conduct and competence committee€¦ · 16. on or around 29 october 2015, you submitted a job...

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Conduct and Competence Committee Substantive Hearing

Monday 20 March 2017 And

Tuesday 21 March 2017 And

Wednesday 22 March 2017 And

Thursday 23 March 2017 And

Friday March 2017 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ

Name of Registrant Nurse: Joanne Waldron NMC PIN: 13I6379E

Part(s) of the register: Registered Nurse – sub part 1

Area of Registered Address: England

Type of Case: Misconduct/Lack of Competence

Panel Members: Emma Boothroyd (Chair Lay member)

Sandra Lamb (Registrant member)

Catherine Askey (Registrant member)

Legal Assessor: Ian Partridge

Panel Secretary: Aadil Anwar Ms Waldron: Not present and not represented

Nursing and Midwifery Council: Represented by Tom Orpin-Massey, counsel,

instructed by NMC Regulatory Legal Team.

Facts proved: 1.1, 1.2, 1.3, 1.4 1.5, 2, 3.1, 3.2, 4, 6.3, 6.5,

6.7, 7.2, 8.1, 9.2, 10, 11.1, 13.1, 15, 5.1, 5.2,

5.3, 5.4, 6.1, 6.6, 6.8, 6.9, 6.10, 7.1, 7.3, 7.4,

8.2, 12.1, 12.3, 13.2, 13.3, 14

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Facts proved by admission: 1.1, 1.2, 1.3, 1.4 1.5, 2, 3.1, 3.2, 4, 6.3, 6.5,

6.7, 7.2, 8.1, 9.2, 10, 11.1, 13.1, 15

Facts not proved: 5.2, 6.2, 6.4, 9.1, 9.3, 9.4, 10.1, 11.2, 12.2, 16,

17

Fitness to practise: Impaired

Sanction: Strike-off order Interim Order: Interim suspension order (18 months)

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Details of charge:

That you while employed by the Salford Royal NHS Foundation Trust as a Band 5 Staff

Nurse at the Salford Royal Hospital failed to demonstrate the standards of knowledge,

skill and judgement required to practise without supervision as a Community Nurse

between July 2013 and 3 September 2015 in that you:

1. On 5 July 2014:

1.1. Intended to administer oramorph instead of oxynorm to an unknown patient

1.2. Had to be prompted to record the administration of oxynorm

1.3. Did not know why fluoxetine had been prescribed to an unknown patient

1.4. Did not complete a medication round within a reasonable amount of time

1.5. Did not handover that an unknown patient was due to receive a Vitamin K

infusion overnight

2. On or around 27 February 2015, mixed an incorrect dose of vancomycin for an

unknown patient

3. On an unknown date in February or March 2015:

3.1. were unable to state what rate vancomycin should have been administered

for an unknown patient

3.2. were unable to explain what the contraindications were of giving medication

over a shorter period of time

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4. Around April / May 2015, incorrectly prepared flucloxacillin instead of amoxicillin


5. On 4 June 2015, during a supervised day shift:

5.1. Did not check a patient's identity before dispensing their medication

5.2. Did not ensure that an unknown medication you had dispensed was checked

by Ms 2

5.3. Did not follow a structured process when you completed your nursing

documentation

5.4. Did not hoist an unknown patient and / or prepare an IV fluid when you had

been requested to do so

6. On 11 June 2015, during a supervised day shift

6.1. Dispensed and / or recorded that you had administered paracetamol when

you were not being supervised

6.2. Incorrectly stated that there were no salbutamol nebulisers available from the

pharmacy when there were

6.3. Did not record that an unknown patient's salbutamol nebuliser had been

administered

6.4. Used abbreviations that were not recognised by the Trust

6.5. Did not inform a patient that they were due to be transferred

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6.6. Incorrectly recorded entries in patients' notes under Staff Ms 7’s name instead

of your own

6.7. Did not record the administration of codeine to an unknown patient

6.8. Incorrectly stated that you could not administer phosphate tablets as there

were none available

6.9. Incorrectly administered one tablet of lansoprazole instead of two

6.10. Did not complete a lines and devices flow chart and / or a stool chart for an

unknown patient

7. On 13 June 2015:

7.1. Discharged a patient when you were not being supervised and / or without

their analgesia

7.2. Used the wrong cuff size when taking Patient A's blood pressure

7.3. Did not check Patient A's dressing to ensure that there was no bleeding

7.4. Did not ensure that Patient A was given pain relief after you were informed

that Patient A was in pain at approximately 13:00 and / or 14:00

8. On 23 June 2015:

8.1. Required prompting to check patients' identities when administering

medication

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8.2. Required prompting to check whether VSL3 could be administered to an

unknown patient who was on a restricted oral intake

9. On 24 June 2015:

9.1. Incorrectly offered an unknown patient a dose of codeine when they were

already prescribed dihydrocodeine

9.2. Did not sign the controlled drugs book to record that you had administered

morphine to an unknown patient

9.3. Used the abbreviation "PO bloods" which is not recognised by the Trust

9.4. Incorrectly informed an unknown patient when they were discharged that they

were prescribed morphine instead of paracetamol and codeine

10. On 10 July 2015:

10.1. Did not ensure that an unknown patient was wearing their anti-embolism

stockings as prescribed

10.2. Were unable to explain why thiamine was highlighted on an unknown

patient's prescription chart

11. On or around 16 July 2015:

11.1. Intended to administer a dose of paracetamol to an unknown patient when the

patient had already received four doses of paracetamol

11.2. Administered a dose of oral analgesia when you had not removed an

unknown patient's patient controlled analgesia ("PCA")

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12. On 30 July 2015:

12.1. Incorrectly administered one tablet of thiamine to an unknown patient instead

of two tablets

12.2. Offered an unknown patient pain relief medication when the patient was

already prescribed PCA

12.3. intended to remove a patient's surgical drain when it was not due to be

removed

13. On 11 August 2015:

13.1. Recorded that you had administered tramadol to an unknown patient when

you had not

13.2. Did not conduct and / or record any observations for Patient B between

approximately 08:00 and 19:56

13.3. Recorded that you had conducted Patient B's observations at 15:55 when you

had not

14. Your actions at Charge 13.3 were dishonest in that you knew that you had not

conducted Patient B's observations but you attempted to make it appear as

though you had

15. In or around August 2015, inappropriately sent a message to Sister Ms 5 via

social media which said "Am sure [Ms 10] will be happy with what you have

achieved today".

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16. On or around 29 October 2015, you submitted a job application and CV which did

not reflect the reason for leaving your previous employment

17. Your actions at charge 16 above was dishonest, in that you deliberately omitted

the reason for leaving

AND, in light of the above, your fitness to practise is impaired by reason of

your lack of competence (charges 1 to 12) and/or misconduct (charges 13 to

17).

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Decision on Service of Notice of Hearing: The panel was informed at the start of this hearing that Ms Waldron was not in

attendance and that written notice of this hearing had been sent to Ms Waldron’s

registered address by recorded delivery and by first class post on 16 February 2017.

Royal Mail “Track and Trace” documentation confirmed that the notice of hearing was

sent to Ms Waldron’s registered address by recorded delivery on that date.

