Conduct and Competence Committee Substantive Hearing 01 September 2016 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE

Transcription

1 Conduct and Competence Committee Substantive Hearing 01 September 2016 Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE Name of Registrant Nurse: Sylvia Adeola Adebayo NMC PIN: 08Y0035E Part(s) of the register: RNLD, Registered Nurse (sub part 1) Learning Disabilities- January 2009 Area of Registered Address: England Type of Case: Misconduct Panel Members: Jane Everitt (Chair Lay member) Jennie Stanley (Registrant member) David Bleiman (Lay member) Legal Assessor: Simon Walsh Panel Secretary: Marina Jones Representation: Miss Adebayo not present but represented by Jacob A Fabowale Makinde via telephone. Nursing and Midwifery Council: Represented by Daniel Brown, counsel, instructed by NMC Regulatory Legal Team. Facts proved: Facts proved by admission: Facts not proved: All All None Fitness to practise: Sanction: Impaired Two year caution order Page 1 of 19

2 Consensual panel determination: The panel has considered the provisional agreement reached by Miss Adebayo and the NMC. It has also had regard to the document detailing the training undertaken by Miss Adebayo since September It has had particular regard to the NMC s guidance Consensual Panel Determination (CPD) effective 9 March The panel had regard to the submissions of Mr Brown on behalf of the NMC. He took the panel through the background of the case and that of the CPD agreement that had been signed by Miss Adebayo. Mr Makinde told the panel that he agreed with the submissions of Mr Brown. It accepted the advice of the legal assessor The provisional agreement reads as follows: The Nursing and Midwifery Council and Miss Sylvia Adebayo, PIN 08Y0035E ( the parties ) agree as follows: The Charges Miss Adebayo admits the following charges: That you, a registered nurse, whilst employed by the Chiswick Nursing Centre as a registered nurse during the night shift of 28/29 April 2015: 1. Did not complete the night care allocation sheet in respect of Resident A. 2. Did not ensure that Resident A was adequately monitored and/or observed. 3. Upon discovering that Resident A was missing, failed to follow the Missing Resident Policy in that you did not: 3.1 inform the duty manager 3.2 notify the police Page 2 of 19

3 3.3 notify Resident A s family AND in light of the above, your fitness to practise is impaired by reason of your misconduct. Background 1. Miss Adebayo (the Registrant) qualified as a registered nurse in January From 19th October 2011 to 25th June 2015 the Registrant was employed as a registered general nurse at the Chiswick Nursing Centre, which is a specialist Nursing Centre complex accommodating those with nursing needs as well as those with Alzheimer s disease and other dementia-type illnesses. 2. The Registrant also worked at Coombe Hill Nursing Home for the Divine Grace Care Agency Ltd from May 2015 until September 2015 as an Agency Nurse. 3. From 21st March 2016 the Registrant worked as a Staff Nurse at Victoria Care Centre. Her duties included allocation of staff to the care-staff on duty, administration of medication and she was responsible for the safety of the residents and tending to their individual needs. 4. Since 27th June 2016 the Registrant has been employed at Lady Sarah Cohen House which is a Nursing Home registered to provide accommodation nursing and personal care for 120 residents. 5. The incident referred to in the charges occurred during the course of the Registrant s employment at the Chiswick Nursing Centre. On 28th / 29th April 2015 the Registrant was the nurse in charge of the night shift. A number of residents in the Centre that night required one to one care. Resident A, a 70 year old man who suffered from Lewes body syndrome, a form of dementia, was one such patient. A symptom of Resident A s illness was that he was convinced that he should be at home and, for that reason, he required 24 hour one to one care. In summary, these charges relate to the Page 3 of 19

