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How should the panel treat a nurse who restrained a resident with dementia to cut their nails?

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When a nurse does not seem to understand that cutting the nails of a vulnerable resident against that resident’s will has caused distress, what should a fitness-to-practise panel do?

Nursing Times you are the panel logo

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.

The charge

Nurse A was charged as follows:

“That you, while employed at the nursing home, sat on the resident’s knees, cut her fingernails against her wishes, caused her to become agitated and caused injury to [her] finger. It was therefore alleged that [your] fitness to practise was impaired by reason of [your] misconduct.”   

 

The background

Nurse A was a staff nurse employed by a trust and via an agency at a nursing home. While on duty at the home, it was alleged that the incident cited above took place. The resident had the capacity to refuse care and treatment.

The trust and agency suspended Nurse A from undertaking any more nursing duties and a safeguarding alert was sent out. She still works for the agency, but in an administrative capacity.

The matter was referred to the police and a criminal investigation started. The decision not to prosecute was subsequently made. Before this incident, Nurse A had an unblemished nursing career spanning 40 years.

 

At the hearing

All charges besides causing injury to the resident’s finger were proved. Injury could not be substantiated because of the lack of medical evidence given to the panel. The panel then moved to consider whether the facts amounted to misconduct and, if so, whether Nurse A’s fitness to practise was currently impaired.

The panel was mindful

of the passage of time since the incident, but found

Nurse A’s inability to clearly answer questions undermined her credibility. She had limited knowledge of the policies on nail care and the content of residents’ care plans. She provided evidence of the training she had undertaken and references attesting to her good character in her current administrative role.

The panel determined that Nurse A’s actions fell short of the standards expected of a registered nurse, and that she had breached several sections of the Nursing and Midwifery Council’s code of conduct.

The proven charges were serious enough to constitute misconduct in a regulatory context. Nurse A did not treat the vulnerable resident with kindness, care or compassion.

The panel considered whether Nurse A’s fitness to practise was currently impaired and whether she was liable to repeat her misconduct. While Nurse A articulated her knowledge of nursing practice and policies, she failed to demonstrate any insight into her actions or any remorse or empathy for the resident’s distressed state. She did not show any insight into the reputational damage such actions would have on public confidence in the profession and the regulator.

The panel recognised Nurse A had taken steps to remediate her practice, and noted the mandatory training she had undertaken, which included dealing with vulnerable adults and child protection. The panel had no evidence that she had applied any of this recent training to a clinical setting since her suspension. The panel therefore concluded Nurse A had not provided enough evidence to show she has fully remedied her misconduct.

It noted that Nurse A’s actions were a single incident in an otherwise unblemished nursing career but felt there remained a real risk of the misconduct being repeated.

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

 

Poll

Which sanction, if any, would you impose of you were on the panel?

View poll results
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