nursing and midwifery council fitness to practise committee

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Nursing and Midwifery Council Fitness to Practise Committee

Substantive Order Review Hearing

Tuesday 8 June 2021

Nursing and Midwifery Council Virtual Hearing

Name of registrant: Jay Linus Fuentes NMC PIN: 18A0147O Part(s) of the register: Registered Nurse – Sub Part 1 Adult Nursing (January 2018) Area of registered address: Cambridgeshire Type of case: Lack of competence/Misconduct Panel members: Alison Stone (Chair, Lay member)

Laura Wallbank (Registrant member) Jonathan Coombes (Registrant member)

Legal Assessor: Peter Jennings Panel Secretary: Safa Musad Nursing and Midwifery Council: Represented by Shanice Mahmud, Case

Presenter Mr Fuentes: Present and unrepresented Order being reviewed: Suspension order (3 months) Fitness to practise: Impaired Outcome: Period of suspension order reduced so as to

expire at the end of 9 June 2021 under article 30(2) and (4); Conditions of practice order (18 months) to come into effect then in accordance with Article 30(1)

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Decision and reasons on whether parts of the determination be marked as private

A request was made that parts of the determination be marked as private on the basis that

your case involves matters relating to your health. The application was made pursuant to

Rule 19 of ‘Nursing and Midwifery Council (Fitness to Practise) Rules 2004’, as amended

(the Rules).

Ms Mahmud, on behalf of the Nursing and Midwifery Council (NMC), indicated that she

supported the application.

The panel bore in mind that while Rule 19(1) provides, as a starting point, that hearings

shall be conducted in public, Rule 19(3) states that the panel may hold hearings partly or

wholly in private if it is satisfied that this is justified by the interests of any party or by the

public interest.

The panel determined that parts of the determination which relate to your health should be

marked as private, in order to protect your privacy. The panel is satisfied that this is

justified and outweighs any prejudice to the general principle of public hearings.

Decision and reasons on review of the substantive order

The panel decided to reduce the length of the current suspension order so that it will end

on 9 June 2021 under Article 30(2) and (4) of the ‘Nursing and Midwifery Order 2001’ (the

Order) and to make a conditions of practice order. This order will come into effect from the

expiry of the suspension order in accordance with Article 30(1).

This is the first review of a substantive suspension order originally imposed for a period of

3 months by a Fitness to Practise Committee panel on 8 March 2021. The current order is

due to expire at the end of 6 July 2021.

The panel is reviewing the order pursuant to Article 30(1) of the Order.

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The charges found proved which resulted in the imposition of the substantive order were

as follows:

‘That you, a registered nurse failed to demonstrate the standards of

knowledge, skill and experience required to practise safely as a Band 5

nurse

1. Whilst subject to an Action Plan between 11 April –14 November 2018

(as updated in June 2018), you failed to demonstrate that you were

competent in the following areas: [PROVED IN ITS ENTIRETY BY

ADMISSION]

a. preparation/ administration of medication

b. infection control

c. lack of leadership / ability to supervise

d. communication skills

e. patient admissions and discharges

f. provision of care to patients and treating patients with dignity

g. record keeping

h. time management and organisation

i. handovers

2. Between approximately February 2018 and November 2018 you failed to

complete and/or pass your Preceptorship Programme. [PROVED BY

ADMISSION]

3. On 4 June 2018, you: [PROVED IN ITS ENTIRETY BY ADMISSION]

a. failed to complete the discharge documentation including the Continuing

Healthcare (CHC) documentation for Patient D

b. manually moved Patient T on your own, when the move required two

members of staff to complete the task safely

c. inappropriately informed Patient J’s family that Patient J would be “up and

walking around in no time” or words to that effect, when Patient J was at

high risk of falls and was for ‘bed to chair transfers’ only.

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4. On 6 June 2018, in respect of an unknown patient you: [PROVED IN ITS

