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Nursing and Midwifery Council

Fitness to Practise Committee

Substantive Hearing

4 September 2018 – 6 September 2018

Nursing and Midwifery Council, 61 Aldwych, London WC2B 4AE

Name of registrant: Agnes Scovia Nyadoi NMC PIN: 01I1782O Part(s) of the register: Sub Part 1 Registered Nurse – Adult (10 September 2001) Area of registered address: England Type of case: Misconduct Panel members: Gill Madden (Chair, Lay member)

Paul Morris (Lay member) Pauleen Pratt (Registrant member)

Legal Assessor: Andrew Granville-Stafford Panel Secretary: Deepan Jaddoo Mrs Nyadoi: Present and represented by Paula Clements,

counsel instructed by the Royal College of Nursing (RCN)

Nursing and Midwifery Council: Farzana Iqbal, NMC Case Presenter Facts proved by admission: 1, 2 (a) & (b) Facts not proved: 3, 4(a) & (b), 5, 6 (a), (b) & (c) Fitness to practise: Impaired Sanction: Caution Order – 4 years

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Details of charge:

That you, a registered nurse:

1. On or around 13 April 2017, as part as your application to Your World

Recruitment Agency (“the agency”), submitted a certificate from Kingston NHS

Foundation Trust (“the Trust”) certifying that you had attended a Moving and

Manual Handling Training Course on 4 September 2016, when you had not

attended this course.

2. Your conduct at Charge 1 above was dishonest in that you:

a) Provided a training certificate which you knew was false;

b) Intended to mislead the agency into believing that you had completed this

training when you knew you had not.

3. On or around 13 April 2017, as part of your application to Your World

Recruitment Agency (“the agency”) submitted a curriculum vitae which incorrectly

stated you had been employed by the Trust as follows: ‘January 2005 – Present.

RGN – Kingston Hospital’

4. Your conduct at Charge 3 above was dishonest in that you:

a) Knew that you had not been employed by the Trust since January 2005 until

the time of your application, as you had only starting working for the Trust via

agency shifts from 25 November 2015;

b) Intended to mislead the agency into believing that you had been in full-time

employment with the Trust since January 2005.

5. On or around 13 April 2017, as part of your application to Your World

Recruitment Agency (“the agency”) submitted an employment reference from

Person A which you knew was false.

6. Your reliance on this reference from Person A was dishonest in that:

a) You knew that Person A had not known you in his capacity as a ‘Charge

Nurse’;

b) You knew that Person A had not been employed by the Trust;

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c) You intended to rely on this reference to mislead the agency into offering you

employment

And, in light of the above, your fitness to practise is impaired by reason of your

misconduct

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Background:

After training in Uganda and completing an adaption programme in the UK, you

qualified as a Registered Nurse in September 2001.

On 27 April 2018, the NMC received a referral from Your World Recruitment Agency

(“the Agency”). The Agency is an international medical recruitment agency that recruits

locums across the medical field for placements through the NHS or private hospitals in

the UK.

The alleged incidents contained in the referral relate to your employment application to

the Agency, for an Agency Nurse role, submitted on or around 13 April 2017.

As part of the Agency’s recruitment process, each candidate is assigned a Compliance

Officer (CO), who ensures that the all the relevant documentation pertaining to the role

is complete and accurate. You were assigned a CO who had concerns about the

supporting documentation you had submitted. The CO escalated his concerns to Mr 1, a

Clinical Advisor at the Agency. Mr 1 reviewed the supporting documentation in question,

in particular a certificate from Kingston NHS Foundation Trust (“the Trust”) and made

further checks in relation to this. On 27 April 2017 Mr 1 referred you to the NMC, which

resulted in the below allegations.

It is alleged that on or around 13 April 2017, as part of your application to the Agency,

you submitted a certificate from the Trust certifying that you had attended a Moving and

Manual Handling Training Course on 4 September 2016, when you had not attended

this course. The NMC allege that your conduct in doing so was dishonest, in that you

deliberately sought to supply a false certificate.

It is also alleged that you submitted a curriculum vitae (CV) which incorrectly stated you

had been employed by the Trust as follows: ‘January 2005 – Present. RGN – Kingston

Hospital’. The NMC allege that your conduct in doing so was dishonest, in that you were

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attempting to show that you had significant employment history as a permanent

member of staff at the Trust when you had not.

