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Conduct and Competence Committee

Substantive Hearing

7 July 2017

Nursing and Midwifery Council, Temple Court 13a Cathedral Road, Cardiff, CF11 9HA Name of Registrant Nurse: Ms Rebecca Louise Pembridge NMC PIN: 93I0206W Part(s) of the register: Registered Nurse – Children Sub Part 1 Level 1 – September 1996 Area of Registered Address: Wales Type of Case: Misconduct and Caution Panel Members: Trevor Spires (Chair, Lay member)

Jodie Banner (Registrant member) Nagarajah Thevamanoharan (Lay member)

Legal Assessor: Anita Coaster Panel Secretary: Tafadzwa Taz Chisango Representation: Present and represented by Mr Chris Green

instructed by the Royal College of Nursing (RCN)

Nursing and Midwifery Council: Represented by Ms Angharad Ansell Jones,

counsel, instructed by Nursing and Midwifery Council (NMC) Regulatory Legal Team.

Facts proved by admission: 1, 2, 3, 4, 6 and 7 No case to answer: 5 Fitness to practise: Impaired Sanction: Striking off order Interim Order: Interim suspension order, 18 months

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Details of charge:

That you, a registered nurse, whilst working at Aneurin Bevan Health Board on the night

shift commencing 13 April 2012:

1. In relation to Baby X, failed to complete hourly observations and/or ensure that

hourly observations were completed and/or recorded at: (proved by Admission)

a) 12 midnight

b) 1am

c) 2am

d) 3am

2. Made retrospective entries to Baby X’s care records and did not record them as

such; (proved by Admission)

3. Recorded inaccurate BIPAP readings for Baby X; (proved by Admission)

4. Your actions in charges 2 and/or 3 above were dishonest, in that you were trying to

conceal the fact that you did not carry out and/or record the observations at the

correct times; (proved by Admission)

5. Between approximately 12 midnight and 3:30am, did not ensure Baby X was fed

and/or did not record that Baby X was fed. (not proved)

6. Did not administer medication to Baby X at the due times in that: (proved by

Admission)

a. Sytron due to be administered at 2am was given at approximately 4.30am;

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b. Flucloxacillin (IV) due to be administered at 1am was given at approximately

2.15am;

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

misconduct

At the outset of this hearing you admitted to charges 1, 2, 3, 4 and 6. The panel

therefore accepted these charges as found proved by way of admission.

Proposal to offer no evidence

The panel considered an application from Ms Ansell Jones on behalf of the NMC that

there is no case to answer in respect of the charge 5. This application was made under

Rule 24(7) and (8) of the Nursing and Midwifery Council (Fitness to Practise) Rules

Order of Council 2004 (as amended 2012) (The Rules). This Rule states:

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…

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.

Rule 24 - (8):

Where an allegation is of a kind referred to in article 22(1)(a) of the Order, the

Committee may decide,—

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

(ii) of its own volition,

to hear submissions from the parties as to whether sufficient evidence has been

presented to support a finding of impairment, and shall make a determination as to

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whether the registrant has a case to answer as to her alleged impairment.

Ms Ansell Jones submitted that the NMC offer no evidence on charge 5 but that this

charge did not materially impact on the overall seriousness of the case based on the

charges admitted. Ms Ansell Jones further submitted that the content of charge 5 is

reflected in charges 1,2,3,4 and 6. The risk of harm identified would still be covered in

the other charges. In light of the above, Ms Ansell Jones proposed to offer no evidence

in relation to charge 5 and invited the panel to find no case to answer.

Mr Green on your behalf did not oppose this application.

The Panel’s decision

The panel has decided to accept Ms Ansell Jones application to offer no evidence.

The panel has taken account of the submissions made by Ms Ansell Jones and those

made by Mr Green on your behalf. It has heard and accepted the advice of the legal

assessor.

The panel accepted the application and agreed with the submissions of Ms Ansell

Jones and Mr Green. The panel are satisfied that the seriousness of the allegations and

the failures identified in your practice would not be undermined if charge 5 was

removed. The panel therefore finds there is no case to answer on the facts as there is

no evidence presented.