ENTIRETY BY ADMISSION]

a. weighed the patient with the incorrect scale settings applied

b. failed to repeat the procedure and obtain the correct weight

c. asked a new nurse to step on the scales and worked out the difference

between the nurse’s weight and the patient’s weight

5. On 20 June 2018, when preparing Patient C for discharge, you: [PROVED IN

ITS ENTIRETY BY ADMISSION]

a. failed to ensure Patient C had blood tests

b. failed to fill out the nutritional and fluid balance sheet

c. failed to take action and/or escalate that Patient C had not passed urine

for 6 hours

d. failed to administer IV fluids

6. On 29 June 2018, following an unsuccessful attempt to insert a catheter into

an unknown patient, you: [PROVED IN ITS ENTIRETY BY ADMISSION]

a. attempted to re-insert the catheter a second time, when you ought to have

obtained a new catheter

b. failed to engage or communicate with the patient during the procedure

7. On an unknown date around July 2018, upon being instructed by Nurse HJ to

prepare a trolley for an aseptic dressing technique you:

a. grabbed the first available trolley without disinfecting the trolley

[PROVED]

b. upon being instructed to rub down/disinfect the trolley, you took an

inordinate length of time to complete the task [PROVED]

c. required Nurse HJ to explain the process of the aseptic technique of the

umbilical dressing [PROVED BY ADMISSION]

d. had to be reminded to dispose of the gauze after cleaning the wound

[PROVED BY ADMISSION]

e. had to be reminded to not repeatedly rub the wound clean. [PROVED BY

ADMISSION]

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8. On 30 August 2018, whilst assisting Patient U to the toilet, you walked in front

of Patient U when you ought to have walked to the side of the patient and

supported her [PROVED BY ADMISSION]

9. In August 2018, you failed to escalate to a doctor or senior nurse that Patient

F had not passed urine for 8 hours [PROVED BY ADMISSION]

10. On 20 September 2018, whilst caring for an unknown patient whose

intravenous cannula line had fallen out you: [PROVED IN ITS ENTIRETY

BY ADMISSION]

a. attempted to re-connect the IV line which had become unsterile from

contact with the bed

b. did not understand why your actions could put the patient at risk of

infection

c. when questioned about your actions, you stated that you had panicked

“because of all the blood” when there was no visible blood present

11. On 15 October 2018, you: [PROVED IN ITS ENTIRETY BY ADMISSION]

a. prepared to administer Patient M a PRN laxative when her nursing

records indicated that the patient was opening her bowels regularly over

the last few days.

b. prepared to administer Patient N Digoxin when it was recorded in the

nursing records/ prescription script that the patient’s heartrate was within

normal range

c. upon being informed by an unknown healthcare assistant (HCA) that

Patient O had raised blood pressure, reduced blood oxygen saturations

and a NEWS score of 2 you failed to:

i) take any action

ii) ensure the patient had a nasal cannula in situ

d. failed to wake an unknown patient to provide nursing care

12. On 16 October 2018, you lost your handover sheet in the canteen [PROVED

BY ADMISSION]

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13. On a number of unknown dates in 2018 you failed to complete the pre-

operative theatre checklist for a number of unknown patients. [PROVED BY

ADMISSION]

14. On a number of unknown dates in 2018, in respect of one or more unknown

patients you: [PROVED IN ITS ENTIRETY BY ADMISSION]

a. failed to complete various risk assessments (including MUST

assessments and SSKins pressure assessments)

b. failed to carry out observations and/or record NEWS scores

c. failed to fill out fluid balance charts

15. On a number of unknown dates in 2018, you failed to wake patients up to

provide nursing care. [PROVED BY ADMISSION]

16. On a number of unknown dates in 2018, you inappropriately giggled in front

of patients and their families. [PROVED BY ADMISSION]

17. On a number of unknown dates in 2018, you failed to demonstrate

competency in moving and handling patients and used prohibited

techniques. [PROVED BY ADMISSION]

18. On an unknown shift in 2018: [PROVED IN ITS ENTIRETY BY

ADMISSION]

a. upon being informed by Nurse SF to administer medication to an

unknown patient you failed to administer the medication

b. incorrectly informed Nurse SF that you had asked Nurse RW to

administer the medication when you had not done so.

c. your actions as described at Charge 18b were dishonest in that you

attempted to cover up that you did not administer medication to the

patient.

19. On an unknown date in 2018, upon being informed that Colleague MW had

hurt her leg you: [PROVED IN ITS ENTIRETY BY ADMISSION]

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a. gave her a commode and got her to sit down and spun her round on the

commode in front of patients.

20. Whilst subject to a formal capability plan between August and September

2018 you failed to be demonstrate competency in the following areas:

[PROVED IN ITS ENTIRETY BY ADMISSION]

a. practice autonomously with legal and ethical professional competencies

recognise and promote patient safety

b. complete a medicines management course

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

your lack of competence in respect to charges 1- 18(a), 19 and 20, and your

misconduct in respect of charge 18(b) and (c).’

