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Nursing and Midwifery Council Fitness to Practise Committee

Substantive Hearing 3 – 5 April 2018

Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of registrant: Miss Mona Lisa Huni NMC PIN: 98C0322E Part(s) of the register: Registered Nurse – Mental Health Area of Registered Address: England Type of Case: Misconduct Panel Members: Janet Leonard (Chair, registrant member)

Hannah Harvey (Registrant member) Belinda Poole (Lay member)

Legal Assessor: Graeme Sampson Panel Secretary: Kelly O’Brien Registrant: Miss Mona Lisa Huni present and

represented by Mr Harry Bentley Counsel Nursing and Midwifery Council: Represented by Ms Katie Mustard, Case

Presenter Facts proved: 1(a)(I), 1(a)(II), 1(b), 1(c), 2(a), 2(b), 2(c), 3(a),

3(b) Facts proved by admission: 1(a)(I), 1(a)(II), 1(b), 1(c), 2(a), 2(b), 2(c), 3(a),

3(b) Facts not proved: None Fitness to practise: Impaired Sanction: Caution Order for 3 years

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Details of charge

1. Whilst working a night shift at Cornerstone House which commenced on 13 June

2017:

2. a) Recorded that you had given Patient A two doses of 30mg/5ml solution

Oramorph, a controlled medication, on or about the following times, when you had

in fact administered doses of 10mg/5ml solution: (charge as amended)

I. On 13 June 2017 at 22.25.

II. On 14 June 2017 at 05.30.

b) Administered the doses set out in charge 1(1) without another qualified person

present.

c) Signed the initials of Colleague A in the ‘witnessed by’ column of the controlled

drug record.

3. When informed of your errors at charge 1(a):

a) Went back to the records you had made and wrote over the ‘3’ in each of the

entries set out in 1(a) above with a ‘1’.

b) Signed the amendment yourself.

c) Did not obtain any counter-signatory for the above amendment.

4. Your actions in charge 1(c) were dishonest in that:

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a) Colleague A had not been present during the administration of drugs set out in

charge 1(a).

b) You intended to create the impression that Colleague A had been present.

AND in light of the above, your fitness to practise is impaired by reason of your

misconduct.

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Decision and reasons on application to amend the charge

The panel heard an application made by Mr Bentley, on your behalf, to amend the

wording of charge 1(a).

The panel heard that the proposed amendment was not opposed by Ms Mustard on

behalf of the NMC.

The proposed amendment was to amend charge 1(a) by adding the word “solution”

following “doses of 30mg/5ml” and “doses of 10mg/5ml”. It was submitted by Mr Bentley

that the proposed amendment would provide clarity and more accurately reflect the

events that took place.

Original charge 1 (a)

a) Recorded that you had given Patient A two doses of 30mg/5ml Oramorph,

a controlled medication, on or about the following times, when you had in

fact administered doses of 10mg/5ml:

Amended charge 1 (a)

a) Recorded that you had given Patient A two doses of 30mg/5ml solution

Oramorph, a controlled medication, on or about the following times,

when you had in fact administered doses of 10mg/5ml solution:

The panel accepted the advice of the legal assessor that Rule 28 of the Rules states:

28. (1) At any stage before making its findings of fact, in accordance with rule

24(5) or (11), the Investigating Committee (where the allegation relates to a

fraudulent or incorrect entry in the register) or the Fitness to Practise Committee,

may amend

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(a) the charge set out in the notice of hearing; or

(b) the facts set out in the charge, on which the allegation is based,

unless, having regard to the merits of the case and the fairness of the

proceedings, the required amendment cannot be made without injustice.

(2) Before making any amendment under paragraph (1), the Committee shall

consider any representations from the parties on this issue.

The panel was of the view that such an amendment, as applied for, was in the interest

of justice. The panel was satisfied that there would be no prejudice to you and no

injustice would be caused to either party by the proposed amendment being allowed. It

was therefore appropriate to allow the amendment, as applied for, to ensure clarity and

accuracy.

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Background The charges arose whilst you were employed as a bank Registered Nurse by the

Sugarman Agency (the Agency). You came onto the register as a Mental Health Nurse

on 23 February 2001. On 13 February 2017, you began a contract placement at

Cornerstone House (the House) operated by Vision Mental Health (VMH).

On the nightshift of the 13 June 2017 – 14 June 2017 you were working with another

registered nurse, Mr 1, and two health care support workers. During that shift you

allegedly recorded in the Controlled Drug (CD) register that you had given Patient A two

doses of 30mg/5ml of Oramorph solution, one on 13 June 2017 at 22.25 hours and one

on 14 June 2017 at 05:30 hours, when you had in fact administered a prescribed doses

of 10mg/5ml solution.