Further Charges:

Ms Ansell Jones notified the panel that there was a further charge against you to be

considered. Namely,

That you, a registered nurse:

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7. On 14 August 2014 received a police caution for Fraud by False Representation

contrary to s. 1(2)(a) and s. 2 of the Fraud Act 2006;

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

After the charge being read you informed the panel that you admit that you received a

caution for fraud by false representation on 14 August 2014. You also accepted that

your fitness to practise is impaired.

The panel found this charge proved by way of admission.

Ms Ansell Jones referred the panel to the agreed facts of this case.

Agreed Facts

1. The NMC received a fitness to practice referral from the Aneurin Bevan

Health Board (The Board) on 20 November 2014 in relation to the

registrant receiving a formal police caution for the offence of fraud by false

representation. During the course of the NMC investigation other

matters came to light concerning the registrants practice on 13 April

2012.

Charges 1, 2, 3, 4 and 6

2. On 13 April 2012 the registrant was working a night shift as a band 6

nurse in the Neonatal Intensive Care Unit at The Royal Gwent Hospital.

The NICU is one of three Units within the Neonatal Unit.

3. The Registrant states that during a night shift it was not common

practise for the nurse in charge (on this occasion the registrant) to have a

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patient allocated to them in addition to their duties of being in charge e.g.

responsibility for 3 nurseries, all staff, admissions, transfers, liaising with

midwifery staff, statistics being taken and inputting information on

computer, checking stock, ordering stock, checking staff levels and off

duty for the following shifts, cot side teaching being a mentor to

students and staff, being shadowed by junior staff member (as was the case

on this shift). If there was a stable baby, and staff levels were such that it

would assist with workloads, then some nurses in charge would also look

after a stable baby. They would not be allocated a baby that required

intensive care due to the nature of the other tasks they were required to

perform as nurse in charge. On the night shift that commenced on 13 April

2012 the Registrant was allocated to care for Baby X.

4. The registrant was required as part of her duties to perform and record

observations on an hourly basis. She was also under a duty to take

BiPAP readings, which are also referred to as Biphasic readings.

5. During the night shift a colleague, noticed that the registrant had not

recorded observations at midnight, 1am, 2am and 3am nor had she

taken or recorded Biphasic readings. The registrant subsequently

admitted that she had not taken or recorded these readings but said that

she had been back and forth to the baby, who was very stable. The

colleague raised these omissions with the registrant. The registrant was

apologetic and said she would sort it right away.

6. The 'trends' monitor records and saves observations. The registrant,

having failed to take the observation at the relevant times, used the

'trends' monitor to retrospectively record observations for Baby X at 12

midnight, 1am, 2am and 3am. The registrant should have recorded that

these were made retrospectively and therefore indicate that the registrant

had not performed the observations at those times. The registrant's

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actions were dishonest as she was trying to conceal the fact that she had

not carried out these observations at the correct times.

7. Biphasic readings would vary slightly from time to time. If they varied to a

level that would compromise the baby's care, an alarm would sound. The

readings are not saved; if the readings have not been taken at a specific

time it is not possible to retrospectively record them. The registrant

entered false readings in Baby X’s records for the Biphasic readings she

had not taken. She made the figures up between the 2 ranges set for the

alarm. The Registrant states that no alarm had sounded through the night.

The registrant's actions were dishonest as she entered false records and

she was trying to conceal the fact that she did not take the Biphasic

readings.

8. There are unavoidable times when there is an emergency on the ward or a

baby's nurse is busy and cannot check an observation at the

recommended time. Usual practise is to document this on the baby's chart

as well as the time the observation was actually checked. If an observation

cannot be retrieved retrospectively, it should be left blank. The reason for

the missed observation should be entered into the nursing kardex. Missed

or late observations should also be communicated during handover to the

next shift.

9. As part of the registrant's duties she was responsible for administering

medication to Baby X.

10. Sytron, used to treat anaemia, was due to be administered at 2am. The

registrant administered Sytron at 4.30am. She asked a colleague to check

the administration. Her colleague noticed that the Sytron was late in being

administered.

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11. Flucloxacillin, an antibiotic, was due to be administered at 1am. Baby X

records show that this was not administered until 2.15am.

12. There are times when the nurse is unavailable to give drugs to her baby at

the time prescribed. This should be recorded and the actual time the

drug was given documented. The registrant gave no explanation for her

lack of documentation. The Registrant states that it was also common

practise, and encouraged to promote cost effectiveness, for a nurse to

prepare and administer IV antibiotics for more than one baby at a time due

to the aseptic technique required.

