A case study of a former nurse who applied for restoration more than 10 years after the strike-off, as in accordance with Article 33 of the Nursing and Midwifery Order 2001
you are the panel
At the substantive hearing in 2008, the panel considered that Nurse A, while employed as a nurse practitioner, failed to recognise that Patient A (who had a history of heart problems) was presenting with cardiac symptoms; failed to take appropriate action following his examination of Patient A; and failed to promptly record details of the examination. His fitness to practise was found impaired by reason of his misconduct and the panel said it was necessary to make a striking off order.
Nurse A worked at a high-security mental health hospital. Patient A complained of feeling unwell and had received medication for suspected indigestion. Patient A was seen in his capacity as a nurse practitioner. Nurse A did not make a note of his examination of patient A and then left the ward to attend a meeting and did not return to duty. Nurse A made a note the following day after enquiries made by Nurse 1.
Nurse A informed Nurse 2, a mental health nurse on the ward, that Patient A was probably suffering from indigestion and the current treatment plan should continue. He did not make any reference to any potential cardiac problems at that time, but later accepted that, when he examined Patient A, he was feeling unwell and complaining of chest/epigastric pain.
Patient A had a significant history of cardiac problems that had led to the fitting of a pacemaker a year earlier.
It was noted that he had problems with indigestion and was generally reluctant to be admitted to hospital.
Nurse A had concerns sufficient to request a review of Patient A later that day. Nurse 1 attended Patient A at approximately 5pm. She was very concerned about the condition of Patient A and called for an ambulance. Patient A was subsequently admitted to hospital and died the next day having suffered a heart attack.
The panel was asked to consider the findings on impairment, which indicated a lack of acceptance by Nurse A of his failings, and a failure to engage with support provided. Nurse A told the panel he had spent 10 years working as a nurse, and in that time enjoyed interacting with colleagues and patients. Nurse A explained during the last three years of practice, he had been promoted quickly to senior roles. He said he now acknowledged his career progression during this period was too rapid.
Nurse A told the panel about his difficult personal circumstances at the time of the incident, and how this exacerbated the challenges he was facing at work. He explained how these factors affected the way he reacted to the incident and the later disciplinary and regulatory proceedings. Nurse A said that he effectively ‘shut down’, went onto ‘autopilot’ and wanted to ‘hide away’ from the situation. He told the panel that he now understood the importance of engaging with such proceedings, and with support provided at a local level. He explained that he wished to return to nursing to ‘give something back’ and emphasised the importance of doing a job in which he could help people and that was fulfilling. He said that he had begun researching courses to assist him in returning to practice, and that he would be willing to undertake anything required to do so. He told the panel about the distress, guilt and remorse he felt following the incident and the subsequent death of Patient A, and explained that this was likely to have contributed to his disengagement with local and NMC proceedings.