted to misconduct.
The panel therefore determined that your actions, in relation to the following charges
amounted to misconduct: 1 (in its entirety), 2(a), 2(b), 2(d) and 2(e).
It was of the view that your conduct breached the following standards in the Code:
1 Treat people as individuals and uphold their dignity
1.4 make sure that any treatment, assistance or care for which you are responsible is
delivered without undue delay
2 Listen to people and respond to their preferences and concerns
2.1 work in partnership with people to make sure you deliver care effectively
8 Work cooperatively
8.2 maintain effective communication with colleagues
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8.4 work with colleagues to evaluate the quality of your work and that of the team
9 Share your skills, knowledge and experience for the benefit of people receiving
care and your colleagues
15 Always offer help if an emergency arises in your practice setting or anywhere
else
15.1 only act in an emergency within the limits of your knowledge and competence
15.2 arrange, wherever possible, for emergency care to be accessed and provided
promptly
17.1 take all reasonable steps to protect people who are vulnerable or at risk from harm,
neglect or abuse
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Decision on impairment
The panel next went on to decide whether as a result of the misconduct found, your
fitness to practise is currently impaired. In reaching its decision the panel took into
account all of the circumstances together with its overarching objective.
In considering current impairment, the panel had careful regard to all of the documents
submitted, including training certificates, testimonials and your written reflective piece.
The panel considered the case of Grant. The panel considered that the limbs (a), (b)
and (c) of the test were engaged. The panel accepted that your actions were not
intended to harm patients. However, the panel considered that, by virtue of your failure
to ensure and provide safe and adequate care to Patient A, you had placed a vulnerable
patient under your care at significant and unwarranted risk. As a result, the panel
determined that you had brought the nursing profession into disrepute. Further, the
panel considered that your actions resulted in a breach of some of the fundamental
tenets of the nursing profession, particularly in terms of the breaches of the code
identified above.
The panel considered whether your actions were remediable, whether they had been
remedied and the likelihood of repetition, in light of the circumstances of the case and
the evidence.
The panel first considered your misconduct in relation to your medication administration
and was of the view that you have made all reasonable efforts to remedy this particular
area of practice, as evidenced by the training certificates and references provided to the
panel. The panel was satisfied that there were no longer any public protection or public
interest considerations regarding this incident.
The panel next considered your misconduct in relation to Patient A. It considered your
reflective piece and considered that you have demonstrated some remorse for your
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actions. The panel acknowledged that you have apologised for your actions, and was
satisfied that you have demonstrated sufficient understanding of how your actions and
omissions were wrong or how your actions and omissions impacted negatively on the
reputation of the nursing profession. The panel was also satisfied that you have
explained what you would do differently if placed in a similar situation. The panel noted
that it had no evidence of any similar issues since this incident. To the contrary, the
panel has been provided with evidence which demonstrates good practice as evidenced
by the positive comments provided by your current employer regarding your
professionalism and good character.
The panel therefore determined that the risk of repetition in this case was sufficiently
low to the extent that there no longer remained any public protection concerns
associated with your practice. However, the panel bore in mind the overarching
objective of the NMC: to protect, promote and maintain the wider public interest which
includes promoting and maintaining public confidence in the nursing profession and
upholding proper professional standards. In the judgement of the panel, given the
potential serious consequences of the lack of care provided to Patient A, a vulnerable
young patient with a history of self-harm, public confidence in the profession and the
regulator would be undermined if a finding of impairment was not made in the particular
circumstances of your case.
The panel therefore determined that a finding of current impairment is necessary solely
on public interest grounds.
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Determination on Sanction
Having determined that your fitness to practise is impaired, the panel has now
considered what sanction, if any, it should impose on your registration. In reaching its
decision on sanction, the panel has considered all the evidence that has been placed
before it.
The panel took into account the submissions from Ms Stannard and Mr Oyegoke. The
panel has heard and accepted the advice of the legal assessor.
Ms Stannard submitted that the appropriate and proportionate order in this case was a
caution order to mark the public interest, given the panel’s earlier findings. Ms Stannard
told the panel that a conditions of practice order would serve no useful purpose given
your level of insight and the training which you have undertaken.
