Warnings

Reference: CAS-2b

Last Updated 28/07/2017

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Purpose of warnings

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A warning is a way of publicly recording that a nurse or midwife's past conduct was unacceptable without the need to hold a hearing.

Issuing a warning against a nurse or midwife who failed to observe the Code, and whose conduct was a source of concern, allows us to promote and maintain professional standards and public confidence in the nurses and midwives we regulate.

Because warnings are issued in cases where the nurse or midwife accepts the basis of our concern, and has demonstrated that they would not be a clinical risk if they were allowed to practise unrestricted, the more restrictive outcomes, or the detailed approach to fact-finding available at a hearing, are generally less likely to be required.

Thresholds

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Warnings are appropriate where:

  • the seriousness of past incidents means there would have been a real prospect of a panel of the Fitness to Practise Committee finding the nurse or midwife's fitness to practise currently impaired, but
  • there is no current need to restrict their practice because the nurse or midwife accepts the regulatory concern, has shown insight, and put any problems in their practice right.


Therefore, warnings will only be issued where the nurse or midwife has:
accepted the regulatory concern

  • demonstrated sufficient insight into the regulatory concern
  • provided evidence of suitable remediation where relevant.


A wide range of regulatory concerns can be dealt with through warnings, given that they publicly mark the serious nature of the past conduct. These include:

  • serious clinical errors or failings, where problems have been addressed
  • incidents which might affect the public confidence in nurses or midwives which are not directly related to clinical practice
  • minor offending resulting in criminal convictions or cautions


A warning is unlikely to be sufficient to protect the public interest, if:

  • the nurse or midwife poses a current risk to patients if they were to practise without restriction. In assessing this it is helpful to consider whether the nurse or midwife has demonstrated that any problems in their clinical practice have been put right through any insight or remediation
  • there is doubt about the level of the nurse or midwife’s insight into the unacceptable nature of their past conduct
  • the incidents are so serious (even if they happened away from the nurse or midwife’s clinical practice) that their impact on the reputation of the professions, or the need to uphold standards and conduct, means that the nurse or midwife may need to be removed from our register either temporarily, or permanently.


There is no public interest in case examiners issuing warnings in cases where the regulatory concern centres on minor issues which would not initially have been serious enough to call into question the nurse or midwife’s fitness to practise. Unless it would be appropriate to provide the nurse or midwife with private advice on a particular area of the Code, the appropriate outcome would be to close the case.

It would not be appropriate for case examiners to issue warnings in cases where the regulatory concern related to the nurse or midwife’s health.

Publication

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Warnings appear on the nurse or midwife’s register entry for 12 months.
The record of the warning sets out the statement of regulatory concern, the relevant standards of practice and behaviour under the Code, and the reason for issuing the warning. The fact that warnings are only issued in cases where the nurse or midwife’s practice does not present a risk to patients is clearly explained as part of the definition of a warning. This is accessible from the online record of the warning itself.

Our statement of regulatory concern always accompanies the material we send out at the end of an investigation. The nurse or midwife will have the opportunity to comment on that statement when they send us their response to the investigation material, before case examiners first consider whether there is a case to answer (and if there is not, whether to issue a warning).

Decisions to warn are published on our website seven days after they have been made.

Review of warnings

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Reviews of decisions to issue warnings can be carried out on the grounds that the decision may be materially flawed, or because there is new information could have led to a different decision.

If the Registrar decides that a review is in the public interest, or is necessary to prevent injustice to the nurse or midwife, the public record of the warning will be amended to show the decision is under review.