Lastly, it is alleged that you submitted an employment reference from Person A, which

you knew was false. The NMC allege that your reliance on this reference was

dishonest, in that you wanted to provide an acceptable reference to the Agency as soon

as possible in order to secure employment.

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Decision and Reasons on application pursuant to Rule 31:

The panel heard an application made by Ms Iqbal under Rule 31 of the Rules to allow

the written statement of Mr 1 into evidence as hearsay.

Ms Iqbal provided the panel with a bundle of documentation which outlined the

numerous and repeated attempts made by the NMC on 4 September 2018 (the first day

of the hearing) to make contact with Mr 1. Ms Iqbal explained that the NMC had used

two telephone numbers for Mr 1 and sent him an e-mail, but had heard no response

from him. Ms Iqbal told the panel that it appeared that Mr 1 was reluctant to attend

today’s hearing and submitted that in the circumstances the NMC had made all

reasonable efforts to make contact with him.

Ms Iqbal referred the panel to the case of Thorneycroft v Nursing and Midwifery Council

[2014] EWHC 1565 (Admin) which outlined a list of factors to be taken into

consideration when determining whether it would be fair to admit the witness statement

of an absent witness into evidence.

She submitted that, whilst it may be said that some unfairness may be caused to you by

not being able to cross examine Mr 1, his statement had been prepared for the purpose

of today’s hearing and sent to you in advance of today’s proceedings. Ms Iqbal

submitted that whilst Mr 1’s documentary evidence may be considered sole and

decisive in respect of the disputed allegations of dishonesty, his witness statement

merely supports this documentary evidence. Ms Iqbal submitted that the allegations are

serious and that the panel can only explore these matters fully if it had sight of this

evidence. As such, Mr 1’s evidence was fair and relevant, and should be admitted into

evidence.

Ms Clements, on your behalf, objected to this application. She submitted that whilst it

was apparent that all reasonable steps had appeared to be taken to contact Mr 1 by the

NMC, it would be wholly unfair for his statement to be adduced as hearsay evidence.

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Ms Clements submitted that the Mr 1 is the only NMC witness from the Agency which

the NMC had chosen to call to give evidence and the only witness in a position to

provide relevant evidence in relation to your CV and in relation to Person A. She told the

panel that it was clear that you intend to challenge his evidence, given that his evidence

is central to the disputed allegations, and that by denying you this right to cross examine

Mr 1 would be contrary to the interests of justice. Ms Clements submitted that it is for

this reason you had previously objected to his evidence being read and that you

required his attendance as you have no other way of challenging the assertions made

by Mr 1 or the reliability of the his conclusions. Ms Clements submitted that it was

undeniable that his evidence was sole and decisive in relation to the disputed charges

and that whilst his evidence is clearly relevant, it was unfair to allow this application

given the serious consequences the disputed allegations may have on you if found

proved.

The panel heard and accepted the legal assessor’s advice on the issues it should take

into consideration in respect of this application. This included that Rule 31 provides that,

so far as it is ‘fair and relevant,’ a panel may accept evidence in a range of forms and

circumstances, whether or not it is admissible in civil proceedings. He took the panel

through the relevant case law, and detailed the principles outlined in Ogbonna and

Thorneycroft.

The panel carefully considered the submissions made by Ms Iqbal, and by Ms

Clements. The panel concluded that the NMC had made all reasonable efforts to

contact Mr 1. The panel accepted that whilst his evidence was sole and decisive,

certainly in respect of charges 3 and 4, it noted that the evidence produced and

exhibited by Mr 1 was largely documentary evidence, and that his statement merely

states what the Agency received at the time. As such, the panel was of the view that

whilst his oral evidence may have assisted the panel, the extent to which it may have

assisted would have been limited to the issue in charge 3. On balance, the panel did not

consider that you would be disadvantaged by the admission of Mr 1’s statement into

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evidence, as you would still have the ability to provide your own evidence on this matter.

The panel also noted that it would attach what weight it deemed relevant to this

evidence.

The panel therefore accepted the application.

Admissions

At the outset of this hearing, Ms Clements, on your behalf, told the panel that you admit

charges 1 and 2.The panel was satisfied that this was sufficient to amount to

unequivocal admissions and accordingly found these charges proved in accordance

with Rule 24(5).

Decision on the findings on facts and reasons

In reaching its decision on the remaining facts, the panel considered all the evidence

adduced in this case together with the submissions made by Ms Iqbal, on behalf of the

NMC and Ms Clements, on your behalf, and heard evidence from Ms 1, Associate

Director of Nursing at the Trust. The panel also heard evidence from you under oath.

