000 days

since the NMC committed to investigate its ‘established procedures’. We’re still watching!

Case Study 12 – ET + FtP complications

Nov 2, 2022 | Case Studies

Stella was referred to the NMC in August 2021 for a number of concerns regarding conduct during the Covid-19 pandemic. As many readers will remember this was an extremely difficult time for everyone working in Healthcare and there were a few well-publicised records of healthcare practitioners being vocal about the use of PPE usage and other measures such as vaccinations.

Stella was reported for communicating her opinions about the pandemic to colleagues, communicating some of those opinions to patients and potentially attending work with Covid symptoms. At the same time the NMC case was running, she was going through an Employment Tribunal as she and her legal representative felt that the local investigation outcome was unfairly having a negative impact on the investigation by the NMC.

We supported this nurse through the legal advocacy of NMC watch and advocated for her through both the ET process and the NMC. This was extremely challenging, especially as the timeframes of both organisations were varied and required many hours of preparation without a guarantee of the preparatory work being heard. Alongside her legal representative, she was allocated a buddy on the buddy support scheme. We also had a case worker to help coordinate and guide her on the preparation she would need to undertake to present her explanations and version of events to the NMC when the time came.

When the allegations were looked at in isolation they appeared rather shocking but through careful mentoring, we were able to establish the context around the incidents. We were also able to get to the core of this nurse’s true opinions and establish that what was being portrayed was not her thought process. She was able to show that she was a safe practitioner, who may have voiced opinions to colleagues, but only as part of a usual 2-way discussion where lots of controversial topics were often discussed. The conversations had potentially been taken out of context but when put in with the other allegations painted a picture of someone who we felt this nurse was not.

We worked with her to provide a robust portfolio to show she was strengthening her practice and even if errs had occurred in the past she was a more improved practitioner now.

The NMC states that

“our guidance identifies key criteria that a nurse, midwife or nursing associate will usually be able to demonstrate if they have insight.

For example:

  1. recognising what went wrong
  2. accepting their role and responsibilities and how they are relevant to what happened
  3. understanding how to act differently in the future to avoid similar problems happening.”

They felt that the information provided did show acknowledgement of points 1 & 2, in that she accepts she behaved unprofessionally but that even though she was trying to advocate for patients she realised now, by looking back that it may have caused anxiety in colleagues and others. Just over a year after her referral, the NMC came back with their decision. She also acknowledged that she allowed her deteriorating relationship with her line manager to affect her judgement and how she handled the situation. Ultimately through all of this, she showed what she would do differently if similar events occurred in future and how she would act next time in a different way.

Just over a year after referral, the case was to be closed with No Case To Answer. However, the NMC did decide that a warning would be put on her record. The warning remains on her record for 12 months so the NMC can demonstrate that should there be any repetition the case can be reopened and reexamined. Although it’s a relief to hear that the case is closed, the registrant struggles with knowing that her record will still contain a warning.

This case outlines:

  • The importance of a close working relationship between the registrant, advocate mentor and legal representative to decipher the behaviour from the allegations and assist in transcribing this effectively to the NMC
  • The ease of allegations being formulated on the basis of assumption rather than fact – the assumption was that this registrant was potentially in league with others holding anti-vax beliefs but this was far from the truth. She believed she was positively challenging and questioning, however, colleagues were not able to hear it as this.
  • Working during unique clinical situations such as a pandemic can heighten anxiety and make professionals behave in a way they may not usually behave in given other circumstances.
  • If the NMC deem that there is indeed no case to answer is it really fair to then place a warning on the record – does this translate to those reading “no smoke without fire” – a culture we are trying to get away from rather than move back to? Does it ultimately hold power over the registrant that is an unfair weight on their shoulders?
  • With the new employer link service, the NMC is supposed to only really kick in when the employer feels there still poses an ongoing clinical risk. This nurse is not currently working, but awaiting Employment Tribunal, which had a hearing scheduled for the week that the NMC decision was sent out, it was postponed a couple of days before.
  • Cynical readers may say that the two processes work closely together and having a 12-month warning in place, despite no case to answer, gives the NMC the ability to reopen if the ET outcome is negative. Time will tell.

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