Conduct and Competence Committee - nmc.org.uk

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Conduct and Competence Committee Substantive Hearing 1-3 February 2017 Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ

Name of registrant: Cicilyamma Simon

NMC Pin: 04J0373O

Part(s) of the register: RN1, Registered Nurse (sub part 1) – Adult

11 October 2004

Area of registered address: England

Type of case: Misconduct

Panel members: Eileen Skinner (Chair, Lay member)

Jane Fraser (Registrant member)

Jacqueline Rendell (Registrant member)

Legal Assessor: Leighton Hughes

Panel Secretary: Nilima Ali

Representation: Nursing and Midwifery Council (NMC): Represented by Jessica Ward, Counsel,

instructed by the NMC Regulatory Legal Team

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Mrs Simon: Mrs Simon was present and was represented

by Kieran Galvin, Counsel, instructed on behalf

of Thompsons Solicitors Facts found proved: 1, 2, 3 and 4

Facts found not proved: N/A

Fitness to practise: Impaired

Sanction: Striking-off order

Interim Order: Interim suspension order: 18 months

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Charges read

That you, a registered nurse, whilst working at Westwood Lodge Nursing Home, on 16

September 2015:

1. Failed to carry out CPR on Resident A when requested to do so by Colleague F;

2. Whilst refusing to carry out CPR said “no leave him, he’s dead anyways” or

words to that effect;

3. Recorded in Resident A’s ‘twice daily evaluation of planned care’ sheet that you

had performed CPR on Resident A with Colleague F, when that was not the

case;

4. Your actions as set out at Charge 3 above were dishonest in that you intended to

give the impression that you had assisted with CPR, when you had not done so.

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

misconduct.

Background

Mrs Simon,

The background to this case was presented by Ms Ward, on behalf of the NMC, as

follows:

This case concerns an incident at Westwood Lodge Nursing Home (“the Home”) on 16

September 2015 involving you and Resident A.

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You were employed through an Agency to work at the Home as a nurse. Also working in

the Home on the date in question were Colleague B (Care Assistant), Colleague C

(Care Assistant), Colleague D (Senior Carer), Colleague E (Senior Carer) and

Colleague F (Nurse).

Charge 1

At approximately 18:15 on 16 September 2015, Colleague B had noticed concerns

about Resident A, including problems with his breathing.

It is alleged that Colleague B had informed you of her concerns, but that you did not

attend to Resident A. Colleague B then asked Colleague D to check on the resident. In

an attempt to assist Resident A, he was sat up in his bed and his breathing seemed to

improve.

It was Colleague B’s evidence that you later conducted some observations on Resident

A and that she recorded the results of these observations.

Following this, at approximately 19:16, some 45 minutes since Colleague B first

informed you of her concerns regarding Resident A, Colleague B heard you call for an

ambulance for the resident.

At approximately 19:30, Colleague B went to check on Resident A again and noticed

that he was still having difficulty breathing.

By approximately 19:54, with no ambulance having yet arrived for Resident A,

Colleague B again asked Colleague D to check on the resident.

Colleague F was due to commence her shift and take over from you at 20:00. She

arrived at the Home at approximately 19:50 and attended Resident A’s room. By this

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time Resident A was grey and unresponsive. There was no Do Not Resuscitate (“DNR”)

order in place for the resident.

Colleague F began to perform CPR on Resident A. You also attended the resident’s

room, whilst Colleague F was conducting CPR. Colleague F asked you to take over

from her but you, allegedly, refused to do so. It was the NMC’s case that this was

witnessed by Colleague B, Colleague D and Colleague F.

Charge 2

Colleague F again asked you to perform CPR on Resident A and you again, allegedly,

refused and said words to the effect of “no leave him, he’s dead anyway”. Colleague B then assisted Colleague F in performing CPR. An ambulance later arrived

and pronounced Resident A dead. It was not suggested by the NMC that there was any

causal link between your refusal to provide Resident A with CPR and his death.

Charge 3

Subsequent to this incident, you completed the ‘Twice Daily Evaluations of Planned

Care’ (“Planned Care form”), in respect of Resident A. It was alleged that, on that plan,

you noted that, at 19:53, you, along with Colleague F, performed CPR on Resident A.

Charge 4

It was the NMC’s case that your entry in the Planned Care form was incorrect and

untruthful because you did not provide CPR to Resident A at all, nor did you assist

Colleague F in providing CPR to the resident. It was the NMC’s case that in recording

untruthful information on the Planned Care form, you were dishonest.

The following matters in issue were therefore:

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• Whether you refused to provide CPR to Resident A;

• Whether you said words to the effect of “no leave him, he’s dead anyway”;

• That you were dishonest in completing the Planned Care Form in the manner as

alleged.

Submission of no case to answer in respect of charge 1

Mr Galvin, on your behalf, made a submission that you have no case to answer in

respect of charge 1, on the basis that no such duty had been established by the NMC.

He submitted that it was apparent from the evidence presented thus far that Resident A

was “clearly dead before CPR was administered” as the resident had not been

breathing for approximately 16 minutes before CPR was commenced. Mr Galvin

submitted that as an experienced registered nurse, you took the decision that it was

“undignified” for CPR to be performed on Resident A, given that he had “clearly passed

away”.

Mr Galvin further submitted that Colleague F’s evidence, as referred to by Ms Ward,

went “against all common sense” in the particular circumstances of this case.

Ms Ward referred the panel to the evidence of Colleague F, who said that in the case of

an unexpected death, and where there is no DNR order in place, a registered nurse

would be expected to perform CPR, and to continue CPR, until the arrival of

paramedics. It was, furthermore, Colleague F’s evidence that policies to this effect did

exist in the Home. Accordingly, she submitted that there was a duty upon you to

perform CPR on Resident A and that you failed to do so.

In the panel’s judgement, the statutory provisions governing the conduct of fitness to

practise proceedings were such as to confer a wide discretion on panels in regulating

their own proceedings. The panel was thus satisfied that the statutory provisions

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extended to enabling the panel, at this stage of the proceedings, to direct the NMC to

make reasonable efforts to obtain the following, prior to the panel retiring to consider Mr

Galvin’s submission:

• Any policies in force in the Home at the material time in relation to unexpected

deaths and DNR orders; and

• The relevant legislation as regards any legal obligation on a registered nurse to

perform CPR and, if relevant, under which circumstances such a legal obligation

would arise.

Ms Ward subsequently provided the panel with an update as regards the panel’s

request for further information. She explained that the NMC had received an email from

the current registered manager of the Home, in which the manager stated that, in 2015,

the Home (previously owned by Meridian Healthcare) was sold to a company called

HC1. As a result, the manager was unable to access any policies that would have been

put in place by the previous company.

As to any relevant legislation, Ms Ward explained that there was no specific statute that

applied to the particular circumstances of this case. She did, however, locate a

guidance document (dated 2015), produced by the Resuscitation Council, which was

applicable to all healthcare professionals.

