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NMC’s new fitness to practise approach acknowledges ‘context’ when errors occur

Regulator aims to help nurses to ‘learn from their mistakes’

The Nursing and Midwifery Council (NMC) has pledged to take into account the context in which nurses make decisions when errors occur.


The NMC aims to move away from a blame culture. Picture: iStock

The regulator’s overhaul of its Fitness to Practise (FtP) processes will acknowledge the ‘daily pressures and challenges facing the UK’s health and care workforce’.

The NMC said the new approach will help it determine how much of any risk to patients is caused by the registrant’s practice, versus how much risk might be caused by the system or environment in which the registrant is working.

Contributing factors

The change in strategy was informed by qualitative research, NMC: Fitness to Practice Insight, which concludes that when investigating errors, the regulator must consider:

  • Structural factors (staffing levels, workload).
  • Systemic factors (task planning and allocation, working practices, access to IT resources).
  • Cultural factors (management pressures, organisational culture).
  • Personal factors (stresses, illness).

Sharing intelligence

The NMC says ‘intelligence’ about contextual factors surrounding errors will be shared with employers and other regulators. 

Under the new FtP structure, nurses might avoid having their practice restricted by the NMC if they can show they have learned lessons from an error.

The NMC will begin making changes to its FtP policies this month.

Learning from mistakes

NMC director of FtP Matthew McClelland said: ‘This is the best way for nurses, midwives and the wider health and care system to learn from mistakes and prevent them from happening again.’

RCN acting general secretary Dame Donna Kinnair said: ‘It is positive to see the NMC move away from the blame culture that can prevent system-wide improvements to patient safety.

‘Systemic errors can only be rooted out through a culture of open reflection in which clinicians can discuss issues without risk of blame, with a focus on prevention rather than prosecution.’

A spokesperson for NMCWatch, a support group for nurses and midwives going through FtP proceedings, said the ideology behind the changes was encouraging. But they said more needed to be done to help registrants trust the FtP process, including moving away from an assumption of guilt from the outset.


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