The Nursing and Midwifery Council’s (NMC) fitness to practise insights and analysis provides a clear indication of factors that place nurses and midwives at heightened risk of referrals and regulatory action. I discuss these heightened risks and look at factors that the insights have shown to reduce the risk of regulatory sanctions.
NMC Fitness to Practise Risk Factors
- The Nursing and Midwifery Council (NMC) fitness to practise cases has seen a 14 percent increase in new concerns.
- Concerns about patient care including diagnosis, observation, or assessment, and delayed or inappropriate responses to patient deterioration are the most common types of concerns raised.
- Concerns focused on professionals’ clinical performance, such as prescribing errors or poor record-keeping, are also frequently raised with the NNC, more commonly so by employers than members of the public.
- Members of the public are more likely to raise concerns about professionals’ behaviour and communication.
- Members of the public were the largest single source of new concerns over the five-year period (accounting for 34 percent of concerns, compared with employers who accounted for 28 percent).
- Members of the public (particularly people who receive midwifery care) are more likely to raise concerns about midwives than employers.
- In comparison, employers are more likely to raise concerns about nurses and nursing associates than members of the public.
- Male professionals working in mental health and learning disabilities settings are particularly affected. Male professionals make up 26 percent of professionals on our register with a qualification to practice in mental health care; however, they account for 40 percent of fitness to practise concerns related to all professionals with a mental health qualification.
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The types of concerns raised
The most common allegations are concentrated in six main areas:
- Patient care
- Prescribing and medicines management
- Record keeping
- Dishonesty
- Behaviour or violence
- Communication issues
Factors that reduce the risk of regulatory sanctions
Demonstrating Insight and Strengthen Practice
Insight and strengthen practice (also referred to as remediation) is about nurses, midwives or nursing associates “putting problems right where they can promote a learning culture.” Demonstrating insight means the professional has taken the opportunity to step back, recognise what went wrong, and take responsibility for their actions. It involves understanding the impact of mistakes on patients and on public trust, and identifying what could be done differently to prevent similar issues from happening again in the future.
Strengthening practice means taking steps to improve (or remediate) practice.
In terms of the range of sanctions, demonstrating insight and efforts to strengthen practice, has been shown to result in lesser sanctions (advice issued, warning issued) or no case to answer. Conversely, lack of insight and efforts to strengthen practice has been show to increase regulatory sanction (Undertakings and a case to answer).
Early engagement
The NMC encourages nurses, midwives, and nursing associates to engage with them early and at every stage of the process. This includes:
- Providing information about their current employment and any steps their employer is taking to manage risk
- Providing information about the context of the incident
- Providing evidence of any steps they’ve taken to address concerns about their fitness to practice
- Providing evidence of any insight or reflection they’ve undertaken about the concerns raised
NMC fitness to practise insights have shown that early engagement can help nurses, midwives, and nursing associates.
Having representation during fitness to practise
Key to all of the above however is the right legal representation. Nurses, midwives, and nursing associates are entitles to legal representation during fitness to practise proceedings and early engagement with legal representation is key.
Early engagement with legal representation is key as it will assist nurses, midwives, and nursing associates with the right early engagement with the NMC and agree the right insight and strengthen practice approach to ensure good outcomes. The NMC’s fitness to practise insights has shown that professionals who were represented at the NMC investigations stage (as opposed to the initial stage or the final hearing stage) lead to cases being closed at an earlier stage, without restriction to future practice.
It was also found that professionals with representation at final hearings were less likely to receive outcomes which restricted their future practice.
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Disclaimer: This article is for guidance purposes only. Kings View Chambers accepts no responsibility or liability whatsoever for any action taken, or not taken, in relation to this article. You should seek the appropriate legal advice having regard to your own particular circumstances.