Oramorph is a CD that is used for pain relief in those with severe pain. According to the

Houses’ Standard Operating Policy (SOP), administration of CD’s should be undertaken

by two registered nurses.

The CD register and Patient A’s drug chart appeared to show that Mr 1 countersigned

the abovementioned drug administrations. Mr 1 denies that he was present during the

drug administrations and alleged that he did not sign these documents. Accordingly it is

alleged that you administered the doses without another qualified person present and

that you falsified Mr 1’s signature in the records.

When informed of the erroneous entry, you allegedly altered the entry by writing over

the ‘3’ with a ‘1’ which was not in accordance with the appropriate procedure for

corrections of record errors. In addition, the amendment was not countersigned by a

colleague as required.

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Decision on the findings on facts and reasons At the start of this hearing you admitted the following charges;

Charge 1 (a)

1. Whilst working a night shift at Cornerstone House which commenced on 13 June

2017:

a) Recorded that you had given Patient A two doses of 30mg/5ml solution

Oramorph, a controlled medication, on or about the following times, when

you had in fact administered doses of 10mg/5ml solution:

I. On 13 June 2017 at 22.25.

II. On 14 June 2017 at 05.30.

This charge is found proved by way of admission.

Charge 1 (b)

b) Administered the doses set out in charge 1(a) without another qualified

person present.

This charge is found proved by way of admission. Charge 1 (c)

c) Signed the initials of Colleague A in the ‘witnessed by’ column of the

controlled drug record.

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This charge is found proved by way admission.

Charge 2 (a)

2. When informed of your errors at charge 1(a):

a) Went back to the records you had made and wrote over the ‘3’ in each of

the entries set out in 1(a) above with a ‘1’.

This charge is found proved by way admission.

Charge 2 (b)

b) Signed the amendment yourself.

This charge is found proved by way of admission.

Charge 2 (c)

c) Did not obtain any counter-signatory for the above amendment.

This charge is found proved by way of admission.

Charge 3 (a)

3. Your actions in charge 1(c) were dishonest in that:

a) Colleague A had not been present during the administration of drugs set

out in charge 1(a).

This charge is found proved by way of admission.

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Charge 3 (b)

b) You intended to create the impression that Colleague A had been present.

This charge is found proved by way of admission. In reaching this decision, the panel took into account your admissions, and accordingly

the panel announced the facts found proved by way of your admissions.

Ms Mustard informed the panel there was an outstanding factual issue to determine. Ms

Mustard submitted that the issue was whether you had administered the CD alone, and

had done so because it was your usual practice to do so, and whether Mr 1 the more

senior nurse was aware of this or had instructed you to do so.

Ms Mustard submitted that as you have admitted all the charges the NMC did not

propose to call their witness, Mr 1 – Mental Health Nurse at the House, at this stage. In

Ms Mustard’s submissions, Mr 1 would speak to the context surrounding the admitted

charges, which would only assist the panel at the impairment stage of the proceedings,

regarding the level of misconduct.

Mr Bentley submitted that Mr 1 should be called to give evidence at this, the facts stage

of the proceedings. Mr Bentley submitted to the panel that the issue in dispute was a

matter of fact, which should logically be decided at the facts stage. Mr Bentley reminded

the panel that at the impairment stage there was no burden of proof. Accordingly, in Mr

Bentley’s submissions, the outstanding issue of fact surrounding Mr 1’s evidence should

be decided at the facts stage.

The panel heard and accepted the advice of the legal assessor.

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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

facts will be proved if the panel was satisfied that it was more likely than not that the

incidents occurred as alleged.

The panel determined that it would hear oral evidence from the witness called on behalf

of the NMC, Mr 1, at this stage of the proceedings. The panel was of the view that

questions of fact had arisen which had to be resolved in order to understand the whole

facts of the case. The panel considered that on balance, as a matter of fairness to you,

it seemed logical to hear any outstanding issues of fact at the facts stage, irrespective of

your admissions.

The panel heard oral evidence from Mr 1 called on behalf of the NMC.

The panel also heard from you under oath.

The panel did not find Mr 1 to be a credible and reliable witness. The panel was of the

view that whilst they felt Mr 1 was honest in his answers, and that it was evident that he

respected you professionally, there were inconsistencies in his evidence. The panel

considered that whilst Mr 1 answered questions put to him directly he did not give a full

account.

