Fitness to Practise Committee Substantive Hearing

12 - 19 December 2017

Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ

Name of Registrant Nurse Shaygan Persaud NMC PIN 11J0103E Part(s) of the Register Registered Nurse Sub Part 1 Adult Nursing – 5 May 2012 Area of Registered Address Chesterfield Type of Case Misconduct Panel Members Jill Wells (Chair & Lay member) Kathryn Smith (Registrant member)

Caroline Williams (Registrant member) Legal Assessor Nigel Ingram Panel Secretary Ian Dennehey Nursing and Midwifery Represented by Clare Stevenson, Counsel. Council (NMC) Registrant: Present and was represented by Kathryn Pitters,

Counsel, instructed by the Royal College of Nursing. Facts Found Proved by admission: 2. Facts Found Proved: 1.1.1; 1.7; 1.8; 1.13.1 and 1.13.2. Facts Found Not Proved: 1.1.2; 1.1.3; 1.2; 1.3; 1.4; 1.5; 1.6; 1.9; 1.10 in its

entirety; 1.11; and 1.12. Fitness to Practise: Currently impaired by reason of misconduct. Sanction: Suspension Order: 9 months. Interim Order: Interim Suspension Order: 18 months.

Detail of Charges: That you, a Registered Nurse, whilst employed as at Haddon Court Nursing Home: 1. On an unknown date or dates between May 2014 and September 2015: 1.1. In relation to Resident A:

1.1.1. Touched Resident A’s neck scarf causing her distress and/or to scream and/or shout at you; Found Proved but only to the extent of touching Resident A’s neck scarf causing her distress

1.1.2. Flicked the resident’s light switch back and forth or on and off; Not Found Proved

1.1.3. Said to the resident, “I can do what I want” or words to that effect.

Not Found Proved 1.2. Left the medication trolley unattended and/or unlocked and or locked with the

keys left on top. Not Found Proved

1.3. Instructed Care Assistant 1 to administer medication to Resident A and/or

Resident B without witnessing the administration and/or without providing sufficient instructions to Care Assistant 1. Not Found Proved

1.4. Said words to the effect of "I wish she would take all her tablets and die" about

an unknown resident. Not Found Proved

1.5. Were prepared to administer unknown pain medication to Resident J without first

checking whether the resident was prescribed and/or permitted the medication. Not Found Proved

1.6. Did not perform adequate checks on Resident C after he had an unwitnessed

fall. Not Found Proved

1.7. Said to Resident E ‘I preferred you when you were poorly’ or words to that effect.

Found Proved 1.8. Did not perform and or record that you had performed hourly checks on Resident

F following a fall. Found Proved

1.9. Said in front of Resident G ‘leave her until morning, she is horrible’ or words to

that effect. Not Found Proved

1.10. In respect of Resident H:

1.10.1. Did not conduct appropriate checks on the resident following a fall Not Found Proved

1.10.2. Picked the resident up from the floor without using a hoist.

Not Found Proved 1.11. Grabbed Resident I by the wrist and walked him quickly into a room.

Not Found Proved 1.12. Left the medication cupboard unlocked.

Not Found Proved 1.13. Indicated to Care Assistant 3:

1.13.1. That if she was pregnant she could not do the same things other staff could do. Found Proved

1.13.2. That you get paid more than her, so she does not have the right to

speak. Found Proved

2. In a comment posted on Facebook on 26 January 2017, made inappropriate

and/or offensive comments about one or more of your work colleagues. Admitted and Found Proved

And, in light of the above, your fitness to practise is impaired by reason of your misconduct Found Proved

This case has been considered in accordance with the provisions of the Nursing and

Midwifery Council (Fitness to Practise) Rules 2004, as amended, (‘the Rules’) and the

Nursing and Midwifery Order 2001.

Background: You were referred to the Nursing and Midwifery Council in relation to reports made

regarding your conduct as a Registered Nurse initially by a healthcare assistant who

worked at Haddon Court Nursing Home.

Application to Admit Hearsay Evidence: Ms Stevenson initially sought to make an application to admit this evidence at the start

of the hearing. However, the panel determined that it would be better made when the

evidence of the other two NMC witnesses had been heard.

Ms Stevenson invited the panel to receive the statement of witness healthcare assistant

2 as hearsay evidence under the provisions of Rule 31. She referred the panel to a

letter dated 8 December 2017 from healthcare assistant 2’s GP [PRIVATE]. The GP is

of the view that healthcare assistant 2 is not fit to give evidence in person by video or

telephone at this time.

Ms Stevenson submitted that healthcare assistant 2’s evidence was relevant. It was the

sole direct evidence to support the facts at a number of the charges. Ms Stevenson

further submitted that the NMC had investigated the alternative methods for securing

the evidence of this witness but these were addressed by the GP’s letter and during a

subsequent telephone call by an NMC case officer. There was a cogent reason for the

absence of the witness. Although, if this were to be admitted under Rule 31, it would not

be tested by cross examination, this was a matter to which the panel could have regard

when assessing the weight to attach to the evidence.

Ms Pitters opposed the application. She did not argue that the evidence would not be

relevant but focussed her submission on the issue of whether it would be fair to admit it.

Ms Pitters submitted that the evidence was challenged and the probity of the witness

and her motivation for her account was in question. Ms Pitters submitted that the

content of the GP’s letter raised a concern because it suggested that this witness had

only recently been put on notice that she would be required to give evidence. Ms Pitters

contended that this was unlikely to be true. Ms Pitters submitted that admitting this

evidence under Rule 31 will deprive you of the ability to challenge the evidence or put to

the witness that what she alleges is untrue and that she has maliciously invented

allegations because she lost her job as a consequence of a complaint you made about

her behaviour towards you.

The panel accepted the advice of the Legal Assessor.

Rule 31 (1) provides the panel with a wide discretion to receive information. It states:

“Upon receiving the advice of the legal assessor, and subject only to the

requirements of relevance and fairness, a Practice Committee considering an

allegation may admit oral, documentary or other evidence, whether or not such

evidence would be admissible in civil proceedings (in the appropriate Court in

that part of the United Kingdom in which the hearing takes place).” The panel accepted the advice of the Legal Assessor and had regard to the legal

authorities to which it was referred, namely the cases of: Bonhoeffer v General Medical

Council [2011] EWHC 1585 (Admin); and Thorneycroft v Nursing and Midwifery Council

[2014] EWHC 1565 (Admin).

The panel accepted that the default position is that a witness should attend in person to

give evidence. However, for various reasons that is not always possible and the panel

has a wide discretion to accept evidence.

The evidence of healthcare assistant 2 is the sole and decisive evidence for three of the

charges. The evidence is challenged and the witness’ probity is in question. The

charges are serious and, if proved, could have serious consequences for your

registration. You have only been made aware at the start of the hearing that healthcare

assistant 2 would not be giving evidence. These factors could all mitigate against

allowing the NMC’s application.

However, the NMC has explored alternative routes through which this witness might

give evidence, for example by telephone or video. The panel has been told she is

unable or unwilling to engage at this time. The panel decided that, because it is unclear

when healthcare assistant 2 might be able to give evidence at some future date, it

would not be appropriate, and no application was in fact made, to adjourn the hearing.

