Decision Making in Referral for Nurses and Midwives

This decision-making guide provides a structured approach for employers of nurses and midwives to determine whether to make a referral based on concerns related to misconduct, competence, serious ill health, or character issues. The decision tree outlines steps to investigate specific concerns and advises on when to refer to the Nursing and Midwifery Council (NMC) for further action.

• Decision Making
• Referral
• Nurses
• Midwives
• Misconduct

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1. Deciding whether to make a referral decision tree

2. Referral decision tree This decision tree should be used together with Advice and information for Employers of Nurses and Midwives, which includes guidance about managing fitness to practise (FTP) issues, the type of allegations we investigate and issues to consider before referral. What sort of concerns are you investigating: Misconduct or competence Serious ill health Character, criminal behaviour?

3. Misconduct and lack of competence has a patient been seriously harmed or is there a risk to patient safety? refer to NMC yes have there been previous conduct, competence concerns? refer to NMC no yes no yes is nurse/midwife s conduct or competence being investigated? investigate using local procedures (refer to NMC if FTP concerns emerge) no

4. Serious ill health has a patient been seriously harmed or is there a risk to patient safety? Refer to NMC yes Is Use local procedures (keep situation under review, including possible referral to NMC if required) nurse/midwife engaging with treatment and management no yes yes no Does nurse/midwife have insight and acknowledge their health condition? Refer to NMC no

5. Character Does the incident involve a criminal investigation, charge, caution or conviction Refer to NMC investigate using local procedures (refer to NMC if FTP concerns emerge) no yes no Do you have concerns about the nurse/midwife s fitness to practise? Refer to NMC yes Call us on 020 7333 9333 for further information and advice