Nursing and Midwifery Council: Fitness to Practise Committee

Transcription

1 Nursing and Midwifery Council Fitness to Practise Committee Substantive Hearing 2-4 October 2017 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ Name of registrant: NMC PIN: Ms Elizabeth Olufumke Adeyemi 08D0981E Parts of the register: Registered Nurse Sub part 1 RNMH Mental Health (Level 1) 22 May 2009 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Ms Adeyemi: Nursing and Midwifery Council: England Misconduct Tim Mann (Chair, lay member) Marian Robertson (Registrant member) John Vellacott (Lay member) Ian Ashford-Thom Siobhán Hamill Present and represented by Mr Adewuyi Oyegoke Represented by Ms Grace Forbes, counsel, instructed by NMC Regulatory Legal Team. Facts proved: 6 Facts proved by admission: 1, 2, 3a, 3b, 4, 5, 7, 8 Fitness to practise: Sanction: Interim Order: Impaired Caution Order (3 years) N/A Page 1 of 20

2 Details of charge: That you, a registered nurse: 1. Obtained employment as a Bank Nursing Assistant at East London Foundation Trust on an unknown date in 1996, having relied upon as part of your application, a forged Home Office letter dated 12 June 1996 stating you had indefinite leave to remain in the United Kingdom [Admitted] 2. Obtained employment as a permanent Nursing Assistant at East London Foundation Trust in or around 15 January 2001, having relied upon as part of your application, a forged Home Office letter dated 12 June 1996 stating you had indefinite leave to remain in the United Kingdom [Admitted] 3. Your conduct in respect of charge 1 and/or 2 above was dishonest in that: a) You knew the Home Office letter dated 12 June 1996 was false; [Admitted] b) You used it to deliberately misrepresent to the Trust that you had the right to work in the UK when you knew you did not [Admitted] 4. On or around 25 October 2000, submitted a job application form to East London NHS Foundation Trust for the role of Nursing Assistant with an incorrect date of birth of 2 November 1955 [Admitted] 5. On or around 3 September 2001, submitted a job application form to East London NHS Foundation Trust for the role of Acute Nursing Grade B with an incorrect date of birth of 2 November 1955 [Admitted] 6. Your conduct in respect of charge 4 and/or 5 above was dishonest in that you knew the date of birth was false but sought to represent it as accurate. [Found Proved] Page 2 of 20

3 7. Did not subsequently notify the Trust after you gained employment, that the date of birth of 2 November 1955 you had provided was incorrect. [Admitted] 8. Provided different dates of birth to the Trust and to the NMC [Admitted] AND in light of the above, your fitness to practise is impaired by reason of your misconduct. Page 3 of 20

4 Admissions At the outset of the hearing, Mr Oyegoke informed the panel that you had admitted the facts in charges 1, 2, 3a, 3b, 4, 5, 7 and 8 in their entirety. Further, Mr Oyegoke informed the panel that a finding of current impairment in relation to your fitness to practise is for the panel s professional judgement. The panel found the facts in charges 1, 2, 3a, 3b, 4, 5, 7 and 8 all proved by virtue of your own admissions. Background The Nursing Midwifery Council ( NMC ) received a referral on 29 May 2015 from East London Foundation Trust ( the Trust ). The referral was regarding allegations of obtaining employment by deception. The Trust allege that you knowingly provided an indefinite leave to remain letter with a false Home Office stamp to gain initial entry onto the Trust s temporary Bank Staff as a healthcare assistant ( HCA ) in 1996 and again in in 2001 to obtain a permanent HCA position. The Trust also alleges that you provided two different birth dates to the Trust. Following an investigation by National Fraud Initiative the Trust commenced disciplinary proceedings and summarily dismissed you for gross misconduct on 24 December You unsuccessfully appealed the decision and brought the matter to the Employment Tribunal for unfair dismissal. You lost the case against the Trust and the decision of the dismissal was maintained and it was concluded that it was fair in the circumstances. You were employed by the Trust for 18 years prior to dismissal. Following a number of promotions you undertook a nursing qualification and obtained a post as a Registered Mental Nurse in May You worked at Newham Centre, which is an 18 bedded acute mental ward, providing assistance to patients requiring a high level of support and intervention. There are no reported clinical concerns raised regarding your practice. The matters alleged arose following a spot check routine investigation by the National Fraud Initiative (NFI) in You were subsequently identified as having supplied a falsified home office letter granting you indefinite leave to remain to obtain employment Page 4 of 20

