Here is an example of one reflection – this registrant was struck off the nursing register but appealed as a self-litigant in the High Court and was able to get the strike off removed and replaced with a 2-month suspension order. The judge agreed with the registrant that the original sanction was excessive and disproportionate and made key recommendations to the NMC that their guidance was flawed and needed urgent review to avoid other careers being dealt with so harshly. As has to happen after a High Court Judgement, the registrant then went back to the NMC to effectively see if they agreed with the judge. On reading the reflection, hearing from the registrant and reading the high court appeal, they revoked the order completely and she returned to the register.
No particular model was used to standardise the reflection but it was received very positively by the NMC panel nonetheless. The author recognises at the time of the incident she was too traumatised to write an effective reflection as she did not understand the process and what was expected or required.
If she can do it – so can you.
Reflective Piece – August 2017
The NMC Charges
On 20 January 2016, I submitted an application form to Career Healthcare which included information about my training status on it. With this documentation, I sent a copy of an A&A certificate which had the date of 27 August 2015 indicating that I had completed training on that date. This date was then transferred on to the application form to comply with their application process. I completed the form stating BLS and ILS and explained at the time that the training was only a BLS standard training as there was no workbook, pre-course work of registration with the Resuscitation council at the end of it. The reason I had indicated on the registration form that I had done both courses was that this was the only way to show it on the form. I admit this was naive of me and I should have just written on the application that I had BLS only.
To provide some context to my mistake, at the time I was recovering from a serious accident where I sustained 6 broken ribs, was hospitalized for a week, and then required a number of weeks at home to recover. The accident happened in September and by January I was starting to feel that I was able to return to work, although still on analgesia, and was evaluating the best route to go down whether it be another senior position, a less senior position contracted, a bank role or an agency role. I applied to a number of agencies during this time to investigate the type of work that may be available.
From the period of September to November, whilst I was still recovering I underwent a particularly stressful time with my employer including whistleblowing against poor practice within the organization.
I am not using any of the above as an excuse for my actions, however, I wanted to reflect on the time and the circumstances to provide the context to the situation.
Since being notified of the error by the NMC I immediately contacted the agencies that I had been communicating with, some of which I had already told verbally I no longer wanted to pursue my application anyway and ceased the application process stating that there was an issue with my certificates. During the period from January 2016 to March 2016, I did not undertake any clinical work and so consequently no patients were put at risk during this time.
In March 2016 I put myself through an online course with Protrainings on basic life support so as to ensure in the meantime I was still up to date and had refreshed my knowledge and skills appropriately in the absence of being able to undertake any practical course. I was unable to undertake a practical course at that time as I had fractured my ankle on 13 February 2016 and was immobilized for 6 weeks whilst it healed and had tests to ensure there was no underlying condition causing my recent multiple fractures. The online BLS course was particularly good and acted as a good refresher on my knowledge. As part of my subscription, I receive regular updates on clinical issues relating to this topic. Also, during this time I self-funded to undertake the PRINCE2 foundation and practitioner courses which I passed on 28 February and 1 March. Although not clinical courses these have given me a great education in many skills including time management, prioritizing workload, team and individual dynamics. I have been able to reflect on work I have done previously, particularly at my last employer, and identify what went wrong, what I could have approached differently and what I could have improved. The course has probably been one of the hardest but most influential courses I have done, next to my cancer nursing, as it has changed the way I work and look at work moving forward.
Once fit for work again I approached HCA International to work at their chemotherapy suite in Harley Street, Leaders in Oncology Care (LOC). I chose this as the place I wanted to work as I had worked with the senior sister and clinical director previously and was confident in their management style. I felt that LOC was a place where I could gain my clinical confidence back at a speed I could direct, regain my self-confidence and re-gather my skills and expertise that I had felt I had lost whilst working for my previous employer. I undertook my mandatory training with them in March/April 2016, which included 22 eLearning modules including BLS, Ethics and the Code of conduct and Safeguarding. I was very impressed with their induction process, was allocated a mentor and had a 3-week supernumerary training induction to demonstrate my competencies before working alone. This reaffirmed my belief that I had most definitely made the right decision and as a bank nurse I was able to control the number of hours I did so as to not overstretch myself. I have also recently had an appraisal with my manager at LOC and we have set some objectives for the next year.
