I have been building a list of things I would like to have known when I was a chief nurse that I have learnt since joining the Nursing and Midwifery Council (NMC), to enable me to work with colleagues to influence improvements. Fitness to practise (FtP) is one area I have been considering.
The regulator of the NMC – the Professional Standards Authority (PSA) – requires the NMC to meet certain standards. This year, the NMC (2023a) shared the news that:
‘We haven't met standard 15, which focuses on how quickly we conclude FtP cases.’
With a current FtP caseload of 5577 – as published in the annual report (NMC, 2023b), 33% (1687) of referrals were from patients or the public and 26% (1323) from employers – there is a need for senior nurses to understand their role in supporting the processes to deliver the primary purpose of the NMC, which is to:
‘Promote and uphold the highest professional standards in nursing and midwifery to protect the public and inspire confidence in the professions.’
The NMC also needs to ensure that it regulates as progressively as possible, proactively supporting professions (NMC, 2023c). This aims to strike the right balance between investigating rare cases of poor practice and promoting excellent practice. Part of being person-centred means that impact on both the members of the public affected by referrals and the registrants who have been referred needs consideration.
Biggar et al (2023) highlighted growing concerns globally over the association between regulatory complaints processes and practitioner mental health and wellbeing. They undertook a study involving the Australian Health Practitioner Regulation Agency (Ahpra). Their research question was: What factors are associated with the distress of practitioners when involved in a regulatory complaints process? They wanted to identify potential strategies to minimise future risk of distress.
The study used semi-structured interviews, to hear first-hand experiences of the regulatory process, to understand if, and when, it caused distress. Themes from the interviews with practitioners were collated under factors contributing to distress, or protective factors.
Notable contributors to distress were:
- The ‘insult’ of the complaint itself
- Communication issues with Ahpra
- Time taken to close the complaint
- External factors and pre-existing conditions.
The major protective factors were:
- Support from family and friends
- Support from practitioner representatives and other health professionals
- Positive interactions with Ahpra.
The researchers' conclusion (Biggar et al, 2023), although recognising the role that health practitioner regulators are mandated to delivery in their duty to protect the public, argues that this does not preclude a simultaneous concern for the wellbeing of practitioners. The authors also concluded that there are elements of the regulatory complaints process that can be improved. Some contributors to practitioner distress require a system-wide, preventive approach, including addressing stigma and misinformation. A more compassionate approach to regulation, it was concluded, has the potential to improve the experience for all those involved and, ultimately, benefit patients, families, practitioners, and the global healthcare system.
Biggar et al (2023) identified that there were implications for policy, practice and wider research across other health practitioner regulators globally to help reduce systemic unintended impacts of regulation on a pressured and ever-diminishing workforce,
Although acknowledging that regulators must maintain their focus on protecting the public, Biggars et al (2023) went on to say that this must be tackled in a timely, fair and robust way to address risk to patients in a more nuanced and humane model of regulation, particularly in cases where there is a potentially high risk of distress or harm to practitioners facing a complaint, while maintaining quality and high standards of health care for all patients.
To support registrants who are currently referred, the NMC has partnered with CiC, a leading employee assistance provider, to offer a careline giving emotional support and practical help and advice to all nurses, midwives, and nursing associates during the FtP process. The careline counsellors are experienced in working with sensitive and personal information. They can also signpost colleagues towards specialist organisations to help with specific issues.
The outputs of the Australian study require consideration in the UK context while the NMC is considering a range of improvements to our current FtP processes.