5 with the Trust in 1996 and Following their investigation it was confirmed by the Home Office that you were granted indefinite leave to remain on 17 December You worked at HCL Solutions Agency ( HCL ) undertaking roles as a Band 5 RGN Mental Health Nurse from 27 April 2014 and are working currently as an agency nurse at Day Webster Group since May Determination on Application under Rule 24 (7) of no case to answer by insufficient evidence The panel considered an application from Mr Oyegoke, on your behalf, that there is no case to answer in respect of charge 6: 6. Your conduct in respect of charge 4 and/or 5 above was dishonest in that you knew the date of birth was false but sought to represent it as accurate. This application was made under Rule 24 (7) of the Rules. This rule states: 24 (7) Except where all the facts have been admitted and found proved under paragraph (5), at the close of the Council s case, and (i) upon the application of the registrant the Committee may hear submissions from the parties as to whether sufficient evidence has been presented to find the facts proved and shall make a determination as to whether the registrant has a case to answer. In relation to this application Mr Oyegoke submitted that the NMC has failed to discharge its burden of proof with regard to charge 6 by not adducing sufficient evidence. He drew the panel s attention to the case of R v Galbraith [1981] 1 WLR Mr Oyegoke stated that the evidence adduced is inherently weak, he submitted that the only evidence adduced before the panel are the two job application forms that demonstrate that you had supplied the incorrect date of birth and the witness statement Page 5 of 20

6 of Ms 1, which details that you made the Home Office aware in October 2002 that the date of birth detailed was incorrect and then provided the correct information. Mr Oyegoke submitted that there is no evidence before the panel to demonstrate that you were intentionally dishonest in providing the incorrect date of birth. On behalf of the NMC, Ms Forbes submitted that sufficient evidence has been produced on which the panel could find charge 6 proved. She submitted that you had maintained throughout the investigation at the Trust that you were not aware of the incorrect date of birth until 2002; however you had made admissions at the outset of this hearing in relation to charge 3 which severely undermined your credibility in relation to your honesty. She accepted that there is no evidence before the panel as to why the incorrect date of birth was used by you; however, taking into account your admission to charge 3 there is some evidence in relation to dishonesty. The panel took account of the submissions made, and heard and accepted the advice of the legal assessor. The panel dealt with the charge under the provisions of Rule 24 (7). The panel referred to the case of R v Galbraith Lord Lane, Chief Justice, laid down the following test: (1) If there is no evidence that the crime alleged has been committed by the defendant, there is no difficulty. The judge will of course stop the case. (2) The difficulty arises where there is some evidence but it is of a tenuous character, for example because of inherent weakness or vagueness or because it is inconsistent with other evidence. (a) Where the judge comes to the conclusion that the prosecution evidence, taken at its highest, is such that a jury properly directed could not properly convict upon it, it is his duty, upon a submission being made, to stop the case. (b) Where however the prosecution evidence is such that its strength or weakness depends on the view to be taken of a witnesses reliability or other matters which are generally speaking within the province of the Page 6 of 20

