nursing and midwifery council fitness to practise ... · colleague 4, band 6 mental health nurse;...

1

Nursing and Midwifery Council

Fitness to Practise Committee

Substantive Hearing

16 September 2019 - 20 September 2019

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

Name of registrant: Fatimah Akinwande NMC PIN: 00I4898E Parts of the register: Registered Nurse – Sub part 1 September 2003 Area of registered address: England Type of case: Misconduct Panel members: David Crompton (Chair, Lay member)

Paul Webb (Registrant member) Linda Redford (Lay member)

Legal Assessor: Sanjay Lal Panel Secretary: Deepan Jaddoo Ms Akinwande: Present and represented by Adewuyi Oyegoke Nursing and Midwifery Council: Sophie Stannard, Case Presenter Facts proved: 1 (in its entirety)

2 (solely in relation to Patient A) Fitness to practise: Impaired Sanction: Caution order – 1 year

2

Details of charge

That you, a registered nurse:

1) On 10 March 2017 drew an incorrect dose of oral medication into a syringe.

2) On 4 July 2017 did not respond adequately when informed that Patient A and/or

Patient B appeared distressed and/or required PRN medication in that you;

a) Asked Colleague 1 and/or Colleague 2 if Patient A and/or Patient B could wait

until after handover or words to that effect.

b) Did not attend Patient A and/or Patient B to assess them.

c) Did not assist Colleague 1 and/or Colleague 2 to find the keys for the medication

cabinet.

d) Did not ask another registered nurse to administer the PRN medication to Patient

A and/or Patient B.

e) Did not escalate Patient A and/or Patient B to the nurse in charge.

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

misconduct.

3

Background

You qualified as a registered nurse in September 2003. On 21 July 2017 the NMC

received a referral from North East London NHS Foundation Trust (“the Trust”). You

commenced employment with the Trust in February 2004 as a Band 5 Mental Health

Nurse. In December 2015 you were transferred to the Ward and placed on a

Performance Improvement Plan (PIP).

At the time of the alleged incidents, you were working as a Band 5 Staff Nurse on the

Brookside Acute Inpatients Unit (“the Unit”) at Goodmayes Hospital (“the Hospital”). Due

the requirements in your PIP, you were unable to administer medication without

supervision.

The Unit is a general acute mental health inpatient ward for young people who were

deemed too high risk to be managed safely in the community. Patients on the Unit have

a range of mental health issues which include anxiety, depression, self-harm, psychosis

and neurodevelopmental disorders.

It is first alleged that on 10 March 2017, whilst you were working in accordance with

your PIP and under the supervision of Colleague 3, Registered Nurse and Manager of

the Unit, you drew an incorrect dose of oral medication into a syringe. It is alleged that

despite correctly calculating the amount of medication to be drawn up, the amount

which you drew was significantly incorrect.

The second set of allegations refer to an incident which occurred on 4 July 2017. It is

recorded that on this date, Colleagues 1 and 2, both of whom are Health Care

Assistants (HCA’s) became aware of two young patients, Patient A and Patient B, who

were displaying signs of distress between 20:00 and 21:00.

Handover on the Unit occurs between 20:00 and 21:00. At the time, Colleague 4, the

only other Registered Nurse on shift, was completing handover to the night nursing

staff.

4

Colleague 1 is recorded to have noticed Patient B rolled into a ball on the floor in the

corridor. Patient B was deemed as ‘high risk’ due to her history of self-harm. Colleague

1 records that at the time she was trying to dig her finger nails into her arm.

Patient A is recorded to have been seen banging his head against the wall.

Colleague 1 records that he attended Patient A immediately after both he and you were

informed of this by another patient on the Unit. Colleague 1 records that he took Patient

A back to his room and that he was finding it difficult to engage with Patient A due to

him being distressed. Colleague 2 records that he went to the nurses’ office and

informed you about both patients and requested that you assist him by talking to both

Patient A and B and administering PRN medication to them. It is alleged that Colleague

1 also went back to the nurses’ office and requested you to administer PRN medication

to Patient A.

