Standards for Pre-Registration Nursing Education: Delivering Quality Care in the UK, Slides of Communication

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Standards for

pre-registration

nursing education

Contents

Section 1: Introduction

The term ‘pre-registration nursing education’ describes the programme that a nursing student in the United Kingdom undertakes in order to acquire the competencies needed to meet the criteria for registration with the Nursing and Midwifery Council (NMC). The standards set out below apply to the approval of all new pre-registration nursing programmes from September 2011.

This introduction aims to assist approved education institutions (AEIs) and their partner organisations understand the standards and how to meet them. It reviews briefly the background and context, and the location, design and delivery of programmes. You might find it helpful to begin by reading the Pre-registration nursing education: Explanation of terms. Throughout, you can access additional information by clicking on the blue hyperlinks.

Background and context

As the regulator of nurses and midwives in the UK, the mission of the NMC is to protect the public, as required by the Nursing and Midwifery Order 2001_._ We achieve this in various ways, primarily by:

• maintaining a register of nurses and midwives
• setting and maintaining standards of education, training and conduct
• ensuring that nurses and midwives keep their skills and knowledge up to date, and uphold the standards of their professional code
• ensuring that midwives are safe to practise by setting rules for their practice and supervision
• providingmandatory guidance and additional advice to people designing and developing education programmes.

Nursing education across the UK is responding to changing needs, developments, priorities and expectations in health and healthcare. Nurses who acquire the knowledge, skills and behaviors that meet our standards will be equipped to meet these present and future challenges, improve health and wellbeing and drive up standards and quality, working in a range of roles including practitioner, educator, leader and researcher. As autonomous practitioners, nurses will provide essential care to a very high standard and provide complex care using the best available evidence and technology where appropriate.

Our standards aim to enable nurses to give and support high quality care in rapidly changing environments. They reflect how future services are likely to be delivered, acknowledge future public health priorities and address the challenges of long-term conditions, an ageing population, and providing more care outside hospitals. Nurses must be equipped to lead, delegate, supervise and challenge other nurses and healthcare professionals. They must be able to develop practice, and promote and sustain change. As graduates they must be able to think analytically, use problem-

solving approaches and evidence in decision-making, keep up with technical advances and meet future expectations.

Professional values must underpin education as well as practice. All nurses and midwives are required to comply with The Code: Professional standards of practice and behaviour for nurses and midwives (NMC 20 15 ).

The Code is central to all education programmes, and educators must enable students to understand, commit to and uphold it.

The public can be confident that all new nurses will:

• deliver high quality essential care to all
• deliver complex care to service users in their field of practice
• act to safeguard the public, and be responsible and accountable for safe, person- centred, evidence-based nursing practice
• act with professionalism and integrity, and work within agreed professional, ethical and legal frameworks and processes to maintain and improve standards
• practise in a compassionate, respectful way, maintaining dignity and wellbeing and communicating effectively
• act on their understanding of how people’s lifestyles, environments and the location of care delivery influence their health and wellbeing
• seek out every opportunity to promote health and prevent illness
• work in partnership with other health and social care professionals and agencies, service users, carers and families ensuring that decisions about care are shared
• use leadership skills to supervise and manage others and contribute to planning, designing, delivering and improving future services.

Nurses must be able to meet all NMC requirements when they qualify and then maintain their knowledge and skills. Newly qualified nurses cannot be expected to have extensive clinical experience, specialist expertise, or highly developed supervision and leadership skills. Opportunities will be needed to develop these through preceptorship and ongoing professional development.

We are fully committed to promoting equality and diversity and this is reflected in the standards. Programme providers are reminded of the need to consider the learning needs of students with disabilities in both academic and practice settings.

Standards and requirements

We are required under the Nursing and Midwifery Order 2001 (the order) to establish standards – minimum requirements by which programme providers determine programme content, learning outcomes and assessment criteria. Our standards are

In the UK students qualify in a specific field of nursing practice and may apply to enter the NMC register as a nurse in one or more of four fields: adult, mental health, learning disabilities and children’s nursing. Those in the adult field must meet EU requirements for training in general care, including the definition of practice (annexe 1), which must include direct contact with service users across a range of client groups and clinical specialities. For consistency, we have also applied the EU requirements for minimum programme length and ratio of theory to practice to all four fields. New nurses will be expected to meet the essential mental and physical health needs of people of all ages and conditions, as well as in their own field of practice.

Our standards are normally reviewed every five years, but we will also continue to seek ongoing feedback from nurses, the public and other stakeholders to ensure that they remain fit for purpose. As ever, we will work closely with the four UK government health departments, and with those who commission education and provide health services, to ensure that our standards are, and remain, sound and meet expectations.