The original panel determined the following with regard to impairment:

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

competence, your 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 and to maintain professional boundaries. 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. Furthermore

nurses have a duty of candour to be honest if something has gone wrong in

their treatment with patients.

In this regard the panel considered the judgment of Mrs Justice Cox in the

case of Grant 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

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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.’

In paragraph 76, Mrs Justice Cox referred to Dame Janet Smith's “test”

which reads as follows:

‘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.’

In considering impairment, the panel decided to consider lack of competence

and misconduct separately.

The panel first considered whether your fitness to practise was impaired by

your lack of competence. The panel noted Ms 4’s evidence that you cannot

work autonomously and that although you have improved in some areas,

she would not feel confident in you being able to practise unrestricted

without direct supervision. It took into account the test of Cohen and was of

the view that the conduct in this case can be remedied. The panel also noted

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that although you have accepted the charges, you have not demonstrated

any significant remediation into the concerns. It was of the view that the

conduct is highly likely to be repeated because your failings that led to the

charges are being repeated in your current role at Askham. The panel bore

in mind that you have completed some online training, however it noted that

you have been working as a healthcare assistant and as a supernumerary

nurse at Askham for around 11 months and you are still unable to perform to

the standards of a band 5 nurse.

The panel recognised your academic ability by passing the Observed

Structured Clinical Exam (OSCE) on your first attempt and also that you

have subsequently completed a number of online courses related to the

charges. The evidence of Ms 1 and Ms 3 is that the clinical concerns are in

relation to your practical ability and not your theoretical knowledge. Ms 4 had

similar concerns about your practical ability and has not yet been able to

sign off any competencies. In the panel’s judgement there is very substantial

practical remediation that needs to take place before you will be able to

perform to the standards of a band 5 nurse.

The panel was of the view that you have started to develop a level of insight

however this is limited to your confidence and you as a person, not into your

failings as a nurse. The panel accepted the difficulties you faced coming

from the Philippines to the UK, however from the evidence of Ms 3, the panel

was of the view that you had received an immense level of positive support

and training far and above other International nurses - not only as a nurse

but also in relation to the change of environment and settling into the UK.

The panel took into account that despite the extensive level of support you

received, you continued to make mistakes and put patients at risk. The panel

noted that you had accepted the majority of the charges and have

apologised for your actions, however it is concerned that you have shown

insufficient insight into your lack of competence and misconduct. In

particular, the panel is concerned that you have not shown satisfactory

insight into the effect that your actions could have had upon patients and

colleagues. Further, the panel is not satisfied that you have shown sufficient

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insight into the effect that your lack of competence and misconduct would

have upon the public’s perception of and confidence in the nursing

profession.

[PRIVATE]. You confirmed that this was your perception although there was

no independent medical evidence to support your assertion before the panel.

The panel considered that moving from the Philippines and commencing a

new role on a busy ward would be challenging. You told the panel that you

moved to Askham Village Community and you had regained your passion for

nursing. You also explained that you had support from a cousin at this new

place of employment. The panel noted that despite this new start and

change of environment many of the clinical concerns still continued to be

deficient.

In addition you also gave two other reasons for your failure at the Trust. One

was that you had not joined a union and the other one was that you had not

been assertive enough, both of which you said would have given you

support and the ability to ask for help. It has been noted by the panel that

you have subsequently joined a union and have completed an assertiveness

online training course. However the panel had noted that none of the above

have materially changed your level of competency and approach to your role

as a band 5 nurse.

The panel have concerns about your commitment and motivation. When

asked by Ms 3 why you had not completed your preceptorship you stated

because you were lazy. Ms 3 gave evidence that she was concerned about

your lack of motivation and commitment. Ms 4 at your current place of

employment, over two years later raised similar concerns about your

commitment, willingness to take responsibility and emphasised you need to

make the effort. The panel has noted that both at the Trust and in your

current employment that your line managers have witnessed your

inconsistency of application and a lack of willingness to demonstrate your

clinical skills as a band 5 nurse.

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In the above circumstances, the panel decided that you have not remedied

your lack of competence as a registered nurse and you are therefore highly

likely to repeat your clinical shortcomings until you develop full insight and

substantially remediate your clinical practice. The panel decided, in light of

the above reasons, that your fitness to practise is currently impaired as a

result of your lack of competence on the ground of public protection.

