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NMC warns nursing directors to ensure safe staffing levels

Directors of nursing who fail to ensure their hospitals have adequate numbers of nurses could find themselves facing fitness to practise panels, the Nursing and Midwifery Council has warned.

Jackie Smith, NMC chief executive and registrar, highlighted the decision last week to issue a five year caution to Jan Harry, the former chief nurse of Mid Staffordshire Foundation Trust.

Ms Harry was found guilty by a fitness to practise panel of putting patients in danger by failing to ensure there were enough nurses on wards at the scandal hit hospital between 1998 and 2006.

The panel concluded Ms Harry’s catalogue of failings amounted to misconduct and that her fitness to practise was impaired. They imposed a maximum five year caution “in order to mark your conduct as unacceptable and signal that this must not be repeated”.

Jackie Smith

Jackie Smith

Ms Smith told Nursing Times it was a “distinct possibility” that other nursing directors could face fitness to practise panels if they failed to ensure there were adequate numbers of nurses “to protect patients”.

She said: “There is a marker here. What the panel said was that it was her responsibility to ensure adequate nursing provision. The panel decided her practice fell well short of what was expected.”

Ms Smith said the NMC expected directors of nursing and those in leadership roles to already be doing what was needed, adding: “This is about protecting patient safety.”

Ms Harry had argued in her evidence to the panel that her role was purely strategic and not operational.

But the panel said nursing directors could not separate the two roles and the public had the right to expect a director of nursing to prioritise the provision of quality “frontline” nursing services.

It ruled against striking her off the register because no patients had been directly harmed by her personally and noted her “long, distinguished and otherwise unblemished” career.

Earlier this year an investigating committee for the NMC ruled Ms Harry’s successor Helen Moss had “no case to answer” and did not refer her to a fitness to practise panel. Ms Moss taking over as chief nurse in 2006.

In his report on the care failings at the trust, Robert Francis QC said there was no sense of urgency and an “unacceptable delay” in addressing the issues when Ms Moss arrived.

From next year the NMC will have new legal powers to re-consider the decisions made by the investigating committees.


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Readers' comments (24)

  • michael stone

    Has the NMC explained how Directors of Nursing ENSURE there are definitely enough nurses, if how the money gets spent isn't always under their control ?

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  • Anything that challenges senior managers 'right' to ignorance or absence of due diligence is to be welcomed, especially when it has teeth.

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  • Too little, too late I'm afraid. The NMC had the opportunity last week to prove that it takes patient safety seriously, that it would strike from its register anyone who puts patients at risk yet they reneged on this. What is the NMC for if it's not to protect patients from nurses who are not fit to nurse?

    What is the point of the NMC if it sees fit only to suspend someone who was fundamental, in allowing the suffering at Mid-Staffs to continue?

    I just wish she'd posted something about it on Facebook then maybe the NMC would've taken a stronger line!

    Is it just me, or do others struggle with the NMC decision?

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  • This is an interesting dilemma. Directors of nursing and chief nurses are responsible to their employers' Boards to make sure services are cost-effective, and to be "involved" in strategic planning (does such a thing exist?); yet, on the other hand they have to look at patient safety and provide frontline services. The NMC have stated their view, so the senior nurses know where they stand. Interesting to see how this will pan out in reality.

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  • In my trust, it's panned out by the DNS getting control of the nursing workforce budget directly for the first time ever and no longer having to work through "strategic plans" with the finance director to get extra staff where needed. Am more hopeful now nurses are getting more power.....

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  • Anonymous | 11-Nov-2013 1:31 pm

    The message is out there for all to see: Directors of Nursing have absolutely nothing to fear from the NMC. A hand slap is about the very worst we can expect them to receive.

    I wonder how the families of those who suffered so appallingly in the Stafford Hospital are feeling about this latest disgrace.

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  • mags | 11-Nov-2013 5:49 pm

    Absolutely right: what a savage indictment of this failed, out of touch, cronyistic organisation. I just hope the NMC have dug their own grave and that this is the beginning of the end, but I doubt it!

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  • Anonymous | 11-Nov-2013 1:31 pm

    If the case papers relating to the Harry case are read and understood it will be realised that the quality of evidence given was so poor one is surprised that the NMC managed to sustain a finding of "unfitness to practice".

    I have campaigned for a long time for these "leaders" of nursing to be made professionally accountable for their actions.

    Until nurses and the professional/trade union take a determined stance these "directors of nursing" will continue to advice that cuts in nurse staffing will not result in harm to patients.


    "Nurse managers" must be held fully accountable for their persistence in and insistence on, patients being put at very considerable risk.

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  • Apologies !

    I failed to adequately proof read my previous comment and this site has no "edit" function.

