Midwifery Council Standards Research Articles

Impact of the Nursing and Midwifery Council (2018) future nurse: Standards of proficiency for registered nurses on children's nursing curriculum – A cross-sectional study

BackgroundStudent nurses in the United Kingdom undertake field-specific pre-registration education. The implementation of the Nursing and Midwifery Council (2018) Future nurse: Standards of proficiency for registered nurses, has raised concerns that the increasingly generic component of pre-registration programmes is not adequately preparing newly qualified children's nurses to care for children safely. ObjectiveTo investigate how the introduction of the Nursing and Midwifery Council standards in the United Kingdom has impacted the structure and field specific content of pre-registration children's nursing programmes. SettingsAn online survey completed by 54 programmes, field, or professional leads linked to 76 pre-registration children's nursing programmes. This represents 80 % of higher education institutions with Nursing and Midwifery Council approved pre-registration children's nursing programmes across all four United Kingdom countries. MethodsA survey to capture the current content and changes to curricula since the introduction of the Nursing and Midwifery Council (2018) Future nurse standards. The survey included closed-ended and open-ended questions. Closed-ended questions were statistically analysed using SPSS v.28 for Windows. Open-ended questions were thematically analysed using Quircos v.2.1. Results50 % of respondents reported changes to theoretical content. In 27 programmes (35.5 %) there was a decrease in child-specific content. Child specific teaching methods accounted for less than 30 % of the content of all programmes whereas cross-field teaching methods (Adult, Mental Health, Learning Disability and Child learners together) accounted for over 70 % of the taught content. Analysis of qualitative data identified three themes: genericism as the focus, the challenge to achieve the standards' proficiencies, and dilution of child specific content. ConclusionsThe survey responses show disparities in how United Kingdom higher education institutions have interpreted the Nursing and Midwifery Council standards highlighting academics concerns on the growing genericism within pre-registration children's nurse education nationally. These findings will inform the next stage of the project comparing the impact of greater or lesser degrees of genericism on the outcomes of the programme for newly qualified children's nurses.

Protecting the integrity of children and young people's nursing as a distinct field of practice.

At certain points in nursing history, it has been necessary to make a case for children and young people to be cared for by specialist nurses educated to meet their specific needs. However, in 2018 the updated Nursing and Midwifery Council (NMC) standards of proficiency for registered nurses adopted a generic rather than field-specific approach. This article reiterates that children, young people and their families have unique needs that are best met by nurses who are trained specifically to care for them. The case is made from a historical and legal perspective, concluding with a proposal that in the best interests of children, young people and their families, the NMC should embed specific competencies for children's nurses into its standards of proficiency to future-proof this field of practice.

The trainee nursing associates' experience of academic learning: the first 6 months

Background: The introduction of the nursing associate role has aimed to provide a different route into nursing careers. Education standards have been structured in line with Nursing and Midwifery Council (NMC) standards for nursing associates for them to meet the proficiency requirement to enter the NMC register ( NMC, 2018c ). However, there are pedagogic challenges due to the inclusive nature of recruitment, which requires only baseline entry qualifications. Objectives: The purpose of this research is to investigate the experience that trainee nursing associates (TNAs) have of academic learning within the first six months of their apprenticeship programme and to determine the impact of this experience on their progression. Design: A quantitative design was adopted using data collected from two focus groups comprising TNAs who had completed their first two trimesters of academic study. This allowed a phenomenological approach to understand the subjective experiences of the participants within a purposeful sample. Findings: Some three key areas that affected learner progression were highlighted in the study: readiness to study; support to study; and transition of trainees to becoming independent learners. Conclusion: Investment and preparation by all partners involved in the TNA course are crucial. Readiness for trainees to study needs robust and timely recruitment, and learners would be supported by having basic study skills prior to commencement.

The erosion of mental health nursing: the implications of the move towards genericism

This article casts a critical lens on the current Nursing and Midwifery Council standards for nurse education and their potential impact on mental health nursing in the UK. It discusses how the standards appear to be transitioning mental health nursing towards a generic, task-orientated nursing role and in doing so, are undervaluing the unique contributions of the profession to contemporary mental health care. It also argues that this descent towards genericism not only risks the erosion of the specialist skill set required of mental health nurses by service users, but also aligns mental health nursing care closer with neoliberal policy and with biomedicine to the further detriment of patient care. This article warns that this current period marks a critical time for the profession and that collective, assertive action is needed now to safeguard the profession's distinct presence on the UK's nursing register.

Time for change? Bringing SCPHN Practice Assessment Documentation into the digital era

This article examines the need for innovation in the form of Practice Assessment Documentation (PAD) in SCPHN education following developments in undergraduate nursing and midwifery programmes across the UK, alongside regional demand and poor historical practice. To successfully identify the evidence base for this development, a critical appraisal of several papers from the available literature was undertaken to examine aspects such as the value and contribution which technology generates in the enhancement of student learning, and the theoretical drivers from both an educational and professional perspective. The article concludes there is a necessity for this development in meeting the educational needs of students, while increasing the robustness of the assessment process for assessors. This paper aims to drive the development of a national SCPHN PAD in accordance with the new Nursing and Midwifery Council's Standards of Proficiency and plans to evaluate the effectiveness of the developed SCPHN PAD at the end of the upcoming academic year 2022/23.

