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Nurse struck off for incompetent practice

A 51-year-old nurse from East Ham, London has been struck off the register following a hearing by the Nursing and Midwifery (NMC's) independent Conduct and Competence Committee panel.

Philomena David was employed as an E-grade practice nurse at Plasnet Road Medical Centre, Maidstone between January 2005 and August 2005 when a string of incidents occurred where she failed to demonstrate the standard of knowledge, skill and judgment required to practise without supervision.

The independent panel heard evidence of how David incorrectly gave an MMR vaccine (which should not be given before a child reaches one year old) to a 27-week-old baby and also appeared to use the needle as a dart, resulting in misconduct. She further failed to demonstrate the appropriate standard of knowledge and skill in infection control, ear care, diabetes management and health promotion.

David also admitted to making offensive and inappropriate comments about mental health patients to colleague Jacqui Liddle, saying words to the effect that she could not "get down to their level."

Commenting on the panel's decision to issue a striking off order, NMC spokesperson Sarah Connolly said: "There was a serious departure from the relevant standards as set out in the Code of Practice. Patients were placed at serious risk by the registrant's lack of nursing skills and poor practice. The public would be at further risk if the registrant were allowed to return to practice.  Therefore the panel considers that confidence in the NMC would be undermined if the registrant were not removed from the register."


Was this the right decision? Your comments: (Terms and conditions apply)

"I think that the decision taken by the NMC is completely wrong. Did they take any action against the employers who don't seem to have given any support to this nurse? Did she received any training or updates to carry out immunisation? We nurses are accountable to our actions, but what about employers?? They are just interested in making money out of us nurses. We are excellent and hard working nurses when they achieve their targets but
when it comes to blaming someone if things goes wrong, then we are incompetent. I have worked as a staff/nurse and practice nurse for the past 35 yrs and have always noted that GPs are ready to grap as much out of patients/PCT but when it comes to spending on medical equipment, staff training or bonus they become deaf. They will dismiss you" - Aziza Amin, Essex 

"Am not sure if this was the right decision at all. I am an RMN with 2 years' experience and never got preceptorship or any further training from my employer. If any such thing were to happen, am to blame but employer never
fulfills what they promise at interview and NMC never checks whether preceptorship etc is offered to their registrants. NMC, you have a duty of care to both public
and nurses and employers have a duty of care to employees and public. NMC be considerate. Do some checks about your nurses not just asking for increased renewal fees every year" - Rutendo Juru, Dublin

"Did the NMC investigate if the nurse in question had appropriate training for this? How is she supported? Appraisal is important does she have it as appropriate? People make mistakes in life. The most important is you learn from it and people deserve a second chance, please call her back and her the support she needed, she must be really good in some area of healthcare, do not take people's livelihood away from them after spending tiring
many years in college. She needs to be cautioned not struck off please. No one is perfect" - Christy Jones, London

"Yes when the public enter the arena of care they put their life into others' hands. They expect high standards. We need the NMC to regulate and perfect the nursing profession. Therefore, any decision by the NMC is just maverick nursing is a reality my father was the victim of such bad practice!" - Joe, N Ireland

"Please do not compare nursing to a driving test
(first of all). It takes 3-4 years to qualify as a nurse in the UK. When you are a student nurse you have to rely on the knowledge and practical procedures from your mentors and your own professional study. You also
have continous assessments and exams throughout the course. The NMC DO REGULAR CHECKS on nurses on the Register. Like all professions (GMC, Law Society), there will be a few incompetent people amongst them. What people have to understand is that nurses work within a time-constrained environment. If the managers of hospitals or care homes pay for enough staff to give the best care possible, it would be a great health service.
But they dont ... it's all about the piece of paper called money. For carers like myself, I see the problems on a daily basis (with nursing). What is needed is more staff to be employed at every level (auxillaries, HCAs, RNs, senior RNs), to help combat the practical load when caring for people. It's the only way." - Jo, Glasgow

"Putting someone at risk is very serious misconduct and the NMC can strike off its registrants for this. My question is, who can strike off the NMC if they put someone at risk? Let me explain this with an example. Before issuing a driving licence to anyone, the DVLA checks the driver's competency by setting two tests (written and practical). If they are satisfied, they issue a licence considering that the driver is safe to drive on the road. That is fair enough. But what does the NMC do to check registrant competency in the first place? They do nothing except asking the registrant to fill out a form and submit their academic certificate, and most of all pay their fee. They do not even bother to investigate whether all the information provided by the registrant is genuine, unless somebody complains against the
registrant. Likewise, many overseas nurses come here and get registered with the NMC without any difficulty. Many overseas nurses have to work in constant fear because they have been threatened by their employer regarding NMC and POVA issues. So this means different types of nurses have been registered with the NMC without their competency being checked. So who is putting people in risk in the first place..? The answer is the NMC ... I don't have any confidence in the NMC. They do not even bother to take an interview before registering which is a joke." - Marcus Den, Scotland