13. The registrant's colleagues were concerned that she showed signs of

being unwell in the course of the shift. They also noticed that she was very

upset upon realising that she had not recorded the BiPAP readings at the

correct times, or provided the medication at the correct time. The

registrant later confirmed that she had felt unwell. The registrant states

that she had also informed a senior member of staff at the beginning of her

shift that she did not feel well.

14. The events of 13 and 14 were investigated by the trust and the

registrant was subject to a disciplinary hearing on the 8 August 2012. On

the 13 August the Trust wrote to the registrant informing her that she would

be demoted to a Band 5 position and made subject to a performance

management plan. It is not clear that this plan was fully completed and/or

signed off.

Charge 7

15. On 14 August the 2014, the registrant received a formal Police Caution for

fraud by false representation.

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16. In 2014 the registrant was employed as a neonatal nurse in the Neonatal

Unit at Royal Gwent Hospital.

17. On 7 March 2014 the registrant contacted the Board to say that she was

unwell and not fit for work. It was expected that she would return to work

on the 15 March with confirmation of this being made on the 14 March.

On the 14 March the registrant contacted the board to say that she

remained unwell and unfit to work. The registrant indicated that she would

return to her doctor and send in a 'sick note'. On 19 March the registrant

contacted the Board to indicate that she had a sick note for 14 days and

will send that in. On the 24 March the registrant contacted the Board to say

that she would be off work until the following Friday (4 April). She indicated

that she would send in a sick note.

18. The registrant states that she provided a sick note, however, the Trust

could not locate this or any record of having received this, and chased the

Registrant for the note in June 2014. The registrant states that she

experienced difficulties obtaining a duplicate sick note and provided this

on the 4 July 2014. The note was dated 19 March 2014 and on the face

of it indicated a period of 4 weeks. On examination it appeared the note

had been amended in that the word 'weeks' had been written over the

initial word 'days'.

19. The GP who issued the sick note was contacted by the Board and

confirmed that the note issued had been for a period of 4 days rather than 4

weeks.

20. A local counter fraud specialist, employed by the Board, interviewed the

registrant on 14 August 2014. On the basis of immediate, full and frank

admissions made by the registrant she was given a formal police

caution at Newport Central Police station on the same day.

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Misconduct

21. The Registrant admits that the facts amount to misconduct because the

charges detailed above, collectively and individually, amount to

behaviour that 'falls short of what would be proper in the circumstances’

1 and are serious in nature.

22. The following a sp e c t s o f t h e Code of Conduct2 have been breached:

The people in your care must be able to trust you with their health

and wellbeing

To justify that trust you must:

• provide a high standard of practice and care at all times

• be open and honest, act with integrity and uphold the reputation of your

profession.

Provide a high standard of practice and care at all times

35 - You must deliver care based on the best available evidence or best practice.

Keep clear and accurate records

42 - You must keep clear and accurate records of the discussions you have,

the assessments you make, the treatment and medicines you give, and how

effective these have been.

43 -You must complete records as soon as possible after an event has

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occurred.

1 Roylance v GMC (No2) [2000] 1 AC 311

2 Standards of Conduct, Performance and Ethics for Nurses and Midwives 2008

Be open and honest, act with integrity and uphold the reputation of

your profession

Act with integrity

49- You must adhere to the laws of the country in which you are practising.

Uphold the reputation of your profession

61 -You must uphold the reputation of your profession at all times.

Charge 4

24. The registrant has acted dishonestly by falsifying medical records showing

that the registrant has been willing to act dishonestly in a clinical setting.

Charge 7

25. Having acted dishonestly in 2012 the registrant has repeated this behaviour in

2014.

Charges 1, 2, 3 and 6

26. The registrant was responsible for an extremely vulnerable patient and

failed to deliver an appropriate level of care.

27. Although no actual harm came to Baby X, the Registrant accepts that by

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departing from standard procedures (including a failure to carry out and record

observations at the correct time, and failing to give the medication at the correct

time), this had potential to put a patient at unwarranted risk of harm.

