Conduct and Competence. Substantive Order Review Hearing. 12 June Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE

Transcription

1 Conduct and Competence Substantive Order Review Hearing 12 June 2017 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of Registrant: NMC PIN: Coleen Angella Swaby-Lawes 90B0727E Part(s) of the register: Registered Nurse Sub part 1 Adult Nursing April 1993 Area of Registered Address: Panel Members: Legal Assessor: Panel Secretary: England John Crawley (Chair, Lay member) Sue Dean (Registrant member) Sylvia Dean (Lay member) David Marshall Jonathan Storey Nursing & Midwifery Council: Represented by Henry Vallance, Case Presenter, instructed by the NMC Regulatory Legal Team Registrant: Order being reviewed: Outcome: Present and represented by Nicole O Reilly, instructed by the Royal College of Nursing Conditions of practice order (18 months) Striking-off order to come into effect at the end of 18 June 2017 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001 Page 1 of 10

2 Decision and reasons on review of the current order: The panel decided to impose a striking-off order. This order will come into effect at the end of 18 June 2017 in accordance with Article 30 (1) of the Nursing and Midwifery Order 2001(the Order). This is the fourth review of a suspension order originally imposed by a panel of the Conduct and Competence Committee on 17 May 2013 for 12 months. This order was reviewed on 12 May 2014 and 15 May 2015 and the suspension order was extended by a further 12 and six months respectively. On 8 December 2015, a panel reviewed and replaced the suspension order with an 18 month conditions of practice order. The current conditions of practice order is due to expire at the end of 18 June The panel is reviewing the order pursuant to Article 30(1) of the Order. The charges found proved which resulted in the imposition of the substantive order were as follows: That you, a Registered Nurse employed from approximately 1 September 2009 to 23 December 2011 by the University College London Hospitals NHS Foundation Trust ( the Trust ), on T13 Haematology Ward ( the Ward ), failed to demonstrate the standards of knowledge, skill and judgment required to practise as a Band 5 Staff Nurse in that you: 1. Whilst subject to an informal action plan between 19 July 2010 and 30 August 2010, on 15 August 2010 did not act appropriately in response to Patient A s temperature increase in that you did not; a) Ensure that blood cultures were completed in a timely fashion. b) Ensure that a doctor attended within the hour so that antibiotics could be prescribed for Patient A. Page 2 of 10

3 2. Whilst subject to a second action plan between 1 September 2010 and 6 October 2010, on 28 September 2010 despite not being authorised to administer medication by the intravenous route, you administered intravenously a 100ml saline solution infused with the drug MgSO4 to Patient C 3. Whilst undergoing stage 1 of the formal competence and capability process and subject to performance objectives between 29 November 2010 and 13 February 2011, a) On 3 December 2010 did not administer the prescribed dose of 263mg of b) Lenograstim to Patient D at 18: Between 29 November 2010 and 9 March 2011 failed to demonstrate that you were a) Able to assess and manage the unwell patient without supervision b) Able to safely administer intravenous medications without supervision c) 5. Shortly after the end of stage 2 of the formal competence and capability process a) On 15 September 2011 administered 5000 units of Fragmin to Patient E at 18:00 when you should not have done so because Patient E s platelet count was below 50. b) On 9 November 2011 administered units of Fragmin to Patient F at 18:00, when that dose had already been properly administered at 08:00 on 9 November Between 1 July 2011 and 28 September 2011 failed to demonstrate that you were Page 3 of 10

