conduct and competence committee substantive meeting …€¦ · page 1 of 22 conduct and...

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Conduct and Competence Committee

Substantive Meeting

5 July 2017

Nursing and Midwifery Council, 2 Stratford Place, Montfichet Road, London, E20 1EJ

Name of Registrant Nurse: Miss Filomena Delicana Divinagracia NMC PIN: 03F0221O

Part(s) of the register: RN1, Registered Nurse – (sub part 1) Adult – (3 June 2003)

Area of Registered Address: Scotland

Type of Case: Lack of Competence

Panel Members: Nicholas Cook (Chair Lay member)

Jennifer Laing (Registrant member)

Sylvia Dean (Lay member)

Legal Assessor: David Clark

Panel Secretary: Vicki Watts

Facts proved: All

Facts not proved: N/A

Fitness to practise: Impaired

Sanction: Suspension Order – 12 Months

Interim Order: Interim Suspension Order – 18 Months

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Decision on Notice served

Notice of today’s meeting was sent to Miss Divinagracia’s registered address in

Scotland by first class post and recorded delivery on 25 May 2017.

The panel has heard and accepted the advice of the legal assessor on service. The

legal assessor advised the panel that the provisions of Rule 11A of the Nursing and

Midwifery Council (Fitness to Practise) Rules Order of Council 2004 (“the Rules”) had

been complied with. However, the Notice sent to the registrant incorrectly stated that

one of the powers available to the panel was a strike off order. This is incorrect because

the allegation involves a lack of competence and, at this stage, striking off is not an

available sanction. The legal assessor advised that, whilst there may be cases where a

registrant would be misled by such an error, the panel may conclude in the particular

circumstances of this case that the error in the Notice was of no material significance.

The panel is satisfied that notice of today’s meeting has been effected in accordance

with Rules 11A(1) and 34 of the Rules.

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Charges

That you a registered nurse

Between 24th July 2015 and 5th November 2015 failed to demonstrate the standards of

knowledge, skill and judgment required to practise without supervision as a band 5 staff

nurse in one or more of the following areas;

1.1.1.1. Nursing Reports/Handovers

1.1.1.2. Ward rounds

1.1.1.3. Care plans

1.1.1.4. Communication with patients and relatives

1.1.1.5. Patient diagnosis and management

1.1.1.6. Identifying and responding to patient needs

1.1.1.7. Organising workload

1.1.1.8. Infection control

1.1.1.9. Medicines management and safe administration of medications

And in light of the above, your fitness to practice is impaired by your lack of

competence.

Background . The NMC received a referral from NHS Greater Glasgow and Clyde (‘the GG&C’) on 25

February 2016. At the time of the events, Filomena Delicana Divinagracia was a Band 5

nurse with GG&C.

It is alleged that Miss Divinagracia failed to demonstrate competence as a nurse during

the second half of 2015, while based at the Queen Elizabeth Hospital (‘the Hospital’),

part of the GG&C. It is alleged that Miss Divinagracia failed to keep full patient records,

make satisfactory nursing assessments, communicate with colleagues, or demonstrate

either proficiency in procedures or adequate knowledge of medication.

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Miss Divinagracia was placed on Stage 1 of the GG&C’s Formal Capability Procedure

from 27 July 2015, following alleged failings in a number of areas including poor

handover of patient information to colleagues, lacking knowledge of patients’ conditions

or medications, and inconsistent record keeping. On 21 September 2015 following

supervisions and assessment, Miss Divinagracia was placed on Stage 2 of the Formal

Capability Procedure, allegedly because she had failed to improve sufficiently in any of

the areas. On 5 November 2015 Miss Divinagracia met with the Lead Nurse to assess

progress. Some improvement had been made, but it was too inconsistent and

unsustained, particularly as regards ensuring procedures were followed, records kept or

patients’ conditions responded to appropriately. She had failed to reach the required

standard of competency in all four objectives of the Capability Action Plan. As a result

Miss Divinagracia was advised in a letter of 27 November 2015 that she would be facing

dismissal or a downgrade to a Band 3 Support Assistant. However Miss Divinagracia

then took long term sickness absence, failing apparently to respond to the GG&C’s

requests for ‘fit notes’. Miss Divinagracia is no longer employed by the GG&C.