The panel found you to be a credible, reliable, and honest witness. The panel

considered that you gave a full and clear account, and tried to assist the panel even

where the answers were to your detriment. The panel was of the view that you

appeared to not want to pass blame to Mr 1, and spoke truthfully regarding your working

relationship with him.

.

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In reaching its decisions on the supplementary factual issue, the panel took into account

all the oral and documentary evidence in this case together with the submissions made

by Ms Mustard, on behalf of the NMC and those made by Mr Bentley on your behalf.

The panel considered that there were many consistencies between your account of

events and Mr 1’s. The only difference between your accounts was as to your

administration of the CD’s and your completion of the CD register. The panel bore in

mind that Mr 1 told the panel that he hadn’t taken the issue of forward because he

feared retribution and was consistently protective of himself all the way through this

investigation.

The panel determined that it preferred your account of events.

The panel found that Mr 1, as the more senior of two nurses on the nightshift on the 13

– 14 June 2017, would and must have been aware that you administered the controlled

drug Oramorph alone. The panel was of the view that it was more likely than not, that

Mr 1 was aware that you were dispensing the CD medication without another qualified

person present.

It also found that given Mr 1 was the Nurse in Charge and the designated CD key

holder, including the responsibility for the CD records, he must have known that you had

signed his initials in the records as having been present at both Oramorph

administrations to Patient A.

It did not find that you or Mr 1 conspired to breach the policy on controlled drugs

administration or conspired in the falsification of the records. It found that those matters

developed as an unintentional consequence of your working relationship although both

you and Mr 1 were aware of those matters and did nothing about them.

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Submission 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. There is no statutory definition of fitness to practise.

However, the NMC has defined fitness to practise as a registrant’s suitability to remain

on the register unrestricted.

The panel heard evidence from you under oath.

Ms Mustard referred the panel to the written witness statement of Ms 2 where she

stated in reference to Oramorph “giving too much or too little could put patients at risk of

serious harm. There is also the consideration that if someone is dishonest the

medication could be pocketed and abused or misused”.

In her submissions Ms Mustard invited the panel to take the view that your actions

amounted to a breach of The Code: Professional standards of practice and behaviour

for nurses and midwives (2015) (the Code). She then directed the panel to following

specific paragraphs 10, 10.2, 10.3, 18, 18.2, 20, 20.1, 20.2 where, in the NMC’s view,

your actions amounted to misconduct.

In Ms Mustard’s submissions, dishonesty amongst professional people is extremely

serious. The dishonesty in this case had a clinical element, namely that it related to

record keeping in relation to CD’s. In Ms Mustard’s submission this increases the

seriousness of the dishonesty as it had potentially very serious consequences for

patients.

In Ms Mustard submissions, your actions represented a sufficiently serious departure

from proper standards and should result in a finding of misconduct.

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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. This included the

need to declare and maintain proper standards and maintain public confidence in the

profession and in the NMC as a regulatory body. Ms Mustard referred the panel to the

cases of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery

Council (2) Grant [2011] EWHC 927 (Admin), and Cohen v GMC (2008) EWHC 581

(Admin).

Ms Mustard submitted that all four of the limbs of Grant are engaged in this case.

In Ms Mustard’s submissions, dishonesty is difficult to remediate. She submitted to the

panel that it is noteworthy that you initially engaged in further dishonesty when the

matter was investigated locally by Ms 2. Accordingly, in her submissions, she said there

was a potential risk of repetition and impairment should be found on public protection

and public interest grounds.

In Mr Bentley’s submissions on impairment, if found, should only be on public interest

grounds. Mr Bentley referred the panel to the case of Bevan v General Medical Council.

[2005] Lloyd's Rep Med 321, and the case of Balamoody v Nursing & Midwifery Council.

[2009] EWHC 3235 (Admin). In his submissions you had accepted with hindsight that

you should have behaved differently, and that your significant insight was material in

determining impairment. Mr Bentley submitted that you had reflected fully by looking at

your own thoughts and behaviour objectively, as well as providing references as to your

high standard of clinical practice.

The panel has accepted the advice of the legal assessor which included reference to

Roylance v General Medical Council (No 2) [2000] 1 A.C. 311.

The panel adopted a two-stage process in its consideration, as advised. First, the panel

must determine whether the facts found proved amount to misconduct. Secondly, only if

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the facts found proved amount to misconduct, the panel must decide whether, in all the

circumstances, your fitness to practise is currently impaired as a result of that

misconduct.