The panel took into account that the notice letter provided details of the allegation, the

time, dates and venue of the hearing and, amongst other things, information about Ms

Waldron’s right to attend, be represented and call evidence, as well as the panel’s

power to proceed in her absence. The “Track and Trace” documentation also indicated

that the notice was received and signed for by Ms Waldron on 17 February 2017. Mr

Orpin-Massey submitted the NMC had complied with the requirements of Rules 11 and

34 of the Nursing and Midwifery Council (Fitness to Practise) Rules 2004, as amended

(“the Rules”).

The panel accepted the advice of the legal assessor.

In the light of all of the information available, the panel was satisfied that Ms Waldron

has been served with notice of this hearing in accordance with the requirements of

Rules 11 and 34. It noted that the rules do not require delivery and that it is the

responsibility of any registrant to maintain an effective and up-to-date registered

address.

Decision on proceeding in the absence of the Registrant: The panel had regard to Rule 21 (2) (b) which states:

“Where the registrant fails to attend and is not represented at the hearing, the

Committee...may, where the Committee is satisfied that the notice of hearing has

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been duly served, direct that the allegation should be heard and determined

notwithstanding the absence of the registrant...”

Mr Orpin-Massey invited the panel to continue in the absence of Ms Waldron on the

basis that she had voluntarily absented herself. Mr Orpin-Massey submitted that Ms

Waldron had confirmed to the NMC she had received the documentation and indicated

that she did not intend to attend the hearing. Ms Waldron had provided written

responses for the panel to consider and asked for a decision to be made on the papers.

He submitted that an adjournment would not secure her attendance on some future

occasion.

The panel accepted the advice of the legal assessor. The panel noted that its

discretionary power to proceed in the absence of a registrant under the provisions of

Rule 21 is one that should be exercised “with the utmost care and caution” as referred

to in the case of R. v Jones (Anthony William), (No.2) [2002] UKHL 5. The panel further

noted the case of R (on the application of Raheem) v Nursing and Midwifery Council

[2010] EWHC 2549 (Admin) and the ruling of Mr Justice Holman that:

“...reference by committees or tribunals such as this, or indeed judges, to

exercising the discretion to proceed in the person's absence "with the utmost

caution" is much more than mere lip service to a phrase used by Lord Bingham

of Cornhill. If it is the law that in this sort of situation a committee or tribunal

should exercise its discretion "with the utmost care and caution", it is extremely

important that the committee or tribunal in question demonstrates by its language

(even though, of course, it need not use those precise words) that it appreciates

that the discretion which it is exercising is one that requires to be exercised with

that degree of care and caution.”

The panel noted the e-mail correspondence from Ms Waldron dated 22 February 2017

in which she stated “I have given my replies and explanations and do not plan to attend

the meetings due to personal circumstances. A decision will have to be made on written

statements only.”

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The panel has decided to proceed in the absence of Ms Waldron. In reaching this

decision, the panel has considered the submissions of the case presenter, and the

advice of the legal assessor. It has had particular regard to the factors set out in the

decision of Jones. It has had regard to the overall interests of justice and fairness to all

parties. It noted that:

• no application for an adjournment has been made by Ms Waldron and there is no

reason to suppose that adjourning would secure her attendance at some future

date;

• Ms Waldron herself stated in an email dated 22 February 2017 that she will not

be attending today’s hearing;

• Seven witnesses have attended today to give live evidence;

• not proceeding may inconvenience the witnesses, their employer(s) and, for

those involved in clinical practice, the clients who need their professional

services;

• the charges relate to events that occurred in 2014/15;

• further delay may have an adverse effect on the ability of witnesses accurately to

recall events;

• there is a strong public interest in the expeditious disposal of the case.

There is some disadvantage to Ms Waldron in proceeding in her absence. She will not

be able to challenge the evidence relied upon by the NMC and will not be able to give

evidence on her own behalf. However, in the panel’s judgment, this can be mitigated.

The panel can make allowance for the fact that the NMC’s evidence will not be tested

by cross examination and, of its own volition, can explore any inconsistencies in the

evidence which it identifies. Furthermore, the limited disadvantage is the consequence

of Ms Waldron’s decisions to absent herself from the hearing, waive her rights to attend

and/or be represented.

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In these circumstances, the panel has decided that it is fair, appropriate and

proportionate to proceed in the absence of Ms Waldron. The panel will draw no adverse

inference from Ms Waldron’s absence in its findings of fact.

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Decision and reasons on application to amend charge

The panel heard an application made by Mr Orpin-Massey, on behalf of the NMC, to

amend the wording of some of the charges. In relation to the stem of the charges, Mr

Orpin-Massey asked the panel to delete the words “as a Community Nurse”. In relation

to charge 6.9, Mr Orpin-Massey asked the panel to add the words “to an unknown

patient”. In relation to charge 9.2, Mr Orpin-Massey asked the panel to add the words

“until prompted” at the end of the charge. In relation to charge 16, Mr Orpin-Massey

applied for the charge to be amended for it to read: “On or around 29 October 2015, you

applied for a job at Peel Care without disclosing the circumstances for your leaving your

employment with the Salford NHS Foundation Trust.”

It was submitted by Mr Orpin-Massey that the proposed amendments would provide

clarity and more accurately reflect the evidence.

The panel accepted the advice of the legal assessor that Rule 28 of the Rules states:

28 (1) At any stage before making its findings of fact …

(i) … the Conduct and Competence Committee, may amend

(a) the charge set out in the notice of hearing …

unless, having regard to the merits of the case and the fairness of the

proceedings, the required amendment cannot be made without injustice.

In relation to the proposed amendments with respect to the stem of the charges, charge

6.9 and charge 9.2, the panel was of the view that such amendments, as applied for,

were in the interest of justice. The panel was satisfied that there would be no prejudice

to Ms Waldron and no injustice would be caused to either party by the proposed

amendments with respect to the stem of the charges; charge 6.9 and charge 9.2 being

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allowed. It was therefore appropriate to allow the amendments, as applied for, to ensure

clarity and accuracy.

With respect to the proposed amendment to charge 16, for it to read: “On or around 29

October 2015, you applied for a job at Peel care without disclosing the circumstances

for your leaving your employment with the Salford NHS Foundation Trust”.

The panel considered the advice of the legal assessor who reminded the panel of the

tests and to bear in mind whether the amendment could be made without injustice. The

panel considered the charge, as currently drafted, was not capable of proof as there

was no such CV or application form in evidence. This allegation had been disclosed to

Ms Waldron very late in proceedings and she provided her response denying the

charge and explaining she had told the manager at Peel Care about her circumstances.

The proposed amendment would significantly alter the charge and widen its scope by

placing a duty on Ms Waldron to have disclosed the reason for leaving her previous

employment of her own volition when applying for the job. This had not been put to Ms

Waldron and she had not been able to comment. Accordingly, the panel did not

consider that the amendment could be made without injustice to Ms Waldron and so

refused the application.

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Decision on the findings on facts and reasons In reaching its decisions on the facts, the panel considered all the evidence adduced in

this case together with the submissions made by Mr Orpin-Massey, on behalf of the

NMC and those made by Ms Waldron in her written response to the NMC dated 2

November 2016 and 20 March 2017.

The panel heard and accepted the advice of the legal assessor.

