000 days

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

Pushing forward

Mar 31, 2021 | Opinion, Reflection | 0 comments

Sitting in my garden reflecting on the last year, it’s lovely to see how we have reclaimed the simple things. Swinging on our swing seat, watching the dogs wrestle, listening to our stupid cockerel cockadoodledooing ( he even does it when it’s dark – he’s very confused ) and generally enjoying the slower pace is rather comforting. Our children have actually re-learnt how to entertain each other rather than needing constant entertainment from us which is always a bonus. Clubs and activities were ceased and replaced with playing in the garden, sadly tick tock and snap chat played a key role but the threats of mum and dad doing their own versions would soon get them logging off! Amazingly very few arguments which we need to bottle and save as a reminder when everything resumes back to normal and this time is a distant memory. Yesterday with the easing of restrictions, some of their friends came over albeit in small numbers, school assessment revision was quite gladly put aside  and we enjoyed seeing the familiar faces return to our garden, noise and mess not worried about as much as before. Fabulous to see normality resuming.

As I have had some enforced rest during lockdown my experience has been rather positive but am aware for so many it has been far from that. When I have had days of feeling rather glum at my slow recovery I have had to kick myself ( in the good leg!) and give myself a stiff talking to – I will recover, I am lucky. The time recuperating has enabled me to get some order to the support group work at NMCWatch also and really focus on what we will aim to achieve over the next year. So many of our group members remain in limbo during lockdown, unable to gain work as employers are fearful to employ whilst there is an ongoing investigation and those that do offer work then find themselves confused by Conditions of Practice orders that they will struggle to support even when not in a pandemic, but during one will be additionally challenging.  Being unable to gain employment during investigation becomes a double attack Catch 22 scenario, with the potential for the process itself to make the registrant “not fit for practice” by restricting their ability to work.

So as with everything we do at NMCWatch we try to look at potential solutions. It’s not easy but it is happening – slowly but surely.

Addressing the elephant in the room: employing the perceived unemployable

  1. A rather lovely Head of Nursing in East of England spoke to me nearly 18months ago about working on a pilot to support those with Conditions of Practice. She has been championing this in her network which includes advising to the CNO of England.
  2. This then moved to discussions with other peers of her level and also those at a higher level of our profession who may be able to influence and encourage particular employers to follow suit
  3. We surveyed our members, and continue to do so – last year we found 26% of those that got No Case to Answer left the profession which was extremely concerning with a further 26% remaining on the register but not working. As this survey has continued over to this year also the number has dropped to 19% but still significant  none the less
  4. We surveyed our members to find out how much of a problem trying to gain employment was and found it a common thread to have over 30 – 40 job applications before success – many times being successful at interview but then the offer withdrawn once HR did their checks
  5. We then talked to the NMC and Andrea Sutcliffe raised the issue with the Chief nursing Officer for England and well as the other CNO’s for
  6. Our regular meetings with the unions kept this at front of discussions but unfortunately no action plan has been commenced and now with pay disputes unlikely to for the near future.
  7. We then begun to talk to recruitment agencies to try to model out how a support program for those with restrictions on their practice might look like. We have commitment  of two currently: Avocet Staffing Ltd and Biolumineux Healthcare Solutions. 

“Why are you bothering?:

Whilst we do have a number of newly qualified nurses and midwives on our group, the majority have been practicing for well over a decade – many for more. Without support this pool of experience will be lost which is a travesty and something which can not be replaced by attracting more into the profession, despite what the government will tell you!

The key aspect of success has to be professional mentoring by peers who have been through the process.  Whilst the majority of mentorship and support will need to be provided in the workplace there is almost certainly a role for it from other sources as well. The agencies that we are working with, have lived experience of the process themselves so understand the reality of a referral to the NMC and also the impact a poor workplace placement can have. The also understand the intense challenges that employers face, pre, during and post pandemic and are very aware that to recruit a member of staff that needs additional support from the offset is a big ask.

Those external to our group will no doubt be cynical and fearful of what we are trying to do. I have had feedback  that it is a guise to help rogue practitioners “get off” or “dodge accountability” , completely understandable when you are a relative who has been at the receiving end of poor care and have battled for accountability for harm caused. We are as committed as anyone to ensure only safe practitioners return to practice. We are equally committed to acknowledging that there will be some on our group that will not be appropriate to get back to the workplace in this way. But we are also committed to recognising that many who are referred to the NMC have found themselves there as a result of a minor event, that has caused no harm, or a one off lapse of judgement that is unlikely to be repeated. But once referred to the NMC the treadmill begins and it is difficult for it to conclude positively without active evidence of current practice. Anyone that has been through FtP will tell you they are a  very different practitioner and person at the end of their process than they were when they begun – a shadow of their former self. I personally found I had regressed somewhat professionally when I returned to work and was extremely under confident and a fearful something which took a very talented team and management structure to support me until I regained my former self to some level.  For some the changes in them will be positive but for many it will have had an extremely destructive impact on their professional and personal confidence. By having peers who have been through the process to support and guide them, explain how they coped with day to day challenges and the techniques they used,  can be the difference between working again and not, making mistakes again and not.

With the removal of midwifery supervision, the impact of a stressed and reduced workforce making preceptorship and mentorship a luxury, if we are to retain and retrain rather than discard we need to be imaginative in how we approach those wanting to work either during or after FtP.

“What’s the problem if we lose a few?

There has been much discussion and excitement around the figures entering the profession, overseas nurse recruitment and such like. Whilst this is an appreciated element needed to address the issue of workforce, the term ” a leaky bucket” has also been raised . There seems little point bringing all of these new nurses and midwives into the profession if many leave due to a regulatory process that is restricting their ability to show safe and effective practice.

The other unrecognised aspect is that even if the nurse or midwife is attempting to gain employment in others areas of healthcare or external to healthcare eg support worker, healthcare assistant, paramedic, counsellor, dental hygienist etc the history of being referred to the NMC often will follow them and preclude employment regardless of whether the role applying for would be affected by the area investigated by the NMC. This will also apply even if a registrant has over turned a decision by the NMC eg strike off at High Court or restoration following acquittal in criminal court. It also follows after being restored to the register – online applications will often ask ” Have you ever been subject to investigation by your regulator ./ Have you ever been subject to disciplinary action”. A simple “yes” on a form can result in the application being discounted regardless of what additional information to explain is given. So, even being referred can have disproportionately adverse effects on your employability…

There needs to be a more person centred approach when looking at genuine issues which should be counterintuitive to employment on public safety issues, and those that with some more global thinking can still fulfil the regulatory concern but without jeopardising the Universal Declaration of Human Rights – Article 23 as below:

The assurance of public safety does not need to be done at the detriment of the human rights of the individual going through FtP. Nurses and midwives as a profession do generally not pursue challenges to decisions by authorise via the courts. This leads to a reactive relationship rather than a collaborative one and as such passivity develops as they begin to feel process is occurring to them without any ability to push back against it.

So the issue is extremely complex but can have key aspects that are simple to address.

  1. It is an issue about compassion and kindness.
  2. It is an issue about fairness and proportionality.
  3. It is an issue about protecting the  rights of everyone involved in process

As nurses and midwives, we are all members of the public too and do not relinquish our rights just because we join the profession – we deserve better.

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