Managing concerns locally

Last Updated 02/02/2021


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If your local investigation finds that a nurse, midwife, or nursing associate’s practice or behaviour are a risk to public safety, you’ll usually be best placed to manage concerns and lessen that risk.

You can often address public safety risks by supporting the professional to make any necessary changes or improvements.

Deciding the best approach

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There are many ways that concerns can be managed. Deciding on the best approach will depend on the nature of the concerns, the local context, and the available options for managing concerns.

As an employer, consider:

  • What are the main concerns?
  • Are they related to clinical competencies?
  • Are they related to the professional’s health or wellbeing?
  • Are they related to professional behaviours?
  • Is there a risk to people who use services if the person continues to practise as they are now?
  • What actions can eliminate the risk to people who use services, while giving the professional the chance to reflect on the issues, and show that they understand the concerns and are both willing and able to improve?

The answers should lead you to a plan for managing any concerns.

In some cases, your investigation into concerns about a person may also reveal wider cultural or behavioural issues in a team. You might need to consider how to address these issues, using a just culture approach that encourages change through openness and learning.

Some of the steps you might consider include:

  • coaching, mentoring, or regular supportive conversations
  • reflective practice
  • performance management
  • competence assessments
  • referral to occupational health or another healthcare professional
  • formal training or retraining
  • role changes
  • supervision
  • supernumerary practice
  • in rare cases, where people who use services can’t be kept safe using other steps, suspension.

Some options may be challenging to put in place depending on the resources available. That’s why it helps to develop a well-documented plan to address the risks that’s realistic and achievable, both for the professional and for your service. You’ll also want to clearly document all of the steps a person has taken to address the concerns about their practice.

Ultimately, if we do become involved, we’ll want to see all of this detailed information so that we’re clear about the steps that have been taken to address any concerns before the referral.

Considering insight

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It will also be important for you to encourage reflection and document any insight the professional gives about the concerns, or any other responses they give during this process. You might need to give someone time and space to think things through.

When you evaluate the strength of their insight, you’ll want to consider:

  • Does the nurse, midwife or nursing associate recognise what went wrong or why their actions, behaviour, or decisions are concerning?
  • Do they recognise potential public safety risks?
  • Have they fully engaged with the investigation process, and the action plan, including completing a reflective statement?

If you subsequently refer a nurse, midwife or nursing associate to us, information about their level of insight and engagement will help us decide on the right course of action.

Making a referral to us

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You may need to make a referral to us if your local action can’t effectively manage any ongoing risks to people who use services.

Find out more about when to make a referral to us

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