Managing concerns: a resource for employers

Last Updated 02/02/2021


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Our vision is safe, effective and kind nursing and midwifery that improves everyone's health and wellbeing. As the professional regulator of more than 700,000 nursing and midwifery professionals, we have an important role to play in making this a reality.

That's why we're committed to promoting and contributing to a just and learning culture, which is when fairness, learning and accountability for actions are balanced. We believe a just culture encourages safe, effective and kind care for people who use services. And it fosters a healthy and inclusive professional environment.

We know that nursing and midwifery professionals work hard every day to provide safe care to people who use services. However, on rare occasions, there may be concerns about whether someone's practice is safe, and their employer will need to take action to respond to those concerns.

We've produced this resource for employers to support you to effectively respond to concerns about a nurse, midwife or nursing associate's practice.

We received about 1,800 referrals from employers last year (2019-2020). More than 62% (1,129) of these referrals progressed to the investigation stage, and about 7% (128) had progressed to a hearing as of early 2021.

We know that these fitness to practise cases can take an emotional toll on everyone involved. But if the process of managing concerns starts well locally, our process – should we need to get involved – can happen more quickly and we can make better decisions. This resource aims to help us all to better manage fitness to practise concerns and the impact on everyone involved.

How we developed this resource

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We've collaborated with employers, professionals, our regulatory partners and representatives of people who use services across the UK to identify good practice that will help you promote a just and learning culture.

We also drew on our own experiences in fitness to practise cases to support you to decide when you should manage concerns and when we need to be involved. We believe in giving professionals the chance to address concerns, but we'll always take action when needed.

It's important to note that this resource is intended to be used alongside, and not to replace, existing guidance and policies that you may need to follow when there are concerns about a nurse, midwife or nursing associate's practice. For example, this would include requirements under local polices and employment or data protection laws.

What's in the resource

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We've set out information which will help you to decide when you might need to manage concerns and when they'll need to be referred to us.

We've also outlined some guiding principles and questions for you to consider when investigating and managing concerns about a nurse, midwife or nursing associate's practice. You can use these for both employees, bank and agency staff.

We've also put together a number of referral scenarios, using examples of concerns about someone's practice to help you make a decision about referrals.

These scenarios might illustrate situations you've come across in the past, or may come across in future. We would highlight that no two cases are exactly the same and it’s quite possible that cases which appear similar, can have very different outcomes due to their particular facts.

We encourage you to use these scenarios only as a general guideline to understand our approach to fitness to practise and the main considerations in deciding whether or not a referral should be made.

We suggest you become familiar with this resource before there's a need to respond to concerns about someone's practice. That way, you can take it into account throughout your processes.

If you do need to make a referral to us, using this resource will help you to provide us with all the information we need. We can then respond more quickly and proportionately to the concerns you've raised.

Want to download and print whole sections of the resource? Visit the downloads page.