Conduct and Competence Committee Substantive Order Review

Conduct and Competence Committee
Substantive Order Review
18 February 2016

Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE

Name of Registrant Nurse: Miss Nathalie Patrick
NMC PIN:
Part(s) of the register: 92C3155E

Area of Registered Address: Registered Nurse – Sub part 1
Panel Members: Adult Nursing (July 1995)

Legal Assessor: England
Panel Secretary:
Nursing & Midwifery Council: James Churchill (Chair/Lay member)
Carol Sanders (Registrant member)
Registrant: Neil Sykes (Lay member)
Order being reviewed:
Outcome: Nigel Ingram

Lesley Rudd

Represented by Miranda Stotesbury, Case
Presenter, instructed by the NMC Regulatory
Legal Team

Present and not represented

Conditions of Practice Order

Varied and extended Conditions of Practice
Order 12 months to commence at the expiry of
the existing order on 26 March 2016

Decision and reasons on review of the current order:

The panel decided to extend the current order of conditions for a further period of 12
months.

This is the third review of a Conditions of Practice Order, originally imposed by a panel
of the Conduct and Competence Committee on 21 February 2014 for a period of 12
months. The current order is due to expire on 26 March 2016. This is the third review of
the order.

The panel is reviewing the order pursuant to Article 30(1) of the Nursing and Midwifery
Order 2001(“the Order”). The sanctions available to the panel that made the substantive
order, and accordingly that are available to this panel, are contained within Article 29 of
the Order. This panel may allow the present order to lapse upon expiry, revoke the
present order with immediate effect, extend the present order, make a caution order,
make a suspension order or impose a striking-off order.

The charges found proved which resulted in the imposition of the substantive order
were as follows:

Charges read:

“That you, whilst employed as a registered nurse by Vitalise, at Jubilee Lodge, Chigwell,
Essex:

1. On or around 8 October 2011 incorrectly transcribed the required dosage of ferrous
sulphate into Patient A's Medicines Administration Record (“MAR”) ("the Patient A
error").

2. On or around 14 October 2011 suggested to Senior Nurse [Mrs 3] that medicines left
over as a result of the Patient A error should be destroyed or words to that effect.

4. On or around 15 October 2011;
a. “potted up” medication prior to its administration to patients; and/or

b. provided “potted up” medicines to Staff Nurse [Ms 2] for administration to
patients.

5. Your actions as set out at 4.1 and/or 4.2 above were contrary to Vitalise’s policy
on medication administration in force at the time.

6. On or around 16th October 2011, having discovered that medication prescribed
and intended for Patient C had been administered in error to Patient B, failed,
promptly or at all, to take any or any adequate steps including that you did not;
a. notify and/or seek the advice of a GP.

8. On or around 16 October 2011, falsely recorded on his Medication Administration
Record that the following medication(s) had been administered to Patient C at
09:00 on 16 October 2011:
a. Amoxicillin 500mg
b. Epilim 100mg
c. Half Sinemet CR 125mg
d. Cetirizine 10mg

AND, in light of the above, your fitness to practise is impaired by reason of your
misconduct.”

The substantive review panel determined the following with regard to impairment:

…the panel determined that there continues to be a risk of repetition and
consequent risk of harm to patients in your care, if you were permitted to return to
practice without restriction. The panel concluded that your fitness to practise
continues to be impaired.

The substantive review panel determined following with regard to sanction:

The panel took into account your continued commitment to the nursing profession
and your engagement with the regulatory process.

In all the circumstances, the panel concluded that a conditions of practice order
would be the least restrictive sanction that would fully address the public interest
concerns in this case, including the protection of the public. Further, the panel
concluded that a period of 12 months would be both appropriate and proportionate
as it would give you sufficient time to comply with the conditions and to provide
written evidence to the next reviewing panel.

Decision on current fitness to practise

The panel has considered carefully whether your fitness to practise remains impaired.
Whilst there is no statutory definition of fitness to practise, the NMC has defined fitness
to practise as a registrant’s suitability to remain on the register without restriction. In
considering this case, the panel has carried out a comprehensive review of the order in
the light of the current circumstances. It has noted the decisions of the previous
substantive panels. However, it has exercised its own judgment as to current
impairment.

The panel has had regard to all of the documentation before it. It has taken account of
the submissions made by Ms Stotesbury on behalf of the NMC and those made by you.

The panel heard and accepted the advice of the legal assessor.

The panel heard the submissions of Ms Stotesbury on behalf of the NMC who explained
the background to the case and guided the panel to the relevant elements of the
previous panel’s decision.

Ms Stotesbury submitted that you have not worked since the last hearing; therefore you
have not been able to meet the conditions of practice on your registration. She stated
that the risk identified by the last panel remains and therefore your fitness to practice
remains impaired. Ms Stotesbury made no submissions on sanction.

You told the panel that you have been a nurse for more than fifteen years with no prior
problems. You stated that although you have tried hard you cannot get paid or unpaid
nursing work because of the restrictions on your practice. You told the panel about the
financial hardships you have faced since these proceedings began.

