A self regulating profession, such as nursing, has to have in place systems which deal with practitioners considered unfit to practise. In addition, students studying to enter the profession may also be subject to systems to address concerns about their professional suitability. While the NMC have left it up to each Higher Education Institution (HEI) to identify the systems which should be in place for students, there is a body of case law and statutory legislation which governs how the NMC deals with fitness to practise amongst qualified nurses and midwives. This paper examines the content of fitness to practise policies in place across HEIs and compares this with how the regulator handles fitness to practise cases. Data was collected using unobtrusive methods and was analysed using content analysis. The results suggest that many HEI's policies have significant gaps which may result in challenges to decision making. In addition, the power of some Vice Chancellors to overturn fitness to practise decisions on appeals calls into question the whole notion of professional self regulation.