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Decision on misconduct When determining whether the facts found proved amount to misconduct the panel had

regard to the terms of the Code.

The panel, in reaching its decision, had regard to the public interest and accepted that

there was no burden or standard of proof at this stage and exercised its own

professional judgement.

The panel was of the view that your actions did fall significantly short of the standards

expected of a registered nurse, and that your actions amounted to a breach of the

Code. Specifically:

Practise effectively You assess need and deliver or advise on treatment, or give help (including

preventative or rehabilitative care) without too much delay and to the best of your

abilities, on the basis of the best evidence available and best practice. You

communicate effectively, keeping clear and accurate records and sharing skills,

knowledge and experience where appropriate. You reflect and act on any feedback you

receive to improve your practice.

10 Keep clear and accurate records relevant to your practice This includes but is not limited to patient records. It includes all records that are relevant

to your scope of practice.

To achieve this, you must:

10.1 complete all records at the time or as soon as possible after an event, recording

if the notes are written some time after the event

10.2 identify any risks or problems that have arisen and the steps taken to deal with

them, so that colleagues who use the records have all the information they need

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10.3 complete all records accurately and without any falsification, taking immediate

and appropriate action if you become aware that someone has not kept to these

requirements

18 Advise on, prescribe, supply, dispense or administer medicines within the limits of your training and competence, the law, our guidance and other relevant policies, guidance and regulations To achieve this, you must:

18.1 prescribe, advise on, or provide medicines or treatment, including repeat

prescriptions (only if you are suitably qualified) if you have enough knowledge of

that person’s health and are satisfied that the medicines or treatment serve that

person’s health needs

18.2 keep to appropriate guidelines when giving advice on using controlled drugs and

recording the prescribing, supply, dispensing or administration of controlled

drugs

Promote professionalism and trust You uphold the reputation of your profession at all times. You should display a personal

commitment to the standards of practice and behaviour set out in the Code. You should

be a model of integrity and leadership for others to aspire to. This should lead to trust

and confidence in the profession from patients, people receiving care, other healthcare

professionals and the public.

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

20.2 act with honesty and integrity at all times…

The panel appreciated that breaches of the Code do not automatically result in a finding

of misconduct. However, the panel was of the view that your admitted shortfalls and

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dishonesty did fall seriously short of the conduct and standards expected of a nurse and

amounted to misconduct.

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Decision on impairment The panel next went on to decide if as a result of this misconduct your fitness to practise

is currently impaired.

The panel considered the judgement of Mrs Justice Cox in the case of Council for

Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011]

EWHC 927 (Admin);

Mrs Justice Cox went on to say in Paragraph 76:

“I would also add the following observations in this case…as to the helpful

and comprehensive approach to determining this issue formulated by

Dame Janet Smith in her Fifth Report from Shipman, referred to above.

At paragraph 25.67 she identified the following as an appropriate test for

panels considering impairment of a doctor’s fitness to practise, but in my

view the test would be equally applicable to other practitioners governed

by different regulatory schemes.

Do our findings of fact in respect of the doctor’s misconduct,

deficient professional performance, adverse health, conviction,

caution or determination show that his/her fitness to practise is

impaired in the sense that s/he:

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

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c. has in the past breached and/or is liable in the future to breach

one of the fundamental tenets of the medical profession; and/or

d. has in the past acted dishonestly and/or is liable to act

dishonestly in the future.”

The panel found that all limbs were engaged in this case. Although no patients had

come to any harm, your actions put patients at an unwarranted risk of harm. It was of

the view that your actions which involve your clinical practice and dishonesty breached

fundamental tenets of the profession which, in turn, brought the profession into

disrepute.

Regarding insight, the panel considered that you had demonstrated a high level of

insight. The panel were of the view that you were genuinely very remorseful, and

understood that you had let the profession down and jeopardised the reputation of

nurses and agency workers alike. The panel carefully considered your oral evidence

and your written reflective piece, and found that you had demonstrated significant

understanding of where your actions fell short of the standards expected of a registered

nurse, the actual and potential consequences of those actions, and how you would act

differently in the future.

The panel bore in mind the circumstances of your working environment at the relevant

time and considered that it can be difficult to work with people who may not be

performing to your own high standards of practice. When questioned by the panel, you

showed a high level of insight by providing examples of how you would act differently in

the future if you found yourself in a similar circumstances.

The panel had regard to the character and clinical practice references from the staff that

have worked with you. The panel bore in mind that one reference was from your current

employer, with whom you have been working since the misconduct, without incident.

