Nurses work in fear of it. The NMC use it as a professional shield. They declare it is to protect the public.
All registration bodies have a code of practice, but how realistic are they?
Consider accountability: Nurse Smith is ordered by her manager to put the dose of medication in a syringe driver. She has not had the specific training for this. Nurse Smith may be afraid to challenge her manager as she is new to post, although there are some nurses who will do so (Ballantyne 2013 ). Nurses who are from overseas also less likely to question ( Health and Safety Executive in Duell 2013).
If nurse Smith attempts the task, and the patient is harmed, she may be reported to the NMC, and may face removal of her registration. Such a case was reported by the Press Association (2014).
The possibility that nurses are removed from the professional register for issues that doctors may not be removed for is supported by many blog comments. An analysis of GMC and NMC cases supports this supposition.
Nurse Brown arrives on shift to find she has 2 carers, not 5, for 30 patients. If this is in a nursing home, after informing the manager or regional manager, if there is one, the next step is to ring the CQC. How many nurses will do this? When they do it does not make them flavour of the month. To quote one regional manager “we have ways of getting managers out”.
The situation may also involve being ordered not to ring an agency, and may also occur in a hospital. In hospital, staff are more likely just to inform ward managers.
Protecting patient dignity is an important part of the nurse’s role. How many times in practice may this be challenged by resources, routine, staffing or culture? Consider, for example, the lack of staff to sit with a patient who is dying.
Accepting gifts raises many dilemmas for nurses. In some cases, even when the nurse asks the patient to donate it to the ward or care home, the patient refuses. Consider this one example. A terminally ill patient insisted a nurse took £5 when she heard he was having a drink after work. The nurse did, and, on finding the lady had died the next day, was proud to have bought a drink in her honour. Technically this was a reportable offence.
Evidence based practice: What evidence is to be accepted? Consider wound care, research abounds regarding methods of treatment. Is a nurse to be aware of absolutely everything? Is a nurse who is aware of more than her seniors to challenge every aspect and work against her own knowledge and beliefs?
Uphold the reputation of the profession at all times: this may conflict with the necessity of the public to know what is occurring within care. Years ago many nurses feared approaching the press, and many still do. Indeed, some that do are referred to the NMC.
Work with others, their families and carers: This may conflict with the ability of private care homes to give one month’s notice of leave to a resident in response to complaining, or to ban people from visiting. Where does the individual nurse stand in such a scenario?
At NMC hearings, the nurse is under question, not the place of work. It is time the NMC considered such factors. It is also time nurses protected themselves by keeping absolutely full and clear records in patients notes, and incident forms. Unfortunately, there are cases when records are amended, which opposes the Code of Conduct. This issue needs to be strongly addressed by nurse education.
There have been cases of inappropriate NMC decision making (Naish 2012 ), when nurses who hit patients were allowed to continue to practice as Registered Nurses. Conversely, nurses may be reported for seemingly trivial issues such as stealing a banana from a patients locker (ibid). Cases may also be fabricated against unpopular nurses (Dimon 2013).
The latest PSA audit (2014), considered 27 cases and found no problems regarding the decision making process, but there were some problems regarding failure to document reasons for decisions (2.13) . The NMC is taking action to resolve any issues highlighted by the PSA report. Presently the NMC is asking for public contribution towards the creation of a new code of conduct for nurses. Will such issues be addressed?
I am not suggesting that the NMC code of conduct, or nurse registration, is unnecessary but that it is not the ultimate panacea.
The NMC need to be clear about who they really protect – the patient, the profession, the manager, the business, the government, or the nurse who protects the patient?
Ballantyne H (2014) Student Life- From Student to Staff Nurse Nursing Standard (28.4) rcnpublishing.com
Dimon C (2013 ) The Commodity of Care Cloister House Press free updates on qualityofnursingcare.webs.com
Duell M (2013) ‘Full of life’ great-grandmother, 100, ‘died from fractured skull after falling 5ft when foreign carers failed to properly strap her into hoist’ mailonline (8.1)
Naish J (2012 ) Rogue Nurses who Attack and Steal from Patients Handed ‘License to Abuse’ As Report Reveals how Few Are Actually Struck Off.
The Press Association (2013) Stafford Nurse Faces NMC over Fatal Drug Error Nursing Times nursingtimes.net
PSA (2014 March) professionalstandards.org.uk
Carol Dimon c 2014