When you become a registered nurse, you will immediately become aware of the importance of upholding the values of the profession. Whether it is through your own practice policies or the GDC Standards, you will be constantly reminded that you work in a professional field and must conduct yourself in a way which is appropriate and fitting to the industry.
As a professional who works with the general public, it is important that you have access to guidelines so that you can ensure you meet required standards at all times. After all, when you have contact with other professionals, you would expect them to work to a standard that prioritises relevant interests. This is why the GDC plays such a key role in our industry; it is there to put the safety and the best interests of our patients first.
You will be familiar with the GDC’s Standards for the Dental Team, which initially came into effect in 2005 and was further updated in 2013. It is a clear professional framework that we are all, as registered professionals, required to adhere to. Failure to meet the Standards outlined in the document can result in disciplinary action being taken against you. Statistics released every year show that those working in the dental industry don’t always work with the integrity and common sense that you would expect from registered professionals.
Whilst it is something we can’t imagine ever happening to us, a surprising number of dental nurses end up in GDC hearings. The GDC’s statistical report from 2014 reveals that there were 3,099 cases brought against registered dental professionals, which is a 4% increase from the 2,990 cases in 2013. In turn, the number of reports in 2013 revealed a 31% increase from 2012. It is clear that the number of complaints are on the rise. But how many of these end up as GDC hearings involving dental nurses?
The GDC’s statistical report from 2014 indicates that at the end of that year there were 52,839 dental nurses registered in the UK. Of the cases that reached both the Interim Orders Committee and the Professional Conduct Committee, there were 72 cases which involved nurses. Although this may seem like a fairly small number, when you consider the extensive initial training we go through and the focus on continuing professional development within the industry, it does seem unfathomable that there are serious errors made. So what are the reasons for dental nurses ending up in GDC hearings?
When looking at cases from the past few months, it seems that there are a variety of reasons – but all centre around professional misconduct. As we know, this is something that we are expected to do when we are completing initial registration.
One example is a nurse appearing before the GDC in a hearing (the outcome of which is still pending) for failing to disclose a caution for theft and failing to update contact details held by the GDC. The GDC were, for a period of time, unable to contact the nurse involved, which they decreed showed a clear problem with the individual’s attitude towards proceedings. (This highlights how important it is to update your contact details with the GDC immediately if they change.) The GDC states, in its Standards for the Dental Team (www.gdc-uk.org/Dentalprofessionals/Standards), that your “personal behaviour maintains patients’ confidence in you and the dental profession”. This is discussed in Standard Nine, which is summarised below:
9.1 Ensure that your conduct, both at work and in your personal life, justifies patients’ trust in you and the public’s trust in the dental profession.
9.2 Protect patients and colleagues from risks posed by your health, conduct or performance.
9.3 Inform the GDC if you are subject to criminal proceedings or a regulatory finding is made against you anywhere in the world.
9.4 Co-operate with any relevant formal or informal inquiry and give full and truthful information.
The GDC decided that the nurse had brought into question her fitness to practice by not disclosing the caution for theft and thus not meeting Standard Nine. As she then further failed to update the GDC with her contact details, she showed herself to be uncooperative and willingly gave untruthful information. The nurse in question could have avoided a hearing if she had immediately informed the GDC of the conviction. Instead, she could now end up facing a suspension or erasure from the register, or could have conditions imposed on her registration.
Similarly, in February of this year, another nurse found herself facing the Professional Conduct Committee and receiving a 6-month suspension for failing to inform the GDC of a conviction for perverting the course of justice. During the hearing, the GDC stated that it had to bear in mind “… its primary duty to address the public interest”. Although it could be argued that such convictions do not bear any relation to your conduct at work, and both the nurses I have mentioned had never had their professional work disputed, anyone who proves to be dishonest can be a risk to the public’s wellbeing.
Further hearings at the start of the year revealed failures to report convictions for burglary, theft, assault, criminal damage and drink driving. Many found they were suspended for a period of months, but one nurse who then failed to cooperate with the GDC on more than one occasion was struck off for her actions. The professional status we are given must bring about absolute trust from the public; after all, they are trusting us with their personal information and dental well-being, so the least we can be expected to do is be honest about our own conduct – even if we feel it may be insignificant in relation to our working life.
While it is clear that erasure from the list of registered nurses would mean the end of your career, even a suspension would make working as a nurse incredibly difficult. You would be expected to earn back trust at your existing practice, but would also then have to disclose your suspension to any future prospective employees – it may put many off from offering you employment. Any nurse would realise this when deciding to fail to disclose information about criminal behaviour, so it seems that either they must feel too ashamed to reveal their convictions, or they simply think can hide them.
A more unusual hearing, held in February, concerned a dental nurse from Bradford who performed a surgical facelift on a friend. It is obvious that the GDC’s decision to remove the nurse in question from the register was the right one; as medical professionals, we can all see what a dangerous and irresponsible act this was. Whilst none of us would consider performing something that is so far outside our scope of practice, the ongoing reports of dental nurses throughout the country carrying out whitening treatments reveals it can occur on a smaller scale.
Thankfully, very few of the cases I looked at related to risk to the wider public, with two nurses facing the Professional Conduct Committee over allegations of inadequate infection control. The hearing revealed that cross-infection standards were not adhered to at a practice; charges included re-using matrix bands, endodontic files, aspirator tubes and 3-in-1 tips, as well as failing to change gloves between patients. Whilst this can be seen as almost unbelievable, these isolated cases show that it does occur, and the rise in complaints to the GDC each year may reveal further incidents.
The hearing discussed above also involved the dentist who worked at the same practice. Both he and the head nurse had displayed a further lack of professionalism by falsifying invoices for disposable items and impeding the investigation by the NHS. The second nurse, it was felt, had only been acting under instruction from the head nurse, and had been in the position where her job and her employer were being protected by her compliance in the situation. She therefore received conditions imposed on her registration for 12 months, whereas the other two members of the dental team were removed from the register. All of them had clearly failed to follow Principle One of the GDC Standards, which states we must “Put patients’ interests first and act to protect them.”
The hearings I studied reveal that although we work in a professional field, some will still fail to uphold the required set of standards; these standards are not in place to make our working lives more difficult, but simply to protect those we are here to provide care for. By maintaining our honesty and integrity, we can ensure that the dental industry doesn’t lose the trust of the public – and with annual reports revealing that complaints are on the rise, this is something which is more fundamentally important than ever.
Amy Shipham BA, RDN