The panel was aware that the burden of proof rests on the NMC, and that the standard

of proof is the civil standard, namely the balance of probabilities. This means that the

facts will be proved if the panel was satisfied that it was more likely than not that the

incidents occurred as alleged.

The panel has drawn no adverse inference from the non-attendance of Ms Waldron.

Background

Allegations arose whilst Ms Waldron was employed at the Salford Royal NHS

Foundation Trust (the Trust). Ms Waldron first qualified as a nurse in 2013 and in

September of that year commenced employment with the Trust. She was taken on as a

Band 5 Newly Qualified Staff Nurse at the Salford Royal Hospital, where she started on

Ward 5. Ward 5 was a short stay pre and post-surgical ward.

On starting at the Hospital Ms Waldron completed a three week preceptorship period,

which was classroom based, in which she and fellow new starters learned about the

record keeping systems used by the hospital. She passed this training period and

started work on Ward 5 on 7 October 2013 on a supernumerary basis.

Concerns arose at to the Ms Waldron’s capability to perform her job to the standard

required of a Band 5 Nurse early in her employment. She seemed overwhelmed by her

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work. These concerns persisted, and chiefly concerned record keeping deficiencies,

mistakes in the administration of medicine, effective communication and time-

management. These concerns gave rise to numerous allegations – set out in the

charges above.

In reaching its decisions on the facts, the panel took into account all the oral and

documentary evidence in this case. The panel heard oral evidence from seven

witnesses called on behalf of the NMC: Ms 1, Ward Manager at Ward H5; Ms 2,

Practice Trainer at the Trust; Ms 3, Staff Nurse; Ms 4, Staff Nurse; Ms 5, Ward Sister;

Ms 6, Team Leader for General Surgery and Ms 11 Ward Matron on Ward B2.

In Ms Waldron’s written response to the charges, she admitted the following charges;

1. On 5 July 2014:

1.1. Intended to administer oramorph instead of oxynorm to an unknown patient

1.2. Had to be prompted to record the administration of oxynorm

1.3. Did not know why fluoxetine had been prescribed to an unknown patient

1.4. Did not complete a medication round within a reasonable amount of time

1.5. Did not handover that an unknown patient was due to receive a Vitamin K

infusion overnight

2. On or around 27 February 2015, mixed an incorrect dose of vancomycin for an

unknown patient

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3. On an unknown date in February or March 2015:

3.1. were unable to state what rate vancomycin should have been administered


3.2. were unable to explain what the contraindications were of giving medication

over a shorter period of time

4. Around April / May 2015, incorrectly prepared flucloxacillin instead of amoxicillin



6.3 Did not record that an unknown patient's salbutamol nebuliser had been

administered

6.5 Did not inform a patient that they were due to be transferred

6.7 Did not record the administration of codeine to an unknown patient

7. On 13 June 2015:

7.2 Used the wrong cuff size when taking Patient A's blood pressure

8. On 23 June 2015:

8.1 Required prompting to check patients' identities when administering medication

9. On 24 June 2015:

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9.2 Did not sign the controlled drugs book to record that you had administered

morphine to an unknown patient

10. On 10 July 2015:

10.2 Were unable to explain why thiamine was highlighted on an unknown patient's

prescription chart


11.1 Intended to administer a dose of paracetamol to an unknown patient when the

patient had already received four doses of paracetamol

13. On 11 August 2015:

13.1 Recorded that you had administered tramadol to an unknown patient when you

had not

15. In or around August 2015, inappropriately sent a message to Sister Ms 5 via

social media which said "Am sure [Ms 10] will be happy with what you have

achieved today".

These were therefore announced as proved by way of admission.

The panel then went on to consider the remaining charges.

The panel considered each charge and made the following findings:

Charge 5:


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5.1 Did not check a patient's identity before dispensing their medication

This charge is found proved.

In reaching this decision, the panel took into account the Feedback Report of Ms 2

dated 4 June 2015 in which she was clear that Ms Waldron “did not check for a name

band” or ask the patient to state their name and date of birth before she dispensed the

patient’s medication. The panel determined that as a Registered Nurse, Ms Waldron

would have been expected to check the patient’s identity on the wristband and by

asking the patient to provide their own identifying information of name and date of birth

for Ms Waldron to cross check with the drug prescription. The panel determined that

although Ms Waldron, in her written response says that she did check the patient’s

identity, the panel held that this was not a thorough check by the standards expected of

a Registered Nurse. It accepted Ms 2’s evidence that Ms Waldron did not ask the

patient to confirm the name and date of birth and considered that looking at the

wristband was not enough.

The panel accordingly found this charge proved.

5.2 Did not ensure that an unknown medication you had dispensed was checked by

Ms 2

This charge is found not proved.

In reaching this decision, the panel took into account the written response of Ms

Waldron in which she stated that she “held it up but not closely enough for her opinion”.

The panel noted that the charge itself (due to the word “ensure”) places a burden upon

Ms Waldron to ensure that Ms 2 has checked the dispensed medication. The panel

determined that it would be reasonable for someone standing next to Ms Waldron to

have seen the medication that had been dispensed by her. The panel acknowledged

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that this is a subjective matter as Ms 2 may herself have wished to have specific sight of

the dispensed medication but that Ms Waldron may not have been aware of Ms 2’s

expectation that the dispensed medication was checked by her in this way.

The panel also bore in mind the information contained in the Feedback Report of Ms 2

dated 4 June 2015 in which she stated that Ms Waldron “did not show me the pack she

was using or the strip of tablets inside it”. In light of this, the panel determined that it is

implicit that Ms 2 was present at the time the medication was dispensed. The panel

determined that the onus would have been upon Ms 2 to ensure that her expectation of

what Ms Waldron was required to do was communicated at the outset of the drug

administration round.

Accordingly, the panel found this charge not proved.

5.3 Did not follow a structured process when you completed your nursing

documentation


The panel noted that Ms Waldron in her written response did accept that she did not

follow a structured process when completing her nursing documentation but this was

due to [private]. The panel accepted Ms 2’s oral evidence that Ms Waldron was moving

between patient records when completing them which made it likely that something

would be missed. The panel, on a factual basis, found this charge proved.

5.4 Did not hoist an unknown patient and / or prepare an IV fluid when you had been

requested to do so


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The panel determined that Ms Waldron knew of the requirement for her to hoist the

patient and to prepare an IV fluid but did not do so. The panel noted Ms Waldron’s

response “If I was given the chance to finish what I was doing I would have”. The panel

accordingly found the charge proved in both aspects.

Charge 6:

6. On 11 June 2015, during a supervised day shift

6.1 Dispensed and / or recorded that you had administered paracetamol when you

were not being supervised


The panel bore in mind Ms Waldron’s explanation that Ms 2 “kept going away” and that

she completed the documentation “and waited for her”. The panel also considered the

evidence of Ms 2 that Ms Waldron “dispensed paracetamol for a patient without being

supervised and signed the patient’s MAR chart to record that she had administered the

paracetamol to the patient.” The panel concluded that Ms Waldron had dispensed the

paracetamol and completed the electronic prescription chart without Ms 2 being

present. The panel preferred Ms 2’s oral evidence to Ms Waldron’s account and

accordingly found this charge proved.