Any such adjournment would be open ended. The allegations are serious and there is a

significant public interest in making progress with the case without undue delay.

The panel is experienced and can decide what weight to attach to evidence which has

not been tested by cross examination. Your case, to the effect that witnesses have

colluded to bring false allegations because they are ill-disposed towards you has been

explored with other witnesses who gave evidence and the panel can have regard to its

assessment of their reliability and credibility in relation to that matter when it determines

what weight to attach to the statement of healthcare assistant 2. Her account can also

be assessed in the light of any evidence you may decide to give. Ms Pitters will be able

to make submissions as to the quality of the evidence in due course.

In the panel’s judgment this means that, although not ideal, there are means by which it

can test the reliability of healthcare assistant 2’s evidence and which makes its

admission fair, subject to it being treated with such caution as the panel deems

appropriate.

Determination on Abuse of Process Application: Ms Pitters applied to have this hearing stayed on the grounds of an abuse of process,

the consequences of which, she maintained, are such that you are unable to receive a

fair hearing.

Ms Stevenson opposed the application on behalf of the NMC.

In considering this application, the panel took account of the written and oral

submissions provided by both Counsel.

The panel accepted the advice of the Legal Assessor.

The panel had regard to the perceived failures of the NMC’s investigatory process as

presented by Ms Pitters but formed no view about this. The panel simply asked itself

whether, in all the circumstances of the case, Ms Pitters has established that it is not

possible for you to receive a fair hearing. Noting that the burden lies with her, the panel

concluded she had not.

The panel has had the advantage of receiving evidence from two witnesses, one of

whom was present at the hearing and one who gave evidence by video link. The panel

has received the hearsay evidence of a third witness. The panel may also receive

evidence from you in due course. In the panel’s judgment it will be able to come to a

view on the facts that are alleged on the basis of this evidence.

Having regard to all of these matters, the panel does not find that the circumstances of

the case are so exceptional that you will be unable either to receive a fair hearing or will

be placed in the position where you will find it impossible to defend yourself. The panel

does not consider that proceeding at this stage will amount to an abuse of process. It

therefore refused the application for a stay on the grounds of an abuse of process.

Determination on the Facts: The allegations in this case relate to your work as a Registered Nurse whilst employed

at Haddon Court Nursing Home (‘the Home’) on an unknown date or dates between

May 2014 and September 2015.

The panel was told that the Home was an 80 bed home over three floors which never

operated at full capacity. There were normally between 50 and 60 residents at any one

time. Residents with general nursing needs were accommodated on the top floor. The

middle floor accommodated Elderly Mentally Infirm (EMI) residents. The ground floor

was an EMI residential unit. The panel heard that residents on the ground floor were

looked after by healthcare assistants, led by senior carers, and that nurses only

attended when required. The panel was told that the Home closed down in April 2017

for financial reasons.

On your behalf, at the start of the hearing, Ms Pitters admitted the facts detailed in

Charge 2. That charge is found proved on the basis of your admission.

In considering the facts alleged in relation to the charges still in dispute, the panel had

regard to all of the documentary and oral evidence before it. The panel received oral

evidence from the following witnesses called on behalf of the NMC, namely:

• healthcare assistant 1, employed at the Home between May 2014 and

September 2015;

• healthcare assistant 3, employed at the Home between approximately February

2014 and April 2017.

The panel took account of the hearsay evidence of healthcare assistant 2, employed at

the Home for approximately 18 months and who was dismissed from her post at the

Home in October 2014. The panel received this evidence under the provision of Rule 31

and, in assessing the weight which could properly be attached to her statement, the

panel had regard to the fact that it had not been tested in cross examination.

The panel also had regard to your own evidence given on oath and to the documentary

evidence submitted on your behalf.

The panel took account of the submissions made on behalf of the NMC by Ms

Stevenson together with the submissions made on your behalf by Ms Pitters.

The panel accepted the advice of the Legal Assessor. The burden of proof rests entirely

upon the NMC. You do not have to prove or disprove anything. The standard of proof is

the civil standard, namely the balance of probabilities. This means that, for a fact to be

found proved, the NMC must satisfy the panel that what is alleged to have happened is

more likely than not to have occurred.

The panel’s attention was drawn by Ms Pitters to the absence of documentary evidence

in this case, such as residents’ notes and care plans, records of local investigatory

interviews and incident reports. Ms Pitters contended that, if available, these documents

might have assisted the panel in assessing the veracity of the oral evidence.

The panel noted that the NMC has sought relevant documentation, albeit somewhat

belatedly and without success. The panel has been careful not to speculate about what

other evidence might have been available and what that evidence might contain. The

panel made its decisions on the basis of the evidence before it and only on that

evidence.

In assessing the weight to give to the evidence the panel assessed the reliability and

credibility of all of the witnesses. It makes the following observations:

• the panel found that healthcare assistant 1 and healthcare assistant 3 both

initially presented well in evidence. Both appeared consistent, credible and

reliable although there were occasions when they were both vague in respect of

dates and names of other colleagues present. It was not their fault that their oral

evidence was not supported by any documentary evidence;

• the hearsay evidence of healthcare assistant 2 was not tested by cross

examination and the panel concluded that her account is also vague in relation to

specific detail;

• the panel found you to be a consistent, credible and reliable witness who sought

to assist the panel to the best of your ability. You displayed an ability to recall

significant contextual detail, for example, in relation to the presentation of specific

residents, their medication regimes and details of care plans. You demonstrated

a clear recollection of the practices of the Home and provided cogent

explanations of why certain allegations were unlikely to be true. You accepted

that your conduct in relation to the charge you have admitted was unprofessional.

The panel’s attention has been drawn to the fact that it is your case that the NMC’s

witnesses colluded to make these allegations against you because they dislike you and,

in effect, are motivated against you because healthcare assistant 2 was dismissed from

the Home having sworn at you.

In the course of hearing your case, the panel received documentation from you that

included a letter dated 20 May 2016 from Ms 4, the then Registered Home Manager for

Haddon Court Care Home, character evidence from other staff employed at the Home

and a telephone attendance noted prepared by an NMC Case Officer that relates to a

conversation between that officer and Ms 4, dated 15 March 2017.

In the panel’s judgment, the content of Ms 4’s letter dated 20 May 2016, which was

addressed to the NMC Case Examiners, is significant. Ms 4 referred to an anonymous

complaint made about you to a number of organisations, including the Care Quality

Commission (CQC), the independent statutory regulator of health and social care

services. Ms 4 noted the similarity between the anonymous complaint to those

organisations and the allegations that are the subject of the NMC referral. She makes

clear that the Home carried out a robust investigation, which found no evidence to

support the allegations, and states that it was believed that the complaints were made

maliciously. She also states that there had never been any reason to question your

clinical abilities. The panel found Ms 4’s remarks in relation to the allegations regarding

medication trolleys being unattended to be particularly relevant. She is clear that the

trolleys which appear in photographs provided to the NMC in support of the allegation

are not those used in the Home and she describes how they are different. Ms 4 also

states the features appearing in the background of the photographs are not those of the

interiors, corridors or rooms at the Home.

