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What should happen to a nurse who struck a child on the head after being struck herself?

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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.

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 with striking Child A on the head. Following the incident, she did not undertake a physical assessment of Child A; undertake or record neurological observations;  complete a body map; seek medical attention; report the incident; record the incident; inform the on-call manager; contact the out-of-hours social worker; or hand over details about the incident to night staff that Child A had sustained a strike to the head. 

In light of the above, her fitness to practise was impaired by reason of her misconduct.

The background

Nurse A was a registered nurse employed at a trust that cares for children with complex care needs. 

As Nurse A was preparing Child A for bed, the child threw a doll into the path of their wheelchair. As Nurse A retrieved the doll, Child A struck her on the back of the head. Nurse A then struck Child A in the head area. She reported the incident to Ms B, nurse manager, and Ms C, head of nursing care for the trust.

At the hearing

Nurse A admitted all the charges. The panel was of the view that the nurse’s actions fell significantly short of the standards expected. 

The panel accepted that the nurse’s actions were reflexive rather than intentional and came about from the shock of being struck.

The panel found that it was to Nurse A’s credit that she had identified from the Code of Conduct, specific obligations, all of which can be set into the fundamental tenets of the nursing profession to prioritise people, practise safely, preserve safety and promote professionalism and trust. 

It was not acceptable for a nurse in any circumstances to strike a child and the panel concluded that Nurse A striking Child A was serious and amounted to misconduct.

Ms A and Ms B felt that she should have been relieved of caring for Child A after the incident. Nurse A did do the one thing directly required of her (report the incident both to Ms C and Ms B). 

Ms C indicated that it was her responsibility as shift leader to prepare an incident report and to hand over at the end of the shift. In these circumstances, the second charge did not, in the panel’s view, amount to misconduct.

The panel next went on to decide if, as a result of this misconduct, Nurse A’s fitness to practise was currently impaired. The panel had no doubt that the incident brought the profession into disrepute and breached fundamental tenets of the profession.

In deciding whether Nurse A was liable to act in these ways in future, the panel gave weight to her evidence, and she was questioned about how she would handle the situation differently in the future. She demonstrated that she is a safe practitioner, the risk of repetition was minimal, and that her remorse and insight are clear.

She studied an online course and provided evidence on what she learned; the panel was encouraged by this. The panel determined that, should she find herself in a similar situation again, she would be unlikely to repeat the misconduct. 

The panel carefully considered the public interest in this case and that this isolated incident, in a career spanning some 38 years, is towards the lower end of the broader spectrum of seriousness. 

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

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?

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