In this series we focus on the important work of NMBI Board members. In this month’s issue, we speak with Eileen Kelly, NMBI Board member and Chair of the Fitness to Practise Committee (2011).

Could you tell our readers about your background and why you chose a career in nursing?

Growing up I was aware of family members who were nurses and I wanted to do something that could make a difference in people’s lives. I enjoyed science at school and at one stage I was interested in becoming a microbiologist. When I was applying to colleges though the CAO, I chose various courses and I also applied to individual hospitals directly for nursing. At the time, you had to apply to each hospital's nursing school to be considered for a place. Beaumont Hospital was newly opened, and this appealed to me the most as I knew it would offer me a broad range of training and experience. I was delighted to have been successful at interview.

I subsequently qualified as a Registered General Nurse from Beaumont Hospital working predominantly in surgical divisions and ICU post qualification. I enjoyed immensely working in the acute wards. I loved how busy it was and how much I was learning on the ground from staff nurses, clinicians and other healthcare professionals. It was both challenging and exciting.

What led you to pursue older person care?

When I returned to Roscommon, I took up a staff nurse role in older person services in a community nursing unit and completed a post graduate qualification in gerontology. Following on from that I moved into the community, working with the Intermediate Care Service which provided multi-disciplinary short term domiciliary rehabilitation to older people. I have always enjoyed working with older people and found it to be very rewarding. I enjoyed the many aspects of the care involved.

I have gained expert knowledge over a long career working in this area. My current role as a CNM2 is very busy. The CNM2 has a pivotal role in service planning, co-ordinating and managing activity and resources within the clinical area. Day to day, as part of the healthcare team, I deal with all aspects of people management, care of the residents, their families and a wide range of staff and disciplines. I am also responsible for ensuring that the National Standards for Residential Care Settings within my setting are abided by. We are, as all residential units are, regularly inspected by the Health Information and Quality Authority (HIQA).

Covid-19 has really impacted nurses and midwives and how they deliver care. What changes have you seen in the care of the older person?

There were huge challenges initially. Older people in the first wave were the most vulnerable of all. The residents and staff required a lot of support. At times the amount of information was overwhelming and brought many big changes to our units. The emotional and psychological impact of Covid-19 was immense for our residents and staff. Like everyone our workloads increased enormously in order to keep our residents safe. 

Nurses and midwives had to quickly upskill, take on new infection prevention and control roles, perform resident and staff testing, and maintain a cohesive, safe and responsible service. The units were still a home to residents, and it was sometimes difficult to balance this aspect with the new IPC measures. There was increased documentation involved and communication with Public Health/HIQA and Outbreak teams if there were outbreaks.

I am proud that nurses and midwives have responded to the challenges and diversified in many ways. This past 22 months have been enormously difficult. Nurses and midwives are human too and have families and loved ones to care for outside of their working hours. It was hard to maintain balance, but the pandemic has shown us to be resilient and strong, and we continue to demonstrate the values of care, commitment and passion.

When did you join the Board and why did you choose to run for election?

I was elected as a representative from the Older Persons Category in December 2017. I felt it was a good opportunity to learn more about the regulation of the professions of nursing and midwifery. I felt I had important knowledge and experience to bring to the role. I am also inherently interested in patient safety and the protection of the public. I have always been committed to ensuring that high quality safe and effective care is delivered wherever that may be. I also knew that it would offer great experience to bring to my own workplace as nurses and midwives are at the forefront of healthcare delivery. There are currently more than 80,000 nurses and midwives on the NMBI Register and it is both a privilege and an honour to represent them. I believe that good regulation is fair, impartial and consistent.

When I joined the Board, I received induction and training which was very important in gaining both an understanding of corporate and regulatory governance. Training has also been available throughout my tenure on the board which has been crucial in supporting my learning.

You’ve recently been appointed chair of the Fitness to Practise committee. Could you tell us about the committee and the work it does?

The Nursing and Midwifery Board of Ireland is legally responsible for considering complaints against nurses and midwives who practise in Ireland. A complaint may be made for several reasons such as professional misconduct, poor professional performance, non-compliance with Code of Professional Conduct, medical disability, an irregularity in relation to the custody, prescription or supply of a controlled drug or another drug that could be abused. The Fitness to Practise Department makes every effort to deal with complaints in line with the principles of fair procedures, natural justice and in strict accordance with the legislation.

The Fitness to Practise Committee of the NMBI is a statutory committee comprised of Board and non-Board members. It has a lay majority which means that slightly more than half of the members are neither nurses nor midwives. Overall, it consists of 33 members as prescribed under the Nurses and Midwives Act 2011, of which eleven members are Board members. The Committee does not meet too often as a full committee unless it is undertaking training or considering policies and procedures. It operates in small groups of three or five persons called subcommittees.

Subcommittees sit at case management hearings (call-overs) and inquiries. There is a call-over meeting every month and a subcommittee will consider different applications which could include the requisition of documents or records for an inquiry, requests for inquiry adjournments and occasionally there may be applications where witnesses or registrants seek for an inquiry to be heard in private or for their names to be anonymised.

