Serious concerns which could result in harm to patients if not put right

Assessing the risks presented by an individual nurse, midwife or nursing associate’s practice means carefully considering the evidence about those risks.

Our evidence will need to clearly explain whether patients were put at risk by the nurse, midwife or nursing associate’s conduct or failings in the past, and what harm did or could have happened to patients because of those failings. When considering the risk of harm to patients, we'll always consider the possible consequences of the concerns, such as members of the public feeling reluctant to access health and care services, experiencing less favourable treatment or both. 

We will need to assess how likely the nurse, midwife or nursing associate is to repeat similar conduct or failings in the future, and if they do, if it is likely that patients would come to harm, and in what way.

Conduct or failings that put patients or service users at risk of harm will usually involve a serious departure from standards. Standards, such as our Code, are intended to ensure that nurses, midwives or nursing associates practise safely and effectively.

We've used the Code to identify some examples below of the kinds of failings which are likely to cause risk to patients if they are not addressed.

We wouldn't usually need to take regulatory action for isolated incidents of these failings unless the incident suggests that there may be an attitudinal issue such as displaying discriminatory views and behaviours. This may indicate a deep-seated problem even if there is only one reported incident. A pattern of incidents is usually more likely to show risk to patients or service users, requiring us to act.

Prioritise people

The evidence shows that the nurse, midwife or nursing associate has failed to:

• uphold people’s dignity, treat them with kindness, respect and compassion, deliver treatment care or assistance without undue delay, or deliver the fundamentals of care (including hydration, nutrition, bladder and bowel care and ensuring people receiving care are kept in clean and hygienic conditions).
• make sure the physical, social and psychological needs of patients are responded to.
• respect people’s right to privacy and confidentiality.

Practise effectively 

The evidence shows that the nurse, midwife or nursing associate:

• has not maintained the knowledge and skills for safe and effective practice.
• is unable to communicate clearly, work cooperatively, keep clear and accurate records, without falsification.
• failed to be accountable for decisions to delegate tasks and duties to other people and/or failed to ensure they are adequately supported.

Preserve safety

The evidence shows that the nurse, midwife or nursing associate has failed to:

• recognise and work within the limits of competence, accurately assess signs of normal or worsening physical or mental health, or make timely and appropriate referrals where needed.
• be open and candid with all service users, or act immediately to put right, explain and apologise when any mistakes or harm have taken place.
• offer help if an emergency arises in practice.
• act without delay if they believe there is a risk to patient safety or public protection.
• raise or escalate concerns.
• advise, prescribe or administer medicines in line with training, law and guidance.
• be aware of, or reduce as far as possible, any potential for harm associated with practice, including controlling and preventing infection, taking precautions to avoid potential health risks to colleagues, patients and public.

Promote professionalism and trust

The evidence shows that the nurse, midwife or nursing associate has failed to:

• uphold the reputation of the profession, by not acting with honesty and integrity, treating people fairly, without discrimination, bullying or harassment, in a way that does not take advantage of their vulnerability or cause them upset or distress.
• maintain the level of health needed for safe and effective practice.
• avoid asking for or accepting loans.
• cooperate with investigations and audits, including requests to act as a witness.
• tell us as soon as they could have about cautions or charges, conditional discharges or convictions for criminal offences.