A constructivist grounded theory study: employers' perspective of the factors that contribute towards a decision to refer an early career nurse to the nursing midwifery council’s fitness to practise committee

The Nursing Midwifery Council Fitness to Practise Committee role is to screen allegations of impaired fitness to practise to determine whether there is likely to be a cause for concern, and investigate those where there may be a case to answer. In 2018, the NMC received 5,509 new concerns, an increase of one % from 2016/17 (NMC, 2018). The total number of concerns received represent approximately 0.8 % of registered nurses and midwives; a number of referrals in England were registrants who had been registered for five years or less. This must be a concern to the profession because early career referral rates potentially reflect on standards of pre-registration education, early post registration career progression, and have implications for public protection. This qualitative research study explained the factors that preceded the referral of an early career nurse to the professional regulator from the perspective of employers. A constructivist grounded theory approach was used. Semi-structured interviews were conducted with 20 healthcare employers in different regions of England across all the fields of nursing practice. The findings highlighted four categories: alarm bells; wanted and unwanted characteristics and values in nurses; a chain of expectations; and situational stressors and health needs. A core category emerged regarding employers’ decision to refer early career nurses to the professional regulator based on a combination of factors; i) the employer’s responsibility of public safety; ii) the employers perceptions of values and expectations of the nurse; iii) the early career nurse’s risk of exposing their professional vulnerability. It is recommended that the employer and employee learn from errors in partnership, taking into consideration patterns of behaviour, work-life balance, health and well-being. Educational strategies are needed to support early career nurse’s resilience and transition into the profession and the workplace. A theoretical model and self-assessment checklist has been recommended for employers and registered professionals which may help to identify practitioners at risk of referral to the professional regulator. This requires piloting and testing in a future study