A case study highlighting how incidents that occurred while the registrant practised as a paramedic led to them being the subject of a Nursing and Midwifery Council fitness to practise hearing
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Nurse A was registered as both a nurse and a paramedic. In 2016, the Health and Care Professions Council (HCPC) made a determination that his fitness to practise was impaired and struck him off the register.
In 2010, the HCPC found that his fitness to practise was impaired and imposed a five-year caution order.
In 2010 Nurse A was made subject to a five-year caution order by the HCPC after failing to carry out a secondary assessment of a critically ill patient and mobilising a clinically unstable patient with dypsnoea.
In 2016 he was struck off the HCPC register after he was called out to a YMCA hostel to treat Service User A, a young woman presenting with breathing difficulties. Nurse A was found to have taken an inadequate amount of equipment into the premises and made an assumption that Service User A was intoxicated based on an inadequate assessment.
The HCPC referred the matter to the NMC. Nurse A also made a self-referral to the NMC a week after the HCPC’s striking off order.
At the hearing
A panel of the Conduct and Competence Committee decided that this case should be considered at a substantive meeting. Nurse A admitted the charges in full and accepted the advice of the legal assessor, who stated that the panel was entitled to find the facts proved by reason of Nurse A’s admissions. As such the panel found the charges proved by reason of Nurse A’s admissions.
The panel had to decide whether in light of the findings of another regulatory body – the HCPC – Nurse A’s fitness to practise as a registered nurse was currently impaired.
The panel considered whether the finding by the HCPC that Nurse A’s fitness to practise as a paramedic was currently impaired, was relevant to his fitness to practise as a registered nurse was also impaired.
The panel took into account that the HCPC found that Nurse A put patients at risk of harm by failing to carry out appropriate patient assessments. Further, the HCPC found he had dishonestly recorded that he had carried out patient assessments. The panel was satisfied that Nurse A had in the past put patients at an unwarranted risk of harm and breached a fundamental tenet of the profession by acting dishonestly.
The panel noted that Nurse A admitted all the charges that were originally proved at the HCPC hearing. Further, he made full admissions in respect of the charges at this NMC meeting. He fully engaged with the NMC processes, his employers, and the HCPC. The panel took careful account of Nurse A’s reflective piece and was satisfied that he had demonstrated an understanding of how his actions put patients at a risk of harm and why what he did was wrong. Nurse A also expressed remorse and apologised to the service user; to his employers; and to the NMC registrar and staff involved in this case.
The panel considered, what steps Nurse A had taken to remedy his shortcomings and took into account that he is currently practising as a registered nurse and has done so since these events without incident. Nurse A also completed relevant training and was studying master’s degree modules in prescribing. The panel took into account that dishonesty is inherently difficult to remedy, but noted that this was a dishonest act involving one patient during a single shift, which occurred in difficult circumstances.
Results of the fitness-to-practise panel
The ftp panel can impose four different sanctions:
- Caution: the nurse or midwife is cautioned for their behaviour, but is allowed to practise without restriction
- Conditions of practice: this will prevent a registrant from carrying out certain types of work or working in a particular setting, it may require them to attend occupational health or do retraining. The order can be applied for up to three years and must be reviewed by an FTP panel again before expiry
- Suspension: the nurse or midwife will be suspended from practice for a period of initially not longer than one year, but this can be extended after review by an FTP panel
- Striking off: a nurse or midwife is removed from the register and not allowed to practise in the UK. The nurse or midwife must apply to be readmitted to the register