Nursing and Midwifery Council. Fitness to Practise Committee. Substantive Order Review Meeting. 18 September 2018

Transcription

1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Order Review Meeting 18 September 2018 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of registrant: NMC PIN: Ms Susan Jones 02I0474W Part(s) of the register: Registered Nurse - Sub Part 1 Mental Health - 30 September 2005 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Order being reviewed: Outcome: Wales Misconduct Matthew Fiander (Chair, lay member) Elaine Hurry (Registrant member) June Robertson (Lay member) Mike Bell Conditions of Practice Order 18 months Conditions of Practice Order 6 months to come into effect on the expiry of the current order in accordance with Article 30 (1)

2 Service of notice of meeting The panel was informed at the start of this meeting that notice had been sent to Ms Jones on 20 July 2018 by recorded delivery and first class post to her registered address. The notice informed Ms Jones that her conditions of practice order would be reviewed before its expiry at a meeting on or after 27 August 2018 and gave her the opportunity to request a hearing. The panel noted that no request for a hearing had been made by Ms Jones. Further, the panel noted that notice of this hearing was also sent to Ms Jones representative at the Royal College of Nursing (RCN) on 20 July The panel accepted the advice of the legal assessor. In the light of the information available the panel was satisfied that notice had been served in accordance with Rules 11A and 34 of The Nursing and Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (as amended February 2012) (the Rules). Decision and reasons on review of the current order The panel decided to impose a further conditions of practice order for a period of 6 months. This order will come into effect at the end of 18 October 2018 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 (as amended) (the Order). This is the second review of a suspension order originally imposed by a Conduct and Competence Committee on 17 March 2016 for 12 months. The first reviewing panel varied the order to a conditions of practice order for 18 months with effect at the end of 18 April The current order is due to expire on 18 October The panel is reviewing the order pursuant to Article 30(1) of the Order. The charges found proved by way of admission which resulted in the imposition of the substantive order were as follows:

3 While employed as a Band 5 Nurse by Betsi Cadwaladr University Health Board you: 1. On 22 March 2010 on the Tegid Ward, Ablett Unit at Ysbyty Glan Clwyd, signed that medication had been administered on a patient s drug chart when in fact the medication had not been administered; 2. On 22 March 2010 on the Tegid Ward, Ablett Unit at Ysbyty Glan Clwyd, left medication with an unsupervised patient. 3. [NOT PROVED] 4. On 5 November 2010 on the Tegid Ward, Ablett Unit at Ysbyty Glan Clwyd, upon being asked to confirm that a syringe contained the correct dosage of insulin, allowed 40 units of insulin to be administered as opposed to the prescribed 4 units; 5. On 17 June 2012 on the Tegid Ward, Ablett Unit at Ysbyty Glan Clwyd, failed to sign Patient C s medicine chart after administering her medication; 6. On an unknown date in June 2012 on the Tegid Ward, Ablett Unit at Ysbyty Glan Clwyd, signed Patient C s chart retrospectively; 7. On 11 March 2014 on the Gwanwyn Ward, Older Persons Mental Health Unit, Maelor Hospital, failed to check a patient s prescription chart and administered 3mg of Warfarin to the incorrect patient; AND in light of the above your fitness to practise is impaired by reason of your misconduct. The original panel determined the following with regard to impairment: The panel considered that you had shown some remorse and insight into your misconduct. You made admissions to all except one of the charges against you, which the panel found not proved. You also made

4 admissions in relation to misconduct and impairment. Moreover, the panel noted that your written statement demonstrated, to some extent, a degree of insight and reflection on your failings and their wider impact on the patients and on the reputation of the profession. However, the panel considered that the depth of this insight into your misconduct was not reflected in your oral evidence to the panel. During your oral evidence, you made a number of general statements of good intent and blanket apologies. When asked to articulate on various matters, you were unable to demonstrate the same level of reflection and understanding into your misconduct. For example, it was clear from your evidence that, over the course of the years, there were many periods when your health had an adverse effect on your ability to perform at a competent level. In the panel s judgement, you have a lack of understanding of the impact that your health had on your nursing practice. Despite having had two years to reflect on your failings, you were only able to attribute the effect of your health to your performance but could not demonstrate a full understanding on how you would manage your health issues within the working environment to minimise the risk of repetition. The panel then considered the question of remediation. It was the panel s view that the failings identified in this case were remediable. However, it also considered that, despite being the subject of three supervision periods, after which you were deemed competent, you continued to make errors over a significant period of time. The panel acknowledged that you were, in your oral evidence, able to explain the mechanisms you would implement to ensure there was no repetition. The panel also noted that, to your credit, you accepted a healthcare assistant role following your disciplinary hearing on 5 December 2014, demonstrating your commitment to the healthcare profession and to returning to safe practice. The panel referred to the