The legal assessor expressed his concern that the panel would have professional

difficulty in seeking to import a duty upon a registered nurse to comply with such a

guidance document that does not specifically relate to the duties of registered nurses.

In response, Ms Ward referred the panel to the evidence of Colleague F, who had

spoken of the existence of a policy in the Home that addressed the specific

circumstances of this case.

Mr Galvin, on your behalf, shared the concerns expressed by the legal assessor.

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Determination on application of no case to answer in respect of charge 1

In reaching its decision on this application, the panel gave careful regard to the

submissions of both advocates, and it accepted the advice of the legal assessor. The

legal assessor referred the panel to Rule 24(7) of the Nursing and Midwifery Council

(Fitness to Practise) Rules Order of Council 2004 (as amended) (“the Rules”):

Order of proceedings at initial hearing 24.-(7) Except where all the facts have been admitted and found proved under

paragraph (5), at the close of the Council’s case, and—

(i) either upon the application of the registrant, or

(ii) of its own volition,

the Committee may hear submissions from the parties as to whether sufficient evidence

has been presented to find the facts proved and shall make a determination as to

whether the registrant has a case to answer.

The legal assessor further referred the panel to the test set out in the case of R v

Galbraith [1981] 73 Cr App R 124, which outlined the following:

“(1) If there is no evidence that the crime alleged has been committed by the defendant,

there is no difficulty. The judge will of course stop the case. (2) The difficulty arises

where there is some evidence but it is of a tenuous character, for example because of

inherent weakness or vagueness or because it is inconsistent with other evidence. (a)

Where the judge comes to the conclusion that the prosecution evidence, taken at its

highest, is such that a jury properly directed could not properly convict upon it, it is his

duty, upon a submission being made, to stop the case. (b) Where however the

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prosecution evidence is such that its strength or weakness depends on the view to be

taken of a witnesses’ reliability or other matters which are generally speaking within the

province of the jury and where on one possible view of the facts there is evidence upon

which a jury could properly come to the conclusion that the defendant is guilty, then the

judge should allow the matter to be tried by the jury….There will of course as always in

this branch of the law be borderline cases. They can safely be left to the discretion of

the judge.”

The panel was mindful that an allegation of a failure requires a professional duty on the

registered nurse to act in a particular way, combined with the fact of not doing so.

It was Colleague F’s evidence that she had asked you twice to perform CPR (“Cardio

Pulmonary Resuscitation”) on Resident A and that you refused to do so on both

occasions. She explained that, on the first occasion, she had asked you to “take over

and do CPR”, so that she could rest her hands. She confirmed that you said “no” in

response. She told the panel “at first, [you] said ‘no’. I asked [you] again, I think I said

‘you have to do it’ and [you] said ‘he [Resident A] is already dead”.

Colleague F told the panel that she was aware, from Resident A’s care records, that

there was no DNR order in place for him. She said that “we need to do CPR if there is

no [DNR]”.

Colleague F told the panel that “the law says we need to try [to perform CPR]… even

the paramedics will ask you to try… if there is no DNR in place, that is the law, you have

to do CPR”. She went on to say “I’ve been trained to do CPR until the paramedics

arrive… sometimes you can do CPR for 2 to 3 hours. You don’t just stop… you never

know when the heart will start beating again… there have been cases when [the heart]

starts beating again”.

When asked by the panel to explain her understanding of her professional duty towards

a resident who she found was not breathing, Colleague F said that the policy in the

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Home at the time, in the case of an unexpected death, was to “call the paramedics…

and the police would be involved… [and to perform CPR] if [the resident] does not have

a DNR in place. Even if the death is unexpected, and they have a DNR, you still need to

call an ambulance”.

Whilst the final assessment of Colleague F’s evidence must await the fact finding stage

of the proceedings, the panel was entitled to undertake a preliminary assessment of

Colleague F, who appeared to present a clear, consistent and firm view that it was the

responsibility of the registered nurse, in the circumstances as presented in this case, to

administer CPR to the resident and to continue CPR until the arrival of the paramedics.

The panel had further regard to paragraphs 8.5 and 15 of the NMC’s publication, ‘The

Code: Professional standards of practice and behaviour for nurses and midwives’

(March 2015) (“the Code”), which requires registered nurses to “work with colleagues to

preserve the safety of those receiving care” and “always offer help if an emergency

arises in your practice setting or anywhere else”.

The panel was satisfied that the evidence, taken at its highest, was sufficient to enable

a panel, properly directed, to conclude that the charge could be found proved. In that

regard, the panel was satisfied, on the evidence before it, that your not carrying out

what may be considered a reasonable request from another registered nurse was

capable of amounting to a failure for the purpose of charge 1.

Accordingly, the panel determined that you do have a case to answer.

Determination on facts

In reaching its determination on facts, the panel had regard to all the evidence adduced,

including all the exhibited documents. It heard submissions from Ms Ward and Mr

Galvin. The panel accepted the advice of the legal assessor.

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The burden of proof rests entirely upon the NMC. You do not have to prove or disprove

anything. The standard of proof is the civil standard, namely the balance of probabilities.

This means that, for a fact to be found proved, the NMC must satisfy the panel that what

is alleged to have happened is more likely than not to have occurred.

The panel heard evidence on behalf of the NMC from the following witnesses, who held

the positions (as listed below) at the relevant time:

• Colleague B, Care Assistant at the Home;

• Colleague D, Care Assistant at the Home;

• Colleague E, Senior Carer at the Home; and

• Colleague F, Nurse at the Home.

The panel made the following findings of fact in respect of the charges:

That you, a registered nurse, whilst working at Westwood Lodge Nursing Home, on 16

September 2015:

1. Failed to carry out CPR on Resident A when requested to do so by Colleague F;

Colleague F gave evidence in respect of this charge. She explained that when she

arrived at the Home at 19:50, she heard Colleague E shouting her (Colleague F’s)

name. Colleague F went to Resident A’s room; she recalled seeing Colleague B,

Colleague D and Colleague E in the room. She also recalled seeing you outside the

room, at the nurse’s desk.

Colleague F saw Resident A lying on the bed. He was grey in colour and was not

breathing. She asked the care assistants what had happened, and she was told that

Resident A had stopped breathing. She also asked where you were, and she was told

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that you were on the telephone. She told the care assistants that she needed to

commence CPR as there was no DNR order in place for the resident.

Colleague F asked Colleague E to call you to assist. At approximately 19:53 Colleague

F commenced CPR.

You then walked into Resident A’s room and Colleague F asked you if you could take

over from her in performing CPR, so that she could rest her hands. At that point

Resident A was still unresponsive. According to Colleague F, you “refused to take over

CPR and said ‘no I’m not doing CPR’.” She asked again and told you that you had to do

it to help her and because there was no DNR order in place. You replied “no leave him,

he’s dead anyways”. She looked at you and told you that “we needed to try” and she

continued to administer CPR whilst you walked out of the room. Colleague F said that

she then asked Colleague B to assist her.

