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Final panel decision: What should happen to a nurse charged with failing to ensure that a patient was promptly reviewed?

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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

The panel found that, as a registered nurse, Nurse B had a duty of care for all the patients on the ward during that night shift, and that she failed in that duty of care.

The panel determined that Nurse B had this duty of care in her role as a registered nurse not as the nurse in charge.

Furthermore, the panel concluded that Nurse B had shown an overall absence of an enquiring professional mind throughout this shift.

She gave evidence that Nurse B did not check the observations charts of any of the patients on the ward at any time on the course of this shift, reducing the amount of clinical information Nurse B was aware of to determine proper patient care, especially in relation to Patient A.

Decision on misconduct

The panel, in reaching its decision, had regard to the public interest and accepted that there was no burden or standard of proof at this stage.

The panel bore in mind that a finding of impairment by reason of misconduct is a two stage process. It must first consider whether, on the facts found proved, Nurse B’s actions constituted misconduct, and second, if so, whether her fitness to practise was currently impaired by reason of that misconduct.

In relation to the first charge, the panel considered that Nurse B’s failure to ensure that Patient A was promptly reviewed by medical staff when she should have known that the patient had a high NEWS score, did amount to misconduct.

Nurse B had a duty of enquiry, and there was sufficient information available for her to have been aware of Patient A’s condition. She failed in her duty as a registered nurse to act appropriately.

In relation to the third charge, the panel found that it was not acceptable that Nurse B left the ward unattended by a registered nurse for approximately five minutes. The panel found that she had made a very poor decision which was wholly unacceptable, but determined that this failure does not meet the threshold of serious misconduct.

In relation to the fourth charge, the panel found that at the time, Nurse B was not aware that an ‘incident’ had occurred that required the completion of an incident form. Nurse B thought that she had completed the documentation that was appropriate after a patient’s death. The panel determined that this was an error that does not amount to misconduct. 

The panel was of the view that Nurse B’s actions in the first charge fell significantly below the standards expected of a registered nurse, and amounted to a breach of the code.

The areas within the code relevant to this misconduct is that the people in your care must be able to trust you with their health and wellbeing

To justify that trust, you must:

  • Make the care of people your first concern;
  • Work with others to protect and promote the health and wellbeing of those in your care;
  • Provide a high standard of practice and care at all times.

As a professional, you are personally accountable for actions and omissions in your practice, and must always be able to justify your decisions.

Decision on impairment

The panel had regard to Nurse B’s reflective statement dated and considered that this had not demonstrate full insight into her responsibilities and duties as a registered nurse.

However, throughout the course of this hearing, and in her oral evidence in particular, it was clear to the panel that her insight has developed further. It found that she now fully understood and accept her failings on the night shift. She demonstrated genuine insight, albeit at a late stage.

The panel was of the view that Nurse B had been able to demonstrate that she is a safe practitioner and there was no risk of repetition. The panel noted that it has been four and half years since these incidents and there is nothing to suggest that Nurse B had repeated the misconduct in that time.

The panel further noted that, prior to these incidents, Nurse B had a career that spanned almost 30 years without incident.

On the basis that the panel has determined that Nurse B had fully remediated her misconduct and that there is was no risk of repetition, it concluded that there was no risk to the public, and consequently determined that her fitness to practice is not currently impaired.

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