Findings on facts and reasons

In reaching its decision on the facts, the panel took into account all the documentary

evidence provided in this case. The following witness statements were also taken into

account:

Ms 1 – Senior Charge Nurse

Ms 2 – Clinical Nurse Educator

The legal assessor advised the panel that the burden of proof was on the NMC to prove

its case. The standard of proof was the usual civil standard, the balance of probabilities.

The panel should draw no adverse inferences from the registrant’s lack of engagement.

The evidence before the panel comprises the material within the hearing bundle, and

the panel should base its findings of fact only on that material.

In reaching its decision, the panel had regard to the witness statement of Ms 1 dated 9

January 2017. In her statement of evidence, Ms 1 states:

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“…I first met Filomena on 29 July 2015 when she arrived on Ward 5B as a new member

of staff. I’d never met her before or had any knowledge of her background. In the week

prior to her arrival on the ward, Lead Nurse L R had advised me that a member of staff

was coming to my area who would be starting a capability program. I was not involved

in the initial creation of the Capability Stage 1 Plan and I was not I advised of what the

areas of concerns were.

On 29th July 2016 [sic] I met with her to have a one to one. First impressions were that

she was quite willing to engage with the support being offered, she did not appear

unhappy and came to work on time. I when I was speaking with her I felt she had some

insight as to why she was here with me but not a great deal. Filomena couldn’t tell me

word for word why she was here and I only had a partial understanding that she was to

start a capability but no further info had been provided. I felt a bit unprepared, not

knowing the expectations. I had to pause our one to one meeting and ask her to join in

with basic care round until I had spoken to L and her previous Senior Charge Nurse

(SCN) KH. When I spoke to K he told me that there had been a meeting, he had raised

concerns regarding Filomena’s professional practice and that’s why she was being

moved. K gave me some documentation regarding an incident with IV meds where by

Filomena had completed the process before being signed off as competent. In doing so

she had incorrectly interpreted infusion checks and there were associated

documentation issues. Following receiving further information form[sic] K I reconvened

my meeting with her and notes of this meeting were made.

Filomena’s Supported Improvement Plan/Action Plan had been developed with LR in a

meeting prior to her commencing on ward 5B. I had not been present at this meeting or

involved in creating the Action Plan. I had received this document from A. It contained

objectives but no specifics. In my work with Filomena I worked on a second version of

the Capability Plan,

As part of the Supported Improvement Plan/Action Plan Filomena was supervised on

every shift. If I was on shift she was supervised by me but if I was not on shift she would

be paired with a band 6 or 7. Records of each shift were noted and shared with

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Filomena as soon as possible so that feedback was given in real time. Filomena was

also given copies of the notes so that she could reflect on their content later on”.

Ms 1 also commented that Miss Divinagracia “cared and wanted to be a good nurse

…she was very good at basic care but in relation to registered nurse care she just didn’t

appear to have the insight.” In conclusion, Ms 1 said “I couldn’t confidently have her

working in my team as a registered nurse without supervision as she couldn’t be

assessed as competent. To be fair a lot of what we assessed her on was fundamentals

of a registered nurse role. These were basic aspects of care in relation to the

documentation and delivery of care.”

In her witness statement dated 11 January 2017, Ms 2 stated “when I worked with

Filomena I found her to have a really nice soft and very caring nature, when speaking to

patients you could hear she had care in her voice.”“ However, Ms 2 also commented

that “I felt she lacked insight into the need for her to improve with certain tasks.” Ms 2

concluded with the following comments: “Although there was improvement in some

areas this wasn’t sustained. She wasn’t questioning her practice with a view to keeping

the patients safe, there were continual small things that potentially indicated that some

quite serious harm could occur if she was allowed to practice unsupervised as a Band

5.”

The Capability Action Plan assessed performance against six levels of competence.

These were:

1 – can perform this activity but not without constant supervision and assistance

2 – can perform this activity satisfactorily but requires supervision and frequent prompting throughout

3 – can perform this activity satisfactorily but still require some supervision and assistance

4 – can perform this activity satisfactorily without supervision or assistance, however takes an excessively long time in doing so

5 – can perform this activity to a satisfactory standard and within more than acceptable speed

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6 – can perform this activity to a satisfactory standard, with a more than acceptable speed and used initiative to solve problems

It was made clear to Miss Divinagracia that, in order to complete Stage 1 of the

capability process, she would need to achieve level 5 across all areas, and that in order

to complete Stage 2, she would need consistently to achieve level 5/6 in all areas.

The panel considered the charges and made the following findings.