It is recorded that both Colleague 1 and 2 approached you at different times regarding

obtaining keys to access the PRN medication, and that you provided similar responses

to both colleagues who spoke to you at different times by saying that you did not have

the keys and directing them to speak to the nurse in charge (Colleague 4).

Colleague 1 records that he did this and returned back to you, informing you that

Colleague 4 did not have the keys, and that you remained seated and did not assist.

Colleague 2 records that he also did this and that upon returning back to you, you told

him that the patients would have to wait until handover was completed when the night

staff were able to assist.

Following this, Colleague 1 found the medication keys in the door of the medicine

cabinet and handed them to you. Colleague 1 records that he immediately returned to

Patient A, and waited for you to attend, however you did not.

The night staff attended both Patient A and Patient B following the completion of

handover and following an alarm being raised due to Patient B being found ligaturing

5

with wire. Colleague 1 and other staff members were able to remove the wire around

Patient B’s neck and take him to the treatment room.

The NMC therefore allege that you did not respond adequately when informed that

Patient A and/or Patient B appeared distressed and/or required PRN medication, in that

you:

Asked Colleague 1 and/or Colleague 2 if Patient A and/or Patient B could wait


Did not attend Patient A and/or Patient B to assess them.

Did not assist Colleague 1 and/or Colleague 2 to find the keys for the medication

cabinet.

Did not ask another registered nurse to administer the PRN medication to Patient

A and/or Patient B.

Did not escalate Patient A and/or Patient B to the nurse in charge.

Admissions

At the outset of this hearing, Mr Oyegoke, on your behalf, with the assistance of Ms

Stannard on behalf of the NMC, prepared a document outlining your partial admissions

to the charges.

Decision on the findings on facts and reasons

In reaching its decision on the charges, the panel considered all of the evidence

adduced in this case together with the submissions made by Mr Oyegoke and Ms

Stannard.

The panel accepted the advice of the legal assessor.

The panel was aware that the burden of proof rests on the NMC, and that the standard

of proof is the civil standard, namely the balance of probabilities. This means that the

6

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

incidents occurred as alleged.

The NMC’s live witness evidence came from:

Colleague 1, HCA;

Colleague 3, Modern Matron on the Unit and Manager of the Unit at the time;

Colleague 2, HCA;

Colleague 4, Band 6 Mental Health Nurse;

The panel also considered the written statement and documentary evidence covering

accounts of events given by Colleague 5.

You also gave evidence under affirmation.

The panel considered Colleague 1’s evidence. The panel found him to be a

straightforward witness who tried to assist the panel. The panel found that Colleague 1

was clear when he could remember details and clear when he could not. Colleague 1’s

evidence was consistent.

The panel considered Colleague 3’s evidence. Colleague 3 was clear, logical and

professional. She was able to address areas of confusion within the NMC’s evidence

and was convincing in her explanations to the panel. Colleague 3 tried her best to assist

the panel despite having some issues of recall which she accepted.

The panel considered Colleague 2’s evidence. The panel found Colleague 2 to be a

credible, straight forward witness and that his oral evidence remained consistent with

his witness statement. However, the panel noted that, by his own admission, he had

limitations to his memory due to the passage of time which impacted upon the clarity of

his evidence. Nonetheless, Colleague 2 had a good grasp of the issues involved in the

7

case and the panel found that he was able to comment on the incident in detail. The

panel found him to be a credible witness.

The panel considered Colleague 4’s evidence. The panel noted that Colleague 4

presented as a nervous witness who provided minimal responses to questions. She was

unable to expand upon her answers in any detail and appeared guarded during

questioning. Nonetheless, the panel found that she tried her best to assist where she

was able.

The panel considered your oral evidence. You presented as a clear witness who tried to

assist the panel. You provided detailed explanations and a rationale for your actions at

the time and accepted that you had made some mistakes. In particular, the panel noted

that you admitted to an allegation which you could have quite easily denied based on

earlier information provided to the panel. The panel noted that there were some minor

inconsistencies in your evidence but also noted that you remained consistent in your

denial in relation to the allegations surrounding Patient B, which added to your overall

credibility.

