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”
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.
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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”
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.
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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.