Where a complaint progresses to an inquiry, a subcommittee of the Fitness to Practise Committee will sit to hear the evidence against a nurse or midwife and it may make findings. The subcommittee is also responsible for recommending a sanction if there are allegations proven and findings against a registrant. There is a wide array of sanctions that can range from advice to suspension or cancellation from the Register. The NMBI Board decides at a later stage following receipt of a report from the Fitness to Practise Subcommittee whether it will impose the recommended sanction or an alternative sanction. The Board stage of the process ensures that the sanctions which are imposed on registrants following an inquiry are consistent with previous sanctions for similar matters.

I think it is essential as a regulator to have all members of society represented on the Fitness to Practise Committee. There is also a strong mix of background, skills and expertise. The Committee meets as a full group every six months and is strongly supported by the Fitness to Practise management team and staff. 

The nature and complexity of some cases requires regular training which is very important in terms of keeping me up to date with legal matters. 

What are the main challenges faced by Fitness to Practise Committee members?

The members of the Committee have been very busy during the year keeping the fitness to practise process moving forward during the pandemic to ensure that complaints were dealt with as effectively and as efficiently as possible was challenging. More than 30 inquiries have been held to date in 2021 and many of those inquiries ran for two or more days.

The NMBI organised remote and hybrid inquiries wherever possible. We were all new to the remote inquiry technology and it was a steep learning curve. Board meetings were also held remotely to progress the work of the committee and to allow us to make decisions that would facilitate safer delivery of care during the pandemic.

Recent legislative amendments (to the Nurses and Midwives Act 2011) will enable changes to improve the efficiency of the process and this will assist committee members in their work on the board. Continued training is vital to keep members updated as the changes to the Act are rolled out.

What would you like to achieve in your new position as Chair of the Fitness to Practise Committee?

The Regulated Professions (Health and Social Care) (Amendment) Act 2020 which came into effect on 01 August 2021 gave rise to a number of changes to the way in which NMBI deals with complaints. I would like to see these amendments fully implemented in my time as chair of the Fitness to Practise Committee.

Most (if not all) of the changes are positive and seek to remove some of the unwieldy administrative steps which can delay the fitness to practise process. The inquiry subcommittee for new inquiries will be reducing from five to three members in 2022. These smaller subcommittees are less formidable for registrants and will allow for more inquiries to be heard, speeding up the scheduling of cases and reducing the wait-time for registrants.

Nursing and midwifery have always been the most trusted professions. Nurses and midwives have endured an enormously challenging few years. Whilst it has been difficult, the regulator must continue to instil confidence in the professions and continue to facilitate development in line with best international practice and evidence.

The NMBI website has been updated in recent times to become more user friendly. I would like to see NMBI continue to educate and support nurses and midwives in understanding the Code of Professional Conduct and Ethics. I would also like to see more information on the fitness to practise process being published in the eZine so that registrants have a greater understanding of the process. This year a new guide was written to explain the complaints process in ‘Plain English Format’.

I would also like to progress the good work that has been done by previous Committee and Board members and the NMBI Fitness to Practise Department in creating a more compassionate approach to Fitness to Practise.

Ultimately, I would like to see workplaces and environments where nurses and midwives can flourish and practise safely and effectively. Changes to the fitness to practise process are currently underway and this can only improve the way things are done. By encouraging openness and transparency the risk to patients is reduced. Encouraging nurses and midwives to learn from their mistakes is more likely to support a learning culture that keeps members of the public safe and free from harm.

Better physical and mental health in the workplace too means nurses and midwives perform better at work and ultimately results in fewer complaints.

How do you find a balance between the demands of your work on the Board and committee, your nursing career and your home life?

I do think that you have to make balance a priority or otherwise you can become defeated very quickly. You have to be wise about the decisions you make. Organisation is key and allowing others to help also assists in making life that bit easier.

There is a lot of preparation involved in being both a Board member and a member of the Fitness to Practise Committee. It is vitally important to give time to the reading material as this impacts on your decision making. The pandemic was helpful in that more meetings were convened online and this greatly reduced the need to travel.

Is there anything about yourself that you would like your readers to know?

Before the pandemic I started doing triathlons which I really enjoyed. Many of the events were cancelled but hopefully in 2022 I will get the opportunity to take part once again.

Finally, what advice would you give someone who is interested in joining the NMBI Board or one of the NMBI Committee?

Go for it! It is a tremendous opportunity to learn about the functions and running of the Nursing and Midwifery Board of Ireland. You really get the chance to learn in detail about the legislation and how it is applied. You also learn about corporate governance and you have a voice at the table allowing you to have an influence over the future direction of the professions.

As a Board member you can draw on the knowledge and education that you have gained in your practice, and this will assist you greatly in all your contributions at board level.

It can be daunting in the beginning but as you move through your time on the Board and attend meetings you gain confidence and skills. The CEO and executive are very supportive of new members. Every effort is made to induct new members and support all Board members with regular training and workshops. You also meet a variety of new people with different backgrounds and that can be very interesting and rewarding.