The panel considered your long 17 year unblemished career as an accomplished and

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able nurse, and concluded that in light of this evidence there is a minimal risk of

repetition. Accordingly, the panel were of the view that impairment could not be found

on public protection grounds.

The panel considered your dishonesty in this case compounded matters. You are an

experienced nurse that had worked in settings involving substance abuse in the past.

You, as stated in your oral evidence, where fully aware of the CD SOP and its

requirements in place at the time for the House.

The panel bore in mind that the overarching objectives of the NMC are to protect,

promote and maintain the health, safety and well-being of the public and patients, and

to uphold and protect the wider public interest, which includes promoting and

maintaining public confidence in the nursing and midwifery professions and upholding

the proper professional standards for members of those professions.

Accordingly, despite your high level of insight, the panel determined that a finding of

impairment was necessary on public interest grounds, in order to send a message

about the standards of behaviour expected of registered nurses, and to uphold public

confidence in the profession and its regulator.

Having regard to all of the above, the panel was satisfied that your fitness to practise is

currently impaired.

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Submissions and determination on sanction

In her submissions on behalf of the NMC, Ms Mustard indicated that the NMC put

forward a Sanction Bid of a Caution Order for the period of 3 - 5 years. She highlighted

what the NMC contends are the aggravating and mitigation features of this case. In Ms

Mustard’s submissions to take no further action would be incompatible with the panel’s

finding of impairment on public interest grounds. She submitted that the caution order

should fall at the higher end of the spectrum to reflect the seriousness of this case when

taken in conjunction with the dishonesty.

In his submissions on your behalf, Mr Bentley agreed with the NMC Sanction Bid and

invited the panel to impose a Caution Order for the period that it deems necessary. Mr

Bentley submitted that the public interest is better served by the least restrictive

measure on a nurse’s practice. He pointed out that the public interest is served by

committing able and experienced nurses like you to practice. Having not found

impairment on public protection grounds, in Mr Bentley’s submissions, a caution order

should be considered the least restrictive sanction to mark the wrongdoing and protect

public confidence in the profession.

The panel considered very carefully the question of what sanction, if any, should be

imposed in this case. The panel decided to impose a Caution Order. The effect of this

order is that your name on the NMC register will show that you are subject to a caution

order and anyone who enquires about your registration will be informed of this order.

In reaching this decision, the panel had regard to all the evidence that has been

adduced in this case, and to its previous decisions at the facts and impairment stages. It

had regard to the submissions made at this stage by Ms Mustard on behalf of the NMC,

and Mr Bentley on your behalf. The panel accepted the advice of the legal assessor

which included reference to the Sanctions Guidance (SG).

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The panel bore in mind that any sanction imposed must be appropriate and

proportionate and, although not intended to be punitive in its effect, may have such

consequences. The panel had careful regard to the SG published by the NMC. It

recognised that the decision on sanction is a matter for the panel, exercising its own

independent judgement.

The panel had regard to the mitigating and aggravating features of the case.

The panel considered that the aggravating factors were as follows:

• Fraudulent entries in a CD record have potential to put patients at serious risk of

harm;

• Your dishonesty is exacerbated by your further dishonesty during the local

investigation; and

• Your failures related to basic nursing practice and breached local policies.

The panel considered that the mitigating factors were as follows:

• No regulatory concerns about you prior to, or since the incidents, on the nightshift

of 13 – 14 June 2017;

• You have put forward positive references and testimonials from current employer

and other professionals who are aware of these matters;

• You have provided evidence of insight and shown an understanding of the

seriousness of your dishonesty and how you would address matters if a similar

situation occurred in the future;

• You admitted the charges at the outset of this hearing and never sought to

minimise your failings; and

• You have engaged with the NMC and been candid throughout these

proceedings.

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The panel had regard to the specific guidance in relation to dishonesty set out within

section SAN-5 of the SG. That guidance reads as follows:

'A nurse found to have acted dishonestly is always going to be at severe risk of

having his or her name erased from the register. A nurse who has acted

dishonestly, who does not appear before the Panel either personally or by

solicitors or counsel to demonstrate remorse, a realisation that the conduct

criticised was dishonest, and an undertaking that there will be no repetition,

effectively forfeits the small chance of persuading the Panel to adopt a lenient or

merciful outcome and to suspend for a period rather than direct erasure.'

This does not mean that in dishonesty cases the Fitness to Practise Committee

is left with an arbitrary choice between suspension and striking-off, or that in the

absence of special circumstances a striking-off order is to be seen as a ‘default’

outcome. Rather, this decision makes clear that honesty is so integral to the

standing of a profession that any departure from it will always risk a striking-off

order as a possible outcome.