5 positive reference provided by your current manager and the statements provided by your other colleagues who described you as a caring nurse. However, you have not been working as a registered nurse for over two years and there is no evidence before this panel that you have been tested in the same or a similar environment. Therefore, the panel cannot be satisfied that you would respond any differently to stressful situations within the work place. Taking all these factors into account, together with the panel s concerns about the depth of your insight and understanding of the underlying causes of your misconduct, it determined that you have not demonstrated the necessary levels of insight and remediation to satisfy it that you are fit to practise without restriction. As such, the panel concluded that there was a real risk of repetition in this case. The panel determined that you are liable, in the future, to act so as to put patients at unwarranted risk of harm, bring the nursing profession into disrepute and to breach one of the fundamental tenets of the nursing profession. Furthermore, the panel determined that the need to uphold proper professional standards and public confidence in the profession and the regulatory process would be undermined if a finding of impairment were not made in the particular circumstances of this case. The original panel determined the following with regard to sanction: The panel next considered the imposition of a conditions of practice order. The panel had careful regard to the ISG. The panel considered that there are identifiable areas of your clinical practice that are in need of assessment and retraining in particular your medicines management and record-keeping. It also noted that you have demonstrated a willingness to undertake training and remedy the failings in your practice. However, the panel also considered that you have already been the

6 subject of three periods of support and supervision by your employer between 2010 and 2014 Despite the comprehensive training and support provided by your employer over a four year period, after which you were deemed competent each time, you continued to make serious drug administration and record-keeping errors. The panel acknowledged that you have shown a degree of insight and reflection into your failings and their wider impact on the patients and on the reputation of the profession. However, the panel has found that the depth of this insight into your misconduct was not reflected in your oral evidence to the panel both at the impairment stage and the sanction stage. Moreover, in your oral evidence at the sanction stage, you indicated a willingness to be referred to the relevant health practitioners to facilitate your safe return to practice. However, again you were unable to articulate or show any understanding of how a referral to the health practitioners that you suggested, would facilitate safe practice. When you were specifically asked by the panel to address the concerns highlighted in its decision on impairment, about your lack of understanding on the impact of your health on your nursing practice, again you were unable to do so. Although you appeared to understand that you should not work whilst you are not fit, you did not appear to consider that there may be mechanisms which could be implemented to enable you to manage your health within the work environment to minimise the risk of repetition. This, again, heightened the panel s concerns regarding your ability to practise safely even with conditions in place. Having already been the subject of three periods of supervision and training, without sustained success, and taking into account your persistent lack of insight into the underlying causes of your misconduct, the panel was not satisfied that it could formulate conditions of practice which were practicable, workable, measurable and proportionate. The

7 panel also determined that no conditions could be formulated which would adequately address the risk you pose at present, in order to protect patients and the public during the period they are in force. Any conditions of practice it may impose would be so stringent that they would be tantamount to a suspension order. The panel also determined that, in this particular case, such an order would not be in the public interest. Having concluded that a conditions of practice order was not appropriate, the panel considered the remaining available sanctions of a suspension order and a striking-off order The panel considered that, even with considerable support and supervision, you continued to make serious errors in fundamental areas of nursing practice. Despite having had 15 months to reflect on your failings, you have not meaningfully addressed the underlying health issues that contributed to your misconduct. Therefore, having regard to all the circumstances of this case, the panel determined that a period of suspension would be a necessary and proportionate sanction. This will provide you with an opportunity and time to reflect on your failings and to address and rectify the issues identified above. The panel was of the view that a period of suspension would sufficiently protect the public until such time as you are in a position to persuade a future panel that you are fit to return to safe practice as a registered nurse. It would also serve the public interest in declaring and upholding standards and in maintaining public trust and confidence in the profession. The panel also considered that this period of suspension would also be in your interests to enable you to address your health issues. When making its decision, the panel considered the more severe sanction of a striking-off order. The panel has reminded itself that the purpose of sanction is not to be punitive. The panel bore in mind that it must strike a fair balance between the interests of the nurse and the