7 jury and where on one possible view of the facts there is evidence upon which a jury could properly come to the conclusion that the defendant is guilty, then the judge should allow the matter to be tried by the jury.there will of course as always in this branch of the law be borderline cases. They can safely be left to the discretion of the judge. The panel s task at this stage is to consider, in relation to the disputed facts and on the assumption that it will hear no more evidence regarding those facts, whether sufficient evidence has been adduced upon which it could find those facts proved. In making its decisions the panel adopted the following approach: Where there was no evidence upon which an allegation might be proved, it would allow the application. Where there was some evidence but where that evidence was so unsatisfactory or unsound, or was so weak, tenuous or insufficient that the panel, relying on that evidence alone, could not conclude that the allegation was proved, it would also allow the application. Where the evidence was such that its strength or weakness depended on the view to be taken of a witness reliability and where, on one possible view of the facts, there is evidence on which the panel could properly come to the conclusion that the allegation is proved, then it would not allow the application. In reaching its decision, the panel has made an initial assessment of all the evidence that has been presented to it at this stage. The panel was solely considering whether sufficient evidence has been presented, such that it could find the facts proved and whether you had a case to answer. The panel noted that the admissions you made at the outset of the hearing in relation to charge 3 were that you knew you were dishonest in that you knew the Home Office letter dated 12 June 1996 was false and that you further admitted that you used the letter to deliberately misrepresent to the Trust that you had the right to work in the UK when you knew you did not. The panel did accept that there was no evidence to suggest why you used the incorrect date of birth, although the forged Home Office letter dated 12 June 1996 does record the incorrect date of birth and the panel noted your obligation to the Trust to notify them of changes to your personal details. Page 7 of 20

8 The panel also bore in mind the application for employment to East London and the City Mental Health NHS Trust in which you detailed your previous employment and educational history, it was of the view that you must have been aware at this stage that the dates were incorrect. The panel concluded that there could be sufficient evidence to support the charge at this stage and that it should get the opportunity to test the evidence before it. The panel therefore rejected the application of no case to answer. What weight the panel gives to any evidence remains to be determined at the conclusion of all the evidence. In reaching its decisions on the facts, the panel considered all the evidence adduced in this case together with the submissions made by Ms Forbes, on behalf of the NMC and those made by Mr Oyegoke on your behalf. The panel heard and accepted the advice of the legal assessor. The panel was aware that the burden of proof rests on the NMC, and that the standard of proof is the civil standard, namely the balance of probabilities. This means that the facts will be proved if the panel was satisfied that it was more likely than not that the incidents occurred as alleged. At the start of this hearing you admitted the following charges; 1, 2, 3, 4, 5, 7 and 8. These were therefore announced as proved. The panel then went on to consider the remaining charge. The panel considered the charge and made the following findings: Charge 6: 6. Your conduct in respect of charge 4 and/or 5 above was dishonest in that you knew the date of birth was false but sought to represent it as accurate. This charge is found proved. Page 8 of 20

9 In reaching this decision, the panel took into account the documentary evidence before it and submissions made by Mr Oyegoke, on your behalf. In the documentary evidence provided to the panel, you maintained that you were not aware that you had provided the incorrect date of birth until 2002 when you were informed by a family member of your correct date of birth. In the disciplinary investigation report undertaken by East London NHS Foundation Trust in relation to whether you provided different dates of birth to the Trust and the NMC, it was detailed: EA denied giving the Trust two different dates of birth stating she found out the discrepancy in 2002 from a family member and hence had it changed on her passport. Mr Oyegoke detailed to the panel the circumstances in which you were born. He explained that you were born in a small town in Nigeria and at that time it was extremely common that individuals did not know their exact date of birth due to the absence of a register that records births in the town. He explained that it is common that family member s associate individual s birth dates with an event and that is why it is not always accurate. He further explained that it was in 2002 your uncle brought it to your attention that you were not born in 1955 and that it was more likely to be in Mr Oyegoke relayed that when you became aware of this you notified the relevant organisations to make the changes, such as the Nigerian Embassy in the UK to alter this information on your passport. He further explained that there was no reason for you to misrepresent your date of birth and that by providing a different date of birth did not afford you greater opportunity in employment and did not provide you any personal gain. He referred the panel to the application of your postgraduate mental health nursing degree dated 2009, in which you then provided the correct date of birth, namely 5 November The panel took into account the positive references provided by you. The panel also had regard to your admissions to the dishonesty charges 3a and 3b. Page 9 of 20

