Employers are expected to follow certain procedures during the recruitment process and throughout a nurse, midwife or nursing associate’s employment to ensure better and safer care for patients. 

New employees

New employees should have:

  • a thorough induction into their area of work
  • training and supervision where necessary
  • preceptorship* and mentoring (especially for newly qualified staff)
  • ongoing access to professional development
  • clinical supervision.

*Preceptorship is a period of support for people who have joined the register to help their transition from student to qualified nurse or midwife.

Professional indemnity arrangements

From 17 July 2014, the Health Care and Associated Professions (Indemnity Arrangements) Act (2014) requires all nurses, midwives and nursing associates to have in place an appropriate professional indemnity arrangement. This should reflect the risks associated with the scope of their practice and provide sufficient cover if a successful claim is made against them.

Read more information on professional indemnity arrangements

Vetting and barring

The sections in the Safeguarding Vulnerable Groups Act 2006 that prohibit individuals from working with children and vulnerable adults, has been in effect since October 2009. These sections cover a much wider range of workplaces.

The management of the different lists of barred individuals is centralised and run by the Disclosure and Barring Service in England, Wales and Northern Ireland, and by Disclosure Scotland.

You must check that anyone you employ is not on the barred lists. It is a criminal offence to knowingly let a barred individual work with vulnerable groups.


  • Always make sure that you receive at least two professional references from an applicant’s last place of work as a nurse or midwife.
  • Be sure to follow up on references too – contact referees yourself rather than relying on any written statements supplied to you by the job applicant.
  • Don’t let a person start work until you have verified their references – if you really cannot afford to wait for references to be confirmed in writing, at least obtain verbal assurances over the phone until the paperwork comes through.

Identity checks

As part of your background checks before employment, you should ask to see proofs of identity and address. Proof of identity should be photographic, for example a passport, photo driving license, or EU or EEA national identity card. Proof of address might include a recent bank statement, utility bill or council tax bill.

You should not employ someone if you are uncertain of their identity, and you should contact us immediately if you believe someone is fraudulently using a nurse or midwife's identity or registration details.

Performance and appraisals

You have a responsibility to recognise and reinforce good performance and to take steps to identify and deal with poor performance. All employees should receive regular performance appraisals (at least annually), during which their training needs should be identified.

You are responsible for the skills and knowledge levels of your staff.

In cases where a nurse, midwife or nursing associate admits to practising beyond their capabilities, resulting in errors or harm, employers will still be held responsible for failing to ensure the employee has the appropriate skills and knowledge.

If a nurse, midwife or nursing associate accepts responsibility for practice which is deemed to be beyond their capability and which has resulted in errors in practice, both the employee and employer are accountable: the employee for failing to acknowledge their limitations, and the employer for failing to ensure that the employee has the appropriate skills and knowledge.

Managing an employee’s fitness to practise

We recognise that many minor incidents are better dealt with by employers at a local level. You may need to discipline a nurse, midwife or nursing associate through your own employment procedures, or provide further training. Depending on the severity of the incident, our involvement is not always necessary.

Evidence of insight into the concerns and a willingness to take steps to address the issues are important factors to consider. If there is no patient safety issues and you know you can help the individual to improve and practise safely, take all steps to do so.

If you do manage a concern locally, you should monitor the situation and review the position if there is a change in circumstances. If you manage a case of poor performance or ill health, and are not sure that the concerns can be adequately dealt with under your own procedures, you can seek advice from our Employer Link Service. The service can provide employers with advice on individual referrals as well as NMC referral thresholds and the information we need for any subsequent investigation.