Serious concerns which are more difficult to put right

A small number of concerns are so serious that it may be less easy for the nurse, midwife or nursing associate to put right the conduct, the problems in their practice, or the aspect of their attitude which led to the incidents happening.

In cases like this, we will be keen to hear from the nurse, midwife or nursing associate if they have reflected on the concerns and taken opportunities to show insight into what happened. Because concerns of this nature, when they aren’t put right, are likely to lead to restrictive regulatory action, if we don’t hear from the nurse, midwife or nursing associate we will usually focus on preparing the case for the Fitness to Practise Committee at the earliest possible opportunity.

We will need to do this where the evidence shows that the nurse, midwife or nursing associate is responsible for:

• breaching the professional duty of candour to be open and honest when things go wrong, including covering up, falsifying records, obstructing, victimising or hindering a colleague or member of staff or patient who wants to raise a concern, encouraging others not to tell the truth, or otherwise contributing to a culture which suppresses openness about the safety of care
• concerns that an individual has engaged in discriminatory behaviours that have taken place either inside or outside the workplace
• concerns relating to harassment, including sexual harassment, relating to the professional context
• sexual assault or relationships with patients in breach of guidance on clear sexual boundaries,
• criminal offending relating to accessing, viewing, or other involvement relating to images or videos involving child sexual abuse
• deliberately causing harm to patients
• deliberately using false qualifications or giving a false picture of employment history which hides clinical incidents in the past, not telling employers that their right to practise has been restricted or suspended, practising or trying to practise in breach of restrictions or suspension imposed by us
• exploiting patients or abusing the position of a registered nurse, midwife or nursing associate for financial or personal gain
• being directly responsible (such as through management of a service or setting) for exposing patients or service users to harm or neglect, especially where the evidence shows the nurse, midwife or nursing associate putting their own priorities, or those of the organisation they work for, before their professional duty to ensure patient safety and dignity.