Part(s) of the register: RNA, Registered Nurse (sub part 1) Adult 21 February BLM Solicitors

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1 Conduct and Competence Committee Substantive Hearing 6 9 June 2017 Nursing and Midwifery Council, Regus Belfast, Forsyth House, Cromac Square, Belfast, BT2 8LA Name of Registrant Nurse: NMC PIN: Natalie Ann Stilges-Stevenson 97B0202S Part(s) of the register: RNA, Registered Nurse (sub part 1) Adult 21 February 2000 Area of Registered Address: Type of Case: Panel Members: Legal Assessor: Panel Secretary: Mrs Stilges-Stevenson: Nursing and Midwifery Council: Facts proved: Facts not proved: Fitness to Practise: Sanction: Interim Order: Northern Ireland Misconduct Nigel Hallam (Chair Lay member) Catherine Hinton (Registrant member) Linda Nixon (Lay member) Michael Ranaghan Zainab Mohamed Present and represented by Katrina Gray of BLM Solicitors Represented by Francis O Toole, Counsel, instructed by the NMC Regulatory Legal Team 1 in its entirety and 2(a), 2(b), 2(c), 2(d) and 2(g) in so far as it relates to 2(a) (d) by way of admission 2(e), 2(f) and 2(g) in so far as it relates to 2(e) and (f) Impaired Caution order 5 years N/A Page 1 of 24

2 Details of charges (as amended): That you, a registered nurse: 1) On 6 June 2015; a. Took two boxes of Zopiclone from ward stocks, without permission or a clinically justified reason; (Proved by way of admission) b. Gave two boxes of Zopiclone to a non-clinical colleague; (Proved by way of admission) c. Took four boxes of Co-codamol from ward stocks, without permission or a clinically justified reason; (Proved by way of admission) d. Gave four boxes of Co-codamol to a non-clinical colleague; (Proved by way of admission) e. Your actions in 1.a. 1.d. above were dishonest, in that you used your position as a nurse to access medication stocks in order to supply your colleague with ward medication which you knew was/believed to be for his personal use. (Proved by way of admission) 2) On occasion(s), in the six months prior to 6 June 2015; a. Took Zopiclone medication from ward stocks, without permission or a clinically justified reason; (Proved by way of admission) b. Gave Zopiclone to a non-clinical colleague; (Proved by way of admission) c. Took Co-codamol medication from ward stocks, without permission or a clinically justified reason; (Proved by way of admission) d. Gave Co-codamol to a non-clinical colleague; (Proved by way of admission) e. Took Lignocaine patches medication from ward stocks, without permission or a clinically justified reason; f. Gave Lignocaine patches to a non-clinical colleague; g. Your actions in 2.a. 2.f. above were dishonest, in that you used your position as a nurse to access medication stocks in order to supply your colleague with ward medication which you knew was/ believed to be for his personal use. Page 2 of 24

3 And, in light of the above, your fitness to practise is impaired by reason of your misconduct. Page 3 of 24

4 Decision and reasons on application to amend the charges The panel heard an application made by Mr O Toole, on behalf of the NMC, to correct the spelling of co-codamol in the relevant charges. He submitted that it was an administrative error. Thus, Mr O Toole submitted that no injustice would be caused to you and invited the panel to accept the amendment. Ms Gray, on your behalf, did not object to the proposed amendments. The panel was mindful of Rule 28 of the Rules which states: 28 (1) At any stage before making its findings of fact (i) the Conduct and Competence Committee, may amend (a) the charge set out in the notice of hearing unless, having regard to the merits of the case and the fairness of the proceedings, the required amendment cannot be made without injustice. The panel accepted the amendments were only to correct a spelling mistake and typographical error in the charges. The panel was of the view that such amendments, as applied for, were in the interest of justice. The panel was satisfied that there would be no prejudice to you or injustice caused to either party by the proposed amendments being allowed, as both parties had agreed to it. It was therefore appropriate to allow the amendment, as applied for, to ensure accuracy. Page 4 of 24