Impairment

28.In light of the above, and particularly paragraph 25, noting there was no actual

harm but that the failings raise the potential for harm, the registrant admits that her

fitness to practise is impaired by reason of her misconduct and caution because

she:

28.1. 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

28.2. Has in the past brought and/or is liable in the future to bring the

professions into disrepute; and/or

28.3. Has in the past breached and/or is liable in the future to breach one of the

fundamental tenets of the professions; and/or

28.4. Has in the past acted dishonestly and/or is liable to act dishonestly in the

future

Charges 4 and 7

29. The registrant's actions involving dishonesty demonstrate a failure to be open

and honest, acting with integrity and uphold the reputation of the Nursing

profession. The charges are behavioural and difficult to remediate. The

dishonesty was repeated.

Submission on misconduct and impairment:

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Having announced its finding on all the facts, the panel then moved on to consider,

whether the facts found proved amount to misconduct and, if so, whether your fitness to

practise is currently impaired. The NMC has defined fitness to practise as a registrant’s

suitability to remain on the register unrestricted.

In her submissions Ms Ansell Jones invited the panel to take the view that your actions

amount to a breach of The Code: Standards of conduct, performance and ethics for

nurses and midwives 2008 (“the Code”). She then directed the panel to specific

paragraphs and identified where, in the NMC’s view, your actions amounted to

misconduct.

Ms Ansell Jones referred the panel to the case of Roylance v GMC (No. 2) [2000] 1 AC

311 which defines misconduct as a word of general effect, involving some act or

omission which falls short of what would be proper in the circumstances.

She then moved on to the issue of impairment, and addressed the panel on the need to

have regard to protecting the public and the wider public interest. This included the

need to declare and maintain proper standards and maintain public confidence in the

profession and in the NMC as a regulatory body. Ms Ansell Jones referred the panel to

the cases of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery

Council (2) Grant [2011] EWHC 927 (Admin).

Mr Green submitted that you do not contest that your conduct and caution fall seriously

short of the standard required of a registered nurse.

In relation to impairment, Mr Green submitted that you acknowledge that your fitness to

practice is currently impaired. He referred the panel to a number of references you

provided. Mr Green submitted that you are a nurse with a good record of clinical

practice and character, and that previous to, these incidents there had been no

evidence to suggest that there are any concerns in terms of your practice.

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Mr Green submitted that you have demonstrated insight and made admissions to the

charges. You have expressed remorse for your actions and have apologised. Mr Green

accepted that in regards to remediation you have been unable to demonstrate this. Mr

Green submitted that the insight and remorse you have shown indicates that you have

learnt from this experience and future risk is unknown at this moment. However this is a

matter of the panel’s own independent judgement.

The panel has accepted the advice of the legal assessor.

The panel adopted a two-stage process in its consideration, as advised. First, the panel

must determine whether the facts found proved amount to misconduct. Secondly, only if

the facts found proved amount to misconduct, the panel must decide whether, in all the

circumstances, your fitness to practise is currently impaired as a result of that

misconduct.

Decision on misconduct

When determining whether the facts found proved amount to misconduct the panel had

regard to the terms of the Code.

The panel, in reaching its decision, had regard to the public interest and accepted that

there was no burden or standard of proof at this stage and exercised its own

professional judgement.

The panel was of the view that your actions, as regards both charges, did fall

significantly short of the standards expected of a registered nurse, and that your actions

amounted to a breach of the Code. Specifically:

The people in your care must be able to trust you with their health and

wellbeing

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To justify that trust you must:

provide a high standard of practice and care at all times

be open and honest, act with integrity and uphold the reputation of

your profession.

Provide a high standard of practice and care at all times

35 - You must deliver care based on the best available evidence or best practice.

Keep clear and accurate records

42 - You must keep clear and accurate records of the discussions you have, the

assessments you make, the treatment and medicines you give, and how effective

these have been.

43 - You must complete records as soon as possible after an event has

occurred.

Be open and honest, act with integrity and uphold the reputation of your

profession

Act with integrity

49 - You must adhere to the laws of the country in which you are practising.

Uphold the reputation of your profession

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61 - You must uphold the reputation of your profession at all times.

