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Exclusive: NMC referral can spark suicidal thoughts in nurses, finds survey

  • 14 Comments

More than half of nurses referred to the Nursing and Midwifery Council may have experienced suicidal thoughts, indicates a snapshot survey by a group campaigning for improved support for those going through fitness to practise (FtP) procedures.

The online survey, which has been completed by about 40 nurses who contacted the support group for help after going through FtP, found that 60% reported their mental health was the aspect of their life most affected by the process.

“They have to merely pick themselves up, dust themselves off and move on”

NMCWatch report

Comments made by nurses who have taken part in the survey so far revealed that the “life changing” impact of FtP cases on those involved, even when they were referred for relatively minor issues.

“It is a very isolating and shaming experience where you are treated as guilty right from the start,” said one.

“The impact is totally disproportionate to the events complained about. It has made me leave my job, as the risks are too high,” they said. “No one deserves to be put through this.”

Another wrote that they would “never be the same nurse again”, following their FtP experience.

Meanwhile, one nurse described how the FtP process had prompted thoughts of suicide. “It’s a constant battle to try and prevent this from ruining me as a person,” wrote the nurse. “I keep having to remind myself I haven’t done anything wrong.

“One person at the NMC spoke to me as if I had murdered someone. That contact will live me and was a trigger for some of the suicidal thoughts that I had,” they added.

The survey was set up by the NMCWatch: Registrants Care group, which was launched earlier and is pushing for reforms to the system. It was sent to registrants who contacted the group via its online support group and have been through the FtP process.

The group – previously called CRISIS (Challenging Regulators in Sanctioning Individuals Safely) – shared its interim findings with Nursing Times, following the launch of a major consultation by the NMC on the future of FtP.

The group’s founders include experienced cancer nurse Cathryn Watters, who successfully appealed a decision to strike her off the NMC register over a relatively minor irregularity in a job application.

She said the survey responses so far painted a compelling picture of the devastating impact of an NMC referral – and often lengthy investigation process – even when a nurse was subsequently found to have done nothing wrong.

“Even when registrants face a no case to answer, after months to up to two years of investigation the impact is huge,” she told Nursing Times.

Meanwhile, a report compiled by the group suggests nurses undergoing FtP may also be reluctant to report mental health issues for fear it could damage their case.

“I have had a few nurses contact me who are being told not to appeal, despite the fact they actually could have had a reasonable case”

Cathryn Watters

Anecdotal evidence from those contacting its online support forum indicates problems “are nearly always unreported for fear it will give their regulator even more ammunition to state they are unfit to practice”.

The survey asked respondents if they experienced various “symptoms” before, during or after FtP proceedings, with more than half reporting suicidal thoughts.

In all, 78% stated they had feelings of paranoia, while the same proportion said they had suffered “acute anxiety”.

All said they had had difficulty sleeping and 68% reported feelings of anger and mood swings. Meanwhile, 89% reported low self confidence and 84% said they had difficulty trusting people.

The survey findings also suggested that FtP can affect nurses’ ability to do their job – even if they are cleared.

Nearly two thirds – 65% – stated they had problems with building professional relationships while 84% said they had difficulty trusting people.

In addition, 71% reported an inability to work at the same level they had been working at before, with 51% saying they had to change their role because of the impact of FtP on their mental health.

Crucially, the survey showed the majority of nurses – 68% – did not know where to go for support during the FtP process, the group highlighted.

Most – 85% – said they turned to their family, while half were helped by online or telephone support groups. But only 45% got support from legal representatives and 42.5% were supported by unions.

Less than a third – 30% – said they had support from work colleagues.

Ms Watters said one of the campaign group’s key concerns was around this perceived lack of support and advice for nurses referred to the NMC.

She said it resulted in nurses not appealing unfair sanctions, even when they had a strong case.

“I have had a few nurses contact me who are being told not to appeal, despite the fact that on paper they actually could have had a reasonable case for changing their sanction,” she said.

“Unions are also actively telling them not to pursue it privately, as it will be very costly,” she said. “This is inaccurate, as my case didn’t cost me anything other than rail fares.

“By the time we are hearing from them, it is way past the 28-day period when they can appeal,” she noted.

The campaign group has also said there is a need for better understanding of the impact of FtP on registrants’ emotional and mental wellbeing.

“For those who have been affected by FtP, there is no recourse – they have to merely pick themselves up, dust themselves off and move on,” said the group’s report.

In its consultation on FtP, which was launched earlier this month and runs until 30 May, the NMC said it was seeking to reform the system and move away from a culture of “blame and punishment”.

“We are not alone in thinking that a culture of blame and punishment is likely to encourage cover-up, fear and disengagement,” said the consultation document.

“We want registrants to engage with the fitness to practise process in a positive way and see it as an opportunity to learn and reflect on their practice, while increasing patient safety,” it said.

Among the NMC’s plans is the idea of dealing with most FtP cases in private in future, in order to encourage nurses and midwives to speak up about problems at an earlier stage in the process.

Nursing Times has also asked the NMC if it would like to comment on the new survey findings.