When the paramedics arrived, at approximately 19:59, Colleague F stopped

administering CPR to Resident A. Observations were taken of the resident and he was

declared dead.

In her oral evidence, Colleague F confirmed that she had asked you twice to perform

CPR on Resident A and that you refused to do so on both occasions.

Colleague F told the panel that she was aware, from Resident A’s care records, that

there was no DNR order in place for him. She said that “we need to do CPR if there is

no [DNR]”.

Colleague F told the panel that “the law says we need to try [to perform CPR]… even

the paramedics will ask you to try… if there is no DNR in place, that is the law, you have

to do CPR”. She went on to say “I’ve been trained to do CPR until the paramedics

arrive… sometimes you can do CPR for 2 to 3 hours. You don’t just stop… you never

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know when the heart will start beating again… there have been cases when [the heart]

starts beating again”.

Colleague F told the panel that the policy in the Home at the time, in the case of an

unexpected death, was to “call the paramedics… and the police would be involved…

[and to perform CPR] if [the resident] does not have a DNR in place. Even if the death is

unexpected, and they have a DNR, you still need to call an ambulance”.

Colleague F disputed the assertion that you had conducted two or three chest

compressions on Resident A; she said “no, it was only me that did the CPR. When [you]

refused, I asked [Colleague B] to help me”. She also disputed the assertion that you had

taken the resident’s pulse whilst in the resident’s room; she replied “I was next to the

bed and [Colleague B] was next to me, and there was no one else near the bed. I took

[Resident A’s] pulse before I started CPR and there was no pulse”.

Colleague B also gave evidence in support of this charge. She described the layout of

Resident A’s room, as well as where all parties were standing in the room at the time.

She said that you were standing approximately four feet behind Colleague F, and that

she (Colleague B) was standing approximately two feet away from Colleague F.

Colleague B confirmed that she heard Colleague F ask you, on two occasions, to

perform CPR on Resident A, and that she (Colleague B) had heard your responses to

each request. When asked if you had, at any point, performed CPR on the resident,

Colleague B replied “not Cicily”.

Colleague B confirmed that, at the request of Colleague F, she had taken over in

administering CPR to Resident A, whilst under the supervision of Colleague F.

Colleague D also gave evidence in support of this charge. She confirmed that she was

in Resident A’s room when Colleague F began performing CPR on the resident, and

that you had entered the room thereafter. She told the panel that Colleague F had

asked you if you “had done CPR”, to which you replied “no”. When asked to clarify her

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evidence, Colleague D said that Colleague F had asked you “to do CPR” on Resident A.

She confirmed that Colleague F had asked you twice to perform CPR and that, on both

occasions, you said “no” and that you “wouldn’t do it”. According to Colleague D, there

was no further conversation between you and Colleague F.

When Colleague D was asked whether there was any time, during the incident, that you

had performed CPR on Resident A, Colleague D replied “no, she didn’t do it… sorry”.

When it was put to Colleague D that you had carried out “a couple of compressions” on

Resident A, she replied “I didn’t see [that]”. She confirmed that both you and Resident A

were in her line of sight throughout the duration of her time in the resident’s room. When

asked if, at any time, she had seen you performing CPR on the resident, she replied

“no”. She also confirmed that at no point was her view of you obscured.

In response to this charge, you disputed the assertion that you had refused to perform

CPR on Resident A. You said that, at approximately 19:25 when you were speaking, on

the telephone, to the ambulance service, you were advised to commence CPR on the

resident. You entered the resident’s room, at which point you noted that Colleague F

had already commenced CPR. You were aware, at least by the time that you had

entered the resident’s room, that there was no DNR order in place for Resident A.

You said that only Colleague F and, to the best of your recollection, Colleague E were in

the room at the time. You therefore disputed Colleague B and Colleague D’s evidence

and said that they were “telling lies”.

You told the panel that you checked Resident A’s pulse and did not identify any pulse.

You said “then I understood in my mind that he [Resident A] had already passed away.

[Colleague F’s] hands were aching and she asked me to continue CPR”. You said that “I

did 3 or 4 compressions, 100% I did it… then I stopped. I stopped because the resident

is no more”. You therefore disputed the assertion that you failed to perform CPR on

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Resident A, and disputed the evidence of Colleague B, Colleague D and Colleague F in

this regard.

You said “[Colleague F] kept on insisting [that I] continue the CPR. After 3 or 4

compressions I stopped. She told me ‘don’t stop, don’t stop’.” After you ceased the

compressions, you told Colleague F that Resident A had “passed away”. You said

“100% I understood, because of my professional judgement, that he [Resident A] has

passed away”.

You said that, “within no time”, the paramedics arrived at Resident A’s room. You said “I

saw them and then I stopped, that’s what I think. I thought it’s too cruel to do CPR… so

when I saw them, I stopped”. You later said that you stopped undertaking compressions

because “he [Resident A] was dead. That was the main reason. I felt it was cruel to give

CPR… when I stopped I saw the paramedics inside the room”.

You accepted that in circumstances where there is no DNR order in place, it is your duty

to perform CPR; you said “yes, of course, all nurses know if [there is] no DNR then we

have to do CPR”. You confirmed that you would be required to continue administering

CPR until the arrival of paramedics.

You told the panel that “I stopped after 3 or 4 compressions, that was my mistake, but I

stopped because I realised that he [Resident A] had passed away. That’s why I

stopped. The training is until paramedics come we cannot stop it [CPR]. That is my

mistake, I realise that. I would have continued [CPR]”. You said that you have, since

these events, undertaken relevant training.

The panel found Colleague F to be wholly reliable and credible, and her evidence was

clear and consistent. Colleague F plainly accepted the responsibility she had for

Resident A, demonstrating awareness and understanding of her nursing responsibilities

in the circumstances.

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Colleague B and Colleague D were nervous when giving evidence, as reflected in their

inability to articulate fully what had happened. Nevertheless, their evidence

corroborated that of Colleague F. The panel found Colleague B and Colleague D to be

generally credible and reliable and that they provided a degree of supporting evidence

for Colleague F’s account.

In the panel’s view, you were not an entirely consistent or convincing witness. You gave

two different reasons for why you say you ceased the chest compressions, and when

this inconsistency was put to you, you simply conflated the two reasons. You told the

panel that Colleague B and Colleague D were “lying”. You disputed Colleague F’s

assertion that you had refused her request to assist her in performing CPR on Resident

A. The panel concluded that this was not a case of misunderstandings and genuine

differences of recollection. It must be that one or other account is incorrect.

The panel was satisfied, on the evidence of Colleague F, that you had a duty to perform

CPR on Resident A. This was supported by your own evidence that you yourself had

been advised, by the emergency services, to perform CPR on the resident. You also

admitted that you were aware of your professional duty, as a registered nurse, to

perform CPR on a resident where there is no DNR order in place, and that you would be

expected to continue to do so until the arrival of the paramedics.