5 Admissions At the outset of the hearing, Ms Gray informed the panel that you admitted the facts in charge 1 in its entirety and the facts in charges 2(a), 2(b), 2(c) and 2(d). She also informed the panel that you admit charge 2(g) in so far as it relates to charges 2(a) (d). Further, Ms Gray informed the panel that you accept that your fitness to practise is currently impaired in relation to the admitted charges. The panel found the facts in charges 1(in its entirety), 2(a), 2(b), 2(c), 2(d) and 2(g) in so far as it relates to 2(a) (d) all proved by way of your admissions. Background The NMC received a referral from Belfast Health and Social Care Trust ( the Trust ) where you had been employed as a Band 5 staff nurse for 16 years before your dismissal. The alleged incident took place at the Royal Victoria Hospital Belfast where you were working on the Vascular ward ( the Ward ). Following concerns that there was a depletion of the level of codeine phosphate in the Ward during April 2015, it was decided that CCTV would be installed in the clean utility room where medication was stored. The CCTV was installed in May 2015 and footage from 6 June 2015 shows you misappropriating Class B&C medication from the ward medication cupboard and supplying a nursing auxiliary with the medication. An Investigation Meeting was held on 25 June 2015 which you attended and were represented by a Royal College of Nursing ( RCN ) representative. At the Investigation Meeting you admitted that on occasion you would take two Paracetamol tablets for headaches or period pain and would also on occasion supply other staff with Paracetamol or Co-codamol for pain. You also confirmed that you were on duty on 6 June 2015 and admitted that whilst in the clean utility room with a nursing auxiliary, you took two boxes of Zopiclone (sleeping tablets) and four boxes of Co-codamol and gave Page 5 of 24

6 it to the nursing auxiliary. Further, you admitted that you had been supplying Cocodamol and Zopiclone to this nursing auxiliary for a period of approximately 6 months prior to June 2015 and suggested that you would normally give strips rather than boxes. It is further alleged that you admitted to taking and supplying lignocaine patches although you later disputed this stating that you had never taken and given lignocaine patches to your colleague. The Police Service of Northern Ireland ( PSNI ) investigated the matter and reported it to the Public Prosecution Service. Following a disciplinary hearing you were dismissed. Page 6 of 24

7 Decision on the findings on facts and reasons In reaching its decisions on the facts, the panel considered all the evidence presented in this case together with the submissions made by Mr O Toole, on behalf of the NMC and those made by Ms Gray, on your behalf. The panel heard and accepted the advice of the legal assessor. The panel was aware that the burden of proof rests with 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. The panel heard oral evidence from three witnesses called on behalf of the NMC, who at the time of these events were employed at the Trust in the following capacity: Ms 1, Clinical Coordinator for the Vascular Burns Plastics & the Abdominal Aortic Screening Programme Ms 2, Lead Pharmacist for controlled drugs Ms 3, Service Manager The panel found Ms 1 to be an honest, credible and a fair witness. She was balanced and objective. The panel found that she was straightforward in her answers and clearly stated what she could recall and what she could not recall. The panel found Ms 2 to be a credible and reliable witness. The panel did however find that there was some inconsistency in her evidence with regard to the interpretation of any reference to Lignocaine and her recall of the preparation of the notes of the Investigation Meeting. The panel considered that the inconsistencies did not undermine her credibility as she did her best to assist the panel despite the passage of time. The panel found Ms 3 to be defensive and guarded. Her evidence was subjective and in part inconsistent. In her oral evidence, Ms 3 mentioned that she, Ms 1 and Ms 2 had a discussion about their notes immediately after the meeting after returning to the room having made coffee with Ms 1 and Ms 2. However, neither Ms 1 nor Ms 2 mentioned having this discussion despite being specifically asked about how they agreed the Page 7 of 24

8 minutes. The panel had concerns about the note taking procedure used at the Investigation Meeting and the written notes produced by Ms 3. In particular, the panel was concerned with her interpretation of the handwritten notes and it was therefore unable to place much weight on the typed Investigation Meeting notes. The panel also found that Ms 3 was somewhat judgemental in her oral and written evidence. She was reluctant to make concessions when it was appropriate to do so and did not want to give credit to you even with regard to the early admissions you had made in the Investigation Meeting. The panel also found that Ms 3 s evidence at times was contradictory and inconsistent which undermined her credibility. For these reasons, the panel had some reservation and was unable to fully rely on her evidence. The panel also heard oral evidence from you. The panel found you to be a credible witness. It considered that you were forthcoming and had admitted to having taken some tablets and given them to a colleague relatively early in the Investigation Meeting. When you were unable to recall certain matters you were honest and made it clear. The panel found that you were consistent throughout your evidence in relation to the disputed particulars. At the outset of the hearing you admitted the facts in relation to charges 1(in its entirety), 2(a), 2(b), 2(c), 2(d) and 2(g) in so far as it relates to 2(a) (d). The panel therefore found those charges proved by way of your admissions. The panel then went on to consider the remaining charges. The panel considered each charge and made the following findings: That you, a registered nurse: Charges 2 (e) and (f) 2) On occasion(s), in the six months prior to 6 June 2015; e. Took Lignocaine patches medication from ward stocks, without permission or a clinically justified reason; f. Gave Lignocaine patches to a non-clinical colleague; These charges are found NOT proved. Page 8 of 24