It was confirmed that the NMC had received those photographs. It is common ground

between the parties that, in the circumstances, the panel does not need to see the

photographs and they have not been produced in evidence. It is accepted that what

assists the panel is Ms 4’s evidence about the photographs.

Although Ms 4 has not been a witness and, therefore, has not given evidence on oath or

been subject to cross examination, the panel however concluded that it could place

significant weight on her account. This is because her letter was produced for the

purpose of NMC proceedings and, although Ms 4 now appears to have withdrawn from

engaging with the NMC, at the time of writing this letter she made clear that she was

willing to attend to give evidence if required.

In the panel’s judgment, the content of Ms 4’s letter lends support to your assertions

that you were bullied at the Home and calls into question the reliability and credibility of

significant aspects of the evidence of the NMC’s witnesses. Although the panel found

no clear or positive evidence of actual collusion between the NMC’s witnesses, it

considered that it was probable that they have at times exaggerated or embellished

their accounts and that this has extended to providing the photographs of open

medication trolleys in support of their claims.

The panel also considered a telephone attendance note of a conversation between Ms

4 and an NMC case officer in March 2017. Ms 4 is not recorded as reporting any

concerns about your clinical practice but she discusses your attitude and refers to you

‘turning into a monster’, having an attitude as if ‘teflon coated’ and to you considering

yourself to be ‘untouchable’.

The panel considered whether what is recorded in the telephone attendance note as Ms

4’s observations, taken together with the unprofessional attitude which is demonstrated

by the content of your Facebook posting which is the subject of charge 2 was relevant

to its consideration of other charges that raise concerns about your attitude to those in

your care, for example, charges 1.1, 1.4, 1.7 1.9 and 1.11. The panel drew a distinction

between your attitude towards some colleagues as illustrated in your Facebook posting

and the evidence from Ms 4’s letters and other colleague’s testimonials that you were

liked by residents at the Home.

The panel now makes the following findings of fact: Charge 1.1.1 The allegation is that on an unknown date or dates between May 2014 and September 2015 you touched Resident A’s neck scarf causing her distress and/or to scream and/or shout at you. This Charge is Found Proved but only to the extent that you touched Resident A’s neck scarf causing her distress. Both healthcare assistant 1 and healthcare assistant 3 were clear that they had

witnessed you touching Resident A’s scarf. They each describe separate occasions

when they claim to have witnessed this interaction. On each occasion, Resident A was

said to have been distressed by your action.

Although Ms 4 states in her letter of 20 May 2016 that you: “were and still are liked by

the residents at the Home”, at the time she was unable to identify Resident A. In the

panel’s judgment, this means that her evidence is of limited assistance in relation to this

charge.

There is no documentary evidence to support a finding that Resident A screamed or

shouted at you in response to you touching her scarf.

The panel concluded that your evidence in relation to this charge was somewhat vague.

You told the panel that you had a good relationship with Resident A and you were able

to describe her in some detail. Although you said that you have no specific recollection

of doing what is alleged, you also conceded that you might have touched Resident A’s

scarf.

In view of your concession and the evidence of healthcare assistant 1 and healthcare

assistant 3, which suggests that this occurred on at least two occasions, the panel finds

this charge proved but only to the extent that you touched Resident A’s neck scarf

causing her distress. In deciding that the NMC has not discharged the burden of proof in

relation to the remainder of this charge, the panel took into account the likelihood that

healthcare assistant 1 and healthcare assistant 3 have exaggerated their accounts.

Charge 1.1.2 The allegation is that on an unknown date or dates between May 2014 and September 2015 you flicked Resident A’s light switch back and forth or on and off. This Charge is Not Found Proved Charge 1.1.3 The allegation is that on an unknown date or dates between May 2014 and September 2015 you said to Resident A “I can do what I want” or words to that effect. This Charge is Not Found Proved. Although the panel considered charges 1.1.2 and 1.1.3 separately, it decided to explain

its reason for its findings collectively since they were made in light of the same evidence

and/or absence of evidence and for the same reasons. The only evidence to support either of these charges comes from healthcare assistant

3.

You were emphatic that you had not done what is alleged. Taking account of its reservations about the unsupported evidence of healthcare

assistant 3, the panel concluded that the NMC had not discharged the burden of proof

required to establish that it was more likely than not that this occurred.

Charge 1.2 The allegation is that on an unknown date or dates between May 2014 and September 2015 you left the medication trolley unattended and/or unlocked and or locked with the keys left on top. This Charge is Not Found Proved. All of the NMC’s witnesses claim that you did this. In the case of healthcare assistant 2

she asserts that this occurred “every time” that she was on shift with you.

You were clear that you did not do this and, in the panel’s judgment, demonstrated a

very good understanding of the serious risks associated with leaving medication

unattended and accessible.

In her letter to the NMC case examiners Ms 4 indicates that she has had no reason to

question your clinical abilities. Even if her opinion as to your character changed over

time, assuming that the NMC Case Officer’s telephone attendance note of 15 March

2017 is an accurate account of what Ms 4 said, that attendance note does not suggest

she had any concerns about your clinical skills.

In the panel’s judgment the NMC’s evidence in support of this charge was seriously

undermined by the evidence that indicates that the photographs submitted to the NMC,

that can only purport to be medication trollies at the home left by you unattended and/or

unlocked and or locked with the keys left on top, are not in fact the trolleys at the Home.

Taken at its highest this was a deliberate attempt to implicate you in misconduct. At the

very least it was a misguided exaggeration to bolster an allegation.

Charge 1.3 The allegation is that on an unknown date or dates between May 2014 and September 2015 you instructed Care Assistant 1 to administer medication to Resident A and/or Resident B without witnessing the administration and/or without providing sufficient instructions to Care Assistant 1. This Charge is Not Found Proved. In light of the fact that no party could identify Resident B, the panel decided to restrict its

consideration of this charge to Resident A.

The only evidence to support this charge comes from healthcare assistant 1. Her

evidence was that you regularly gave her medication to administer to Resident A. It

would appear that healthcare assistant 1 really only became concerned when she

offered to assist an Agency Nurse with the administration of medication and was told

that she should not be doing that because she was not appropriately trained.

In her letter to the NMC Case Examiners, Ms 4 addressed this allegation, stating that it

was contrary to the Home’s policy for a nurse to instruct a healthcare assistant to

administer medication to a resident without witnessing the administration or providing

sufficient instructions. However, she explains that nurses were permitted to allow a

healthcare assistant to administer medication within sight of the nurse as this was

sometimes the only way a resident would accept medication. Ms 4 also states that there

have never been any other complaints to suggest that you have ever acted

inappropriately in this regard, namely by instructing a healthcare assistant to administer

medication when out of your sight.

You told the panel that you had not done this and, in the panel’s judgment, your

credibility was reinforced by what it determined was a clear memory that Resident A did

not regularly or generally require medication and in fact was only prescribed antibiotics

from time to time when she was suffering from an infection. In the panel’s judgment this

undermined healthcare assistant 1’s evidence.