    I hope the "sense" of what I wrote is intelligible .


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  • michael stone

    The Nobody | 11-Nov-2013 5:23 pm


    But when push comes to shove, if a Director of Nursing honestly believes that within the budget restraints it isn't possible to employ enough nurses 'to adequately ensure patient safety', are Directors of Nursing going to at that point resign, or will people start to play fast-and-loose with 'adequate patient safety' ?

    It seems to me that only the rich (and most nurses probably are not rich) or the incredibly principled, will resign from their job and ALSO give the "I had to resign because ..." valedictory speech.

    It is remarkable how once people have retired from the job, they THEN [sometimes] talk about 'everything that wasn't up to scratch'.

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  • michael stone | 12-Nov-2013 2:38 pm

    I've resigned from two jobs - quite recently - due to concerns about patient care and not being prepared to cut corners or put people at risk. Both were relatively lowly positions and both in the private sector (one a recently privatised service); if I can do it I don't see why the upper echelons should be exempt from having a conscience and taking responsibility for their actions or lack thereof.

    If you take the salary, you take whatever responsibility goes with that job. If Chief Nurses or whoever know that patients are being at risk and they fail to do anything about it then they should consider their position or be prepared to take the consequences if things were to go wrong!

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  • Anonymous | 12-Nov-2013 3:32 pm


    It is easy to have principles and pass an opinion when you are in a position of no jeopardy. Not many put their money where their mouth is....or have to.

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  • Directors of nursing in the future won't be nurses, and the NMC will have no power anyway

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  • michael stone

    Anonymous | 12-Nov-2013 3:32 pm

    Good on you - you've clearly got a strong sense of right and wrong. I applaud you.

    If you are old enough, you might remember that Lord Carrington resigned from Goverment apparently not because he thought he had directly made a mistake, but because 'mistakes were clearly made on my watch'. I don't think any other minister has done that more recently, though, so far as I can remember.

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  • tinkerbell

    Anonymous | 13-Nov-2013 0:00 am

    Exactly! Well spotted.

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  • Isn't it a bit sad that Directors of Nursing should have to be reminded of their responsibilities to the patients in their hospitals? I mean really should all of this have to be spelt out to them? And how on earth did Jan harry at Stafford ever get the idea that staffing levels were nothing to do with her? I think she knew full well it came within her remit.

    Anyway that can be no more excuses, it should now be crystal clear that the buck stops at the top. Don't take the job if you cant handle the responsibility. Oh and the same should go for Chief Execs too.

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  • Directors of Nursing have to be reminded what their roles are... by an organisation that is not fit for purpose.
    Can only happen in Britain......

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  • Surely this thread should be closed because of the legal nature of the article?

    Of course if there was a bigger emphasis on appraisal and senior managers being held accountable for not achieving desired outcomes this wouldn't happen. Or would it?

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  • I found one of the previous comments particularly interesting. ' Directors of Nursing' will, in the future no longer be Nurses? If indeed this is the case, what about directors of Medicine?
    If such changes are implemented across the senior positions then we could be entering the final stages of any form of responsibility, professional credibility and accountability within the NHS?
    It is doubtful that Nursing or Medical directors could be held to account, especially if they hailed from a senior banking or local authority background? In this particular instance; no accountability, no professional code of conduct and consequently no inherent blame to failing 'directors' despite organisational failures that affect patients.
    Personally, I would not work as a nurse or attend as a patient at any NHS trust that does not have a director of nursing that was not a registered Nurse or medical director that was not a GMC registered Doctor. The thin end of the wedge is being used in this instance (if indeed the case) for the executive ranks to be above any form of responsibility. Shamefully the 'wedge' is being used as a blunt tool to undermine all Nurses, Doctors and AHP's. Nevertheless, albeit initially, we seem alright about it?

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  • I wasn't the previous poster but what I think s/he meant was that fewer nurses who go into management will retain any clinical time and so no longer have a PIN number so maybe once trained and worked as nurses but not be registered any more. I don't think the same thing will happen in medicine in hospitals but it is happening in CCGs where GPs do fewer and fewer sessions in their practice until they stop working as clinical practitioners altogether and become medical managers instead. Whilst it doesn't mean non clinical staff like local authority managers or people from banking ending up as nursing directors, again this has happened in CCGs and their predecessors for many years. I've known "commissioners" for things like continuing care and older people's services who've come from the motor industry, marketing, banking, retail, all sorts, and they talked the talk but OMG they knew so little about the service and patients. It's a shame that some nurses denigrate management roles so much because your experience. Insight and compassion are invaluable to these roles and they are better done by you. But we need more staff caring for patients first.

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