The panel appreciated that breaches of the Code do not automatically result in a finding

of misconduct. However, the panel was of the view that your actions constituted a

significant departure from the standards one would expect of a registered nurse. You

were responsible for a vulnerable patient and failed to deliver the appropriate level of

care. You failed to carry out and record observations and failed to administer medication

at the correct times. This has been compounded by your dishonesty by falsifying

medical records. On a totally separate occasion some two years later you dishonestly

falsified a sick note and submitted it to your employer.

Accordingly, the panel found that your actions did fall seriously short of the conduct and

standards expected of a nurse and amounted to misconduct.

Decision on impairment

The panel next went on to decide if as a result of this misconduct and caution your

fitness to practise is currently impaired.

Nurses occupy a position of privilege and trust in society and are expected at all times

to be professional and to maintain professional boundaries. Patients and their families

must be able to trust nurses with their lives and the lives of their loved ones. To justify

that trust, nurses must be honest and open and act with integrity. They must make sure

that their conduct at all times justifies both their patients’ and the public’s trust in the

profession. In this regard the panel considered the judgement of Mrs Justice Cox in the

case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery

Council (2) Grant [2011] EWHC 927 (Admin) in reaching its decision, she said:

“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

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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.”

She went on to say:

“I would also add the following observations in this case having heard

submissions, principally from Ms McDonald, as to the helpful and

comprehensive approach to determining this issue formulated by

Dame Janet Smith in her Fifth Report from Shipman, referred to above.

At paragraph 25.67 she identified the following as an appropriate test for

panels considering impairment of a doctor’s fitness to practise, but in my

view the test would be equally applicable to other practitioners governed

by different regulatory schemes.

Do our findings of fact in respect of the doctor’s misconduct,

deficient professional performance, adverse health, conviction,

caution or determination show that his/her fitness to practise is

impaired in the sense that s/he:

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

medical 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 medical profession; and/or

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

dishonestly in the future.”

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The panel finds that criteria a, b, c and d are engaged. The panel finds that your actions

at the time put Baby X at risk of harm. The panel was of the view that you breached

fundamental tenets of the nursing profession and that your actions fell below the

standards expected of a registered nurse. This incident was not remote or outside of

your knowledge and experience. You are considered an experienced practitioner who

was responsible for delivering safe nursing care to Baby X and you did not do so. The

panel also found that by your misconduct and police caution, you have brought the

nursing profession into disrepute, and you are liable to do so in the future. Your actions

in regards to charges 4 and 7 were dishonest.

With regard to future risk, the panel considered the questions posed in the case of

Cohen v General Medical Council [2008] EWHC 581 namely whether your conduct was

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 issues

of insight and remediation.

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.

The panel had regard to the positive testimonials you provided. The panel noted that

you have not been working as a registered nurse since November 2014. Although you

stated you had undertaken a performance plan whilst still employed in the Neonatal

unit, the panel had no evidence before it that you have had any relevant training or

supervision in regards to your record keeping, observations and administration of

medication which would address some of the issues identified in this case.

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.

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The panel acknowledged that you made early admissions to the charges and noted

from your reflective statement how remorseful you are. You have shown some insight

into your misconduct and acknowledge the impact your actions had on colleagues,

patients and the public. The panel determined that although you have demonstrated a

developing insight into these matters there remains a risk of future misconduct arising

from such errors.

The panel also took into consideration the dishonesty in this case. The panel is of the

view that dishonesty is, by its very nature, not easily remediable and you have

presented little evidence of remediation. Your dishonesty occurred in two incidents over

a two year period. One of these incidents there was a risk of patient harm as a result of

your dishonesty and in both incidents your dishonesty risked bringing the profession into

disrepute.

The panel concluded that in all the circumstances, it could not be satisfied that there

was no risk of repetition. On the basis of the information currently available, the panel

finds that you are liable in the future to put patients at unwarranted risk of harm, to bring

the profession into disrepute, breach fundamental tenets of the profession and act

dishonestly.

The panel considered that the need to uphold proper professional standards and

maintain public confidence in the profession would be undermined if a finding of

impairment were not made.

The panel therefore finds your fitness to practise is currently impaired on the grounds of

public protection and public interest.

Determination on sanction:

Having determined that your fitness to practise is currently impaired, the panel next

considered what sanction, if any, it should impose on your registration. In reaching its

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decision on sanction, the panel has considered all the information that has been placed

before it.