Charge 1.4 The allegation is that on an unknown date or dates between May 2014 and September 2015 you said words to the effect of "I wish she would take all her tablets and die" about an unknown resident. This Charge is Not Found Proved. The only evidence in support of this charge is the untested evidence of healthcare

assistant 2. She was unable to name the resident but claimed to recall she was

“particular and liked her routine”. She does not offer any explanation as to why you

might make such a remark.

You deny this allegation. In the absence of any corroboration, and taking account of the evidence contained in

Ms 4’s letter to the NMC’s Case Examiners that the Home carried out a robust

investigation into the allegations against you including this matter and found no

evidence to support the claims, the panel decided that the NMC has not discharged the

burden of proof in relation to this charge.

Charge 1.5 The allegation is that on an unknown date or dates between May 2014 and September 2015 you were prepared to administer unknown pain medication to Resident J without first checking whether the resident was prescribed and/or permitted the medication. This Charge is Not Found Proved. The only evidence in support of this charge is the untested evidence of healthcare

assistant 2.

You deny this allegation.

In the absence of any corroboration, and taking account of the evidence contained in

Ms 4’s letter to the NMC’s Case Examiners that she had never had any reason to

question your clinical abilities and, moreover, albeit in relation to a different charge

regarding the administration of medication, stated that there was no other complaint that

you acted inappropriately, the panel decided that the NMC has not discharged the

burden of proof in relation to this charge.

Charge 1.6 The allegation is that on an unknown date or dates between May 2014 and September 2015 you did not perform adequate checks on Resident C after he had an unwitnessed fall. This Charge is Not Found Proved. The only evidence in support of this charge is the untested evidence of healthcare

assistant 2.

You deny this allegation.

In the absence of any corroboration, and taking account of the evidence contained in

Ms 4’s letter to the NMC’s Case Examiners that falls happened on a regular basis, that

in response to such events you had always acted appropriately and that there had

never been fractures, lacerations or any other concerns that had not been noticed and

acted upon by you when you attend to residents who have fallen, the panel decided that

the NMC has not discharged the burden of proof in relation to this charge.

Charge 1.7 The allegation is that on an unknown date or dates between May 2014 and September 2015 you said to Resident E ‘I preferred you when you were poorly’ or words to that effect. This Charge is Found Proved. You told the panel that you are unable to recall this incident. You said that you had a

friendly relationship with Resident E which appears to have extended to engaging in

banter with her. On the face of it, healthcare assistant 3 viewed this incident sufficiently seriously that

she raised her concerns with the CQC. In coming to this factual finding the panel

decided her evidence, on this particular point, was both credible and reliable.

In the panel’s judgment the possibility that this was said in a light hearted manner and

without any ill intent is likely to be relevant to any assessment of misconduct.

Charge 1.8 The allegation is that on an unknown date or dates between May 2014 and September 2015 you did not perform and or record that you had performed hourly checks on Resident F following a fall. This Charge is Found Proved. In coming to this factual finding the panel took account of your admission in evidence

that you had not undertaken or recorded any such checks. You told the panel because,

on your account, they were not warranted. You told the panel that this was because

hourly checks of a resident’s neurological status would be undertaken if a resident had

a fall, was transferred to hospital or seen by the paramedics and such checks were

required on discharge. You explained that in the event of a fall, the nurses on duty

would carry out an assessment of the resident’s condition, summon emergency services

if required or, as appropriate, help the resident up and/or to their bed.

In the panel’s judgment your contextual evidence in relation to this charge is likely to be

relevant to any assessment of misconduct.

Charge 1.9 The allegation is that on an unknown date or dates between May 2014 and September 2015 you said in front of Resident G ‘leave her until morning, she is horrible’ or words to that effect. This Charge is Not Found Proved. The only evidence in support of this charge is the evidence of healthcare assistant 3.

You deny this charge.

In the panel’s judgment, healthcare assistant 3’s account is vague. She refers to ‘an

occasion’ in the singular when this occurred but then goes on to state that if Resident G

was in a bad mood you “would say right in front of her ‘leave her until the morning, she

is horrible’”. This suggests that you were in the habit of making this comment.

Healthcare assistant 3 further states that this would be said in the context of Resident G

being quite aggressive “when her medicines weren’t right.”

You demonstrated a good recollection of Resident G and were able to remember that

she did not have capacity to be aware of the detail of her medication. You thought that,

at times, her medication would be administered covertly.

In the panel’s judgment, in these circumstances, it would be improbable that Resident G

would know whether her medicines were correct and this tends to undermine healthcare

assistant 3’s evidence in relation to this charge.

For these reasons the panel decided that the NMC has not discharged the burden of

proof in relation to this charge.

Charge 1.10.1 The allegation is that on an unknown date or dates between May 2014 and September 2015 in relation to Resident H you did not conduct proper checks on the resident following a fall. This Charge is Not Found Proved. Charge 1.10.2 The allegation is that on an unknown date or dates between May 2014 and September 2015 in relation to Resident H you picked the resident up from the floor without using a hoist. This Charge is Not Found Proved. Although the panel considered charges 1.10.1 and 1.10.2 separately, it decided to

explain its reason for its findings collectively since they were made in light of the same

evidence and/or absence of evidence and for the same reasons. The only evidence in support of these charges is the evidence of healthcare assistant 3.

You deny this charge.

Healthcare assistant 3’s account is that she found Resident H on the floor and pulled

the emergency buzzer. According to her account you came to the room, she told you

what had happened and you “just picked up” Resident H.

The panel was told that Resident H was quite a large individual and this was not

challenged.

Your evidence is that, in response to the emergency buzzer being sounded, the other

nurse on duty would also have attended. You stated that it was the Home’s policy and/

or practice that residents who fell would not be lifted by a member of staff. You asserted

that, in the case of Resident H, this would have been impossible. It is your case that if

the Home’s policy/practice was as you state, and you had done what healthcare

assistant 3 claims, the other nurse would have required an explanation from you of how

the resident had been returned to bed and would have reported what had occurred as a

breach of policy/practice. You explained what checks would be carried out on a resident

who had fallen and in the panel’s judgment demonstrated a sound clinical awareness of

why these were required.

In her oral evidence, healthcare assistant 3 raised for the first time the suggestion that

you were assisted by another healthcare assistant in lifting Resident H. This was not in

her witness statement and, when asked, she could not name this other healthcare

assistant.

The panel also had regard to the evidence contained in Ms 4’s letter to the NMC’s Case

Examiners which makes clear that you always acted appropriately in relation to

incidents at the Home in which a resident had fallen.

For these reasons the panel decided that the NMC has not discharged the burden of

proof in relation to this charge.

Charge 1.11 The allegation is that on an unknown date or dates between May 2014 and September 2015 you grabbed Resident I by the wrist and walked him quickly into a room. This Charge is Not Found Proved. The only evidence in support of this charge is the evidence of healthcare assistant 3.

You deny this charge.

In the panel’s judgment, healthcare assistant 3’s written account is vague. She claims in

her witness statement that in approximately the beginning of 2015 she saw you grab

Resident I by the wrist and walk him quickly into another room. She does not claim that

you held both of Resident I’s wrists.

