The NMC makes clear that remediation is central to deciding whether a nurse, midwife or nursing associate’s fitness to practise is impaired. When assessing remediation, decision makers at various stages of the NMC’s fitness to practise process will to take into account the following questions:
These factors are key points for decision makers to consider, but they are not a definitive test of whether a nurse, midwife or nursing associate’s fitness to practise is currently impaired.
The NMC’s guidance recognise that whilst it can often be very difficult, if not impossible, to put right the outcome of the clinical failing or behaviour, decision makers should instead “assess the conduct that led to the outcome, and consider whether the conduct itself, and the risks it could pose, can be remedied.”
More often than not, remediation is possible in cases involving clinical failing or behaviour that alleges impaired fitness to practise. However, it is also the case that, sometimes, the conduct of a particular nurse, midwife or nursing associate can fall so far short of the standards that remediation may not be possible. Usually, this involves cases where the behaviour suggests underlying problems with the nurse, midwife or nursing associate’s attitude.
Examples of cases that might be difficult to remedy include:
Where things have gone wrong, reassurances will need to be demonstrated that there will be a negligible risk and that any ongoing risk can be adequately managed.
It is a well-established fact that simply saying sorry is not enough. Insight and remediation must be genuine and demonstrable. NMC guidance states that “Decision makers do more than simply look at whether a nurse, midwife or nursing associate has shown ‘any’ insight or not. They need to assess the quality and nature of the insight.”
When evaluating the strength of insight, the NMC will consider, for example, whether a nurse, midwife or nursing associate has:
A brief word on apologies and insight. Careful though needs to be given because an apology might be interpreted as an admission of guilt. On the issue, the NMC states:
“While a willingness to apologise for mistakes or failings should be encouraged, there is no requirement for the nurse, midwife or nursing associate to make admissions at an early stage. Decision makers should be sensitive to circumstances which may prevent a nurse, midwife or nursing associate from offering a clear apology. Offering an apology may be perceived as an admission of guilt, which could have implications for any separate legal proceedings.”
It is always advisable that you seek expert legal advice at the earliest opportunity to ensure your response and approach to any allegation is well considered.
Much of this article has focussed on remediation. However, remediation can only follow once a nurse, midwife or nursing associate has gained the appropriate insight.
When considering the likelihood of repeating wrong conduct, the NMC will assess the extent of the nurse, midwife or nursing associate’s insight into the concerns, and will also consider whether the steps taken to remedy concerns are sufficient.
Whilst the circumstances of each case will be determined by its own circumstances, the NMC does state that the likelihood of the conduct being repeated in the future may be reduced where:
Reflecting on the circumstances that might have led to alleged impairment of your fitness to practise will vary based on the circumstances but you must be able to demonstrate you have gained real and genuine insight.
Some things to consider when undertaking a reflective piece:
NMC Defence Barrister
I am an experienced Nursing & Midwifery Council (NMC) Defence Barrister who has represented nurses and midwives at all levels of a fitness to practise investigation and panel hearings. I am a practising healthcare and medical law defence barrister with a proven track record of success, years of experience and renowned for being “hands on”.
I can help with all matters relating to NMC Fitness to Practise Referrals issues including:
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If you have been notified by the NMC that you’re under investigation or are facing difficulties with your registration, contact me today for an initial free and no obligation consultation on 0207 060 1983 or Stephen.McCaffrey@kingsviewchambers.com.