title: Understanding pre-registration nursing fitness to practise processes.
abstract: BACKGROUND
  Protection of the public is a key aspect of pre-registration nursing education and UK Nursing and Midwifery Council monitoring processes. Universities must ensure that nursing students are "fit to practise" both during their programme and at the point of registration. However, current evidence suggests that institutional fitness to practise policies and processes can be inconsistent, lacking in clarity, and open to legal challenge.
  
  
  OBJECTIVE
  To examine fitness to practise processes in pre-registration nursing programmes in Scotland.
  
  
  METHODS
  Academic personnel (n=11) with key roles in fitness to practise processes in nine of the eleven Scottish universities providing pre-registration nursing programmes.
  
  
  METHODS
  Semi-structured qualitative interviews were conducted with eleven academics with responsibility for fitness to practise processes in pre-registration programmes. The qualitative data and documentary evidence including institutional policies and processes were thematically analysed.
  
  
  RESULTS
  In this paper, we focus on illuminating the key theme of Stages and Thresholds in Fitness to Practise processes i.e. Pre-fitness to practise, Stage 1, Stage 2, and Appeal, along with two thresholds (between Pre-fitness to practise and Stage 1; between Stage 1 and Stage 2.
  
  
  CONCLUSIONS
  Diverse fitness to practise processes are currently in place for Scottish pre-registration nursing students. These processes draw on a shared set of principles but are couched in different terminology and vary according to their location within different university structures. Nevertheless, universities appear to be confronting broadly similar issues around ensuring fitness to practise and are building a body of expertise in this area. Examples of good practice are identified and include the use of staged processes and graduated outcomes, the incorporation of teaching about fitness to practise into nursing programmes, positive attitudes around health and disability, and collaborative decision making. Areas of challenge include systems for student support and consistent, equitable, and auditable fitness to practise processes.
authors.affiliation: School of Health in Social Science, The University of Edinburgh, Old Medical Quad, Teviot Place, Edinburgh EH8 9AG, UK. Electronic address: Jessica.MacLaren@ed.ac.uk.
authors.forename: Jessica
authors.initials: J
authors.lastname: MacLaren
authors.affiliation: School of Health in Social Science, The University of Edinburgh, Old Medical Quad, Teviot Place, Edinburgh EH8 9AG, UK. Electronic address: E.A.Haycock-Stuart@ed.ac.uk.
authors.forename: Elaine
authors.initials: E
authors.lastname: Haycock-Stuart
authors.affiliation: School of Health Nursing and Midwifery, University of the West of Scotland, Paisley PA1 2BE, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: McLachlan
authors.affiliation: School of Health Nursing and Midwifery, University of the West of Scotland, Paisley PA1 2BE, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: James
mesh_terms: D004506:Education, Nursing; D015402:Nursing Education Research; D013338:Students, Nursing; D006113:United Kingdom
keywords: Education; Fitness to practise; Nursing; Professional regulation; Qualitative studies; Students