6.2 Incorrectly stated that there were no salbutamol nebulisers available from the

pharmacy when there were

This charge is found not proved.

The panel bore in mind Ms Waldron’s explanation that the salbutamol nebulisers were

not held in the correct drawer and that there were two other staff members that were

looking for the salbutamol nebulisers. The panel noted that Ms Waldron’s explanation

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was not challenged by any other evidence. Furthermore, the panel also noted Ms 2’s

explanation in her Feedback Report dated 4 June 2015 that Ms Waldron had said that

she needed to order the salbutamol nebulisers from the pharmacy implying that there

were none available. Although another nurse located a nebuliser there is no evidence

that contradicts Ms Waldron’s account that she was unable to find them because they

were not in the correct drawer. The panel did not consider that this demonstrated that

Ms Waldron had failed to demonstrate the standards of knowledge, skill and judgement

required to practice without supervision.

The panel accordingly found this charge not proved.

6.4 Used abbreviations that were not recognised by the Trust This charge is found not proved.

The panel did not have sight of any policy from the Trust which required Ms Waldron to

use a certain set of abbreviations or any evidence that abbreviations were not

permitted. Ms Waldron said that she had been given an approved list of abbreviations

by her Ward Manager and was using that list. The panel determined that in order for this

charge to be proved it would need to be satisfied that it was not appropriate for Ms

Waldron to have used abbreviations. Ms Waldron said in her written response that she

had been given a list of abbreviations by her Ward Manager that she was using and it

was only Ms 2 that did not recognise them.

The panel noted that the issue of unacceptable abbreviations was only raised by Ms 2

during the course of Ms Waldron’s extensive supervised practice and by no other

witnesses. The panel could not be satisfied, on the evidence, that Ms Waldron had used

abbreviations that were not recognised by the Trust as a whole.

The panel accordingly found this charge not proved.

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6.6 Incorrectly recorded entries in patients' notes under Staff Nurse Ms 7’s name

instead of your own


In reaching this decision, the panel took into account the statement of Ms 3 in which she

stated: “I noticed that she was logged into the system under Staff Nurse Ms 7’s name. I

informed her that she needed to log out and complete her patient records under her

name as it would appear as though Juliana had completed the documentation. I asked

Joanne to amend the records and indicate that she had mistakenly completed the

documentation under Ms 7’s name. However, when I later checked, she had not done

so. Ms 7 wrote a note on the patient’s records to confirm that she did not input the

information recorded under her name.”

Ms 3 gave oral evidence that this was a simple task and although she acknowledged

that staff nurse Ms 7’s should have logged out of the system she was firm in her

evidence that it was also Ms Waldron’s responsibility to correct her error.

In light of the evidence before it, the panel determined that Ms Waldron failed to change

the name under which the patient notes were recorded. The panel accordingly found

this charge proved.

6.8 Incorrectly stated that you could not administer phosphate tablets as there were

none available


The panel bore in mind Ms Waldron’s explanation that “I would have said I had to get

more before administration, not that I couldn’t”. In addition, the panel also had regard to

the statement of Ms 3 in which she stated that Ms Waldron “said that she checked the

medication cupboard with Staff Nurse Ms 8 and could not find any. I had cared for the

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patient during the previous shift and I knew that phosphate was in stock.” The panel

found the account of Ms 3 to be corroborated by Ms 3’s Feedback Report dated 11

June 2015 in which she stated that “…Joanne had stated there was none in the clinic. I

knew there was as I had her yesterday but later I’d seen she had ordered it from

pharmacy.” The panel bore in mind that Ms 3 had also affirmed this account in her oral

evidence to the panel. In addition, the panel noted that the Feedback Report dated 11

June 2015 was a more contemporaneous account of the incident.

In light of the above, the panel attached greater weight to the evidence from Ms 3 and

accordingly found this charge proved.

6.9 Incorrectly administered one tablet of lansoprazole instead of two to an unknown

patient


The panel had regard to Ms Waldron’s explanation that “the strip was finished. I was

looking for more on the tray when challenged.” In addition, the panel also had regard to

the witness statement of Ms 3 in which she stated that “[t]he patient was prescribed with

30mg of lansoprazole. Joanne dispensed one 15mg tablet of lansoprazole. I prompted

Joanne and informed her that she needed to administer an additional 15mg tablet so

that the patient was given the correct dose.” The panel bore in mind that in addition to

her written statement, Ms 3 also gave oral evidence under oath. Ms 3 confirmed in her

evidence that Ms Waldron needed to be prompted by Ms 3 to give the correct dosage

and had put the tablets back in the box.

In light of the above, the panel preferred the evidence of Ms 3 and accordingly found

this charge proved.

6.10 Did not complete a lines and devices flow chart and / or a stool chart for an

unknown patient

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In making its decision, the panel had regard to the written response of Ms Waldron that

“I do this after administration of medicines to speed up medicines round as I did in other

wards. [Ms 2] prefers all at the same time.” In relation to this charge, the panel had

regard to the evidence of Ms 3 and noted that she said “Joanne did not complete a lines

and devices flow chart for the patient.” In addition, the panel also bore in mind the notes

from the contemporaneous Feedback Report dated 11 June 2015 in which Ms 3 stated

“Bed 2c – No lines and devices done.”

The panel bore in mind that Ms 3 gave oral evidence under oath and also noted the

contemporaneous nature of the Feedback Report dated 11 June 2015.

In light of the above, the panel found this charge proved.

Charge 7:

7. On 13 June 2015:

7.1 Discharged a patient when you were not being supervised and / or without their

analgesia

The panel found this charge proved.

In reaching its decision, the panel bore in mind Ms Waldron explanation that “I was

challenged about this…I was blamed scapegoat.” The panel also had regard to the

explanation contained in the statement from Ms 9 in which she stated “[t]he sister from

the Accident and Emergency department called the Ward and said that it was a failed

discharge due to the patient being sent home without the appropriate analgesia.” The

panel also had regard to the statement dated 13 June 2015 from the Sister related to

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the incident in which she explained, in relation to the patient that “…it could have

prevented her being readmitted if she had analgesia…”

The panel heard no evidence to refute the accounts given by Ms 9 and the sister related

to the incident. Although Ms Waldron now says she did not discharge this patient the

panel had regard to her admission to Ms 9 on the day that she had discharged this

patient without supervision. Accordingly, the panel found this charge proved.

7.3 Did not check Patient A's dressing to ensure that there was no bleeding


In reaching its decision, the panel had regard to Ms Waldron’s explanation that “I have

always checked dressings…I always check.” In addition, the panel also had regard to

the evidence of Ms 6 that “Joanne did not check her dressing to ensure that there was

no bleeding. I was concerned by this…[w]hen I looked at her dressing her umbilical

wound was bleeding heavily.” In her oral evidence, Ms 6 expanded on her account to

explain that as she was a trained nurse, she put a pressure dressing on her daughter’s

wound before going to seek assistance from another nurse. In addition, Ms 6 account in

her statement was supported by the letter of complaint dated 13 June 2015.

In light of the above, the panel accepted the evidence of Ms 6 that the dressing was not

checked by Ms Waldron and accordingly found this charge proved.