4 Registrant s failure to manage the care staff in the centre appropriately during that night shift which resulted in a period around 5:30 am when Resident A was left unsupervised. During that period, Resident A left the Centre. The charges in this case further reflect the Registrant s failure to follow the Centre s policy for missing residents after she realised that Resident A had left the Centre and could not be found. Resident A was later found by the police unharmed and returned to the Centre at approximately 14:30 that day, the 29th April The Facts 6. The Centre Director, Mr 1, made a routine telephone call to the Home at 07:54 on the morning of 29th April. At that point, Mr 1 was informed for the first time by a receptionist that Resident A had been missing from the Centre since 5:30 am that morning. Mr 1 then asked to speak to the Registrant as the nurse in charge of the shift. During the course of that conversation, Mr 1 formed the view that the Registrant was uncertain as to what she should do and was not in charge of the situation. The Registrant informed Mr 1 that she thought Resident A had left the building and exited the grounds via the garden. Mr 1 advised the Registrant to send staff to search the area around the rear of the garden and asked the Registrant whether she had called the police, to which the Registrant replied that she had not. 7. Mr 1 then telephoned the Registrant again at 08:00. When he was informed that Resident A had still not been found, Mr 1 instructed the Registrant to send staff out across the wider locality to search for him. Mr 1 again asked the Registrant whether she had informed the police to which the Registrant replied that she was about to telephone them. 8. At 08:29 Mr 1 telephoned the Centre and spoke with the Deputy Manager of Nursing who had by then arrived at the Centre. The Deputy Director reported to Mr 1 that the police had still not been informed by the Registrant and, therefore, she would undertake that task herself. In addition, the Deputy Director of Nursing informed Resident A s relatives of the situation as the Registrant had not already done so. Page 4 of 19

5 9. Mr 1 arrived at the Home at 10:00 and told the Registrant to go home and that she would be suspended pending an investigation into the incident. It was later reported that a staff member had seen a man climb over the garden wall at around 5:30 am when Resident A first went missing. 10. An internal investigation subsequently conducted by the Centre concluded that Resident A had been left unsupervised from 5 am and was first noticed to be missing at approximately 5:30 am. That investigation also noted that the door alarm on the door to the garden had not been switched on that night. The investigation also concluded that toward the end of the night shift the one to one care of Resident A had been compromised in order to free up staff to carry out general duties relating to other residents. 11. As reflected in Charge 1, the internal investigation also revealed that the Registrant had not completed the night care allocation sheet in respect of Resident A. Consequently, there was no record of which members of staff had been allocated to undertake one to one care of Resident A during the night shift. 12. As set out in charge 2, the Registrant did not ensure that Resident A was adequately monitored and/or observed during the night shift. The Registrant s job description establishes that the Registrant had a duty to ensure that all residents were adequately monitored and the Centre s Personal Care and Support Policy highlights the need for close constant supervision when dealing with one to one care residents. Resident A s risk assessment also recorded that he required close constant supervision at all times. 13. The Chiswick Nursing Centre s Missing Resident Policy states that staff should immediately raise the alarm by informing the Duty Manager if a resident went missing. The Registrant did not do this and the Centre Director actually had to make contact with the Registrant himself. Page 5 of 19

6 14. The Missing Resident Policy also requires that if no sign of the resident can be found, or if information is provided from either staff or other residents that raises concern that the resident may be at risk, then the local police should be alerted and their advice and assistance sought. The Registrant did not do this and the police were eventually contacted by the Deputy Director of Nursing. 15. The Missing Resident Policy also requires that members of the missing resident s family should be contacted. The Registrant did not do this and the family were eventually contacted by the Deputy Director of Nursing. 16. Following an internal disciplinary hearing in June 2015 the Registrant s employment at the Chiswick Nursing Centre was terminated and the Registrant was referred to the NMC in September During the course of the NMC s investigation references have been obtained from the Registrant s last two employers. In relation to her employment between May 2015 and September 2015 at Coombe Hill Nursing Home the Deputy Manager reported that: The nursing and care staff have found her a reliable person, who has been professional in her approach to care and nursing practice. Throughout the time of her nursing agency work with myself, in Coombe Hill- there has been no issue with Sylvia s shifts. 17. In relation to her current position at Lady Sarah Cohen House, a nursing home run by Jewish Care, the Registrant s employer stated that: She has now completed 7 days induction including the company induction at our Head Office which involves Moving and Handling, Fire Training, PEG Feeding, and First Aid as well as well as learning about the Jewish culture. Ms Adebayo has always under supervision and to date has satisfactorily completed her medication competency along with her other training sessions. Page 6 of 19

