United Kingdom | Fitness to practise

Patient slaps nurse. Nurse slaps back and loses her PIN. When does self-defence stop counting?

A Scottish nurse with more than 30 years’ experience was struck off after slapping a dementia patient who had been hitting staff. She said she was protecting herself. The regulator said that was not enough.

5 September 2026
FNA News and analysis

A registered nurse in Scotland has been removed from the Nursing and Midwifery Council register after slapping a confused patient and making a remark about taking her to the mortuary.

Lynn Rowan was working as a bank nurse at University Hospital Ayr when the incidents happened on a night shift in May 2024. A six-day virtual fitness-to-practise hearing found five charges proved. Rowan did not attend and was not represented. The panel struck her off and imposed an 18-month interim suspension.

The case is being read by nurses as a simple story: patient hits nurse, nurse hits back, career ends. The record is less simple. The patient was aggressive. The nurse used force. She also shouted, insulted the woman and joked about the mortuary. The regulator treated all of that as one picture of misconduct.

The question left on the ward is still the one in the headline. When does self-defence stop counting?

What happened

The events took place on 5–6 May 2024 in the Combined Assessment Unit.

Patient A, an older woman with dementia, had been admitted that evening. Staff said she was confused, possibly dehydrated and infected, and needed full help with personal care. They also said she was physically and verbally aggressive.

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NHS Ayrshire and Arran referred the case to the NMC on 13 September 2024.

The panel found that Rowan:

• told a colleague she had left her unwell mother at home to look after “that,” meaning the patient
• shouted at the patient and called her a “horrible woman”
• said, “How do you like being shouted at?”
• said, “If you don’t behave, I’ll wrap you up and take you to the mortuary,” or words to that effect
• slapped the patient on the wrist or hand and shouted “No”

Witnesses said the slap followed contact from the patient. During personal care, Patient A became agitated, ripped Rowan’s lanyard off and was striking staff. A nursing assistant told the hearing that as the patient hit out, Rowan raised her hand, slapped the patient’s arm and left the room. Another account said Rowan walked over and slapped the patient’s wrist after the woman struck a colleague.

No specific physical injury was identified.

What the nurse said

Rowan accepted parts of the allegations in written evidence.

She said the slap was a defensive reaction. The patient had been lashing out, she said, and she was protecting herself.

On the mortuary comment, she said the patient had asked if staff were wrapping her up to take her away. Rowan said she replied “jovially” that they would take her to the mortuary if she did not start behaving.

In a statement to the NMC she wrote:

“On reflection, I feel yes a bad joke, but it was not said in a cruel, unkind and threatening manner.”

A colleague described a colder scene. Rowan put a blanket over the patient. The woman asked if she was being wrapped up. Rowan said the only way she would be wrapped up was in a body bag for the mortuary. The room went silent. Rowan laughed, then appeared to see the reaction. Staff left.

What the NMC decided

The panel rejected both explanations.

It found that Rowan used physical force against a patient who lacked capacity and depended on staff for care and protection. It called the slap an assault. Even without a recorded injury, it said the conduct created a risk of physical and psychological harm.

It also rejected “banter” as a defence. The mortuary remark, it said, was cruel and wholly inappropriate.

In a 59-page decision, the NMC described the overall behaviour as degrading, abusive and cruel. It said Rowan’s actions were liable to frighten and alarm Patient A and were a serious departure from the standards expected of a registered nurse.

Striking-off, the panel concluded, was the only sanction that protected the public and marked the seriousness of the misconduct.

Rowan had been on the adult nursing register since 22 September 2003.

Analysis: the line the profession keeps arguing over

Nurses will split on this case because two things can be true at once.

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Patient A was not a well adult choosing a fight. She was newly admitted, cognitively impaired, unwell and frightened. A slap used to scold a person in that state is not care. It is force used against someone who cannot fairly meet it.

It is also true that nurses are assaulted at work. Patients grab, scratch, spit, bite and tear at clothing and ID. UK law still allows a person to protect themselves from immediate harm. The NMC Code does not require a nurse to stand still and absorb injury. What it does require is that any force is necessary, proportionate and aimed at safety, not punishment.

That is where this case was lost.

Self-defence, in regulation as in law, is narrow. It can cover breaking a grip, stepping back, calling for help and using the minimum contact needed to get free. It does not cover a slap delivered as a reprimand. It does not cover “No” used like a parent correcting a child. It does not cover “horrible woman,” “how do you like being shouted at,” or a joke about a body bag.

Once the response becomes a lesson, it stops being self-defence. That is the standard the panel applied.

The public interest test made the outcome harder still. The NMC does not only ask whether a nurse was scared. It asks whether a reasonable member of the public would trust that nurse with a vulnerable patient tomorrow. A confused woman on her first night in hospital, dependent on staff for washing and protection, is the patient the public pictures. Contempt towards that patient is what the regulator called incompatible with remaining on the register.

What this means for nurses

The practical lesson is uncomfortable and specific.

Document the assault. Call for support. Use approved holding and de-escalation if trained and if the situation requires it. Get out of reach when you can. Report the incident the same shift.

Do not slap. Do not follow contact with humiliation. Do not dress cruelty up as banter in front of colleagues who will later give evidence.

Rowan’s defence asked the panel to isolate the slap from the rest of the night. The panel refused. That is the part nurses should take most seriously. In fitness-to-practise cases, the regulator reads the whole scene: the words, the tone, the audience, the vulnerability of the patient, and whether the nurse still had another option.

Workplace violence against nurses is real. So is the duty owed to a patient who cannot understand the room she is in. This decision does not settle the wider fight about staff safety. It does settle what the NMC will do when a defensive story is attached to degrading language.

That is when self-defence stopped counting.

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