The standards for competence and standards for education are set out below. The standards for competence address what nursing students must do and achieve during their programme, while the standards for education concern the framework within which programmes must be delivered.

Standards for competence

The standards for competence in section 2 identify the knowledge, skills and attitudes the student must acquire by the end of the programme, as set out in the degree-level competency framework. This framework comprises four sets of competencies, one for each field of practice: adult, mental health, learning disabilities and children’s nursing. Each set comprises both generic competencies and field-specific competencies. The competencies are organised in four domains:

• professional values
• communication and interpersonal skills
• nursing practice and decision making
• leadership, management and team working.

The context in which the competencies are acquired in relation to the field of nursing defines the scope of professional practice at the point of registration.

Standards for education

The standards for education in section 3 comprise 10 standards for programme approval and delivery. They provide the framework within which programmes are delivered, and specify the requirements that all programmes must meet, including those relating to the teaching, learning and assessment of nursing students (see also Standards to support learning and assessment in practice (NMC 2008).

Nursing degrees

Our required minimum outcome award for a pre-registration nursing education programme is a degree in nursing. Degree-level registration underpins the level of practice needed for the future, and enables new nurses to work more closely and effectively with other professionals. The intellectual, professional, academic and practical competencies that nursing graduates must acquire are informed by the European Tuning project (2009, 3.2). The programme must also provide the programme hours specified in Directive 2005/36/EC and be at least equal to a first cycle (end of cycle) qualification of the European Higher Education Area (EHEA).

The institution that offers the programme makes the award and determines the title of the degree. It also decides whether to offer programmes at a higher academic level.

Length of programme

The programme can be no less than three years and must consist of at least 4,600 hours. There is no maximum time limit within which the programme must be completed. Responsibility for the management of course completion timescales rests with the AEI. The absence of maximum time limits does not have any impact on the level of proficiency required to complete a programme and be admitted to the register. Entry to the register is still subject to the individual meeting all of the proficiencies within the relevant education standards and the completion of their education programme. The AEI will still be responsible for confirming that the individual is fit and proper for admission to the register.

Some students may have previous relevant learning, including formal certificated learning such as an access course or another degree, or practice-based learning that was part of another course or gained through paid or voluntary work. Evidence of this learning may contribute to meeting some programme requirements, assessed through the AEI’s own accreditation of prior learning (APL) process. Up to a maximum of 50 percent of the programme can be accredited in this way.

Location of programmes

Programmes are offered by AEIs across the UK. Sufficient learning opportunities must be provided to achieve the expected programme outcomes. Learning may take place in diverse environments in different, often widely spread locations, in a range of settings in the National Health Service (NHS) and elsewhere in the public, independent and voluntary sectors. Some aspects of the programme might be undertaken outside the UK for up to six months (or 17.5 percent) of the programme.

Every student who steps off the programme before completion will receive a transcript of training giving details of learning achievements in theory and practice. This may lead directly to an alternative academic or vocational award, or it may contribute to a future award. The transcript may also be helpful to students transferring from one AEI to another, rejoining a programme after a break, when starting afresh, or be used to access employment opportunities. Approval and monitoring of AEIs

AEIs and their partner practice learning providers are required to meet these standards and requirements in all UK pre-registration nursing programmes. Their performance in programme development and delivery will be measured against the standards through our quality assurance processes.

We ensure that programmes meet our standards through a robust procedure known as approval. Programmes are normally approved for up to five years. We check compliance before allowing the programme to run, following which it is subject to NMC monitoring.

Direct links should be made between what is assessed in practice and academic settings, with the processes overseen by external examiners to ensure that theory and practice remain integrated. The assessment of theory and practice learning is given equal weighting. AEIs will use a range of assessment methods to meet the programme’s academic requirements, including projects, essays, portfolios, assignments, formal tests and examinations.

We encourage innovative ways of achieving practice learning outcomes and enable flexibility in who can support and assess nursing students in practice settings, while maintaining continuity through the use of the nurse mentor system.

A nurse mentor who has completed specific preparation in assessing students is normally responsible for ongoing supervision and assessment in practice settings and in simulation. Other registered professionals who have been suitably prepared can supervise and contribute towards the assessment of nursing students. During a period of at least 12 weeks practice learning towards the end of the programme, a sign-off mentor (a nurse mentor who has met additional criteria), who is registered in the field of practice that the student intends to enter, makes a final judgement of competence (see Standards to support learning and assessment in practice (NMC 2008)). The evidence must show that the student is safe and effective in practice at the end of the programme.

Section 2: Standards for competence

Context

Competence is a requirement for entry to the NMC register. It is a holistic concept that may be defined as “the combination of skills, knowledge and attitudes, values and technical abilities that underpin safe and effective nursing practice and interventions” (adapted from Queensland Nursing Council 2009).