You told the panel that Resident I was a tall and strongly built man who could be

physically aggressive. You said that he had been the subject of a number of

safeguarding reports because of physical aggression towards other resident and to

staff. You also stated that it would require at least two members of staff to contain

Resident I when he became aggressive and that a range of distraction techniques

would need to be employed. You said what worked on one day would not necessarily

work on the next occasion.

When pressed in her oral evidence, healthcare assistant 3 agreed that Resident I was

tall, strong and could be aggressive.

In the panel’s judgment, given that you were aware of Resident I’s history of aggression

and the need for more than one member of staff to manage any aggressive incident, it

was improbable that you would expose yourself to the risk of harm by seeking to contain

him by grabbing one of his wrists as alleged. You are likely to have recognised that

such an action might result in a violent physical response by Resident I.

For these reasons the panel decided that the NMC has not discharged the burden of

proof in relation to this charge.

Charge 1.12 The allegation is that on an unknown date or dates between May 2014 and September 2015 you left the medication cupboard unlocked. This Charge is Not Found Proved. The only evidence in support of this charge is the evidence of healthcare assistant 3.

You deny this charge.

In her witness statement, healthcare assistant 3 says that she saw you leaving

medication cupboards unlocked on many occasions, especially on the lower ground

floor. However, she was not able to elaborate on the detail of this evidence.

The panel had regard to the evidence in Ms 4’s letter to the NMC’s Case Examiners.

Although she does not specifically address the issue of medication cupboards being left

unlocked, she makes clear she has no concerns about your clinical abilities and she

addresses the very similar allegation that you left medication trolleys unlocked. On

investigation, Ms 4 found those allegations to be unsubstantiated.

In view of the positive evidence of your clinical abilities, your own evidence and taking

account of the potential that some of the evidence against you has been inflated, the

panel decided that the NMC has not discharged the burden of proof in relation to this

charge.

Charge 1.13.1 The allegation is that on an unknown date or dates between May 2014 and September 2015 you indicated to Care Assistant 3 that if she was pregnant she could not do the same things other staff could do. This Charge is Found Proved. Healthcare assistant 3’s evidence is that when she became pregnant your attitude

towards her changed. She stated that you told her that if she was pregnant, then she

could not do the same things that other staff could do. It was healthcare assistant 3’s

belief that you did not want to work with her because this would mean you would have

to do more.

It is common ground that at the material times, healthcare assistant 3 was moved to a

different floor of the Home.

You told the panel that this was to avoid her being exposed to potentially aggressive

residents and that when this was explained to her she said that she would hold you

responsible if any harm came to her unborn baby.

In the panel’s judgment, it is implicit from healthcare assistant 3’s own belief that you did

not want to continue working with her because this would mean more work for you that,

in fact, her pregnancy did mean some adjustments to her duties were required to

reduce risks to her.

In coming to this factual finding the panel decided that healthcare assistant 3’s

evidence, on this particular point, was both credible and reliable, all the more so

because it was supported by the evidence that she was moved to a different floor and

by your own evidence that this was because she was at risk from aggressive residents.

This was clearly due to her pregnancy and it was this that distinguished her from other

staff. Charge 1.13.2 The allegation is that on an unknown date or dates between May 2014 and September

2015 you indicated to Care Assistant 3 that you get paid more than her, so she does not have the right to speak. This Charge is Found Proved.

The only evidence in support of this charge is the evidence of healthcare assistant 3.

You deny this charge.

The panel bore in mind the evidence contained in your Facebook postings which form

the basis of the charge you have admitted. These demonstrate, on you own account, a

view that some colleagues were “beneath you”. The panel considered the contextual

evidence of a hierarchy at the Home in which nurses instructed healthcare assistants.

In coming to this factual finding the panel decided that the evidence of healthcare

assistant 3, on this particular point, supported by the contextual evidence was both

credible and reliable.

Determination on Misconduct and Current Impairment: This determination should be read in conjunction with the panel’s earlier determination

on the facts.

In reaching its decisions at this stage, the panel had regard to all the relevant

information available to it. The panel also had regard to the submissions made by Ms

Stevenson on behalf of the NMC and the submissions made on your behalf by Ms

Pitters.

The panel noted the information to which it was referred regarding your previous NMC

regulatory history, as well as the nature of the conduct complained of in the charges

which were admitted and those which were contested and subsequently found proved

at a hearing in March 2016.

Ms Stevenson referred the panel to the 2008 edition of the NMC’s document: ‘The Code

Standards of conduct, performance and ethics for nurses and midwives’ (‘the Code’)

and the 2015 edition of that document: ‘The Code Professional standards of practice

and behaviour for nurses and midwives’ (‘the 2015 Code’). She submitted that the facts

amounted to misconduct, contending they involved repeated breaches of elements of

the Code(s) and occurred in the context of an attitudinal problem. Ms Stevenson invited

the panel to find that your fitness to practise is currently impaired. She submitted that

the misconduct would not be easily remedied, has not been remedied and, as a

consequence, is likely to be repeated. She submitted that those in your care would be at

risk of emotional harm, thereby resulting in a breach of a fundamental tenet and that

any repetition would bring the profession into disrepute and undermine public

confidence in the profession.

Ms Pitters submitted that although it was right that the panel had been provided with

information regarding your previous NMC regulatory history, that information should be

approached with a degree of caution. She reminded the panel that it had not heard any

of the evidence in the previous case. It had not been provided with a transcript of those

proceedings nor with a copy of the previous panel’s determination(s).

Ms Pitters drew the panel’s attention to the fact that the charges in this case, with the

exception of charge 2, relate to matters which predate the matters dealt with at the

previous hearing. She reminded this panel that the previous panel had determined that

you had remedied the misconduct which was found proved and did not find that your

fitness to practise was impaired.

Ms Pitters further submitted that, moreover, this panel should be making its finding on

impairment on the basis of the charge set out in the notice of hearing. The relevant part

of the charge states “In light of the above your fitness to practise is impaired by reason

of your misconduct”. Ms Pitters submitted that the phrase “in light of the above” must

refer to the facts set out in the notice of hearing. The charge is not “in light of the above

and other matters...”

Ms Pitters submitted that the facts at Charge 1.1.1, Charge 1.7 and Charge 1.8

individually and/or collectively were not sufficiently serious as to amount to misconduct.

She told the panel that you accept that, taken together, charge 1.13.2 and charge 2 are

sufficiently serious as to be capable of constituting misconduct.

The panel accepted the Legal Assessor’s advice, noting that he advised that in

considering the question of current impairment, in the event that misconduct was found,

the panel should have regard to all information relevant to an assessment of your

current fitness to practise. The Legal Assessor advised that this included information

about your previous regulatory history.

The panel applied the principles, as relevant, set out in the Legal Authorities to which it

was referred, namely: Roylance v General Medical Council [1999] UKPC 16; Meadows

v General Medical Council [2006] EWCA Civ 1390; Calhaem v General Medical Council

[2007] EWHC 2606 (Admin); Yeong v General Medical Council [2009] EWHC 1923

(Admin); and Council for Healthcare Regulatory Excellence and Nursing and Midwifery

Council v Grant [2011] EWHC 927 (Admin).