It was of the view that your failure to demonstrate a satisfactory level of

competency in a number of wide ranging basic nursing skills placed patients

at unwarranted risk of harm. It was also of the view that your dishonesty

could have put a patient at risk as they could have missed their prescribed

medication. The panel noted that your lack of competence, poor practice,

lack of dignity shown towards patients, repeated behaviour and your

dishonesty have breached fundamental tenets of the profession and has

brought the reputation of the profession into disrepute. It was of the view that

due to your limited insight into your dishonesty, there is a risk that you will

act dishonestly in the future. The panel was satisfied that confidence in the

nursing profession would be undermined if its regulator did not find the

charge relating to dishonesty extremely serious.

The panel then moved onto consider if your fitness to practise is currently

impaired by your misconduct.

The panel noted that not only were you dishonest in your actions but you

sought to place blame onto another nurse. It took into account that although

you admitted the charges and admitted to Ms 2 shortly after the incident that

you had lied and had expressed remorse at the time, there are still concerns

regarding your integrity. Ms 2 expressed to the panel that she was surprised

that this dishonesty came so easily and it made her question your honesty in

general. In particular, it noted that Ms 3 in her oral evidence said that she

was disappointed in your dishonesty because she had already discussed

issues with you around your integrity and honesty. The panel considered that

this is very serious.

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The panel noted that charges 4, 10 and 18 arose because you disguised

clinical failings. Ms 3 who had spoken to you said she was concerned that

without transparency she could not support you with your professional

development. Charge 4 relates to the falsification of a patient’s weight and

your behaviour in charge 10 is misleading because you claimed to have

seen a large quantity of blood when none existed. The incident relating to

charge 18 included a charge of dishonesty that had occurred despite the fact

that Ms 3 had previously highlighted the importance of transparency on a

previous occasion namely in relation to charge 4.

The panel accepted that you apologised, admitted the charge, and showed

some insight however it could not be confident that dishonesty would not

occur again in the future. In these circumstances, the panel was of the view

that, if faced with similar circumstances, you would likely react in the same

way that you did and act dishonestly. The panel was concerned about your

limited insight into your dishonesty in your written reflections and oral

evidence. Accordingly, the panel determined that although you have shown

some insight into your dishonesty there is a real risk that you will repeat such

conduct in the future.

The panel was of the view that you have not demonstrated a full

understanding of how your actions put patients at a risk of harm or how your

actions impacted negatively on the reputation of the nursing profession. It

was also of the view that you have not demonstrated a comprehensive

understanding into the effect that your actions and dishonesty has had on

patients, work colleagues, the public’s perception of nurses or upon the

reputation of the nursing profession. Furthermore, you have not yet

demonstrated a full understanding of why what you did was wrong or how

your dishonesty affected the nurse you implicated. In reaching its decision

that your fitness to practise is currently impaired by reason of your

misconduct, the panel is of the view that, whilst difficult, dishonesty is

potentially remediable. However, the panel, for the above reasons, is

concerned that your insight into your dishonesty is at present, limited and

needs to fully develop.

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The panel therefore determined that your fitness to practise is currently

impaired on the ground of public protection in relation to your misconduct.

In relation to both lack of competence and misconduct, 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 and protect the wider public interest. This 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 considered the impact of the facts found on other nurses in the

profession. They would fundamentally expect to be able to trust a band 5

nurse and be confident in your clinical competence and professional

behaviour.

The panel determined that a finding of impairment on public interest grounds

is required. It was of the view that a member of the public, fully appraised of

the facts in the case, would be concerned if the panel did not find your

fitness to practise to be impaired due to your failure to meet the standards

required of a band 5 nurse and also because of the dishonesty that resulted

in a finding of misconduct. The panel therefore concluded that public

confidence in the profession would be undermined if a finding of impairment

were not made in this case and therefore finds your fitness to practise

impaired on the ground of public interest.

Having regard to all of the above, the panel is satisfied that your fitness to

practise is currently impaired as a result of your lack of competence and

misconduct.’

The original panel determined the following with regard to sanction:

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‘Having found your fitness to practise currently impaired, the panel went on

to consider what sanction, if any, it should impose in this case. 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 SG. The

decision on sanction is a matter for the panel independently exercising its

own judgement.

The panel took into account the following aggravating features:

Patients were put at risk of physical and emotional harm;

You have not demonstrated any significant insight into your failings,

behaviour or the impact of your dishonesty;

Your lack of professionalism, transparency and motivation;

You were caring for vulnerable patients with dementia;

A repeated pattern of clinical failings over a period of time;

Your clinical failings included a failure to protect the dignity of patients.

