Fitness to Practice within pre-registration nurse education - whose responsibility?

In the United Kingdom standards for pre-registration nurse education are set out by the professional nursing body, The Nursing & Midwifery Council who address what nursing students must do to achieve entry to the register. Their academic training is delivered by Higher Education Institution’s with Practice Learning partners acting as placement providers. Clinical practice is a fundamental aspect of pre-registration nurse education, with registered nurses acting as mentors, responsible for the assessment of competence which establishes a students’ fitness for practice. The academic institution awards a recognised qualification, the student then applies to join the professional register. This thesis is an examination of the perceived responsibilities between the symbiotic pre-registration nurse education partnership; professional body, academic institution and the practice setting when managing fitness to practice. The term fitness for practice and fitness to practice is an intermingled concept and remains an enigma with general definition and process defying clarity. This has resulted in confusion and regionalised responsibility between the academic and practice partner. The aim of this study is to explore how fitness to practice is perceived and managed between the three-way partnership and to explore the possible discourses of responsibility and ownership of nursing students. Through a qualitative single exploratory case study approach, themes have been built using a framework matrix of ownership, focus groups of academic and practice mentor participants, to scrutinise collaborative demarcations of fitness to practice management. By developing ‘The Ownership Gap’ three key themes were identified: Education, Clinical Practice and Professionalism. Through this model, the findings suggest that fitness to practice remains separated between process and responsibility between the academic and clinical partnership, coined as the ‘ownership gap’. The study offers recommendations to influence and enhance collaboration between the academic institution and practice to procedurally maintain fitness to practice processes. In conclusion, the study has shown that a gap in ownership exists between the partnership and that responsibility is a default of the academic institution.