7.4 Did not ensure that Patient A was given pain relief after you were informed that

Patient A was in pain at approximately 13:00 and / or 14:00


The panel once again had regard to the statement of Ms 6 where she explained that

“…Joanne said that she would go and get pain relief and administer it…[h]owever,…she

27

was not given pain relief until the night staff came on at approximately 20.00. The panel

had regard to the explanation given by Ms Waldron that “I was in a meeting the patients

were being watched by other staff. I came back and was told off”. The panel bore in

mind the time that would have elapsed between 13.00 and/or 14.00 and the time at

which the night staff came on at 20.00.

Ms 6, in her oral evidence, explained that she asked Ms Waldron at around 13.00 and

again at 14.00 for pain relief for her daughter. The panel accepted this account and it

considered that Ms Waldron was aware of the request for pain relief. Ms Waldron did

not dispute this. The panel had seen no evidence that Ms Waldron had handed over this

request to another nurse or ensured that pain relief was given.

The panel accordingly found this charge proved.

Charge 8:

8. On 23 June 2015:

8.2 Required prompting to check whether VSL3 could be administered to an

unknown patient who was on a restricted oral intake


In reaching its decision, the panel bore in mind Ms 3’s statement in which she explained

that “Joanne prepared to administer VSL3 to the patient, despite having restricted oral

intake. I told Joanne that she needed to check with the doctor that she was able to

administer the medication. She checked with the doctor and was advised that she

should not give the patient the medication.”

Ms 3 explained in her oral evidence that the procedure on the ward at the time was well

known. The patients of a particular doctor were on restricted oral intake because of the

28

nature of their surgery. Ms Waldron said she was in the process of checking the notes

and wasn’t given a chance. However, the panel accepted Ms 3’s account that Ms

Waldron had mixed the VSL3 and was about to administer it to the patient before she

had to intervene. This was supported by Ms 3’s written feedback report of 23 June

2015.

The panel accordingly found this charge proved. Charge 9: On 24 June 2015:

9.1 Incorrectly offered an unknown patient a dose of codeine when they were

already prescribed dihydrocodeine

The panel found this charge not proved.

The panel bore in mind that Ms 2 was not present and did not witness the conversation

and therefore the panel is not persuaded that it is likely that Ms Waldron had actually

offered the patient a dose of codeine. The panel noted Ms 2’s oral evidence that she

could not recall whether this particular patient was prescribed codeine. The panel was

not persuaded on a balance of probabilities that the incident occurred as alleged. The

panel accordingly found this charge not proved.

9.3 Used the abbreviation "PO bloods" which is not recognised by the Trust


In reaching its decision the panel bore in mind its earlier findings on charge 6.4. The

panel determined that, although the abbreviation “PO bloods” may have been used by

Ms Waldron it was not satisfied in line with its earlier findings, that this was not

recognised by the Trust. The panel adopted its earlier reasoning in relation to this

29

charge.

9.4 Incorrectly informed an unknown patient when they were discharged that they

were prescribed morphine instead of paracetamol and codeine


The panel noted that this was a lack of attention to detail. The panel also bore in mind

that Ms Waldron was working in a busy environment and that this was likely to have

been an error in communication. The panel was not satisfied, on the balance of

probabilities, that this was an error which indicated Ms Waldron had failed to

demonstrate the standards of knowledge, skill and judgement required to practice

without supervision. Charge 10:

10. On 10 July 2015:

10.1 Did not ensure that an unknown patient was wearing their anti-embolism

stockings as prescribed

The panel found this charge not proved. In her written response, Ms Waldron said she asked the patient to put them on. The

patient said that she did not want to “because she did not like wearing them.” It is

accepted that Ms Waldron said she would get some advice from the doctor. The panel

had regard to the evidence of Ms 2’s statement that said “Joanne did not need to put

the prescribed stocking on the patient whilst she obtained advice from the doctor.”

The panel therefore concluded that there was no evidence that Ms Waldron was

required to ensure that the patient was wearing their stockings and her actions were

reasonable in light of the patient’s refusal to put them on.

30

Charge 11:


11.2 Administered a dose of oral analgesia when you had not removed an unknown

patient's patient controlled analgesia ("PCA")


In reaching its decision, the panel took into account the evidence of Ms 5. The evidence

was not in dispute that it was correct to give the oral analgesia whilst the PCA was both

connected and switched on. Ms 5 said that Ms Waldron should have switched off the

PCA after 30 minutes but did not do so. The panel noted that Ms Waldron was both

supernumerary and supervised in relation to medications and on the basis of the

evidence it heard, it concluded that she was not instructed to remove the PCA before

administering the oral analgesia. Therefore, although the PCA had not been removed

when Ms Waldron administered the analgesia, this fact is not probative of the stem of

the charge.

Charge 12:

12.1 Incorrectly administered one tablet of thiamine to an unknown patient instead of

two tablets

The panel found this charge proved. The panel noted Ms Waldron’s account that there were no more tablets in a nearly

empty box and she was not given a chance to get more. The panel accepted the oral

evidence of Ms 2 that Ms Waldron only dispensed one tablet and put them back into the

cardboard sleeve. Ms 2 stated that Ms Waldron had to be prompted to give a second

31

dose. The panel were persuaded by Ms 2’s recollection and preferred her account.

Accordingly, then panel found this charge proved.

12.2 Offered an unknown patient pain relief medication when the patient was already

prescribed PCA


In making its decision, the panel noted Ms Waldron’s explanation that she was chatting

to the patient about their pain whilst waiting for the electronic prescription charts to

open. The panel noted that Ms Waldron did not attempt to dispense or administer pain

relief medication and it concluded that it was mentioned in the context of a discussion

about what might be available to help manage the patient’s pain. The panel considered

this was appropriate. The panel did not consider that Ms Waldron had failed to

demonstrate the standard of knowledge skill and judgment required to practice without

supervision. Accordingly, the panel was not satisfied that this charge is proved.

12.3 intended to remove a patient's surgical drain when it was not due to be

removed


The panel took into to account Ms Waldron’s explanation that Ms 2 was mistaken and

she had removed the correct drain. In her evidence, Ms 2 stated that she went to check

the position with another nurse and had to intervene to prevent Ms Waldron incorrectly

removing the drain. The panel was persuaded by Ms 2’s evidence and considered her

recollection was likely to be accurate. This was supported by her feedback form in

relation to this incident completed at the time.

Charges 13 and 14:

13. On 11 August 2015:

32

13.2 Did not conduct and / or record any observations for Patient B between


Charge 14:

14. Your actions at Charge 13.3 were dishonest in that you knew that you had not

conducted Patient B's observations but you attempted to make it appear as though

you had


The Panel considered Ms Waldron’s explanation that she did conduct the observations

for Patient B but she was delayed in inputting the details.

The Panel had regard to Ms 5’s evidence that she would expect Ms Waldron to have

conducted 3 sets of observations during the shift at around 10:00, 14:00 and 18:00. Ms

5 explained that Ms Waldron had said to her that she had not done some of her

observations although Ms 5 could not be clear whether these were the morning or

afternoon observations. Ms 5 said that when she checked Patient B’s documentation at

19.15 no observations had been recorded and she prompted Ms Waldron to complete

them.

Ms Waldron says that Patient B was not on the ward and she was behind with her

tasks. She inputted two sets of observations for Patient B towards the end of her shift.