That you a registered nurse

Between 24th July 2015 and 5th November 2015 failed to demonstrate the standards of

knowledge, skill and judgment required to practise without supervision as a band 5 staff

nurse in one or more of the following areas;

1.1.1.1. Nursing Reports/Handovers

This charge is found PROVED

The panel also had regard to the Capability Action Plan (Stage 1) for the period 27

July 2015 to 21 September 2015; Capability Action Plan (Stage 2 ) for the period

21 September 2015 to 5 November 2015.

The panel noted in relation to this charge, at Stage 1 of the action plan, Miss

Divinagracia achieved level 3 and the following comments were made:

“Can give a reasonable handover to her peers from shift to shift about patients she has

provided care for but expanding on what the plans are for progression of care can at

times be lacking. Can take the nursing handover and is able to prioritise her care

according to the information received. Needs prompting to be more proactive with

progressing plans for moving care forward and for discharge planning”.

At Stage 2 of the action plan, Miss Divinagracia achieved level 3/4 the comments

were the same as set out in Stage 1 but with the additional comments:

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“Overall improvements seen in this area with the scope to extend practice in a more

consistent and structured way”.

The panel accepted the evidence of Ms 1 as set out in the Stage 1 and Stage 2

Capability Action Plans and determined that Miss Divinagracia failed to demonstrate the

standards of knowledge, skill and judgment required to practise without supervision as a

band 5 staff nurse in the areas of Nursing Reports/Handovers

The panel therefore found this charge proved.

1.1.1.2. Ward rounds


In reaching this decision, the panel had regard to the Capability Action Plan (Stage

1) for the period 27 July 2015 to 21 September 2015; Capability Action Plan (Stage

2 ) for the period 21 September 2015 to 5 November 2015.



“Has participated in ward rounds and is able to pass over accurate information to the

nursing team post round. Sharing information between the medical/nursing team to

allow medical staff to form plans based on all aspects [of] care is not performed well but

is a skill that can be practised and developed”.

At Stage 2 of the action plan, Miss Divinagracia achieved level 4 and the

comments made were the same as at Stage 1.




band 5 staff nurse in the area of Ward rounds.


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1.1.1.3. Care plans







“Is aware of what needs to be completed for each patient on a daily basis. As an

accurate knowledge of the timeframe in which Falls/PAC/MUST need to be completed

and PVC and catheter care plans. Does not complete these assessments consistently

and requires prompting even when asked if all documentation complete. Can overlook

completion of PVC/Food chart/Fluid Balance, therefore it is difficult for her team to be

directed to complete them. Can complete accurate reflection of care in nursing record

but needs to expand on adding patient plans from medical rounds – this is developing

but not consistent. If unable to complete certain aspects of care or documentation

needs to ensure that this is handed over to the next team. This can be overlooked”






band 5 staff nurse in the area of Care Plans.


1.1.1.4. Communication with patients and relatives


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“Needs to be more proactive in updating relatives and patients about ongoing plans of

care. Needs to be directed to this – information prompting is required. Communication

could be clearer, patients often find it difficult to comprehend, due to accent, and

Filomena has to repeat herself or the instruction”.






band 5 staff nurse in the area of communicating with patients and relatives.


1.1.1.5. Patient diagnosis and management







“Background knowledge is of a basic nature. Has a basic knowledge about

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care/needs/condition/diagnosis. Needs to be prompted to initiate care that is not within

the normal routine.

At Stage 2 of the action plan, Miss Divinagracia achieved level 3/4 and the





band 5 staff nurse in the area of understanding patient diagnosis and management.


1.1.1.6. Identifying and responding to patient needs







“Follows a task based approach to her care. Knowing what needs to be done and

completing it. Anything out with this approach is difficult. Does not show a good

background knowledge to support her actions in relation to professional judgement and

cannot propose a course of action to an identified problem without prompting and

direction focus is on the task and not the whole care of the patient. Professional

judgement is not supported by background knowledge. This is continued to be the pub

of practice”.



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band 5 staff nurse in the area of Identifying and responding to patient needs.


1.1.1.7. Organising workload







“Again using a task based approach can transfer patients into the ward and complete

the correct paperwork correctly and within a reasonable timeframe. Needs to ensure

communication with patients is clear and that if able they are clear about the plan of

care. Can discharge patients safely using the correct paperwork and following the

correct process. Actions for drug ordering is now more structured and consistent in

practice and overall drug administration and the process involved is safer”.






band 5 staff nurse in the area of organising workload.


