Commitment 8: Where an incident has occurred because of cultural problems, we’ll concentrate on taking action to minimise the risk of the same thing happening again
While we expect nurses, midwives and nursing associates to comply with the Code at all times, we recognise the psychological evidence about how hard it can be to speak up or to disobey group norms, even if that means people acted in a way that looks unacceptable with hindsight. If the evidence shows that an incident occurred because of a poor culture we'll take this into account when deciding what action we need to take.
As we explain in our guidance on seriousness, some concerns are so serious that they may be more difficult for the individual to put right. Such concerns include things like causing deliberate harm to people who use services, concerns of harassment, discrimination or victimisation that have taken place either inside or outside the workplace, or a person breaching the professional duty of candour, for example by falsifying records or covering up their mistakes. For these concerns we'd follow the approach in our guidance "serious concerns which are more difficult to put right". We'd still look into the impact of poor culture or group norms, and evidence of these would be considered as part of our assessment of the case. However, concerns such as these are more likely to call into question fundamental aspects of the individual's fitness to practise, and require us to take regulatory action.
Where cultural problems are at the heart of the concern, we'd need to seek assurance that the individual has since reflected and demonstrated that they can act appropriately if they found themselves in a similar working environment. Without this evidence, regulatory action may be required to stop the problem from happening again.
Where there's evidence that other individuals on our register took part in the same poor practices as the person referred to us, we'd need to consider what other action to take to keep people safe. This might mean opening referrals against them. We are less likely to open a new referral if we're confident that the individual has reflected on the incident and demonstrated that they can act appropriately if they found themselves in a similar working environment. We'll also consider sharing information with other regulators and employers via our regulation advisors.
In these types of situations, the people leading or fostering poor cultures should be held accountable as well as and not instead of the people who carry the behaviours out. We'll need to consider whether we need to take any action against those in senior positions who were responsible for the poor culture and for ensuring correct processes were in place, known about, understood and adhered to.
If managers knew poor practices were happening and did nothing, it might call their management arrangements and the level of support they provided into question. It might also be a concern if managers didn't know of a widespread cultural issue. Again, we may need to consider opening referrals against people on our register or sharing information with other regulators or employers who also have a role in preventing future harm to people who use services.
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- Last Updated: 29/11/2021
The guidance in our library, needs to be read alongside our NMC Guidance during the Covid-19 emergency period. We have new rules that are in force during the period of the coronavirus emergency that are relevant to how it applies.
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FtP library
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Understanding Fitness to Practise
- Aims and principles for fitness to practise
- Allegations we consider
- How we determine seriousness
- Why we screen cases
- When we use interim orders
- Investigations
- Examining cases
- How we manage cases
- Meetings and hearings
- Resolving cases by agreement
- What sanctions are and when we might use them
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Taking account of context
- Taking account of context - overview
- 1: We’ll approach cases on the basis that most people referred to us are normally safe
- 2: We’ll seek to build an accurate picture about the nurse, midwife or nursing associate’s practising history
- 3: We’ll always carefully consider evidence of discrimination, victimisation, bullying or harassment
- 4: Where risks are caused by system and process failures, we’ll concentrate on the action we can take to help resolve the underlying issues
- 5: In cases where a nurse, midwife or nursing associate was required to use their professional judgement we’ll respond proportionately
- 6: Evidence of steps the nurse, midwife or nursing associate has taken to address serious concerns caused by a gap in knowledge or training or personal context factors
- 7: We’ll always look into whether group norms or culture influenced an individual’s behaviour before taking action
- 8: Where an incident has occurred because of cultural problems, we’ll concentrate on taking action to minimise the risk of the same thing happening again
- What context factors we think are important to know about when considering a case
- Insight and strengthened practice
- Engaging with your case
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Screening
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Our overall approach
- Our overall approach - overview
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The Three Stages of our Screening Decision
- The Three Stages of our Screening Decision - overview
- Stage One: Do we have a written concern about a nurse, midwife or nursing associate on our register?
- Stage Two: Is there evidence of a serious concern that could require us to take regulatory action to protect the public
- Stage Three: Is there clear evidence to show that the nurse, midwife or nursing associate is currently fit to practise?
- Clinical advice
- Referrals to other regulators
- Referrers that wish to remain anonymous
- Whistleblowing
- If we don't refer a case
- Determining the regulatory concern
- Screening incorrect or fraudulent entry cases
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Our overall approach
- Interim Orders
- Investigations
- Case Examiners
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Preparing for the FtP Committee
- Reviewing cases after they get referred to the FtPC
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Drafting charges
- Why do we have guidance on charges?
- Jargon buster
- General approach
- How a charge becomes final
- Practical drafting issues
- Particular features of misconduct charging
- Drafting charges in health cases
- Other fitness to practise charges
- Multiple allegations
- Drafting charges in incorrect or fraudulent entry cases
- Documents panels use when deciding cases
- Gathering further evidence after the investigation
- Disclosure
- Notice of our hearings and meetings
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Case management
- Hearing fitness to practise allegations together
- Telephone conferences
- Preliminary meetings
- Dealing with cases at hearings or meetings
- Voluntary removal
- Cancelling hearings
- Constitution of panels
- Proceeding with hearings when the nurse, midwife or nursing associate is absent
- Case management during hearings
- Hearings in private and in public
- When we postpone or adjourn hearings
- FtP Committee decision making
- Sanctions
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Reviews
- Reviewing case examiner decisions
- Interim order reviews
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Substantive order reviews
- Substantive order reviews - overview
- Standard reviews before expiry
- Early review
- Exceptional cases: changing orders with immediate effect at a standard review
- Review of striking-off orders
- New allegations
- Reviewing orders when there may have been a breach
- Reviews where an interim order is in place
- Allowing orders to expire when a nurse or midwife’s registration will lapse
- Appeals and restoration