"If it is true as is quoted in the article, that there were a 'string of incidents' that had occurred, then surely, her employers should have recognised and dealt with this appropriately. She should have been offered support and further training before it came to this. Certainly the nurse should not have accepted to carry out duties for which she did not feel competent in the first place, however, her employers should also be held accountable." - Linda, Edinburgh

"I am employed as a practice nurse in Cardiff where childhood immunisations are carried out as part of a team effort. The clinics are never expected to run with one nurse only - in reality it is a way of protecting not only the nurses involved in the clinic, but also the patients - it could be argued our most precious patients of all! I agree with the Elaine, it is difficult, if not impossible to have an opinion on a situation which one was not involved in, and therefore not in possession of the full facts of the case. However, there are a number of questions which have arisen out of this article. How long had she been qualified? Simply to say that she was 51 years of age does not mean that she has been qualified for many years. As we all know people enter the nursing profession at different ages and for many different reasons. What training had she received to be able to complete diabetic reviews? This is a complex and challenging area of healthcare and should not be entered into lightly by either practice nurses or their GP employers. As far as the issue of infection control is concerned, yes we should all be aware of this vital piece in the jigsaw, especially with patients being moved out of hospital earlier to reduce the risk of healthcare-associated infections." - Helen Lewis, South Wales

"I am not able without full knowledge to make a decision. I would, however, ask what was the nurse's background? Practice nursing is a specialist field. Many GPs think a nurse is a nurse is a nurse and do not consider the competency needed. On the other hand, she should not have been carrying out procedures that she was not competent or confident to do. However, for any of us that have worked with GPs on a regular basis (and not all are the same) it is very hard to hold your own against an adamant GP who is also your employer. I hope this GP practice and the GPs were reprimanded at least as they would have delegated the tasks and should
have ensured that they were aware that this nurse could be entrusted with the work they were delegating to her. If this had been a senior nurse delegating to a junior or HC assistant, that senior nurse would also be held accountable" - Elaine Wilson, South Wales

"This, like any other story, portrays only one side. No reference is made to how long this nurse had been qualified, what her previous experience was and, like previously mentioned comments, whether she fulfilled the whole criteria for the job or whether she was just excellent at interview and her employers were dazzled without fully understanding the implications of
the roles that they were absolving themselves of. I can see both sides of the argument that the NMC and ourselves have a duty to protect the public but the NMC also have a duty to nurses to stop them being the scapegoat for what sometimes end up being mistakes by lack of education or ownership. As we all know, money is at a premium within the NHS, PCTs and even in private healthcare provision, and unfortunately education and training seem to be the main areas that are suffering. This does nothing but to serve to widen the gaps between need, want and provision and I do agree that nurses sometimes become easy targets. However, this does not detract from the nurse in question's inherent responsibility to accept her limitations and own up to this. This is a very hard thing to do if you may
have led your employers to think otherwise. Yes, she may have lost her job but would not have been struck off. As a practising nurse myself, I think these are hard times for the profession" - Dianne Oliver, Manchester

"Yes. Glad it was not my 27-week-old child. The public put trust in nurses and if one is not sure about how and when to give a vaccine (accountability) they should not be giving it. Tough decision but where does one draw the line? I agree with the NMC" - J Wood, Wales

"Not hearing the story from both sides, it is difficult to pass judgment. First of all, we are our patients' advocates - what level was she at, that it was difficult to utter such snide remaks? The PCT has some degree of blame if they had not reviewed the knowledge and skills of the employee. It is sad indeed, but we are accountable for our actions and if the nurse knew she was not competent to carry out a procedure, she should have informed her employers. Communication, communication, communication." - Marion Alleyne, West Hampstead, London

"These do not sound like reasons to remove a nurse from the register. Has level 5 these days? Has the employer been informed that an E grade would not have the skills base to do baby imms and run a diabetes review? 'They' sound like they are employing on the cheap with a lower grade (and hence experienced) nurse than the job requires? I feel less confident in the NMC -  this result shows such little empathy with the nurse's potential predicament and possible lack of support." - Lynne Hayward, Manchester

"Decisions are often debatable. Who sat on the committee? What is their training and expertise? Again the NMC says they would have been undermined if they did not remove the nurse from the register. Who is
removing NMC members that make mistake? I hope the nurse in question was informed of her mistakes and given updated training and supervision while this was taking place, before her hearing. I feel that there is more to this situation. I'm sure many other readers will respond with their opinions, being fed up with the nurse taking all the backlash. I ask, where were the nurse's colleagues, senior staff, mentors? I again wonder who really is to blame?. I do hope the young child was unharmed and the parents kept informed of the facts, which again might have been overlooked in this day of "who's right and who's wrong and who shall we blame" environment." - Malcolm Smith, Suffolk

