Focus on Fitness to Practise (FTP) series
This second article in the Focus on Fitness to Practise (FTP) series provides an overview of emerging trends and issues in relation to complaints.
What is a relevant medical disability?
The Nurses and Midwives Act 2011 defines a relevant medical disability, in relation to a nurse or midwife as:
a physical or mental disability of the nurse or midwife (including addiction to alcohol or drugs) which may impair his or her ability to practice nursing or midwifery or a particular aspect thereof.
Complaints about registrants solely on the basis of a relevant medical disability are extremely rare. If a registrant has a physical or mental disability and they are receiving treatment from an appropriate health professional and adhering to that treatment, then they are extremely unlikely to be the subject of a complaint.
The most common scenario giving rise to a complaint is where the registrant does not fully accept that they have a health problem; is not receiving any or any appropriate treatment; and as a consequence engages in behaviour that may constitute professional misconduct.
Examples of such behaviour are:
- Being on duty whilst in an unfit state, e.g. under the influence of drugs or alcohol or when their metal state is affecting on their ability to give safe care;
- Theft of drugs, prescription pads, needles and syringes from their place of work;
- Forging of prescriptions;
- Forging of colleagues signatures in drug records, e.g. the MDA Schedule 2 Register; and
- Making false entries in patient records.
It is these actions that give rise to the complaint, not the underlying health issue.
Many of these actions may also result in a registrant facing criminal charges.
The Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives (NMBI December 2014) states that:
You are responsible and accountable for your own health and wellbeing. If you become aware that your own health is affecting your ability to practice safely, you must get help to manage your condition.
Registrants who fail to seek help to manage health issues may find themselves the subject of complaints on the grounds of non-compliance with the Code of Professional Conduct, in addition to the grounds of relevant medical disability and professional misconduct.
How common is this type of complaint?
The most common health issue that gives rise to a complaint is abuse of drugs. The drugs may be taken for their effects alone or to self-treat underlying problems such as depression and/or anxiety or chronic physical pain. A history of un-addressed traumatic events is not uncommon. Abuse of alcohol may also be a feature, though abuse of drugs is far more common.
Historically these types of complaints were rare. When made, they almost always lead to a fitness to practise inquiry being held. In the last few years the numbers of these types of cases has increased. In 2017, one third and in 2018, just over a quarter of all inquiries held related to these types of cases.
The drugs abused:
The most commonly abused drugs are:
- Opioids, e.g. morphine, pethidine, cyclimorph, fentanyl, codeine and oxycodone. Abuse of these drugs may start with abuse of over-the-counter preparations containing codeine
- Benzodiazepines, e.g. midazolam, diazepam, alprazolam
- Hypnotics, e.g. zopiclone, zolpidem tartrate
- Other drugs abused have included antidepressants, propofol, steroids and levothroxine.
The use of ‘street drugs’ is not common but has been an element of some complaints.
The abuse of these drugs potentially poses very significant health, personal and professional risks for the individuals themselves, in addition to the potential risks for patients and employers.
Avoiding a complaint:
Registrants can reduce the likelihood of being the subject of this type of a complaint by seeking appropriate treatment from relevant health professionals rather than self-treating if they have a physical or mental health problem. Registrants should avail of health care and support from:
- Their general practitioner, including referral for specialist medical services or counselling;
- Occupational health and employee assistance services, if available through their employment; and/or
- Voluntary organisations and professional associations may also provide assistance and support.
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)