The panel engaged in a two stage process. It first decided whether the facts found

proved constituted misconduct. Whether that is the case is a matter for the exercise of

the panel’s independent judgment. There is no standard of proof to be applied. Neither

the Nursing and Midwifery Order nor the Rules define impairment of fitness to practise.

The NMC considers that the concept of fitness to practise refers to a registrant’s

suitability to remain on the Register without restriction.

In the case of Roylance, Lord Clyde stated that:

‘Misconduct is 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 by a...practitioner in the particular circumstances...’

In assessing the issue of misconduct the panel therefore had regard to the 2008 and

2015 editions of the NMC Code.

In the panel’s judgment the facts proved at charges 1.7, 1.8 and 1.13.1 are not

sufficiently serious, either individually or collectively, to cross the threshold for

misconduct. Your comment to Resident E, though inappropriate, may have been said in

a light-hearted manner, given the evidence, which the panel accepted at face value and

which was not challenged, as to the nature of your friendly relationship with Resident E.

The absence of hourly checks on Resident F and the consequent lack of recording of

such checks must be considered in the light of the lack of a firm evidential basis that

they were required. On one interpretation, your comment to healthcare assistant 3

about her not being able to do the same things other staff could do might be considered

as evidence of a condescending, abrupt and arrogant approach to colleagues whom

you believe are beneath you. However, it is also possible that it was no more than an

inappropriately phrased attempt to reinforce the decision that had been taken, in

response to healthcare assistant 3’s pregnancy, to adjust her duties by relocating her to

a floor of the Home where she would be less at risk from residents who might become

aggressive.

However, in the panel’s judgment the facts that have been proved at charges 1.1.1,

1.13.2 and 2, both individually and collectively, involve serious departures from the

standards of conduct expected of a Registered Nurse as set out in the provisions of the

Code(s) as cited above and amount to misconduct. In the case of charge 1.1.1 and

charge 2, these departures were made more serious because they were repeated.

By touching Resident A’s scarf you caused her emotional distress. Although touching a

resident’s scarf may not in itself seem serious, disrespect for a resident’s view or wishes

and lack of concern for the distress caused and repeating this behaviour is serious.

Resident A was vulnerable by reason of her age and it was your role to care for and

protect her health and wellbeing. The panel was concerned that this repetition amounts

to a potential abuse of power.

The panel had no doubt that the only plausible reason for you to tell healthcare

assistant 3 that you were paid more than she was and that she did not have the right to

speak was to impress upon her your seniority and superiority and to demean her own

role and importance in the Home. The panel was of the view that this was extremely

disrespectful to a junior colleague.

On Thursday 26 January 2017 you posted the following comment on Facebook: “I work

with some of the most stupid and spineless nurses in this whole fucking world! I swear

to god how they have got a fucking pin I will never know...yet some fuckers can say I’m

a bad nurse...fuck right off you uneducated cunts? NOT ON MY LEVEL!...” Thereafter,

up until 18:36 on the following day, you continued to post comments in response to a

number of replies to your original comment. These included the following: “Whatever I

post has nothing to do with you...”, “Well we can’t help stupidity can we?...” and, “What

about all the other shit that those thick fucks write about me when I did nights?...”

[For the avoidance of any doubt a ‘PIN’ in the content of your posted comment is a

nurse’s Personal Identification Number that is used to verify the status of a nurse’s

registration with the NMC]

In the panel’s judgment your conduct in making these comments on social media

demonstrates a seriously unprofessional attitude towards colleagues and represents a

most serious departure from the standards expected by the public of a nurse. On your

own account, your original message referred in its first part to fellow nurses at the

Home, whom you perceived had not supported you sufficiently, and in its later part,

referred to healthcare assistants whom you believed were not on your level. Even if

these comments were because of what you believed to be the reaction of these

individuals to you personally, the comments were offensive, unprofessional and

disrespectful and would seriously undermine the public’s confidence in you as a nurse

and the profession.

The panel took account of the attendance note of the telephone conversation between

Ms 4 and an NMC case officer in which Ms 4 is recorded as describing your attitude as

‘teflon coated’ and saying that you considered yourself to be ‘untouchable’. This is

reinforced by your attitude as portrayed in your Facebook postings in January 2017.

The panel determined that the parts of the 2008 Code that you breached are as follows:

‘The people in your care must be able to trust you with their health and wellbeing To justify that trust, you must: • Make the care of people your first concern, • Work with others to protect and promote the health and wellbeing of those in

your care, their families and carers, and the wider community • ...uphold the reputation of your profession. As a professional, you are personally accountable for actions and omissions in your practice, and must always be able to justify your decisions. Make the care of people your first concern... 1. You must treat people as individuals and respect their dignity. 3. You must treat people kindly and considerately. Collaborate with those in your care

8. You must listen to the people in your care and respond to their concerns

and preferences. Work effectively as part of a team

24. You must work cooperatively within teams and respect the skills, expertise

and contributions of your colleagues. 27. You must treat your colleagues fairly and without discrimination.

The panel determined that the parts of the 2015 Code that you breached are as follows:

Prioritise people

You put the interests of people using or needing nursing or midwifery services first. You make their care and safety your main concern and make sure that their dignity is preserved and their needs are recognised, assessed and responded to. You make sure that those receiving care are treated with respect, that their rights are upheld and that any discriminatory attitudes and behaviours towards those receiving care are challenged.

1 Treat people as individual and uphold their dignity

To achieve this you must:

1.1 treat people with kindness, respect and compassion

1.5. respect and uphold people’s human rights.

2 Listen to people and respond to their preferences and concerns

To achieve this you must:

2.6 recognise when people are anxious or in distress and respond

compassionately and politely.

8 Work cooperatively

To achieve this you must:

8.1 respect the skills, expertise and contributions of your colleagues, referring matters to them when appropriate

8.2 maintain effective communication with colleagues

20 Uphold the reputation of your profession at all times

To achieve this you must:

20.1 keep to and uphold the standards and values set out in the Code

20.3 be aware at all times of how your behaviour can affect and influence the

behaviour of other people

20.5 treat people in a way that does not take advantage of their vulnerability or cause them upset or distress

20.7 make sure you do not express your personal beliefs (including political,

religious or moral beliefs) to people in an inappropriate way

20.8 act as a role model of professional behaviour for students and newly qualified nurses and midwives to aspire to

20.10 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.

Having determined, for the reasons set out above, that the facts in charges 1.1.1, 1.13.1

and 2 amount to misconduct, the panel next considered whether your fitness to practise

is currently impaired by reason of that misconduct. This required an assessment by the

panel as to whether your misconduct is easily remediable; whether it has been

remedied; and the likelihood of any repetition of the misconduct. In addressing the

question of the risk of repetition, the panel also had regard to the issue of insight. In

assessing these matters the panel had careful regard to all of the relevant information

available to it.

The purpose of these proceedings is not to punish the practitioner for past failings but to

protect the public against the acts and omissions of those who are not fit to practise and

to maintain public confidence in the profession and the regulatory process. The panel

thus looks forward not back. However, in order to form a view as to your suitability to

practise without restriction today, the panel took account of the way in which you have

acted and/or failed to act in the past.