10 The panel took into account the issues with records and documentation in relation to births in the town you were born, and this understandably could cause issues. However, the panel were of the view that on the basis of the admissions made by you in charges 4 and 5 that you accepted you provided the incorrect date of birth on two application forms to gain employment, you must have been aware of your age when you were compiling the details of your employment and educational history for these posts. An eight year age difference is too great to be explained by the lack of local records of your birth. The panel had not been provided with any passports prior to On the balance of probabilities, the panel were of the view that it is more likely than not that you were aware you were misrepresenting your age and date of birth in order to support the forged letter to the Home Office which records your date of birth as the 2 November 1955, which stated that you had the right to work in the UK at that time. The panel next addressed the issue of dishonesty. The panel considered the case of Ghosh as advised by the legal assessor when making its decision and applied the twostage test. The panel determined that objectively, a reasonable, honest person would see your actions as dishonest and such a person would not expect a nurse to intentionally mislead or misrepresent information in order to be granted indefinite leave to remain in the UK. In terms of the subjective test, the panel determined that you knew by those standards that you were acting dishonestly in that you supplied a date of birth in support of the forged Home Office letter. The panel found this charge proved on the balance of probabilities. Evidence: You gave evidence on oath. You told the panel that you admitted the charges against you because you wanted to be open and honest. You provided the panel with the details of personal circumstances that were occurring in your life at the time when the dishonesty occurred. [PRIVATE] Page 10 of 20

11 You explained the circumstances in which you acquired the forged Home Office letter and you accepted that you knew this was counterfeit and acknowledged that you knew this was breaking the law. You further described to the panel how it came to light that you were in fact using the incorrect date of birth, you said that you were talking to your uncle about a family bereavement and you were discussing dates. You told him that you thought you were born on the 2 November 1955, when he told you that this was incorrect. You explained that once your uncle had sent you the relevant documentation, you provided this information to the Nigerian Embassy for your passport details to be amended to reflect your correct date of birth. However, you did say that you did not complete an employment disclosure form in order to update your personal details within the Trust. When you were asked about how you would act differently if you were faced with a similar situation, you said that you would be more honest and open and nothing would put you in that situation again. You further detailed that you would never do something like this again no matter the difficulty and especially when it comes to your profession. You said that you felt so bad looking back at your actions and that you think you had used the forged document to seek employment, you were living in poverty and you needed to look after your son. You explained that it was only for a better life. You went on to explain that you would be open and honest in the future as this has caused you great distress and embarrassment. You explained that you feel so small and that this behaviour was not like you. You expressed that you felt that this experience has made you learn a lot. You were further asked if you would have raised your dishonesty if it was not found out, you said you would and that there becomes a period in your life that you reflect and you believe you would have raised this. You expressed to the panel that you are really, really sorry for what you had done, you said that you were sorry to the NMC, to the panel and your colleagues. Page 11 of 20

12 You explained that you had undertaken a course on Duty of Candour, which you paid for yourself. You said that you had learnt that as a professional you need to be open and honest as the public look up to nurses who are held in high esteem. You expressed that to become a nurse was always your dream. [PRIVATE] You said that if the panel grant you the opportunity to return back to your nursing duties, you plan to continue working as a mental health nurse, be an honest and good nurse to your clients, listening and supporting them. You told the panel that you love your job and you felt that the patients appreciate when you are on shift. You told the panel that you are currently working at Day Webster agency and you are placed within various hospitals depending on the need. You explained that you do on average three or four shifts per week and these can be in excess of ten hours a shift. Submission on misconduct and impairment: Having announced its finding on all the facts, the panel then moved on to consider, whether the facts found proved amount to misconduct and, if so, whether your fitness to practise is currently impaired. There is no statutory definition of fitness to practise. However, the NMC has defined fitness to practise as a registrant s suitability to remain on the register unrestricted. Ms Forbes referred the panel to the case of Roylance v GMC (No. 2) [2000] 1 AC 311 which defines misconduct as a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. She then moved on to the issue of impairment, and addressed the panel on the need to have regard to protecting the public and the wider public interest. This included the need to declare and maintain proper standards and maintain public confidence in the profession and in the NMC as a regulatory body. Ms Forbes referred the panel to the cases of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) and Nandi v GMC [2004] EWHC 2317 (Admin). Page 12 of 20