This whole period of time since the beginning of my referral until now, has given me a great deal of time to reflect on what happened, where I want to go with my career and what the future holds for me as a Nurse. I have reached the conclusion that I wanted to get back to the clinical care that I loved, namely chemotherapy nursing and care of oncology patients. By the time the issue raised by the NMC had been brought to my attention, I had already decided I did not want to continue down the agency route and wanted to work somewhere that would enable me to regain my confidence whilst I continued my recovery – both physically and emotionally.
As a registered nurse I am responsible and accountable for my own acts and have accountability for everything I do. The Remediation and Insight Guidance produced by the NMC in 2016 outlines how panels can assess insight by registrants, even in the absence of denying charges. As I was the person who submitted the form and certificate, it was my responsibility to ensure everything on it was documented correctly and accurately. I am prone to rushing things, such as emails, and have had this raised at appraisals in the past. If I had taken more time over it I would have been able to consider better how to complete the application form. Also if I had taken more time and checked the certificate closer I would have noticed on closer inspection that the date looked like it had been amended and consequently not forwarded it to the company but checked its accuracy by contacting ex-colleagues to try to determine when the training had taken place.
Due to the reasons for leaving my previous employment, it was not easy for me to access records. Unfortunately, many of these colleagues have now left the organization so if this had proven difficult I would have told the agency that I could not confirm the date of training and undertake the training again if I had chosen to pursue work for them. As previously stated, at the time I was applying to a number of agencies and becoming frustrated at needing to send repeated information off to them all, sometimes in duplicate when I had sent it before. I think this may have contributed to my error causing me to rush and not check things through. I have been unable to find any original documents for the training so can not cross-reference them now.
A reflection was not submitted to the NMC when the allegations arose as my legal representation felt as I was denying some of the allegations, the reflection would have only solidified to the panel my lack of insight. I have now been through the appeal process as a self-litigant and have had the benefit of reviewing the Remediation and Insight Guidance which I was not aware of previously. I now feel that the insight and remorse I have been able to show through true reflection on the whole proceedings has enabled me to provide this reflection piece before you today.
Accurate documentation is the backbone of our nursing practice. I educate all those under my supervision to ensure that any documentation is accurate, factual and legible. Therefore, I am ashamed of myself that I did not apply the same practice when I was completing the application to Career Healthcare.
If I were back at that time and applying again I would have taken more care, looked at the application form a couple of times before sending it and also double-checked the certificates I was sending. Since the incident was raised with me by the NMC and whilst I was allowed to continue working for the 10 months prior to my CCC hearing, I adopted a step-back approach in all of my practice at home and at work and made sure when sending documentation or writing information down that I take a pause, sometimes of a few days, relook at it and ensure all is well before sending. I only wish I had applied this logic back in January 2016.
My denial of the allegation of dishonesty was maintained throughout the CCC hearing and to this day. My reasoning behind this was that I did not change the certificate so could not admit to something I did not do. However, I did not elaborate on this denial and I understand why the NMC may have taken this negatively. I am not a dishonest person as I have shown through testimonials, previous investigation by the NMC on allegations raised at employer level that I was found to be “open and honest throughout” and through the appeal process whereby the judge accounted for my good character. However, I understand why the NMC state that this action was dishonest and that this is a different dynamic to my own honest character. I am not a dishonest nurse just a busy mum who tends to rush things and at times not think things through. This has now changed and taught me a very valuable lesson.
I deeply regret how this lapse of judgment has caused such issues. However, as with every period of challenge in my career, this has taught me a great deal also. I believe in learning from everything that happens, nursing is an amazing career for showing you that you never stop learning. My work at LOC helped me regain my strong clinical knowledge I have in my speciality, but also helped me get back to what I love most, which is my patients. They are the ones that have taught me the most and each day there is something to reflect on. I undertook regular reflections after particular episodes whilst working there so I continued to ensure I was learning and growing. I have learnt from it and have decided that I want to continue to be by the bedside with my patients and not in a senior role. Although I know I could do a management role again, it has helped me realize that where I am now is now where my skills are best used, I can introduce my knowledge and experience from my time in previous roles to influence and support the environment I am working in now but I am happy to have a certain level of distance from the unit management side of previous roles.
