The High Court confirmed the Nursing and Midwifery Board of Ireland’s decision to censure a nurse and impose two conditions following findings of professional misconduct involving forged medical letters. The court said its role under section 74(3) of the Nurses and Midwives Act 2011 was limited: it was not hearing an appeal on the merits and could refuse confirmation only if there was a good reason, such as a substantial procedural irregularity, a failure to observe natural or constitutional justice, or an unreasonable decision.
The misconduct findings concerned an undated letter the nurse gave to a divisional nurse manager while employed as a staff nurse at a regional hospital. She represented it as written by a consultant cardiothoracic surgeon at another hospital, although she knew or ought to have known it was not. Further findings concerned statements about the letter’s authenticity and her mother’s alleged admission to that hospital, and further undated letters provided to the Director of Nursing in December 2011.
The nurse did not appear or make representations to the Board or its Fitness to Practise Committee during the original consideration. In March 2016, the Board indicated it was considering censure and four conditions. In May, it considered erasing her from the register but rejected that proposal. It imposed censure and two conditions: before returning to nursing work, she had to complete a Board-approved return-to-nursing-practice course; and for two years after any return, the sanctions had to be notified to any nursing employer.
When the Board first sought court confirmation, the judge raised concerns about whether the sanction adequately addressed the dishonest conduct and its effect on public confidence. The matter was adjourned. The judge clarified that he had not asked or directed the Board to reconsider its decision. The Board reconvened on its own initiative on 23 November 2016, after receiving a letter from the nurse accepting responsibility and expressing remorse.
In explaining its decision to retain the sanction, the Board cited what it described as exceptional mitigating circumstances: relatively isolated incidents during acute distress, a previously unblemished record, acknowledgment of wrongdoing, psychological distress that had led to hospital care, and no evidence of harm to patients. The court also considered the nurse’s written representations.
The judge concluded that the Board’s decision was not unreasonable under the statutory test and confirmed the sanction. The court’s ruling did not substitute its own view of the appropriate sanction; it determined that there was no basis under its limited jurisdiction to depart from the Board’s decision.