Recently I have been reflecting on my own emotions which have been rather topsy turvy to say the least.
The impact of enforced rest with an injury has been a mixed blessing. I have felt incredibly guilty about my lack of being able to go to work, but have managed to balance that slightly by my wonderful employer enabling me to work from home. The irony doesn’t pass me by that a previous time of being off work with injury led to giving my then employer ample opportunity to “move me on”, having raised concerns about leadership and clinical safety. However, this time, despite being employed in a lower position and as a bank staff member rather than a permanent member of staff, my employer showed what a compassionate employer they are. They could have easily said for me to get back in touch once well enough, but instead enabled me to keep working by covering our out-of-hours triage service from home. This has been a massive relief from any financial worries but also helped me feel I am still contributing in some way. and maintain the links with the team, an important aspect of any work validity. I tell people in the group how important it is to pick the right employer and once again, this has reiterated that to me again.
Being homebound has been challenging though, not only because my mobility is limited, but also the added challenge that so many families are having of lockdown and homeschooling. But with the immobility comes an excuse to veg on the sofa and concentrate on the NMCWatch work without having to ration it, which has been great – lots of things caught up on and the rare opportunity to be able to finish things rather than juggle lots and not complete anything. The group feels like it is really going places now – we have a meeting with the Chief Nursing Officer for England. We were invited to write to Jeremy Hunt, on the impact FtP has on the workforce and have launched our first round table sessions – challenging key aspects to the process in the hope of generating some wider discussion than just in the group. We have met 2 out of 3 of the largest nursing and midwifery unions to try to reassure them that we are here to complement and not work against them. All of this brings a self-fulfilled high which I don’t underestimate – the feeling you are making a difference can not be beaten. We also seem to be getting a certain following from the media, which has previously been isolated to the nursing press but is now at last catching the eye of the wider press network. There is always a certain amount of trepidation with this as the balance of getting the story out whilst not compromising the group or our members’ feelings of safety in it is really important to assure. Really encouraging though that we are getting such movement and really feeling like our “little” group is becoming recognised and respected.
Last week it was my pleasure to support a registrant through her 3-day hearing, alongside one of our independent legal representatives. The process needs so much more than legal representation, it needs advocacy from someone who understands what it feels like to go through FtP. It also just needs someone sitting beside you – albeit in the virtual world, explaining what each step and each decision means and keeping you calm when you feel like running. Having an advocate with you also means that the legal side can be focussed on separate to the emotion with neither being compromised. We entered the 3 day hearing with positivity. This particular case seemed for once quite cut and dry on paper. Serious accusations that absolutely needed to be investigated, but complete clarity from our review, that there was no case against her and we should be able to facilitate it coming to an early resolution to the benefit of the registrant. She already had a complete police report which categorically stated that the complainant’s motive was financial and there was no case. Yet here we were – 1000 days since the nurse met the person raising the allegation and 26 months since the NMC first had the referral. At last despite all this astronomically long period of time to get here – she could reach some closure and move forward.
Sadly, this is far from what happened.
Even after the allocated 3 days the case didn’t get started – numerous procedural issues and poor game-playing by the NMC. This combined with the connectivity challenges that a virtual hearing brings, made for a very stressful and frustrating time for all including the panel. The panel kept their neutrality, as they should, but one does wonder if this had been a case in front of a court judge or tribunal judge, whether he or she would have said enough is enough and thrown the case out. It was obvious throughout events that the NMC was bending over backwards to safeguard their one and only witness who created explanations for events that disputed the version of the nurse and to anyone watching (if it got that far!) was quite clearly fantasy in comparison to the more logical explanation of the nurse. It seemed that the NMC was extremely loathe to stand up and be brave to say this referral was inappropriate, which was saddening considering they are aware that up to 70% of cases referred do not meet the regulatory threshold. Yet still, they are investigated.
The nurse continued to be present throughout, listening to the poor case prep by the NMC and the continued stop-starts whilst the panel had to adjourn to make decisions, come back in to present findings to both parties, and parties go away to present their response, panel adjourn to consider again. Basic impoliteness which we know occurs for all registrants we meet – being kept in waiting rooms for the hearing to start after having been told to be available at a certain time, to be kept waiting whilst anxiety rises and we have to calm the nurse’s paranoia down that it wasn’t about her it was about the process. Conversations happening between the case presenter and their key witness – keeping the nurse waiting for over an hour at one point, and yet at the same time no conversation with the nurse to give her the same level of support and explanation. Waiting, hanging by our emails in case we are called back in to be told after an hour or two that the panel now needed further time for lunch, as we grab a sandwich whilst eyes fixed on inbox and barely catching a loo break!