The panel considered the following charges.

Charge 1


This charge is found PROVED.

The panel noted that you admit this charge on the basis that the oral medication used

was Lactulose.

The panel noted that the evidence in support of this charge came solely from Colleague

3 who, in her oral evidence to the panel, was of the view that the oral medication used

8

was probably Fluoxetine. Colleague 3 provided a rationale as to why she believed this,

stating that if the medication had been Lactulose she would not have been as

concerned as she was at the time. Colleague 3 described how “shocked” she was at

how significantly incorrect the medication drawn up was, and told the panel that

Lactulose would never be administered via a syringe.

The panel took into account that there was no documentary evidence to support

Colleague 3’s assertion that the medication used was in fact Fluoxetine. However, it

noted that in your internal interview you made reference to a dose of Lactulose being

prepared. There was no evidence provided by the NMC of any challenge by the Trust at

the time or subsequently after your interview.

Given that there was no other independent evidence to refute your assertion that the

medication used was Lactulose, the panel preferred your evidence.

Accordingly, the panel determined that on balance, it was more likely than not that the

medication used at the time was in fact Lactulose. The panel found this charge proved.

Charge 2(a)



a) Asked Colleague 1 and/or Colleague 2 if Patient A and/or Patient B could wait



The panel noted that you admit this charge on the basis that you only asked Colleague

1 if Patient A could wait until after handover or words to that effect.

9

The panel therefore accepted this admission, solely in relation to Colleague 1 and in

relation to Patient A. It then went on to consider the remaining aspect of the charge,

namely, whether you asked Colleague 2 if Patient A and/or Patient B could wait until

after handover or words to that effect.

The panel considered the evidence of Colleague 2. In his NMC statement, Colleague 2

states:

“I went to the nursing office, where the Registrant was sitting at the computer doing

work. I informed her that there were two young patients in distress and requested that

she attend the patients to assist with the situation by talking to them and helping to calm

them down. I also requested that the Registrant administer PRN medication to the

patients.”

The panel noted that you deny that such a conversation with Colleague 2 took place. In

your written statement provided to the panel, you stated “I was not contacted by

Colleague 2 concerning Patient B”. You reaffirmed and stood by this in your oral

evidence to the panel. On balance the panel is satisfied that the NMC have not

discharged the evidential burden of demonstrating that Colleague 2 had this

conversation with you. This is because there was no reference by Colleague 1, in both

his written and oral evidence to Patient B nor was there any relevant contemporaneous

evidence in support of Colleague 2’s oral evidence, for example in the local

investigation.

Accordingly, the panel found this charge proved solely on the basis and rationale which

you admitted to the allegation, as outlined above.

Charge 2(b)

b) Did not attend Patient A and/or Patient B to assess them.

10


The panel noted that you accept this charge on the basis that you did not attend to

Patient A. The panel noted that the remaining part of the charge falls given its earlier

finding in charge 2(a), namely you could not have failed to assess Patient B as you had

not been informed of their condition.

Accordingly, this charge is found proved.

Charge 2(c)

c) Did not assist Colleague 1 and/or Colleague 2 to find the keys for the medication

cabinet.


The panel noted that you accept this charge on the basis that you did not assist

Colleague 1 in the sense that you did not physically go with Colleague 1 to look for the

keys. Whilst the panel noted that it was your evidence that you got out up from your

seat to look within the office for the keys, it had no other evidence to support or refute

this. In the panel’s view, this was to some extent irrelevant given your admission to the

charge.

The panel noted that the remaining part of the charge falls given its earlier finding in

charge 2(a).

Accordingly, this charge is found proved.

11

Charge 2(d) and (e)


A and/or Patient B.

e) Did not escalate Patient A and/or Patient B to the nurse in charge.

These charges are found PROVED.

The panel noted that you accept both charges on the basis that you did not ask another

registered nurse to administer the PRN medication to Patient A, nor did you escalate

Patient A to another nurse on duty.

The panel noted that there was only one other registered nurse on duty, namely

Colleague 4. It also noted that it was not disputed that you did not speak to Colleague 4,

nor was in dispute that you did not escalate Patient A to Colleague 4.