9 In reaching this decision, the panel took into account all the written and oral evidence, in particular your oral evidence and that of Ms 1, Ms 2 and Ms 3. The panel had sight of the handwritten notes of Ms 1, Ms 2 and Ms 3 dated 25 June It also had sight of the Investigation Meeting notes. The panel noted that the only contemporaneous evidence of Lignocaine being mentioned during the Investigation Meeting was in the handwritten notes of Ms 2 and Ms 3. Ms 2 recorded the following: earlier you said strip a tablets lidocaine [sic] and Ms 3 recorded the following: pain relief + lignocaine patches. Ms 1 made no mention of Lignocaine in her notes. The only evidence in support of this charge is an alleged admission by you at the Investigation meeting which you have consistently disputed from when you first received a copy of the typed Investigation Meeting notes. Further, the panel noted the following statement written by you on the meeting notes which you signed and dated 15 September 2015: re question 45: I do not recall saying about Lignocaine as I would never have given these to [the nursing auxiliary]. The panel noted that unlike the Co-codamol and Zopiclone medication, there was no CCTV footage of you taking Lignocaine patches nor was there any other evidence to support this allegation. Further, the panel noted that Ms 1 had no recollection of you mentioning Lignocaine. In addition, during Ms 2 s oral evidence, when questioned about this matter and the possible interpretations of her note about Lignocaine, Ms 2 could only recall that it was part of your explanation of what may have occurred and accepted that it was open to interpretation. The panel further noted paragraph 6 of Ms 3 s witness statement which stated as follows: Natalie s reference to Lignocaine suggests to me a possibility that she may in the past have taken Lignocaine from the ward cupboard and provided it to this colleague. The panel found that this reference in paragraph 6 of Ms 3 s statement amounts to nothing more than speculation on the part of Ms 3. Page 9 of 24

10 The panel considered that there was only brief mention of Lignocaine in the typed notes of the Investigation Meeting. The notes themselves do not demonstrate that any mention of Lignocaine was explored further nor did the Trust undertake any investigative steps to establish whether Lignocaine patches were in fact missing. The panel further noted that Lignocaine did not form any of the charges of the investigation by the Trust and was not one of the reasons for your dismissal. Nor were you questioned by the PSNI about this medication during its investigation. You have stated that you do not recall mentioning Lignocaine during the Investigation Meeting and have consistently denied taking it or giving it to a colleague. The NMC s case against you in relation to charges 2 (e) and (f) relies heavily, in the panel s view, on the admission allegedly made by you at the Investigation Meeting. The panel found that even taken at its height, the typed and handwritten notes of the Investigation Meeting fall far short of an admission by you to the theft and supply of Lignocaine. The burden of proof rests upon the NMC at the fact finding stage. The panel considered that the NMC had not adduced sufficient evidence to prove this charge and had therefore failed to discharge its burden. Accordingly, the panel found charges 2 (e) and (f) not proved. Charge 2 (g) 2) On occasion(s), in the six months prior to 6 June 2015; g. Your actions in 2.a. 2.f. above were dishonest, in that you used your position as a nurse to access medication stocks in order to supply your colleague with ward medication which you knew was/ believed to be for his personal use. This charge is found NOT proved. As the panel found charges 2(e) and (f) not proved, this charge falls in so far it relates to those two charges. Page 10 of 24

11 Determination on misconduct and impairment Having announced its finding on all the facts, the panel went on to consider, whether the facts found proved amount to misconduct and, if so, whether your fitness to practise is currently impaired. The NMC has defined fitness to practise as a registrant s suitability to remain on the register unrestricted. The panel gave careful consideration to the submissions made by Mr O Toole on behalf of the NMC and those made by Ms Gray on your behalf. You also gave oral evidence at this stage and provided the panel with a bundle of documents, including training certificates, a reflective piece in relation to a training course you undertook and references. The panel was referred 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. 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. Further, in determining past and current impairment, the panel was referred to the cases of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927 (Admin) and Cohen and GMC [2008] EWHC 581 (Admin). The panel heard and accepted the advice of the legal assessor. The panel adopted a two stage process in its consideration as advised. Firstly, the panel must determine whether the facts found proved amount to misconduct. Secondly, the panel must then 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 Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives 2008 ( the 2008 Code ), which was in force at the time of the incidents in charge 2 and The Code: Professional standards of practice and behaviour for nurses Page 11 of 24

