NMC chief pledges to crack down on poor nursing practice

15 December 2009 | By Dave West

The NMC will take a “proactive” hard line against nurses and nurse leaders who neglect patient care, the regulator’s new chief executive has told Nursing Times.

Dickon Weir-Hughes said the Nursing and Midwifery Council should investigate trusts if it suspects problems and, where concerns were justified, suspend their training role and strike staff off the register.

He said: “One of the myths that’s worth shattering is that there has to be a complaint to the NMC for something to be done, because there doesn’t and that is clearly set out in legislation.”

The new approach will include action against scandal-hit trusts, which in the past the NMC has left to other regulators.

Investigations can be prompted by anything that “creates a concern” and Professor Weir-Hughes said they should be triggered where several sources – such as press reports and complaints – suggest there is a problem.

It has happened only once in the past - at North West London Hospitals Trust in 2005. That inspection, prompted by a damning Healthcare Commission report on maternity services, resulted in trainees being removed.

Professor Weir-Hughes plans, if necessary, to investigate trusts much more often. He wants to be alerted when the Care Quality Commission, the health and social care “super regulator”, suspects poor nursing care. Inspectors from both would visit trusts together and decide what action should be taken.

“We’d really like to be in there at the beginning with the CQC rather than on the back foot,” Professor Weir-Hughes said. The NMC is seeking to agree a “memorandum of understanding” with the CQC.

Professor Weir-Hughes particularly emphasised the responsibility of nurse leaders and managers to tackle poor care and, if they can’t, to report it.

He said: “The bottom line is nurses and midwives are expected to make care of patients their first priority regardless of where they are in the hierarchy.”

Professor Weir-Hughes stressed there were many ways of raising concern such as filling out risk forms or, for a nursing director, formally telling the board and contacting regional nursing directors.

He said: “There are tons of ways people can adhere to the code without doing something they might consider unorthodox or too radical.

“If they have major concerns about staffing levels and didn’t feel they were being adequately listen to there are steps they could take.”

Professor Weir-Hughes said he would like the NMC “recognised for the support we provide to nurses and midwives”, and said investigation reports would highlight good practice as well as any problems.

Julie Hendry, who joined Mid Staffordshire Foundation Trust as interim nursing director in November, eight months after it was criticised for “appalling” care – much of it related to nursing – by the Healthcare Commission, the CQC’s predecessor, said a more proactive approach would be welcome.

The NMC did not investigate the trust. Ms Hendry said: “For some nurses the most they have to do with the NMC is when they register. So an approach where they come into organisations and advise, support and challenge would be welcome.

“When things do go horribly wrong they [the NMC] should be in the organisation – it would be useful to have their professional perspective.”

Council for Healthcare Regulatory Excellence chief executive Harry Cayton welcomed the change as a significant move towards better checks on quality of care.

He said: “We think regulators should be more active in working with employers to identify areas of weakness.”

Unison head of nursing Gail Adams said although she recognised the NMC’s legal responsibility, her “slight reservation” was that many of these cases were failures of the system rather than individual registrants.

“While I recognise nurses and midwives have a duty to make sure they’re raising concerns about poor standards of care, things might be preventing them doing the job in the way they would wish, and from raising concerns.

“We need to make sure there’s a clear framework in place for them to do that, and when concerns are raised, they are listened to and acted upon.”

Ms Adams said she did not believe nurse leaders would not have questioned staff shortages. “There is no nurse or nurse leader I now who is going to say, ‘Yes let me give up part of my workforce,’ without making an argument.”

A CQC spokeswoman said: “The CQC meets regularly with the NMC to discuss the continued benefits of a working relationship and how it can progress, this includes the development of a memorandum of understanding.”

Readers' comments (46)

Anonymous | 16-Dec-2009 9:33 am
If they are so worried about standards why doesn't the NMC take control of nurse eduction again instead of washing their hands of it like the old UKCC did?

While they're at it why don't they lobby parliament to make sure there is enough money for staff to have in-service training?
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Malcolm Chalk BA, RN | 16-Dec-2009 12:45 pm
I believe that modern 'nurse education' is exceptional and the universities that teach it are on the right track so far as nursing practice is concerned. I go by what I see, from the many students and newly qualified nurses that I have seen on placement and in practice, the vast majority are dedicated in patient care as much as in nursing practice, which is what it is all about, isn't it?
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Anonymous | 16-Dec-2009 4:06 pm
The NMC fails in the credibility stakes because of its own ineptitude and crass systems. The glaring weaknesses and failures of the NMC itself bring any shred of trust in its capabilities to the floor. The NMC cannot even police itself!!!!
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Anonymous | 16-Dec-2009 5:17 pm
Fine words Mr Wier-Hughes but you’ll forgive us if we wait to see if the NMCs actions actually live up to the rhetoric.

