What should happen to a nurse who did not escalate concerns about two vulnerable patients? | Nursing Times

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Nurse A, who was working as a director and care manager, was referred to the Nursing and Midwifery Council after concerns reported to them by colleagues were not escalated

The charges

That Nurse A:

1. In relation to Patient A:

a. On being informed that the patient may have a urinary infection, failed:

i. To assess the patient;

ii. To escalate these concerns to the social work department;

b. On being informed that the patient had mobility difficulties, failed:

i. To assess the patient;

ii. To escalate these concerns to the social work department;

2. In relation to Patient B, on being informed that the patient may not be taking their medication, failed:

a. To assess the patient;

b. To escalate these concerns to the social work department.

The background

When the allegations arose, Nurse A was employed as a director and care manager to whom any concerns would be raised. Their responsibility was to take any action required. In the case of clients referred by the social work department, the department ought to have been notified of any concerns or changes as they might affect the care package provided.

In the case of Patients A and B it is alleged that carers reported concerns to Nurse A and that they failed to assess these clients and also failed to escalate these concerns to the social work department.

At the hearing

The NMC’s representative outlined the background to Nurse A’s case. They submitted it was more likely than not that Nurse A had failed to escalate three concerns to the social work department. They submitted that Witnesses 1, 2 and 3 were consistent in their evidence in that they had all encountered issues with clients and had repeatedly told Nurse A of these concerns and that nothing happened. The representative submitted that this “fits” with the evidence of Witness 4 who said that they could not find any records of calls to the social work department.

The NMC’s representative submitted that Nurse A had a duty to inform the department of any concerns with clients and that Witness 5 had told the panel that they would expect the department to be informed of any change noted in a client’s circumstances. Nurse A admitted charges 1a(i), 1b(i) and 2a, which were announced as proved. The panel then considered the remaining charges. Charges 1a(ii) and 1b(ii) were found proved. Charge 2b was found not proved.

The panel found that Nurse A’s actions fell significantly short of the standards expected of a nurse. It was of the view that Nurse A’s failures to escalate the concerns raised about Patient A, who was vulnerable, were serious enough to amount to misconduct.

The panel determined that Nurse A’s failures had in the past put patients at risk of harm and they failed to deliver the fundamentals of care to vulnerable patients by failing to assess them.

The panel took account of Nurse A’s written response to the concerns sent to the NMC. It considered that, although there was a limited degree of insight in this documentation, Nurse A blamed other factors for their failings. The panel considered that nothing else before it suggested that Nurse A had developed sufficient insight into their failings.

The panel was of the view that there was a risk of repetition based on the lack of insight into the misconduct or any evidence of remediation of their failings. The panel considered that the public would expect Nurse A to have acted on the concerns raised to them regarding the care of two vulnerable patients. The panel determined that, in this case, a finding of impairment on public interest grounds was required. The panel was satisfied that Nurse A’s fitness to practise was impaired.

Results of the fitness-to-practise panel

The FtP panel can impose four different sanctions:

  • Caution: the nurse or midwife is cautioned for their behaviour, but is allowed to practise without restriction
  • Conditions of practice: this will prevent a registrant from carrying out certain types of work or working in a particular setting, it may require them to attend occupational health or do retraining. The order can be applied for up to three years and must be reviewed by an FTP panel again before expiry
  • Suspension: the nurse or midwife will be suspended from practice for a period of initially not longer than one year, but this can be extended after review by an FTP panel
  • Striking off: a nurse or midwife is removed from the register and not allowed to practise in the UK. The nurse or midwife must apply to be readmitted to the register

Share what you believe is the right action for the NMC panel to take below and then find out what they decided: Final panel decision and reasons

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