These terrifying three words: A qualitative, mixed methods study of students' and mentors' understandings of ‘fitness to practise’

• The first multicentre study examining fitness to practise concerns of mentors and students.
• Students find developing an understanding of FtP challenging.
• Students perceive FtP as primarily punitive rather than a developmental process.
• Some students and mentors experience fear or anxiety about FtP.
• Mentors report communication about FtP can be difficult with some HEIs.

BackgroundThere is little empirical published research pertaining to fitness to practise and pre-registration nursing students. Much of the existing fitness to practise literature focuses on medical students and there is a preponderance of literature reviews and descriptive or discursive papers.ObjectivesThe multicentre study aimed to explore students' and mentor's understandings of fitness to practise processes in pre-registration nursing programmes.DesignA qualitative study in the interpretive paradigm with interpretive analysis involving 6 focus groups and 4 face-to-face interviews with nursing students and mentors.SettingEleven Higher Education Institutions providing pre-registration nursing education in the UK. Data were collected January 2014–March 2015 following ethical approval.ParticipantsPurposive sampling was used to recruit mentors and nursing (but not midwifery) students from pre-registration nursing programmes at different stages of educational preparation.MethodsQualitatively driven semi-structured focus groups (n = 6) and interviews (n = 4) were conducted with a total of 35 participants (17 pre-registration nursing students and 18 nursing mentors).ResultsThree themes identified from the student and mentor data are considered: Conceptualising Fitness to Practise; Good Health and Character; and Fear and Anxiety Surrounding Fitness to Practise Processes.ConclusionsUncertainty about understandings of fitness to practise contributed to a pervasive fear among students and reluctance among mentors to raise concerns about a student's fitness to practise. Both students and mentors expressed considerable anxiety and engaged in catastrophic thinking about fitness to practise processes. Higher Education Institutes should reinforce to students that they are fit to practise the majority of the time and reduce the negative emotional loading of fitness to practise processes and highlight learning opportunities.