Students' and Mentors' Understandings of Fitness to Practice Processes in Pre-Registration Nursing Programmes in Scotland: 'These Terrifying Three Words'.

The Purpose of the Project

This project was carried out in order to explore pre-registration nursing students’ and nursing mentors’ understandings of fitness to practise (FtP) processes in pre-registration nursing programmes in Scotland. The project builds on the findings of the previous SCEPRN/NES funded project “Identifying Good Practice in Fitness to Practise Processes in Higher Education Institutes in Scotland” (Haycock-Stuart et al., 2014). Ensuring the protection of the public through robust FtP processes is an important aspect of pre-registration nursing education and Nursing and Midwifery Council (NMC) monitoring processes. Through identifying key issues around students’ and mentors’ understandings of FtP processes, this timely project contributes to the development of a robust evidence base for pre-registration nursing FtP processes, provides guidance to HEIs around the development of FtP processes and teaching about FtP, and also highlights areas which require further research.

Methods

The review of the 2004-2014 literature conducted by Haycock-Stuart et al. (2014) was up-dated, revealing that there is little new literature to add to the original review, and FtP for pre-registration nursing students remains an under researched area. The project collected data through interviews and focus groups with nursing students and mentors based in HEIs and health boards across Scotland (n=38). Ethical approval was sought and obtained from the Principal Investigator’s HEI, and evidence of this supplied to all the institutions involved, appropriate approvals were also sought from the relevant health boards.

Interview and focus group data were thematically analysed, and issues were identified in three main areas: Conceptualising Fitness to Practise; Assessing and Evaluating FtP; and Improving FtP Processes. The findings of the project were used to develop seven recommendations to support the development of good practice in FtP processes, and the education of nursing students and mentors around FtP. A limitation of the study is that it did not reach data saturation. New themes emerged continuously throughout the period of data collection, and some themes were unique to particular groups of participants.

Findings and Conclusions

The findings of this inquiry highlight six key issues around nursing students’ and mentors’ understandings of FtP processes for pre-registration nursing students. These include:
1. Uncertainty and ambiguity about the concept of FtP, and FtP processes
2. High levels of fear and anxiety associated with FtP processes
3. A lack of understanding of pre-registration FtP as supporting students’ professional development
4. The need for improved communication between HEIs, mentors, and students
5. Uncertainty about disability rights, discriminatory attitudes and lack of support for reasonable adjustments
6. The role of students in raising concerns about other practitioners’ FtP.

This is a highly complex area, which touches upon a number of important related issues. The fact that the study did not reach data saturation highlights the breadth and the complexity of the topic under investigation, and the need for further inquiry in this area to develop a more comprehensive evidence base.

This report concludes that there are some significant issues around how well nursing students and mentors understand pre-registration FtP processes, as well as important related issues around disability discrimination and the role of students as whistle-blowers. There is an opportunity for HEIs to take positive action to better educate students and mentors about FtP processes, to reduce the high levels of anxiety and fear around FtP, to promote positive attitudes around disability, and to better educate and support students in acting as whistle-blowers.