"I would not give a definite answer either way without full knowledge of the facts and surrounding circumstances. I think the environment within which she works should be checked out. If the nurse was performing her duties below the standard required of her competence this should have been picked up by her seniors. Was retraining an option?" - V Henry, London

"I am unable to say that the nurse should have been struck off, because i haven't heard the full story. Was she given the appropriate training? Was she under stress? Was support given at any time? In light of the many incidents that occurred, was she given warning? Until i know that I can't judge." - Nichole Reid, Birmingham

"If there was a catologue of events occurring, what training and supervision did this nurse have within the practice? Her  inabilities should have been noted and additional training given. As far as giving an mmr the changes in childhood immunisations can be confusing as no two injections are the same. Why is the junior nurse given such an important role? The practice obviously think immunisation can be given to any nurse. Mistakes will occur - who was available to check immunisation prior to administration? Some practices use two nurses, others train a member of administration who inputs onto computer etc." - Mary Swinney, Hebburn

"No not struck off. Pressure of work, competence, supervision, support, training, length of time in post, danger to life, employer's responsibility are just a few reasons why! Suspension, investigation, further training and previous good conduct should all have been taken into account first. Hopefully the correct procedures were in place at this nurse's place of work before she found herself struck off the register. Blame cultures are not helpful for the nurse or the public." - Helen McGrath, Brighton

"Surely there has to be a string of other incidents that has led to the deregistration. I do not agree if this was as a result of giving the MMR vaccine before 13 months. One has to take into consideration the fact that a lot of NHS employers are failing their staff in terms of clinical supervision, training and updates and increased workloads with minimal staffing. This in itself is a threat to the general public in terms of quality of care and certainly will undermine the confidence in the NMC. I think a lot of the employers themselves need to be investigated in relation support in place for their staff. I agree that the nurse has a responsibility also to uphold the NMC Code of Conduct in relation to competent practice, but one has to wonder what level of  supervision was given prior to and during this post. A period of supervised practice could have resolved this issue, but as always the finger has to be point at someone and unfortunately it is the 'NURSE'." - Josette Davidson, Birmingham

"Not knowing all the circumstances of this case makes it difficult to judge. If the decision was based on the inappropriate MMR immunisation then I would need a lot of info before I could decide if this should result in the nurse in question being struck off. Was this a one off incident or had there been similar occurences? Had her employers provided opportunities for appropriate training? Was clinical supervision available?

What was the nurses rationale for giving the vaccine? It may have been appropriate in certain cases? Was she working under stress, with unreasonable workloads? Did she have anyone to discuss concerns with?" - Munchkin, East of England

"Being struck off just because of the MMR given is a wrong decision. There was no mention of whether the child was travelling or not. Having recently attended a travel study day, the information given was to immunise any children travelling abroad with MMR even if the child is under 13 months old. And when the child reaches 13 months, he/she will need to continue with the normal MMR schedule." - Cindy Wong, London

"The nurse had only been in post from January to August 2005. To gauge if the decision was correct, you would need to know how much training and support the nurse had received prior to the incidents, and also what previous experience she had had." - Ellen Nicholson, Somerset

"I tend to agree with Jim. What previous actions had been taken by the practice to address these issues? Surely any concerns relating to this nurse's practice would, presumably, have been identified at her first appraisal. Perhaps there are previous matters/concerns relating to this nurse." - C Park, London

"No, I think she needed to retrain with peer additional support when working with the general population." - Pamela Peers, North West

"What training, assessment and supervision had this nurse received? Who had assessed her as being competent to fulfil the requirements of the job description? And what efforts had been made to enable retraining to be undertaken to meet the requirements of the post?" - Kath Hier, South Wales

"No, I think she should have been suspended from active nursing care for a bit of time and given support to gain those skills. I am sure she is registered as a nurse, and so must have had some nursing education and skills to be on the register in the first place. However, for the skills regarding MMR, proper training should be given. I wonder whether the employers took into account her work experience and the relevance of her recent post as a practice nurse � " - Jim, London

"Not necessarily. First, if you are paying a practice nurse on an E grade you have to wonder about the standards of her care and what her training has been!The immunisation programme has been constantly changing over the past few years - it is very complicated and while she has other problems with her
work (which is a separate issue), I believe that more mistakes of this type will be made while the powers-that-be fail to recognise how difficult it is for practice nurses to implement the programme." - Lynn Meredith, West Midlands

"I think it was the right decision" - Joice Handry, Bromley PCT

"I absolutely agree this was the right decision.  We need to uphold the professionalism of nursing - this nurse certainly didn't do that." - Jan Drury, West Bromwich

"Confidence in the NMC would be undermined if the registrant was not removed from the register. I think that confidence in the NMC is already shaky � they should be worried more about the confidence in the nursing profession..." - Jane Usrey, Glasgow

"Will she be offered any support in learning from her mistakes? Will the practice be supported in improving standards? What else goes on there?" -  Pam Fry, Berkshire