7 I am fully aware of Ms Adebayo s conditions of practice and she explained to me at interview about her NMC hearing. I am very satisfied with Ms Adebayo s standard of work but she will continue to be supervised at all times by another Senior Nurse until we have heard your decision 18. An interim Conditions of Practice Order has been in place since September The Registrant has fully complied with the conditions imposed by that order. In addition, the Registrant has provided the NMC with proof of attendance on a significant number of training courses, including: - Safeguarding adults course (Central Training, ) - Health and Safety, The Essentials (Central Training, ) - HACCP (Social Care TV Online Training, ) - Medication awareness (Central Training, ) - Documentation and Record Keeping (Train Healthcare, ) - Basic Life Supoort, COSHH, Equality, Diversity and Inclusion, Fire Safety, Food Hygiene, Handling Medication, Handling Violence, Health and Safety, Infection Control, Information Governance, Lone Worker, Manual Handing, RIDDOR, SOVA & SOCA Level 2 (Healthier Business UK, ) - Duty of care & Risk Assessment (Train Healthcare, ) - COSHH & Infection Control & Safe admin of medicines (Careshield, ) - Understanding your role & Your Personal Development, (Train Healthcare, ) - Assessing Needs (Social Care TV, ) - Moving and Positioning (Care Shield, ) - Anxiety (Social Care TV, ) - Awareness of mental health, dementia and learning disability (Train healthcare, ) - Pressure Ulcer Training, (Central London Community Healthcare, ) - Consent (Social Care TV, ). 19. A matrix setting out all training undertaken by the Registrant since September 2015 is attached to this agreement at Appendix One. Page 7 of 19

8 Registrant s Response 20. The Registrant has fully engaged with the NMC throughout this investigation. In her response to the charges the Registrant made full admissions to all of the charges. 21. The Registrant accepts that the resident was able to leave the Care Centre unsupervised on her shift and that as the nurse in charge she was accountable for the failings of staff who left their stations contrary to instructions. She also accepts that her instructions to staff were not documented as they should have been that night. She fully cooperated with the local investigation. 22. In her reflective piece the Registrant states that: I accept the facts of the charges against me. I also accept that it was my responsibility to ensure that Resident A was not at risk. I further accept impairment on the basis that it is necessary for public confidence in the nursing and midwifery profession to be maintained. On reflection, I accept that as Senior Nurse in charge, I am accountable for the failings of the staff under me who left their stations contrary to instructions I accept that I should have followed the Centre s policy that night by calling the Duty Manager and the Police and notifying the Resident s family 23. The Registrant reflects on what she has learnt from the incident by commenting: The lesson I learnt from the incident is to promptly refer to policies that are in place coupled with the facts that procedures must always be followed with accurate record keeping at the workplace at all times. Misconduct Page 8 of 19

