If an appropriately qualified nurse is allocated to a patient but her competence is questioned by a staff member, what are the responsibilities of the manager?
While the law holds that the patient is entitled to a reasonable standard of care – as measured by the Bolam Test, nurses know that in practice the range of competence among nursing staff can range from the superbly effective to the simply adequate.
Inevitably there will be occasions when practitioners come to question the competence of colleagues. What action must they then take?
Initially it may be possible for staff to assist an incompetent practitioner to remedy her or his practice.
A simple suggestion for changing a particular system of work may be sufficient to resolve the problem.
However, the incompetence may be more intractable, the colleague less accepting and action in the form of a report to the manager may be necessary. What is clear is that, aware that there is a danger to the safety of patients or colleagues, managers cannot ignore the incompetence – they must take action to ensure that patient safety is promoted.
If a manager becomes aware of incompetence, she or he is under a duty to take action to ensure the practitioner is corrected. The manager must have evidence as to where the failings lie, and then decide on the appropriate action to take. It may be that a retraining session will improve the practitioner’s competence; human resources can be involved if there are failings in communications.
The practitioner in question must be given the opportunity to explain the situation. If all of these strategies fail then disciplinary proceedings may be necessary. It may be that there has to be an acceptance the practitioner is unable to continue in their post and has to be transferred to a different job that they are competent enough to perform. If there is no such alternative, then the practitioner’s employment may have to be terminated.
No manager can ignore a situation where a patient is in danger.
Bridgit Dimond, MA, LLB, DASA, AHSA, is barrister-at-law and emeritus professor, University of Glamorgan, Pontypridd