Credit to you though for acknowledge that Article 22 (6) of Part 5 of The Nursing and Midwifery Order 2001 gives the NMC the power to act where a formal allegation hasn’t been made but it appears to the Council that there should be an investigation nonetheless. Shattering myths is good, especially those held by your own staff, however now you’ve done it you don’t have any excuse not to examine the fitness to practice of the senior nurses who presided over horror stories like Brighton & Sussex, Mid-Staffordshire and Basildon. As William Haigh might say, lets hope you’ve got the Cojones to see your ‘new approach’ to implementing the NMCs long established remit through.
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Anonymous | 16-Dec-2009 9:56 pm
you may have to start with dealing with cliques in services; believe me they exist in every organisation, even the NMC. thats why a lot of issues are not dealt with. Unfortunately, work places have become the only social environments most nurses have as they can hardly afford anything else.
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Anonymous | 16-Dec-2009 10:54 pm
the nmc are a waste of space
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Anonymous | 17-Dec-2009 7:02 am
A good point, well made.
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Anonymous | 17-Dec-2009 8:29 am
My concern if the NMC get involved is that they will seek to investigate individual registrants, be it ward nurses or nurse directors - which in turn will ensure we continue to have a blame culture within the NHS.

Also - if there has to be a case for the NMC to be in on failing hospitals from the start - then there also has to be a case for the GMC to be involved as most clinical directorates are now led by Medical Clinical Directors
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Anonymous | 17-Dec-2009 11:16 am
I agree with the comment above, it seems that the NMC would be reinforcing the blame culture we are trying to move away from in the NHS. Although nurses need to be held to account if poor care on an individual level has led to adverse harm to a patient. But perhaps the NMC should be questioning whether this poor nursing care is occuring because staffing levels are getting worse and worse, as our patient dependancy levels increase, we have less bed capacity and a culture where you are expected to do more and more with less and less. Surely many of these poor standards are due to systemic problems that need to be addressed. Why don't they address these issues because I'm sure having safe staffing levels would improve patient care, and have far more of an impact for all patients, improve staff morale, enable better mentoring for junior staff and reduce HCAI into the bargain.
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Annie Ford | 17-Dec-2009 7:22 pm
Brillliant news for patients, finally being able to alert the NMC to a systems failure. Our mum was starved in acute NHS Trust and we are currently exploring options to expose the NHS Secondary Care provider. The demise of mum aged 86 who had vascular dementia was robbed of her dignity and starved, she was such a wonderful elegant and intelligent woman. Sadly after she lost 1 stone in weight after a 3 week neglectful stay she passed away. Well done Mr Weir Hughes fantastic news keep the good work going, for too long secondary care has got away with responding in a sterile way to complaints from individual members of the public, when the public should be able to report the systems failure for patient abuse.
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Abel | 18-Dec-2009 2:42 am
DeLucia, Ott, & Palmieri (2009) concluded the following: "the profession of nursing as a whole is overloaded because there is a nursing shortage. Individual nurses are overloaded. They are overloaded by the number of patients they oversee. They are overloaded by the number of tasks they perform. They work under cognitive overload, engaging in multitasking and encountering frequent interruptions. They work under perceptual overload due to medical devices that do not meet perceptual requirements (Morrow et al., 2005), insufficient lighting, illegible handwriting, and poor labeling designs. They work under physical overload due to long work hours and patient handling demands which leads to a high incidence of MDs (Musculoskeletal disorders). In short, the nursing work system often exceeds the limits and capabilities of human performance.”
When we talk about patient safety, we should also and always consider the safety of health care providers, especially Nurses who are likely to suffer the most from the failures of the healthcare system (depression, burnout, professional conflicts, injuries, high incidence of divorce, etc…).
If NMC has a duty to protect the public, they have also the responsibility to ensure that Nurses work in safe and reasonable conditions. I shall add that if NMC needs more powers to help Nurses perform their duties towards the best possible care, they should also address this claim with the government and Parliament.
The protection of the public starts with the protection of Nurses.
Abel Sidhoum (RN, Australia)
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Anonymous | 18-Dec-2009 2:38 pm
With referrence to the posting made by Annie Ford - I sympathise with your plight and am as concerned as any compationate nurse to hear individual stories such as yours. This I have no doubt needs addressing. However, the introduction of the NMC in inspections will look for individuals as this is what the governing body is set up to do - it will only look at nurses as this is its remit and will undoubtably come out with a nurse or nurses to blame when the systems nurses work in are often well outside of their control. I think it should remain an independant body who has access to refer individuals to the NMC if they see fit.