Ms Waldron entered at 19.56 that a set of observations had been done for Patient B at

15:55.

The Panel had regard to a nursing evaluation completed for Patient B at 15.52 and

entered onto the computer system at 15.53. It states that Patient B is in the shower. The

Panel considered it was unlikely that Ms Waldron had carried out the observations at

15.55 given that she was entering information onto the computer at 15.53 and Patient B

33

was in the shower. Ms Waldron stated to the local investigation that this was an

estimate of the time and although she could not be sure of the time it was around then.

The Panel also had regard to the contemporaneous statement made by Patient B. The

Panel took into account that Patient B did not attend to give evidence and so the Panel

had not had the benefit of testing his recollection. However, the panel considered that

there was no evidence to suggest that Patient B had any ulterior motive or that there

was any reason to doubt his credibility. Patient B said that there were no observations

done on him until around 19:00 – 20:00.

The panel noted that Ms Waldron had given different accounts about the timing of the

15:55 observations and her reasons for not recording them at the time. The Panel were

not persuaded that she had undertaken the observations at around 15:55. It was more

likely than not in the Panel’s view that Ms Waldron had realised that no observations

had been done and did a set of observations just before the end of her shift. This is

corroborated by Patient B.

The Panel considered that there is no evidence to corroborate Ms Waldron’s account

that observations were done at 15:55 or around that time. The evidence of Ms 5

suggests that Ms Waldron told her she had not done the observations and Patient B

confirms this. In addition, the timing of the entries on to the system would indicate that

no observations were done at around 15:55.

The panel considered all of the evidence carefully and concluded that it was more likely

than not that no observations were conducted or recorded for Patient B between


The Panel considered that the recording of Patient B’s observations for 15:55 was a

deliberate attempt by Ms Waldron to cover up the fact that she had not conducted any

observations for Patient B until the end of her shift. Ms Waldron had been prompted a

34

number of times by Ms 5 to conduct her observations and according to Ms 5 had said

she had not yet done them and was behind.

The Panel considered it was more likely than not that when entering her evening

observations of Patient B Miss Waldron realised that no earlier observations had been

done and attempted to cover up this fact by recording a set of observations that she had

not conducted.

Charge 16:

16. On or around 29 October 2015, you submitted a job application and CV which

did not reflect the reason for leaving your previous employment


In reaching its decision the Panel was mindful of its earlier decision on Mr Orpin-

Massey’s application for the charge to be amended. In his submissions Mr Orpin-

Massey asked the Panel to consider again his application to amend the charge on the

basis that a serious charge should not be allowed to fail because of imprecise drafting.

The Panel saw no reason to re-visit its earlier decision. It did not consider that the

charge was imprecisely drafted but rather based on different evidence to that which had

been put to Ms Waldron. The Panel therefore considered this charge as drafted.

The Panel had sight of no evidence that Ms Waldron had submitted a CV or job

application that had omitted her reason for leaving her previous employment. The Panel

had regard to the email from a manager at Peel Care who did not interview Ms Waldron

and who was no longer working there. He was not available to give evidence. Although

he did not know why Ms Waldron had left her previous job there was no evidence that

she had misled anyone or that she had been asked why she had left her previous

employment at the time of her application to Peel Care.

Charge 17:

35

17. Your actions at charge 16 above was dishonest, in that you deliberately omitted

the reason for leaving The panel found this charge not proved In light of its findings above in relation to charge 16, the panel found charge 17 not

proved.

36

Submission on misconduct, lack of competence and impairment:

Having announced its findings on all the facts, the panel then moved on to consider

whether the facts found proved in charges 13 – 15 amount to misconduct and, if so,

whether Ms Waldron’s fitness to practise is currently impaired. The NMC has defined

fitness to practise as a registrant’s suitability to remain on the register unrestricted.

In his submissions Mr Orpin-Massey invited the panel to take the view that Ms

Waldron’s actions amount to a breach of The Code: Standards of conduct, performance

and ethics for nurses and midwives 2008 (“the Code”). He then directed the panel to

specific paragraphs and identified where, in the NMC’s view, her actions amounted to

misconduct.

Mr Orpin-Massey referred the panel to the case of Roylance v GMC (No. 2) [2000] 1 AC

311 which defines misconduct as a word of general effect, involving some act or

omission which falls short of what would be proper in the circumstances.

He then moved on to the issue of impairment, and addressed the panel on the need to

have regard to protecting the public and the wider public interest. This included the

need to declare and maintain proper standards and maintain public confidence in the

profession and in the NMC as a regulatory body.

The panel has accepted the advice of the legal assessor which included reference to a

number of judgments which are relevant.

The panel adopted a two-stage process in its consideration, as advised. First, the panel

must determine whether the facts found proved in charges 13 - 15 amount to

misconduct. Secondly, only if the facts found proved amount to misconduct, the panel

must decide whether, in all the circumstances, Ms Waldron’s fitness to practise is

currently impaired as a result of that misconduct.

37

Lack of competence: Mr Orpin-Massey submitted that the facts found proved showed that Ms Waldron that

lack of competence at the time was below the standard expected of a band 5

Registered Nurse. Mr Orpin-Massey referred to relevant paragraphs of the Code and

identified where Ms Waldron’s actions amounted to a lack of competence.

Mr Orpin-Massey submitted that the charges from 1 to 12 found proved demonstrated a

lack of competence. Mr Orpin-Massey reminded the panel of the oral evidence that it

had heard from the seven NMC witnesses and asked the panel to bear in mind all the

documentary evidence before it.

The panel adopted a two stage process, as advised. First, the panel must determine

whether the facts found proved amount to a lack of competence. Secondly, only if the

facts found proved amount to a lack of competence, the panel must then decide

whether, in all the circumstances, Ms Waldron’s fitness to practise is currently impaired

as a result of that lack of competence.

38

Decision on lack of competence

When determining whether the facts found proved amount to a lack of competence the

panel had regard to the terms of the Code.

The panel, in reaching its decision, has had regard to the public interest and accepts

that there is no burden or standard of proof at this stage and exercised its own

professional judgement.

The panel was informed that the definition of lack of competence, as taken from the

NMC ‘Reporting lack of competence: A guide for employers and managers’, is:

A lack of knowledge, skill or judgment of such a nature that the registrant

is unfit to practise safely and effectively in any field in which the registrant

claims to be qualified or seeks to practice.

The panel has taken into account the following paragraphs of the Code:

• work with others to protect and promote the health and wellbeing of those in

your care, their families and carers, and the wider community

• provide a high standard of practice and care at all times

22. You must work with colleagues to monitor the quality of your work and maintain

the safety of those in your care.

24. You must work cooperatively within teams and respect the skills, expertise and

contributions of your colleagues.

26. You must consult and take advice from colleagues when appropriate.

39

28. You must make a referral to another practitioner when it is in the best interests of

someone in your care.

32. You must act without delay if you believe that you, a colleague or anyone else

may be putting someone at risk.