4 a) Able to assess and manage the unwell patient without supervision b) Able to safely administer intravenous medications without supervision c) AND, in light of the above, your fitness to practise is impaired by reason of your lack of competence. The third reviewing panel determined the following with regard to impairment: The panel has carefully read your bundles of evidence and your reflective statement. It considered that your insight has developed and that you have reflected at length about the charges and the consequences of your failings. The panel has noted your engagement with these proceedings and that you have complied with the previous panel s recommendations. The panel is of the view that your misconduct is remediable, and that you have attempted to take steps to remediate your failures as far as your current circumstances allow. The panel accepts that it is difficult for a nurse who is suspended to fully remedy clinical failings. The panel has also placed weight on the fact that you have not practised as a registered nurse for a considerable amount of time, and therefore it could not be satisfied that you would currently be a safe practitioner without any restrictions imposed. Due to the fact that you have not fully remediated your failings and that you have not practised as a registered nurse for a length of time, the panel concluded that there remains a risk of repetition, and it has determined that your fitness to practise remains impaired. The third reviewing panel determined the following with regard to sanction: Page 4 of 10

5 The panel then considered whether a Conditions of Practice Order would be appropriate and proportionate in this case. It noted the factors set out in the ISG which may indicate that such an order is appropriate. Specifically, it looked at whether conditions would be sufficient to protect patients and the public interest. The panel is mindful that any conditions imposed must be proportionate, measurable and workable. The panel acknowledged that you are willing to comply with conditions. It further noted that your level of insight has considerably progressed since the last review hearing. The panel considered that it was now appropriate to give you an opportunity to comply with conditions. The panel considered a Conditions of Practice Order for a period of 18 months was the appropriate sanction. This would adequately protect the public, and maintain public confidence in the profession and its regulator. It would also allow you sufficient time to complete a return to practice course, obtain employment as a registered nurse and demonstrate your compliance with the conditions. The panel did also consider whether a further suspension order would be appropriate. However, it concluded that, with the right conditions imposed, your competencies are more likely to develop fully whilst practising as a registered nurse in a clinical environment. Furthermore, it acknowledged that a further period of suspension may cause you significant financial hardship. It would also serve no useful purpose to you or to the wider public interest, as it would prevent you from developing your practice in order to demonstrate that you can return to safe practice. The panel determined that a conditions of practice order is sufficient to protect patients from harm and to maintain public confidence in the profession and that to suspend you would be disproportionate. Decision on current fitness to practise This panel has considered carefully whether your fitness to practise remains 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 Page 5 of 10

6 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. The panel has had regard to all of the documentation before it, including your bundle of documents. It has taken account of the submissions made by Mr Vallance, on behalf of the NMC, and those made by Ms O Reilly, on your behalf. Mr Vallance outlined the background to the case and invited the panel to conclude that your fitness to practise remains impaired on the grounds of public protection and is otherwise in the public interest. Ms O Reilly conceded that you accept that your fitness to practise remains impaired, and invited the panel to impose a varied conditions of practice order with immediate effect under Article 30(2) of the Order for a period of 12 months. She submitted that you concede that your fitness to practice remains impaired as you have not had the opportunity to fully comply with the current conditions to which you are subject. Ms O Reilly submitted that you have applied for a number of return to practice courses since the last review hearing. You have also had 17 unsuccessful interviews for a practice placement or work. She invited the panel to impose an additional condition of practice to require you to undertake a return to practice course before commencing work as a registered nurse. Ms O Reilly further submitted that the current condition 1, requiring you to be indirectly supervised by a nurse of band 6 or above, has had the effect of a suspension order, and invited the panel to vary this condition of practice so that you should only be supervised by a nurse of band 5 or above. Ms O Reilly submitted that this variation is proportionate and would protect the public and uphold the public interest in the profession and the NMC as its regulator. The panel heard and accepted the advice of the legal assessor. Page 6 of 10

7 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 considered whether your fitness to practise remains impaired. The panel took careful note of the determination of the original panel, including its view that: These were serious failings, concerning a wide range of basic nursing practice, which placed vulnerable patients at significant risk of harm. The panel concluded that, as a result of your lack of competence, you had in the past placed patients at unwarranted risk of harm, and that you were liable to do so in the future. The panel noted that you have conceded that your fitness to practise remains impaired due to the lack of opportunity you have had to remediate your failings as a registered nurse. In light of this the panel determined that you remain liable to repeat matters of the kind found proved as a result of your lack of competence, placing patients at unwarranted risk of harm. The panel therefore decided that a finding of continuing impairment is necessary on the grounds of public protection. The panel had borne in mind that its primary function was to protect patients and the wider public interest which includes maintaining confidence in the nursing profession and upholding proper standards of conduct and performance. The panel determined that, in this case, a finding of continuing impairment on public interest grounds is still required. For these reasons, the panel has found that your fitness to practise remains impaired. Page 7 of 10

