Alicia Jayne Daniels was an epilepsy nurse employed at University Hospital Bristol. Daniels was struck off after lying to her employees about having cancer. Throughout this essay I aim to discuss professionalism, ethics and the legal role of the regulatory body in nursing and how these relate to the case of Miss Daniels.
Professionalism is a key aspect within the nursing profession and is clearly shown within the nursing and midwifery (NMC) code (2018). The code states that one should uphold the reputation of their profession at all times (NMC 2018).
Nurses tend to be regarded as trustworthy, a characteristic that is essential to establish care and trust with a patient (Din? and Gastmans 2011). The NMC code (2018) states that an individual should act with honesty and integrity at all times. By lying to her colleagues Miss Daniels not only destroys this perception in her colleagues’ minds but as this case is publicly known, patients would lack trust and confidence in Daniels ability to practice if had not been struck off, therefore, I feel as though Daniels has not upheld this section of the code.
Miss Daniels behaviour retracted any capacity to act as a role model for professional behaviour for students and newly qualified nurses, midwives and nursing associates. This again is a quality highlighted by the NMC code (2018). This is vital as students, in particular, are not only learning technical skills from staff within clinical environments but they are also aware of behaviours and qualities being exhibited. This means that these members are being exposed to dishonest behaviour which could be mimicked or it could impact their view of the clinical area or the career as a whole.
Although I personally do not believe Miss Daniels adheres to the NMC code on professionalism she may not have intended be in this position. Her decision to relinquish her professionalism could have been a result of an underlying medical condition that is known but not disclosed to the public. This may have impacted her decision making and placed her in a position where she felt a lie was the only way she could cope with the situation. Dependent on the nature of the condition, it may have impacted her decision making. However, the documentation from the fitness to practice hearing submits no evidence to this (NMC 2019, p.18). The condition in question may carry a stigma or have altered her colleague’s impression of her. This could have been why she chose a condition that induces sympathy and compassion. As this condition is widely known Daniels may have felt as though it would be more readily believed and would require less explanation compared to a rarer condition. In addition, Daniels may not have intended for this lie to continue for such a length of time. Daniels may have felt as though admitting it was a lie would be more damaging to her professionalism thus causing her to continue with her deceit. To conclude, I feel as though Miss Daniels has not upheld her professional standards by entering into and continuing such a lie. Daniels has been continually dishonest and inconsiderate to her colleagues.
Ethically I feel as though Miss Daniels was wrong to evoke a sense of sympathy from individuals. In addition to being ethically incorrect it also contradicts with the NMC code (2018) as nurses should be aware of how their behaviour affects and influences the behaviour of others and should not take advantage of an individuals’ vulnerability or cause upset or disease. As Daniels lied about a condition that is often fatal and impacts the majority of people whether directly suffering, with 330,000 people being diagnosed each year in the UK (Macmillan Cancer Support 2014), or being in close relations with someone suffering from cancer. In my opinion this takes advantage of the vulnerability of individuals. A lie such as this reaches into the past or present emotions of individuals impacted by this condition. This means that these emotions are real and raw and, therefore, more easily manipulated. If another rarer condition had been used by Daniels, the likelihood of as many people being able to relate and provide sympathy would be greatly decreased and may, therefore, impact the result of the lie. I feel this case would have been less severe if another condition had been used such as rheumatoid arthritis. This is due to less people having such a personal connection to the condition as, although, it is serious and can be debilitating and severely painful it is not fatal (NHS 2016).
From the 4 ethical principles: justice, respect for autonomy, beneficence and non-maleficence (BMJ 1994), I feel justice, beneficence and non-maleficence apply to the case of Miss Daniels. Justice refers to elements of fairness (Oxford English dictionary 2019). By manipulating colleagues Daniels extracted sympathy which would impact on the way in which she was treated within her work environment. Furthermore, Daniels received leave from work due to her claimed diagnosis. I feel as though this is unfair to her colleagues, employers and patients.
Beneficence relates to acting within the patient’s best interest (Nora 2013) and links closely with non-maleficence which is the balance between risk and harm (Alzheimer Europe 2009). This is crucial within the nursing environment. As Daniels was suffering from a concealed medical condition, she may have been endangering patient safety. This may not have been Daniels motivation for lying or an impact she was aware she may have; however, it should be considered that she was inadvertently putting patients at risk. I feel this highlights Daniels lack of ethical consideration for those around her.
In addition, Miss Daniels continued her deceit over the course of many years and forged documentation to support her lie. By creating false documents Daniels not only calls her own character into question but it also endangered the career of the consultant radiographer whom she impersonated which furthers the imbalance between risk and benefit. This behaviour is reckless and I feel it increases the severity of the case as it introduces the element of forgery and planning.
Nurse Daniels was struck off by the NMC following a fitness to practice hearing (NMC 2019). I feel the conclusion reached was correct. This is due to Daniels undertaking such a severe lie and her decision to continue it for such a long time. There were various opportunities for Daniels to admit to what had happened, explain herself and why she chose to lie. However, she made no attempt to end the deceit over the years or explain herself during her trial. This I feel highlights a lack of remorse on Daniels part. By forging documentation Daniels increases the level of dishonesty exhibited and reveals a level of planning. In my opinion this reveals that Daniels has not been ‘accidentally’ caught up within a lie, but she has intentionally created this detailed story.
Furthermore, the severity of the treatment that Daniels is claiming to be undergoing increases over time from radiotherapy to surgery which shows a distinct lack of desire to end the lie. Daniels furthered this sense of intention by continuing her lies when moving forward into a new job at Bristol Community Health. Daniels proclaimed she would be unable to provide a reference from her previous line manager as they no longer work there. This could be argued to be Daniels attempt to move forward and step away from her previous lies. By removing the possibility of her previous line manager writing a reference Daniels decreases the chance of her cancer lie moving forward with her. This may show potential remorse; however, I feel changing the lie does not improve my assessment of her character as she is maintaining a sense of dishonesty.
It should be taken into account that Daniels wrote a reflective piece in which she states that she was ‘mortified’ about forging documents (NMC 2019, p.18). Within this piece she apologises and highlights that she has learnt that being honest is the correct way to deal with situations. By writing this poignant piece Daniels shows a desire to rectify the situation and I feel it is a positive reflection on her character. However, the piece is undated which could cause the question of relevance to arise. Daniels has admitted to all charges put against her which I feel shows a willingness to take responsibility for her actions. However, as Daniels refused to participate in the hearing, I surmise she has no desire to provide an explanation or make amends to those impacted by the years of deceit.
To conclude I feel as though the NMC were justified in their decision to strike off Miss Daniels. I hold this opinion as the lie was concerning a severe and life-threatening condition, upheld for a great length of time despite various opportunities to confess. In addition, Daniels showed clear levels of planning and intent. Therefore, I do not feel Daniels regrets her decisions or feels any remorse and her lack of attendance at the hearing solidifies this impression.?