39. You must recognise and work within the limits of your competence.

The panel heard evidence that Ms Waldron always worked on a supernumerary basis

on Ward 5. The panel also heard that she was never signed off as being competent to

dispense medicine without supervision. This was due to repeated concerns about her

competence to fulfil the standard expected of her. In light of all the evidence before it,

the panel noted that Ms Waldron made very little improvement even after she had been

seconded to a less demanding ward and had been provided with extensive support over

an extended period of time. The panel bore in mind that one of her colleagues

described her as being at the level of a first year student nurse.

The panel also noted that Ms Waldron was assisted by the Learning and Development

Team, supervised on a one-on-one basis, and kept on a supernumerary basis. She was

nonetheless observed over this period of time to make frequent mistakes and

omissions, a number of which are the subject of the charges found proved.

In addition, the Panel have heard that Ms Waldron seemed to have a defensive attitude

when challenged about the standard of her performance, or individual mistakes. She

was described as having an attitude not conducive to learning. [Private]

In considering whether the facts found proved amount to a lack of competence, the

panel concluded that Ms Waldron breached the aforementioned paragraphs of the

Code, which are the standard by which every registered nurse is measured. The panel

bore in mind, when reaching its decision, that Ms Waldron should be judged by the

standards of the reasonable average band 5 Registered Nurse and not by any higher or

40

more demanding standard. Taking into account the reasons given by the panel for its

findings of facts, the panel has concluded that Ms Waldron’s practice was well below

the standard that one would expect of the average Registered Nurse acting in the role

that Ms Waldron was in. In all the circumstances, the panel determined that Ms

Waldron’s performance demonstrated a lack of competence.

41

Decision on misconduct

When determining whether the facts found proved amount to misconduct the panel had

regard to the terms of the Code.

The panel, in reaching its decision, had regard to the public interest and accepted that

there was no burden or standard of proof at this stage and exercised its own

professional judgement.

The panel was of the view that Ms Waldron’s actions did fall significantly short of the

standards expected of a registered nurse, and that her actions amounted to a breach of

the Code. Specifically:

• be open and honest, act with integrity and uphold the reputation of your

profession.

42. You must keep clear and accurate records of the discussions you have, the

assessments you make, the treatment and medicines you give, and how effective

these have been.

44. You must not tamper with original records in any way.

61. You must uphold the reputation of your profession at all times.

The panel appreciated that breaches of the Code do not automatically result in a finding

of misconduct. However, in this case the panel was of the view that the breaches of the

code did amount to a finding of misconduct for the reasons below.

42

In relation to charges 13 and 14 the panel determined that the creation of false

information to cover up the fact that Ms Waldron had not done the required observations

amounted to conduct that would be considered “deplorable” by fellow Nurses.

Moreover, the panel determined that the falsification of such medical information

created a risk to the patient. He might have been poorly and this would not have been

detected in a timely manner.

In relation to charge 15, the panel noted that despite the context of the message being

in dispute, the panel heard evidence from Ms 5 that she felt intimidated by the message

that she had received. The message arrived in the early hours of the morning after Ms

Waldron had been suspended. The panel determined that this sort of behaviour was

unprofessional and took a nursing matter into the public domain. It was a message, in

the panel’s view, intended to be retaliation for Ms 5 reporting her concerns about Ms

Waldron. The panel determined that this sort of behaviour fell short of that expected by

a Registered Nurse.

The panel found that her actions found proved in charges 13 to 15 did fall seriously

short of the conduct and standards expected of a nurse and amounted to misconduct.

43

Decision on impairment The panel next went on to decide if as a result of the misconduct found and lack of

competence Ms Waldron’s fitness to practise is currently impaired.

Nurses occupy a position of privilege and trust in society and are expected at all times

to be professional. Patients and their families must be able to trust nurses with their

lives and the lives of their loved ones. To justify that trust, nurses must be honest and

open and act with integrity. They must make sure that their conduct at all times justifies

both their patients’ and the public’s trust in the profession. In this regard the panel

considered the judgement of Mrs Justice Cox in the case of Council for Healthcare

Regulatory Excellence v (1) Nursing and Midwifery Council (2) Grant [2011] EWHC 927

(Admin) in reaching its decision, in paragraph 74 she said:

In determining whether a practitioner’s fitness to practise is impaired by

reason of misconduct, the relevant panel should generally consider not

only whether the practitioner continues to present a risk to members of the

public in his or her current role, but also whether the need to uphold

proper professional standards and public confidence in the profession

would be undermined if a finding of impairment were not made in the

particular circumstances.

Mrs Justice Cox went on to say in Paragraph 76:

I would also add the following observations in this case having heard

submissions, principally from Ms McDonald, as to the helpful and

comprehensive approach to determining this issue formulated by

Dame Janet Smith in her Fifth Report from Shipman, referred to above.

At paragraph 25.67 she identified the following as an appropriate test for

panels considering impairment of a doctor’s fitness to practise, but in my

44

view the test would be equally applicable to other practitioners governed

by different regulatory schemes.

Do our findings of fact in respect of the doctor’s misconduct,

deficient professional performance, adverse health, conviction,

caution or determination show that his/her fitness to practise is

impaired in the sense that s/he:

a. has in the past acted and/or is liable in the future to act so as to

put a patient or patients at unwarranted risk of harm; and/or

b. has in the past brought and/or is liable in the future to bring the

medical profession into disrepute; and/or

c. has in the past breached and/or is liable in the future to breach

one of the fundamental tenets of the medical profession; and/or

d. has in the past acted dishonestly and/or is liable to act

dishonestly in the future.

The panel finds all four limbs of the Grant test to be engaged in this case. The panel

determined that patients have been put at unwarranted risk of harm in light of Ms

Waldron’s lack of competence. The panel also determined that in light of her conduct

found proved in charges 13 to15, Ms Waldron has brought the nursing profession into

disrepute and placed patients at risk of harm. By virtue of finding Ms Waldron to be in

breach of numerous parts of the Code, the panel finds her to be in breach of a number

of the fundamental tenets of the nursing profession. In addition, Ms Waldron is found to

have acted dishonestly.

Regarding insight, the panel noted that Ms Waldron had admitted some of the charges.

However, the panel was not satisfied that Ms Waldron had sufficient insight into her

actions. It had not been provided with any evidence to show that Ms Waldron had

demonstrated full insight into her actions.

45

In its consideration of whether Ms Waldron has remedied her practice, it has had sight

of no evidence that her practice has been remedied. The panel noted that there is

evidence that Ms Waldron has worked as a Registered Nurse since the incidents

relating to the charges found proved but it has not had sight of any evidence as to the

nature of her role and whether or not the identified shortfalls have been remedied.

Hence, the panel could not be satisfied that Ms Waldron has remedied her practice. The

panel is of the view that there is a risk of repetition based on a lack of remediation. The

panel therefore decided that a finding of impairment is necessary on the grounds of

public protection.

In relation to Ms Waldron’s found dishonesty, the panel noted that there is no evidence

that she has accepted her dishonesty. Ms Waldron’s dishonest actions were to cover up

her lack of competence and therefore the panel is of the view that there remains a risk

of repetition.

The panel bore in mind that the overarching objectives of the NMC are to “protect,

promote and maintain the health safety and well-being of the public and patients, and to

uphold/protect the wider public interest, which includes promoting and maintaining

public confidence in the nursing and midwifery professions and upholding the proper

professional standards for members of those professions.” The panel determined that,

in this case, a finding of impairment on public interest grounds was required.