9 24. Misconduct is a word of general effect, involving some act or omission which falls short of what would be proper in the circumstances. The standard of propriety may often be found by reference to the rules and standards ordinarily required to be followed by a medical practitioner in the particular circumstances : Roylance v GMC (No.2) [2000] 1 AC The parties agree that the Registrant s conduct, as described in the charges, amounted to acts and omissions which fell seriously short of what would have been proper in the circumstances, to the extent that those acts and omissions can quite properly be described as professional misconduct. 26. Specifically, the Registrant accepts that her failure to complete the night care allocation sheet, her failure to ensure that Resident A was adequately observed and her failure to follow the Missing Resident Policy exposed Resident A to a risk of harm and amounted to conduct that fell far below the standards expected of a registered nurse. In reaching that conclusion, the parties agree that the Registrant s conduct amounted to a serious and significant departure from the following parts of the NMC s Code of Conduct: - Point 8.2: Maintain effective communication with colleagues; - Point 8.3: Keep colleagues informed when you are sharing the care of individuals with other healthcare professionals and staff; - Point 8.5: Work with colleagues to preserve the safety of those receiving care; - Point 8.6: Share information to identify and reduce risk; - Point 10.1: Complete all records at the time or as soon as possible after an event, recording if the notes are written some time after the event; - Point 11.2: Make sure that everyone you delegate tasks to is adequately supervised and supported so they can provide safe and compassionate care; - Point 14.1: Act immediately to put right the situation if someone has suffered actual harm for any reason or an incident has happened which had the potential for harm; Page 9 of 19

10 - Point 14.2: Explain fully and promptly what has happened, including the likely effects, and apologise to the person affected and, where appropriate, their advocate, family or carers, and; - Point 14.3: Document all these events formally and take further action (escalate) if appropriate so they can be dealt with quickly; - Point 16.1: Raise and, if necessary, escalate any concerns you may have about patient or public safety, or the level of care people are receiving in your workplace or any other healthcare setting and use the channels available to you in line with our guidance and your local working practices; - Point 16.4: Acknowledge and act on all concerns raised to you, investigating, escalating or dealing with those concerns where it is appropriate for you to do so; - Point 17.1: Take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse; - Point 17.2: Share information if you believe someone may be at risk of harm, in line with the laws relating to the disclosure of information, and - Point 17.3: Have knowledge of and keep to the relevant laws and policies about protecting and caring for vulnerable people Impairment 27. The Registrant admits that her fitness to practice is currently impaired by reason of her misconduct according to the principles laid down in CHRE v (1) NMC and (2) Grant [2011] EHWC 927 (Admin). This is a matter of judgment for the panel of the Conduct and Competence Committee, which is invited to find that her fitness to practise is impaired for the following reasons. 28. The Registrant recognises that her conduct exposed a vulnerable resident to an unwarranted risk of harm. Furthermore, the Registrant acknowledges that the extent of her departure from the standards ordinarily expected of a Registered Nurse was such that she brought the profession into disrepute and breached fundamental tenets of the profession. Page 10 of 19

11 29. However, the parties agree that, for the reasons set out below, the Registrant has fully remediated the previous deficiencies in her practise. 30. The Registrant has shown insight and remorse in relation to her misconduct, as evidenced by the admissions that she had now made and the reflective statement submitted to the NMC. Specifically, the parties agree that the Registrant has demonstrated an understanding of the importance of accurate record keeping and the need to refer to and follow policies and procedures that are in place to protect the welfare of patients. 31. Since regaining employment as a nurse the Registrant has completed a significant number of training courses and assessments, as set out in Appendix One and referred to above. In addition, the NMC has been provided with positive references from a recent and a current employer. The reference from the recent employer, dated 15 May 2016, states that the Registrant was regarded as, A reliable person, who has been professional in her approach to care and nursing practice. The reference from her current employer outlines the satisfactory manner in which the Registrant is currently working and confirms that they have not concerns regarding her fitness to practise. 32. The parties recognise that the issue of impairment is a matter for the judgment of the panel and that the panel are not bound to accept or agree with any conclusions expressed by the Case Examiners. However, for the reasons set out within their decision, the parties respectfully invite the panel to agree with the following conclusions reached by the Case Examiners when deciding whether to refer this matter to the Conduct and Competence Committee: The Case Examiners then considered wither there was a realistic prospect of finding Miss Adebayo s fitness to practise to be currently impaired. They noted the positive reference from the Agency saying that there were no concerns, only positive feedback from care homes on Miss Adebayo s performance. They also noted the detailed submissions by Miss Adebayo s representative which itemised the training and assessments undertaken to address the concerns raised by these Page 11 of 19

