SG joined our group after going through her NMC Fitness to Practice process three years previously, she had an interim suspension order.
On joining NMCWatch she was being represented by her union but struggling to find employment. She asked us if we were able to help her find a position as a support worker or HCA so she could at least work
In May 2021 she had an Interim Review Hearing of her suspension order and it was replaced with a Conditions of Practice Order which she was thrilled at, as this meant she could return to working as a nurse. However, it was challenging to find an employer willing to take that leap of faith to help her.
We have been working on developing a pilot, working with a number of sites around the country. Soon we hope to laugh the pilot formally, but in the meantime, we have been able to network with sites that are interested and if appropriate talk to them about specific candidates who may be suitable for placement. We were really pleased to hear that Barnet, Enfield and Haringey Mental Health NHS Trust felt able to support this nurse. It was going to be a big ask for the nurse as well, as would involve travelling an 80-mile round trip, almost 2 hours each way and staying away from home to fulfil her shifts. As she had struggled to get employment locally she was keen to pursue this.
Thanks to a wonderful supervisor and wider supportive team, she was able to return to work and begin her learning with a specifically designed PDP to both suit her needs and also the requirements of the NMC Conditions of Practice.
It was a tough journey, with her supervisor meeting her initially every 2 weeks to review progress and help her work through aspects she was struggling with. It also involved clear coordination with the other teams so they understood the role she was in whilst working there, and also, whilst maintaining her confidentiality, ensuring she was not made to work outside of her CoP.
The longer she was at Barnet her confidence grew. She initially stayed locally when doing shifts and travelled home during days off. However, after a few months, she found this very difficult to continue with and so then decided to commute daily for each shift, with her husband driving her many times. This showed her determination to fulfil the placement. As well as the support from the workplace team she also required a great deal of support from her mentor at NMCWAtch, who sometimes would speak to her daily if she had had a bad day to assist her to keep on track.
There were times when she will admit, she almost gave up, the journey took its toll and she felt like she was never going to achieve her CoP. Her supervisor continued with patience but also gentle assertion of the importance of her continuing and listening to feedback. We all believed she could do it – even when she didn’t think she could.
One of the hardest things with Fitness to Practice processes is that it can destroy your self-belief, your ability to trust your own instincts, and makes you question yourself in every way. It is easy to become a person who believes they do not deserve to be nursing and that there is no way back from FtP. It is also extremely difficult for workplace teams and managers to have someone working for them during FtP. The nurse may not be able to work at the same pace as others. They may not be able to retain information or grasp tasks as quickly as others due to PTSD impact. They may need time off sick when their mental health dips. This is why it is so important to not only have peer-to-peer support from others who have been through the process as only they really know how people are feeling, but it is also so important to surround yourself with the right team.
This nurse will acknowledge that the place she worked when she had her incidents, was not the right place for her at that time. She was reasonably newly qualified and the unit was high-stress and extremely specialised. This nurse will also say that she would not have considered working in a mental health unit previously. However, she will also admit that it was most definitely the right placement for her as not only was supportive but also taught her about her own psychological response to trauma and the NMC process. Working there showed her why she behaved the way she had done, why incidents occurred and how she could reset her mind in order to react differently in the future.
The nurse approached her union to ask for a review of the CoP and to get a date set for a hearing, as she was aware this may take a few weeks to months to set. They refused and said that it would be looked at in December and not before. We suggested she gently discuss with the union that she had achieved her CoP achievements and to wait another few months would be extremely difficult for her – she needed resolution. As the union continued to refuse to assist with this, she decided to ask NMCWatch to support her case moving forward. She knew this would mean she would no longer be covered by her union but felt it was important in order to get her CoP reviewed and potentially lifted – she had lost faith in her union. We made sure she didn’t take this decision lightly and took her time to decide. She discussed this with her supervisor. Once she had decided to let us help her we applied for an early review and mentored her to ensure she was building evidence to show a review was appropriate. This involved gathering testimonials from colleagues and managers, evidence of training, appraisals and PDP outcomes and up-to-date and thorough reflections, bridging the gap between the ones done immediately after the incident, at the suspension review hearings and now – evidencing how she grew.
This week (October 2022), six years after the original allegations and 5 years after she was first referred to the NMC, she attended the NMC for a review of her CoP. NMC Watch represented her case, and her supervisor attended to give evidence to give the panel insight into her journey.
The NMC did not oppose our view that the CoP should be lifted, however, they presented that the order should continue until the 18-month period was over and allow it to lapse – that would effectively be in two months’ time. The legal assessor clearly directed that if the panel felt there was ongoing impairment then the CoP should be continued, but if there was not, it should end.
At the end of the Substantive Order Review hearing, we were delighted to be told that the panel had decided to revoke the order with immediate effect, there were no ongoing concerns and she had shown sufficient insight and remediation to satisfy there was no further risk.
Key issues with this case:
- Inflexibility of the union representative in their approach
- Lack of direction given by the union on how to resolve employment issues with CoP
- Importance of peer-to-peer support
- Importance of tailored support in the workplace
- A holistic approach to ensure CoPs are achieved
- The need to set a realistic amount of time for registrants to both achieve but also embed the learning required during CoP assessments
- Mentorship includes pastoral support as well as clinical task achievement
Everyone deserves compassion and most can improve if they are only given a chance.
Each nurse or midwife will have their own pace at which to learn