8 public interest. In the particular circumstances of this case, the panel did not consider that a striking-off order was the only sanction sufficient to protect the public interest. It came to the conclusion that such a sanction would be disproportionate at this stage and, to an extent, punitive. It also determined that public confidence in the profession and the NMC, as regulator, did not require your permanent removal from the register today. In terms of the length of suspension, the panel was satisfied that a suspension order for the period of 12 months is necessary and proportionate to reflect the seriousness of the incidents and the panel s serious concerns about your persistent lack of insight into the impact of your health on your ability to practise safely. This period of suspension would also allow you sufficient time to engage with the relevant health professionals; to reflect upon on the panel s findings; and to demonstrate full insight into the impact of your health on your ability to practise safely as a nurse. The first reviewing panel determined the following with regard to impairment: The panel considered whether your fitness to practise remains impaired. The panel noted that you accept that your current fitness to practise is impaired. Regarding insight, the panel noted that the last panel found that you had insufficient insight into your misconduct. At this hearing you have provided the panel with documents and evidence as suggested by the previous panel, save as to training. The panel had particular regard to the positive reference from your manager in your current role and that you have undertaken mandatory training and belong to a monthly journal club where issues pertaining to nursing practice are discussed. The panel also had regard to your long standing health condition which is being managed. A letter from your GP states that you are fit to return to

9 nursing practice and the panel therefore considered that there is now a level of stability. The panel was encouraged that you are able to [PRIVATE], and that you have put in place a support network and coping mechanisms. The panel also had regard to your reflective piece and oral evidence, which the panel considered was honest. In light of all these circumstances the panel was satisfied that your level of insight into your misconduct has developed since the last hearing. However, in its consideration of whether you have remedied your practice the panel took into account that you have been unable to undertake training on the administration of medication in your work place as you are employed as a HCA. The last panel determined that you were liable to repeat matters of the kind found proved. This panel noted that whilst you have developing insight, you have not remediated your misconduct by completing training on the administration of medication. In light of this the panel determined that you remain liable to repeat matters of the kind found proved. The panel therefore decided that a finding of continuing impairment is necessary on the grounds of public protection. The panel bore in mind the overarching objective of the NMC: to protect, promote and maintain the health safety and well-being of the public and patients and the wider public interest which includes promoting and maintaining public confidence in the nursing and midwifery professions and upholding the proper professional standards for members of those professions. The panel was of the view that public confidence in the profession would be undermined should a nurse, in circumstances such as these, be permitted to practise without restriction. The panel determined that, in this case, a finding of continuing impairment on public interest grounds is necessary. The first reviewing panel determined the following with regard to sanction: The panel first considered whether to take no action but concluded that this would be inappropriate in view of the risk of repetition identified and

10 the seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to take no further action. Further, the panel considered that taking no further action would not restrict your nursing practice and therefore would not protect the public. The panel then considered whether to impose a caution order but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to impose a caution order. Further, the panel considered that imposing a caution order would not restrict your nursing practice and therefore would not protect the public. The panel considered substituting the current suspension order with a conditions of practice order. Your misconduct was serious however there has been evidence produced to show that you have developing and ongoing insight and that you wish to return to nursing. Further the panel considered that it would be possible to formulate practicable and workable conditions, that if complied with, may lead to your unrestricted return to practice and would serve to protect the public and the reputation of the profession in the meantime. The panel considered that this order should be for a period of 18 months in order to give you time to obtain a nursing role and complete the requirements of the order. The panel decided that the public would be suitably protected as would the reputation of the profession by the implementation of the following conditions of practice: 1. You must remain employed within a hospital setting. 2. At any time that you are employed or otherwise providing nursing services, you must place yourself and remain under the

