Discontent over nursing board move

Unions are up in arms over An Bord Altranais decision to publish details of nurses' disciplinary hearings

AN BORD Altranais, the nursing board, has defended its decision to publish details of the case against nurses found guilty of misconduct by its fitness to practice inquiries.

The board, which regulates the nursing profession, had since 2003 published just the name, Pin and sanction of those who have been punished.

However, for the first time, it has outlined in detail the case against nurses that it has disciplined, along with the sanction. The move was approved in July last year and became operational last month. The findings are published on the board's website.

The reasons for the publication of more details was revealed on the website in its autumn newsletter.

It said it took the decision to revise its obligations under the Nurses Act (1985) in order to inform the public and also to guide nurses and midwives on all matters related to "ethical conduct and behaviour".

"An Bord Altranais does not wish any nurse to be in ignorance of what may constitute professional misconduct or unfitness to practice," it added.

It also warned that, in cases of significant public interest, its findings may be published by means of a press release.

The move has caused considerable disquiet among the nursing unions who claim that it is a step too far, and could affect the future careers of the nurses involved.

Clare Treacy, who has responsibility for fitness to practice within the Irish Nurses Organisation (INO), said she was "seriously concerned" that the board was publishing details of cases as a guidance for nurses.

"It is entirely inappropriate to use these cases to teach nurses right from wrong. The board should be publishing the guidelines in a positive manner, as the medical council does for doctors, rather than use these cases as an example of what not to do."

Treacy also said the INO was concerned about the publication of psychiatric or addiction problems that an individual nurse might have - saying it was of "absolutely no benefit" to the public to know such details.

She believes the members of the inquiry should exercise their discretion in relation to whether details should be published or not, but on only one occasion in the past five years was it decided to withhold a name from the public.

In a case published in this newspaper last week, three nurses accused of withholding information about a patient at the Central Mental Hospital in Dundrum who died were publicly named.

They were suspended for two months from September 1st following an inquiry by the board's fitness to practice committee.

Siptu nursing representative Louise O'Reilly, who represented the three nurses suspended in the Dundrum case, said there had to be a balance between the public's right to know and a nurse's right to their good name.

She said the decision to publish all of the findings of guilt by the fitness to practice inquiry, except in very few cases, was a step too far.

"The board tends to publish unless they have a good reason not to, and then only in exceptional circumstances. I would think they should look at the value of not publishing unless there is a good reason to publish instead," she said.

Several of the nurses named in the fitness to practice inquiries just published were censured or lost the right to practice as a nurse for either stealing prescription drugs or being drunk on the job.

O'Reilly said there was often a time lag of several years between an offence and the outcome of a fitness to practice inquiry.

"There can be a painful human story behind these cases. If a nurse has a drink problem, she may have overcome that problem by the time the fitness to practice inquiry has published its findings. She could now be a valuable functioning professional and I would question the public interest in publishing those kind of details," she said.

"In other cases a fitness to practice inquiry often takes place after a Garda investigation or a coroner's report has been concluded. It is often the last investigation to be carried out and the process can go for years. It is a long time for nurses to have to worry about the publication of findings against them."

In other cases, published by the board, a nurse was censured and conditions were attached to the registration of her name in the Register of Nurses for repeatedly pressing the "manual breath" button on the ventilator of a baby who had a slow heart rate instead of recognising that the baby required suctioning.

Another nurse had his name erased from the register of nurses because he had stolen blank prescription forms and forged a prescription and another had a similar sanction for being drunk on two occasions.

Other nurses were censured for administering the wrong drugs or the wrong procedure to patients.

The Psychiatric Nurses Association (PNA) said it was "seriously concerned" about proposals in the planned new Nurses and Midwives Act to hold fitness to practice inquiries in public.

The board stated that publishing more details of fitness to practice inquiries was "a move in that direction".

PNA chief executive Des Kavanagh said psychiatric nurses were often subject to malicious and false allegations by mentally ill patients and holding fitness to practice inquiries in public could tarnish the reputation of nurses who could be innocent of the charges against them.

"Even if you were cleared, you'd never recover. It would only increase the trauma of a fitness to practice inquiry," he said.

Kavanagh said he would have preferred the status quo to have remained where cases were heard in camera and only the bare details were published afterwards.

He said the names of nurses should be published only in extreme cases.

He cited the example of the English nurse Beverley Allitt who was convicted of killing four children and injuring five others on a child's ward in Lincolnshire as an example where the details should be published.

"I have a personal view that publication should occur only in cases where there is a need for the public to know, though what the public needs to know is open to debate."

The board's acting deputy chief executive officer, Ursula Daly, said it had taken into account the effect of publication for individual nurses or midwives into consideration, but it felt "the rationale for the new policy supported the change. The role of An Bord Altranais in protection of the public was of paramount importance."

She also defended the decision not to publish the name of the hospital or medical institution where nurses, who appear in front of the fitness to practice inquiries, actually work.

"Findings and sanction following a fitness to practice inquiry relates to an individual registrant and not to where they were or are employed," she explained.