The panel also took into account the following mitigating features:

You made early admissions to the charges;

You expressed remorse;

You are beginning to demonstrate some level of insight;

You have engaged with the NMC;

You have undergone online training courses in: dementia care,

leadership, communication, infection control, assertiveness and

medicines administration;

Your current employer spoke of your “kind and caring” attitude towards

residents;

[PRIVATE];

The difficulties you faced adjusting to professional life in the UK.

Before its consideration in relation to sanction, the panel also had regard to

the NMC guidance entitled “Considering sanctions for serious cases” and in

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particular the section entitled “Cases involving dishonesty” and “Particular

features of misconduct charging”.

The panel carefully considered the type of dishonest conduct in your case.

The panel acknowledged, at the outset of this exercise, that not all

dishonesty is equally serious. The panel carefully considered the various

indicators as to the seriousness of any dishonesty as set out in the NMC’s

guidance.

The panel was of the view that the dishonesty was serious in this case. You

were asked by Ms 2 to administer a drug to a patient and failed to do this.

You then incorrectly informed Ms 2 that you had asked another nurse to give

the drug when you had not done so. When Ms 2 investigated and found that

this was untrue, you admitted that you had lied. The panel considered,

although not premeditated, you had deliberately breached the professional

duty of candour by seeking to cover up that you had not given the

medication to the patient. The panel found these two components to be

serious aspects of your dishonesty. This occurred despite the fact that Ms 3

had previously spoken to you regarding the need to be open, honest and

transparent in everything that you do.

The panel went on to consider the indicators in the NMC’s guidance which

are described as “Dishonest conduct…generally…less serious”. The panel

found these indicators to be engaged in your case. The panel noted that this

was a one-off incident which involved spontaneous conduct. In this regard,

the panel noted in your oral evidence that you panicked when Ms 2

approached you. The panel found that there was no direct personal gain to

you through your dishonesty and this was not a case of systematic or

longstanding deception. Having carefully considered the facts of your case,

the panel therefore decided that your dishonesty was serious but towards

the bottom end of the spectrum of dishonesty.

When considering the lack of competence and misconduct charges the

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

would be inappropriate in this case. The panel was of the view that taking no

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action would be insufficient to mark the seriousness of the charges. To take

no further action would fail to address the public protection concerns in this

case. In addition, it would be inadequate to address the wider public interest

considerations arising from the nature and circumstances of the misconduct.

The panel was also of the view that taking no action would undermine the

public confidence in the NMC as a regulator.

For the same reasons, the panel considered that imposing a caution order

would not mark the seriousness of the charges or address the wider public

interest considerations.

The SG 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 your misconduct was not at the lower end

of the spectrum and that a caution order 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 impose a caution order.

The panel next considered whether placing conditions of practice on your

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 SG, in particular, that conditions

of practice may be appropriate when some or all of the following factors are

apparent (this list is not exhaustive):

No evidence of harmful deep-seated personality or attitudinal

problems;

Identifiable areas of the nurse or midwife’s practice in need of

assessment and/or retraining;

Potential and willingness to respond positively to retraining;

Patients will not be put in danger either directly or indirectly as a result

of the conditions;

The conditions will protect patients during the period they are in force;

and

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Conditions can be created that can be monitored and assessed.

The panel acknowledged that conditions of practice could be devised which

would address your lack of clinical competence and sufficiently protect the

public. However the panel considered the dishonesty in this case. It noted

that although there is no evidence of harmful deep-seated personality or

attitudinal problems, the dishonesty is serious. It also noted that it had found

a risk of repetition in relation to the dishonesty due to your limited insight. It

was of the view that a conditions of practice order would not be sufficient to

satisfy the public interest in respect of the dishonesty charge. It also noted

the dishonest misconduct identified in this case was not something that can

be addressed through retraining. The panel noted that there is a requirement

to maintain public confidence in the nursing profession and the NMC as

regulator. The panel therefore concluded that the placing of conditions on

your registration would not adequately address the seriousness of your

dishonest misconduct, nor satisfy the public interest.

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

appropriate sanction. The SG states that suspension order may be

appropriate where some of the following factors are apparent:

A single instance of misconduct but where a lesser sanction is not

sufficient;

No evidence of harmful deep-seated personality or attitudinal

problems;

No evidence of repetition of behaviour since the incident;

The Committee is satisfied that the nurse or midwife has insight and

does not pose a significant risk of repeating behaviour;

In cases where the only issue relates to the nurse or midwife’s lack

of competence, there is a risk to patient safety if they were allowed

to continue to practise even with conditions.