11 supervision of a workplace line manager, mentor or supervisor nominated by your employer, such supervision to consist of working at all times on the same shift as, but not necessarily under the direct observation of, a registered nurse of band 6 or above who is physically present in or on the same ward, unit, or floor that you are working in or on. 3. You must work with your line manager, mentor or supervisor (or their nominated deputy) to create a personal development plan designed to address the concerns about your medicines management. This should include a comprehensive medicines management competency assessment framework to include at least six observations of successfully completed drug rounds. 4. You must not carry out unsupervised medication rounds until such time you have completed a medicines management competency framework. Such supervision to be carried out by a registered nurse band 6 or above. 5. You must meet with your line manager, mentor or supervisor (or their nominated deputy) at least every month to discuss the standard of your performance and your progress towards achieving the aims set out in your personal development plan. 6. You must forward to the NMC a copy of your personal development plan within 28 days of the date on which these conditions become effective or the date on which you take up an appointment, whichever is sooner. 7. You must send a report from your line manager, mentor or supervisor (or their nominated deputy) setting out the standard of your performance and your progress towards achieving the aims set out in your personal development plan to the NMC at least 14 days before any NMC review hearing or meeting.

12 8. You must maintain a monthly reflective practice profile, which must set out the administration of medication undertaken by you and any specific learning points. 9. You must provide a copy of this reflective practice to the NMC at least 14 days before any NMC review hearing or meeting. 10. [PRIVATE] 11. You must notify the NMC within 14 days of any nursing appointment (whether paid or unpaid) you accept within the UK or elsewhere, and provide the NMC with contact details of your employer. 12. You must inform the NMC of any professional investigation started against you and/or any professional disciplinary proceedings taken against you within 14 days of you receiving notice of them. 13. You must within 14 days of accepting any post or employment requiring registration with the NMC, or any course of study connected with nursing or midwifery, provide the NMC with the name/contact details of the individual or organisation offering the post, employment or course of study. 14. You must immediately inform the following parties that you are subject to a conditions of practice order under the NMC s fitness to practise procedures, and disclose the conditions listed at (1) to (13) above, to them: a. Any organisation or person employing, contracting with, or using you to undertake nursing work; b. Any prospective employer (at the time of application) where you are applying for any nursing appointment; and

13 c. Any educational establishment at which you are undertaking a course of study connected with nursing or midwifery, or any such establishment to which you apply to take such a course (at the time of application). Decision on current fitness to practise The panel has considered whether Ms Jones fitness to practise is currently impaired. Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to practise as a registrant s suitability to remain on the register without restriction. In considering this case, the panel has carried out a comprehensive review of the order in light of the current circumstances. It has noted the decision of the last panel. However, it has exercised its own judgment as to current impairment. In reaching its decision, the panel was mindful of the need to protect the public, maintain public confidence in the profession and to declare and uphold proper standards of conduct and performance. The panel has had regard to all of the documentation before it, including the hearing bundle, a letter from Ms Jones GP dated 10 August 2018, positive professional references and a reflective piece written by you. It has taken account of the written submissions made by your representative, on your behalf. The panel accepted the advice of the legal assessor. Regarding insight, the panel noted that the first reviewing panel was satisfied that Ms Jones level of insight had developed since the substantive hearing. The panel noted the terms of Ms Jones reflective piece and the positive references supplied by her. It noted the terms of the letter from Ms Jones GP that states there was no reason to think that [Ms Jones] would not be medically fit to work in a nursing position. The panel was satisfied that Ms Jones was able to [PRIVATE], and that she has put in place a support network and coping mechanisms and that her long standing health condition is being managed. The panel also has regard to her reflective piece. In light of all these

14 circumstances the panel was satisfied that Ms Jones level of insight into her misconduct has continued to develop since the last hearing. In its consideration of whether Ms Jones has remediated her practice the panel took into account that she provided it with further documents and references relating to maintenance of her nursing skills and training. The panel noted the terms of the reference from Ms Jones former line manger that stated she has maintained her nursing skills and although not strictly involved in the administration of medication she has kept herself up to date with changes in medication. However the panel also noted that Ms Jones has only recently obtained employment as a registered nurse and up to this point was working as a health care assistant. As such she has been unable to undertake appropriate training on the administration of medication in the workplace. This panel noted that whilst Ms Jones has shown continuing developing insight, she has not remediated her misconduct by completing training on the administration of medication. In light of this the panel determined that she remains liable to repeat matters of the kind found proved. The panel therefore decided that a finding of continuing impairment is necessary on the grounds of public protection. The panel bore in mind the overarching objective of the NMC: to protect, promote and maintain the health safety and well-being of the public and patients and the wider public interest which includes promoting and maintaining public confidence in the nursing and midwifery professions and upholding the proper professional standards for members of those professions. The panel was of the view that public confidence in the profession would be undermined should a nurse, in circumstances such as these, be permitted to practise without restriction. The panel determined that, in this case, a finding of continuing impairment on public interest grounds is necessary. For these reasons, the panel finds that Ms Jones fitness to practise remains impaired. Determination on sanction Having determined that Ms Jones fitness to practise is currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel noted