The panel was further satisfied, on the basis of the evidence of Colleague F as

supported by the evidence of Colleague B and Colleague D, that you were asked on

two occasions by Colleague F to assist her in performing CPR on Resident A, and that

you had refused to do so on both occasions.

Accordingly, the panel found charge 1 proved.

2. Whilst refusing to carry out CPR said “no leave him, he’s dead anyways” or

words to that effect;

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Colleague B confirmed that she heard you say, at some point during this incident, that

Resident A was dead.

In her contemporaneous statement of the incident, signed and dated 17 September

2015, Colleague D reported that when Colleague F had asked you, on the second

occasion, to perform CPR on Resident A, you said “no, he’s [Resident A’s] gone”.

Colleague D told the panel that she heard you refuse to perform CPR on Resident A

because “[you] said that [Resident A] had already passed away”.

In her contemporaneous statement of the incident, signed and dated 17 September

2015, Colleague F reported that you had refused to perform CPR on Resident A and

told her to “leave him, [he] is dead anyway”.

Colleague F told the panel that when she had asked you, on the second occasion, to

perform CPR on Resident A, “I think I said ‘you have to do it’ and [you] said ‘he

[Resident A] is already dead”.

You told the panel that when Colleague F had asked why you stopped administering

CPR to Resident A, you told her “he [Resident A] has already passed away”.

On the basis of all the evidence before it, the panel was satisfied that whilst refusing to

carry out CPR on Resident A, you said words to the effect of “no leave him, he’s dead

anyways”.


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3. Recorded in Resident A’s ‘twice daily evaluation of planned care’ sheet that you

had performed CPR on Resident A with Colleague F, when that was not the

case;

The panel had sight of Resident A’s Planned Care form, in which you made the

following entry, timed 19:53 and dated 16 September 2015: “The paramedicals a

[Colleague F] and I given the CPR”.

Colleague F told the panel that, contrary to the entry you made in the form, you did not

assist her in performing CPR on the resident. She said that the “the way I read [the

entry], it says that [you] gave CPR with me”. She went on to say that that was not the

case.

You accepted that the entry in question was made by you, albeit in a hurry. You

accepted that you recorded that both you and Colleague F performed CPR on Resident

A; you said “I did it so I wrote it”. You said that the entry was “absolutely true, I have

never said a lie in my life”. You further said “whatever I have written… happened”.

Having found charge 1 proved, and on the basis of your evidence that the entry in

question had in fact been made by you, the panel found charge 3 proved.

4. Your actions as set out at Charge 3 above were dishonest in that you intended to

give the impression that you had assisted with CPR, when you had not done so.

In order to reach its decision in respect of this allegation, the panel was referred to the

objective and subjective tests set out in the case of R v Ghosh [1992] EWCA Crim 2.

The panel was advised to consider first, having found the matters above proved,

whether it was satisfied on the balance of probabilities that what you did would be

regarded as dishonest by the ordinary standards of reasonable and honest people (the

objective test). Only where the panel was satisfied that the objective element of this test

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was met, would it go on to consider whether it was satisfied on the balance of

probabilities that you must have realised that what you were doing would be regarded

as dishonest by those standards.

The panel was advised by the legal assessor to have regard to your good character,

and your otherwise unblemished, long nursing career, as factors to take into account in

your favour in relation to your credibility and as to the likelihood of you acting in the

manner alleged.

In the panel’s view, recording that you had performed CPR on Resident A with

Colleague F when that was not the case could only be regarded as dishonest, by the

ordinary standards of reasonable and honest people. In the light of the panel’s

assessment of your credibility as a witness, and having found proved that you did not

perform CPR on Resident A as you so claim, the panel concluded that you must have

realised that what you were doing would be regarded as dishonest by those standards.

Indeed, you accepted that any record made by a registered nurse must be truthful and

accurate; you said “definitely, no doubt, [it must] be accurate and true”. You also

accepted that an incorrect and untruthful record would be regarded as dishonest. The

panel was satisfied that you made this dishonest entry in the Planned Care form in

order to falsely give the impression that you had assisted with the CPR of Resident A.

The panel was satisfied that this was the correct conclusion, notwithstanding your

previous good character.


Determination on misconduct and impairment

Following its findings of fact, the panel invited submissions on the matters of misconduct

and impairment.

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Ms Ward submitted that in order to make a finding of misconduct, the panel must

determine that your failures, actions and omissions were serious. In this regard, Ms

Ward referred the panel to the paragraphs 1.4, 2.1, 8.5, 15.2 and 20.2 of the NMC’s

Code.

In respect of charges 1 and 2, Ms Ward submitted that you were, at the material time,

the only registered nurse on duty, as Colleague F was not due to commence her shift

until 20:00. You were, therefore, the only qualified practitioner who could provide CPR

in the circumstances. Ms Ward contended that your failure to perform CPR without

undue delay, and your failure to work cooperatively with Colleague F to preserve the

safety of Resident A, was serious.

In respect of charges 3 and 4, Ms Ward submitted that your deliberate actions in

dishonestly completing Resident A’s Planned Care form in the manner that you did, fell

far below the standards expected of a registered nurse, and had the potential to bring

the profession into disrepute.

Ms Ward therefore invited the panel to conclude that the charges found proved,

individually and collectively, amounted to misconduct.

As to impairment, Ms Ward invited the panel to have regard to the approach formulated

by Dame Janet Smith in her Fifth Report of the Shipman inquiry. In so referring, she

submitted that limbs b), c) and d) applied in this case. She also invited the panel to have

regard to the case of Council for Healthcare Regulatory Excellence v (1) Nursing and

Midwifery Council (2) Grant [2011] EWHC 927 (Admin), in particular to paragraph 71 of

the judgment of Mrs Justice Cox, in which the following was held:

“… it is essential, when deciding whether fitness to practise is impaired, not to lose sight

of the fundamental considerations… namely the need to protect the public and the need

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to declare and uphold proper standards of conduct and behaviour so as to maintain

public confidence in the profession”.

Ms Ward contended that it was “difficult” for you to remedy your misconduct, as it was

reflective of your attitude. She also submitted that your misconduct was, in part,

demonstrative of poor judgement in that, as accepted by you, you made a mistake in

not continuing to administer CPR to Resident A.

Ms Ward further contended that you have demonstrated a clear lack of insight, as

regards your actions on the date in question, the impact of your actions on others and

your attempt to place blame on Colleague F. Ms Ward accepted the difficulty of your

position in you having initially provided one account at the facts stage and then shortly

thereafter at the impairment stage, being expected to demonstrate insight into

something which you continue to deny. She submitted, however, that there was a clear

refusal on your part to accept the findings of the panel.

Ms Ward submitted that your integrity could not be relied upon. She referred the panel

to the evidence you gave in relation to the reflective statement contained in the bundle

of documents submitted to the panel, relating to an incident involving a cardiac arrest in

which you acknowledged that this document had not been written by you.