8 Determination on sanction Having found your fitness to practise currently impaired, the panel then considered what, if any, sanction it should impose in this case. The panel has also taken into account the NMC s Indicative Sanctions Guidance (ISG) and has borne in mind that the purpose of a sanction is not to be punitive, though any sanction imposed may have a punitive effect. The panel first considered whether to take no action or impose a caution order but concluded that neither would be appropriate in view of the risk of repetition identified and the seriousness and wide ranging nature of the failings in your practice due to your lack of competence. The panel decided that it would be neither proportionate nor in the public interest to take no further action or to impose a caution order. The panel considered very carefully whether to extend the current conditions of practice order. With regard to the submission that the current condition 1 amounted to imposing suspension, the panel was provided with no evidence that the requirement for a band 6 nurse rather than a band 5 nurse was preventing you from returning to practice. In any case, this panel, like the last panel, was of the view that supervision by a senior grade would be essential. The panel was of the view that your previously established serious lack of competence in wide ranging areas of nursing practice has most likely been the underlying factor in your failure to obtain a placement. In particular, the panel had in mind the original panel s determination with regard to sanction, which stated: The panel carefully considered whether it would be possible to formulate workable and practicable Conditions of Practice which would address the wide ranging and serious concerns in this case. The panel concluded that it would not be possible to do so. As the panel has already determined in its decision on impairment, in the panel s judgment, the support and supervision which you were given on the Ward in an attempt to address and remedy the deficiencies in your practice were of the highest standard. Nonetheless, you continued to make serious mistakes and were unable to demonstrate that you possessed the Page 8 of 10

9 standards of knowledge, skill and judgment required to practise as a Band 5 Staff Nurse. In the panel s judgment, whilst you have indicated that you would be willing to undergo further training, the evidence demonstrates that you lack the potential to respond positively to any further re-training which might be required as a Condition of Practice, and this would, in any event, need to be of a basic and general nature. The panel noted that the third reviewing panel, in imposing an 18 month conditions of practice order, considered that it was now appropriate to give you an opportunity to comply with conditions It would also allow you sufficient time to complete a return to practice course, obtain employment as a registered nurse and demonstrate your compliance with the conditions. Given the lengthy period involved, and the clearly extensive but wholly unsuccessful attempts you have made to return to practice in that period, this panel has concluded that a further opportunity, by way of extension, is not justifiable as serving the public interest. The panel noted that whilst you have continued your engagement with these proceedings, you have not taken the opportunity to provide further evidence of your practice in the healthcare system by way of up to date references and a reflective statement on what you have learned over the last 18 months. In light of the above, the panel considered that any conditions of practice order would not be workable and would serve no useful purpose. The panel next considered imposing a suspension order. The panel noted that it has been over four years since your original hearing, and you have now had 18 months to comply with conditions of practice. The panel considered that you have not managed to demonstrate sufficient progress in remediating your lack of competence. In these circumstances, the panel determined that a period of suspension would not serve any useful purpose where there is no clear route to your returning to safe practice as a registered nurse at the end of such a period of suspension. Page 9 of 10

10 The panel determined that it was necessary to take action to prevent you from practising in the future and concluded that the only sanction that would adequately protect the public and serve the public interest was a striking-off order. The panel therefore directs the registrar to strike your name off the register. In accordance with Article 30 (1) of the Order, this striking-off order will come into effect upon the expiry of the existing conditions of practice order, namely at the end of 18 June This decision will be confirmed to you in writing. That concludes this determination. Page 10 of 10