Latest newsletter for employers

Published on 01 December 2021

Hear from Fiona Millington, chief nurse at Florence, about her experience supporting nurses through the fitness to practise process.

Since 2019, Fiona Millington has been working as the chief nurse for the agency employer, Florence. In our latest newsletter for employers, Fiona spoke to us about how she supported one nurse through the fitness to practise (FtP) process.

She was also involved in the development of our resource for employers and told us how she thinks it can improve FtP processes in the future.

Here's an extract from Fiona's article:

After joining the social care sector, I noticed that nurses in this sector seemed more at risk of being referred to the NMC. So when I joined Florence in 2019, I put a clear policy in place for making FtP referrals to the NMC. Before that we didn’t have anything formal in place to support and monitor our professionals.

The NMC support process has three phases - the acute phase, the interim phase and the maintenance phase. The acute phase addresses the root cause of the incident. The interim phase looks to the future. It involves reviewing the professional’s actions, encouraging them to undertake additional learning and to reflect on what happened. The maintenance phase happens after the outcome of the FtP referral. It may be in place for a few months to support the nurse and their employer.

The nurse in this particular example was a diligent worker. When we received a concern from the care home he’d been working at, it seemed out of character. We offered our support and put weekly meetings in place to discuss his progress. But when he was involved in a second incident I became concerned about his ability to practise safely. So I referred him to the NMC. He was given an interim suspension order (ISO), which meant he couldn’t practise as a nurse.

During the early stages of the referral, this nurse was facing both physical and mental health challenges. I’d say that it’s important for professionals to have contact with their employer throughout the process. It can be reassuring for professionals who are scared of potentially losing their registration.

It was important that the nurse engaged with the NMC process and was willing to learn from his experience. Otherwise it could happen again. We put a series of fortnightly calls in place, then moved to monthly meetings once the ISO was lifted. We used these meetings to reflect, learn and review what had happened.

Together we clearly outlined our next steps and what evidence we needed to send to the NMC. We assigned timescales and adapted where relevant. This helped the nurse to stay focused, and feel supported and prepared for his hearing. Reflecting on the experience also helped him to look for learning opportunities and restore his confidence.

Once we know the outcome of the investigation, we’ll continue to meet until the nurse is confident that he can continue independently. It’s always rewarding to know that the nurse feels supported in the process and to see them progress.

What do you think of the NMC’s resource for employers? What difference do you think it will make?

The NMC’s guidance for employers is a breath of fresh air. It offers support to employers and encourages them to review the circumstances before making a referral. It identifies areas for improvement and how to reduce risks. It also helps employers to make the most appropriate decision, which might not always be to make an FtP referral. This is helping to develop a more open, honest and transparent culture, where safety is the priority and professionals are confident to report errors or incidents. Working towards a no blame culture is key to the evolution of social care, and the NMC’s guidance for employers is essential to making this happen.

When I first started nursing, the NMC was seen as a punitive organisation that would simply remove professionals from the register after a referral. But people shouldn’t feel afraid to raise concerns and report errors. It’s become clear that we need to understand the context in which incidents occur and the NMC’s resource helps with this.

I also don’t think care homes expect agencies to have an effective system in place to deal with concerns. So they often expect employers to refer nurses to the NMC straight away. That’s certainly one thing my organisation is monitoring. Once they know that we have an effective system in place, I hope they’ll have more confidence that the incident can be managed locally.

Florence supports the need for an independent NMC investigation, and will continue to support the registrant if the NMC decides further safety measures are needed at some point.

The NMC worked with colleagues across health and care to create 'Managing concerns: a resource for employers' as part of our work to improve fitness to practice. It's here to help you manage concerns quickly, locally, whenever it's appropriate and fair.

A lot of concerns are best managed at a local level. But if you do need to escalate something to us, our investigations can happen more quickly, and we make decisions earlier, when the concern has been well-managed by an employer.

As an employer, you can also contact our employer link service for more advice.

What else can I expect when I read this newsletter?

You can also read a guest article by Michelle Wayt, from NHS Employers, who explains how preceptorship programmes improve retention within health and care services.

You’ll also find the latest information about our mid-year data report, a link to our webinar about our standards for student supervision, and an article about how we’re updating the language we use as part of our Fitness to Practise process.

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