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Earlier this year, the Nursing and Midwifery Council (NMC) published a new resource to support employers of nurses, midwives and nursing associates to take appropriate and fair action when concerns are raised about the practice of registrants. 

The resource encourages organisations to investigate, manage and resolve concerns locally. Crucially, it outlines the NMC’s expectation that employers should only seek regulatory involvement when it’s necessary and that they shouldn’t make a referral unless they’ve exhausted their own processes. 

This approach is positive for members because resolving issues locally can be much fairer. Not only does an emphasis on local processes help avoid unnecessary NMC investigations and all the stress they can entail, but it also helps to improve patient safety and tackle wider problems affecting nursing staff.

RCN Head of Legal (Regulatory) Roz Hooper

Roz Hooper

Although titled Managing Concerns: A resource for Employers, we think the resource will be a really useful tool for reps too. Reps should be proactively taking this resource to their employers; making sure they’re aware of it and using it to promote and support a local and fair approach to managing concerns in their workplace. 

Familiarising yourself with the content will be useful for reps. It includes powerful examples and could help bring about better outcomes for members facing local investigations or in supporting members who fear a referral may occur.

This approach is positive for members because resolving issues locally can be much fairer

Considering context

The resource ties in with a wider piece of work recently carried out by the NMC to review its fitness to practise policy. The review has resulted in improvements that should help promote a just culture that avoids blame and encourages nursing staff and employers to be open and learn from mistakes.

In line with this approach, the guidance is designed to help employers avoid fear and blame when looking at concerns locally and to create an environment in which nursing staff feel able to speak up.

A key part of the improvements made by the NMC to its fitness to practise process is an increased emphasis on the importance of considering context in all NMC cases. This is something that should be mirrored in any local processes or investigations. 

I think there’s an opportunity now for reps to help members and employers think about context

A culture where context is examined can improve safety and avoid wrongly placing the blame solely on one person. It can also help employers identify and address wider issues that affect patient care.

I think there’s an opportunity now for reps to help members and employers think about context. Members should be encouraged to consider the context in local investigations and in any NMC cases and bring this information to the attention of those looking at the case or representing them. If there are wider factors, reps should be aware of these so they can work with employers to raise and address issues.

NMC cases

Of course, sometimes an NMC referral is unavoidable and if this happens, the RCN is here to support members. We’re closely monitoring how the NMC is taking context into consideration, particularly for referrals made during the COVID-19 crisis. 

The NMC also paused some cases during the pandemic to relieve the pressure on nursing staff. Although this was a reasonable decision, it is one that has inevitably led to delays and has resulted in a backlog of cases. 

The NMC has put several strategies in place to tackle this, including taking on more staff. We’re aware that some members may have been waiting an extremely long time for movement on their case, which we know can be incredibly hard. We’re working with the NMC to address this and pressing it to progress cases in which members are involved. 

Reps may find that sharing the NMC’s work on context is reassuring for members who are concerned. The NMC is clear that any investigations will very much take the context in which the person was working and having to make decisions into account. Read more about how the NMC’s new approach to investigations will support members.

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