It is nevertheless vital that all Fitness to Practise Committee panels continue to

start with the least restrictive sanction, and work upwards in order of

restrictiveness. A finding of dishonesty does not remove this responsibility.

The nature of the dishonest conduct must be carefully assessed. Not all

dishonesty is equally serious. Generally, the forms of dishonesty which are most

likely to call into question whether a nurse or midwife should be allowed to

remain on the register will involve:

• deliberate dishonesty to conceal clinical issues, particularly those causing

harm to patients

• misuse of power

• vulnerable victims

• personal financial gain from a breach of trust

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• direct risk to patients

• premeditated, systematic or longstanding deception

Dishonest conduct will generally be less serious in cases of:

• one-off incidents

• opportunistic or spontaneous conduct

• no direct personal gain

• no risk to patients

• incidents in private life of nurse or midwife

The panel noted that this case involved dishonesty in order to conceal record keeping

issues which had the potential to cause harm to patients. The panel were of the view

that the dishonesty was not systematic, deliberate or longstanding, having regard to

your lengthy career. Rather, it was opportunistic, and could only have started at the

earliest on 7 June 2017 when Patient A was initially prescribed the Oramorph. The

dishonesty, whilst wrong in any circumstance, was engaged in to facilitate the timely

delivery of the necessary pain relief to Patient A.

The panel further considered that there was no misuse of power, no personal or

financial gain, and that no actual harm was caused to patients. The panel bore in mind

the working environment and your working relationship with Mr 1. He was the more

senior registered nurse, the nurse in charge, the designated CD key holder, and the

only other registered nurse on the night shift of 13 – 14 June 2017 that could have

signed the CD record. The panel therefore concluded that the dishonesty was not

towards the higher end of the spectrum.

The panel first considered whether to take no action but concluded that this would be

inconsistent with its earlier findings and inappropriate in view of the seriousness of the

case. The panel decided that it would be neither proportionate nor in the public interest

to take no further action.

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Next, in considering whether a caution order would be appropriate in the circumstances,

the panel took into account the Sanctions Guidance, which states that a caution order

may be appropriate where ‘the case is at the lower end of the spectrum of impaired

fitness to practise and the panel wishes to mark that the behaviour was unacceptable

and must not happen again.’

The panel noted that you have shown considerable insight into your misconduct, and

dishonesty. The panel noted that you made admissions to all the facts, the misconduct

and impairment at the outset of this hearing. You apologised to this panel for your

misconduct and dishonesty during your evidence, and displayed genuine remorse for

what you had done and how this put patients at risk of harm and damaged the

reputation of the profession. You have undertaken to the panel that you will not repeat

the misconduct and described how you would act if a similar set of circumstances arose

in your future clinical practice.

You have engaged with the NMC since referral. The panel has been told that there have

been no adverse findings in relation to your practice either before or since these

incidents. Furthermore, you have provided the panel with several very positive

character and clinical practice testimonials, including one from your current employer.

The panel considered whether it would be proportionate to impose a more restrictive

sanction and looked at conditions of practice. The panel considered that given the

nature of this case and the misconduct and dishonesty, there were no workable or

measurable conditions of practice that would be appropriate. No clinical retraining is

needed, and you are working safely in practice at the moment.

The panel concluded that no useful purpose would be served by a conditions of practice

order. It is not necessary to protect the public and would not assist your return to

nursing practice.

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The panel further considered that a suspension order would have a wholly

disproportionate effect given your family circumstances and the inevitable financial

hardship this would cause them.

The panel has decided that a caution order would adequately satisfy the public interest.

Having considered the general principles above and looking at the totality of the findings

on the evidence, the panel has determined that to impose a caution order for a period of

3 years would be the appropriate and proportionate response. It would mark not only

the importance of maintaining public confidence in the profession, but also send the

public and the profession a clear message about the standards required of a registered

nurse.

For the next 3 years your employer or any prospective employer will be on notice that

your fitness to practise had been found to be impaired and that your practice is subject

to a restriction.

At the end of this period the note on your entry in the register will be removed. However,

the NMC will keep a record of the panel’s finding that your fitness to practise had been

found impaired. If the NMC receives a further allegation that your fitness to practise is

impaired, the record of this panel’s finding and decision will be made available to any

practice committee that considers the further allegation.

This decision will be confirmed in writing.

That concludes this determination.