To examine the evidence of how poorly performing nurses and midwives are managed in the UK National Health Service (NHS).

Nurses and midwives form the largest clinical group in the NHS. There is little evidence, however, about poor performance and its management in nursing and midwifery literature.

The present study comprised a literature search, analysis of recent Nursing and Midwifery Council (NMC) data and observation at NMC fitness to practice hearings.

Nurses and midwives are the clinical groups most likely to be suspended in the NHS; Trusts do not report data on suspensions therefore no data exist on numbers, reasons for suspensions, managerial processes, gender, area of work, or ethnicity of those suspended; the few major research projects identify variable management practices, the significant financial cost to the NHS and the personal cost to those suspended; there is evidence that inexperienced, poorly trained, or poorly supported managers use suspension inappropriately. Our observation supported this.

There is a need for robust data gathering and research in the field of NHS managerial practice.

Managers should refrain from adopting punitive forms of performance management. Frontline staff and management need better training and support for dealing with poor performance.