Each month, Nursing Times will consider a real-life case that was heard by the Nursing and Midwifery Council’s Fitness to Practise case.
Nursing Times you are the panel logo
Each month, Nursing Times will consider a real-life case that was heard by the Nursing and Midwifery Council’s Fitness to Practise case. We’ll give you the facts of the case, as presented to the panel, and you’ll get a chance to consider what decision you’d have made if you were on the panel. You can choose your response at the end of this article and then go to The Results to find out what really happened.
Registrant A was charged with failing to appropriately manage Resident A’s diabetes by administering fluids while she was unconscious and/or in a diabetic coma, and failing to assess the severity of her condition and seek medical intervention that was both appropriate and timely.
In light of the above, his fitness to practise was impaired by reason of his misconduct.
Registrant A was a nurse working at a care home. He was referred to the Nursing and Midwifery Council after a local safeguarding team raised a concern about his treatment of Resident A when she had a diabetic episode.
On finding Resident A asleep when he went to give her fluids to raise her blood sugar level, he said he “elevated the head rest” of her bed to try to give her a small amount of a “sugary drink”.
At the hearing
Registrant A admitted all charges and that his fitness to practise was impaired. The panel considered whether the facts constituted misconduct and whether this amounted to a serious departure from the NMC’s Code. Registrant A admitted this was so and, in particular, that he had not:
- Protected the health and wellbeing of those people in his care;
- Maintained their safety;
- Made referrals when it was in their best interests;
- Upheld the profession’s reputation.
The panel heard that the registrant provided two responses to the NMC. In the first, a couple of months after the incident, he gave an account of it but no insight into his action was shown. He submitted a second reflective statement 18 months after the incident, and recognised that he had not shown sufficient insight in his first statement.
The panel determined that Registrant A had reflected on his actions. He showed remorse, stating that he “regrettably and apologetically accepted that he had gone very seriously wrong in assessing [the resident]”.
The panel heard he showed insight by considering the “early warning escalation tools of the nursing tools” he should have used to diagnose the resident as being in a diabetic coma. He had reflected that he should not have tried “to give fluids or sugary drinks, even when the patient is in deep sleep, let alone in a coma, unconscious or unresponsive”. He then said that he “should have called the ambulance immediately”.
Registrant A recognised he was the only registered nurse on duty and would have been clinically responsible. He also accepted that his “poor judgement could have led to irreparable damages to the safety of the patient”.
The panel heard he had attempted to remediate his misconduct by completing a six-month Level 2 course in Understanding the Care and Management of Diabetes, developing and implementing a personal development plan, and undertaking an assessment with his manager.
The panel decided that, although serious, this was a one-off incident and the risk of repetition was low. However, it believed that, although Registrant A’s conduct did not cause any patient harm, a finding of impairment was necessary to maintain public confidence in the profession. The panel accepted that Registrant A intended no malice or neglect towards Resident A, and was trying to help her but failed to do so appropriately.
Results of the fitness-to-practise panel
The ftp panel can impose four different sanctions:
- 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
- Caution: the nurse or midwife is cautioned for their behaviour, but is allowed to practise without restriction
- Suspensions: 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
Share what you believe is the right action for the NMC panel to take below and then find out what they decided: Final panel decision and reasons
Which sanction, if any, would you impose of you were on the panel?