Trustworthy

How much does trust matter to you? Is it something you value? Trust is a key component of the fourth theme of the Code; promote professionalism and trust.

Students and registrants are expected to be committed to the standards of practice and behaviour set out in the Code. Such an approach should gain from clients, carers, members of the public and other Health Care professionals, trust and confidence in the profession of nursing.

The NMC (2015)

Why is trust so important?  Nurses and midwives have the privilege of engaging with individuals who are often vulnerable as a result of the effects of distress and or disease.  Ideally members of the nursing profession are individuals that no one wants to have to encounter but when they need to they expect that the nurses they meet will be reliable, responsible and dependable.

Nurses and midwives must tell the truth. Members of the public expect nurses to be honest and trustworthy, at all times but perhaps particularly so when things have gone wrong and mistakes have occurred. This was recently illustrated by the comments of an individual with a terminal illness that she made to those responsible for her care, and shared with her permission, “all I want, and expect, is that all staff caring for me treat me as an individual and always tell me the truth.  Telling me now that the primary cause of my illness cannot be found and that things I have been previously told about my condition were wrong is not going to affect my situation, but I appreciate you telling me. I know I am going to die and there is nothing more that can be done for me so please don’t shake my trust in you by pretending otherwise. I need to be able to trust you, to know you will always tell me the truth. It’s not your fault I’m dying, it’s the disease which is killing me.  I’m not interested in suing you, I just want you to be honest with me”.

Nurses occupy a position of trust and are expected to maintain the standards expected of them upholding the reputation of their profession at all times. The NMC in its guidance regarding Cases with particular risks for public confidence  comment that “dishonesty, even where it does not result in direct harm to patients but is related to matters outside of a nurse or midwife’s professional practice can undermine the trust the public place in the profession. Honesty, integrity and trustworthiness are to be considered the bedrock of any nurse or midwife’s practice“. NMC 2017.

Third year students at the University of Salford will shortly be grappling with some recent registrant fitness to practise cases as a part of their ongoing professional development.  They will perhaps discover that, as Mark Twain commented,  “truth is stranger than fiction”.

You may be familiar with the courtroom oath / affirmation “The truth, the whole truth and nothing but the truth” perhaps not because you have spoken those words yourself but have witnessed them being spoken in some form of dramatic setting. Telling the truth in court is essential and not just because there is a fear of being charged with perjury should it subsequently be discovered that witness lied but because judgements about the truth can only be made fairly if everyone behaves and speaks honestly. In a criminal court the standard of evidence must be “beyond all reasonable doubt”, the logical explanation / interpretation of the evidence is that the defendant committed the crime.

The civil standard of proof; “balance of probabilities” requires that the decision makers must the conclusion that what is alleged to have occurred is more likely to have occurred than not to have done so. This is the standard of proof which is used to adjudicate the fitness to practise of registrants.

Dishonesty in a registrant, even if short lived, and if it did not cause any harm to clients is always a serious matter. The Nursing & Midwifery Council’s consideration of fitness to practise cases which involve dishonesty frequently include reference to  Mr Justice Mitting’s comments in the case Parkinson v Nursing and Midwifery Council [2010] EWHC 1898 in which it was made clear that dishonesty always gives rise to a “severe risk” of having the registrant’s name erased from the register. Dishonesty comes in many forms and must be carefully assessed. There is a difference in  severity between deliberate, planned, deceptive acts which pose a risk to clients or involve client harm, or breach the trust of vulnerable clients and opportunistic, one-off incidents arising in the registrant’s private life which pose no risk to clients. The former modes of dishonesty are most likely to result in consideration of the continuance on the register of the individuals who perpetrate such acts.

We may spend many years building up trust only to discover that suspicion, not proof, destroys it. Think of how many public figures; including actors, sports people and politicians, you are aware of who have had their reputations shattered by comment not proof.

The Nursing & Midwifery Council published its latest guidance on “Making decisions on dishonesty charges” on 15 December 2017, and it makes for interesting reading. It is well worth the effort to read the Supreme Court Judgment given on 25 October 2017 which is referred to by the Nursing & Midwifery Council in its guidance. The case is about a professional gambler who sues a casino for winnings and raises questions about “the meaning of the concept of cheating at gambling, the relevance to it of dishonesty, and the proper test for dishonesty if such is an essential element of cheating”. The judgment of the Supreme Court Ivey v Genting Casinos [2017] UKSC 67, The more warped the defendant’s standards of honesty are, the less likely it is that he will be convicted of dishonest behaviour……..” is the problem with the Ghosh test for dishonesty (the leading authority on the concept of dishonesty in law). The Supreme Court concluded that Ghosh does not correctly represent the law and directions based upon it ought no longer to be given.

Truth would seem to have the ability to elicit a whole raft of emotions and feelings; the truth will set you free, the truth hurts, it is its own reward said Plato, it is rarely pure and never simple commented Oscar Wilde. Many individuals claim to experience great relief and peace from telling and hearing the truth as was the case of the woman cited in the anecdote above.

We should all ensure that all our actions, comments and thoughts make us trustworthy practitioners.