Understanding pre-registration nursing fitness to practise processes

Protection of the public is a key aspect of pre-registration nursing education and UK Nursing and Midwifery Council monitoring processes. Universities must ensure that nursing students are "fit to practise" both during their programme and at the point of registration. However, current evidence suggests that institutional fitness to practise policies and processes can be inconsistent, lacking in clarity, and open to legal challenge.

To examine fitness to practise processes in pre-registration nursing programmes in Scotland.

Academic personnel (n=11) with key roles in fitness to practise processes in nine of the eleven Scottish universities providing pre-registration nursing programmes.

Semi-structured qualitative interviews were conducted with eleven academics with responsibility for fitness to practise processes in pre-registration programmes. The qualitative data and documentary evidence including institutional policies and processes were thematically analysed.

In this paper, we focus on illuminating the key theme of Stages and Thresholds in Fitness to Practise processes i.e. Pre-fitness to practise, Stage 1, Stage 2, and Appeal, along with two thresholds (between Pre-fitness to practise and Stage 1; between Stage 1 and Stage 2.

Diverse fitness to practise processes are currently in place for Scottish pre-registration nursing students. These processes draw on a shared set of principles but are couched in different terminology and vary according to their location within different university structures. Nevertheless, universities appear to be confronting broadly similar issues around ensuring fitness to practise and are building a body of expertise in this area. Examples of good practice are identified and include the use of staged processes and graduated outcomes, the incorporation of teaching about fitness to practise into nursing programmes, positive attitudes around health and disability, and collaborative decision making. Areas of challenge include systems for student support and consistent, equitable, and auditable fitness to practise processes.