The panel noted that the remaining part of the charge falls, in so far as it relates to

Patient B, given its earlier finding in charge 2(a).

Accordingly, these charges are found proved.

12

Determination on misconduct and impairment:

Having announced its finding on all the facts, the panel then moved on to consider

whether the facts found proved amount to misconduct and, if so, whether your fitness to

practise is currently impaired. The NMC has defined fitness to practise as a registrant’s

suitability to remain on the register unrestricted.

Ms Stannard referred the panel to her written submissions. She referred the panel to the

case of Roylance v General Medical Council (no. 2) [2000] 1 AC 311 in which Lord

Clyde defined misconduct “as a word of general effect, involving some act or omission

which falls short of what would be proper in the circumstances. The standard of

propriety may often be found by reference to the rules and standards ordinarily required

to be followed by a practitioner in the [relevant field]. Such falling short as is established

should be serious.”

Ms Stannard submitted that this case engages both public protection and public interest

considerations. She reminded the panel that there is no burden of proof at this stage

and the decision on misconduct is for the panel’s independent judgment.

Ms Stannard invited the panel to take the view that your actions amount to a breach of

‘The Code: Professional standards of practice and behaviour for nurses and midwives

(2015), (the Code). She then drew the panel’s attention to specific paragraphs and

identified where, in the NMC’s view, your actions amounted to misconduct.

She then moved on to the issue of impairment, and addressed the panel on the need to

have regard to protecting the public and the wider public interest. Ms Stannard referred

the panel to the case of Council for Healthcare Regulatory Excellence v (1) Nursing and

Midwifery Council (2) Grant [2011] EWHC 927 (Admin).

Ms Stannard submitted that the following limbs are engaged:

13

a. has in the past acted and/or is liable in the future to act so as to put a patient or

patients at unwarranted risk of harm; and/or

b. has in the past brought and/or is liable in the future to bring the medical

profession into disrepute; and or

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

fundamental tenets of the medical profession;

d. […]

Ms Stannard submitted that the allegations found proved relate to two separate

incidents which occurred on different dates, namely 10 March 2017 and 4 July 2017.

She told the panel that your failings relate to the following areas of nursing practice:

medication administration, assisting staff members, providing safe care to vulnerable

patients under your care and escalating concern. Ms Stannard submitted that these

were all fundamental areas of nursing and that your actions, in relation to both incidents

had the potential to place the patients under your care at unwarranted risk of harm. She

further submitted that by your actions, you had brought the reputation of the nursing

profession into disrepute and breached fundamental tenets of the nursing profession.

Ms Stannard reminded the panel that, in order to assess whether you would put patients

at risk of harm in the future, it should determine to what extent you have shown

remorse, demonstrated insight and/or remedied any misconduct. Ms Stannard

submitted that in light of you having brought the profession into disrepute and placed

patients at unwarranted risk of harm, a finding of impairment is necessary on both public

protection and public interest grounds in order to uphold proper professional standards

and uphold public confidence in the NMC as a regulator.

Mr Oyegoke submitted that your fitness to practise is not currently impaired.

Mr Oyegoke submitted that these were one off incidents and that this is the first time

you have been brought before your regulator. Mr Oyegoke noted the mitigating

circumstances in your case as outlined previously in his submissions on facts. These

14

included staff shortages on the Unit and two family bereavements which may have

impacted upon your judgment and practice at the time.

Mr Oyegoke next referred the panel to a bundle of documentation containing training

certificates and references which attest to your good practice and good character. Mr

Oyegoke referred the panel to a reference from your current employer who is aware of

your referral to the NMC and your fitness to practise case and continues to support you

in your role as the Unit Manager.

Mr Oyegoke submitted that, since these incidents, you have displayed remorse and

undertaken training courses to remedy your past shortcomings. He explained that a

number of these training courses were face to face, and some were online. He indicated

to the panel which courses were mandatory and provided by your employer, and which

were independently arranged and privately funded by you.