The panel accepted the advice of the legal assessor.

The panel was aware that the burden of proof rests on the NMC, and that the standard

of proof is the civil standard, namely the balance of probabilities. This means that the

facts will be proved if the panel is satisfied that it was more likely than not that the

incidents occurred as alleged.

The panel considered Ms 1 to be a credible witness. The panel considered that Ms 1’s

evidence was clear, straightforward and consistent. Whilst Ms 1 was not a direct

witness to any of the incidents, it found that she assisted the panel to the best of her

recollection.

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The panel considered your evidence and found that when questioned, you provided

clear and credible answers which were consistent with your written statement.

The panel considered the remaining charges and made the following findings:

Charge 3

3. On or around 13 April 2017, as part of your application to Your World Recruitment

Agency (“the agency”) submitted a curriculum vitae which incorrectly stated you had

been employed by the Trust as follows: ‘January 2005 – Present. RGN – Kingston

Hospital’

This charge is found NOT proved.

In reaching this decision, the panel took into account all of the oral and documentary

evidence presented in this case.

The panel noted that there were no direct witness in relation to this allegation who could

provide the panel with any further information as to what occurred during your interview

with the Agency, or as to what documentation you handed over to the Agency at the

time. The panel took into account that the only evidence to support this charge was

hearsay evidence of Mr 1.

The panel noted that you had not been able to cross examine Mr 1 or explore the

details of the exchange between you and the Agency. The panel considered the

documentary evidence, namely the CV (“the Agency’s CV”) exhibited by Mr 1. The

panel took into account that the NMC had not received the Agency’s CV until November

2017, despite Mr 1 making his referral to the NMC in April 2017. The panel had sight of

a CV you had provided (“Your CV”) and your e-mail on 15 March 2017 attaching this CV

to the Agency, prior to your interview at the Agency.

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The panel noted that your CV differed, as it was full and clearly listed the roles which

you had been employed. The panel noted that your CV contained no mention of having

worked at the Trust, which was consistent with your oral evidence. The panel also noted

that you had sent a payslip along with this document to the Agency, which clearly

showed that you had worked at Croydon. The panel also had sight of a P45 which

showed when you left your employment with Croydon. The panel found the Agency CV

produced by Mr 1 to be incomplete, and appeared to have been rewritten and realigned

from your CV. The panel also noted that in your oral evidence, you strongly denied

providing any other CV, other than your CV, to the Agency. In the absence of any other

direct evidence, the panel accepted your evidence.

In the panel’s view, it had no way of knowing how the Agency had obtained the

incomplete CV, or where it had come from and considered its provenance was lacking.

The panel also determined that there was no reason for you to have provided the

Agency with a half-finished, inaccurate CV when you had a CV which clearly set out

your full employment history.

In the absence of any direct evidence, or any further information as to the provenance

of the Agency’s CV, the panel was not satisfied, on balance, that you had submitted

such a CV stating that you had worked at the Trust.

The panel therefore determined that the NMC had failed to discharge its evidential

burden in relation to this charge.

Accordingly, the panel found this charge not proved.

As a result, charges 4 (a) and (b) fall.

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Charge 5

5. On or around 13 April 2017, as part of your application to Your World

Recruitment Agency (“the agency”) submitted an employment reference from

Person A which you knew was false.

This charge is found NOT proved.

In your oral evidence, you were candid about your relationship with Person A, and

explained to the panel that Person A was a person who you had worked with many

years ago and someone who you, at the time, believed you could trust. You told the

panel that you had worked with Person A at Croydon in 2005 and that as far as you

knew, he had never worked at the Trust. You were also clear in stating that the first time

you had actually seen the reference provided by Person A was when it had been sent to

you by the NMC. After receiving this document from the NMC, you called Person A to

confront him about this, at which point he hung up the phone. You tried calling him back

but he failed to answer.

The panel first considered the wording of the charge and determined that it was clear

that you had not yourself submitted the employment reference to the Agency. However,

even if the panel were to interpret the wording more widely, (e.g. ‘that you allowed for

an employment reference to be submitted’), the panel determined that there was no

evidence which could lead it to determine that, on balance, you knew and were aware of

the inaccuracies in the document. The panel also had sight of the instruction on the

reference form which stated that the referee should send this directly to the Agency.

