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What should happen to a nurse who acted aggressively towards a patient in his care?

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A case study showing an example of a nurse who acted aggressively towards a patient and had his fitness to practise called into question by the Nursing and Midwifery Council’s fitness to practise panel

you are the panel

you are the panel

The charge

That Nurse A:

1. Moved towards Patient A and/or said to Patient A on one, or more occasions: “Come on then, start” or words to that effect;

2. Pushed and/or shoved Patient A in the chest area with both hands;

3. Following Colleague A having separated/attempted to separate Nurse A and Patient A/de-escalate the situation: pushed Patient A; continued to provoke Patient A; pulled and/or held Patient A’s shirt over his head; and restrained Patient A by applying pressure to his chest;

4. Had conduct that was inappropriate, disproportionate; and/or contrary to best practice and/or the trust’s procedures and guidance.

The panel was informed at the start of this hearing that Nurse A was not attending and drew no adverse inference from this.

The background

Nurse A was employed as

a clinical practitioner at a trust. In early 2016, an incident occurred on an adjoining ward between Nurse A and Patient A. Nurse A attended to an alarm, which was activated on the ward.

Nurse A was not part of the ward response team but stayed on the ward after the response team had dealt with the initial disturbance with Patient B. Nurse A was in the day room. Staff members Ms 1, Ms 2, and Ms 3 were also in the day room. 

Patient A became verbally abusive towards Nurse A and in response he used provocative language towards Patient A, moved towards him, pushed and/or shoved Patient A, continued to engage in a physical altercation with Patient A after Ms 1 had attempted to separate them, and used restraint techniques not in line with the trust’s policies.

The trust undertook an investigation and a disciplinary hearing was held. 

At the hearing

The panel was of the view that Nurse A’s actions fell significantly short of the standards expected of a registered nurse, amounting to a breach of the Code. 

The panel felt that Nurse A had provoked, pushed and continued to engage in a physical altercation with a vulnerable patient in his care. 

The panel also considered the evidence of Ms 2 (who was a newly qualified nurse at the time), who in oral evidence said that the events had made her question her career choice. The panel considered Nurse A’s actions to be reprehensible in every sense. It therefore found that Nurse A’s actions fell seriously short of the conduct and standards expected of a registered nurse and amounted to misconduct.

The panel considered that Nurse A placed patients at an unnecessary risk of harm by provoking, pushing and continuing to engage in an altercation. Patient A, and other patients in the vicinity, could have been injured as a result of the misconduct. 

Nurse A’s misconduct took place within view of patients and other professionals. The panel had regard to the oral evidence of Ms 1 and Ms 2 and noted the distress caused. The panel was satisfied that Nurse A had brought the nursing profession into disrepute.

The panel found Nurse A had breached fundamental tenets of the nursing profession; namely, treating people as individuals and upholding their dignity; and treating people with kindness, respect and compassion.

Nurse A had not accepted fault and sought to justify his actions by stating that he was trying to protect others in a situation which in fact he escalated. The attitudinal problem appeared to the panel to be arrogance and lack of understanding of the effects of his actions on others.

Results of the fitness-to-practise panel

The ftp panel can impose four different sanctions: 

  • Not impaired: the panel finds that the registrants’s fitness to practise is not impaired; therefore they can continue to practise
  • 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

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

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