In closing, Ms Ward submitted that it was necessary to make a finding of current

impairment, on the ground of both public protection and the wider public interest.

Mr Galvin told the panel that in the light of the panel’s findings and your evidence at this

stage of the hearing, he could not make any “sensible” submissions in respect of

misconduct and impairment; instead, stating that both matters were conceded.

In reaching its decision, the panel had regard to all the evidence before it, including your

oral evidence at this stage, and the submissions made by Ms Ward and Mr Galvin. The

panel accepted the comprehensive advice of the legal assessor.

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The panel was advised that, in relation to impairment by reason of misconduct, it must

engage in a two stage process: it must first consider whether, on the facts found proved,

your actions amounted to misconduct; and second, if so, whether your fitness to

practise is currently impaired by reason of that misconduct.

The panel accepted that there was no burden or standard of proof at this stage and

exercised its own professional judgement.

The panel was aware that not every instance of falling short from what would be proper

in the circumstances, and not every breach of the Code, would be sufficiently serious to

be described as misconduct, going to a registrant’s fitness to practise. Accordingly, the

panel had careful regard to the context and circumstances of the matters found proved.

It is a primary and fundamental responsibility of a registered nurse to provide the

necessary nursing intervention needed to preserve the health, wellbeing and safety of

patients. Registered nurses are required to assess the needs of patients, deliver

appropriate treatment, and give help without undue delay and to the best of their

abilities, on the basis of the best evidence available and best practice. This requires

effective communication, working cooperatively and keeping accurate records.

You had a duty to perform CPR on Resident A. You confirmed that you were so aware.

You had also been specifically asked to do so on two occasions by Colleague F, as well

as by the emergency services during the course of your telephone conversation with

them. The panel concluded, in its preceding determination, that you had failed to

discharge your duty in this regard and was satisfied that this was a serious departure

from the standards expected of a registered nurse.

You had, furthermore, a duty to work cooperatively with your colleagues. Colleague F

had asked you to assist her in administering CPR as she needed to rest her hands. You

refused to do so. The panel again concluded, in its preceding determination, that you

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had failed to discharge your duty in this regard. The public have a right to expect that

nurses responsible for their care will work together and respect each other’s

professional judgement. This was a further serious failing by you.

Record keeping is an essential nursing skill and the ability to perform this duty diligently

and competently is integral to safe nursing care. Good records improve accountability;

show how decisions in relation to patient care are made; support patient care and the

continuity of care; help identify risks; and promote better communication and sharing of

information between practitioners. Registered nurses are required to take the utmost

care in respect of patient records. It is a firmly established principle that records must be

completed accurately and without any falsification.

You made a dishonest entry in Resident A’s Planned Care form in order to falsely give

the impression that you had assisted with the CPR of Resident A. Your actions were

motivated by self-interest and self-preservation; you knew that you did not perform CPR

on Resident A but sought to create the impression in his Planned Care form, a legal

document, that you had done so. This was thoroughly dishonest behaviour and an

extremely serious professional failing for a registered nurse.

The panel considered that by virtue of the facts found proved, you breached the

following provisions of the Code:

1.4 Make sure that any treatment, assistance or care for which you are responsible is

delivered without undue delay…

2.1 work in partnership with people to make sure you deliver care effectively

8.5 work with colleagues to preserve the safety of those receiving care

10.3 complete all records accurately and without any falsification…

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15.2 arrange, wherever possible, for emergency care to be accessed and provided

promptly…

20.2 act with honesty and integrity at all times…

The panel was in no doubt that your conduct fell far below the standards expected of a

registered nurse and was of the kind that other practitioners and the general public

would consider deplorable. Taking the charges found proved together, the panel

concluded that your conduct represented very serious departures from acceptable

standards and amounted to misconduct.

The panel then went on to consider the question of impairment. In considering your

fitness to practise the panel reminded itself of its duty to protect patients and its wider

duty to protect the public interest, which includes declaring and upholding proper

standards of conduct and behaviour, and the maintenance of public confidence in the

profession and the regulatory process.

“Impairment of fitness to practise” has no statutory definition. However, the NMC has

defined “fitness to practise” as a registrant’s suitability to remain on the register without

restriction.

The panel was assisted by the observations of Mrs Justice Cox in the case of Grant:

“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.”

[Paragraph 74]

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The panel further took into account the approach formulated by Dame Janet Smith in

her Fifth Report of the Shipman inquiry, which was cited with approval in the case of

Grant:

“Do our findings of fact in respect of the [registrant’s] misconduct […] show that [her]

fitness to practise is impaired in the sense that [she]:

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 [nursing]

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 [nursing] profession; and/or

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

The panel concluded that all four limbs were engaged in this case.

Whilst there was no evidence to establish a causal link between your refusal to assist

Colleague F and Resident A’s death, it was the panel’s view that your failures gave rise

to a clear risk of harm. You were required to act in an emergency situation, to

resuscitate a resident who was not breathing and was unresponsive. The actions

required of you in the circumstances related not only to basic responsibilities of a

registered nurse, but were fundamental in the light of Resident A’s presentation at the

time.

You were, at the time, the only registered nurse formally on duty; Colleague F was not

due to commence her shift until 20:00. You were, therefore, the only qualified registered

nurse who could perform CPR. You were aware of your obligations in the particular

circumstances. As a basic requirement, you ought to have prioritised Resident A’s care.

Rather than delegating the task of contacting the emergency services to the care

assistants on duty, you made the phone calls yourself, including a personal call to your

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husband at this time, whilst they remained with Resident A. As a result of your refusal to

perform CPR on the resident, a junior colleague was asked to assist Colleague F in

providing emergency treatment which she was not otherwise trained to do. Members of

the profession and the public would rightly expect a registered nurse of your many

years’ experience and knowledge, to provide emergency care to a resident who had just

stopped breathing and was unresponsive, with no DNR order in place. Your refusal to

do so, and your overall conduct in the particular circumstances, was entirely

unbecoming of a registered nurse.

You recorded, in the Planned Care form, that you had performed CPR on Resident A

with Colleague F, when that was not the case, and your actions in so doing were

thoroughly dishonest and driven by self-interest. By virtue of your conduct, you

breached fundamental tenets of the profession, namely to protect and promote the

safety and wellbeing of those in your care, to provide a high standard of care at all

times, and to be open and honest. It is a bedrock of the nursing profession, and thus an

indispensable responsibility, that registered nurses act with integrity at all times and

uphold the good standing and reputation of the nursing profession. You failed in that

regard.

The panel was in no doubt that your fitness to practise was, at the time, impaired.

In considering whether your fitness to practise is currently impaired, the panel had

regard to the issues of future risk and public confidence. It is aware that it has a duty,

not only to protect patients, but also to safeguard the public interest. This includes the

declaring and upholding of proper standards of conduct and of behaviour, and the

maintenance of public confidence in the profession and the regulatory process.