The panel noted that NMC has not provided any evidence which refutes your assertion

that you had never seen this document prior to the NMC sending it to you, or that you

knew the document to be false prior to Mr 1 sending this to the Agency.

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The panel determined that the NMC had not discharged their evidential burden in this

case, and was therefore not satisfied on the balance of probabilities that this incident

had occurred as alleged.

Accordingly, the panel found this charge not proved.

As a result of the above finding, charge 6 (in its entirety) falls.

Submission on misconduct and impairment:

Having announced its finding on all the facts, the panel then moved on to consider,

whether the facts found proved by way of admission amount to misconduct and, if so,

whether your fitness to practise is currently impaired. The NMC has defined fitness to

practise as a registrant’s suitability to remain on the register unrestricted.

Ms Iqbal submitted that this case solely engages public interest considerations. She

reminded the panel that there is no burden of proof at this stage and the decision on

misconduct is for the panel’s independent judgment.

Ms Iqbal referred the panel to the case of Roylance v General Medical Council (no. 2)

[2000] 1 AC 311 in which Lord Clyde defined misconduct “as a word of general effect,

involving some act or omission which falls short of what would be proper in the

circumstances. The standard of propriety may often be found by reference to the rules

and standards ordinarily required to be followed by a practitioner….”

Ms Iqbal invited the panel to take the view that your actions amount to a breach of ‘The

Code: Professional standards of practice and behaviour for nurses and midwives

(2015), (the Code). She directed the panel’s attention to the following paragraphs

where, in the NMC’s view, your actions amounted to breaches of the Code, namely: 20,

20.1, 20.2 and 20.8.

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Ms Iqbal invited the panel to consider that by acting dishonesty, your actions constituted

serious departures from the values and standards of a Registered Nurse and should

result in a finding of misconduct.

Ms Iqbal invited the panel to consider the public interest and referred the panel to the

case of Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery

Council (2) Grant [2011] EWHC 927 (Admin), particularly paragraph 76 of Mrs Justice

Cox’s judgement, wherein she endorsed the questions formulated by Dame Janet Smith

in her Fifth Shipman Report. Ms Iqbal submitted that limbs (b), (c) and (d) in paragraph

76 of Mrs Justice Cox’s judgement in the case of Grant were engaged in this case.

She then referred the panel to the case of Cohen v General Medical Council [2008]

EWHC 581 (Admin) and reminded the panel that they should undertake a forward

thinking exercise in order to determine to what extent your actions have been remedied.

Ms Iqbal referred the panel to the case of Grant and stated that the public interest

remains paramount. Ms Iqbal submitted that in light of you having brought the

profession into disrepute, a finding of impairment is necessary on the grounds of public

interest in order to uphold proper professional standards and uphold public confidence

in the profession and in the NMC as a regulator.

Ms Clements, on your behalf, told the panel that you take full responsibility for your

actions, and that you accept that your actions breached the codes identified by the

NMC.

Ms Clements next referred the panel to a bundle of documentation containing

references which attest to your good practice and good character. Ms Clements

acknowledged that whilst some details pertaining to the referees had been omitted, for

example a PIN for a Registered Nurse, there was sufficient detail in these references for

the panel to consider these when making their decision at this stage.

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Ms Clements told the panel that it was clear, through your oral evidence and through

your reflective statement (undated), that you have had time to take a step back from

your actions, and that you have shown a considerable amount of reflection into your

failings. She submitted that you now understand what you did was wrong, how your

actions have affected the reputation of the nursing profession and what the correct

course of action should have been. She further submitted that you recognise the

damage your actions had on the wider public confidence in the profession and how a

member of the public would consider your actions to fall short of the accepted standards

and behaviour of a Registered Nurse. Ms Clements told the panel that you accept that

your actions were inexcusable and that regardless of your difficult personal

circumstances they should not have occurred.

Ms Clements submitted that your actions relate to one single instance of dishonesty,

which occurred under very unique circumstances. She reminded the panel that you

have 22 years of nursing experience, that you have worked as a registered nurse for

over 17 years in the UK without incident, and that you have never appeared before your

regulator before. She therefore invited the panel to conclude that it was highly unlikely

for you to repeat such behaviour in the future, such that a finding of current impairment

was not required in order to maintain confidence in the profession and uphold the public

interest in this case.

The panel has accepted the advice of the legal assessor which included reference to

Council for Healthcare Regulatory Excellence v (1) Nursing and Midwifery Council (2)

Grant [2011] EWHC 927 (Admin).