The panel had regard to the submissions of Ms Ansell Jones, on behalf of the NMC and

Mr Green on your behalf. Ms Ansell Jones referred the panel to the NMC’s Indicative

Sanctions Guidance to Panels (ISG) as amended on 26 September 2016 and asked the

panel to apply the principle of proportionality when considering sanction, starting with

the least restrictive. She also referred the panel to paragraphs 36 to 38 of the ISG which

deal with dishonesty. Ms Ansell Jones informed the panel that it is a matter for its own

independent judgement as to what sanction is imposed.

Mr Green on your behalf submitted that you have accepted that the misconduct was

serious. You have reflected and acknowledged that it was wrong and unsafe practice.

Mr Green stated that dishonesty in this case was not planned or calculated. He told the

panel that you had panicked which resulted in your dishonest actions. Mr Green

informed the panel that at the time of these incidents you were suffering from ill health

which could have impacted on your judgement. You have had an unblemished career of

15 years prior to these incidents and this is attested by the testimonials you have

provided. Mr Green referred the panel to the ISG and in particular paragraph 37

In Parkinson v NMC,14 Mr Justice Mitting said:

“A nurse found to have acted dishonestly is always going to be at severe risk of having

his or her name erased from the register. A nurse who has acted dishonestly, who does

not appear before the Panel either personally or by solicitors or counsel to demonstrate

remorse, a realisation that the conduct criticised was dishonest, and an undertaking that

there will be no repetition, effectively forfeits the small chance of persuading the Panel

to adopt a lenient or merciful outcome and to suspend for a period rather than direct

erasure.

He invited the panel to impose a suspension order for a period of 12 months.

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The panel accepted the advice of the legal assessor.

The panel has borne in mind that any sanction imposed must be appropriate and

proportionate and, although not intended to be punitive in its effect, may have such

consequences. The panel had careful regard to the Indicative Sanctions Guidance

(“ISG”) published by the NMC. It recognised that the decision on sanction is a matter for

the panel, exercising its own independent judgement.

The panel found the following aggravating features:

Baby X was a very vulnerable patient;

Dishonesty in a clinical setting in 2012;

There was a further dishonesty incident in 2014.

The panel identified the following mitigating features:

You have made early admissions to the charges;

You have engaged with these proceedings and expressed remorse for your

actions;

You have shown some insight;

You have provided positive testimonials;

You were known to have some health issues at the time of the incidents.

The panel has considered all of the sanctions available to it in ascending order of

seriousness when deciding what sanction, if any, would be appropriate and

proportionate in this case.

The panel first considered whether to take no action but concluded that this would be

inappropriate in view of the seriousness of the case and the risk of repetition identified

by the panel. Your dishonest actions, on more than one occasion, were serious. In the

panel’s judgment, a finding of impairment alone together with no further action being

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taken would not be sufficient to satisfy the public interest in this case nor would it

manage the public protection risk.

Next, in considering whether a caution order would be appropriate in the circumstances,

the panel took into account the ISG, which states that a caution order may be

appropriate where ‘the case is at the lower end of the spectrum of impaired fitness to

practise and the panel wishes to mark that the behaviour was unacceptable and must

not happen again.’ The panel considered your misconduct was not at the lower end of

the spectrum and that a caution order would be inappropriate in view of the seriousness

of the case and the risk of repetition identified by the panel. The panel concluded that to

impose a caution order would not restrict your practice, and therefore would not

adequately protect the public. The panel further concluded that it would be neither

proportionate nor in the public interest to impose a caution order.

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

factors set out in paragraphs 63 to 65 of the ISG which indicate when such an order

may be appropriate, in particular where there are identifiable areas of nursing practice

that require assessment and/or retraining. The panel has not been informed of any

employment you have undertaken since 2014. Whilst the panel considers that the

clinical aspects of your misconduct in 2012 could potentially be addressed through the

imposition of conditions, the panel is not satisfied that your repeated dishonesty could

be adequately addressed by a conditions of practice order. The panel concluded that

the placing of conditions on your registration would not adequately protect the public,

nor serve the public interest considerations in this case.