You gave the panel information about your current role as a teacher. You stated that
although you enjoy teaching, your heart is in nursing. You stated that nursing is about
trust and you believe that you should be allowed to practice.

In reaching its decision, the panel was mindful of the need to protect the public,
maintain public confidence in the profession, and the need to declare and uphold proper
standards of conduct and behaviour.

The panel considered whether your fitness to practise remains impaired. It noted your
submissions. However, the Panel was concerned that you presented none of the
documentary evidence requested by the last panel or required by the conditions of
practice currently imposed.

Regarding insight, the panel has taken account of the findings of the last panel that you
have gained sufficient insight into your past failings. It recognised your difficult
circumstances and that you have been unable to meet the requirements placed on you
as you have not been in a clinical setting. However, these requirements must be met in
order to prove you have fully remediated the concerns about your practice. As the
concerns about your practice have not been remediated, there remains a risk of
repetition of such errors.

The panel had borne in mind that its primary function was to protect patients and the
wider public interest which includes maintaining confidence in the nursing profession
and upholding the proper standards and behaviour.

Although the panel recognised the hardships you have faced, the concerns regarding
your practice have not been remediated and therefore it has determined that your
fitness to practice is currently impaired.

The panel determined that, in this case, a finding of impairment on public interest
grounds was also required.

Determination on sanction

Having found your fitness to practise currently impaired, the panel then considered
what, if any, sanction it should impose in this case. The panel noted that its powers in
relation to sanction are set out in Article 29 of the Order. The panel has also taken into
account the NMC’s Indicative Sanctions Guidance (ISG) and has borne in mind that the
purpose of a sanction is not to be punitive, though any sanction imposed may have a
punitive effect.

The panel first considered whether to take no action, but concluded that this would be
inappropriate in view of the seriousness of the case. The panel decided that it would be
neither proportionate nor in the public interest to take no further action.

The panel then considered whether to impose a caution, but concluded that this would
be inappropriate in view of the ongoing public protection concerns. The panel decided
that it would be neither proportionate nor in the public interest to impose a caution order.

The panel next considered the imposition of a conditions of practice order. The panel
was of the view that a conditions of practice order is sufficient to protect patients and the
wider public interest. It noted that the requirements of the last panel have not been met,
and that the conditions in place would protect patients during the period they are in
force. The panel considered whether the conditions on your registration could be varied
but determined that the conditions currently in place are the bare minimum required in
order to protect patient safety and otherwise the public interest.

The panel considered whether a period of suspension could be appropriate in your
case. However, it determined that you should be allowed to practice with conditions on
your registration in order to remediate the concerns about your clinical practice.

Accordingly, the panel determined, pursuant to article 30(1)(c), to make a further
conditions of practice order for a period of 12 months, which will come into effect on the
expiry of the current order. It determined that 12 months would give you an adequate
opportunity to comply with, and show evidence of your compliance with the

requirements placed on you. It decided to impose the following conditions which it
considered are appropriate and proportionate in this case:

1. You must notify the NMC within 7 days of any nursing or midwifery appointment
(whether paid or unpaid) you accept within the UK and elsewhere, and provide the
NMC with contact details of your employer.

2. You must inform the NMC of any professional investigation started against you
and/or any professional disciplinary proceedings taken against you within seven
days of you receiving notice of them.

3. You must within seven days of accepting any post or employment requiring
registration with the NMC, or any course of study connected with nursing or
midwifery, provide the NMC with the name/contact details of the individual or
organisation offering the post, employment or course of study.

4. At any time that you are employed or otherwise providing nursing services, you must
place yourself and remain under the supervision of a workplace line manager,
mentor or supervisor nominated by your employer. Such supervision to consist of:

(a) Working at all times on the same shift as, but not necessarily under direct
observation of, a registered nurse who is physically present in or on the same
ward, unit, floor or home that you are working in or on.

5. You must not undertake the unsupervised administration of medication until such
time as you have been signed off as competent by a registered nurse.

6. You must work with your line manager, mentor or supervisor (or their nominated
deputy) to formulate a Personal Development Plan. This should specifically address
the potential impact of medication errors on patients and the issues that form the
basis of the charges found proved.

7. You must send a report from your line manager mentor or supervisor (or their
nominated deputy) setting out the standard of your performance and your progress
towards achieving the aims set out in your Personal Development Plan at least 14
days before any NMC review hearing or meeting.

8. You must immediately inform the following parties that that you are subject to a
conditions of practice order under the NMC’s fitness to practise procedures, and
disclose the conditions listed at 1 to 7 above, to them:

• Any organisation, agency or person employing, contracting with, or using
you to undertake nursing work

• Any educational establishment at which you are undertaking a course of
study connected with nursing or midwifery, or any such establishment to
which you apply to take such a course (at the time of application)

This decision will be confirmed to you in writing.

That concludes this determination.