How the United Kingdom's Nursing and Midwifery Council Applies Guidance When Exercising Its Disciplinary Functions

Background: The Nursing and Midwifery Council (NMC) is responsible for addressing concerns about UK-registered nurses and midwives through its fitness-to-practice process. Purpose: To assess whether the NMC considers relevant factors at all stages of its deliberations into nurse misconduct, as required by the determinations in the appeal cases of Cohen v. General Medical Council (GMC), Zygmunt v. GMC, and Azzam v. GMC, and to assess whether the circumstances described in its Sanctions Guidance warranting the suspension or removal of a nurse from the practice register lead to that outcome. Methods: Cases between July and September 2021 that highlighted aggravating circumstances deemed as serious enough to warrant removal were identified and included in this study. Specific factors, including patient safety and dishonesty, included when determining impairment of fitness to practice were compared with their subsequent consideration when determining the severity of sanction. Pearson's χ2 and Fisher's exact tests were used to detect any variation from the expected distribution of data. Results: Fifty-nine cases met the inclusion criteria. Each of the four factors considered was more likely to be heard when determining a sanction after first being factored into the consideration of impairment. Where the aggravating factors of dishonesty or risk of harm to patients or the public were identified as an aspect of a nurse's misconduct, the sanctions of suspension or removal were no more likely to be imposed than when they were absent. Conclusion: The NMC does, in general, factor the rulings of High Court appeal cases into their deliberations on the impairment of fitness to practice; however, we were unable to demonstrate that dishonesty or risk of harm were more likely to result in suspension or removal of a nurse from the practice register.