Regulators are looking for more than reflection from nurses and midwives following a complaint. They want to see insight, says Mary Chiarella.

Speaking at the NSWNMA Professional Day, Mary Chiarella, a professor of nursing at the University of Sydney, said one of the key things regulators are looking for when nurses and midwives respond to complaints is that they “show some ownership of the registrant’s role in the issue, regardless of what that might be”.

Professor Chiarella’s study of 712 responses by nurses and midwives to complaints made to the Nursing and Midwifery Council of New South Wales (NMCNSW) also found that regulators are looking for evidence that nurses and midwives have taken some action in response to the complaint.

“That action might be a demonstration of lessons learnt through discussion, or how the registrant might respond if such an incident happened again, and perhaps some learning if the complaint relates to something such as poor medication administration technique errors.”

Professor Chiarella explained that her study’s aim was to research the link between reflecting on an adverse incident and a practitioner’s competence.

If nurses and midwives are all registered as competent practitioners then why, she wondered, do we need a complaints process? “We’re all competent, so why would we ever end up having a complaint about competence?”

“My view was there was this missing thread, and this was this concept of insight. What we felt was if you were aware you were competent then you were safe, and if you were aware you were incompetent then you were probably safe. Certainly, if you were unaware you were incompetent then you were definitely not safe.”

To test this theory, the reflective responses required by NMCNSW from nurses and midwives to complaints about their competence at work proved an ideal research database.

What Professor Chiarella found was a difference in the self-reflections that showed real insight compared to those who didn’t. She says the NMCNSW are looking for nurses and midwives to show some or all of following in their responses:

• They accept the incident occurred and their role in it.
• They reflect on and analyse the incident.
• They reflect on where they were that day, what they were thinking and doing.
• They analyse the context in which the incident occurred.
• They recognise their own failures or mistakes.
• They express remorse or regret.
• They show a commitment to improving oneself.
• They show some thinking about what you would do differently next time.
• They have sought out some counselling or mentorship.

Professor Chiarella gave the example of a nurse who acknowledged that external and unaddressed stress in her life was making her erratic. In her response the nurse outlined a plan to address her stress. The NMCNSW, seeing that she showed insight into her behaviour, “didn’t even bring her in”.

“What we know is that reflection alone does not constitute reassurance about the insight that the regulators are seeking.”

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