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Final panel decision and reasons: How should the panel treat a nurse who restrained a resident with dementia to cut their nails?

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Find out how the NMC panel acted in this case. Not yet read the case? Read the charge and background here

Nurse A’s representative made an application (on her behalf) for matters relating to her personal life and health to be heard in private. This was in accordance with NMC Rule 19. The panel decided that Nurse A’s interests outweighed any prejudice which may be caused to any party or the public interest. Accordingly, the panel granted the application.

The panel made a suspension order for a period of 12 months. After careful consideration and balancing all of the above, the panel determined that the seriousness of Nurse A’s misconduct was such as to require her temporary removal from the Register. The panel decided that a suspension order was the most appropriate and proportionate response in this case, so as to mark the seriousness of Nurse A’s misconduct and to satisfy the public interest. Further, it was felt by the panel that a period of suspension would give Nurse A time to reflect on the panel’s findings and the opportunity to demonstrate fuller evidence of remediation to a subsequent panel who would review the suspension order before its expiry.

The panel reached this decision by weighing the public interest with Nurse A’s own interests and took into account mitigating and aggravating factors. The public interest includes the protection of members of the public including patients, the maintenance of public confidence in the profession and the declaring and upholding of proper standards of conduct and behaviour within the profession. The panel took into account the NMC’s Indicative sanctions guidance to panels (“ISG”), bearing in mind that the decision on sanction is one for its own independent judgement. The panel recognised that the purpose of the sanction is not to punish, although any sanction may have a punitive effect.

The panel considered the mitigating and aggravating factors in this case and concluded that Nurse A’s misconduct had fallen significantly short of the standards expected of a registered nurse. The panel concluded that it could not be satisfied that there is no risk of repetition of the misconduct of the kind found proved. As such, it was the panel’s duty to protect the public from the risk of harm and to declare and uphold proper standards of conduct, so as to maintain public confidence in the profession. The panel first considered whether to take no action but decided that this would be inappropriate in view of the seriousness of Nurse A’s misconduct, the need to protect the public and the need to declare and uphold proper standards of conduct.

The panel considered the sanctions available to it. It felt that a caution order would be inappropriate and insufficient in view of the seriousness and nature of Nurse A’s misconduct. Furthermore, making a caution order would be inconsistent with its findings as to the risk of repetition and would not satisfy the public interest.

The panel next considered whether placing conditions of practice on Nurse A’s registration would be a sufficient and appropriate response. The panel noted that the issues raised by this case did not relate to clinical competence but related to Nurse A’s conduct. The panel noted that there was no evidence of harmful deep-seated personality or attitudinal problems. There was no evidence of general incompetence. Nurse A has demonstrated a willingness to engage in training. The panel was not satisfied that a conditions of practice order would be sufficient to address Nurse A’s lack of insight and would be insufficient to satisfy the public interest.

The panel considered that a striking-off order would be disproportionate. The seriousness of Nurse A’s case was not incompatible with ongoing registration, after a period of considerable suspension. This was an isolated incident in an otherwise unblemished career. The panel accepted that it was in the public interest to retain a skilled and experienced practitioner.

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  • 1 Comment

Readers' comments (1)

  • It is really hard to weigh up when we don't hear what the nurse has said herself about what happened or know the mitigating factors.
    Did she really not express any remorse and if so, why not? Why did she behave like this which seems to have been out of character - unblemished career.
    At suspension-nhs.org we know of people who have been referred to the NMC who say the general approach to them was that they were guilty unless they could prove their innocence and that they were disbelieved because a manager said otherwise.
    Sometimes it seems staff need help not judgement....
    Julie Fagan, founder member of CAUSE UK and the website

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