What to Do If Your Employer Refers You to the NMC

Why Employers Refer Nurses and Midwives to the NMC

Employers — including NHS Trusts, private hospitals, and care organisations — have a duty to refer a registered nurse or midwife to the NMC when they believe there is a risk to patient safety or when the registrant's conduct or competence may amount to a fitness to practise concern. Common reasons for employer referrals include:

• A serious patient safety incident or clinical error
• Allegations of misconduct — including dishonesty, inappropriate behaviour, or boundary violations
• Competence concerns identified through capability or performance management processes
• A criminal conviction or caution
• Health concerns that have affected safe practice
• Gross misconduct findings in a disciplinary process

An employer is not required to wait until their own disciplinary process is complete before making a referral — they can refer at any point where they believe the NMC threshold is met.

The NMC and Employment Processes: Understanding the Difference

Two separate processes may run at the same time when an employer refers you to the NMC. It is essential to understand that they are independent of each other and can reach different outcomes.

• Your employer's disciplinary process is governed by employment law and your contract. Its outcomes — including dismissal — are employment outcomes, not regulatory findings. Being dismissed by your employer does not automatically mean your NMC registration will be affected.
• The NMC fitness to practise investigation is a regulatory process governed by the Nursing and Midwifery Order 2001. Its purpose is to protect the public, not to punish you as an employee. The NMC makes its own independent assessment of the evidence and is not bound by your employer's findings.

Your Immediate Steps After an Employer NMC Referral

Your first call should be to your professional defence organisation — the Royal College of Nursing (RCN), Unite, or your professional indemnity insurer. Do not respond to the NMC or your employer about the referral until you have their advice. These organisations have specialist expertise in NMC proceedings and their involvement from day one is critical.

When the NMC contacts you about the referral, you will typically be given the opportunity to provide a written response to the concerns. This is an important document. A response that is defensive, minimises the concern, or is inconsistent with the evidence the NMC holds can damage your position significantly. Prepare it carefully with your defence organisation's support — never respond spontaneously or under time pressure.

From the moment you become aware of the referral, keep a careful written record of all communications with your employer, the NMC, colleagues, and your defence organisation. Note dates, times, and the substance of any conversations. Preserve any documents, emails, or messages that may be relevant. Do not delete anything.

Whatever the outcome of your employer's disciplinary process, the NMC will assess whether you have taken genuine steps to address the concern that gave rise to the referral. Starting a remediation record early — including accredited CPD relevant to the concern, a reflective log, and any supervision arrangements — gives you the best opportunity to demonstrate genuine professional engagement before any NMC hearing or Case Examiner decision.

Panels and Case Examiners consistently distinguish between registrants who began engaging with remediation as soon as they were aware of a concern and those who assembled evidence shortly before a hearing. Early remediation carries significantly more weight.

If your employer's disciplinary process is still ongoing, be aware that anything you say or admit in that process may be disclosed to the NMC. Seek employment law advice in parallel with your NMC defence advice. The two sets of advisers need to be aware of each other's involvement and aligned in how they approach the overlapping processes.

What Happens After the NMC Receives an Employer Referral

Once the NMC receives a referral from your employer, it follows its standard fitness to practise screening and investigation process. The referral is assessed against the threshold for investigation. If the threshold is met, a formal investigation is opened, evidence is gathered, and the case proceeds through the NMC's standard stages — potentially to a Case Examiner decision or, in more serious cases, a Fitness to Practise Committee hearing.

For a full explanation of each stage, see our guide to the fitness to practise investigation process. The NMC follows a closely comparable process to the GMC.