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Fitness to practise: why nurses’ employers should cut down on NMC referrals

Regulator urges managers to avoid blame and deal with nurses’ performance issues locally
Nurse has meeting with her manager – NMC urges employers to resolve nurse fitness to practise concerns themselves where possible

NMC says it must focus its energies on FtP referrals that are necessary for public protection

The nursing regulator has issued guidance to employers on how they can prevent unnecessary fitness to practise (FtP) referrals.

The Nursing and Midwifery Council (NMC) uses the document to spell out when it is inappropriate for organisations to escalate concerns, as well as the local steps they should take instead.

It urges organisations to treat staff in a way that is fair and avoids fear and blame.

In 2019-20, the NMC judged that as many as 70% of referrals did not require its regulatory input.

If nurses, midwives, nursing associates and employers can focus on learning from mistakes at an

NMC says it must focus its energies on FtP referrals that are necessary for public protection

Nurse has meeting with her manager – NMC urges employers to resolve nurse fitness to practise concerns themselves where possible
Picture: iStock

The nursing regulator has issued guidance to employers on how they can prevent unnecessary fitness to practise (FtP) referrals.

The Nursing and Midwifery Council (NMC) uses the document to spell out when it is inappropriate for organisations to escalate concerns, as well as the local steps they should take instead.

It urges organisations to treat staff in a way that is fair and ‘avoids fear and blame’.

In 2019-20, the NMC judged that as many as 70% of referrals did not require its regulatory input.

‘If nurses, midwives, nursing associates and employers can focus on learning from mistakes at an early stage, care will be provided even more safely’

Rosalind Hooper, RCN

‘We want to make sure we are focusing our work on referrals that are necessary to protect the public,’ said NMC chief executive Andrea Sutcliffe.

‘Employers have a key role in making sure that happens and this resource is designed to support them in appropriately managing or escalating concerns about someone’s fitness to practise.’

Promoting fairness for nurses in their workplaces

The guidance states: ‘Using tools and processes that promote a just culture will help you look at concerns in a way that avoids fear and blame.’

It says concerns should only be raised with the NMC if:

  • There is a serious risk to a service user and this cannot be put right.
  • The employer is unable to manage the situation.
  • Action needs to be taken to protect public confidence in the profession.

The document urges employers to ensure referral decisions are fair and unbiased.


Nurse ethnicity and likelihood of FtP referral

The NMC’s latest annual Equality, Diversity and Inclusion report shows that nurses of black African heritage made up 13.3% of new referrals to the NMC in 2019-20, despite only forming 7% of the register.

In 2018-19, the figure was 12.7%.

In contrast however, white British nurses, who make up 70% of the register, are under-represented in FtP statistics, accounting for 61% of referrals in 2019-20 and in 2018-19.


Local resolution of nursing staff performance issues

RCN head of legal services (regulatory) Rosalind Hooper said dealing with performance issues at local level can often mean they are dealt with more quickly and effectively.

‘If nurses, midwives, nursing associates and employers can focus on learning from mistakes at an early stage, care will be provided even more safely.’


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