Corr, Alison
(2025)
Midwives’ experiences following the conclusion of a Nursing and Midwifery Council Fitness to Practise Referral: a phenomenological study.
PhD thesis, University of Nottingham.
Abstract
Background:
The Nursing and Midwifery Council (NMC) is an independent regulatory organisation which dictates the standards for practice and education for midwives, and undertakes fitness to practise (FtP) investigations when concerns are raised regarding a midwife’s practice or conduct. Yet, institutions that monitor health and social care regulators in the UK have criticised the NMC’s own practices, condemning the length of time taken to conclude referrals. Concerns have also been raised regarding the possible effects an FtP referral could have on registrants’ health and well-being, however this has not been researched.
The poor health and well-being of UK midwives in general has been evidenced. Midwifery is recognised as a stressful occupation due to the emotional intensity of the role and high workload. Midwives suffer high levels of stress, depression, anxiety, personal and work-related burnout. It is therefore possible that midwives are already emotionally vulnerable when entering the FtP process, with the potential for levels of stress to increase when experiencing an FtP investigation. This raises concerns regarding the effects of the FtP process on midwives and the resultant consequences on the care they provide.
Aims:
The aim of the research was to examine midwives’ experiences following the conclusion of an NMC FtP referral. Particular focus was given to influences on midwives’ experiences, to inform recommendations for improving the FtP process and to improve support midwives receive throughout the FtP process and following its conclusion.
Study design:
A scoping review was completed to assess the existing research on healthcare professionals’ experiences of professional investigations. Empirical research was then undertaken with a philosophical lens of standpoint feminism and a hermeneutic phenomenological methodology. Fourteen semi-structured interviews were conducted. A purposive sample of midwives who had been referred to the NMC FtP process and received the conclusion between 2016 and 2021 were included.
Findings:
Theories of belonging were employed to discuss the findings, as the research found that an FtP referral can affect a midwife’s sense of belonging. Belonging was affected by the FtP referral questioning the midwife’s identity and an accumulation of trauma experienced through the FtP process. The FtP process also required midwives to undertake additional emotion work beyond that involved in the midwife’s role, causing further stress. The research found midwives felt powerless in their relationship with the NMC and the FtP process. This lack of trust in the NMC and the negative impacts of the FtP process on the midwife, led midwives to interpret the support they received, or did not receive, through the lens of trauma, affecting how they engaged with support.
Recommendations:
Reducing the length of time the NMC take to conclude an FtP referral would assist in alleviating the distress experienced by midwives during the process. Midwives should be treated with compassion and empathy by the NMC, recognising the distress a midwife may be experiencing during and following an FtP referral. A support programme for midwives following the conclusion of an FtP referral should be introduced, with the aim of supporting their well-being. More education should be provided to qualified midwives and student midwives, by the NMC and pre-registration institutions, to inform them of the role of the NMC, the FtP process and how to seek support. Research should be undertaken into whether the changes the NMC have introduced to the FtP process since the conclusion of this research have improved the midwives’ experience, as well as more focused research into the experiences of registrants from an ethnic minority.
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