RCN Head of Legal (Regulatory) Roz Hooper explains how the NMC’s new approach to investigations will support nursing staff and improve patient care
Prior to the COVID-19 pandemic, the Nursing and Midwifery Council (NMC) reviewed its fitness to practise strategy to make improvements to the way it investigates concerns about nurses, midwives and nursing associates on the NMC register.
As part of this work, the NMC has introduced a new priority around context. This places increased emphasis on the importance of considering context in all NMC cases, something that has without doubt become even more relevant this year with the pandemic.
The NMC wants to avoid a culture of blame. It has said it will always adopt the starting point that the majority of nursing staff are safe practitioners so, if something has gone wrong, it will endeavour to understand everything about that situation and by doing that, hopefully unearth systemic issues like short staffing or poor systems that have contributed to any errors.
Improving safety
A culture where context is examined should improve safety for everyone and avoid wrongly placing the blame solely on an individual. It can help identify, and then address, systemic issues which affect patient care.
This doesn’t mean that the NMC won’t investigate individuals, and it recognises that some people may have an attitudinal problem. However, members should be reassured that the NMC will work to understand the entirety of a situation and put an individual’s actions and behaviour into context looking at other factors. This can include factors like discrimination, if there was a bullying culture or a culture where lots of staff did the same thing.
In relation to COVID-19, context is so important. Nursing staff have been redeployed into different and unfamiliar situations, and there are stresses and strains as a result of the pandemic that couldn’t have been anticipated. But nursing staff are still expected to deliver care and make decisions about that care.
The NMC is clear that if nursing staff make use of their professional judgement, using the principles of the NMC code, then they can expect to be treated sympathetically if those decisions are revisited at a later stage. Any investigations will very much take the context in which the person was working and having to make decisions into account.
This could include factors such as nursing staff working in an area that they don’t ordinarily practise in or nursing staff having to make decisions about novel medical issues.
We know that members have had to make extremely difficult decisions throughout the pandemic and that nursing staff everywhere are working under great pressure because the overall demands on the health service have increased.
The important thing in any situation is to be able to justify your decisions
As a result, some members will understandably be more worried about how to make the right decisions. The important thing in any situation is to be able to justify your decisions and the NMC code will help you with this.
As highly skilled professionals, we know that nursing staff have good professional judgement. You should feel confident that your previous experience will have prepared you well to use that judgement, including in circumstances that present fresh challenges.
The RCN is also here to help you. If you’re worried or you need support, you shouldn’t hesitate to contact our advice team. If you do face criticism at any point, we will be here to support without judgement.
Taking care online
As nursing staff, it’s also important to think about your actions outside of the workplace. The pandemic has resulted in an increased reliance on communicating virtually.
Social media can play a powerful role in campaigning, raising awareness and helping us to keep in touch with others during these difficult times. However sometimes, perhaps when emotions are running high or because we’ve become used to communicating in this way, people can forget or pay less attention to the fact that there can be professional consequences to voicing strong views online.
Nursing staff are respected by the public as a source of sound health advice
The NMC code creates an obligation to support evidence-based public health messages and avoid sharing views that may undermine such messages. Nursing staff are respected by the public as a source of sound health advice and should avoid expressing views based on misinformation.
Of course, the NMC code also requires nursing staff to be mindful of other factors too, such as maintaining patient confidentiality.
The NMC has social media guidance to help registered nursing staff use social media responsibly.
Caring with Confidence
The NMC has recently launched a campaign to highlight key aspects of the code and how it can support nursing staff in their work and with decision making. Caring with Confidence is a series of short animations covering topics such as accountability, professional judgement, delegation and speaking up. Take a look at the animations.
