Nurses not assured over winter pressures referrals, NMC told

NMC Watch, a group which works to support registrants going through the fitness to practise (FtP) process, has written a letter outlining its concerns to Andrea Sutcliffe, chief executive and registrar of the Nursing and Midwifery Council.

“The Code is a blunt tool which is difficult to flex around context"

NMC Watch letter

The letter, which has been signed by more than 100 nurses and midwives who have gone through FtP, warned that the NMC Code allowed no flexibility to acknowledge the extreme pressures staff are under.

It was written in direct response to the NMC’s statement on winter pressures published on 11 January, which set out to offer reassurances to nursing staff who may be concerned about making mistakes and being referred to the regulator.

In the statement, Ms Sutcliffe reiterated that the regulator was there to support staff who were concerned about the professional implications of working under sustained pressure.

She said: “Remember that the Code is there to guide your professional judgements.

“And please also remember that concerns are only raised with us about a tiny minority of professionals each year, and when they are, we always take context into account."

These points were also acknowledged in Ms Sutcliffe’s joint letter with the UK’s chief nursing officers and the Care Quality Commission published on 11 November 2022.

In that letter, they said: “In such challenging times, when you may need to depart from established procedures to care for people, we understand some could be fearful that they will be referred to your regulator.

“Please be assured that your professional code and principles of practice are there to guide and support your judgments and decision-making in all circumstances.”

However, NMC Watch said in its letter of response that it felt “confused” by this statement and disputed the idea that context would help referees.

The letter said: “All cases we have observed over the last few years have orientated about how the practitioner has diverted or potentially diverted from their code of conduct.

“The Code is a blunt tool which is difficult to flex around context and cases as recent as the last few months have not shown any difference in this approach.”

“Departing from established procedures under pressure doesn’t have to mean deviating from the high-level principles of the Code"

Anne Trotter

NMC Watch warned that for many nurses and midwives, they may feel unable to escalate concerns relating to the workplace being unsafe, out of fear that they will reprimanded by management for doing so.

It said: “As our regulator it is imperative that your teams are receptive when registrants disclose to you, as per duty of candour, aspects of their workplace that may have contributed to their issues arising.”

Responding to the letter, Anne Trotter, NMC assistant director of professional practice, told Nursing Times that the regulator wanted to see the Code used a “friend and guide” for registrants.

She said: “Departing from established procedures under pressure doesn’t have to mean deviating from the high-level principles of the Code.

“In fact as nurses, nursing associates or midwives, the Code supports us to use our professional judgement to make decisions in difficult and challenging situations.”

Ms Trotter, who is a registered nurse of more than 40 years, added that on occasions when risks existed, professionals should “work together to mitigate them much as possible”.

“If something does go wrong, it’s important that professionals feel confident and can say sorry or speak up without fear of blame,” she said.

"Everyone working in health and care, including managers and leaders, has a part to play in fostering a positive culture of openness and learning that prevents these mistakes from happening in the future.”