1.1.1.8. Infection control

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“Is clear about her roles and responsibilities in relation to hand hygiene and basic

infection control policy and procedures. Needs to be reminded about the basic rules

from time to time. Understands the need for cleaning checklists and uses them well.”






band 5 staff nurse in the area of infection control.


1.1.1.9. Medicines management and safe administration of medications







“Task based approach and can follow the correct procedure. Is now demonstrating

more consistent practice and is consistently using the tools needed for a more and

informed and safer process to drug administration. Interventions are less and practice is

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safer.”






band 5 staff nurse in the area of Medicines management and sage administration of

medications.


Decision on Lack of Competence and Impairment

The legal assessor reminded the panel that the allegation against the registrant is that

her fitness to practise is impaired by reason of lack of competence. In assessing the

statutory ground, there is no burden or standard of proof. It is a matter for the panel’s

professional judgement. The panel should measure the registrant’s performance against

the standard of a competent practitioner in her grade. Lack of competence connotes a

level of performance which is unacceptably low and which, usually, is demonstrated by

reference to a fair sample of the registrant’s work. The panel should take account of the

standards set out in the NMC Code, but should bear in mind that a breach of the

standards does not automatically result in a finding of impairment.

The legal assessor advised the panel that there is no burden or standard of proof in

relation to the assessment of impairment. It is, again, a matter for the panel’s

professional judgement. The NMC equates fitness to practise with the suitability of a

registrant to remain on the register without restriction. The panel should assess the

registrant’s fitness to practise as of today; it is a question of current fitness to practise.

The panel should assess the extent to which the registrant has put patients at

unwarranted risk of harm in the past, and the extent to which she is liable to do so in the

future. The panel should take into account any evidence of insight and remediation on

the part of the registrant. The greater the level of insight and the steps taken to put right

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any failings in her practice, the less likelihood there is of repetition. The panel should

ask itself whether the deficiencies in the registrant’s practice are easily remediable,

whether they have been remedied and whether there is a likelihood of repetition. In

forming a view about the registrant's fitness to practise, the panel should also consider

the wider public interest and ask whether a finding of current impairment is necessary in

order to maintain public confidence in the profession and the regulatory process, and in

order to declare and maintain proper standards of conduct, behaviour and performance.

In considering whether Miss Divinagracia’s practice is currently impaired, the panel first

determined whether the facts found proved amount to a lack of competence and, if so,

whether her fitness to practise is impaired by reason of such lack of competence. In so

doing, it had regard to all the evidence and accepted the legal assessor’s advice. In

deciding this issue, the panel noted that there is no standard or burden of proof and that

it must exercise its own independent professional judgement.

The panel noted that neither The Nursing and Midwifery Order (2001) nor the NMC

(Fitness to Practise Rules) (2004) define what is meant by impairment of fitness to

practise. The NMC has, however, defined fitness to practise as a registrant’s suitability

to remain on the register without restriction.

The panel considered whether, on the basis of the matters found proved, Miss

Divinagracia’s fitness to practice is currently impaired by reason of lack of competence.

The panel was mindful that its duty is primarily one of public protection and also to

protect the public interest by upholding proper professional standards and public

confidence in the profession and the NMC as a regulator.

The panel considered that by virtue of the facts found proved, Miss Divinagracia

breached the following provisions of The Code: Professional standards of practice and

behaviour for nurses and midwives (2015).

1.2 . Make sure you deliver the fundamentals of care effectively

6.2 . Maintain the knowledge and skills you need for safe and effective practice.

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7. Communicate clearly

8. Work cooperatively

10. Keep clear and accurate records relevant to your practice

18. …dispense or administer medicines within the limits of your training and

competence, the law, our guidance and other relevant policies, guidance and

regulations

19. Be aware of, and reduce as far as possible, any potential for harm associated

with your practice

20. Uphold the reputation of your profession at all times

The panel noted that all of the facts found proved are where Miss Divinagracia has

demonstrated a lack of competence in the most basic skills required of every registered

nurse. The panel was mindful that Miss Divinagracia had qualified as a nurse in 2005.

The errors demonstrated by the charges occurred at time that she had been working as

a registered nurse for at least 10 years and was very well supported by her employers,

yet she still failed to satisfactorily complete the various objectives the Hospital set her.