12 and midwives 2015 ( the 2015 Code ), which was the version in force at the time of the incidents in charge 1. 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 determined that your actions in charge 1 breached the 2015 Code as follows: Promote professionalism and trust 20 Uphold the reputation of your profession at all times To achieve this, you must: 20.1 keep to and uphold the standards and values set out in the Code 20.2 act with honesty and integrity at all times, treating people fairly and without discrimination, bullying or harassment 20.3 be aware at all times of how your behaviour can affect and influence the behaviour of other people 20.4 keep to the laws of the country in which you are practising The panel determined that your actions in charge 2 breached the 2008 Code as follows: From the preamble 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 As a professional, you are personally accountable for actions and omissions in your practice and must always be able to justify your decisions. Paragraphs from the Code: 61 You must uphold the reputation of your profession at all times. Page 12 of 24

13 The panel found the theft and supplying of medication and prolonged acts of dishonesty constituted breaches of the Code, as nurses in a position of trust must be open and honest. The panel recognised that breaches of the Code do not automatically result in a finding of misconduct. The panel considered all the circumstances and whether the facts found proved fell well below the standards expected of a registered nurse. You had admitted to taking two boxes of Zopiclone and four boxes of Co-codamol on 6 June 2015 and giving them to a non-clinical colleague for his personal use without permission or a clinically justified reason, and that in doing so your actions were dishonest. You also admitted to taking Zopiclone and Co-codamol from ward stocks on a number of occasions prior to 6 June 2015 to give to your colleague for his personal use without permission or a clinically justified reason, and in doing so your actions were dishonest. The panel found that there were multiple acts of dishonesty. There was a sustained course of dishonest conduct over a period of six months. Despite knowing what you were doing was wrong, you continued to act dishonestly and it only came to an end as a result of you being caught on CCTV footage. Although there was no evidence of patient harm, you took medications which were for patients and potentially deprived patients of that resource. You told the panel that the taking of medication for personal use was common practice on the ward. However, the panel considered that as an experienced nurse of 17 years, you should have known better. Further, you were held in high regard and abused the trust of your patients and employer. Nurses must always be open and honest. The panel considered that a fellow practitioner would be appalled and disgraced to hear of a nurse behaving in such a way. The panel concluded that your dishonest actions were unacceptable and fell significantly short of the conduct and standards expected of a registered nurse. It Page 13 of 24

14 determined that your actions in all the proven charges, viewed both individually and cumulatively, were serious enough to amount to misconduct. Decision and reasons on impairment The panel recognised that a finding of misconduct does not automatically result in a finding of impairment. The panel next went on to decide whether your fitness to practise is currently impaired by reason of your misconduct. The panel was mindful of the overriding duty to protect the public and to act in the wider public interest. Nurses occupy a position of privilege and trust in society and are expected at all times to be professional. Patients and their families must be able to trust nurses with their care and the care of their loved ones. To justify that trust, nurses must 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 determining whether your fitness to practise is currently impaired the panel considered the judgment of Mrs Justice Cox in the case of Grant. In paragraph 74, she said: 74. 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 approve the following questions when considering current impairment, in Paragraph 76: Do our findings of fact in respect of the doctor s misconduct, deficient professional performance, adverse health, conviction, caution or Page 14 of 24

15 determination show that his/her fitness to practise is impaired in the sense that s/he: a. has in the past acted and/or is liable in the future to act so as to put a patient or patients at unwarranted risk of harm; and/or 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 first considered the issue of past impairment. It asked itself whether the misconduct in question had breached one or more fundamental tenets of the profession to an extent that would bring the profession into disrepute. It had careful regard to its findings of fact and the matters set out above. Whilst the panel concluded that there was little or no evidence that your actions had put patients at unwarranted risk of harm, it concluded that your misconduct had in the past: Brought the profession into disrepute; Breached fundamental tenets of the nursing profession as set out in the Code; and, Involved acts of dishonesty. For these reasons, the panel had no doubt that at the time these events occurred your fitness to practise had been impaired by reason of your misconduct. The panel next considered whether your fitness to practise is currently impaired and whether you are liable to repeat your misconduct. The panel had careful regard to the issues of insight, remediation, remorse, your past history and current practice. The panel considered the three questions identified by Silber J, in the case of Cohen, namely whether the misconduct is easily remediable, whether it has been remedied and whether it is highly unlikely to be repeated. Page 15 of 24