The standards in this section relate to the competence required of all nursing students at the end of their pre-registration nursing programme, when they are at the point of registration. The standards have been informed by the Royal College of Nursing definition of nursing as “the use of clinical judgement in the provision of care to enable people to improve, maintain or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability until death” (Royal College of Nursing 2003).

The standards have also been informed by the European Tuning project (Tuning 2009), which adopted this definition of the nurse in 2003: “A professional person achieving a competent standard of practice at first cycle level following successful completion of an approved academic and practical course. The nurse is a safe, caring, and competent decision maker willing to accept personal and professional accountability for his/her actions and continuous learning. The nurse practises within a statutory framework and code of ethics delivering nursing practice (care) that is appropriately based on research, evidence and critical thinking that effectively responds to the needs of individual clients (patients) and diverse populations.”

The competency framework

The competency framework sets out the standards for competence and the related competencies that every nursing student must acquire before applying to be registered at first level on the nurses’ part of the register.

There are separate sets of competency requirements for each of the four fields of adult nursing, mental health nursing, learning disabilities nursing or children’s nursing. Each set is laid out under the following four domains:

1 professional values

2 communication and interpersonal skills

3 nursing practice and decision-making

4 leadership, managementand team working.

Each domain is comprised of a generic standard for competence and a field standard for competence. It also includes the generic competencies that all nurses must achieve and the field competencies to be achieved in each specific field. The number of field competencies varies in number in each domain and between nursing fields of practice.

Competencies for entry to the register: Adult nursing

Domain 1: Professional values

Generic standard for competence

All nurses must act first and foremost to care for and safeguard the public. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights. They must show professionalism and integrity and work within recognised professional, ethical and legal frameworks. They must work in partnership with other health and social care professionals and agencies, service users, their carers and families in all settings, including the community, ensuring that decisions about care are shared.

Field standard for competence

Adult nurses must also be able at all times to promote the rights, choices and wishes of all adults and, where appropriate, children and young people, paying particular attention to equality, diversity and the needs of an ageing population. They must be able to work in partnership to address people’s needs in all healthcare settings.

Competencies

1 All nurses must practise with confidence according to The Code: Professional standards of practice and behaviour for nurses and midwives (NMC 20 15 ), and within other recognised ethical and legal frameworks. They must be able to recognise and address ethical challenges relating to people’s choices and decision-making about their care, and act within the law to help them and their families and carers find acceptable solutions.

1.1 Adult nurses must understand and apply current legislation to all service users, paying special attention to the protection of vulnerable people, including those with complex needs arising from ageing, cognitive impairment, long-term conditions and those approaching the end of life.

2 All nurses must practise in a holistic, non-judgmental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognises and respects individual choice; and acknowledges diversity. Where necessary, they must challenge inequality, discrimination and exclusion from access to care.

3 All nurses must support and promote the health, wellbeing, rights and dignity of people, groups, communities and populations. These include people whose lives are affected by ill health, disability, ageing, death and dying. Nurses must understand how these activities influence public health.

4 All nurses must work in partnership with service users, carers, families, groups, communities and organisations. They must manage risk, and promote health and wellbeing while aiming to empower choices that promote self-care and safety.

5 All nurses must fully understand the nurse’s various roles, responsibilities and functions, and adapt their practice to meet the changing needs of people, groups, communities and populations.

6 All nurses must understand the roles and responsibilities of other health and social care professionals, and seek to work with them collaboratively for the benefit of all who need care.

7 All nurses must be responsible and accountable for keeping their knowledge and skills up to date through continuing professional development. They must aim to improve their performance and enhance the safety and quality of care through evaluation, supervision and appraisal.

8 All nurses must practise independently, recognising the limits of their competence and knowledge. They must reflect on these limits and seek advice from, or refer to, other professionals where necessary.

9 All nurses must appreciate the value of evidence in practice, be able to understand and appraise research, apply relevant theory and research findings to their work, and identify areas for further investigation.

5 All nurses must use therapeutic principles to engage, maintain and, where appropriate, disengage from professional caring relationships, and must always respect professional boundaries.

6 All nursesmust take every opportunity to encourage health-promoting behaviour through education, role modelling and effective communication.

7 All nurses must maintain accurate, clear and complete records, including the use of electronic formats, using appropriate and plain language.

8 All nurses must respect individual rights to confidentiality and keep information secure and confidential in accordance with the law and relevant ethical and regulatory frameworks, taking account of local protocols. They must also actively share personal information with others when the interests of safety and protection override the need for confidentiality.

