Each month, Nursing Times will consider a real-life case that was heard by the Nursing and Midwifery Council’s Fitness to Practise case.
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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.
Nurse A was charged with pretending to administer prescribed medications to a resident and recorded that wound dressings were changed
Background to charges
Nurse A was referred to the NMC following a number of concerns being raised during her time as a staff nurse.
It was alleged in December 2014 she signed off a number of medications (including aspririn, Calceos, Seretide inhaler and Metformin) as being administered to the resident when they had not been, and removed medication from the blister packs so it appeared medication had been administered.
In January 2015, Nurse A failed to undertake a wound review of Resident B despite being reminded to do so. Then she signed the care record to falsely indicate that she had changed the dressing. Upon being reminded on 18 January 2015 to carry out the wound review, she allegedly amended the 17 January entry date to 18 January to suggest she had carried out a review.
On 19 January 2015 she took a prescribed food supplement received by the home in the name of Resident C, who was deceased, from the Home, giving them to Colleague B. It was further alleged that she attempted to cover up the removal of the supplements by asking Colleague A, who had overheard her talking to Colleague B, not to tell anyone that she had taken them.
In light of the above, Nurse A’s fitness to practise was impaired by reason of her misconduct.
At the hearing
Nurse A admitted all the charges and further that her fitness to practise was currently impaired.
The panel first considered whether the facts found proved amounted to misconduct and had regard to the terms of The code: Standards of conduct, performance and ethics for nurses and midwives 2008 (the Code).
The panel determined that Nurse A’s actions did breach the Code and were serious omissions that could have led to serious harm for the patient. Further she was in a position of considerable trust and she breached this trust, failed to provide adequate patient care and committed acts of dishonesty in order to conceal this.
The panel considered that Nurse A displayed dishonest conduct on multiple occasions. The panel was of the view that the dishonesty in respect of Resident A’s medication was calculated. Nurse A compounded her dishonesty after being challenged about not administering medication to Resident A by removing the drugs from the blister packs. The panel concluded Nurse A repeated this dishonest conduct in relation to Resident B’s wound care plans.
In all the circumstances, the panel found that Nurse A’s actions did fall seriously short of the conduct and standards expected of a nurse and amounted to misconduct.
The Panel found that in applying the test as set out by Dame Janet Smith in the Fifth Shipman report that Nurse A put patients at unwarranted risk of harm. The panel also determined that her repeated dishonest conduct brought the profession into disrepute and breached fundamental tenets of the profession.
Regarding insight, the panel noted that Nurse A made full admissions to the charges and impairment. It noted that Nurse A attempted to remediate her practice by completing some training courses, for example, on good clinical record keeping. She was currently working as a registered nurse and had provided a number of positive testimonials which spoke highly of her current practice.
But the panel could not be satisfied that there is no risk of repetition and it is necessary to protect patients from a dishonest nurse and therefore determined that Nurse A’s fitness to practise was impaired on the grounds of public protection.
The panel considered that Nurse A had developing insight into her misconduct however, the panel bore in mind that she focused her reflection on the impact on herself and her career rather than the patients.
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?