16 The panel noted your engagement with the Trust s investigation and the NMC proceedings and your early admission to the charges found proved. The panel was informed that you are currently working as a registered nurse at a nursing home and have been the subject of an interim conditions of practice order which you have fully complied with. Further, the panel had been provided with training certificates for medication awareness and administration of medicines update training you have undertaken, a reflective statement following the medicines update training and a number of positive references. With regard to your insight, the panel noted that you made early admission to the charges found proved and accepted that your fitness to practise was impaired by reason of your misconduct. It was evident from your oral evidence that you fully acknowledged that your actions were unacceptable. You repeatedly expressed how wrong it was to act in the way you did and that you would never repeat those actions. Further, you acknowledged the potentially serious impact and reputational damage your dishonest actions have had on the trust of your patients, your colleagues and public confidence. The panel did however have some concern with regard to your explanation for why you gave your colleague the medication. The panel also found that although there was evidence of reflection on your part, you had not expressed a deeper and personal reflection. When asked did you consider the potential dangers of supplying medication to your colleague, your reply was he was an adult. You also stated that it never crossed your mind to advise your colleague to seek medical advice or that there may have been other reasons for his need for medication. The panel found that whilst you have demonstrated some insight it is not yet complete. Despite that, the panel was satisfied from the evidence that it heard that the likelihood of you repeating such actions was low and that you had learnt a salutary lesson. You articulated and appreciated the seriousness of your actions and the impacts it had on patients, public confidence and the profession. You made repeated expressions of remorse which having considered your evidence the panel accepted were genuine. Further, you told the panel of a similar situation you faced in your current work place where a care assistant had asked you for medication. You informed the panel that you Page 16 of 24

17 refused to give the medication and had reported it to the matron. The panel noted that this was not referred to in the reference provided by the matron but was satisfied from your evidence that this was a genuine account of what had happened. With regard to remediation, the panel recognised that dishonest acts can be more difficult to remediate than clinical failings. You have provided the panel with training certificates for Medication Awareness and Administration of Medicines Update training that you had undertaken and a reflective statement in relation to the medicines update training. You have also provided a number of references and testimonials attesting to your otherwise good character and clinical practice, one of which was provided by your current manager. The panel noted that you have been working as a registered nurse, albeit under an interim conditions of practice order, at a nursing home for the past year without any further concerns raised regarding your conduct. The panel was informed that you have been offered the post as a Palliative Care Link Nurse and that palliative caring was always an area of nursing that you were interested in pursuing. The panel acknowledged all the steps you have taken to keep your skills and knowledge up to date. The panel noted that you have expressed remorse in that you have repeatedly apologised for your actions and asserted that you would never repeat those actions. With regard to your past history, the panel noted that you had not previously been brought before your regulator. The panel noted that you have since practised as a registered nurse for approximately a year with no concerns raised regarding your conduct or practice. You appear to have learnt a lesson from your misconduct and acknowledged that your behaviour was wrong and unacceptable. The panel has considered your failings in context and has had full regard to the issues of insight, remediation and your past history. Based on all the evidence before it, the panel was satisfied that there was low risk of repetition. The panel went on to consider whether the need to uphold proper professional standards and public confidence in the profession would be undermined if a finding of impairment of fitness to practise were not made in the circumstances of this case. The panel considered the seriousness of your case and the particular nature of your Page 17 of 24

18 misconduct which involved the theft of medication from your employer which was supplied to your colleague. Your dishonest conduct was repeated for a period of six months and had only come to an end because you were caught on CCTV footage. The panel also noted that at least on one occasion, namely 6 June 2015, you took and supplied a large quantity of medication to a colleague for his personal use without permission or any clinical justification. Honesty and integrity are the bedrock of the nursing profession and your actions breached fundamental tenets of the nursing profession. Regardless of the evidence of remediation and the low risk of repetition, in such a case, the panel considered that public confidence in the profession and in the regulatory process would be undermined if there were no finding of impairment. The panel found that members of the public would be appalled if a finding of no impairment was made in a case of repeated and prolonged dishonesty involving the theft and supply of medication. It therefore considered that a finding of impairment was required on the grounds of the wider public interest in declaring and upholding proper professional standards and maintaining public confidence in the profession and the regulatory process. Accordingly, the panel has determined your fitness to practise is currently impaired by reason of your misconduct on public interest grounds alone. Page 18 of 24