Domain 3: Nursing practice and decision-making

Generic standard for competence

All nurses must practise autonomously, compassionately, skilfully and safely, and must maintain dignity and promote health and wellbeing. They must assess and meet the full range of essential physical and mental health needs of people of all ages who come into their care. Where necessary they must be able to provide safe and effective immediate care to all people prior to accessing or referring to specialist services irrespective of their field of practice. All nurses must also meet more complex and coexisting needs for people in their own nursing field of practice, in any setting including hospital, community and at home. All practice should be informed by the best available evidence and comply with local and national guidelines. Decision-making must be shared with service users, carers and families and informed by critical analysis of a full range of possible interventions, including the use of up-to-date technology. All nurses must also understand how behaviour, culture, socioeconomic and other factors, in the care environment and its location, can affect health, illness, health outcomes and public health priorities and take this into account in planning and delivering care.

Field standard for competence

Adult nurses must be able to carry out accurate assessment of people of all ages using appropriate diagnostic and decision-making skills. They must be able to provide effective care for service users and others in all settings. They must have in-depth understanding of and competence in medical and surgical nursing to respond to adults’ full range of health and dependency needs. They must be able to deliver care to meet essential and complex physical and mental health needs.

Competencies

1 All nurses must use up-to-date knowledge and evidence to assess, plan, deliver and evaluate care, communicate findings, influence change and promote health and best practice. They must make person-centred, evidence-based judgments and decisions, in partnership with others involved in the care process, to ensure high quality care. They must be able to recognise when the complexity of clinical decisions requires specialist knowledge and expertise, and consult or refer accordingly.

1.1 Adult nurses must be able to recognise and respond to the needs of all people who come into their care including babies, children and young people, pregnant and postnatal women, people with mental health problems, people with physical disabilities, people with learning disabilities, older people, and people with long term problems such as cognitive impairment.

2 All nurses must possess a broad knowledge of the structure and functions of the human body, and other relevant knowledge from the life, behavioural and social sciences as applied to health, ill health, disability, ageing and death. They must have an in-depth knowledge of common physical and mental health problems and treatments in their own field of practice, including co-morbidity and physiological and psychological vulnerability.

7.2 Adult nurses must understand the normal physiological and psychological processes of pregnancy and childbirth. They must work with the midwife and other professionals and agencies to provide basic nursing care to pregnant women and families during pregnancy and after childbirth. They must be able to respond safely and effectively in an emergency to safeguard the health of mother and baby.

8 All nurses must provide educational support, facilitation skills and therapeutic nursing interventions to optimise health and wellbeing. They must promote self- care and management whenever possible, helping people to make choices about their healthcare needs, involving families and carers where appropriate, to maximise their ability to care for themselves.

8.1 Adult nurses must work in partnership with people who have long-term conditions that require medical or surgical nursing, and their families and carers, to provide therapeutic nursing interventions, optimise health and wellbeing, facilitate choice and maximise self-care and self-management.

9 All nurses must be able to recognise when a person is at risk and in need of extra support and protection and take reasonable steps to protect them from abuse.

10 All nurses must evaluate their care to improve clinical decision-making, quality and outcomes, using a range of methods, amending the plan of care, where necessary, and communicating changes to others.

Domain 4: Leadership, management and team working

Generic standard for competence

All nurses must be professionally accountable and use clinical governance processes to maintain and improve nursing practice and standards of healthcare. They must be able to respond autonomously and confidently to planned and uncertain situations, managing themselves and others effectively. They must create and maximise opportunities to improve services. They must also demonstrate the potential to develop further management and leadership skills during their period of preceptorship and beyond.

Field standard for competence

Adult nurses must be able to provide leadership in managing adult nursing care, understand and coordinate interprofessional care when needed, and liaise with specialist teams. They must be adaptable and flexible, and able to take the lead in responding to the needs of people of all ages in a variety of circumstances, including situations where immediate or urgent care is needed. They must recognise their leadership role in disaster management, major incidents and public health emergencies, and respond appropriately according to their levels of competence.

Competencies

1 All nurses must act as change agents and provide leadership through quality improvement and service development to enhance people’s wellbeing and experiences of healthcare.

2 All nurses must systematically evaluate care and ensure that they and others use the findings to help improve people’s experience and care outcomes and to shape future services.

3 All nurses must be able to identify priorities and manage time and resources effectively to ensure the quality of care is maintained or enhanced.

4 All nurses must be self-aware and recognise how their own values, principles and assumptions may affect their practice. They must maintain their own personal and professional development, learning from experience, through supervision, feedback, reflection and evaluation.

5 All nurses must facilitate nursing students and others to develop their competence, using a range of professional and personal development skills.

6 All nurses must work independently as well as in teams. They must be able to take the lead in coordinating, delegating and supervising care safely, managing risk and remaining accountable for the care given.