The panel next considered the imposition of a suspension order. The panel referred

itself again to the aggravating and mitigating factors in this case. The panel noted that

your misconduct which led to the charges found proved was serious and that your

behaviour brought the reputation of the profession into disrepute and breached a

fundamental tenet of the profession. The panel noted that your misconduct involved a

very vulnerable patient; it also included two incidents of dishonesty. Whilst you attended

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the hearing and were represented you chose not to give evidence. Without having an

opportunity to hear from you first hand the panel was not able to form a view on your

insight into the matters of dishonesty and therefore on the risk they would be repeated.

The panel noted that the second incident of dishonesty occurred less than two years

after you had been subjected to a formal disciplinary process by your employer as a

result of the first act of dishonesty. Given the serious nature of your misconduct, the

panel was of the view that a suspension order would therefore not be an appropriate or

proportionate response and would be insufficient to satisfy the public interest

considerations in this case.

The panel then went on to consider whether imposing a striking off order was the

proportionate sanction in these circumstances. The panel noted that this was

misconduct which was aggravated by your repeated dishonesty. Further, you have only

demonstrated limited recognition of the impact your dishonesty had on the reputation of

the profession.

The panel considers that there is a significant risk of such behaviour being repeated for

the reasons set out in its determination on impairment.

The panel took into account the key considerations appropriate for a striking off order at

paragraphs 71 and 72 of the ISG, the relevant parts of which state:

71.1 Is striking-off the only sanction which will be sufficient to protect the public

interest?

71.2 Is the seriousness of the case incompatible with ongoing registration?

71.3 Can public confidence in the professions and the NMC be sustained if the

nurse or midwife is not removed from the register?

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72. This sanction is likely to be appropriate when the behaviour is fundamentally

incompatible with being a registered professional, which may involve any of the

following (this list is not exhaustive):

72.1 Serious departure from the relevant professional standards as set out in key

standards, guidance and advice including (but not limited to):

72.1.1 The code: Standards of conduct, performance and ethics for nurses and

midwives

…

…

72.6 Dishonesty especially where persistent or covered up

72.7 Persistent lack of insight into seriousness of actions or consequences

72.8 Convictions or cautions involving any of the conduct or behaviour set out

above

Your actions constitute a serious departure from the standards of conduct and ethics to

be expected of a registered nurse. Both of your acts of dishonesty impacted on your

employer, with one of them occurring in a clinical setting. The panel also noted that

Baby X was a very vulnerable patient. You have only demonstrated limited insight into

the seriousness of your dishonesty. The panel was of the view that honesty, integrity

and openness are fundamental tenents of the nursing profession and that to allow you

to continue practising would severely undermine public confidence in the nursing

profession and in the NMC as a regulatory body. The panel considered that misconduct

of this gravity is fundamentally incompatible with continuing to be a registered nurse. In

all the circumstances the panel determined that a striking off order is the only

appropriate and proportionate order that would be sufficient to protect the public

interest.

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The panel has therefore determined to impose a striking off order and directs the

Registrar to strike your name off the register.

You will be informed of this decision in writing and will have 28 days from the date when

written notice of the result of this hearing is deemed to have been served upon her in

which to exercise her right of appeal. Unless you exercise your right of appeal, the

direction imposing the striking off order will take effect 28 days from when written notice

of the decision is served upon her.

Determination on Interim Order

The panel considered the submissions made by Ms Ansell Jones that an interim order

should be made to cover the interim period before the substantive suspension order

takes effect and/or to cover any appeal period, on the grounds that it is necessary for

the protection of the public and is otherwise in the public interest. Ms Ansell Jones

submitted that an interim suspension order for a period of 18 months should be

imposed.

Mr Green did not oppose the application for an interim order.

The panel heard the advice of the legal assessor.

In reaching its decision to impose an interim order the panel had regard to the

seriousness of the facts found proved and the reasons set out in its decision for the

substantive order.

The panel was satisfied that an interim suspension order is necessary for the protection

of the public and is otherwise in the public interest. Not to impose such an order would

be inconsistent with its earlier findings. The panel was also satisfied that such an interim

order was proportionate in the circumstances of your case.

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The period of this order is for 18 months to allow, in the event of an appeal, for the

appeal determined.

If no appeal is made then the interim suspension order will be replaced by the

substantive suspension order 28 days after you are sent the decision of this hearing in

writing.

That concludes this determination.