What happened
The Nursing and Midwifery Council’s case concerned a registered adult nurse, on the register since 2005, who managed a care home with a dementia unit in Fife. It covered her management from June 2018 to June 2019, in eleven charges.
One of them was the restraint. In or around February 2020, the charge was that she tied residents’ nightclothes to stop them reaching their continence pads, or failed to make sure other staff did not. The agreed facts describe night staff on her shifts tying residents’ nightdresses from front to back, in a knot between the legs.
The rest is management failure of the same shape. Unexplained bruising to a resident was reported between 22 April and 12 June 2019; she did not investigate it in time and did not tell the Care Inspectorate or the local authority. In or around May 2019 she did not complete fifteen care plan audits, and recorded that they had been done. Relatives’ complaints about hygiene and about a blocked door were not looked into.
The outcome
At a consensual panel determination hearing on 16 June 2025 the panel accepted the agreement that all charges were proved, that her fitness to practise was impaired, and that striking off was appropriate. It made a striking-off order with an interim suspension order of 18 months.
She did not attend and was not represented. No criminal proceedings are recorded in the decision.
What went wrong
The finding on the restraint is narrow and it is the point. Challenged about the knot, she did not accept the practice was unacceptable. She asked what else she was supposed to do.
A manager who does not recognise tying a nightdress between the legs as restraint cannot supervise it, audit it or stop it. The agreed facts put the practice with night staff across her shifts, not with one nurse on one night.
The audits sit in the same place: fifteen recorded as done when they were not.
What it teaches
Tying a garment is mechanical restraint, and it hides: no raised voice, nobody on the floor, often no incident form. It is applied at night, by one carer, for a reason that sounds like care.
That reason is what makes it durable. Keeping a pad in place is a continence task, and the knot gets the task done by force. A resident who removes a pad needs a continence assessment or a pad that fits. Neither is a knot.
So restraint governance is a management competence, not only a hands-on one. It lives in audits that are completed and bruises that are investigated.
Questions for the room
- A night carer tells you the knot is the only way to stop a resident soiling herself. What is your answer tonight?
- Fifteen audits signed off as complete when they were not. Who checks the checker?
- Which restraint in your service would leave no mark and no incident report?
Evidence and limits
Confidence: probable. The account rests on one document, the Nursing and Midwifery Council’s determination of 16 June 2025, as summarised in the case précis. The determination as read stops short of the panel’s sanction reasoning, so none is quoted.
Restraint is one element of a wider management-failure case; this page is about governance, not an injury or a death. The home is anonymised, so only the region is given.
The restraint charge is dated February 2020, after the period the case otherwise covers; the précis does not explain the gap.
No criminal proceedings are recorded, so the manager is described by role and not named. A striking-off is a regulatory sanction, not a conviction.
Our training on vulnerable and volatile persons covers what restraint is, including the forms that leave no mark.
Sources
- Nursing and Midwifery Council, Fitness to Practise Committee, reasons of the consensual panel determination hearing, 16 June 2025 (published on nmc.org.uk)
Reviewed 20 October 2026.