With regard to future risk, the panel considered whether your misconduct was easily

remediable, whether it had been remedied and whether it was highly unlikely to be

repeated. In considering these questions, the panel had particular regard to the issue of

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insight. The panel recognised that the level of insight shown by a practitioner is central

to a proper determination of that practitioner’s fitness to practise.

The panel was mindful that to effectively remediate past failings, registered nurses must

demonstrate insight into their behaviour and undertake sufficient remedial steps to

address the concerns in question. In the panel’s view, the clinical aspects of your

misconduct are, in principle, capable of remediation. That being said, the panel was

mindful that where the behaviour in question may be indicative of a deep-seated

attitudinal problem, such concerns can be inherently difficult to remedy. In that regard,

the panel took into account its finding of dishonesty, and of your attitude and

demeanour whilst giving evidence at this stage of the hearing. In light of the specific

issues raised in this case, the panel considered that meaningful remediation primarily

required substantial insight.

The panel took careful of your oral evidence. The panel would have benefited from

hearing about the practical steps you have taken in order to improve your nursing

practice and how you believe your failures, objectively speaking, would have impacted

on residents, Resident A’s family, your colleagues, the profession and the public. In that

evidence, you demonstrated little, if any, genuine reflection and less still remorse,

despite prompting.

Since September 2015 you have worked, on an intermittent basis, as a registered nurse

through an agency. From May to September 2016, you worked as a staff nurse at

Bluebell Court Nursing Home. From September 2016, you have worked in numerous

care homes in staff nurse posts, caring for patients suffering from dementia. You work

day shifts and you are “always in charge of shifts”.

You said that no concerns were raised in relation to your nursing practice whilst at

Bluebell Court Nursing Home. Furthermore, you said that no concerns have been raised

as regards your current nursing practice whilst in subsequent care homes.

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You told the panel that you have another ongoing NMC referral against you, relating to

a two month period at a care home.

You said that your professional training is currently up to date. You said that you have

completed all mandatory courses, as well as courses in Resuscitation and Life Support,

and Safeguarding.

When asked what you would do if you found yourself in a similar situation, you said

“until the paramedics come I have to continue CPR, I should not stop it. Even though I

came to know [the resident] died, I should not stop it”. You said “that is the mistake I

made. I agreed that it was my mistake, that I should not have stopped CPR”.

You maintained that you have “learned a good lesson” from the incident in question.

You stated “even though I am sure a person has died, we cannot stop CPR. We have to

continue until the paramedics arrive… this is what I have learned in this country”.

You told the panel that you had no subsequent experience of resuscitating a patient.

You have, however, successfully completed training in this regard, and you now know

“how to do it properly, when to stop and start [CPR]”. You completed CPR training

“every year” prior to the incident, but you said that you “didn’t know” that you were

required to continue administering CPR until the arrival of paramedics.

When asked to comment on how you considered your actions may have affected your

colleagues, you said that Colleague F had “purposely hurt [you]” and that “maybe

because of her feelings she has complained about me”. The panel considered that this

demonstrated a fundamental lack of insight into your proven misconduct and amounted

to a groundless and malicious attack upon the character of another registered nurse.

When asked to comment on how you considered your actions may have impacted upon

Resident A’s family, you replied “I called the ambulance twice and I called the GP…

while I was on the phone he [Resident A] must have died. I couldn’t help more than

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this… the carers in the room, they could have pressed the emergency buzzer… that

was my mistake, I could have asked them to press the buzzer and then I could have

made the phone call”. The panel considered you to be unwilling or unable to appreciate

the impact of your behaviour on Resident A’s family, your profession or the wider public.

You acknowledged that you have a duty, as a registered nurse, to work collaboratively

and cooperatively with colleagues; you said “of course, team work is the main thing”.

Your assertion, however, was not supported by any meaningful demonstration of this

duty.

You referred the panel to documentation you completed in October 2016 for the

purpose of ‘revalidation’ (part of the process of renewing your NMC registration).

You were referred, by the panel, to a copy of a reflective statement contained in your

bundle of documentary evidence, relating to an incident concerning a cardiac arrest. In

responding to panel questions in relation to that statement, you looked at it and said

that, to the best of your recollection, the incident referred to occurred prior to September

2015.

You were asked to comment on the difference in the handwriting in that reflective

statement, compared with your writing in the Planned Care form. You then stated that

the statement did not belong to you, that it had been provided to you as a “sample” to

assist you in completing your own reflective statements, and that its presence in your

bundle was a “mistake”. You specifically answered questions in relation to that reflective

statement, which indicated that that was the first time that you had undertaken CPR.

However, you subsequently disclosed that, contrary to what was written in that

statement, you have “done CPR many times”.

It is a registrant’s right to deny allegations levelled against them. In that regard, the

panel took care to not automatically conclude that your continued denials, despite its

findings of fact, would necessarily prevent you from developing or demonstrating

insight. That being said, the panel took note that you did not accept its findings, that you

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actively maintained that the NMC witnesses were lying and that, in the case of

Colleague F, you said that she was “purposefully” trying to “hurt” you. These assertions

were rejected by the panel. In the panel’s view, your evidence was entirely self-serving

and demonstrated neither insight, remorse nor effective remediation.

Whilst you were able to verbalise what you would do differently if you were faced with a

similar situation, the panel was far from assured, and thus had serious reservations, that

you would in fact discharge your professional duties as required. Your responses were

confused and lacked depth, thoughtfulness and care. As such, the panel was not

satisfied that you genuinely accepted accountability for your failures and, when

practising autonomously, you would be able to act promptly and proactively when

dealing with an emergency situation. Your evidence was demonstrable of a significant

shortfall in your understanding and appreciation of the fundamental responsibilities of a

registered nurse.

You were probed a number of times when asked to comment on what you believed to

be the impact of your failures on your colleagues and on Resident A’s family. Your

responses were wholly unsatisfactory and gave the panel considerable cause for

concern about your acceptance of responsibility in relation, not only to patients, but your

profession and public confidence in you as a registered nurse.

You told the panel that you had successfully completed annual training in resuscitation.

It was therefore inexplicable that you were unaware, on the date in question, that you

were required to perform CPR on Resident A, and continue to do so until the arrival of

the paramedics.

The panel was mindful that your position was that you maintained that you had

performed CPR on Resident A, along with Colleague F, and that therefore your entry in

the Planned Care form was an honest and accurate account.

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In assessing your oral evidence, the panel came to the view that you do not recognise

the implications of your failures. In the panel’s judgement, you have not demonstrated

the depth of insight or reflection necessary to effectively commence the process of

remediation.

The panel thus determined that your evidence was demonstrative of a woeful lack of

insight.

The panel carefully considered the bundle of documentary evidence you submitted at

this stage of the hearing for its consideration, which included numerous Reflective

Account/Discussion forms, Continuous Professional Development (“CPD”) log and

certificates. However, on the basis of the five reflective statements contained therein,

which you confirmed had not been written by you, and the fact that many of the

accounts were undated, the panel had great difficulty in placing any reliance on this

bundle.