13 She accepted that your acts of dishonesty did not cause any patient harm and these related to acts largely outside of your nursing career and you had enjoyed an otherwise unblemished career. She stated that although you had made admissions to the majority of the charges against you, albeit at a late stage, these were contradicted by contemporaneous statements relating to these charges provided to the panel. She submitted that this is a case of serious dishonesty sustained over a long period of time, namely the forging of an official immigration letter which you relied upon to obtain employment and you used this on a number of occasions. You further provided the incorrect date of birth in order to misrepresent your age. She concluded that you had been dishonest and your actions fell short of what was expected of a registered nurse and therefore a finding of impairment should be found on the grounds of public interest. Mr Oyegoke submitted that you had made admissions to a majority of the charges against you. You had shown significant insight into your dishonesty which can be seen in both your written and oral evidence. He stated that you had shown significant understanding of the implications of your dishonesty, how you would handle a similar situation and had expressed genuine remorse. He submitted that this demonstrated that there the risk of repetition in this case is very remote especially taking into account the unique circumstances you were in at that period of your life. He invited the panel to take regard to the positive references that had been adduced before the panel from colleagues, in which they speak highly of your conduct and professionalism. He told the panel that there is no other information before the panel to suggest you are not of good character. He also referred the panel to the course you completed on Duty of Candour. Mr Oyegoke explained that this is a case in which there are no public protection concerns in relation to your practise. You have enjoyed an unblemished career since these acts of dishonesty, some 15 years, and there are no concerns about your clinical competence. He asked the panel to consider the circumstances which led you to being dishonest and that this was an isolated incident. The panel has accepted the advice of the legal assessor which included reference to a number of judgments which are relevant, these included: Roylance v General Medical Page 13 of 20

14 Council (No 2) [2000] 1 A.C. 311, Nandi v GMC [2004] EWHC 2317 (Admin), and GMC v Meadow [2007] QB 462 (Admin). The panel adopted a two-stage process in its consideration, as advised. First, the panel must determine whether the facts found proved amount to misconduct. Secondly, only if the facts found proved amount to misconduct, the panel must decide whether, in all the circumstances, your fitness to practise is currently impaired as a result of that misconduct. Decision on misconduct When determining whether the facts found proved amount to misconduct the panel had regard to the terms of The code: Standards of conduct, performance and ethics for nurses and midwives The panel, in reaching its decision, had regard to the public interest and accepted that there was no burden or standard of proof at this stage and exercised its own professional judgement. The panel was of the view that your actions did fall significantly short of the standards expected of a registered nurse, and that your actions amounted to a breach of the Code. Specifically: The people in your care must be able to trust you with their health and wellbeing To justify that trust, you must: be open and honest, act with integrity and uphold the reputation of your profession. 61 You must uphold the reputation of your profession at all times. The panel appreciated that breaches of the Code do not automatically result in a finding of misconduct. In this case, your misconduct amounted to knowingly providing a forged official Home Office letter in order to obtain an employment post and knowingly providing the incorrect birth date on two nursing assistant job application forms. You provided this false information on a number of occasions and spanned over an extended period of time. You only made admissions to these charges at the substantive Page 14 of 20

15 hearing. The panel found that your actions did fall seriously short of the conduct and standards expected of a nurse and amounted to misconduct and breached one of the fundamental tenets of the nursing profession. Decision on impairment The panel next went on to decide if as a result of this misconduct your fitness to practise is currently impaired. Nurses occupy a position of privilege and trust in society and are expected at all times to be professional and to maintain professional boundaries. Patients and their families must be able to trust nurses with their lives and the lives of their loved ones. To justify that trust, nurses must be honest and open and act with integrity. They must make sure that their conduct at all times justifies both their patients and the public s trust in the profession. In this regard the panel considered the judgement of Mrs Justice Cox in the case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) in reaching its decision, in paragraph 74 she said: In determining whether a practitioner s fitness to practise is impaired by reason of misconduct, the relevant panel should generally consider not only whether the practitioner continues to present a risk to members of the public in his or her current role, but also whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment were not made in the particular circumstances. Mrs Justice Cox went on to say in Paragraph 76: I would also add the following observations in this case having heard submissions, principally from Ms McDonald, as to the helpful and comprehensive approach to determining this issue formulated by Dame Janet Smith in her Fifth Report from Shipman, referred to above. At paragraph she identified the following as an appropriate test for panels considering impairment of a doctor s fitness to practise, but in my Page 15 of 20

