Other fitness to practise charges

Reference: HEA-1g

Last Updated 28/07/2017

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Lack of competence

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Where it is alleged that a nurse or midwife’s fitness to practise is impaired by reason of their lack of competence, in the preamble to the charge we will assert that they have failed to demonstrate the standards of knowledge, skill and judgment required of them over a period of time. There are a number of ways of making this assertion.

For example, the preamble could read:

“That you, between 1 January 2015 and 1 January 2017 failed to demonstrate the standards of knowledge, skill, and judgement required to practise without supervision as a band 6 midwife.”

The charge should then set out a series of factual assertions which demonstrate a pattern of failings occurring over a period of time, rather than a few isolated episodes. These may describe an initial error or set of errors, followed by further errors made during a period of informal and formal supervision.

Dates and details of specific incidents should be set out in chronological order.

In some cases it may be relevant to explain that the nurse or midwife has failed to demonstrate the competency skills required while under formal supervision by their employer. The charge might then read:

“That you failed to demonstrate the standards of knowledge, skill, and judgement required to practise without supervision as a band 6 midwife in that:

While subject to a Stage 1 formal capability process at St Paul’s Hospital Trust you:

On 1 February 2017, failed to recognise and/or escalate to a doctor abnormal decelerations in Patient A’s cardiotocograph (CTG).

On 1 March 2017, failed to give the correct dose of syntocinon to Patient B.

On 1 April 2017, failed to recognise and/or escalate to a doctor abnormal decelerations in Patient C’s CTG.

While subject to a Stage 2 Formal Capability process at St Paul’s Hospital Trust you…”.

In some cases the nurse or midwife’s lack of competence may be demonstrated by a failure to meet objectives or pass assessments. In such cases the charge will describe how the nurse or midwife failed to meet the objectives or pass the assessments. For example:

“That you failed to demonstrate the standards of knowledge, skill, and judgement required to practise without supervision as a band 6 nurse as follows:

You failed to meet your medicines administration objective, in that you:

On 1 January 2017, while under supervision at St Thomas’s Hospital Trust, attempted to administer twice the prescribed dose of co-codamol to Patient A.

On 4 February 2017, could not explain what tramadol was used for.

On 16 February 2017, while under supervision, poured out the wrong dose of lactulose for Patient B.”

The charge will conclude with an assertion that the nurse or midwife’s fitness to practise is impaired by reason of their lack of competence.

Conviction and cautions

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In a case where the allegation is that a nurse or midwife’s fitness to practise is impaired by reason of a caution or conviction, the preamble simply needs to state, “That you, a registered nurse…”

After this, the charge will include the court of conviction, the date of conviction, and the offence. This information will be found in the certified memorandum or certificate of conviction or caution which we will rely upon to prove our case.

Because we are alleging impairment because of the conviction or caution itself, the sentence does not need to be included in the charge. Comments made during sentencing or the effects of sentence may be referred to in evidence if these are relevant to the panel’s consideration of the issue of impairment.

The charge should conclude with a statement that the nurse or midwife's fitness to practise is impaired by reason of their conviction or caution.

English and Welsh convictions resulting in an absolute or conditional discharge are a special case. A conviction resulting in an order of absolute or conditional discharge will not be deemed to be a conviction for our purposes as a regulator unless the nurse or midwife breaches the terms of their discharge.1 Accordingly,we will not use a conditional discharge cannot as the basis of a charge of impairment by reason of a criminal conviction. Where the conduct for which the conditional discharge was received amounts to serious professional misconduct, this should be charged as such.

In Scotland a similar rule applies where an offence results in an absolute discharge. A criminal offence resulting in an absolute discharge will not be deemed to be a conviction for our purposes as a regulator unless the nurse or midwife breaches the terms of their discharge. Where the conduct underlying the absolute discharge itself amounts to misconduct, it should therefore be described as such and not as a criminal conviction.

Not having the necessary knowledge of English

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If a registrant faces an allegation that their fitness to practise is impaired by reason of not having the necessary knowledge of English, the charge will generally read:

“That you, a registered nurse, do not have the necessary knowledge of English to practise safely and effectively and in light of the above, your fitness to practise is impaired by reason of your lack of knowledge of English.”

Findings of another body responsible for regulating a health or social care profession or licensing body overseas

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In some cases the allegation of impaired fitness to practise will be by reason of a determination by another organisation responsible for the regulation of a health or social care profession in the UK (or a licensing body elsewhere), to the effect that the nurse or midwife’s fitness to practise is impaired. In such circumstances it may not be necessary to describe the circumstances that led the other body to find the nurse or midwife’s fitness to practise impaired. It may be enough to plead the fact that the finding has been made. The charge could read as follows:

“That you, a registered nurse on 1 January 2016 were reprimanded and made the subject of conditions by the Nursing and Midwifery Board of Australia and in light of the above, your fitness to practise is impaired by reason of the findings of another body responsible for the regulation of nurses."

1 Under section 14 of the Powers of Criminal Courts (Sentencing) Act 2000