Analysis

Nurses facing fitness to practise hearings ‘pushed to breaking point’

Registrants under NMC investigation can experience poor mental health while waiting years for their cases to be heard. Stephanie Jones-Berry reports.

Registrants under NMC investigation can experience poor mental health while waiting years for their cases to be heard. Stephanie Jones-Berry reports

Suicidal nurses facing fitness to practise investigations by the Nursing and Midwifery Council are among about 100 nurses supported by the RCN’s counselling service each year.

Stress, depression and anxiety are typical symptoms experienced by RCN members who rely on the counselling service for support, according to the college’s counselling service lead Sarah Murphy. She says NMC proceedings account for much of its work with members.

Picture credit: Alamy
Picture credit: Alamy

Establishing figures for the number of nurses who have committed suicide while facing fitness to practise (FtP) investigations is hard. The NMC does not keep a record of nurses who have died during the regulator’s typically long investigation process.

This approach is in contrast to the medical profession, where there is a growing awareness of the distress such investigations can cause.

In 2014, the General Medical Council (GMC) pledged to review the way it treats doctors after it found that up to 28 doctors killed themselves while facing FtP investigations. An independent review commissioned by the GMC identified 114 doctors who died between 2005 and 2013 while under investigation. Of these, 24 were classified by coroners as suicide and four were suspected suicides.

While there is no such data for nurses, two British research studies show nursing carries a higher suicide risk than many other occupations – underlining the potential vulnerability of nurses under investigation.

The GMC recently began a review of its FtP processes to better support vulnerable doctors. The doctors’ regulator has now published a set of draft proposals that will go before the GMC’s council later this year. Key aims and proposals include making mental health safety ‘a strand that runs throughout the way the GMC performs its role’.

It is no wonder that anxiety can take hold during an NMC investigation. The average FtP case takes 23 months from instigation to completion.

Ms Murphy says these delays place a heavy burden on a nurse’s mental state and many are pushed to breaking point. ‘The length of time the cases are taking takes a tremendous toll on members’ health – being in limbo is difficult and creates huge anxiety.

‘A lot of members are the main breadwinner in their house, which makes finances virtually impossible. If you have that hanging over your head for two years or more, it is intolerable,’ she says.

‘I’ve been through the system and it’s dehumanising’

Band 5 adult nurse Dani Gray was dismissed from her job on the grounds of gross misconduct in 2010.

She had only been qualified for a couple of years, but the ensuing FtP case went on for six years and was finally concluded in January, with all conditions placed on her practice removed.

However, case closure did not make up for the ordeal and Ms Gray says she feels the NMC should do more to direct nurses to sources of support.

She says she effectively stopped working and the financial burden was hard to carry.

During the process, Ms Gray was diagnosed with a neurological disorder that her GP linked to the stress of the NMC case. She is part of a private online support group, set up by and for nurses going through NMC FtP proceedings.

‘Everyone is saying they feel the same, a lot of people are diagnosed with depression – one has been diagnosed with post-traumatic stress disorder. It feels awful – it makes you feel horrible. The NMC doesn’t know how FtP proceedings affect you and your family. You are constantly thinking: “Do people know about me?” It feels shameful and you want to hide away.’

Ms Gray says the regulator needs to improve its communication with nurses who are under FtP investigation.

‘It can be months and there will be no correspondence from them on the proceedings.

‘I get the feeling the NMC doesn’t care about you as an individual. They even refer to you as a “respondent” and entirely dehumanise you.’

No case to answer

There will always be legitimate complaints against health professionals but many are unfounded. A total of 5,183 complaints against nurses or midwives were made to the NMC in 2014-15. More than half (53%) of all the 2,207 FtP cases ultimately considered by the NMC investigating committee were closed on the grounds of no case to answer.

Ms Murphy is glad the GMC is taking the issue so seriously and she wants the NMC to do the same. Nurses who are the subject of FtP investigations, talk of being treated ‘like a criminal’ or ‘feeling guilty until proven innocent’. However, the Doctors Who Commit Suicide While Under GMC FtP Investigations review recommended doctors under investigation should feel they are treated as ‘innocent until proven guilty’.

‘The NMC should be looking at what the doctors have been doing and recreating that – it has a responsibility to monitor what is happening,’ says Ms Murphy.

One experienced senior nurse, qualified and practising for more than 20 years, who did not wish to be identified, says her NMC referral effectively ended her previously untarnished career.

‘It’s soul-destroying,’ she says, outlining the difficulty of not knowing how long the NMC proceedings will last. ‘There has to be a regulator – but the time-frames are ludicrous and part of what affects your mental health. It has taken away all my confidence, everyone has told me I’m not me anymore. A couple of times I’ve thought about taking antidepressants.’

The financial impact can also be devastating. ‘My partner said we are going to have to put the house on the market,’ the senior nurse continues, explaining she had to use her children’s savings to pay the mortgage. With four children to feed and clothe, she has run up thousands of pounds in credit card debt and has resorted to cleaning and ironing work to pay the bills.

The NMC says: ‘We understand that it can be stressful for nurses and midwives going through a FtP investigation, and that this can have a psychological impact. If we identify a nurse or midwife as requiring mental health support during our FtP investigation, we strongly encourage them to seek this through their union, representative body or other support organisations.

‘In 2015 we were asked by the Commons health committee about the mental health of nurses and midwives undergoing FtP, and we responded by committing to a piece of work to better understand the intersection of mental health and the investigation process.’

‘We regularly collaborate and share information with other regulators, and learning from the GMC’s work on mental health has influenced our own. Our work is ongoing’.

To contact the RCN counselling service telephone 0345 772 6100

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