16 view the test would be equally applicable to other practitioners governed by different regulatory schemes. Do our findings of fact in respect of the doctor s misconduct, deficient professional performance, adverse health, conviction, caution or determination show that his/her fitness to practise is impaired in the sense that s/he: a. b. has in the past brought and/or is liable in the future to bring the medical profession into disrepute; and/or c. has in the past breached and/or is liable in the future to breach one of the fundamental tenets of the medical profession; and/or d. has in the past acted dishonestly and/or is liable to act dishonestly in the future. The panel concluded that your actions had engaged limbs b, c and d in relation to the above case of Grant. The panel determined your dishonest actions have breached a fundamental tenet of the profession and had brought the profession into disrepute. The panel found you to be open, honest, genuine and sincere in your evidence that you provided on oath and had tried your best to assist the panel in remembering details from over 15 years ago. It noted that you were very remorseful and the events of that period of your life had impacted on you greatly. The panel accepted that you had experienced difficult circumstances in your life around the time the dishonesty occurred and also that the dishonesty in question was not related to your nursing career. The panel accepted that being a nurse is important to you. The panel took account of the reflective statement you provided, a number of positive references and the certificate from the completed course on Duty of Candour. It accepted that you had made admissions into your dishonesty. Page 16 of 20

17 The panel was satisfied that you had shown insight into your misconduct and had demonstrated understanding of the implications of your misconduct on your employer, your colleagues, the NMC and your patients. You apologised to this panel for your misconduct and demonstrated genuine remorse. When questioned during the course of this hearing about how you would handle the situation differently in the future, you were able to provide sufficiently detailed answers in that you would be more open and honest and that you would not put yourself in a similar situation no matter how difficult the circumstances were. The panel found there to be a low risk of repetition in this case and therefore the panel concluded you were not impaired on public protection grounds. The panel bore in mind that the overarching objectives of the NMC are to protect, promote and maintain the health safety and well-being of the public and patients, and to uphold/protect 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 determined that, in this case, a finding of impairment on public interest grounds was necessary. The panel concluded that you were deliberately dishonest; you acquired a forged Home Office letter in order to support your right to remain in the UK and mislead your employer that you had the right to work in the UK. You used this document on a number of occasions to apply for nursing assistant posts prior to undertaking nursing training in You further misrepresented your date of birth on two job applications, which you knew to be false. You continued to be dishonest for an extended period of time and this was a breach of a fundamental tenet of the nursing profession. The panel were of the view that if a finding of impairment was not found, public confidence in the profession and in the NMC as a regulatory body could be put in to disrepute. Having regard to all of the above, the panel was satisfied that your fitness to practise is currently impaired. Page 17 of 20

18 Determination on sanction: The panel has considered very carefully the question of what sanction, if any, should be imposed in this case and has decided to make a caution order for a period of 3 years. The panel took into account the submissions from Ms Forbes, on behalf of the NMC, and those made by Mr Oyegoke, on your behalf. It also had regard to all the information that has been placed before it during the course of the hearing. The panel has accepted the advice of the legal assessor who referred the panel to Atkinson v General Medical Council EWHC 3636 (Admin) and Watters v NMC [2017] EWHC 1888 (Admin). The panel has borne in mind that any sanction imposed must be appropriate and proportionate. The purpose of any sanction is not intended to be punitive even though it might have a punitive effect. The panel had careful regard to the Sanctions Guidance (SG) published by the NMC in July The panel identified the mitigating and aggravating factors of the case. It has recognised that the decision on sanction is a matter for the panel exercising its own independent judgement. The panel considered the following aggravating and mitigating factors: Aggravating: Your dishonesty in acquiring a forged immigration letter amounted to breaking the law; There was a degree of sophistication in your dishonesty; There was reliance on the forged documentation to secure employment; You were dishonest to your employer over a long period of time; You sought to use dishonesty in order to obtain employment posts in 1996 and Mitigating: The dishonesty in question was prior to your registration with the NMC as a registered nurse; You were experiencing immensely difficult personal circumstances at the time; There is a significant amount of time passed since the dishonesty occurred; Page 18 of 20