15 that its powers are set out in Article 29 of the Order. The panel has also taken into account the NMC s Sanctions Guidance. The panel first considered whether to take no action but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to take no further action. The panel then considered whether to impose a caution order, but concluded that this would be inappropriate in view of the risk of repetition identified and seriousness of the case. The panel decided that it would be neither proportionate nor in the public interest to impose a caution order. The panel next considered the imposition of a further conditions of practice order. The panel was satisfied that the imposition of a further conditions of practice order is sufficient to protect patients and the wider public interest. The panel was satisfied that whilst Ms Jones misconduct was serious there has been evidence produced to show that she has developing and ongoing insight and that she wishes to return to nursing. Further the panel considered that it would be possible to formulate practicable and workable conditions that, if complied with, may lead to her unrestricted return to practice and would serve to protect the public and the reputation of the profession in the meantime. The panel went on to consider imposing a suspension order, but considered that this would be disproportionate in all the circumstances. The panel considered that this order should be for a period of 6 months in order to give Ms Jones time to complete the requirements of the order. The panel decided that the public would be suitably protected as would the reputation of the profession by the implementation of the following conditions of practice: 1. You must remain employed within a hospital setting.

16 2. At any time that you are employed or otherwise providing nursing services, you must place yourself and remain under the supervision of a workplace line manager, mentor or supervisor nominated by your employer, such supervision to consist of working at all times on the same shift as, but not necessarily under the direct observation of, a registered nurse of band 6 or above who is physically present in or on the same ward, unit, or floor that you are working in or on. 3. You must work with your line manager, mentor or supervisor (or their nominated deputy) to create a personal development plan designed to address the concerns about your medicines management. This should include a comprehensive medicines management competency assessment framework to include at least six observations of successfully completed drug rounds. 4. You must not carry out unsupervised medication rounds until such time you have completed a medicines management competency framework. Such supervision to be carried out by a registered nurse band 6 or above. 5. You must meet with your line manager, mentor or supervisor (or their nominated deputy) at least every month to discuss the standard of your performance and your progress towards achieving the aims set out in your personal development plan. 6. You must forward to the NMC a copy of your personal development plan within 28 days of the date on which these conditions become effective or the date on which you take up an appointment, whichever is sooner. 7. You must send a report from your line manager, mentor or supervisor (or their nominated deputy) setting out the standard of your performance and your progress towards achieving the aims set out in your personal development plan to the NMC at least 14 days before any NMC review hearing or meeting. 8. You must maintain a monthly reflective practice profile, which must set out the administration of medication undertaken by you and any specific learning points. 9. You must provide a copy of this reflective practice to the NMC at least 14 days before any NMC review hearing or meeting.

17 10. [PRIVATE] 11. You must notify the NMC within 14 days of any nursing appointment (whether paid or unpaid) you accept within the UK or elsewhere, and provide the NMC with contact details of your employer. 12. You must inform the NMC of any professional investigation started against you and/or any professional disciplinary proceedings taken against you within 14 days of you receiving notice of them. 13. You must within 14 days of accepting any post or employment requiring registration with the NMC, or any course of study connected with nursing or midwifery, provide the NMC with the name/contact details of the individual or organisation offering the post, employment or course of study. 14. You must immediately inform the following parties that you are subject to a conditions of practice order under the NMC s fitness to practise procedures, and disclose the conditions listed at (1) to (13) above, to them: a. Any organisation or person employing, contracting with, or using you to undertake nursing work; b. Any prospective employer (at the time of application) where you are applying for any nursing appointment; and c. Any educational establishment at which you are undertaking a course of study connected with nursing or midwifery, or any such establishment to which you apply to take such a course (at the time of application). This decision will be confirmed to Ms Jones in writing. That concludes this determination.