Care home nurse ‘sorry’ for failing to call ambulance for patient

A care home nurse has apologised for failing to call an ambulance for a patient she accepted needed hospital treatment.

Julie Elizabeth Burton told a Nursing and Midwifery Council (NMC) fitness to practice hearing today that she was sorry for not acting sooner after recording “abnormal” observations about the woman, who had been discharged to the home to recuperate after a hospital stay.

The panel concluded that all eight charges against Ms Burton were found proved, including that she had tried to take a blood pressure reading from the side on which the patient had a broken arm or shoulder, and that she had failed to call 999 after taking readings for the patient’s temperature, blood pressure, heart rate and respiration which should have warranted escalation.

At the outset of the hearing yesterday, Ms Burton admitted that she did not carry out frequent enough observations on the woman, identified as ‘Patient A’ – but denied the other seven allegations.

All charges related to her conduct at Mount House and Severn View care home in Shrewsbury, operated by Barchester Healthcare, on May 26, 2018.

In her closing submissions on Tuesday, Isabelle Knight, the barrister presenting the case for the NMC, said Ms Burton had admitted a number of the other charges in her live evidence the previous day.

She said Ms Burton had acknowledged that she had failed to call for an ambulance after recording the concerning observations on the afternoon of Saturday, May 26, or send her to hospital due to her low fluid intake.

Ms Knight said witness statements and evidence from two live witnesses – the manager at the time and a senior carer who had been on shift with Ms Burton on the day in question – confirmed the patient was “visibly unwell” and that Ms Burton had failed to get her the help she needed.

Ms Knight said Ms Burton had also admitted in evidence that she had failed to notify the NMC when Barchester Healthcare began disciplinary proceedings against her, despite her being required to do so within 14 days under a previous conditions of practice order imposed by the NMC in January 2018.

In her own closing submissions to the panel, Ms Burton, who was representing herself, said she accepted she had not acted swiftly enough but argued that she was not entirely to blame – claiming the patient should not have been admitted to the home in the first place and that other professionals had also failed to raise any concerns.

She said: “The deputy manager was the nurse that went out and assessed this particular patient when she was to be admitted to the Mount to one of the D2A [discharge to assess] beds.

“It was the deputy manager that was accountable for this lady being at the Mount when she really wasn’t suitable at all.

“I also find it quite concerning that the doctor saw the patient on the 25th and the occupational therapy team also saw the patient on the 25th as well, even though there were no concerns reported regarding this matter.

“Apparently observations were taken and obviously there is no information regarding what they were, but that was the day before.

“I think it’s also significant that the night nurse on the 25th reported no concerns.”

On the allegation that she had attempted to take a blood pressure reading from Patient A’s fractured arm, Ms Burton said: “It wasn’t a fractured arm, it was a fractured clavicle; however it would still be painful for me to have taken blood pressure from that arm and I am sure if I saw that she was in some distress I would have stopped.

“I am just grateful that somebody was there to inform me because I wasn’t aware of that.”

Ms Burton told the panel that she accepted she should escalated the patient on the Saturday.

She said: “I wish I had admitted this lady. I wish I had contacted Shropdoc and admitted this lady into hospital.

“The delay of 24 hours wasn’t very good for her wellbeing, she should have been in hospital where she would have received much better care, because the home was in a state of distress and not suitable for any D2A patients.

“I am really disappointed that the night nurse didn’t do anything about it on their shift, because that was a regular nurse that was on duty.

“On the Sunday when I came in I did act, but I wish I acted the day before.

“I should have contacted Shropdoc as soon as her observations were abnormal.

“I think it’s a shame no other observations were recorded, only mine – even though they weren’t done frequently enough, so I am at fault there.”

Ms Burton also explained why she had failed to notify the NMC that the care home provider had begun disciplinary proceedings.

She said: “I was removed from the home that day and I thought, ‘that’s it, my nursing career is over’, that’s probably why I didn’t contact the NMC.”

Ms Burton said she had not returned to nursing since, adding: “This has really affected me.

“I definitely will never go back to working in a nursing home again, but nursing is a massive field, there are lots of different roles out there.

“I am training as a counsellor and it would be of benefit to me to keep my registration.

“I am really sorry for everything that has happened, it’s really upset me.

“I apologised to the son on the Sunday morning, not just for the fact that I delayed. They told me the family weren’t happy with the whole set up at the Mount.

“I don’t think I’m totally to blame, but I should have done something and I didn’t.”

The panel said it intended to amend the wording of the charge relating to the blood pressure reading to reflect that it may have been either a fractured shoulder or arm.

This was accepted by Ms Knight and Ms Burton.

Ms Burton said: “It’s slightly better than before, even though I am disappointed that we didn’t have the discharge summary in the case notes for this particular lady, and then we could have had a clearer picture as to why she was admitted.

“It was an inappropriate admission for the home and I know that was one of the things the son was really unhappy about, because he discussed that with me.

“It’s just a shame we didn’t have details of this lady’s medical diagnosis and no notes or care plan.”

The panel returned decisions that the seven charges Ms Burton had not admitted were found proved, with the final charge proved by admission.

The hearing will reconvene on Wednesday morning to hear submissions from Ms Knight and Ms Burton about whether the charges amount to misconduct and whether Ms Burton’s fitness to practice is currently impaired.