Applying the relevant elements of Dame Janet Smith’s test from her Fifth Shipman

report, cited with approval by Mrs Justice Cox in the case of Council for Healthcare

Regulatory Excellence and Nursing and Midwifery Council v Grant [2011] EWHC 927

(Admin), the panel considered whether your misconduct indicates that your fitness to

practise is currently impaired in the sense that you:

• have in the past acted and/or are liable in the future to act so as to put a patient

or patients at unwarranted risk of harm; and/or

• have in the past brought and/or are liable in the future to bring the nursing

profession into disrepute; and/or,

• have in the past breached and/or are liable in the future to breach one of the

fundamental tenets of the nursing profession.

In the panel’s judgment, all of these elements from Dame Janet Smith’s test apply, both

as to the past and the future.

Your misconduct placed patients at unwarranted risk of emotional harm. Your

misconduct means that you have breached fundamental tenets of the profession,

namely the duty to treat people with dignity, practice effectively and work cooperatively.

Your misconduct will undoubtedly have brought the profession into disrepute. In the

panel’s judgment, the public do not expect a nurse to act as you did, because they

require nurses to adhere at all times to the appropriate professional standards at all

times.

In the panel’s judgment your misconduct may not be easily remedied. Aspects of your

misconduct in this case, namely what seems to be your attitude to professional

colleagues as demonstrated in the contemptuous nature of your comments on social

media and your disregard for Resident A’s distress appear to be echoed to a degree by

what the panel was told in relation to the facts which were proved at the previous

hearing. Although this panel understands that the panel on that occasion concluded that

your had remedied your misconduct, that remediation and your insight in respect of that

misconduct, did not prevent you from committing the misconduct detailed in charge 2 at

this hearing.

Furthermore, in the panel’s judgment, your attitude towards colleagues demonstrated by

the facts in charge 2 contained more than an echo of your disturbing conduct

demonstrated towards those in your care which was the subject of aspects of your

previous misconduct. Taken together, the misconduct found during this hearing when

seen in the light of your previous regulatory history indicates a worrying attitudinal

problem that may encompass both those in your care and your professional colleagues.

For all these reasons the panel determined that your misconduct may not be easy to

remedy.

Notwithstanding Ms Pitters’ submission that, save for charge 2, the facts in this case

predate the matters considered at the previous hearing and which that panel found had

been remedied, there is no evidence before this panel of any remediation on your part.

In these circumstances the panel could not be confident that you have remedied your

misconduct. You admitted charge 2 and this is indicative of a degree of insight which is

to your credit. However, this is limited. There is no evidence of reflection. As a

consequence, in the panel’s judgment, you remain liable to repeat your misconduct.

Having reached that conclusion the panel had regard to paragraph 74 of Mrs Justice

Cox’s ruling in the case of Grant as follows:

“In determining whether a practitioner’s fitness to practise is impaired ... the

relevant panel should generally consider not only whether the practitioner

continues to present a risk to members of the public in his or her current role, but

also whether the need to uphold proper professional standards and public

confidence in the profession would be undermined if a finding of impairment were

not made in the particular circumstances.”

The panel was satisfied that, having regard to the nature of your misconduct, the “need

to uphold proper professional standards and public confidence in the profession” would

be undermined if a finding of current impairment were not made. The panel concluded

that the public would be appalled if they knew that a nurse was being so unprofessional

in a public forum and had caused a resident in her care distress.

For all the above reasons, the panel decided that your fitness to practise is currently

impaired by reason of your misconduct both on public protection and public interest

grounds.

Determination on Sanction: Having determined that your fitness to practise is currently impaired by reason of your

misconduct, the panel next considered what sanction, if any, should be imposed in

respect of your registration.

The paneI took account of all of the relevant information available to it together with the

submissions made by both Counsel.

Ms Stevenson referred the panel to the NMC’s current Sanctions Guidance document

and invited it to consider such aggravating and mitigating features it considered were

relevant.

Ms Pitters invited the panel to impose a conditions of practice order. She invited the

panel to consider the context in which your Facebook postings had taken place, which

included the campaign of bullying to which you had been subjected and which was

attested to by Ms 4. She submitted that a more restrictive sanction would be

disproportionate.

The panel accepted the advice of the Legal Assessor.

The decision as to what sanction, if any, to impose is a matter for the panel’s

independent judgment. The purpose of imposing a sanction is not to be punitive,

although it may have a punitive effect.

The panel had regard, as it has throughout this hearing, to the overarching objectives of

the NMC which are (i) the protection, promotion and maintenance of the health, safety

and well-being of the public and patients; and (ii) the wider public interest which

includes (a) promoting and maintaining public confidence in the professions and (b)

upholding the proper professional standards for members of those professions.

The panel applied the principle of proportionality, and balanced the public interest with

your own interests in being allowed to continue in your chosen profession without

restriction. The panel must impose the least restrictive sanction necessary to protect the

public and satisfy the wider public interest.

The panel had regard to the NMC’s sanctions guidance but noted that:

• each case will depend on its own facts;

• the sanctions guidance is not to be regarded as laying down a rigid tariff.

The panel took account of the aggravating and mitigating features which it identified as

being relevant to the case, as follows:

a. aggravating features:

• your previous adverse regulatory history;

• aspects of your misconduct involved an attitudinal problem towards

colleagues;

• your misconduct caused distress to a vulnerable resident;

• the limited extent of insight which you have demonstrated;

• your misconduct was repeated.

b. mitigating features:

• your full engagement with the NMC including attendance throughout these

proceedings;

• your early admission to charge 2 and recognition that your conduct in making

the relevant Facebook postings was unprofessional;

• the challenging circumstances you experienced at the material times in your

place of work;

• positive testimonials confirm that there are no clinical concerns about your

practice.

The panel first considered and rejected taking no action. In the panel’s judgment, your

misconduct requires the imposition of a sanction for a number of reasons including the

following:

• you caused Resident A distress on two occasions;

• the attitude underpinning the misconduct, notwithstanding any contextual basis;

• the nature of the language of your initial Facebook posting;

• you continued to post further unprofessional comments despite being told that

your initial posting was offensive;

• the need to declare proper standards of professional behaviour and maintain

public confidence in the profession and the system of professional regulation.

The panel next considered imposing a caution order. This would not restrict your

practice. The sanctions guidance makes clear that a caution order would generally only

be appropriate if the panel is satisfied that there is no risk to the public or patients which

requires your practice to be restricted. Having regard to the limits of your insight, as

demonstrated to this panel, and taking account of the nature of your misconduct, a

caution order would not protect patients or satisfy the public interest in the case, which

requires that it be marked by a more restrictive sanction.

The panel next considered imposing a conditions of practice order. Conditions of

practice are primarily designed to protect the public and thereby address the wider

public interest. They may also support a registrant in addressing learning needs,

thereby facilitating an eventual return to safe and unrestricted practice.

Although Ms Pitters urged this sanction on the panel, submitting that you could be

subject to supervision and that reports could be provided, for example, attesting to your

conduct towards and communication with patients and colleagues, in the panel’s

judgment such an order would not be sufficient or appropriate.

