Fitness to Practice: Meeting the Professional Standards in Nursing

It is essential that nurses must practice to the highest of standards and that entails following the most updated guidelines, recommendations, and using the best available evidence when providing care to patients. On top of that, nurses also need to act in a professional manner at all times especially when it comes to situations that involve the representation of one’s registration such as giving health advices, performing clinical procedures and assessing patients. In addition, nurses must also be law abiding citizens which everybody is expected to be as well. All of these are important for fitness to practice.

So what is fitness to practice? According to the Health & Care Professionals Council (HCPC) (2019), it means that “a registrant has the skills, knowledge, character and health to practise safely and effectively”. In other words, being fit to perform the tasks under one’s registration or profession. That also includes observing the most recent of the practice standards, implementing care that is evidence-based, promoting professionalism and trust and be law abiding. Nurses also are registered under a professional body in which they are then expected to uphold its standards.

In the United Kingdom, nurses have to register to the Nursing and Midwifery Council (NMC) in order to practice as a registered nurse. Once registered, it is expected that one must uphold to the NMC Code which consists of statements that serve as the standards to which nurses must follow.

When a nurse falls short in practice and a referral to the NMC takes place, they will undergo a fitness to practice process in which they will be assessed if whether they failed to observe the NMC Code at some point in their practice. The NMC Code as of this writing was updated on the 10th of October 2018 to reflect the responsibilities of the nursing associates. The NMC Code contains four themes:

· Prioritise People

· Practice Effectively

· Preserve Safety, and

· Promote Professionalism and Trust.

Prioritise People

Nurses must always put people first and must continuously place the patients at the centre of their care. This includes promoting a person-centred care approach and treating the patients with utter dignity and respect. The care delivered must be designed to a system that is tailored according to patient’s needs. Patients must be involved in the decision making and in the formulation of care goals, listening to what they want to achieve from the care and service received. They should be able to decide on the basis of informed decisions, meaning that patients must be educated and informed of the possible options to choose rather than for clinicians to just decide for them. In a nutshell, delivering care must always be in the best interest of patients.

Practice Effectively

Nurses must practice in an effective manner. Morgan (1997) defines clinical effectiveness as providing the best possible care option for the circumstances in which it is given. How nurses practice should always be according to the best available evidence and this can be done by adhering to the most recent care standards and guidelines, following hospital Trust policies and making sure that the nursing professional is trained and competent in performing the various nurse-related tasks (e.g. clinical procedures, communication skills, documentation and etc.). Nurses are accountable for their decisions that’s why it is very important that they be knowledgeable and skilful in practice by being updated with trainings, communicating clearly, being competent, evidence-based and by making sure that documentations are accurate, complete, and follows all the principles of good record-keeping.

Preserve Safety

Nursing practice should always be centred around patient safety. Everything that nurses do should always be in promoting safety. Patients should be ensured that they are in safe hands in the care they receive thus nurses must act without delay if patients are at risk to safety or public protection and must offer help in cases of emergency (NMC, 2018). In addition, nurses must also be cognizant of their scope, capabilities and the limits of their competence. If a concern needs to be raised, this must be done immediately to safeguard those who are at risk and those who need the protection.

Promote Professionalism and Trust

Having a registration that’s recognised under a professional body such as the NMC, nurses must do whatever it takes to protect this. This involves being professional by fulfilling all the requirements of what a professional is. Being professional is a broad discussion in itself but a few things that speaks of what professionalism is in nursing is by making sure that patient information is kept confidential, being honest, and exhibiting an appropriate attitude and behaviour. Nursing is a regulated profession and the registered nurse (RGN) is a protected title, thus nurses must avoid any involvement of professional misconduct.

The Fitness to Practice Process

According to Barker (2014), if an allegation or referral for a nurse took place because of a complaint to the NMC, a screening process will be done. This is to determine if there is a case to investigate and the one being referred to is really registered with the NMC (or professional body when speaking in general). Once all the screening checks are satisfied, an investigation follows. The case will then be discussed in a hearing. Depending on the findings of the investigation and the evidence presented, the committee will decide if the case will be closed or sanctions have to be made. This is now the adjudication stage, wherein the committee will determine the final course of action depending on the outcome of the hearing.

Figure 1: Fitness to Practice Process

According to the NMC (2019), the Fitness to Practice Committee will impose on sanctions to a nurse, midwife or nursing associate when needed in order to protect the public, maintain public confidence in the professions and the NMC, declare and uphold proper standards of conduct and performance. Sanctions can either be as follows:

· Caution Order – this is like a warning and the professional can still practice. However, a caution order will appear on the registrant’s record usually for a certain period where it then gets reviewed.

· Conditions of practice order – as the statement says, it is “conditional”, meaning there will be restrictions in practice such as not being allowed to perform specific clinical tasks.

· Suspension order – the professional won’t be allowed to practice within a specified length of time.

· Striking-off order – the professional will be removed from the register and therefore will not be able to practice.

Being a prudent nurse

It is significant that nurses should exercise good judgement and be compliant with practice standards all the time. The nursing profession carries with it an enormous amount of responsibility. The accountability attached to it is also wide-ranging. Nurses must ensure that the best of care is provided to their patients by utilising an evidence-based approach and adhering to the accepted care guidelines and standards. Also, nurses must recognise the limits of their competence and work within their scope. They must do everything that they can to update themselves through trainings and be compliant with the requirements of the professional body (the NMC). In a fitness to practice process, a nurse will be assessed if whether there has been some violations in the Code and if he / she was able to function as what a prudent nurse should be. It is therefore important for nursing professionals to be knowledgeable with the NMC Code and comprehend this by heart so that in day to day’s work, the nurse can be reminded of being fit to practice.

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Reference List:

Barker, J. (2014) ‘What to do if you are referred to the NMC’, Nursing times (1987). England: Macmillan Publishing Ltd, 110(17), p. 10. Available at: https://cdn.ps.emap.com/wp-content/uploads/sites/3/2014/04/230414-What-to-do-if-you-are-referred-to-the-NMC.pdf

Health & Care Professionals Council, 2019. The Fitness To Practise Process: Information For Employers And Managers. [online] Hpc-uk.org. Available at: <http://www.hpc-uk.org/globalassets/resources/the-fitness-to-practise-process---information-for-employers-and-managers.pdf> [Accessed 4 October 2020].

Morgan, E., 1997. Clinical effectiveness. Nursing Standard, [online] 11(34), pp.43-50. Available at: <https://journals-rcni-com.libezproxy.open.ac.uk/doi/full/10.7748/ns.11.34.43.s47> [Accessed 4 October 2020].

Nursing & Midwifery Council. (2018). The code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. Available from http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf

Nursing & Midwifery Council, 2019. Sanctions We Can Impose. [online] Nmc.org.uk. Available at: <https://www.nmc.org.uk/concerns-nurses-midwives/hearings/sanctions-info/> [Accessed 4 October 2020].