19 You made admissions at the outset of the hearing and engaged fully with the NMC s proceedings; No further regulatory matters have been raised against you; The dishonesty was not in relation in your clinical practise and your high level clinical ability is attested in positive references provided to the panel; You have demonstrated significant insight, understanding into the implications and genuine remorse into your act of dishonesty. The panel first considered taking no further action but concluded that, given the nature of the misconduct and the dishonesty identified in this case, this would be inappropriate. The panel determined that to take no further action would not serve to declare and uphold proper professional standards and maintain public confidence in the profession. To take no further action would therefore not satisfy the public interest in this case. Next, in considering whether a caution order would be appropriate in the circumstances of this case, the panel took into account the Sanctions Guidance, which states that a caution order may be appropriate where the case is at the lower end of the spectrum of impaired fitness to practise and the panel wishes to mark that the behaviour was unacceptable and must not happen again. Although the panel has found that the charges were serious and acknowledged all acts of dishonesty are serious, it has come to the conclusion that the case, as a whole, falls at the lower end of the spectrum. The panel carefully assessed the nature of your dishonest conduct; it considered it to be under unique circumstances in that you were experiencing stressful personal circumstances in your life at that time. It determined that your behaviour was opportunistic and there were no risk to patients as a result of your dishonesty. The panel noted that you had shown significant insight into your conduct and have since trained as a nurse and subsequently been employed as a registered mental health nurse since the incident of dishonesty, with no adverse findings in relation to your clinical practice and professionalism. It took regard to the amount of time elapsed since this dishonest act. It also noted that you had fully engaged with the NMC s proceedings and even provided evidence on oath at the hearing. You made admissions at the outset of the hearing and apologised to this panel during your evidence, showing evidence of genuine remorse. The panel took into account the number of positive testimonials you Page 19 of 20

20 provided which attest to your clinical competence, professionalism and good character. It also had regard to a certificate demonstrating the completion of a course in Duty of Candour. The panel next considered whether it would be proportionate to impose a more restrictive sanction and had regard to a conditions of practice order. The panel noted that there have been no clinical issues with your practice and concluded that there were no conditions that would appropriately address your misconduct. The panel therefore concluded that no useful purpose would be served by a conditions of practice order. The panel further considered that a suspension order would be disproportionate in this case. Removing your entry from the register, even for a limited period of time, was not necessary in order to adequately satisfy the public interest. The panel also took regard to your current financial obligations and noted the impact a suspension order would have on you. The panel were of the view that it is in the public interest not to suspend you as this would deprive the profession of a dedicated and highly regarded nurse. Having considered the general principles above and looking at the totality of the findings based on the evidence, the panel has determined that to impose a caution order for a period of 3 years would be the appropriate and proportionate response. For the next 3 years your employer or any prospective employer will be on notice that your fitness to practise has been found to be impaired. The caution order would mark not only the importance of maintaining public confidence in the profession, but also send the public and the profession a clear message about the standards required of a registered nurse. The panel determined that a period of caution greater than 3 years would be disproportionate. At the end of this period the note on your entry in the register will be removed. However, the NMC will keep a record of the panel s finding that your fitness to practise had been found impaired. If the NMC receives a further allegation that your fitness to practice is impaired, the record of this panel s finding and decision will be made available to any practice committee that considers the further allegation. That concludes this determination. Page 20 of 20