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Focus on Fitness to Practise (FTP) series

This first article in the Focus on Fitness to Practise (FTP) series provides an overview of emerging trends and issues in relation to complaints.

Article One: Trends and Issues in FTP

(December 2018)

Every nurse and midwife has a responsibility to uphold the values of their profession and to ensure their practise reflects high standards of professional practice and behaviour and protects the public. 

The role of the Preliminary Proceedings Committee (PPC) is to give initial consideration to complaints and to decide whether or not to refer a complaint to a Fitness to Practise (FTP) Inquiry. The role of the Fitness to Practise Committee is to conduct FTP Inquiries into relation to complaints referred by the PPC. 

The most common types of complaints investigated by NMBI relate to clinical practice/competence issues, communications issues, the behaviour of a nurse or midwife and health issues. 

There are emerging trends in the types of complaints being made and in who is making the complaints. Overall the number of complaints against nurses and midwives is increasing; however the percentage of complaints against registrants (0.18% of the approximately 70,000 on the Register) remains low in comparison with national and international figures for complaints against health professionals. 

Types of complaints investigated by NMBI

Clinical Practice/Competence Issues

Competence has been defined as the ability of the registered nurse or registered midwife to practice safely and effectively, fulfilling their professional responsibility within their scope of practice. Complaints about clinical practice or competence often relate to: 

(a)  Single episodes of care where it is alleged that the standard of care fell seriously short of what it should have been, e.g. the care of one particular patient during a particular day/night shift; or

(b) The provision of care to a particular patient over a period of time, usually in a long-stay care facility. This type of complaint is often made about more than one registrant in the same facility; or

(c) Serious concerns about the competence of a registrant that has not responded to actions at local level, such as education, support, and supervision.

With regards to clinical practice/competence complaints, the trends which were identified in this area were the following:  

  • Serious and repeated concerns about medication management; 
  • A failure to adequately assess a patient’s condition; 
  • A failure to identify a deterioration in a patient’s condition; and
  • A failure to take appropriate actions if deterioration occurs.

Deficits in the standard of documentation were often linked to these types of failures.

Communication issues

Some complaints received focused on a failure to communicate adequately or appropriately with patients and/or their families. Complaints made by patients and/or their families more frequently focused on this issue.

Behaviour of the Nurse or Midwife

In cases of complaints which were linked to the behaviour of the nurse or midwife, the most common issue was verbal and physical abuse of patients. 

Health issues

The most common type of complaint linked to a health issue was drug abuse. In these types of complaints, there was an additional factor(s) such as theft of drugs, forging of prescriptions and/or being on duty in an unfit state. The most common drugs involved were those that are usually available on prescription only, not ‘street’ drugs.

Emerging Issues

In the period of January-December 2017, a number of emerging issues were identified: 

  • A total of 127 complaints were received during 2017. This represents a 90% increase on 2016 figures (69 complaints). It appears likely that this increase will continue in 2018
  • In previous years, a common trend was that complaints usually came from employers or work colleagues; however in 2017 the largest number of complaints (63%) were made by members of the public. This represents a significant rise from 8% of complaints coming from members of the public in 2016. In 33% of complaints in 2017, employers or work colleagues were the complainant. In 4% of cases in 2017, the Board was the complainant
  • Of the complaints received, nineteen complainants made a complaint about more than one registrant, with a range of two to eight registrants. Nearly all of these complaints related to clinical practice issues, e.g. the standard of care provided to the complainant’s relative in a long-stay care facility. Seventy complainants made a complaint about one registrant only.

In 2017, the PPC referred 46% of cases where a decision was made to a FTP Inquiry. This was up from 33% in 2016.

In relation to FTP inquiries concluded during 2017, findings were made against twenty two registrants. No findings were made against registrants in three cases.

For more information

Further information can be found in the following publications, which are available on the NMBI website.

Making a Complaint (2014)
An Employer’s Guide to Making a Complaint (2014)
What to do if a Complaint is made about you (2014)
What to do if called to give evidence at a Fitness to Practise Inquiry (2014)
A Guide to Fitness to Practise (March 2017)
Guidance on Sanctions (March 2018)

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