Having regard to all of the above, the panel was satisfied that Ms Waldron’s fitness to

practise is currently impaired.

46

Determination on sanction:

The panel has considered this case very carefully and has decided to make a striking-

off order. It directs the registrar to strike Ms Waldron off the register. The effect of this

order is that the NMC register will show that Ms Waldron has been struck-off the

register.

In reaching this decision, the panel has had regard to all the evidence that has been

adduced in this case. The panel accepted the advice of the legal assessor. The panel

has borne in mind that any sanction imposed must be appropriate and proportionate

and, although not intended to be punitive in its effect, may have such consequences.

The panel had careful regard to the Indicative Sanctions Guidance (“ISG”) published by

the NMC. It recognised that the decision on sanction is a matter for the panel,

exercising its own independent judgement.

The panel found the aggravating features in this case to be that:

• It has found an allegation of dishonesty proved which was also tied to a risk of

unwarranted harm to a patient;

• Ms Waldron has demonstrated a lack of remediation and lack of insight into her

failings.

The panel found the mitigating features in this case to be that Ms Waldron:

• made some admissions to the charges;

• was experiencing some difficult personal circumstances at the time which

affected her performance as a Registered Nurse;

• has engaged with the NMC and this hearing.

The panel first considered whether to take no action but concluded that this would be

inappropriate in view of the seriousness of the case. The panel decided that it would be

neither proportionate nor in the public interest to take no further action.

47

Next, in considering whether a caution order would be appropriate in the circumstances,

the panel took into account the ISG, which states that a caution order may be

appropriate where ‘the case is at the lower end of the spectrum of impaired fitness to

practise and the panel wishes to mark that the behaviour was unacceptable and must

not happen again.’ The panel considered that Ms Waldron’s misconduct was not at the

lower end of the spectrum and that a caution order would be inappropriate in that it

would not restrict Ms Waldron’s practice and would not protect the public from the risk

the panel had identified. The panel decided that it would be neither proportionate nor in

the public interest to impose a caution order.

The panel next considered whether placing conditions of practice on Ms Waldron’s

registration would be a sufficient and appropriate response. The panel is mindful that

any conditions imposed must be proportionate, measurable and workable. The panel

took into account the ISG, in particular:

64.8 It is possible to formulate conditions and to make provision as to how

conditions will be monitored

The panel is of the view that there are no practical or workable conditions that could be

formulated, given the nature of the charges in this case. The panel noted that in relation

to the charges relating to Ms Waldron’s lack of competence, she had already been

subject to intensive clinical supervision by the Trust at which she was working at the

time of the incidents. Furthermore, the panel also noted that she was assisted by the

Learning and Development Team, supervised on a one-on-one basis, and kept on a

supernumerary basis at the time of the incidents. In addition, the panel had also borne

in mind its findings on Ms Waldron’s dishonesty in relation to charges 13 and 14. The

panel determined that it could not formulate workable conditions that would address the

dishonesty found proved.

48

The panel concluded that the placing of conditions on Ms Waldron’s registration would

not adequately address the public interest and would not protect the public.

The panel then went on to consider whether a suspension order would be an

appropriate sanction. Paragraph 66 indicates that a suspension order would be

appropriate where (but not limited to):

66.1 Does the seriousness of the case require temporary removal from the register?

66.2 Will a period of suspension be sufficient to protect patients and the public interest?

The aggravating factors that the panel took into account, in particular, are the potential

patient harm by virtue of Ms Waldron’s found dishonesty in charges 13 and 14, and the

lack of insight into her failings and the risk of repetition.

The conduct, as highlighted by the facts found proved, was a significant departure from

the standards expected of a registered nurse.

The panel has taken into account the mitigation put forward Ms Waldron in her written

responses to the NMC.

The panel determined that in light of the seriousness of the charges found proved in

relation to Ms Waldron’s dishonesty, a suspension order would not be sufficient to

protect the public from an unwarranted risk of harm and would not be in the public

interest. The panel reminded itself of its findings in relation to impairment and noted that

it had found Ms Waldron was at risk of repeating her misconduct and had shown a lack

of insight and remediation.

Balancing all of these factors, the panel has determined that a suspension order would

not be an appropriate or proportionate sanction.

49

Finally, in looking at a striking-off order, the panel took note of the following paragraphs

of the ISG:

71.1 Is striking-off the only sanction which will be sufficient to protect the public interest?

71.2 Is the seriousness of the case incompatible with ongoing registration?

71.3 Can public confidence in the professions and the NMC be sustained if the nurse or

midwife is not removed from the register?

72. This sanction is likely to be appropriate when the behaviour is fundamentally

incompatible with being a registered professional, which may involve any of the

following (this list is not exhaustive):

72.1 Serious departure from the relevant professional standards as set out in key

standards, guidance and advice including (but not limited to):

72.1.1 The code: Standards of conduct, performance and ethics for nurses and

midwives

72.1.4 Record keeping: Guidance for nurses and midwives

72.1.6 Raising and escalating concerns: Guidance for nurses and midwives

72.2 Doing harm to others or behaving in such a way that could foreseeably result in

harm to others, particularly patients or other people the nurse comes into contact with in

a professional capacity, either deliberately, recklessly, negligently or through

incompetence, particularly where there is a continuing risk to patients. Harm may

include physical, emotional and financial harm.

72.6 Dishonesty, especially where persistent or covered up

72.7 Persistent lack of insight into seriousness of actions or consequences

Ms Waldron’s dishonesty was a significant departure from the standards expected of a

registered nurse, and is fundamentally incompatible with her remaining on the register.

50

The panel was of the view that the findings in this particular case demonstrate that Ms

Waldron’s actions were serious and involved dishonesty directly relating to her clinical

practice. To allow her to remain on the Register would undermine public confidence in

the profession and in the NMC as a regulatory body.

Balancing all of these factors and after taking into account all the evidence before it

during this case, the panel determined that the appropriate and proportionate sanction

is that of a striking-off order. Having regard to the matters it identified, in particular the

effect of Ms Waldron’s actions in bringing the profession into disrepute by adversely

affecting the public’s view of how a registered nurse should conduct herself, the panel

has concluded that nothing short of this would be sufficient in this case.

The panel considered that this order was necessary to mark the importance of

maintaining public confidence in the profession, and to send to the public and the

profession a clear message about the standard of behaviour required of a registered

nurse.

51

Determination on Interim Order The panel has considered the submissions made by Mr Orpin-Massey that an interim

suspension order should be made on the grounds that it is necessary for the protection

of the public and is otherwise in the public interest.

The panel accepted the advice of the legal assessor.

The panel was satisfied that an interim suspension order is necessary for the protection

of the public and is otherwise in the public interest. The panel had regard to the

seriousness of the facts found proved and the reasons set out in its decision for the

substantive order in reaching the decision to impose an interim order. To do otherwise

would be incompatible with its earlier findings.

The period of this order is for 18 months to allow for the possibility of an appeal to be

made and determined.

If no appeal is made, then the interim order will be replaced by the striking-off order 28

days after Ms Waldron is sent the decision of this hearing in writing.

That concludes this determination.

conduct and competence committee€¦ · 16. on or around 29 october 2015, you submitted a job...

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