A case study showing an example of a nurse who was accused of not providing the appropriate level of care to patient, and how this led to the nurse’s fitness to practise being called into question
you are the panel
That Nurse A:
1. Failed to provide the appropriate level of care to Patient A. Upon recording a Modified Early Warning Score (MEWS) of 4, she:
1.1. Failed to inform the patient’s medical team;
1.2. Failed to inform the critical care outreach team;
1.3. Failed to take and/or record observations at 30-minute intervals;
1.4. Made a retrospective entry about care;
2. In 2017, she worked on shift as a midwife on a postnatal maternity ward while not registered as a midwife;
3. In 2017, on one occasion or more she misrepresented that she was a midwife.
Nurse A was employed as an agency nurse working a bank shift in the trauma and orthopaedic department at a trust. During a shift, concerns arose about the appropriate level of care delivered to Patient A. Her MEWS deteriorated throughout that shift which was not appropriately escalated.
The NMC received a referral from an NHS trust alleging that Nurse A indicated to staff present on the maternity ward that she was registered with the NMC as a midwife, having received training in nursing and midwifery in a foreign country. It is alleged that during this shift, concerns were raised by staff about her lack of competence, as she could not undertake and complete basic midwifery tasks. Later that shift, staff at the maternity ward checked her registration and discovered that she was not a registered midwife in the UK, and only registered with the NMC as a registered adult nurse.
At the hearing
Nurse A made an admission to charge 1, which the panel accepted. Therefore, the panel found charge 1 proved by way of admission. The panel considered that there was no case to answer in respect of charge 2. The panel received evidence that the system that books agency staff did not specify that the role was that of a registered nurse or midwife, only that the shift was offered as a ‘band 5 shift’. Nurse A also told staff on the ward on arrival that she had not worked on a maternity ward before.
The panel noted that some of the NMC witnesses accepted that on a rare occasion, registered nurses did work on the maternity ward at the trust.
The panel had no evidence that Nurse A had undertaken any specific duties that were outside her sphere of practice. The panel determined that Nurse A did not work as a registered midwife on the maternity ward. There was no case to answer in charge 2.
The panel found Nurse A to be an honest witness who held a genuine belief that she had attended the maternity ward to provide nursing assistance. The panel then went on to consider charge 3, which they found not proved.
The panel heard that it was possible to circumnavigate the booking system at the trust so as not to specify whether a nurse or a midwife was required to attend the maternity ward. The panel had regard to her unchallenged oral evidence that she had completed a qualification which combined nursing and midwifery outside of the UK, which enabled her to work on antenatal and postnatal wards while in that country. The panel noted that upon arriving at trust, Nurse A presented Ms 4 with her ID card, which clearly states that she was a registered nurse.
Nurse A did not undertake any specific midwifery duties while on shift on the maternity ward and did not actively seek this shift in a midwifery capacity. In light of the above, the panel determined that the NMC had not been able to discharge its burden of proof and, as a result, the panel found the charge was not proved.
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