Your future in their hands

The defendant sits at right angles to the witness, less than 10
feet apart. Both are avoiding eye contact to the point where neck
strain seems a possibility. The defendant says nothing beyond
confirming her name and the dates she was employed. Her husband,
representing her, has no legal training but puts up a good
fight.

This is a conduct hearing presided over by the Nursing and
Midwifery Council (NMC), nursing’s equivalent of the General Social
Care Council and its UK counterparts. Each month, about 30 such
hearings are held in hotels and conference venues around the UK. At
stake is a nurse’s reputation and livelihood: if misconduct is
proven, the nurse may be struck off the NMC’s register, preventing
them from practising again.

In this case, a registered nurse has been accused of manhandling a
dementia patient in a nursing home, of physical abuse causing
bruising to the face and of performing a “manual evacuation” on
another patient without properly recording this procedure.

The nurse in question is a small, slim woman in her early fifties,
impeccably dressed in a dark suit and with short, silvery blonde
hair. She sits nervously next to her husband. Despite the plush
location – a meeting room overlooking a windswept hotel garden – it
is a court room, and the stakes are high.

These hearings are not a minor undertaking for the NMC – which
spends about 40 per cent of its income on investigating misconduct.
A minimum of 12 people are in attendance, including a legal
adviser, a council solicitor, a chairperson and two members of the
professional conduct committee, as well as council officers. A
series of exhibits are recorded and distributed, and a succession
of witnesses are sworn in.

For those at its sharp end, the process is daunting and
confrontational. Witnesses and respondent are under intense strain,
which manifests itself in different ways. Some are barely audible,
others stare blankly into space, a few giggle uncontrollably before
lapsing into embarrassed silence.

In this particular case, bitter personality clashes and tit-for-tat
allegations seem to be the order of the day. Clearly, these people
did not much like each other when they worked together, and having
their day “in court” is doing nothing to improve matters.
Conflicting statements, claims and counter-claims continue for most
of the day. The room is frequently plunged into silence while a
particular document is presented, approved and distributed.
Eventually, after five witnesses, the hearing is adjourned, leaving
everyone facing another tense few weeks of waiting.

So what will social care’s new misconduct system look like?
Probably quite similar. The aim is to make the hearings less
daunting, but the legal process is essential to protect
professionals and the public.

It will not be without problems. First, the NMC hearing system
relies heavily on written evidence and documentation, including
care plans, daily journals and medication records. This could be a
disaster for any social workers whose record-keeping is less than
meticulous. If an entry on a particular date was missed or a
detailed rationale for a decision was not recorded allegations of
misconduct could prove difficult to defend.

Second, nurses’ work is often limited to health care settings. The
GSCC and its UK-wide counterparts will need to work out how to deal
with social workers whose disputed actions involved other
professional groups – from police and health care professionals, to
education and youth justice staff. Will the records of all these
agencies tie up? Could social workers accused of being involved in
a child death be facing a conduct hearing with 10 or 20 witnesses,
each with their own version of events?

For now, the UK councils should soak up their role as benign
benefactors to the workforce. Because as soon as a few social
workers have sweated in the spotlight of a professional conduct
hearing, the register may not seem so benign.

Two years and still waiting 

The Nursing and Midwifery Council (NMC) has been investigating
Amanda* since allegations of physical abuse were made against her
two years ago. She recently attended her first conduct hearing, and
is awaiting a second. 

“It has been a long time since it happened,” Amanda says. “Two
years exactly. When they put the allegations to me, I was
incredibly angry and hurt. I wish I hadn’t given them the
satisfaction of seeing me upset. But I couldn’t believe what they
were saying. I just didn’t recognise myself in their version of
events. 

“I resigned on the spot. My income disappeared overnight. I’ve
been offered two good jobs since it happened, but it’s a funny
situation. You are allowed to work and you don’t have to disclose
the investigation. But a new employer will always go to your
previous employer for a reference. In my case, they gave me a good
reference, but they also made sure my new employer knew that I was
being investigated. So neither of the jobs went anywhere. For
anyone without someone to support them the consequences could be
terrible. 

“My first hearing was last week. I was incredibly nervous when I
walked in, and all the way through. It was awful. I had to sit
there and listen to lies being told about me, and try to keep calm
and not react. I just can’t emphasise how bad it is. But whatever
the outcome is, the NMC has done things properly all the way
through. I do think I have been treated fairly. 

“The length of time it all takes is one of the worst things. You
have this great weight hanging over you for month after month. It
takes over your life. Before this happened, I wasn’t on any
medication. Within a few weeks of it happening, I was on
antidepressants. Now I have bleeding stomach ulcers, and I’m being
investigated for breast lumps.  

“It’s hard on your relationships. I’m extremely fortunate in
that I’ve been married a long time and my husband has been great.
But I couldn’t tell my daughter about it for a year. I felt it was
shameful and embarrassing. It is not something you can talk about
to anyone. It has been worse because I’ve had my name and my photo
splashed over my local paper. 

“I started nursing at 18, and I’ve never had a blot on my
copybook. It is just as though the rug has been pulled from under
me. I would never go back to nursing now, even if I were cleared.
No way. But I worked all those years and I just refuse to go out
this way. I don’t want this hanging over me.” 

*Not her real name

How nurses are regulated   

The Nursing and Midwifery Council (NMC) receives more than 1,000
allegations of misconduct each year, most of them from employers.
About one-third of the charges relate to clinical practice issues,
including failing to keep accurate records. A quarter relate to
physical, verbal or sexual abuse of patients. Far fewer relate to
non-reporting of criminal convictions, dishonesty, sexual
harassment and bullying and behaviour unrelated to work but which
“undermines public confidence” in the profession.  The allegations
are filtered by a preliminary proceedings committee and about one
in seven is investigated by the professional conduct committee,
which meets in public. In 2002-3, the committee met 370 times and
considered 326 cases of alleged misconduct. Of these, 154
registered nurses were struck off the register and 66 others were
cautioned.