NMC - Nursing Midwifery Council Professional Duty of Candour Questions and Answers 1 — Questions and Answers
Question 1: A nurse administers a patient's morning medication an hour later than prescribed due to a busy ward. The patient suffers no observable harm. According to the professional duty of candour, what is the most appropriate action?
- Record the delay in the patient's notes but do not mention it unless the patient asks.
- Inform the patient about the delay, explain why it happened, and apologise for the error. (Correct answer)
- Ask a colleague to monitor the patient for adverse effects but say nothing to the patient to avoid causing anxiety.
- Only report the incident to the ward manager as no harm occurred.
Correct answer: Inform the patient about the delay, explain why it happened, and apologise for the error.
The professional duty of candour requires nurses to be open and honest with patients when something goes wrong, even if no harm has occurred. This includes apologising, explaining what happened, and being transparent about the error. Not informing the patient would breach this fundamental professional responsibility.
Question 2: Which of the following statements best distinguishes the professional duty of candour from the statutory duty of candour?
- The professional duty applies only to doctors, while the statutory duty applies to nurses and midwives.
- The professional duty is focused on organisational learning, whereas the statutory duty is focused on individual apologies.
- The professional duty applies to individual registrants and is triggered by any harm or distress, while the statutory duty applies to organisations and is triggered by 'notifiable safety incidents' of moderate to severe harm. (Correct answer)
- The professional duty is a legal requirement enforced by the CQC, while the statutory duty is an ethical guideline from the NMC.
Correct answer: The professional duty applies to individual registrants and is triggered by any harm or distress, while the statutory duty applies to organisations and is triggered by 'notifiable safety incidents' of moderate to severe harm.
The professional duty of candour is a responsibility for individual healthcare professionals (like nurses and midwives) to be open and honest when any level of harm or distress is caused, or even when there was the potential for it. The statutory duty of candour applies to healthcare organisations as a whole and is legally triggered by specific 'notifiable safety incidents' that result in moderate harm, severe harm, or death.
Question 3: A newly qualified nurse discovers a medication error made by a senior colleague. The senior colleague insists it is a minor issue and that telling the patient will only cause unnecessary distress. What should the newly qualified nurse's primary action be, in line with the duty of candour?
- Agree with the senior colleague to avoid confrontation and document the conversation.
- Anonymously report the senior colleague to the NMC.
- Discreetly tell the patient's family about the error without informing the colleague.
- Respectfully explain the professional duty to be open and honest and escalate the concern to the nurse in charge if the colleague refuses to act. (Correct answer)
Correct answer: Respectfully explain the professional duty to be open and honest and escalate the concern to the nurse in charge if the colleague refuses to act.
The professional duty of candour includes fostering a culture of openness and honesty. The nurse should first encourage the colleague to do the right thing. If that fails, they have a professional responsibility to escalate the concern to ensure the duty to the patient is met. This supports both patient safety and the professional standards expected of all registrants.
Question 4: According to joint NMC and GMC guidance, what is the correct approach to offering an apology to a patient after a care incident?
- An apology should only be given after a full investigation has concluded and liability is established.
- Offering an apology is an admission of legal liability and should therefore be avoided.
- An apology should be offered as soon as possible, and it is not an admission of legal liability. (Correct answer)
- Only the hospital's chief executive is authorised to give an official apology to a patient.
Correct answer: An apology should be offered as soon as possible, and it is not an admission of legal liability.
The joint guidance from the NMC and GMC is clear that an apology should be given as soon as something has gone wrong. It explicitly states that offering an apology is not an admission of legal liability and is a crucial part of being open and honest with the patient.
Question 5: A patient experiences a fall while being assisted by a student nurse. A full assessment reveals no injuries. The student is very distressed. As the supervising registered nurse, how do you apply the principles of the professional duty of candour?
- Complete the incident form but tell the patient it was an unavoidable accident to protect the student.
- Tell the patient the student made a mistake and will be disciplined.
- Explain to the patient what happened in a factual and honest way, apologise for the event, and involve the student in the conversation to support their learning. (Correct answer)
- Wait 24 hours to see if any bruising develops before deciding whether to inform the patient about the full details.
Correct answer: Explain to the patient what happened in a factual and honest way, apologise for the event, and involve the student in the conversation to support their learning.
The duty of candour requires an open and honest explanation of what happened, an apology, and reassurance about what is being done. This situation is also a crucial learning opportunity. Involving the student (with support) helps them understand their professional responsibilities and fosters a culture of transparency. It is not about blaming, but about honesty and learning.
Question 6: Which of the following situations would NOT typically trigger the professional duty of candour for a nurse?
- A patient's condition deteriorates as a result of the natural progression of their illness. (Correct answer)
- A delay in administering pain relief causes a patient significant distress.
- A 'near miss' where the wrong medication was prepared but the error was caught before administration.
- A patient's confidential information is accidentally shared with another patient.
Correct answer: A patient's condition deteriorates as a result of the natural progression of their illness.
The NMC and GMC guidance specifies that the professional duty of candour applies when something goes wrong with a patient's treatment or care. It is not intended for circumstances where a patient's condition worsens due to the natural progression of their illness. The other scenarios all represent things 'going wrong' with care that have the potential to cause (or have caused) harm or distress, and thus would trigger the duty.
NMC - Nursing Midwifery Council Professional Duty of Candour Questions and Answers 1
A nurse administers a patient's morning medication an hour later than prescribed due to a busy ward.
The patient suffers no observable harm.
According to the professional duty of candour, what is the most appropriate action?