A nurse has launched a petition calling for fundamental change in the way fitness to practise (FtP) cases are handled by the Nursing and Midwifery Council, after she was struck off in a decision described as “excessive and disproportionate” by a High Court judge.
Cathryn Watters, who has been a nurse for 27 years, specialising in cancer care, was accused of dishonesty and struck off by the NMC in February this year for allegedly altering the date on a training certificate she submitted as part of a job application – a charge she has consistently denied.
“It is like a roller-coaster – up and down, panic attacks, not sleeping, stressed beyond belief”
However, the striking off order was overturned on appeal by a judge who said the sanction was “disproportionate and excessive”, and ruled in favour of a two-month suspension.
Ms Justice Cheema-Grubb said: “This was a one-off fault in the context of a life-long career of public service of a high standard. It was wholly out of proportion for the panel to conclude that suspension was not a suitable penalty.”
The suspension was later revoked with immediate effect at a review hearing in August. The NMC review panel noted it was in the “public interest that a skilled and specialist nurse should be allowed to return to practise”.
Ms Watters, who has previously worked on inspection teams for the Care Quality Commission, told Nursing Times the whole experience had been “horrendous”.
“It is not only the thought you can never work in your profession again, it’s the shame of it all,” she said.
“When you have been nursing as long as I have, it’s not just your job it is who you are – it is your identity – it is everything you have done, it is your whole being,” she said. “I was devastated.”
“There were literally no jobs I could do that were health-related. I was in despair”
Ms Watters, who has four children aged under 14 and is the main breadwinner for her family, said she and her husband feared they would lose their home.
“We were just like, oh my God, we’re going to lose the house and if we lose the house we’ll never get another mortgage, because my husband is self-employed and I’m not working,” she said.
“You look at all the jobs out there and even the ones that aren’t patient based require a registration number,” she said. “There were literally no jobs I could do that were health-related. I was in despair.
“It is just this roller-coaster – up and down, panic attacks, not sleeping, stressed beyond belief,” she told Nursing Times.
While she admitted submitting the training certificate and copying the date onto her application, she has always denied altering the date on the original document.
She concedes that she should have checked her paperwork more thoroughly and would have accepted a caution but, having enjoyed a long and successful career in oncology nursing, was horrified to be struck off for what she considered a relatively minor mistake.
“When you go in there you are so vulnerable – I cried the whole three days”
Her petition claims the current FtP process creates “fear and a lack of transparency”. Ms Watters admitted she even considered confessing to something she claims she did not do, simply to increase her chances of a lighter penalty.
“At one point with my lawyer when we were preparing, I said: ‘Would I be in a better position if I actually said I had done it?’ And she said: ‘Well, did you do it?’ and I said: ‘No’ and she said I had to tell the truth.”
“After I was struck off, I wondered if it would have been better to say that I had changed it [the certificate] and that I was really sorry,” she said. “I probably would not have been struck off, but it would have been a lie just to get the outcome I wanted.”
Ms Watters also revealed that she very nearly did not appeal against being struck off because she had been so traumatised by the process and hearing itself.
“When you go in there you are so vulnerable – I cried the whole three days I was there,” she said. “They said my evidence was unconvincing and without substance. Of course it was. I could barely speak!
“I was so mortified at being there in front of them,” she said. “There was no duty of care over my psychological state at the time.”
She said: “When I walked in for that hearing I felt worse than a criminal – you are cross-examined like in criminal law and it is just horrendous. I can see why a lot of people get to that and say ‘you know what – I’m just walking away’.”
“The current process does not protect either the public or the profession and is damaging to both”
Even on the day of the appeal, where she represented herself, she considered withdrawing despite being encouraged to fight by other nurses who had been through the process.
Her petition has been signed by more than 650 people so far, including many fellow nurses. “The current process does not protect either the public or the profession and is damaging to both,” states her petition, which is based on the website www.change.org.
“We are constantly struggling to retain experienced nurses in the profession and should be ensuring these nurses with irreplaceable experience are not thrown away,” it adds.
Since launching the petition, Ms Watters said she had been inundated with messages from other nurses who said they had endured similar experiences.
She said the support she had received showed she was not the only nurse to have been sanctioned harshly, or been unnecessarily lost to the profession through FtP processes.
Together with some of the nurses that contacted her, she is forming a campaign group to call for the FtP system to be changed and “made fairer”. It is expected to meet for the first time early next year.
One of the key issues highlighted in her petition is a lack of consistency in the way FtP cases are handled. The judge who heard her appeal called for the NMC to look again at the Indicative Sanctions Guidance that panels use to decide what sanctions to impose.
This echoed a previous call from another judge Mr Justice Kerr. He criticised the guidance for lumping thieves, criminals and fraudsters together with someone who may have committed a much more minor infraction, such a breaking a contract, and concluded it needed to be more “nuanced”.
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Ms Watters, who is now back on the register and has a job lined up with an employer that has supported her throughout the NMC investigation, hearing and appeal, said the new campaign group would be calling for the guidance to be structured better, less vague and “open to interpretation”.
She also said they would like to see further checks and balances before the decision to strike someone from the register and more nurses serving on panels who could relate to the experience of nurses in practice and the impact of removing them from the profession.
“If you are going to get to something as severe as striking someone off, there needs to be another check and balance in there, because you are talking about destroying someone’s livelihood and their life really,” she said.
“Yes, there are nurses out there who should not be on the register, but there’s a lot more out there who are no longer on the register and could have been helped to maintain their registration,” she said. “At the end of the day, what is our profession about? It is about caring and we should be caring for our professional colleagues as well – and the NMC needs to lead in that.
“Our whole profession is about openness, honesty, duty of candour, but actually the processes in a hearing don’t promote you telling the truth almost – it is almost encouraging people to say what they need to say to get through it,” she added.
“Our current processes are too adversarial and do not give us the flexibility we need”
The NMC told Nursing Times that it had listened to the comments of the judge in Ms Watters’ case and had already fed this into new guidance.
“In the case of Ms Watters, the judge agreed with the independent panel’s findings of fact and that the fitness to practise of Ms Watters was impaired,” said a spokesman for the regulator.
“The judge decided that the striking off order imposed by the panel was excessive and replaced it with a two-month suspension order,” he said. “It is important to recognise that openness and honesty are key to patient safety, and dishonesty and cover up are things that we have to take extremely seriously.
“In coming to his conclusion, the judge made some extremely helpful comments about our guidance,” he said. “We’ve taken these comments on board and they have been reflected in our new guidance in this area.”
The spokesman stressed that the NMC was keen to update its FtP processes, but this would require further changes to the law to be agreed by government.
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“Recent changes to our legislation has gone some way to help modernise our fitness to practise arrangements, but we are clear that these changes fall far short of what’s required,” he said.
“Our current processes are too adversarial and do not give us the flexibility we need to react to changes in the external environment,” he said.
“That’s why the government must deliver real reform in this area. In the meantime, we will continue to explore ways in which we can improve our processes within our restrictive legislative framework,” he added.