The panel was satisfied that in this case, the misconduct was not

fundamentally incompatible with you remaining on the register.

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The panel noted that you have demonstrated some insight into your failings

and demonstrated some remediation by completing online courses. However

the panel was of the view that you have not demonstrated a significant level

of insight into your dishonesty. Although the panel has concerns regarding

your motivation to work at the level of a band 5 nurse it did not find any

evidence of you having a “harmful, deep-seated personality or any attitudinal

problems”. The panel is of the view that, whilst your insight at present is

significantly limited, you are capable of developing sufficient insight into your

shortcomings. You have demonstrated some remorse and have undertaken

some online learning.

The panel was of the view that although the competency issues in this case

are clinical and could be addressed with a conditions of practice order, the

dishonesty in this case is sufficiently serious and must be marked. The panel

was of the view that this could not be done by a conditions of practice order

and therefore determined that a suspension order was the appropriate and

proportionate order. It noted that honesty is a fundamental requirement and

that the public and colleagues must be able to trust a nurse. In balancing the

facts of your case, the level of your dishonesty and the need to satisfy the

public interest, the panel determined to mark your failings by the making of a

suspension order.

The panel did go on to consider whether a striking-off order would be

proportionate but, taking account of all the information before it, and of the

mitigation provided, the panel concluded that it would be disproportionate.

Whilst the panel acknowledges that a suspension may have a punitive effect,

it would be unduly punitive in your case to impose a striking-off order.

Balancing all of these factors the panel has concluded that a suspension

order would be the appropriate and proportionate sanction.

The panel noted the hardship such an order will inevitably cause you.

However this is outweighed by the public interest in this case.

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The panel considered that this order is 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.

When considering the length of the suspension order the panel noted that

the dishonesty charge is a single instance of misconduct, there is no

evidence of harmful deep-seated personality or attitudinal problems and

there is no evidence of repetition of behaviour since the incident. It also

noted that you have demonstrated a level of insight and remorse.

The panel therefore determined that a suspension order for a period of three

months was appropriate in this case to mark the seriousness of the

dishonesty, meet the wider public interest and to maintain public confidence

in the NMC as a regulator.

At the end of the period of suspension, another panel will review the order.

At the review hearing the panel may revoke the order, it may confirm the

order, or it may replace the order with another order.

Any future panel reviewing this case would be assisted by:

Your attendance and continued engagement with the process.

A reflective piece using an accepted model, for example Gibbs Model.

This should address:

i) How your dishonest action could have adversely affected the

patient;

ii) How your dishonesty impacted your colleagues;

iii) How your dishonesty impacted your nursing team and the team

morale;

iv) How your dishonesty impacted the wider nursing profession,

the public and your own integrity.

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A separate reflective piece in relation to your clinical competence that

covers:

i) What hindered you in the past from reaching the level of

competency of a band 5 nurse, given the support you received

from the Trust and the support given to you by your current

employer;

ii) What you will do differently in the future to increase your

confidence and achieve the competency level of a band 5

nurse;

Testimonials from employers or voluntary employers which address:

i) Competence in the care you undertake, if you are working as a

healthcare assistant or in any caring capacity;

ii) Motivation;

iii) Professionalism.

1. [PRIAVTE].

The panel sought to highlight that whilst you have demonstrated some

remediation by completing online courses, your learning has not sufficiently

developed in a practical nursing setting. The panel was of the view that you

must be able to show practical application of your clinical knowledge in a

healthcare setting. This could be done if you continue to work as a

healthcare assistant or in any caring capacity.

This will be confirmed to you in writing.’

Decision and reasons on current impairment

The panel has considered carefully whether your fitness to practise remains impaired.

Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness to

practise as a registrant’s suitability to remain on the register without restriction. In

considering this case, the panel has carried out a comprehensive review of the order in

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light of the current circumstances. Whilst it has noted the decision of the last panel, this

panel has exercised its own judgement as to current impairment.

The panel had regard to all of the documentation before it, including the NMC bundle, two

reflective pieces from you both dated 7 June 2021, a testimonial from the lead nurse at

your current place of work, and your oral evidence. It has also taken account of the

submissions made by Ms Mahmud on behalf of the NMC.