Mr Oyegoke submitted that it was clear, through your oral evidence and reflective

statement, that you have shown insight into your previous errors. Given your reflection

and the steps you have taken since these incidents to improve your practise, he invited

the panel to consider that you have fully remedied your past failings to the extent that

your fitness to practise is not currently impaired.

The panel accepted the advice of the legal assessor.

15

Decision on misconduct

The panel first considered whether the facts found proved amounted to misconduct.

This is a matter for the panel’s judgement. In considering whether the conduct, as found

proved, amounted to misconduct, the panel reminded itself that not every act falling

short of what would be proper in the circumstances, and not every breach of the Code,

would be sufficiently serious that it could properly be described as misconduct.

The panel has reminded itself that registrants are personally accountable under the

NMC Code for acts and omissions in their practice. The panel had regard to the relevant

version of the NMC Code (2015). The Code contains the underlying principles that

guide the nursing profession and is in place to protect the public and to ensure that

proper standards of the profession are upheld.


The panel took into account that, at the time of this incident, you were subject to a PIP

which had been specifically amended in 2016 to improve your medication

administration. The panel heard clear, unchallenged, evidence from Colleague 3 in

relation to this. Given the surrounding context of this medication administration error,

the panel was of the view that a member of the public would be concerned if a nurse

under such a performance plan continued to make errors of a fundamental nature. It

determined that your conduct fell significantly below the standards expected of a

registered nurse and amounted to misconduct.



a) Asked Colleague 1 if Patient A could wait until after handover or words to that

effect.

16

b) Did not attend Patient A to assess them.

The panel noted that the incident involving Patient A was first brought to your attention

by a young patient who attended the nurses’ office who informed you that Patient A was

“banging his head” against the corridor wall. Given the risk of harm Patient A posed

towards himself, the panel determined that failing to attend Patient A in order to assess

him fell significantly below the standards expected of a registered nurse. The panel also

considered that, without attending Patient A, there would have been no reasonable way

of making an informed decision to delay administering PRN medication to him until after

handover. Whilst the panel heard evidence that Colleague 1 may not have vocalised

Patient A’s condition or the urgency of Patient A’s situation, the opportunity for you to

ask Colleague 1 about this was not taken, and in the circumstances should have been.

The panel therefore determined that your actions in this regard also fell significantly

below the standards expected of a registered nurse. The panel determined that your

actions in respect of both of the above matters amounted to misconduct.

c) Did not assist Colleague 1 to find the keys for the medication cabinet.

The panel took account of its earlier finding in relation to this charge and noted that you

had made some attempt to assist Colleague 1 in finding the keys for the medication

cabinet. The panel also noted that there were other factors which contributed to the

difficulties in Colleague 1 finding these keys. On that basis, the panel did not consider

your actions to amount to misconduct.


A.

The panel noted that at the time you were unable to administer medication due to the

restrictions on your PIP and that Colleague 4 was the only other member of staff who

was permitted to do this. In the circumstances, the only practical method of ensuring

that Patient A was administered PRN medication would have been to interrupt the

17

handover being carried out by Colleague 4 and ask her to administer this medication to

Patient A. You did not do this. Instead you did nothing. In the panel’s view, your failure

to act in a proactive manner fell significantly below the standards expected of a

registered nurse and amounted to misconduct.

e) Did not escalate Patient A to the nurse in charge.

The panel noted that as a consequence of your misconduct in relation to charge 2(b),

you would have been fully unaware of Patient A’s condition at the time and therefore

unable to make an informed decision to escalate Patient A’s condition to the nurse in

charge. In the panel’s view, your earlier omission in relation to charge 2(b) did not

excuse your failure to escalate Patient A’s condition. Furthermore, the panel took into

account that you would have been aware of Patient A’s risk factors due to his previous

attempt of self-harm. The panel determined that your conduct fell significantly below the

standards expected of a registered nurse and amounted to misconduct.

The panel therefore determined that your actions, in relation to the following charges

amounted to misconduct: 1 (in its entirety), 2(a), 2(b), 2(d) and 2(e).