12 incidents, including Safeguarding Vulnerable Adult s training. The Case Examiners noted the positive references from Marissa Lawingco, Deputy Manager of Victoria Care Centre and Angie Hamilton, the Unit Manager of that centre, showing that Miss Adebayo has worked as a nurse there from 12 March Miss Adebayo appears to accept responsibility for the alleged events and to have attempted to address them once she achieved employments. The Case Examiners conclude that the risk of repetition could be said to have reduced, given the references and the actions of Miss Adebayo, particularly in the light of the matrix submitted, showing relevant training completed from October 2015 to May In line with the guidance, Insight, remediation and risk of recurrence (NMC, December 2015), the Case Examiners decide that Miss Adebayo could be said to have shown some insight and remorse and consequently determine that her current fitness to practise could not realistically be found to be impaired. 33. The Case Examiners went on to refer this case to the Conduct and Competence Committee on the grounds that the Registrant s fitness to practise might be impaired on public interest grounds alone. 34. Having regard to the Registrant s insight, remorse and the steps that she has taken to remediate her practise, coupled with evidence of recent good practise, the parties agree that whilst the Registrant has in the past exposed a patient to a risk of harm, breached fundamental tenets of the profession and brought the profession into disrepute, she is not liable to do so again in the future. 35. However, the parties agree that the nature of the misconduct in this case is such that a finding of impairment is necessary to uphold and declare proper professional standards and to maintain public confidence in the profession. The Registrant s conduct exposed a particularly vulnerable patient to an unnecessary risk of harm for a number of hours. Consequently, the parties agree that public confidence in the profession would be undermined if a finding of impairment were not made in this case. Sanction Page 12 of 19

13 36. The parties agree that the appropriate sanction in this case is a two year caution order. 37. The aggravating factors of this case are agreed as follows: - Particularly vulnerable patient put at unnecessary risk of harm; - Registrant failed to manage that risk; - Registrant failed to respond appropriately once risk materialised; - Registrant was the Nurse in charge on the date in question. 38. The mitigating factors of this case are agreed as follows: - Whilst the Registrant did not ensure that the carers monitored Resident A, the carers themselves also had a clear responsibility for monitoring Resident A; - No actual Patient harm; - The Registrant has shown insight and remorse, provided significant evidence of retraining and also provided positive employment references. 39. In light of the reasoning behind the parties agreement in relation to the issue of impairment, the aspects of the public interest that need to be protected in this case are limited to the maintenance of public confidence in the profession and the regulatory body and the declaring and upholding of proper standards of conduct and behaviour. 40. A Panel engaged in fitness to practice proceedings must necessarily keep the imperative of the public interest at the forefront of their decision-making. The Indicative Sanction s Guidance (ISG) notes at paragraph 11: The public interest must be at the forefront of any decision on sanction and this includes the particular need to protect patients and the collective need to maintain the confidence of the public in the professions. Page 13 of 19

14 41. Dealing with the available sanctions in ascending order, it is agreed between the parties that this is not a matter in which it would be appropriate take, no future action, in that such a sanction would be insufficient to mark the seriousness of the Registrant s misconduct and to maintain public confidence in the profession and the NMC as a regulatory body. 42. Having regard to the Registrant s insight, continuing training and references it is agreed that a two year caution order would be sufficient to protect the public interest in this case, namely the need to uphold and declare proper professional standards and to maintain public confidence in the profession. Such a sanction would allow the panel to mark that the Registrant s behaviour was unacceptable and must not happen again (paragraph 60 of ISG). 43. The ISG notes that a Panel may consider a caution order to be appropriate where the nurse or midwife s history is such that the panel is confident that there is no risk to the public or to patients which requires the nurse or midwife s practice rights to be restricted (paragraph 61 of ISG). In light of the agreement between the parties that the risk of repetition in this case is minimal, it is agreed between the parties that no risk exists at the present time. 44. In addition, the parties agree that, in the context of this case, a conditions of practice order would serve no useful purpose as there are no identifiable areas of the Registrant s practice currently in need of assessment and / or retraining (paragraph 63 of ISG). With reference to the NMC s Guidance to panels on conditions of practice orders a panel must consider whether conditions are relevant, proportionate, workable and measurable (paragraph 16). In particular it is agreed that imposition of a conditions of practice order would not be proportionate. Proportionality requires that the conditions must be no more than necessary to achieve the legitimate aims of protecting the public and upholding confidence in the profession. They must also strike a fair balance between the interests of the registrant and the public interest, which includes public protection and public confidence. As mentioned above, it is agreed that a two year caution order adequately protects the public and is sufficient to declare proper professional standards and to maintain public confidence in the profession Page 14 of 19