The misconduct is not limited to discrete areas of your clinical practice. Your misconduct

as accepted by Ms Pitters had an attitudinal basis. You ignored Resident A’s distress. In

the panel’s judgment, although you may have had reason to feel ill-disposed towards

the colleagues whom you perceived to have bullied you, your Facebook postings have

been wholly unjustified. The language used is deplorable. This element of your

misconduct occurred outside the work place. For these reasons, the panel concluded

that conditions of practice could not be constructed which would address your

misconduct and they would not be sufficient to satisfy the public interest at this time.

The panel therefore went on to consider imposing a suspension order. Such an order is

intended to protect the public whilst conveying a message to the registrant, the

profession and the wider public regarding the gravity of unacceptable and inappropriate

behaviour and the importance of maintaining and upholding proper standards of

professional conduct. A suspension order may be imposed, for up to one year, where, in

the particular circumstances of the case, the behaviour being considered falls short of

being fundamentally incompatible with continued registration.

The Sanctions Guidance indicates that key considerations for a suspension order are:

• Does the seriousness of the case require temporary removal from the register?

• Will a period of suspension be sufficient to protect patients and the public

interest?

In the panel’s judgment, although your misconduct is not a single instance, the public

will be protected from any risk whilst a suspension order is in effect. Although the panel

has found evidence of an attitudinal problem, as accepted by your representative it is

not able to determine whether this is deep-seated. You have demonstrated a limited

degree of insight and may have the potential to develop this further. Positive

testimonials indicate that you are a clinically competent nurse.

Taking full account of the potential impact of a suspension order on you, the panel

determined that it could protect the public and declare and uphold proper standards of

professional behaviour, and thus maintain public confidence in the profession and the

regulatory process by imposing such an order. The panel concluded that suspending

your registration for a period of nine months is the appropriate and proportionate

response to the seriousness of your misconduct and will satisfy the public interest at this

time. In deciding that this was the appropriate duration the panel had regard to the

nature of the misconduct, the importance of maintaining public confidence by marking

the misconduct and the need for proportionality.

This suspension order will also provide you with an opportunity to reflect on the panel’s

findings, and allow you time to develop and demonstrate further insight, and to take

steps to provide information for a subsequent review of this order. However, this is all a

consequence of the panel’s decision and not the reason for it.

Having come to the provisional view that a suspension order for nine months was

appropriate and sufficient, the panel nevertheless considered a striking-off order. The

panel determined that your misconduct did not warrant such an order at this stage.

Although the seriousness of the case overall requires the temporary removal of your

name from the Register, the public can be protected and the public interest can be

satisfied by a lesser sanction than a striking-off order. Such an order would, therefore

be disproportionate at this time and would deprive the public of a Registered Nurse who

may be able to return to safe practise at some future date.

Although the panel heard no evidence about the financial impact of this suspension

order on you, it may cause you significant personal and professional hardship because

it will prevent you from working as a Registered Nurse. In any event, applying the

principle of proportionality, the panel determined that your private interests were

outweighed by the need to protect the public and by the wider public interest, including

the need to maintain public confidence in the profession and the NMC as the Regulatory

Authority.

This suspension order will be reviewed by a fitness to practise panel shortly before it is

due to expire. A reviewing panel will be able to impose such further order as it

determines is appropriate in light of the information available to it, up to and including a

striking-off order or to let the order lapse. The NMC will notify you of the date of that

hearing in advance and you will be invited to attend.

In the judgment of this panel, the panel reviewing the order will be assisted by your

attendance and by receiving information from you to assist in its assessment of your

fitness to practise as a Registered Nurse at that time, which you should provide to the

NMC in advance of the date of the Review hearing. That information could helpfully

include the following:

• a written reflection, employing a recognised model, addressing your personal

accountability for all aspects of your misconduct and in particular addressing

your reflection on your future use of social media;

• verifiable evidence, ideally in writing, of engagement with a mentor with whom

you should have discussed your misconduct, your decision making, the

implications for patient safety and public confidence in the profession and the

steps you might take to restore confidence if returned to practice;

• up to date references in relation to any work you undertake, whether paid or

unpaid, that include addressing the nature of your communication and

interaction with colleagues;

• any other evidence which demonstrates your fitness to practice including any

evidence of you keeping up to date with nursing practices.

Right of Appeal: You will have 28 days from the date when written notice of the result of this hearing is

deemed to have been served upon you in which to exercise your statutory right of

appeal. You will be provided with a note explaining your right of appeal. Unless you

decide to exercise that right, the direction imposing a Suspension Order for 9 months

will take effect 28 days from when written notice of the decision is deemed served upon

you.

Determination on Interim Order Having already determined to impose a substantive suspension order, the panel has

now also decided to impose an interim suspension order, for a period of 18 months and

directs the Registrar accordingly.

In reaching its decision, the panel applied the principle of proportionality.

Ms Stevenson sought an interim suspension order for 18 months to cover your statutory

28 day appeal period and the duration of any appeal which might be made. She sought

the order on the basis that it is necessary for the protection of the public and is

otherwise in the public interest.

Ms Pitters did not oppose the imposition of an interim suspension order.

The panel accepted the Legal Assessor’s advice.

An interim order can only be made on one or more of three grounds, namely that:

• it is necessary for the protection of the public; and/or

• it is otherwise in the public interest; and/or

• it is in the registrant’s own interests.

The panel decided an interim order in this case is necessary for the protection of the

public, and is otherwise in the public interest in order to maintain public confidence in

the profession due to the nature of the misconduct and the risk of repetition.

The panel then considered what type of interim order to impose. In accordance with the

principle of proportionality, it must impose the least restrictive order appropriate to the

circumstances of the case.

The panel determined that an interim conditions of practice order would be inconsistent

with its earlier findings and so would be perverse. The panel is satisfied that an interim

suspension order is necessary, appropriate and proportionate in the circumstances of

this case for the same reasons as given for the imposition of the substantive suspension

order.

The period of this interim suspension order is 18 months. In coming to its conclusion

that 18 months is the appropriate period, the panel had regard to the length of any

appeal process, noting that this includes the time likely to elapse before any appeal is

listed and determined by the High Court, which may be significant.

The panel had careful regard to the fact that this interim suspension order will prevent

you from working as a Registered Nurse. This is likely to cause you personal and/or

professional hardship. However, applying the principle of proportionality, the panel

determined that your interests were outweighed by the need to protect the public and

the wider public interest.

If there is no appeal, this interim suspension order will lapse at the end of the 28 day

appeal period, when the panel’s substantive suspension order for 9 months takes effect.

In the event that an appeal is lodged but concluded before the expiration of 18 months,

this interim suspension order will lapse at the conclusion of the appeal. If an appeal is

lodged but not concluded within the period of 18 months, it will be necessary for the

NMC to apply to the High Court for an extension of this interim suspension order.

In the meantime, your entry in the NMC register will show that you are subject to an

interim suspension order and anyone who enquires about your registration will be told

about that order.

The panel’s decisions in this case will be confirmed in writing.

That concludes this hearing.