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

Case Study 9: reflection leads to positive outcome

Sep 14, 2022 | Case Studies

Riva was referred to the NMC in September 2020 by a previous employer, identifying a number of concerns in regard to medicines management, care of the deteriorating patient, wound care and documentation. The incidents occurred in a workplace that he had worked in since coming to the UK in 2018 on a sponsored visa. He had complied with a local investigation at the time, during which there was a coroner referral and had outlined that some of his mistakes were due to being unfamiliar with local policy.

The referral occurred after he left employment.

Riva approached NMCWatch after being told of us through the Filipino nursing association. As his case was early on in the process we were able to mentor him to understand more about the process and what the NMC needed him to demonstrate. We worked with him in one-to-one sessions to help him structure his response to the allegations and provide further context. We also explained to him about reflections and how to look at each individual allegation separately, from a step-back approach and to show the NMC what he had learnt since the incident. He had been working for a new employer for some time and this employer was extremely supportive of him, offering testimonial to confirm that there was no current ongoing risk.

The NMC guidance states:

“…we do not “always need to comment on each individual piece of evidence about each separate issue in [our] decision, because the case to answer decision is about our concerns about the nurse, midwife and nursing associate’s fitness to practise as a whole, rather than individual factual scenarios.”

This is difficult for registrants to understand as it can feel on paper that the evidence is doing just the opposite of this.

They also go on to state that:

“Our role is to make final decisions about whether the incidents or issues in the case did or didn’t happen.” …as such we do not “test the evidence”… “we look carefully at the overall weight, or impression, of the evidence as a whole.”

Again this is an area we will try to explore more so that we can explain what it means to our members but may give some explanation as to why the nature of NMC investigations do not orientate around “root cause analysis” or a neutral investigation. Instead, it is about establishing if there is enough evidence to establish for the case to proceed.

Riva denied some of the allegations as he felt the way they were structured could not allow a yes or no response. Instead, he completed a context form to give further information about what occurred around events. This was a form that had not been given to him readily by the NMC but one that we had advised him to request to assist with the evidence he presented to the NMC.

Other concerns were admitted by Riva and he reflected heavily and appropriately on them. This was acknowledged by the NMC and given appropriate weight.

The NMC use their guidance to help make their decisions on Taking account of context. The guidance says:

“When things go wrong, it can be easy to assign blame rather than take the time to understand why something happened and what can be done to prevent it from happening again.

This means we need to look beyond the actions of an individual and understand the role of other people, the culture and environment they were working in when something went wrong. Only then can we identify what needs to happen to keep people safe in the future – even if we’re not the ones who can take that action.”

Some of the context taken into consideration was that this nurse trained overseas and that there were some transitional and cultural issues that played a part in how he was treated and how he found it difficult to assert himself with an employer that had sponsored his arrival in the UK. With many overseas nurses being brought to the UK to assist with our staffing crisis, caution needs to be taken on ensuring they are supported not punished when struggling to adapt to a new working environment. Caution also is needed to ensure that any institutional bullying or conflict is not being ignored.

After 2 years of process, Riva is relieved the case is now over. He can continue working at his new employer, who has been aware of the investigation throughout but supported him.

This case study has shown the following lessons:

  • It is important for registrants to admit their mistakes rather than blame others and show they have learnt to avoid them happening again
  • Providing context early on can assist the  NMC in closing a case early
  • A nurse or midwife may be more likely to engage if they have peer-to-peer support
  • Having an employer who supports you through the process is vital to show no current risk and help address any outstanding areas to improve on
  • Previous employers may still use the NMC FtP process to punish old employers which the NMC need to be aware of and advise on
  • It is important for registrants to admit their mistakes rather than blame others and show they have learnt to avoid them happening again
  • Whilst the screening, case examiner and early parts of the FtP process are improving to be more person-centred, this is still not routine. Therefore registrants need advice that will prepare them to be informed of what they need to do to get a positive outcome.

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