In the absence of any other evidence of remediation, remorse or insight, the panel was

unable to conclude that you had a complete understanding of the significance of your

misconduct and how to address it. The panel was therefore unable to conclude that

your misconduct had been remedied. You provided no reassurance, of which the panel

could accept or be satisfied, that your misconduct is not liable to recur in the future. In

all of those circumstances, the panel concluded that there is a real risk of you repeating

your misconduct.

The panel was aware that any approach to the issue of whether fitness to practise

should be regarded as impaired must take account, not only of the need to protect the

public, but also the collective need to maintain confidence in the profession as well as

declaring and upholding proper standards of conduct and behaviour.

For this additional reason, the panel went on to consider whether the need to uphold

proper professional standards and public confidence in the profession, and the NMC as

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a regulator, would be undermined if a finding of impairment of fitness to practise were

not made in the circumstances of this case. The panel concluded that it would.

The panel decided that this is a case where the firm declaration of professional

standards so as to promote public confidence in the profession is required. The public

would expect a qualified registered nurse to demonstrate sufficient understanding and

knowledge of the fundamental requirement to provide the necessary nursing

intervention needed to preserve the health, wellbeing and safety of patients. In the

panel’s view, you failed to demonstrate and deliver safe nursing care. As a result, you

placed Resident A at unwarranted risk of harm, and the consequences of your failures

could have been serious. The public also needs to have trust and confidence in nurses

to be honest, act with integrity and abide by the overriding principle in record keeping,

that is to ensure that records are completed accurately and without any falsification.

You displayed a cavalier disregard for your colleagues, and an indifference towards the

gravity of your failures and the extent of your departure from the standards expected of

you as a registered nurse. Of greater concern was that at no stage did you refer to the

impact of your failures on Resident A, or express any remorse.

Your misconduct was such a material departure from appropriate nursing standards that

a finding of no impairment would fundamentally undermine proper professional

standards and public confidence in the profession, and significantly damage the

regulatory process. Accordingly, the panel further concluded that a finding of current

impairment, on public interest grounds, was proportionate, notwithstanding your

previous good character.

Accordingly, the panel determined that your fitness to practise is currently impaired by

reason of your misconduct.

Determination on sanction

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Following its findings of misconduct and current impairment, the panel invited

submissions on the matter of sanction.

Ms Ward referred the panel to the NMC’s ‘Indicative sanctions guidance to panels’

(September 2016) (“ISG”). She reminded the panel that the purpose of sanction is to

protect the public interest. The public interest includes protection of patients and others;

maintenance of public confidence in the professions and the regulatory body; and

declaring and upholding proper standards of conduct and behaviour.

Ms Ward further reminded the panel of its duty to act proportionately, balancing the

interests of the public against your own interests.

Ms Ward referred the panel to paragraphs 36-38 of the ISG, which deal with the matter

of dishonesty.

As to aggravating features in this case, Ms Ward invited the panel to have regard to the

following:

• In respect of charges 1 and 2, there was more than one refusal to perform CPR

on Resident A;

• During the course of this substantive hearing you have demonstrated a serious

lack of insight; you said that in raising a complaint against you, Colleague F was

trying to “hurt” you; you failed to appreciate or accept the potential impact of your

actions on other colleagues, including the care assistants in this case, and on

Resident A’s family; and you failed to accept the panel’s findings.

• The panel’s assessment of the training folder you submitted as evidence of

remediation, which contained documents which had not been completed by you

and did not reflect work done by you.

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Mr Galvin submitted that it was your position that the reflective accounts in your training

folder which had not been completed by you, were used by you as a “template” to assist

in completing your own reflective accounts. Mr Galvin confirmed that you had not

submitted these “template” accounts to the NMC for the purpose of you renewing your

NMC registration/revalidation.

Mr Galvin contended that your failure to assist your colleagues was not borne out of

idleness. Rather, you genuinely believed that Resident A had died and you were

concerned for his dignity.

Mr Galvin further submitted that the comment you made, as set out in charge 2, was not

intended to be derogatory.

Mr Galvin submitted that there are varying degrees of dishonesty and, whilst the panel

found that your dishonest actions were done for self-preservation, your dishonest entry

would not have given rise to a risk of harm to the resident. To that extent, he contended

that your dishonesty was “not the most serious form”.

Mr Galvin informed the panel that you have worked as a registered nurse for

approximately 36 years, and he said that you are a “caring person”.

In all of those circumstances, Mr Galvin invited the panel to “stop short” of directing that

your name be removed from the Register.

In reaching its decision, the panel had regard to the submissions of Ms Ward and Mr

Galvin. It accepted the advice of the legal assessor.

The panel took into account the advice set out in the ISG. It had regard to the principle

of proportionality, weighing your interests against the public interest. The panel bore in

mind that the purpose of a sanction is not to be punitive, although it may have that

effect, but is intended to protect patients and serve the wider public interest. The wider

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public interest includes maintaining public confidence in the profession and the NMC as

its regulator, and declaring and upholding proper standards of conduct and behaviour.

Any sanction imposed must be no more than is necessary to protect the public and

satisfy the public interest.

As to aggravating features in this case, the panel accepted the factors identified by Ms

Ward. As to mitigating features in this case, the panel considered the following factors

to apply:

• Your otherwise unblemished nursing career of 36 years;

• Your engagement in these regulatory proceedings;

• A testimonial provided by a family member of a patient for whom you provided

care;

• You have undertaken training since September 2015.

Under Article 29 of the Nursing and Midwifery Council Order 2001 (“the Order”), the

panel, when considering sanction, can take no action or consider the following in

ascending order, beginning with the least restrictive sanction: make a caution order for

one to five years, make a conditions of practice order for no more than three years,

make a suspension order for a maximum of one year, or make a striking-off order.

The panel determined that action was necessary in this case because of the

seriousness of your misconduct and the panel’s finding that there remains a real risk of

repetition. Furthermore, the panel considered that taking no action would be wholly

insufficient for the purpose of upholding public confidence in the nursing profession and

in the NMC as its regulator.

The panel then considered whether to make a caution order, bearing in mind that such

an order would not restrict your ability to practise. The panel concluded that a caution

order would be inappropriate in this case. Such an order would not properly mark the

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seriousness of your misconduct, nor would it be sufficient to address the real risk of

repetition found or satisfy the wider public interest. This is not a case at the lower end of

the spectrum of impaired fitness to practise.

The panel next considered the imposition of a conditions of practice order. The panel

noted that this sanction primarily focuses on remedying identifiable areas of concern

within a registrant’s clinical practice or skills that may require retraining, assessment

and supervision. In addition, it requires the potential for and willingness of a registrant to

engage with any conditions imposed.