Ms Mahmud outlined the background of the case and referred the panel to the relevant

documents. She drew the panel’s attention to the testimonial from the lead nurse and

noted that you continue to work as a healthcare assistant. Ms Mahmud submitted that the

positive testimonial demonstrates your progress and it describes you as a ‘good team

player.’ Ms Mahmud also referred the panel to your reflective pieces. She submitted that

they demonstrate reflection, progress and developing insight into your past failings.

Ms Mahmud submitted that you have only been suspended from practising for a couple of

months and this has been a short period within which to demonstrate remediation and

address previous failings. She submitted that there were numerous wide-ranging and

serious concerns and your fitness to practise remains impaired.

Ms Mahmud submitted that although there has been progress in your clinical practice,

there is still room for you to continue to remediate and address your previous failings. She

submitted that whist you have continued to engage with the NMC and continue working

within a healthcare capacity, an order still remains necessary to ensure that you are safe

to practise moving forward.

Ms Mahmud submitted that you have demonstrated insight and remediation in relation to

your dishonesty and any order imposed may focus on monitoring your clinical practice.

She submitted that the panel may find that a conditions of practice order is more

appropriate than a further suspension order given the circumstances but noted that any

decision is entirely a matter for the panel.

The panel also had regard to your oral evidence.

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You told the panel that you wish to improve and work towards your dream of working as a

band 5 nurse in the UK. You told the panel that you have gained insight in relation to your

dishonesty after implicating your colleague, by stating that she was one to give the

medication to a patient. You told the panel that if you were in that position you would feel

hurt and you would have lost trust in other nurses but that you have now gained insight.

You conceded that your fitness to practise is currently impaired. [PRIVATE].

[PRIVATE]. You told the panel that your first employment in the UK was in a clinical

environment that you were unfamiliar with which included working with dementia patients.

[PRIVATE]. When questioned by the panel, you submitted that you are not yet confident to

practise as a band 5 nurse alone but you think that working as a supernumerary nurse will

help you learn and build confidence in the future.

You outlined the impact of your actions and failings on patients, colleagues and the wider

public and the damaging impact it had on the reputation of the nursing profession.

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

In reaching its decision, the panel was mindful of the need to protect the public, to maintain

public confidence in the profession and to declare and uphold proper standards of conduct

and performance.

The panel considered whether your fitness to practise remains impaired.

The panel first considered whether your fitness to practise remains impaired by way of

your misconduct. The panel noted that you had developed insight into your past failings

and notably in relation to your dishonesty. It took into account the testimonial from the lead

nurse and your reflective pieces dated 7 June 2021. It noted that you demonstrated an

understanding of how your actions put the patient at a risk of harm. Further, the panel

noted that you were able to demonstrate an understanding of how your dishonesty

impacted not only on your colleagues and patients, but how it impacted negatively on the

reputation of the nursing profession.

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When questioned about how you would handle the situation differently in the future, you

were able to provide sufficient answers and you outlined how you would seek support and

guidance from staff and undertake further training. The panel was of the view that you

were able to recognise the impact of your dishonesty and it was satisfied that your fitness

to practise is no longer impaired by way of your misconduct.

The panel then went on to consider whether your fitness to practise remains impaired as a

result of your lack of competence. In its consideration of whether you have remedied your

practice, the panel took into account your reflective pieces, your oral evidence and your

admission of impairment in that you are not yet confident that you have the skills to

practise as a band 5 nurse. The panel noted that you have not been able to practise as a

registered nurse and have therefore been unable to address the clinical concerns

identified. In light of this, this panel determined that you are still liable to repeat matters of

the kind found proved. The panel therefore determined that your fitness to practise

remains impaired as a result of your lack of competence and decided that a finding of

continuing impairment is necessary on the grounds of public protection.

The panel has borne in mind that its primary function is not only to protect patients but also

to meet the wider public interest which includes maintaining confidence in the nursing

profession and upholding proper standards of conduct and performance. The panel

considered that a member of the public would be concerned to learn that a nurse who has

not yet been able to address such wide-ranging and serious concerns was permitted to

return to practise unrestricted. The panel therefore determined that, in this case, a finding

of continuing impairment on public interest grounds is also required.

For these reasons, the panel finds that your fitness to practise remains impaired.

Decision and reasons on sanction

Having found your fitness to practise currently impaired, the panel then considered what, if

any, sanction it should impose in this case. The panel noted that its powers are set out in

Article 30 of the Order. The panel has also taken into account the ‘NMC’s Sanctions

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Guidance’ (SG) and has borne in mind that the purpose of a sanction is not to be punitive,

though any sanction imposed may have a punitive effect.