Mr Oyegoke invited the panel to consider taking no further action and submitted that the
public interest in this case had been marked sufficiently by the panel’s earlier finding of
impairment.
Under Article 29 of the Nursing and Midwifery Council Order 2001, the panel can take
the following actions in ascending order: no further action; make a caution order for one
to five years; make a conditions of practice order for no more than three years; make a
suspension order for a maximum of one year; or make a striking off order. The panel
has borne in mind that the purpose of a sanction is not to be punitive, though it may
have a punitive effect.
The panel also noted that it should first consider the least restrictive sanction. If it
considers that no further action is not appropriate then it should approach the issue of
sanction in ascending order of seriousness.
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The panel has applied the principles of fairness, reasonableness and proportionality,
balancing the interests of patients and the public with your own interests and taking into
account any mitigating and aggravating factors in the case. The public interest includes
the protection of patients, the maintenance of public confidence in the profession and
declaring and upholding proper standards of conduct and behaviour. The panel has also
taken account of the NMC publication Sanctions Guidance (SG).
The panel concluded that the aggravating features in this case include the following:
your actions and omissions placed Patient A at risk of harm.
The panel concluded that the mitigating features in this case include the following:
you have demonstrated insight and understanding throughout this
hearing and by way of your reflective piece;
you have made admissions to some of the charges in part;
you have provided a number of positive references, one of which is from your
current employer, which all attest to your good character, clinical aptitude and
professionalism;
you have provided evidence that you have undertaken relevant training pertinent
to the clinical concerns identified in this case;
you are currently working as a Unit Manager without issue and are well
supported by your employer.
The panel first considered taking no further action and decided that this would be
inappropriate. The charges found proved against you are serious and in those
circumstances taking no further action would be insufficient to mark the public interest in
this case. To do so would not maintain the standards of, or confidence in, the profession
or the regulator.
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The panel then went on to consider whether a caution order would be appropriate. The
panel notes that the SG states that “… a caution may be appropriate where the case is
at the lower end of the spectrum of impaired fitness to practise and the Fitness to
Practise Committee wishes to mark that the behaviour was unacceptable and must not
happen again”.
The panel considered that, whilst the charges are serious, this case could be described
as being at the lower end of the spectrum of impairment given the mitigating factors,
your insight and remediation and, importantly, that the panel has concluded that there is
little risk of repetition.
The panel bore in mind that in this case it has not found impairment on the ground of
public protection and there are no concerns relating to your clinical practice. You have
reflected as to how you would behave differently if placed in a similar situation in the
future. The issue in this case relates solely to the public interest in declaring standards
and maintaining public confidence in the profession. The SG states in relation to a
caution order that it is only appropriate when the panel is satisfied that there is no risk to
the public or to patients which requires the nurse’s practice to be restricted. The panel
considers that this is such a case.
Before deciding on a caution order the panel considered whether a conditions of
practice order would be appropriate in this case. Given that there is no risk to patients
and no concerns about your clinical practice, there were no workable conditions which
could be formulated in this case. In the panel’s view, such an order would serve no
useful purpose and would be disproportionate. The panel noted that you have been
working without further incident and had sight of positive testimonials which attest to
your good practice and professionalism.
Balancing all these factors the panel decided that a caution order was the sanction that
was appropriate, proportionate and least restrictive on your practice. It would serve to
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declare and uphold standards and to maintain public confidence in the profession, and
in the NMC as regulator.
The panel considered that a reasonable, well-informed member of the public in full
possession of all the facts would consider that a caution order ensures that proper
standards are upheld within the profession. The effect of such an order is that, although
your practice is not restricted, the caution is recorded against your registration and
recorded on the NMC’s website. It forms an alert about your past conduct, visible and
disclosable to anyone enquiring about you or your fitness to practise history. It has to be
declared to anyone considering employing you as a nurse. It is therefore a significant
sanction and a mark of the panel’s disapproval of your misconduct.
The panel took into account that there is a public interest in returning a competent nurse
to practice.
The panel has decided that the order should be imposed for a period of one year. It
considers that this is the least available period which marks the gravity of the facts
found in this case. It also sends a message to the profession, and to the public, that
your behaviour is unacceptable and must not happen again.
This decision will be confirmed to you in writing.
That concludes this determination.