Your misconduct in part called into question your clinical competence, in relation to the

administration of CPR, your ability or willingness to work with colleagues and the

integrity of your record keeping. The panel determined that, whilst conditions could be

devised to address these issues, such an order would not address what the panel found

to be evidence of a harmful attitudinal problem, your very concerning lack of insight and

the identified risk of repetition of dishonesty.

Furthermore, the panel concluded that, given the seriousness of your misconduct,

including the dishonesty involved, a conditions of practice order would not protect the

public or satisfy the wider public interest. The panel thus determined that such an order

would not be a sufficient or proportionate sanction in all the particular circumstances of

this case.

The panel next considered imposing a suspension order. A suspension order is

intended to convey a message to the registrant, the profession and the wider public as

to the gravity of unacceptable and inappropriate behaviour but which, in the particular

circumstances of a case, falls short of being fundamentally incompatible with continued

registration. A period of suspension can also serve to provide the registrant with an

opportunity to reflect on their misconduct and to take action to commence or complete

the process of remediation.

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The panel took note that there was no evidence of any repetition of your misconduct

since 16 September 2015 and no evidence before this panel of a history of you having

previously conducted yourself in a manner similar to that found proved in this case. The

panel also acknowledged that you have attended these proceedings.

The misconduct in this case, whilst limited to a single shift, involved significant failures

to discharge the fundamental duties of a registered nurse. There was, as stated above,

evidence before the panel of a harmful, deep-seated attitudinal problem. The panel was

mindful that you did not simply deny the matters found proved (which indeed is your

right to so do) but you actively maintained that the witnesses were lying and that

Colleague F had complained about you in order to “hurt” you.

The panel reminded itself of its earlier determination, in its finding of current impairment,

that you had demonstrated a woeful lack of insight and that your oral evidence was not

indicative of genuine reflection or remorse. The panel did not accept the training record

you submitted at the preceding stage of the hearing, as evidence of remediation. The

panel was, furthermore, deeply concerned by your attitude and demeanour when giving

evidence. You gave the impression that you knew better than your colleagues in the

circumstances, including another registered nurse and the emergency services who

both asked you to undertake CPR. You have provided no acceptable explanation as to

why you failed to act in direct contravention of your obligations as set out in the Code.

Whilst you were able to verbalise the actions that were required of you in the

circumstances, the panel was not assured that you would have the knowledge or

understanding of transferring those skills to other situations or settings.

In the panel’s view, you have not demonstrated the level of insight, remorse, reflection

and acceptance of responsibility to sufficiently address its concerns in relation to patient

safety and public perception of you as a registered nurse.

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You answered specific questions from the panel about a reflective statement relating to

an incident involving a cardiac arrest, as contained in your training record, which you

later confirmed had not been written by you.

Whilst the public would be protected temporarily by the imposition of a suspension

order, the panel concluded that, in the particular circumstances of this case, such an

order, even for the maximum period of 12 months, would not address the panel’s

concerns about the risk of repetition, nor would it satisfy the wider public interest in the

maintenance of public confidence in the profession and the declaring and upholding of

standards of behaviour and conduct. Equally, the panel determined that such an order

would be insufficient for the purpose of conveying a clear public message of the

importance of basic principles of nursing. The panel therefore determined that a

suspension order would not be an appropriate or sufficient sanction.

Your misconduct represented a significant and serious departure from the standards

expected of you as a registered nurse. Your overarching duty was to safeguard a

vulnerable patient in your care. You failed wholly to discharge that duty. The panel was

mindful of your persistent lack of insight into the seriousness of your failures, their

adverse consequences both to patients and to the reputation of the profession, and the

critical importance of being honest and acting with integrity.

The panel concluded that misconduct of the kind found proved in this case, in the

context of the panel’s assessment of a deep-seated attitudinal problem and a significant

risk of repetition, is fundamentally incompatible with continued registration. In the

panel’s judgement, the identified aggravating factors substantially outweigh any

mitigating factors and, in consequence, the public interest outweighs your own interests.

For all those reasons, the panel concluded that the only proportionate and appropriate

sanction, sufficient to protect the public interest, is a striking off order. The panel

determined that public confidence in the profession and the NMC as its regulator, could

not be sustained with a less severe sanction.

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In reaching its decision the panel had regard to the significant professional, financial

and personal impact such an order is likely to have on you. Nevertheless the panel

considered that the public interest outweighs your own personal circumstances and

requires the imposition of a striking off order.

The panel therefore directs that your name be removed from the NMC Register.

The order will take effect 28 days from the date when notice of it is deemed to have

been served upon you.

Your record in the NMC Register will show that your name has been removed. You may

not apply for restoration until five years after the date that this decision takes effect.

Determination on interim order The striking-off order will take effect 28 days from the date when notice of it is deemed

to have been served upon you.

The panel considered whether it was appropriate to impose an interim order to cover

the appeal period before the substantive order takes effect, or to cover any time

required for an appeal of the substantive decision in this case to be heard.

Article 31 of the Order outlines the criteria for the imposition of an interim order. The

panel may make an interim order on one or more of three grounds:

• Where it is satisfied that it is necessary for the protection of members of the

public;

• Where it is satisfied that such an order is otherwise in the public interest;

• Where it is satisfied that such an order is in the interests of the registrant.

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The panel may make an interim conditions of practice order or an interim suspension

order for a maximum period of 18 months.

Ms Ward made an application for the imposition of an interim suspension order for a

period of 18 months on the grounds that it was necessary for public protection and that

it was otherwise in the public interest. She submitted that an interim suspension order

was appropriate and proportionate, in light of the panel’s finding of current impairment

and in the light of its decision to impose a striking-off order. She further submitted that

an 18 month interim order was necessary to allow for any appeal process.

Mr Galvin made no submission in response.

In reaching its decision, the panel had regard to the submissions made by Ms Ward and

it accepted the advice of the legal assessor.

For all the reasons set out in the panel’s determination thus far, and in all the

circumstances of this case, the panel decided to impose an interim suspension order on

the grounds that it was necessary for public protection and that it was otherwise in the

public interest. The panel first considered an interim conditions of practice order but

determined that, for the reasons set out in its determination on sanction, such an order

would not be appropriate.

The panel considered that, in the light of the reasons set out above for imposing a

striking-off order, members of the public would be put at risk of harm, and confidence in

the NMC’s regulatory process would be damaged if, pending an appeal, there is no

interim order preventing you from working as a nurse before the substantive order takes

effect.

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The panel determined that the order should run for a period of 18 months to allow for

any appeal process. The panel considered this to be an appropriate and proportionate

period.

If at the end of the appeal period of 28 days you have not lodged an appeal, the interim

order will lapse and will be replaced by the substantive order. On the other hand, if you

do lodge an appeal, the interim order will continue to run until the conclusion of the

appeal.

That concludes these proceedings.

Conduct and Competence Committee - nmc.org.uk

Documents

Transcript of Conduct and Competence Committee - nmc.org.uk