19 Decision on sanction and reasons Having considered what, if any, sanction is appropriate in this case, the panel has decided to impose a caution order for a period of five years. The effect of this order is that your name on the NMC register will show that you are subject to a caution order and anyone who enquires about your registration during this period will be informed of this order. In reaching this decision the panel has had regard to all the evidence that has been adduced in this case together with the submissions of Mr O Toole, on behalf of the NMC and those made by Ms Gray on your behalf. The panel heard and accepted the advice of the legal assessor. The panel was referred to and had regard to the cases of Grant, Parkinson v NMC [2010] EWHC 1898 (Admin), Abbas v GMC [2017] EWHC 51 (Admin) and Meadows v GMC [2006] EWCA Civ 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 has had careful regard to the Indicative Sanctions Guidance ( ISG ). It is a guide and no more. It is for the panel to exercise its own independent judgment having had the opportunity to see and hear from you and assess all the evidence. The panel was mindful of its duty to protect the public interest. This includes: the protection of patients and others; maintenance of public confidence in the profession and in the regulatory body; and, declaring and upholding proper standards of conduct and performance. The public interest includes a nurse s return to safe and effective practice if appropriate and achievable. The panel first considered the aggravating and mitigating factors in your case. The panel determined that the aggravating factors are: The seriousness of your misconduct, which involved theft of medication from your employer and supply to a colleague. This was not a single incident; you acted dishonestly over a period of 6 months. Page 19 of 24

20 You are an experienced nurse and should have known better. The panel determined that the mitigating factors are: You made early admissions to the charges. You are otherwise a nurse of good character who has been described by colleagues as a highly skilled, honest and competent nurse. You have practised as a nurse for the past year without any concerns raised. You have provided excellent testimonials and references from credible and fully informed referees which speak extremely highly of you and attest to your otherwise good character. Your career has otherwise been exemplary. There is low risk of repetition of the misconduct. You have expressed genuine remorse and have apologised for your actions. You acknowledged the reputational damage your misconduct would have on the profession. You have reflected and demonstrated insight. You have taken all appropriate steps to keep your skills and knowledge up to date and have remedied your misconduct. You have never previously been brought before the NMC. You have engaged fully with the Trust investigation, the PSNI investigation and the NMC proceedings. The panel bore in mind the aggravating and mitigating factors identified above when considering the appropriate sanction in this case. When considering what, if any, sanction to impose, the panel had particular regard to your dishonest acts, and to paragraphs 36 and 37 of the ISG: 36 Dishonesty, even where it does not result in direct harm to patients but is related to matters outside of a nurse or midwife s professional practice, for example, fraudulent claims for monies, is particularly serious because it can undermine the trust the public place in the profession. Honesty, integrity and trustworthiness are to be considered the bedrock of any nurse or midwife s practice. Page 20 of 24

21 37 In Parkinson v NMC [2010] EWHC 1898 (Admin), Mr Justice Mitting said: A nurse found to have acted dishonestly is always going to be at severe risk of having his or her name erased from the register. A nurse who has acted dishonestly, who does not appear before the Panel either personally or by solicitors or counsel to demonstrate remorse, a realisation that the conduct criticised was dishonest, and an undertaking that there will be no repetition, effectively forfeits the small chance of persuading the Panel to adopt a lenient or merciful outcome and to suspend for a period rather than direct erasure. The panel was also mindful that dishonesty is highly serious matter but also noted the guidance of the High Court in Abbas and other recent decisions which stress the importance of considering the individual circumstances of each case. The panel took the view that your conduct had fallen below the standards expected of a registered nurse. As such, it was the panel s duty to declare and uphold proper standards of conduct, so as to maintain public confidence in the profession. The panel first considered whether to take no further action. The panel paid careful consideration to the significant mitigating factors in your case. It noted that since the incidents in 2015 you have practised as a registered nurse for the past year without any concerns raised regarding your conduct or practice. It also noted all the positive references and testimonials you have provided. You expressed genuine remorse and had reflected on your actions. The panel was therefore satisfied that the risk of repetition is low. However, the panel concluded that due to the seriousness of the misconduct, taking no further action would be inappropriate in view of the seriousness of your misconduct and the need to declare and uphold proper standards of conduct. It would not satisfy the public interest considerations in this case The panel went on to consider whether a caution order would be an appropriate response. Given that the next available option, a conditions of practice order, would most likely be inappropriate in this case now that all the evidence has been considered, the panel examined this option closely. There are no public protection concerns in this case and there are significant mitigating factors. The panel noted that the mitigating Page 21 of 24