Those who continue to allow or dedicated nurses to practice at a pace which is condusive to error and impossible work overload should be the ones who are brought to task.
What we need is the NMC and the Nursing Unions to bite the bullet and spend their energies working at identifiying minum registered nurse levels and minimum staffing levels overall that are deemed acceptable on our wards - not the skill mix split but actual numbers of registered nurses and health care assistants required to safely nurse our patients. Until we have this - we will always be dictated by finance and understaffed.
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Phil Dup | 18-Dec-2009 3:30 pm
As many of the above posts state - especially that by 'Abel Sidhoum RN Australia' (an extremely articulate and accurate analysis ) - the NMC will just target individual Nurses who may have been working under horrendously demanding workloads when their "poor care" occurred. I'm sure in the past when I've worked whole shifts on a 28 bed acute medical ward with just 2 HCAs and myself then many patients would have experienced care at a much lower level than they would have done if the ward were staffed at adequate levels. So should I be struck off and join the dole queue for that ? Due to the nature of our job its generally impossible to remember exactly what one had to do on a particularly busy shift - thereby making oneself so much more vulnerable to charges of inadaquate nursing. I always protect myself nowadays by carrying a tiny digital voice recorder on shift. It can record up to 16 hours of sound and is time / date stamped and transfers easily to a computer for permanent records. As I'm working I'll state everything that is potentially compromising my time for patient care - eg stock or equipment missing, computers down, staff down, agency staff with little knowledge of the working environment, disruptive patients / visitors , prioritisation of one or more severely ill patients etc etc. When a complaint comes in months later regarding some aspect of patient care this data proves invaluable at protecting oneself and bouncing it right back to the bosses who routinely allow poor staffing and working systems just to save money.
Digital voice recorders are cheap and easily available and still allow one to work as you go so I would recommend to anyone who wants to keep those easy target seeking desk jockeys known as the NMC off their backs !
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Anonymous | 18-Dec-2009 4:49 pm
I love Abel!!! Good post. You too Dup.

Militant Medical Nurse.
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Anonymous | 18-Dec-2009 4:57 pm
Listen to the woman on this video. And then realise that the situation in the UK is exponentially worse than anything she is describing.

http://www.youtube.com/watch?v=OIkwHcuA0F0

and here

http://www.youtube.com/watch?v=bIHrFg33d34&feature=related

here

http://www.youtube.com/watch?v=JkhZ9dCZIp8&feature=related

The situation is exponentially worse in the UK. I cannot stress that enough.
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Anonymous | 18-Dec-2009 5:05 pm
Here's another.

http://www.youtube.com/watch?v=kVpJ-icOk1I&feature=related
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Anonymous | 18-Dec-2009 6:01 pm
"Ms Adams said she did not believe nurse leaders would not have questioned staff shortages. “There is no nurse or nurse leader I now who is going to say, ‘Yes let me give up part of my workforce,’ without making an argument.”"

With all due respect Ms. Adams:
A. Your "nursing leaders" have been off the words so long that they do not know what a staffing shortage is for nurses. These people think that on RN to 12 patients with no adjustmants made for acuity are fine. They are idiots.

B. Any nursing leader who does kick up a fuss over staffing gets shown the door.
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Anna Lincoln | 18-Dec-2009 6:02 pm
is fine not are fine.
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Anna Lincoln | 18-Dec-2009 6:02 pm
That was my post by the way.
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George Kuchanny | 19-Dec-2009 8:58 am
This is all good news as far as patients are concerned. That is the business of the NHS after all. Quality care when needed. I have only ever had one complaint but it was not investigated properly and nothing was done. Unfortunately a Dr and Nurse deliberately killed my wife - to cover a management blunder. Not the usual sort of complaint I will grant you
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