Decision on misconduct

The panel considered whether the admitted facts amounted to misconduct. Whilst it

noted that you accept that your actions breached provisions of the Code, this is a matter

for the panel’s judgment. In considering whether the conduct, found proved by way of

admission amounted to misconduct, the panel reminded itself that not every act falling

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short of what would be proper in the circumstances, and not every breach of the Code,

would be sufficiently serious that it could properly be described as misconduct.

The panel accepted your account in relation to charges 1 and 2. When you applied to

the Agency you needed to supply an up to date manual handling certificate. You had in

fact completed that training and obtained a current certificate but could not locate it. You

were told that it would cost £52.00 to re-do the training. When you spoke to Person A on

the telephone about him providing a reference for you, he said he “could get [you] a

certificate”. You knew that you should refuse this offer. The panel had sight of your valid

certificate during the course of hearing.

However, the panel was of the view that your actions, in allowing a falsified certificate to

be submitted to the Agency in an attempt to quickly obtain employment fell well short of

the standards expected of a registered nurse.

The panel has reminded itself that registrants are personally accountable under the

NMC Code for acts and omissions in their practice. The panel had regard to the relevant

version of the NMC Code (2015). The code contains the underlying principles that guide

the nursing profession and are in place to protect the public and to ensure that proper

standards are upheld.

The panel was of the view that your actions amounted to breaches of the Code:

Specifically, standards:

20 Uphold the reputation of your profession at all times

To achieve this, you must:

20.1 keep to and uphold the standards and values set out in the Code

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20.2 act with honesty and integrity at all times, treating people fairly and without

discrimination, bullying or harassment

20.8 act as a role model of professional behaviour for students and newly

qualified nurses and midwives to aspire to

Taking the matters found proved, the panel concluded that your conduct was serious

enough to amount to misconduct.

Decision on impairment:

In considering current impairment, the panel considered your oral evidence at the facts

stage and submissions made by Ms Clements on your behalf. It has had careful regard

to all of the documents submitted, including the testimonials and your reflective

statement. The panel considered whether your actions were remediable, whether they

had been remedied and the likelihood of repetition, in light of the circumstances of the

case and the evidence.

Nurses occupy a position of privilege and trust in society and are expected at all times

to be professional and to uphold professional standards. Members of the public, and

patients must be able to trust nurses with their lives and the lives of their loved ones. To

justify that trust, nurses must be honest and open and act with integrity. They must

make sure that their conduct at all times justifies both their patients’ and the public’s

trust in the profession.

The panel considered the case of Grant, in which Ms Iqbal identified the appropriate test

for assessing a healthcare practitioner’s fitness to practise. In Grant, Mrs Justice Cox

went on to say in Paragraph 76:

“Do our findings of fact in respect of the … misconduct… show that his/her

fitness to practise is impaired in the sense that s/he:

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a. […]

b. has in the past brought and/or is liable in the future to bring the

medical profession into disrepute; and/or

c. has in the past breached and/or is liable in the future to breach

one of the fundamental tenets of the medical profession; and/or

d. has in the past acted dishonestly and is liable in the future to act

dishonestly”

The panel considered that the limbs (b), (c) and (d) of the test were engaged. The panel

considered that by acting dishonestly you had brought the nursing profession into

disrepute. Trust and integrity are the bedrock of the nursing profession. Furthermore,

the panel considered that your actions resulted in a breach of the fundamental tenets of

the nursing profession, particularly in terms of the breaches of the code identified

above.

The panel noted that you demonstrated genuine remorse in your evidence. In assessing

your insight, the panel took account of your admissions at the outset of this hearing and

your comprehensive reflective statement. You have apologised to this panel for your

dishonesty and have demonstrated an understanding of why what you did was wrong

and how this impacted negatively on the reputation of the nursing profession. You have

also explained what you would do differently in the future if placed in a similar situation.

However the panel considered that your dishonesty was carried out in a calculated and

deliberate manner, and that you sought to mislead the Agency, despite knowing that

your actions were wrong and against the standards and behaviour expected of you as a

Registered Nurse.

The panel bore in mind the overarching objective of the NMC: to protect, promote and

maintain the health safety and well-being of the public and patients and the wider public

interest which includes promoting and maintaining public confidence in the nursing

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profession and upholding proper professional standards. In the judgement of the panel,

taking into account the nature of your dishonesty, public confidence in the profession

and the regulator would be undermined if a finding of impairment was not made. The

panel therefore determined that a finding of current impairment is necessary on public

interest grounds.

