A nurse who smacked a ‘challenging and violent’ patient across the face and tapped him on the cheek after he hit out at her has been suspended from working for 12 months.

The incident happened on the trauma and orthopaedic ward of Withybush Hospital in May 2022 when Primrose James – described as an experienced and respected nurse - was providing personal care for the 80-year-old man, identified only as Patient D.

A professional standards panel heard that the man, who had a broken hip, had been cared for on the ward for around six months and “at times he was known to strike out and sometimes hit members of staff”.

Incident witnessed

A healthcare assistant who witnessed the incident and reported it to the charge nurse, said: “Primrose was stood next to the bed, and she smacked him across his face with her right hand. She then started tapping him on the cheek with her fingers on her right hand while telling him off for hitting out.”

In a 'reflective' piece provided to the committee, Ms James said she became a nurse to help people, would never want to harm them and regretted reacting to being hit by the patient. 

"Difficult encounter"

She added: “This was a difficult encounter and things happened very quickly. I was reacting to a fluid and moving situation.

"I knew this patient’s background, how volatile he could be, how frequently he hit out at staff so I should have been more prepared for him to hit out at me during the interaction.

“At the time, I was trying to block to further hitting out and I am sincerely sorry that I made contact with Patient D.”

Number of allegations

Ms James faced a number of allegations at the NMC professional standards hearing, two of which were found proved, and the rest not proved.

The two found proved were that on May 2022 she smacked Patient D across the face and that on the same date she then tapped him on the cheek with her fingers.

Allegations that Ms James poked him on his forehead, pressed her finger against his nose and pushed his face and told him “you’re a horrible man, you will stay here and you will die here” or words to that effect, were found not proved.

"Previous unblemished career"

The panel said it took into consideration the patient’s difficult behaviour, Ms James’ previous unblemished career and her regret since the incident. It heard how the nurse was initially struck in the face during the interaction and “reacted almost instinctively”.

Members were told: “The pattern of assaults against staff had been ongoing for some time, was known to the senior staff but there had been an absence of action to address the problem.”

But in a written decision the panel said the charges found proved were “serious involving physical assault on a vulnerable patient” and a sanction was required.

"Limited support"

“The panel noted that it was not uncommon for Patient D to hit out at members of staff in an aggressive manner at times, due to his underlying medical conditions. and that, on the evidence, limited support had been provided to help manage Patient D’s behaviour.

“The panel acknowledged that you (Primrose James) initially got involved with Patient D’s care in order to assist a colleague, who you were working the night shift with, allowing the other member of staff to take their break. However, the panel took into account that you have worked with dementia patients for approximately 15 years and were therefore experienced in caring for patients with dementia.

“The panel also noted that Patient D at times had acted aggressively and assaulted other members of staff, however none responded in the way you did, they did not physically retaliate.”

Harm or distress

The hearing was told that no physical injury to Patient D was noted or observed as a result of the incident but the panel concluded that there was “a significant risk of psychological harm and/or distress to both Patient D and his family”.

Striking Ms James off for 12 months the panel, which sat from July 24 to August 1 August and October 17 to October 18, said her ability to work as a nurse was impaired despite the fact she had shown insight and “has a clear and unblemished regulatory record over 16 years”.

The incident was “a single one-off interaction with a challenging and violent patient for a very short period of time” and was a one off incident in the nurse’s career.

The panel said an assessment showed James to be ”a competent, hardworking and diligent nurse”. But it judged that a suspension order for 12 months with review at the end of that periods “was appropriate in this case to mark the seriousness of the misconduct”.