Alcohol Misuse and Nursing

Alcohol Dependency, Misuse, and the NMC

Many nurses drink a great deal outside of work. On occasions alcohol becomes a problem for a nurse. She or he may binge drink, or need to drink to relax, to such an extent that it affects their health or judgement. Some nurses go on to acquire a dependency and rely on alcohol to get through their shifts. Where concerns are raised by an employer, colleague or a member of the public, the Nursing and Midwifery Council (NMC) may become involved. Our lawyer, Ms Maudsley, summarises below some of the difficulties that nurses face in such circumstances.

Alcohol and Nurses, by Ms P Maudsley, barrister (who also previously practised as a qualified nurse, and qualified midwife)

There are two situations where a nurse who has an alcohol related problem may face difficulties practising as a nurse. She/he may either be registered and receives a referral from a third party relating to his/her conduct or a criminal conviction or she/he may be applying to register and there are issues surrounding his/her character.

If a nurse is in practise and the Nursing and Midwifery Council receive a referral either from a third party or from the nurse herself/himself about an alcohol related issue then the NMC will potentially investigate her/his ability to practise safely.

Situations where a referral is made could be, for example, a nurse turning up for work smelling of alcohol, acting intoxicated resulting in inappropriate behaviour, slurring of speech or appearing unsteady on her/his feet. The employer may feel justified in suggesting that patient safety is being put at risk if the nurse continues to remain on duty and may as a consequence, refer the nurse to the NMC for issues of misconduct.

Alternatively, a nurse is found to be drunk outside of work but becomes involved in acts not befitting a registered nurse. This may/may not result in a criminal conviction.

A nurse might receive a conviction for drink driving (drug driving) or other alcohol related driving offences.

It is the responsibility of any nurse, under the Code, to self- refer for any conviction. As The Code states atparagraph:

23.2: tell both us and any employers as soon as you can about any caution or charge against you, or if you have received a conditional discharge in relation to, or have been found guilty of, a criminal offence (other than a protected caution or conviction).’

A drink related criminal conviction (or any other conviction) may be reported to the NMC by the police or court under the Notifiable Occupations Scheme. This Scheme relates to professions or occupations which carry special trust or responsibility (such as nursing), in which the public interest in the disclosure of a conviction and other information by the police generally outweighs the normal duty of confidentiality owed to the individual nurse.

The NMC say ‘they will not investigate referrals based on convictions for offences that are not sufficiently serious to impact upon a nurse’s fitness to practise.’ However, the NMC may consider that drink-driving offences are more likely to call into question a nurse’s fitness to practise if:

  • the offence occurred either in the course of a nurse’s professional duties, driving to or from those duties, or during on-call or standby arrangements
  • there are aggravating circumstances connected with the offence, or
  • it is a repeat offence.

If a nurse has been convicted of a drink-driving offence, the NMC will:

  • look at any available information on the background to any offending, and
  • seek information from the nurse’s general practitioner or occupational health department, if it appears that the NMC need to explore any underlying alcohol issues that could mean that the nurse’s fitness to practise is impaired because of his/her health.

If the NMC decide there is sufficient information then there has to be a decision taken as to whether the case is a misconduct case under Article 22 (a) (i) of the Nursing and Midwifery Order 2001 or a health case, under Article 22 (a) (iv).

If the NMC decide the case is a misconduct case and there is a case to answer having investigated the matter, the nurse may be referred to a Fitness to Practise Panel who will decide whether the facts as charged by the NMC are proven and if so, whether there is current impairment. If the Fitness to Practise Panel decides there is current impairment, it will impose a sanction restricting the nurse’s ability to work. This may be reviewed at the end of the period of restriction.

If the nurse has a suspected underlying alcohol dependant disorder the NMC will ask the nurse to submit for testing to check if there is an ongoing alcohol problem. This will impact on the nurse’s fitness to practise and can be dealt with before the Fitness to Practise Panel as a health case. If there is a concern about the health of the nurse then the nurse will have to show that he/she is making attempts to address the problem so as to not put patient safety at risk or damage the reputation of the

profession. If there is a real concern regarding a lack of insight and attempts at remediation the Panel will again impose a restriction on the registration of the nurse. This can be reviewed prior to expiry of the Order

If a nurse is not already registered but is applying to be registered, then she/he has to comply with rule 5 of The Nursing and Midwifery Council (Education, Registration and Registration Appeals) Rules 2004 (SI 2004/1767), which states;
‘Application for admission to a part of the register

5.—(1) An application for admission to a part of the register shall be—
(a) made in writing using the personalised documentation provided by the Council which shall include a declaration by the applicant as to her good health and good character and the other information listed in Schedule 3;’

A nurse therefore has to declare that she is in good health and is of good character. If her health is affected by an alcohol related problem or she has been charged, received a conviction or caution for alcohol related problems then she may struggle to register (either registration or re-admission).

Refusal to register is an appealable decision under Article 37 of the Nursing and Midwifery Order 2001.

If you would like advice on health matters relating to alcohol and the NMC, please contact us. To speak to Penny Maudsley, in confidence, and without commitment. Call on: 0800 0122 506