It was of the view that your conduct breached the following standards in the Code:

1 Treat people as individuals and uphold their dignity

1.4 make sure that any treatment, assistance or care for which you are responsible is

delivered without undue delay

2 Listen to people and respond to their preferences and concerns

2.1 work in partnership with people to make sure you deliver care effectively

8 Work cooperatively

8.2 maintain effective communication with colleagues

18

8.4 work with colleagues to evaluate the quality of your work and that of the team

9 Share your skills, knowledge and experience for the benefit of people receiving

care and your colleagues

15 Always offer help if an emergency arises in your practice setting or anywhere

else

15.1 only act in an emergency within the limits of your knowledge and competence

15.2 arrange, wherever possible, for emergency care to be accessed and provided

promptly

17.1 take all reasonable steps to protect people who are vulnerable or at risk from harm,

neglect or abuse

19

Decision on impairment

The panel next went on to decide whether as a result of the misconduct found, your

fitness to practise is currently impaired. In reaching its decision the panel took into

account all of the circumstances together with its overarching objective.

In considering current impairment, the panel had careful regard to all of the documents

submitted, including training certificates, testimonials and your written reflective piece.

The panel considered the case of Grant. The panel considered that the limbs (a), (b)

and (c) of the test were engaged. The panel accepted that your actions were not

intended to harm patients. However, the panel considered that, by virtue of your failure

to ensure and provide safe and adequate care to Patient A, you had placed a vulnerable

patient under your care at significant and unwarranted risk. As a result, the panel

determined that you had brought the nursing profession into disrepute. Further, the

panel considered that your actions resulted in a breach of some of the fundamental

tenets of the nursing profession, particularly in terms of the breaches of the code

identified above.

The panel considered whether your actions were remediable, whether they had been

remedied and the likelihood of repetition, in light of the circumstances of the case and

the evidence.

The panel first considered your misconduct in relation to your medication administration

and was of the view that you have made all reasonable efforts to remedy this particular

area of practice, as evidenced by the training certificates and references provided to the

panel. The panel was satisfied that there were no longer any public protection or public

interest considerations regarding this incident.

The panel next considered your misconduct in relation to Patient A. It considered your

reflective piece and considered that you have demonstrated some remorse for your

20

actions. The panel acknowledged that you have apologised for your actions, and was

satisfied that you have demonstrated sufficient understanding of how your actions and

omissions were wrong or how your actions and omissions impacted negatively on the

reputation of the nursing profession. The panel was also satisfied that you have

explained what you would do differently if placed in a similar situation. The panel noted

that it had no evidence of any similar issues since this incident. To the contrary, the

panel has been provided with evidence which demonstrates good practice as evidenced

by the positive comments provided by your current employer regarding your

professionalism and good character.

The panel therefore determined that the risk of repetition in this case was sufficiently

low to the extent that there no longer remained any public protection concerns

associated with your practice. However, the panel bore in mind the overarching

objective of the NMC: to protect, promote and maintain the wider public interest which

includes promoting and maintaining public confidence in the nursing profession and

upholding proper professional standards. In the judgement of the panel, given the

potential serious consequences of the lack of care provided to Patient A, a vulnerable

young patient with a history of self-harm, public confidence in the profession and the

regulator would be undermined if a finding of impairment was not made in the particular

circumstances of your case.

The panel therefore determined that a finding of current impairment is necessary solely

on public interest grounds.

21

Determination on Sanction

Having determined that your fitness to practise is impaired, the panel has now

considered what sanction, if any, it should impose on your registration. In reaching its

decision on sanction, the panel has considered all the evidence that has been placed

before it.

The panel took into account the submissions from Ms Stannard and Mr Oyegoke. The

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

Ms Stannard submitted that the appropriate and proportionate order in this case was a

caution order to mark the public interest, given the panel’s earlier findings. Ms Stannard

told the panel that a conditions of practice order would serve no useful purpose given

your level of insight and the training which you have undertaken.

Mr Oyegoke invited the panel to consider taking no further action and submitted that the

public interest in this case had been marked sufficiently by the panel’s earlier finding of

impairment.

