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Case Study 6: leaving the register despite CoP

Nov 22, 2021 | Case Studies

This nurse finally concluded their Fitness to Practice experience with removal from the register – but this time she was in charge of how and when.

The incidents occurred over 4 years ago and she had been through a prolonged process since then. She had been subject to Conditions of Practice for a number of years but found it impossible to get employment with them in place. She would admit that for the first couple of years, she was in a difficult place mentally – struggling with the process and the impact it had on her and the injustice of it all. She also experienced a marriage break up which brought challenges around personal responsibilities. Elderly relatives who previously could be relied upon for childcare became ill. However, with some gentle mentoring and support, we were able to slowly get her to a place she felt able to return to a different way of working as well as to start contemplating applying for work.

Shortly before one of her reviews, she secured employment as a nurse and it finally looked as though she would be able to work with the CoP in place. Sadly this was not meant to be. Despite best efforts and the new employer being fully aware of the poor culture she had experienced which contributed to the incidents, her new manager received a poor reference and, as the new employer was risk-averse, could not disregard it, despite its vexatious nature. This is completely understandable – it is a leap of faith for employers to take nurses on who are subject to CoPs. They will always worry about making the wrong choice to take someone on who has restrictions, as opposed to someone that doesn’t.

It was a big blow to the nurse as she thought, after such a long period of time, that she may stand some chance of getting her nursing back on track. She was due to revalidate in a few weeks but hoped that with an extension granted on the basis that she was working, she would be able to fulfil the requirements. The withdrawal of the job offer meant that this opportunity was gone and she resigned herself to realising that a return to nursing was now not an option.

We attended her CoP review hearing with her and presented these facts to the panel:

  • thorough reflection showing insight on the concerns raised from 2014 – 2017
  • challenges faced that prevented her demonstrating remediation other than theoretical and not practical
  • the wish to remove from the register rather than being exposed to ongoing hearings that she felt she had no hope to end

This was a learning curve for us all as whilst there is an order in place and in theory the case has not concluded, a nurse or midwife can not remove themselves from the register – a Catch22-type scenario. Whilst it is completely understandable that the process is there to protect the public, it feels as though there is little to protect and safeguard the registrant from additional harm caused by continuing to engage in a process when you have no intention of working again.

The panel were very understanding, after input from the legal assessor, they suggested a short interim order that would cover the period of time until her revalidation date had passed. After that time the panel could reconvene and if the registrant still intended to leave they could allow the order to lapse on its completion. We explained that even if the registrant were able to secure a nursing role the day after the hearing, completing the 450 practice hours and the 35 hours of CPD needed by the revalidation extension date would be impossible.

The final hearing date is set – the nurse has notified the case officer that she will not be present or represented and still intends to not continue on the register. She has secured employment as a carer which she loves and has confirmed that she can be a valuable healthcare professional without being a nurse. She is happy with her decision – it has been a process in itself and we hope we have helped her come to the decision with the support and mentorship we have offered.

The last email from the NMC Case officer was interesting though and outlined the requirements of a registrant, in order for the panel to “consider” lapsing registration. This included:

  1. Evidence of new employment (or that you are seeking employment in a new field)
  2. Letters from medical professionals evidencing a long-term health condition that would prevent you from returning to work
  3. Documents to show you have retired (such as pension payslips)
  4. A signed declaration stating that you will not apply for readmission to the register for at least 5 years
  5. A detailed statement clearly setting out your current situation and your future intentions focusing specifically on work as a registered nurse or work in any other area which does not require registration with the NMC.

We challenged this with the case officer, especially around the first point – why does the NMC need to know about employment if it is not in nursing – they do not have any remit over non-nursing roles.

The email felt like another example of the NMC not believing what they are being told about a registrant and wanting, even when the career is over, to maintain control in a somewhat paternalistic manner. The registrant has made it clear she will not be providing any more information than she has already. It feels, once again that a nurse or midwife’s PIN is not actually theirs but almost on loan to them – a bizarre concept.

The lessons we would like to pass on from this are:

  • you do have choices
  • the choices are yours
  • walking away is a success, not a failure

More information is available on the NMC website.

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