The panel first considered whether to take no action or to impose a caution order but

concluded that this would be inappropriate in view of the seriousness of the case, and the

public protection issues identified. As neither of these orders restricts your practice they

would not be appropriate in the circumstances. The SG 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 decided that it would be neither proportionate nor in the public

interest to take no further action or to impose a caution order.

The panel considered making a conditions of practice order. Despite the seriousness of

your case, there has been evidence produced to show that you have developed insight

and provided evidence of remediation into your failings. You have indicated that you wish

to return to nursing albeit by your own admission you are not fully confident and would

need further support and training.

The panel was satisfied that, since you have remediated your dishonesty, it would now be

possible to formulate practicable and workable conditions that, if complied with, may lead

to your unrestricted return to practice and would serve to protect the public and the

reputation of the profession in the meantime.

The panel decided that the public would be suitably protected as would the reputation of

the profession by the implementation of the following conditions of practice:

‘For the purposes of these conditions, ‘employment’ and ‘work’ mean any

paid or unpaid post in a nursing, midwifery or nursing associate role. Also,

‘course of study’ and ‘course’ mean any course of educational study

connected to nursing, midwifery or nursing associates.’

1. You must ensure that you are supervised by a registered nurse any time

you are working. Your supervision must consist of:

Working at all times on the same shift as, but not always directly

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observed by, a more experienced registered nurse.

Meeting with your line manager, mentor or supervisor (or their

nominated deputy) fortnightly initially to for the first three months and

then thereafter as often as required by your supervisor, but at least

monthly, to discuss your clinical practice and performance and your

progress towards achieving the aims set out in your PDP.

2. You must work with your line manager, mentor, or supervisor (or their

nominated deputy) to create a personal development plan (PDP). Your

PDP must address the concerns identified in the substantive hearing as

follows:

a) Preparation/ administration of medication

b) infection control

c) lack of leadership / ability to supervise

d) communication skills

e) patient admissions and discharges

f) provision of care to patients and treating patients with dignity

g) record keeping

h) time management and organisation

i) handovers

you must:

Send your case officer a copy of your PDP within three months

from the start of this order.

Send your case officer a report from your line manager, mentor or

supervisor (or their nominated deputy) every six months during the

period of the order and before any NMC review hearing or

meeting. This report must show your progress towards achieving

the aims set out in your PDP.

3. You must keep the NMC informed about anywhere you are working by:

a) Telling your case officer within seven days of accepting

or leaving any employment.

b) Giving your case officer your employer’s contact

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details.

4. You must keep the NMC informed about anywhere you are studying by:

a) Telling your case officer within seven days of accepting

any course of study.

b) Giving your case officer the name and contact details of

the organisation offering that course of study.

5. You must immediately give a copy of these conditions to:

a) Any organisation or person you work for.

b) Any agency you apply to or are registered with for work.

c) Any employers you apply to for work (at the time of

application).

d) Any establishment you apply to (at the time of

application), or with which you are already enrolled, for

a course of study.

e) Any current or prospective patients or clients you intend

to see or care for on a private basis when you are

working in a self-employed capacity

6. You must tell your case officer, within seven days of your becoming

aware of:

a) Any clinical incident you are involved in.

b) Any investigation started against you.

c) Any disciplinary proceedings taken against you.

7. You must allow your case officer to share, as necessary, details about

your performance, your compliance with and / or progress under these

conditions with:

a) Any current or future employer.

b) Any educational establishment.

c) Any other person(s) involved in your retraining and/or

supervision required by these conditions.

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The period of this order is for 18 months.

The suspension order is reduced in length so that it will expire at the end of 9 June 2021 in

accordance with Article 30(2) and (4). This conditions of practice order will come into effect

on the expiry of the current suspension order at the end of 9 June 2021 in accordance with

Article 30(1).

Before the end of the period of the order, a panel will hold a review hearing to see how

well you have complied with the order. At the review hearing the panel may revoke the

order or any condition of it, it may confirm the order or vary any condition of it, or it may

replace the order for another order.

Any future panel reviewing this case would be assisted by:

Your attendance at the hearing and continued engagement with the NMC.

Commencement or completion of your employer’s preceptorship

programme.

Testimonials from a line manager, supervisor or others in relation to your

practice.

A further reflective piece on your progress to date.

This will be confirmed to you in writing.

That concludes this determination.

nursing and midwifery council fitness to practise committee

Documents