A mental health nurse faced the Nursing and Midwifery Council’s fitness-to-practise panel after they were seen inappropriately restraining a patient on several occasions
The charges
That Nurse A employed as an agency nurse at a hospital:
1. While in charge of a shift:
a. Provided and/or allowed a poor standard of care to be provided to Patient A in that:
i. They allowed two minutes to elapse before assessment took place when they fell from
the sofa;
b. Inappropriately restrained Patient A at 3:42am, 4:34am; 4:39am; 4:42am and 5:01am or thereabouts;
c. Did not record the provision of incontinence underwear to Patient A in their notes;
d. Did not record the actions in charges 1ai adequately and/or at all in Patient A’s notes.
The background
Nurse A was employed as an agency nurse at a hospital. They were working a night shift as the nurse in charge of the shift. During the shift, Patient A presented as agitated, chaotic and uncooperative. Patient A undressed and spent a prolonged period of time naked in the communal areas of the ward.
Patient A repeatedly made attempts to gain access to the corridor that led to other patient bedrooms during the night. They were led back to the communal areas by Nurse A and other staff on duty that night. Patient A eventually settled in the early hours of the morning and Nurse A’s shift ended.
Following a routine audit of CCTV from that evening, a number of clips were provided to Witness 1, the hospital director, to carry out an investigation into the incidents that occurred during that shift. The CCTV was not provided in its entirety and the original footage has now been erased.
At the hearing
The panel considered each of the charges. Charge 1ai was found not proved. The other charges were found proved.
The panel found when the charges were considered individually and collectively, Nurse A’s actions fell significantly short of the standards expected of a nurse and breached the Code.
The panel acknowledged that the circumstances in which they were working that night were difficult: it was clear from the CCTV footage that Patient A was exhibiting challenging behaviour; all staff on the ward were agency staff; and Nurse A told the panel that one of the healthcare assistants was working one-to-one with a patient in seclusion.
The panel accepted Nurse A’s evidence that it was the worst night they had experienced in their practice. But the panel found that as an experienced mental health nurse, they should not have “panicked” as they said they did. The panel was satisfied that their inappropriate use of restraint on Patient A was a serious falling short of the standards required of a registered nurse. It concluded that Patient A was put at risk of physical harm by Nurse A’s inappropriate restraint techniques.
The panel accepted that Nurse A had attended training courses on managing and caring for patients and record keeping. It accepted the supportive references that they provided from registered mental health nurses who had worked with them recently, and that they have been working for three years since the incident with no further concerns raised.
The panel found that their insight was not yet fully developed. It noted that their reflective statement continued to reference the ‘contextual factors’ that Nurse A considered precipitated their misconduct, and did not specifically address the “panic” they told the panel that they had felt on that night or how they would behave differently in a similar situation.
The panel decided that a finding of impairment was necessary on the grounds of public protection.
Results of the fitness-to-practise panel
The FtP panel can impose four different sanctions:
- Caution: the nurse or midwife is cautioned for their behaviour, but is allowed to practise without restriction
- Conditions of practice: this will prevent a registrant from carrying out certain types of work or working in a particular setting, it may require them to attend occupational health or do retraining. The order can be applied for up to three years and must be reviewed by an FTP panel again before expiry
- Suspension: the nurse or midwife will be suspended from practice for a period of initially not longer than one year, but this can be extended after review by an FTP panel
- Striking off: a nurse or midwife is removed from the register and not allowed to practise in the UK. The nurse or midwife must apply to be readmitted to the register
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