Meanwhile, the NMCWatch group has asked any registered nurses who have been through the FtP process to contibute to its ongoing research by completing its survey.

 

  • 14 Comments

Readers' comments (14)

  • I cleared my name after 3 years of torture. I was suspended twice by the NMC. They state that suspension is not a form of punishment but my salary was taken from me without them knowing my circumstances and if I was able to support myself financially. I did consider suicide, had my GP not organised therapy quickly, I may not be sat here to type this. I thought of walking away from nursing. My OH helped me and I was able to defend myself, as my union failed to provide the service into which I had paid.It is so humiliating as people think you must have done something terrible as you have been referred. I had to ask colleagues and friends to write testimonials, but for them to do this they had to be aware of my 'charge'. There are a lot of malicious referrals out there. There has to be a better initial process. EG, if there is no evidence of the issue being looked at prior to the referral, then send it back to the employer and charge them a fee for wasting NMC time. Thank goodness I found support from an online group.

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  • I have been pleased to be able to start discussions with the NMC about how better support can be available and how the process can be reviewed in light of the feedback we are getting. I am encouraged by Mathew McClelland, Director of Fitness to Practice and the team we have met with as they have shown openness and a willingness to discuss further. However there are some aspects which can not be changed as they are bound by legislation. This legislation underpins the process and may be contributing to some of the problems registrants are facing - it needs urgent review and all stakeholders need to be proactive in ensuring the process is improved for the better of everyone. The NMC can only strive to improve dealing with what is put in front of them to assess. If unions do a poor service to registrants by not fighting their case appropriately, or by not presenting the information in a right way, then outcomes may continue to not be completely appropriate. We hope there will be a joined up approach from all parties involved and an independant review of all registrants who have been through FtP to determine if there are key themes that can be examined. Registrants are not used to pushing themselves forward and will always put the patient first, this theme runs through our veins. However, currently the process is just disengaging more registrants and as members of the public, their public interest and that of their families and friends who witness what they have been through is not being best served. I hope we will get there - together.

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  • can I add that there are a few errors in this article:
    The survey was a snapshot from registrants who had been through FtP and not ALL registrants. The registrant quoted has not "murdered someone"!! This should read "... spoke to me as if I had murdered someone" it's quite different !!!!

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  • There should be a filtering system in place, those who make malicious referrals should be held accountable. Some of the referrals may be errors made due to long hours, lack of breaks, staffing levels as well as the high demands to get paperwork in order. Something needs changing.
    Protecting the public should not solely be about punishing nurses, the NWC should look at the ward environment, staffing levels etc.

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  • Sorry typo error I mean't NMC should look at the ward environment etc.

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  • How can people learn from their mistakes if they are scare of being open and honest for fear of referral to their regulator. So many registrants damaged by this process and for what? The possibility that they may cause harm or to just teach them a lesson? Neither benefits patient care and infant may harm it!!

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  • The NMC FtP screening process over 4 stages does not identify nor intend to identify malicious referrals. The GMC are running pilots in each of the UK’s four countries of safeguards to reduce the risk of their procedures being used to disadvantage whistleblowers, a concern raised by Sir Anthony Hooper QC who was commissioned by the GMC to undertake an independent review of how the GMC deals with whistle-blowing. The changes include new referral forms requiring any health organisation raising a concern about a doctor to disclose whether the doctor had previously raised concerns about patient safety. I wonder why the NMC are still avoiding such steps to emulate the good practices of the GMC which could potentially save millions of pounds if vexatious referrals were identified from the FtP screening outset.

    Another “Think Tank” called CIVITAS carried out a survey about vexatious referrals to the GMC in 2012-2013 and concluded an average of 2,000 referrals were actually vexatious.

    There seems to be no screening process to filter out vexatious referrals and motives for this; therefore deeming the nurse / midwife as being guilty from the outset OR No Case to Answer/ Not guilty many years later which by this time has caused a great deal of harm to the registrant. 

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  • Unfortunately the current system does not encourage openness and honesty. The process is about what you can prove and if you unable to prove you are deemed guilty. You can not remediate for something you have not done! Once you are restored to the register there are still a load of hurdles to jump over in order to make your PIN active again - making you feel once again like the NMC don't want you. You can't pay your fees for example whilst under investigation and then once restored your registration lapses meaning that you have to do a mini revalidation to get back on the register even though a panel or court have said that you can.I This is pretty hard when you have not been able to practice for x amount of months / years!!! if I could have afforded it I would not have bothered!! Very sad

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  • This is the most humiliating experience I’ve ever had to endure. It’s the shame that hurts the most, even though most of the allegations are completely unfounded. And because it drags on for so long you start to doubt yourself, which leads to a whole multitude of psychological problems. The paranoia is horrific, and the flashbacks still affect my work-life to this day, even though I’m not working as a nurse. This process has turned me into a person I don’t like...thanks a bunch NMC.

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  • I felt like I was treated like I had commited a criminal offence rather than a isolated judgement error in an otherwise unblemished career

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