As the hearing days sped by with still no case progression I could feel the nurse getting more and more despondent and I could not help but wonder – is this why so many are” not present and not represented” – do they just give up? We arrived at the final day of hearing no further forward and the case is adjourned until June. The nurse asked to speak to the panel and through the tears explained the impact that getting to day 3 and still not having any conclusion, was having on her and her husband who have suffered immensely throughout this process. The case presenter gave lots of explanation about how to further adjustments needed to be made, to avoid any additional stress to the complainant and yet if the registrant had said she could not take part for the same reasons, no doubt this would have had a negative outcome. The additional stress caused to the nurse is seen as collateral damage and an unavoidable part of the process – really?! The power play was never so obvious as it was with this case hearing. It saddened me immensely that here was a clinical situation that I could not safeguard or protect against harm – completely alien to my profession. BUT, it confirmed to me the need to be even more resolute and that we need to hold the hand of registrants going through this harsh and cruel process.
I will feedback to the NMC about the poor safeguarding of the nurse and the poor process. But the standard response will no doubt be that they can not comment on individual cases. They will ask me to give them the case details, so they can “investigate” – I feel reluctant to do so this time when previously have done so with the registrant’s consent – why should we give further opportunity to avoid accountability? What they seem to keep missing, time and time again, is that these issues are not unique to this one case. This one case merely highlights again the poor behaviour whether conscious or subconsciously towards the registrant and creates a feeling in the nurse who stands accused of being bullied by their regulator, whether intensional or not. It also gives those watching who are registrants to ensure they avoid this process at all costs as no registrant will get out of it unscathed. The NMC hold all the power and the nurse or midwife undergoing process has none. They can regather a little portion of power back at specific points, by presenting evidence or having a witness for the NMC actually back up their own version of events. But these are rare moments in a long series of events which continues to punch and knock anyone who deems to deny charges.
My previous week had ended with a high that we were starting to make a real difference. A reporter asked me at the end of the week, do you think there will come a point when NMCWatch will not be needed? I answered I would love to say yes but I am a realist, the NMC process will fundamentally not change – because there is no real force to ensure it does. The only thing that can change is the way we react to it – that we will always be needed for.
I found myself crashing down after witnessing the hearing – the sheer frustration and disappointment that the culture within the NMC is just too entrenched. A few weeks previous I had witnessed such a different attitude with a registrant that was applying for restoration back to the register. But is this because ultimately the registrant is accepting their fault? Can the NMC process really ever protect the innocent, or will it only give damage limitation to your career if you fall on your sword and beg forgiveness?
All the registrant can hope for is come June, having had the same panel secured, process with resume and they will not tolerate any repetition of the poor process that occurred this month. Hopefully, it will conclude with whatever outcome that is with the nurse leaving the process with a semblance of their dignity intact. This nurse maintained her professionalism throughout and I have the utmost respect for the mere fact that she continued to sit through a quite frankly shambolic process coordinated by our regulator.
So my absorbed anger did come out once we left the hearing, which shocked me and took a few days to realise that is what was happening. How do I continue to be constructive in how we push for positive change when a week like we had destroys any small amount of respect I had left for my regulatory body?
This week has started with more hope again and spirits lifted. We have launched our multidisciplinary round table discussions on a number of aspects around FtP. It’s easy, because our group supports those that tend to be aggrieved with the process, to become blinkered. I think now is the right time to try to widen the discussion anbronpost to people to aden the conversation network to see how everyone else views the issues we are raising. We have revisited conversations with the unions to try to encourage better engagement and were encouraged to hear from a few nurses and midwives over the last couple of weeks, reporting better engagement by their union. Is this a change in culture or having our involvement? It doesn’t really matter, what matters is the change is coming and that can only be good. We have linked in with two key support organisations The Laura Hyde Foundation and Embrace Resilience.
Both will help us to increase the mental health support we can signpost our group members to. The network gets bigger and support only gets better.
But it is tricky not to absorb the emotions of those we support. It’s also difficult to not get angry on their part. One has to try to maintain some detachment but that’s really difficult when witnessing someone else’s trauma can get you reliving your own. So I might access some of the support myself,
So the best way forward is to continue doing our best and try to remember to everyone else involved in the process – it’s just a job – to us it’s personal. To maintain our credibility we will keep reminding ourselves;
To try to educate the NMC with kindness and compassion.
To continue to give the NMC the benefit of the doubt, that they are doing it for the best reasons.
To remember some things you just can’t change
To treat the NMC with respect even when respect is not reciprocated.
This does mean though, in order to continue our passion for change;
We will ignore the fact that we have raised many of the same points of learning almost continuously for the past 4 years.
We will ignore the lack of compassion and instead to the registrant at the centre of the process
We will remember that the purpose of this process is to safeguard the public and not the registrant, but politely remind the NMC this is just as important.
We will have respect for ourselves and not seek it from our regulator – we know our truth, the NMC has to prove their case it is not up to us to disprove it.
And in the words of the great, legendary Captain Tom – “tomorrow will be a good day” – ever hopeful – ever trusting…we keep going. The good days are great and the bad days will be better tomorrow.