Lack of competence
Lack of competence would usually involve an unacceptably low standard of professional performance, judged on a fair sample of their work, which could put patients at risk. For instance when a nurse, midwife or nursing associate also demonstrates a lack of knowledge, skill or judgement showing they are incapable of safe and effective practice.
Unless it was exceptionally serious, a single clinical incident would not indicate a general lack of competence on the part of a nurse, midwife or nursing associate.
We recognise that nurses, midwives and nursing associates sometimes make mistakes or errors of judgement. Our starting position is that the nurse, midwife or nursing associate is usually a safe and competent professional but something may have happened that got in the way of them delivering safe care.
If concerns are raised about the general competence of a nurse, midwife or nursing associate we’ll seek to understand the circumstances at the time. We’ll also look at their practising history and not just at the period of time when the concerns arose. This will help us understand if there is a particular area of practice where there may be concerns or whether they are more general in nature.
Where we identify a gap in the nurse, midwife or nursing associate’s knowledge or training we’ll try to help them understand what they can do to address this gap and demonstrate they’re safe to practise.
It’s important that we find out how this gap occurred and in particular if it raises a concern about the quality or availability of support and supervision at a particular setting or whether there’s evidence of discrimination or victimisation. If there is such evidence we may need to take some additional action, such as sharing information with other regulators or employers.
- Download
- Email Page
- Last Updated: 14/04/2021
The guidance in our library, needs to be read alongside our NMC Guidance during the Covid-19 emergency period. We have new rules that are in force during the period of the coronavirus emergency that are relevant to how it applies.
Want to download and print whole sections of this FtP library? Visit the downloads page.
FtP library
-
Understanding Fitness to Practise
- Aims and principles for fitness to practise
- Allegations we consider
- How we determine seriousness
- Why we screen cases
- When we use interim orders
- Investigations
- Examining cases
- How we manage cases
- Meetings and hearings
- Resolving cases by agreement
- What sanctions are and when we might use them
-
Taking account of context
- Taking account of context - overview
- 1: We’ll approach cases on the basis that most people referred to us are normally safe
- 2: We’ll seek to build an accurate picture about the nurse, midwife or nursing associate’s practising history
- 3: We’ll always carefully consider evidence of discrimination, victimisation, bullying or harassment
- 4: Where risks are caused by system and process failures, we’ll concentrate on the action we can take to help resolve the underlying issues
- 5: In cases where a nurse, midwife or nursing associate was required to use their professional judgement we’ll respond proportionately
- 6: We’ll look for evidence of remediation where a serious concern was caused by a gap in knowledge or training or personal context factors
- 7: We’ll always look into whether group norms or culture influenced an individual’s behaviour before taking action
- 8: Where an incident has occurred because of cultural problems, we’ll concentrate on taking action to minimise the risk of the same thing happening again
- What context factors we think are important to know about when considering a case
- Remediation and insight
-
Screening
-
The four stages of our screening decision
- The four stages of our screening decision - overview
- Stage one: Determine if the concern is serious enough to affect fitness to practise
- Stage two: Check it meets our formal requirements
- Stage three: Check whether we can obtain credible evidence
- Stage four: Check for evidence of remediation
- Cases not referred for further investigation
- Determining the regulatory concern
- Screening incorrect or fraudulent entry cases
-
The four stages of our screening decision
- Interim Orders
- Investigations
- Case Examiners
- Preparing for the FtP Committee
-
Case management
- Hearing fitness to practise allegations together
- Telephone conferences
- Preliminary meetings
- Dealing with cases at hearings or meetings
- Voluntary removal
- Cancelling hearings
- Constitution of panels
- Proceeding with hearings when the nurse, midwife or nursing associate is absent
- Case management during hearings
- Hearings in private and in public
- When we postpone or adjourn hearings
- FtP Committee decision making
- Sanctions
-
Reviews
- Reviewing case examiner decisions
- Interim order reviews
-
Substantive order reviews
- Substantive order reviews - overview
- Standard reviews before expiry
- Early review
- Exceptional cases: changing orders with immediate effect at a standard review
- Review of striking-off orders
- New allegations
- Reviewing orders when there may have been a breach
- Reviews where an interim order is in place
- Allowing orders to expire when a nurse or midwife’s registration will lapse
- Appeals and restoration