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:
- Using physical force to restrain a patient while attempting to administer an intravenous (IV) infusion against the patient’s wishes;
- Speaking in an inappropriate manner to patient, saying words to the effect of “What are you doing?”,“You’re stupid” and “You’re an idiot”;
- Failing to demonstrate the standards of knowledge, skill and judgement required to practise without supervision as a grade D staff nurse as she failed to complete clinical observations assessments (COAs) on four occasions.
Nurse A was a registered staff nurse employed at a hospital. On the night shift of July 28/29 2013, she was working in a mixed gender, emergency surgical admissions unit. She used force to restrain Patient A, while attempting to administer an IV infusion despite the patient’s objections and spoke in an inappropriate manner.
The trust investigated and Nurse A was given a final written warning and set competency objectives to complete within a six-month time frame.
After going on long-term sick leave, Nurse A returned to work in October 2014 where she failed to meet multiple assessments on the objectives. She was dismissed in April 2015.
At the hearing
Nurse A made limited admissions of fact to the extent that she failed to successfully complete the COAs on the dates set out, so these were announced as proved.
The panel took into account all the oral and documentary evidence in the case. The panel heard evidence from five witnesses called on behalf of the Nursing and Midwifery Council, who they found to be credible, reliable and with a good recollection of the events. The panel found Nurse A to be often evasive in her responses, blaming others, and not accepting personal accountability for her practice.
The panel was of the view that she failed basic and essential standard competencies that every registered nurse must possess. They considered that by failing to successfully complete COAs on the dates outlined in charges, she failed to demonstrate the standards of knowledge, skill, and judgement required to practise without supervision as a grade D staff nurse. Accordingly, it found these charges proved in their entirety.
When determining whether the facts found proved amount to a lack of competence, the panel had regard to the terms of the Code that was in force at that time.
The panel concluded that Nurse A breached the Code. It was of the view that charges related to failures of basic and essential standard competencies that Nurse A consistently could not demonstrate. In all the circumstances, the panel determined that her performance demonstrated a lack of competence.
The panel went on to decide if her fitness to practise is currently impaired. The panel considered the deficiencies in Nurse A’s practice to be easily remediable. However, while she had undertaken some further training, it was not relevant to the practical elements of the assessments she failed. The panel also heard evidence of witnesses who considered Nurse A to be capable but not willing to comply with the best practices, indicating attitudinal issues. The panel bore in mind that its primary function is to protect patients and the public, which includes maintaining confidence in the nursing profession and upholding the proper standards and behaviour.
Results of the fitness-to-practise panel
The ftp panel can impose four different sanctions:
- Not impaired: the panel finds that the registrant’s fitness to practise is not impaired; therefore they can continue to practise
- 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