Under Article 29 of the Nursing and Midwifery Council Order 2001, the panel can take

the following actions in ascending order: no further action; make a caution order for one

to five years; make a conditions of practice order for no more than three years; make a

suspension order for a maximum of one year; or make a striking off order. The panel

has borne in mind that the purpose of a sanction is not to be punitive, though it may

have a punitive effect.

The panel also noted that it should first consider the least restrictive sanction. If it

considers that no further action is not appropriate then it should approach the issue of

sanction in ascending order of seriousness.

22

The panel has applied the principles of fairness, reasonableness and proportionality,

balancing the interests of patients and the public with your own interests and taking into

account any mitigating and aggravating factors in the case. The public interest includes

the protection of patients, the maintenance of public confidence in the profession and

declaring and upholding proper standards of conduct and behaviour. The panel has also

taken account of the NMC publication Sanctions Guidance (SG).

The panel concluded that the aggravating features in this case include the following:

your actions and omissions placed Patient A at risk of harm.

The panel concluded that the mitigating features in this case include the following:

you have demonstrated insight and understanding throughout this

hearing and by way of your reflective piece;

you have made admissions to some of the charges in part;

you have provided a number of positive references, one of which is from your

current employer, which all attest to your good character, clinical aptitude and

professionalism;

you have provided evidence that you have undertaken relevant training pertinent

to the clinical concerns identified in this case;

you are currently working as a Unit Manager without issue and are well

supported by your employer.

The panel first considered taking no further action and decided that this would be

inappropriate. The charges found proved against you are serious and in those

circumstances taking no further action would be insufficient to mark the public interest in

this case. To do so would not maintain the standards of, or confidence in, the profession

or the regulator.

23

The panel then went on to consider whether a caution order would be appropriate. The

panel notes that the SG states that “… a caution may be appropriate where the case is

at the lower end of the spectrum of impaired fitness to practise and the Fitness to

Practise Committee wishes to mark that the behaviour was unacceptable and must not

happen again”.

The panel considered that, whilst the charges are serious, this case could be described

as being at the lower end of the spectrum of impairment given the mitigating factors,

your insight and remediation and, importantly, that the panel has concluded that there is

little risk of repetition.

The panel bore in mind that in this case it has not found impairment on the ground of

public protection and there are no concerns relating to your clinical practice. You have

reflected as to how you would behave differently if placed in a similar situation in the

future. The issue in this case relates solely to the public interest in declaring standards

and maintaining public confidence in the profession. The SG states in relation to a

caution order that it is only appropriate when the panel is satisfied that there is no risk to

the public or to patients which requires the nurse’s practice to be restricted. The panel

considers that this is such a case.

Before deciding on a caution order the panel considered whether a conditions of

practice order would be appropriate in this case. Given that there is no risk to patients

and no concerns about your clinical practice, there were no workable conditions which

could be formulated in this case. In the panel’s view, such an order would serve no

useful purpose and would be disproportionate. The panel noted that you have been

working without further incident and had sight of positive testimonials which attest to

your good practice and professionalism.

Balancing all these factors the panel decided that a caution order was the sanction that

was appropriate, proportionate and least restrictive on your practice. It would serve to

24

declare and uphold standards and to maintain public confidence in the profession, and

in the NMC as regulator.

The panel considered that a reasonable, well-informed member of the public in full

possession of all the facts would consider that a caution order ensures that proper

standards are upheld within the profession. The effect of such an order is that, although

your practice is not restricted, the caution is recorded against your registration and

recorded on the NMC’s website. It forms an alert about your past conduct, visible and

disclosable to anyone enquiring about you or your fitness to practise history. It has to be

declared to anyone considering employing you as a nurse. It is therefore a significant

sanction and a mark of the panel’s disapproval of your misconduct.

The panel took into account that there is a public interest in returning a competent nurse

to practice.

The panel has decided that the order should be imposed for a period of one year. It

considers that this is the least available period which marks the gravity of the facts

found in this case. It also sends a message to the profession, and to the public, that

your behaviour is unacceptable and must not happen again.

This decision will be confirmed to you in writing.

That concludes this determination.

nursing and midwifery council fitness to practise ... · colleague 4, band 6 mental health nurse;...

Documents