15 45. Having regard to all the circumstances of this case, including the absence of evidence demonstrating harmful deep-seated personality or attitudinal problems and the absence of repetition of behaviour since the incident, the parties agree that a suspension order or a striking off order would be a disproportionate response to the Registrant s misconduct. The seriousness of the this case is not such that temporary removal from the Register is required and public confidence in the profession and the NMC as a regulator can be maintained if the Registrant is not permanently removed from the Register. Further Agreement 46. The parties understand that this provisional agreement cannot bind a panel, and that the final decision on findings of impairment and sanction are a matter for the panel. The parties understand that, in the event that a panel does not agree with this provisional agreement, the admissions to the charges set out above, and the agreed factual background as set out above, may be placed before a differently constituted panel that is determining the allegation, providing that it would be relevant and fair to do so. Signed.. Sylvia Adeola Adebayo Dated Signed (For and on behalf of the NMC) Dated The panel s decision The panel carefully considered the terms of the provisional agreement. The panel was aware that its task was to consider the provisional agreement in the round and to decide whether the sanction could be supported as the appropriate outcome to this case. Page 15 of 19

16 The panel noted that Miss Adebayo has made full admissions to the charges. The panel therefore found the facts proved by way of admission. Finding on misconduct and impairment The panel then moved on to consider whether the facts found proved amount to misconduct and, if so, whether Miss Adebayo s fitness to practise is currently impaired. The NMC has defined fitness to practise as a registrant s suitability to remain on the register in unrestricted practice. The panel concluded that the facts found proved amounted to misconduct. The panel agreed that Miss Adebayo had breached the parts of the code identified in the CPD agreement. The panel was of the view that Miss Adebayo s conduct was a significant departure from that expected of a Registered Nurse and adopted the reasons for finding misconduct set out in the CPD agreement. The panel then considered whether Miss Adebayo s fitness to practise is currently impaired. The panel noted that the CPD agreement states that Miss Adebayo is impaired on public interest grounds alone. The CPD agreement states that Miss Adebayo has demonstrated full insight and that there is now a low risk of repetition. However, the panel was of the view that it did not have before it sufficient evidence in the CPD agreement document alone to satisfy itself of this and requested sight of the employment references and the reflective piece which are quoted in part in the CPD agreement. The panel was provided with two employment references, one dated 15 May 2016 and another dated 21 July 2016, and a witness statement dated 26 July 2016 by Miss Adebayo, which contains some reflection. The panel was still not satisfied that it could make a full assessment of Miss Adebayo s insight, and therefore the likely risk of repetition of similar misconduct, on this evidence. The panel requested further information with regard to any additional reflection from Miss Adebayo. The panel also requested the core care competency assessment and Page 16 of 19