The panel was mindful that although the patients were protected by the very close

supervision of Miss Divinagracia, her lack of progress, persistent deficiencies and

repeated errors in clinical practice demonstrated her lack of competence. This included

Miss Divinagracia’s inability to undertake basic elements of nursing practice including;

nursing reports/handovers, ward rounds, care plans, communication with patients and

relatives, patient diagnosis and management, identifying and responding to patient

needs, organising workload, infection control and medicine management and safe

administration of medications.

The panel concluded that the failures demonstrated and proved in the charges

amounted to a lack of competence in that Miss Divinagracia failed to demonstrate the

standard of knowledge, skill and judgment to practise without supervision between 24

July 2015 and 5 November 2015.

The panel next went on to consider whether Miss Divinagracia’s fitness to practise is

currently impaired by reason of her lack of competence.

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On the advice of the legal assessor the panel bore in mind the guidance set out in the

judgment in CHRE v NMC and Grant [2011] EWHC 927, including the relevant parts of

the test formulated by Dame Janet Smith in the Fifth Shipman report which states;

Do our findings of fact in respect of the [nurse’s] … deficient professional performance,

show that her fitness to practise is impaired in the sense that she:

a. has in the past acted and/or is liable in the future to act so as to put a

patient or patients at unwarranted risk of harm; and/or

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

profession into disrepute; and/or

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

fundamental tenets of the profession; …

The facts found proved included failures which relate to knowledge and skills which are

fundamental to the safe practice of any registered nurse. These errors persisted over a

period of 5 months despite close supervision and extensive support from the Hospital

and from more senior members of staff on the ward who were assigned to work with

Miss Divinagracia. All considered that Miss Divinagracia was not safe to practise

unsupervised.

The panel was of the view that Miss Diviniagracia has shown limited insight into her lack

of competence. She went off sick in November 2015 and despite the Hospital’s attempts

to contact her on numerous occasions in order to ascertain her status regarding her

fitness to work, she did not respond to them and she has not engaged with the NMC at

any stage of its investigation into these charges. The panel could not be satisfied that

Miss Diviniagracia has shown any real insight into her lack of competence or its

potential implications for patient safety.

The panel noted that it has no information about Miss Divinagracia’s current situation or

whether she has made any attempt to remedy her deficiencies.

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In the light of all these considerations, the panel concluded that there is insufficient

evidence to alleviate its concerns regarding Miss Divinagracia’s fitness to practise and

that there remains a real risk of repetition of her clinical errors, with a consequential risk

of serious harm to patients.

The panel is therefore satisfied that Miss Divinagracia’s fitness to practise is currently

impaired by reason of her lack of competence.

In view of the serious nature of Miss Divinagracia’s lack of competence, which includes

deficiencies in basic and fundamental nursing skills and knowledge, the panel further

concluded that the need to uphold proper professional standards and public confidence

in the profession would be undermined if a finding of impairment were not made in this

case.

Decision on Sanction and Reasons

The panel has heard and accepted the advice of the Legal Assessor. The legal

assessor drew the panel's attention to the NMC Indicative Sanctions Guidance (ISG),

the most recent edition of which was published in September 2016. The purpose of

sanction is not to punish the registrant, although the sanction may have a punitive

affect. The primary purposes of sanction are the protection of patients and the

maintenance of public confidence in the professions and the regulatory process, and the

declaring and upholding the proper standards of conduct and behaviour. Any decision

on sanction should be proportionate. This means that it should strike an appropriate

balance between the interests of the registrant and the wider public interest. The panel

should impose the least restrictive sanction which is consistent with the proper

protection of the patients and public interest. The legal assessor confirmed that the

option of a strike off order was not available to the panel because of the circumstances

of the case.

The panel has borne in mind that any sanction imposed must be reasonable,

appropriate and proportionate. The purpose of any sanction is not intended to be

punitive even though it may have a punitive effect. The panel had careful regard to the

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ISG published by the NMC. It has recognised that the decision on sanction is a matter

for the panel exercising its own independent judgement.

The panel was mindful, given the facts found proved, that protection of the public was

their main concern.

The panel noted as mitigating factors the following matters: both Ms 1 and Ms 2

emphasised Miss Divinagracia’s caring nature and that she appeared willing, albeit

unable, to work with her mentors and supervisors to improve her practice.

In relation to aggravating factors the panel noted the wide ranging and persistent in

nature of Miss Divinagracia’s failures, despite the close monitoring and support which

her employers provided.