22 factors in this case substantially outweighed the aggravating factors. The panel has been told that there have been no adverse findings in relation to your conduct or practice either before or after these incidents in You have been working as a registered nurse for the past year without any concerns raised regarding your conduct or practice. The panel noted the exemplary references and testimonials you have provided, one of which was provided by your current manager who described you as open and honest. The panel considered that the misconduct in this case, albeit serious, was a significant error of judgement on your part. It noted that the theft and supply of the medication was not for personal use or gain but rather it was done in your belief to help a friend. Further, you informed the panel of a similar incident which had occurred at your current work place which you dealt with appropriately by refusing to give your colleague the requested medication and reporting it to the matron. The panel was particularly impressed with this as it demonstrated that you have learnt a salutary lesson and know what you must do when placed in a similar situation. This would also reinforce the confidence of the public that you have learnt your lesson and would not repeat such conduct. The panel accepted that this was a lapse of judgement on your part, albeit a serious one. You have had an otherwise exemplary career of 17 years. The panel noted that there were no deep-seated attitudinal issues, you are otherwise of good character and are a nurse who is held in high regard. You expressed genuine remorse and repeatedly apologised for your actions, reassuring the panel that you would never again act in such a way. One of the NMC witnesses also told the panel that you were immediately remorseful and full of regret and that you continued to display this remorse and regret during your contact with the Trust whilst you were under suspension. You acknowledged the seriousness of your misconduct and the impact it had on the trust of your patients, colleagues and employers. You also appreciated the negative impact such dishonest conduct has on public confidence, the reputation of the profession and the NMC as its regulator. You expressed the importance of being open, honest and acting with integrity. Page 22 of 24

23 In the particular circumstances of this case, the panel has concluded that a caution order is the most appropriate and proportionate sanction. The panel was satisfied that a caution order would be sufficient to maintain public confidence in the nursing profession and the regulator, to uphold proper professional standards by marking that such a failing is unacceptable and falls below the standards expected of a registered nurse. It was satisfied that a reasonable and informed member of the public would understand the reasons for taking such an exceptional course in your case. The panel also took into account the public interest in retaining a highly valued and experienced nurse in practice. It therefore concluded that a caution order is the most appropriate and proportionate sanction, balancing the public interest with your interests. The panel noted your personal and financial circumstances but was mindful that such circumstances can only be given limited weight in those cases where a sanction is required to protect the public interest. The panel considered whether it would be appropriate and proportionate to impose a more restrictive sanction and considered a conditions of practice order. This is not a case which concerns clinical failings. There were no identifiable areas in your practice which you required further retraining or supervision. The evidence before the panel was that you in fact are a highly skilled, hardworking and competent nurse. The panel therefore found that there would be no useful purpose served in imposing a conditions of practice order, nor would it be appropriate or proportionate in these circumstances. The panel went on to consider the next available sanction of suspension. The panel was mindful that a period of suspension would also sufficiently serve the public interest considerations in this case. However, given the significant mitigating factors in your case and the fact that you have had an otherwise exemplary career, the panel determined that in the particular circumstances of this case, a suspension order would be disproportionate and punitive. It would also deprive the public of the services of a highly skilled and experienced nurse. The panel next considered the appropriate length of time for the caution order. The panel concluded that the maximum period of five years would be adequate, proportionate and would protect the wider public interest, marking the seriousness of the misconduct and sending out a message that such conduct is unacceptable and that Page 23 of 24

24 it must not happen again. During this period any prospective employer will be on notice that your fitness to practise has been found to be impaired and that a caution order has been imposed. Any prospective employer could make enquiries as to the circumstances of the making of the caution order and this will put the employer on notice of any potential problem. At the end of this period the note on your entry in the register will be removed. That concludes this determination. This decision will be confirmed in writing. Page 24 of 24