Background: Nursing and midwifery academics have multiple responsibilities, including developing curricula that promote public safety and ethical practice. Effective governance processes are required to help academics manage students who pose a risk to public safety. However, the pressure to increase graduate numbers and prioritise student-centred approaches can pose challenges. Aim: To discuss the challenges facing Australian nursing and midwifery academics who endeavour to optimise the number of successful graduates whilst fulfilling their legislative duty to identify and manage students who may pose a risk to public safety. Methods: A case study approach is used to gain insight into implementing governance processes that maintain quality, safety, and public safety in nursing and midwifery education and training programs. Discussion and conclusions: Academics must understand their responsibilities, including the need for transparency in accessibility and equity policies. Awareness of the definition of impairment and the provision of reasonable adjustments as defined by the Australian Health Practitioner Regulation Agency are vital to support students in making informed career choices.