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

inappropriate in view of the findings set out above regarding Miss Divinagracia’s

impaired fitness to practise and her lack of full insight. To impose no sanction would

allow Miss Divinagracia to practise as a registered nurse without restriction. Further, it

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

The panel then considered whether it would be appropriate to impose a caution order in

this case. The panel concluded that the lack of competence found in this case was not

“at the lower end of the spectrum of impaired fitness to practise” as Miss Divinagracia’s

lack of competence relates to deficiencies in basic nursing skills. The panel was not

satisfied that such an order would provide adequate protection to the public, nor would it

address the shortcomings in Miss Divinagracia’s practice as identified by the panel in its

earlier determination on impairment.

The panel next considered whether placing conditions of practice on Miss Divinagracia’s

registration would be a sufficient and appropriate response. The panel is mindful that

any conditions imposed must be proportionate, measurable and workable.

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The panel again noted the nature of Miss Divinagracia’s deficiencies, and the fact that

they involve a number of basic nursing skills. Whilst there was no evidence that her

actions caused actual harm to any patients, the panel considered that there would have

been the potential for patient harm, but for the fact that Miss Divinagracia was subject to

close supervision and intervention.

The panel determined in its findings of impairment that the areas of the lack of

competence relate to basic nursing skills. The supervision, mentorship and support

given by the Hospital was extensive, yet she failed to demonstrate any significant or

sustained improvement in her clinical practice or ability.

The panel noted that in many competence cases, conditions of practice are appropriate.

Miss Divinagracia has already been through a period of intensive supervision and

mentorship by the Hospital and she has not subsequently engaged at any stage with

the NMC. The panel also considered that for conditions of practice to be workable, Miss

Divinagracia would need to demonstrate her willingness to cooperate with any

conditions and her commitment to a successful outcome. The panel therefore

concluded that a conditions of practice order would neither be workable or

proportionate.

The panel then went on to consider whether a suspension order would be an

appropriate sanction. The panel considered the seriousness of Miss Divinagracia’s

departure from the standards to be expected. The failures in Miss Divinagracia’s clinical

care identified in this case were serious, with her actions falling well short of the

fundamental standards of care expected of a registered nurse.

Balancing all of these factors and after having taken into account all the evidence before

it, the panel has determined that the appropriate and proportionate sanction is that of a

suspension order. In fact, having regard to the matters it has identified the panel has

concluded that no lesser sanction than a suspension order would be sufficient or

appropriate in this case.

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The panel considers that this order is necessary to protect the public, and maintain

public confidence in the profession, by sending a clear message to the public and the

profession about the standards required of a registered nurse.

The panel took into account the potential financial hardship and damage to her

professional reputation that such an order could cause Miss Divinagracia.

Notwithstanding the absence of any information as to Miss Divinagracia’s

circumstances, the panel concluded that in any event the need to protect the public

interest outweighs Miss Divinagracia’s own interests in this regard.

The panel concluded that a suspension order for a period of 12 months is a

proportionate and appropriate sanction in this case and would adequately address the

need to protect the public and the public interest. Moreover, this period would give Miss

Divinagracia time to reflect on her actions.

Towards the end of the period of suspension a future panel will review the order. At the

review hearing the panel may revoke the order, or it may confirm the order, or it may

replace the order with another order. The panel believes that the reviewing panel may

be assisted by Miss Divinagracia supplying the following to the NMC:

Evidence, by way of a written reflective piece outlining that Miss Divinagracia has

considered the panel’s findings and is willing to address the shortcomings in her

clinical practice and the impact on patient care.

Miss Divinagracia’s engagement with the NMC.

Evidence of training and keeping skills up to date.

Evidence of successfully working in a related area, albeit not as a registered

nurse.

Any relevant references or testimonials.

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Decision and reasons on interim order

The legal assessor advised the panel that, pursuant to Article 31(2) of the Nursing and

Midwifery Order 2001, an interim order could be imposed on the grounds that it was

necessary for the protection of the public, otherwise in the public interest, or in the

registrant’s own interests. The maximum duration of an interim order is 18 months. The

imposition of an interim order is not automatic and the panel should give proper

consideration to the requirements of Article 31.

The panel accepted the advice of the legal assessor.

The panel was satisfied that an interim suspension order is necessary for the protection

of the public and is otherwise in the public interest. To do otherwise would be

incompatible with its earlier findings.

The period of this order is for 18 months to allow for the possibility of an appeal to be

made and determined.

If no appeal is made, then the interim order will be replaced by the substantive order 28

days after Miss Divinagracia is sent the decision of this hearing in writing.

That concludes this determination.

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