17 the further employment references referred to in the CPD agreement. Neither Mr Mackinde nor Mr Brown had any objection to this. The panel was provided with a bundle of further documentation consisting of employment references, a core care competency assessment as part of an induction process dated 21 March 2016, a number of training certificates and a short reflective piece. These documents satisfied the panel that Miss Adebayo has sufficiently remediated her practice. It considered that the assessments during the induction process demonstrated that Miss Adebayo has satisfied her mentor, a fellow registered nurse, that she is able to understand policies and has demonstrated competence in areas such as observation of risks to residents, safeguarding, deprivation of liberty, reporting of incidents and record-keeping. The panel had regard to the additional positive testimonials which attest to Miss Adebayo s current good practice including a reference dated 14 May 2016 from her Unit Manager which confirmed that Miss Adebayo s duties include the allocation of staff, leading the shift and delegating duties to the care-staff on duty. A further reference from a staff nurse colleague dated 26 June 2016 stated Sylvia ensures that the residents are kept safe at all times and acts as their advocate during multidisciplinary meetings Sylvia delegates tasks to other staff appropriately and ensures that specific tasks are followed up. The panel had particular regard to the testimonial dated 09 May 2016 from a relative of an ill resident which states that Miss Adebayo acted very confidently and professionally and managed to get the out of hours GP to visit and treat expeditiously, thus helping to avoid would what have otherwise been an emergency hospital admission. The panel noted that this was a one off incident and there has been no repetition in the period of time since this incident occurred. The panel also bore in mind the training courses that Miss Adebayo has completed since September These courses include safeguarding vulnerable adults, dementia training, consent and awareness of mental health, mental capacity act and bests interests, dementia and learning disability, duty of care and principles of delegation, accountability and working with others which the panel determined were particularly relevant to this case. Further, it considered that Page 17 of 19

18 Miss Adebayo has admitted the facts of this case, has admitted breaching relevant sections of the code and has admitted impairment. In all the circumstances, the panel was satisfied that Miss Adebayo has insight into her misconduct and agrees with the CPD agreement s assessment of the risk of repetition as low. Therefore it was able to conclude that Miss Adebayo is not impaired on public protection grounds. However, the panel was of the view that Miss Adebayo s misconduct in leaving a vulnerable patient exposed to an unnecessary risk of harm for a number of hours was so serious that public confidence in the profession and the NMC as a regulator would be undermined if a finding of impairment were not made. The panel therefore finds that Miss Adebayo s fitness to practise is impaired. Determination on sanction The panel has considered this case very carefully and agreed that a caution order is the appropriate sanction. In reaching this decision, the panel has had regard to all the information before it. The panel has borne in mind that any sanction imposed must be appropriate and proportionate and, although not intended to be punitive in its effect, may have such consequences. The panel had careful regard to the Indicative Sanctions Guidance ( ISG ) published by the NMC. It recognised that the decision on sanction is a matter for the panel, exercising its own independent judgement. The panel accepted the advice of the legal assessor. The panel agreed with the aggravating and mitigating factors set out in the CPD agreement. The panel then considered what, if any, was the appropriate sanction in this case. It adopted the reasons set out in the CPD that to take no action would not serve the public interest. Page 18 of 19

19 The panel agreed that a caution order is the appropriate sanction in this case. The panel has found that there are no public protection issues in this case. It agreed with the CPD agreement that the misconduct in this case can be remedied and has been remedied. The panel therefore determined that a caution order would sufficiently satisfy the public interest particularly due to the remediation demonstrated by Miss Adebayo and the low risk of repetition identified in this case. The panel considered a conditions of practice order but determined that this is a public interest only case and so conditions would serve no purpose. The panel considered that a suspension order would be disproportionate in light of the remediation undertaken by Miss Adebayo and the fact that she is a well regarded nurse. The panel agreed with the reasons identified by the CPD agreement that the seriousness of this case is not such that temporary removal from the Register is required and public confidence in the profession and the NMC as a regulator can be maintained if the Registrant is not permanently removed from the Register. The panel agreed with the CPD agreement that a two year caution order would be sufficient to protect the public interest in this case, namely the need to uphold and declare proper professional standards and to maintain public confidence in the profession. Such a sanction would allow the panel to mark that the Registrant s behaviour was unacceptable and must not happen again. That concludes this determination. Page 19 of 19