Determination on sanction

The panel has considered this case carefully and has decided to make a caution order

for a period of 4 years.

In reaching this decision, the panel has had regard to all the evidence that has been

adduced in this case together with the submissions of Ms Iqbal and by Ms Clements.

The panel heard and accepted the advice of the legal assessor, who referred the panel

to the Sanction Guidance (SG) dealing with dishonesty.

The panel has borne in mind that any sanction imposed must be appropriate and

proportionate and, although not intended to be punitive in its effect, may have such

consequences. The panel had careful regard to the SG. It recognised that the decision

on sanction is a matter for the panel, exercising its own independent judgment.

The panel first considered the aggravating and mitigating factors in this case, as follows:

The panel identified the following aggravating factors:

Your dishonesty was deliberate and intended to enable you to maintain

employment.

The panel identified the following mitigating factors:

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This was a single act of dishonesty;

You have accepted that you were dishonest;

You have fully engaged with proceedings and made admissions to the

charges found proved;

You have displayed genuine insight and remorse;

There have been no other regulatory findings in relation to your practice

in the course of your 17 year long career as a nurse in the UK;

The panel has identified a low risk of repetition;

At the time of these incidents, you were experiencing difficult issues in

your private life;

There is evidence which attests to your good clinical practice and good

character as of today;

You are currently working as an Agency nurse without issue;

There is no evidence of harmful or deep seated attitudinal issues.

The panel then turned to the question of which sanction, if any, to impose. It considered

each available sanction in turn, starting with the least restrictive sanction and moving

upwards.

The panel first considered whether to take no action, but concluded that this would be

inappropriate in view of the seriousness of the case. The panel determined that it would

be neither proportionate nor in the public interest to take no further action.

Next, in considering whether a caution order would be appropriate in the circumstances,

the panel took into account the SG, which states that a caution order may be

appropriate where ‘the case is at the lower end of the spectrum of impaired fitness to

practise and the panel wishes to mark that the behaviour was unacceptable and must

not happen again.’

The panel considered that your dishonesty was as a result of poor judgment,

exacerbated by external pressures relating to your private life at the time, rather than a

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deep seated attitudinal problem. The panel also noted that this was an isolated incident

against the backdrop of your lengthy nursing career. The panel therefore considered

that your action was at the lower end of the spectrum of dishonesty.

The panel noted that you have made admissions and apologised to the panel for your

dishonesty during your oral evidence, showing genuine remorse. You have engaged

with the NMC since your referral. It further considered that you have shown sufficient

insight into your past dishonesty and assured the panel it will never be repeated. The

panel has been told that there have been no adverse findings in relation to your practice

either before or since this incident in your career as a nurse. The panel also recognised

that attending this hearing has been a salutary lesson for you.

The panel considered whether it would be proportionate to impose a more restrictive

sanction and looked at conditions of practice. The panel noted that you have been

working as a Registered Nurse since the incident without restriction or further incident

and that your clinical practice has never been called into question. The panel has also

had sight of positive testimonials which attest to your good character and good practice.

For the reasons above the panel concluded that no useful purpose would be served by

a conditions of practice order. The panel further considered that a suspension order

would be disproportionate in your case as the public interest requirements can be

satisfied by the imposition of a caution order. The panel took into account the significant

financial impact and consequences a suspension order would have on you and your

family. Further the panel has heard that you are a competent nurse and that you are

currently working as an Agency nurse without concern. As such, it considered that it

would not be in the public interest to deprive the public of a competent nurse even if

only for a short period.

The panel has decided that a caution order would adequately serve the public interest.

For the next 4 years your employer or any prospective employer will be on notice that

your fitness to practise had been found to be impaired and that your practice is subject

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to a restriction. Having considered the general principles above and looking at the

totality of the findings on the evidence, the panel has determined that to impose a

caution order for a period of 4 years would be the appropriate and proportionate

response. It would mark not only the importance of maintaining public confidence in the

profession, but also send the public and the profession a clear message about the

standards expected of a registered nurse.

At the end of this period the caution on your entry in the register will be removed.

However, the NMC will keep a record of the panel’s finding that your fitness to practise

had been found impaired. If the NMC receives a further allegation that your fitness to

practise is impaired, the record of this panel’s finding and decision will be made

available to any practice committee that considers the further allegation.

This decision will be confirmed in writing.