I have re-read the Code of Professional Standards of practice and behaviours for nurses and midwives (NMC, 2015) and have reflected on the following in relation to this incident:
Practice effectively: by submitting a form with inaccurate information contained in it I was potentially unable to practice effectively. This meant that I did not adhere to “keep clear and accurate records relevant to your practice”.
- 2 – by notifying relevant personnel as soon as the issue was brought to my attention I complied with this
- 3 – I did not comply with this as I did not complete all documents accurately without falsification. The documents weren’t accurate, although at the time I was not aware of this, but I should have taken more care to ensure they were accurate. I did take immediate and appropriate action as soon as I became aware of the issue, however.
- 5 – I did not comply with this as I did not make sure that all records were stored securely. As I was forced to be away from my workplace in my last 4 ½ months of employment my portfolio was left in an open office in a cupboard that others had access to. Once I was aware that I would be away from work for a while I should have requested someone secure the portfolio properly in my absence.
- 2 – helps us look at ensuring we raise issues at work if having concerns. I consistently raised issues at my place of work, CPUK, in order to fulfil this requirement, despite it leading to a very difficult working situation and ultimately my leaving the organization. However, I could have escalated further by notifying CQC of my concerns which I did not at the time – if this situation were to occur again I would most likely have done so.
Promote professionalism and trust
- 3 I have reflected on how this action may lead to others losing trust in me. It could raise concerns over my integrity and honesty. I am a person that cares deeply about how others perceive me and what they think of me so it does sadden me to think that my action may have caused others to lose faith in me. I can only continue to be honest about my actions and show in my everyday practice that I am trustworthy and honest. I have told all professional and personal colleagues about the investigation and suspension and will continue to do so in any further employment
- 9 I did fulfil this by not working during periods of ill health, namely from September 2015 to January 2016 due to my riding accident and again from February 2016 to March 2016 due to another separate injury.
- 2 – I informed my employer HCA International about the NMC investigation and subsequent CCC hearing outcome. I have been in regular contact with them throughout my suspension period and they were delighted to hear the outcome of my appeal – a copy of the email is enclosed which confirms they are keen to have me back to work as soon as possible. Their support has been incredible and has no doubt given me the strength to decide that I want to continue as a nurse if the NMC allows it.
- 1 – I have always prided myself in being able to be good at identifying priorities, applying skilled time management and the resources I have to deal with risk and ensuring that the quality of care is maintained. At times this has been very challenging particularly when the organisation I have worked for has felt priorities should be different. However, I have always ensured that the patient is kept at the centre of everything I do and their needs are prioritised. Even though I was working as a bank nurse, LOC see their bank nurses as valuable members of the team. This is refreshing to work within and means that I can bring my experience from management roles and help support the staff on the unit so they can ensure the team achieve what they need to. I offered guidance and advice where I could if I witnessed situations that the more junior members of the team found difficult, but also was able to help them appreciate where the organization or the senior managers may be coming from, having been there myself.
- 2 – During my role at LOC over 10 months prior to suspension by the NMC, I used my knowledge and previous experience to help the team ensure they have the knowledge for safe practice. As the managers know my prior experience they value my input and respect it if I raise issues that I feel need to be addressed, which again is refreshing for me. As I was able to be in control of the hours I work, I was able to ensure I increased my knowledge on the treatments patients are receiving on the unit, some of which I have not been involved with before. I have been able to increase my knowledge slowly and learn about all aspects of patient care so that I can practice safely and effectively.
Since the decision by the CCC hearing of the strike-off order, I have been unable to work but have kept up to date via online reading as well as doing some governance work for a friend’s nursing company.
Although it was very stressful, the appeal process has taught me many things and given me the ability to reflect on my nursing career and how I wish to continue. There is no doubt that this process has changed me and I am not the same person I was last year, however, I truly believe everything happens for a reason and if nothing else it has made me more determined than ever to continue in the profession that I love.