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ECT conundrum

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A staff nurse has been given a demonstration of new ECT machinery, which involved no assessment of her competence. Can she refuse to use it?

It is a principle of professional practice that a registered practitioner should not work outsider her competence. The NMC says: ‘To practise competently, you must possess the knowledge, skills and abilities required for lawful, safe and effective practice without direct supervision. You must acknowledge the limits of your professional competence and only undertake practice and accept responsibilities for those activities in which you are competent.’

Professional practice can be extended by learning how to use new equipment and developing new skills. For example, registered nurse practitioners may request X-rays if they have had training and comply with the latest ionising radiation regulations.

But what is happening here seems to be more than introduction of new equipment and an expansion of the nursing role to assist with electroconvulsive therapy. Such a development would be within the scope of professional practice but only if the registered practitioner had received training, assessment of competence and appropriate initial supervision.

There seems to have been no careful planning of the expansion of the scope of professional practice – training is inadequate, no assessment of competence has been carried out, nor does supervision appear to be in place.

The answer must therefore be ‘yes’. A nurse would be acting contrary to the code of professional conduct if she ignored her competence. If, as a result, she caused harm to the patient, she could face fitness to practise proceedings, disciplinary action and even criminal prosecution.

In addition, her employers could be sued by the patient for their vicarious liability.

The nurse, together with other staff, should use a constructive approach to management to seek the training, assessment and supervision required to ensure the new activity comes into the scope of their professional practice and competence.

Bridgit Dimond, MA, LLB, DSA, AHSA, is barrister-at-law and emeritus professor, University of Glamorgan, Pontypridd

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