NMC new rules

Helping Activists support members
Roz Hooper
Senior Legal Officer
RCN Legal Directorate
RCN Joint Representatives’ Conference
15th June 2013
Aims of the day:
• Understand NMC processes
• Recent case types
• How can you help members facing
NMC proceedings?
• CRB/DBS… news
How nurses are regulated
Employment contract
NMC registration: Fitness to Practise
Criminal justice system
Who refers nurses to the
NMC in numbers:
• Year
NMC new referrals
New interim orders
• 2007/8
199 (13%)
• 2008/9
• 2009/10
• 2010/11
424 (12%)
• 2011/12
922 (21%)
Are nurses getting worse?
• Nearly 600 nurses and midwives were
banned from practising last year by the
Nursing and Midwifery Council, Nursing
Standard has learned.
• A total of 589 nurses were removed from the
NMC register following fitness to practise
(FtP) hearings in 2012/13, up from 365 in
• Real reason: Up to Jan 2012, 9 cases
being heard a day, now 22.. Clearing
Outcomes in the NMC:
• RCN secures a no case to answer or no
sanction finding in 85% of cases. NMC
equivalent for all cases is 81% (but not
quite like for like as figure includes 40%
screened out, many without notification)
• Rest were no sanction/ cautions
/Conditions of practice/ suspensions/
strike off
NMC: The practicalities
• Court room set up: Panellists and Legal
• Standard of proof: Balance of
• RCN representation: Usually specialist
Fitness to Practise Cases
• “Fitness to practise is a registrant’s suitability to
be on the register without restrictions.”
• Reporting a case of unfitness to practise to the
NMC is only appropriate if the conduct, practice
or health of a registrant is impaired to the extent
that public protection may be compromised
• (Reporting unfitness to practise: A guide for
employers and managers. NMC 2004)
NMC Advice to employers
• Do all you can at a local level
• We will not normally become involved in a
case if you cannot demonstrate that you have
already taken measures to tackle the situation
at a workplace level.
• Before contacting us, make sure you:
• carry out your own internal investigations
• carefully collect and manage evidence
• make use of your own disciplinary and
competence procedures
Types of cases:
• Misconduct
• Lack of competence
• Health
• Conviction or caution
• Determination by another body
It is current fitness that is assessed
Typical misconduct cases
• Clinical: drug errors, neglect, recording
errors, missed observations, home manager
failings etc
• Dishonesty: working while on sick leave,
sleeping on duty, misleading on CV, failing to
disclose NMC referral to employer, altering a
• Abuse of patients : shouting, rough handling
• Boundaries: flings with patients, language,
social network sites, colleagues
Case study 1
Comments to Colleagues (not malicious):
‘This response would not have been given to a
white woman and the fact that Ms Rowe was a
black woman was fundamental to the listener’s
perception of humour. This had the effect of
isolating Ms X and making her feel different. For
these reasons the panel concludes that the joke
was a racist joke and thus a racist remark as
Sanction: 2 year caution
Case study 2
• 4 failures to administer medication, and
record that she had administered it
• 12 month Conditions of practice
• “You must not carry out the
administration of medication unless
under the direct supervision of another
registered nurse”
Case study 3
Sexual relationships with 2 student nurses
registrant was mentoring
“Both of the relationships that Mr Y had
with Student A and Student B were
consensual. The panel has heard from Mr
Y today and he has expressed remorse
and shame for his failings”
Sanction: 12 month caution order
Case Study 4
• Some poor practice, and undertook
invasive procedures that were
unjustified and made an inappropriate
comment to Patient B with words to the
effect “It’s time to go for the big sleep”
• Did not attend, so no insight or attempts
to remedy
• Sanction: Struck off
Danger areas: Social
networking sites
• Badmouthing your workplace,
identifying yourself as a nurse and
commenting on your Trust’s policies,
commenting on colleagues (Where I
work they are all a load of…)
• Communicating with patients (eg ‘Hi
• Commenting on your activities (eg I’m
on duty in 4 hours and I am trashed…)
Danger areas: Boundaries
• You share personal problems or aspects of your
intimate life with patients or keep secrets with
patients or take gifts.
• You become defensive when someone questions
your interaction with the patient.
• You speak to the patient about your own professional
needs or inability.
• You speak poorly of co-workers or the hospital to
• You speak poorly of co-workers or the hospital to
• You talk to patients/families about things that are out
of your scope of practice.
• You give patients personal contact information/
money or extra attention.
• You feel that you understand the patient’s problems
better than other members of the healthcare team.
DBS (the Disclosure and Barring
Service).. Formerly CRB and ISA
• Everyone in a nursing role (including
HCAs) requires a CRB certificate.. In
future to be called a DBS check
• Checks contain convictions, cautions
and enhanced disclosure, which
includes any information that the chief
police officer believes ‘might be
relevant’ and ‘ought to be included’... so
unproven allegations can go in
• If a member is unhappy with the entry in
the DBS check, refer to RCND
• DBS can also bar people (not just
nurses) from working with children or
vulnerable adults
• If a member is referred, refer to RCND
• The new update service
• Police do refer on to the NMC and DBS
• NMC treats a caution as an admission
that they cannot go behind
• The olive oil incident…
Advice to a member facing an
NMC referral
• Contact RCND immediately.. Should be
with the lawyer within a day
• Tell employer immediately (a duty under
the code)
• Write reflective pieces.. Consider how to
demonstrate remorse and remediation
(courses and work)
• Keep the evidence/witness details.. but
don’t breach patient confidentiality
Any questions or comments?

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