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What should happen to a nurse whose inaccurate records and inaction led to a patient’s death?

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A nurse in charge of a team failed to ensure a patient was correctly observed with adequate records kept, and did not escalate concerns to a doctor, but he now shows remorse. What should the panel do?

 

Nursing Times you are the panel logo

Nursing Times you are the panel logo

Each month, Nursing Times will consider a real-life case that was heard by the Nursing and Midwifery Council’s Fitness to Practise case. We’ll give you the facts of the case, as presented to the panel, and you’ll get a chance to consider what decision you’d have made if you were on the panel. You can choose your response at the end of this article and then go to The Results to find out what really happened.

The charge

Nurse A’s fitness to practise was impaired by his misconduct. He was charged with:

  • Not ensuring appropriate measures were put in place to prevent the patient from absconding while being transported to court;
  • Recording incorrect information in clinical records and not ensuring record keeping was accurate;
  • Not escalating concerns about the patient;
  • Not ensuring vital cardiopulmonary resuscitation was carried out when the patient collapsed or that an ambulance was called in a timely manner.

These charges contributed to the patient’s death.

The background

Nurse A was a night services manager and senior staff nurse in a clinic at a secure psychiatric hospital. A man with schizophrenia, aged 20, had been sectioned under the Mental Health Act and referred to the hospital from prison because his psychosis had become too serious to manage outside of a medical institution. He was receiving antipsychotic medication.

Two months later the patient tried to abscond when he was placed in an unlocked minibus. Nurse A was the team leader in charge. On returning to the clinic, the patient was given a strong antipsychotic to control his delusions. The patient requested an ambulance, but this was not escalated to a doctor.

The following day Nurse A was the team leader in charge. The patient punched ma television and was taken into seclusion for his own safety. The doctor was contacted and placed the patient on 1:1 observations. Nurse C was tasked with continuously observing the patient. He recorded in the clinical record that the patient appeared to be “playing theatre” and was “pretending to be unwell in order to be let out of hospital”.

That evening, the patient collapsed while in seclusion during a period when not being observed.

Nurse A allegedly told the night shift nurse (Nurse B) the patient had collapsed but did not ask her to provide assistance. She did however, and found the patient lying on the floor, unresponsive. No one was administering CPR, which she and a healthcare support worker then started. An ambulance was not called until more than 20 minutes later; paramedics arrived more than 30 minutes later.

A coroner’s inquest into the patient’s death revealed Nurse B said she intended to call an ambulance, but was told by Nurse A to wait; Nurse A claimed “we are in a lot of deep, deep trouble”. The police conducted a criminal investigation, which led to no convictions. After the trust’s investigation, Nurse A and all the other members of clinical staff on duty were dismissed.

At the hearing

All charges were found proved. Nurse A told the panel, since the time of the incidents, he had undertaken much training to improve his knowledge and skills, showing seven training certificates and a testimonial. He said he was working as a nurse at a care home for older people and, since the incidents in question five years before, no concerns have been raised about his practice. He expressed remorse and described the events as a “learning experience” for him. He accepted responsibility, and said that he now carried out observations of patients more robustly.

Results of the fitness-to-practise panel


The ftp panel can impose four different sanctions:

  • Conditions of practice: this will prevent a registrant from carrying out certain types of work or working in a particular setting, it may require them to attend occupational health or do retraining. The order can be applied for up to three years and must be reviewed by an FTP panel again before expiry
  • Caution: the nurse or midwife is cautioned for their behaviour, but is allowed to practise without restriction

  • Suspensions: the nurse or midwife will be suspended from practice for a period of initially not longer than one year, but this can be extended after review by an FTP panel

  • Striking off: a nurse or midwife is removed from the register and not allowed to practise in the UK. The nurse or midwife must apply to be readmitted to the register

Share what you believe is the right action for the NMC panel to take below and then find out what they decided: Final panel decision and reasons

Poll

Which sanction, if any, would you impose of you were on the panel?

View poll results
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