Case Study 8: reflection + learning = No Case to Answer

Sep 1, 2022 | Case Studies


This nurse found herself referred to the NMC for two separate incidents (see case study 7) – the previous case was complicated and concluded after the hearing a year previously.

She had been qualified for seven years and worked in a care home. Whilst at work, a resident was standing in the corridor where two carers wanted to pass him to take another resident for a shower. However, the resident refused to move. Distraction techniques were used but did not work. A senior carer was asked to encourage them to move, so as not to block the slope leading to the shower room.

The two residents clashed verbally and there was some physical aggression towards staff by one. The nurse under investigation felt there may be a new clinical issue going on with the patient to make them aggressive and put things in place to investigate this. The situation escalated with agency staff being drawn in and gentle restraint was required whereby one resident suffered some bruising. A safeguarding referral was later made by a whistleblower accusing the nurse of patient harm and the police became involved.

This nurse resigned shortly after the incident and no disciplinary measures were taken against them; no further action was pursued by safeguarding or the police.

The case took a further year to conclude following the other incident described in Case Study 7 during which time she had had time off for ill health and a change in personal circumstances.

Gaining perspective

When we met this nurse she was in a delicate state mentally. Understandably the two referrals had caused her great emotional torment and she was extremely fragile. She was allocated a case manager who took time to support her professionally and psychologically to help her gather some direction and find a way through the process for both cases.

Through reflecting with her case manager, individual work done with professional mental health experts, and personal reflection, the nurse gained some perspective on events. She understood that she needed to show the NMC that her health had impacted events but that she was now a different person who had learned and remediated through the process.

There were times when the nurse was not able to engage, but with personalised support and by enabling her to control the pace of engagment, her mentor was able to witness her growing through the events.

By the time the case examiners reviewed her case, we were able to help her produce a robust portfolio that demonstrated she posed no current risk and was able to practice safely. She was able to recognise her limits as well as things to put in place should her mental health struggle again in the future.

The journey for this nurse has been tough, but she has persisted, accepted her vulnerabilities and accepted what she can and can’t change. She received a No Case To Answer and is now returning to work and rebuilding her life.

This case study has shown us the following:

  • With support, healthcare professionals with mental health issues can continue to play a powerful and professional contribution to our workforce. BUT they are at high risk of leaving the profession if they do not receive a holistic approach to their support
  • A lengthy investigation can sometimes give the registrant the necessary time to pause, heal, learn and show remediation
  • The NMC need to hold a responsibility to safeguard registrants against harm and risk-assess those with pre-existing conditions
  • NMC should provide guidance to a potential referrer as to how the incident could be handled to avoid a referral
  • Ongoing support will be needed even after a No Case to Answer outcome

“There are some seriously amazing people in this world and Cathryn and Simon are both sitting proudly at the top of them! Special people who are the most supportive and caring individuals. Just off to sob as the 2nd case is dropped and I am finally FREE!!!”


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