LAUSR

Abstract Background Losing or keeping registration following a complaint about clinical performance is often based on ability to demonstrate insight. Clear descriptions about the behaviours that manifest as insight are missing from the regulatory literature. Methods To identify and describe the elements of insight present or absent in case files where the registrant is the subject of a complaint about nursing/midwifery performance, 712 complaint files from a regulatory authority were analysed for content. Key descriptive elements of 148 files were then thematically analysed. Findings Key elements of insight included: ownership of/taking responsibility for the incident; reflection on/analysis of the incident; reflection on/analysis of their mental and/or physical state; analysis of the context in which the incident occurred; recognition of own failures/mistakes; expressions of remorse or regret; improvement through education; describing what they would do differently next time; and seeking out counselling/mentorship. Key elements that raised concern included where the registrant: did not understand the issue; took no personal responsibility; made excuses for why the error/incident had occurred; made no attempt to change; and was non-compliant with improvement strategies. The critical differences between the positive attributes of insight and those behaviours demonstrating lack of insight are ownership of the event and action on reflection.