999 ‘emergency’ – the immersion of student health care professionals within the The SIMEX series disaster and emergency response exercise (2022)

As part of the SIMEX Series exercise [1] the University hosted a simulated mass casualty incident where Nursing/Allied Health students were joined by colleagues from the local Hospital Trust to treat simulated patients with a variety of presentations. The exercise was an educational activity and at key points in the simulation, action was paused to enable everyone to learn from significant injuries. The students involved were able to assist the emergency team to test disaster event response and build vital skills including interpersonal communication, supporting distressed patients, de-escalation techniques, and recognition of deteriorating patients. Nursing students assumed the roles of Band 5 Nurses and were allocated a shift. Also participating were Radiographer and Operating Department Practitioners students. Each student was designated an area (e.g. minors, majors) and was linked with a Nurse from the Acute Trust who coordinated care. The exercise used 43 simulated casualties, consisting of drama and healthcare students. Professional actors helped to support the authenticity of the event, especially around some of the more complex injuries such as a lady who required a Perimortem C Section and a patient presenting with schizophrenia. An amputee actor played the role of a person who required an amputation as a result of the simulated emergency. He was able to draw upon his own experience adding depth to the role. Simulations were designed in coordination with the hospital team to rehearse treatment of uncommon presentations. Further scenarios were developed to enable the students to achieve their proficiencies and to display the professional values required to support patients in challenging situations. Initial feedback has been very positive, highlighting how the event has helped the students build upon and consolidate the fundamental skills required to be confident and competent in their future roles [2]. We are currently awaiting formalised evaluation from a partnering university who undertook pre- and post-evaluation from all ‘players’. Immediate feedback included the students using language such as ‘empowered’, ‘empathy’, ‘unity’, and ‘team spirit’ to describe their experiences. Furthermore, the students identified that the exercise had high-fidelity and enabled them to embark on interprofessional learning to test not only their physical skills but also their emotional intelligence. Following the success of SIMEX 2022, discussions surrounding SIMEX 2023 have commenced and it is hoped the event will expand to a larger number of students across the Faculty, in line with Nursing and Midwifery Council Standards [3]. 1. The Simex Series Disaster & Emergency Response Exercise. 2. Nursing and Midwifery Council (2018) Standards of proficiency for registered nurses. 3. Nursing and Midwifery.(2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing. associates

Using experiential-based simulation learning to develop adult nursing students’ communication skills to support practice

In the light of the practice placement limitations due to COVID-19, the Faculty Practice Simulation Group at a University in South West England, commissioned a pilot programme of simulated practice components for 200 second year adult nursing students over five consecutive days. The aim was to support the development of communication skills required by the Nursing and Midwifery Council Standards [1]. In partnership with an external communication skills organisation, the University provided each student with 37 hours of simulated practice placement, focused on communication skills through participative simulation with simulated patients (SPs) in bespoke, authentic scenarios. This included facilitated participation, structured live feedback from SPs, discussion with students, debriefing and reflection according to ASPiH guidelines for best practice in simulation [2]. Scenarios were designed to challenge and explore the range of skills required in Annex A of the Standards [1], at a level expected of first year students. Learning outcomes included the development of caring conversation techniques, patient management and colleague communication in multiple, varied situations. Students interacted with SPs and relatives who reflected diverse characteristics and ages, and a range of physical and mental health challenges. Students also interacted with simulated colleagues in a variety of professional situations. 106 students completed feedback questionnaires consisting of 41 5-point Likert items, before and after their sessions. Facilitators noted that students described the simulation as a meaningful learning opportunity which allowed them to explore and develop their communication skills and better prepared them for the practice element of their degree. They also noted that students said they preferred simulation as it gave them time to stop and think and to get advice and ideas from their colleagues. This was particularly so in ‘breaking bad news’ scenarios as most had never had to approach this and appreciated the opportunity to consider and practise their response. Consequently, students stated that simulation would have been even more beneficial had it been timed prior to attending practice placement. Facilitators observed the improvement in communication skills was in student’s confidence and their awareness and sensitivity, particularly in complex multi-factorial situations. Evaluations for the programme have yet to be analysed. Experiential learning through simulation-based education with SPs provides a powerful approach, offering a safe and supportive environment, which avoids unsafe situations and enables students to effectively practise and prepare for real world experiences. 1. Nursing and Midwifery Council, Standards of Proficiency for registered nurses. 2. Simulation-Based Education in Healthcare. 2016. Standards Framework and Guidance. Association for simulated practice in healthcare (ASPiH) standards for simulation-based education.

A unified approach to faculty development

Due to the effect of the global pandemic and rising student cohort numbers, simulated practice placements are being implemented into nursing curricula. To deliver simulation-based education (SBE) within the Higher Education Institutions (HEI) staff must be adequately prepared. For SBE to be effective, thoughtful consideration to appropriate staff training is important [1]. A structured unified approach is more beneficial as it sets the same aspirations and contributes to a shared philosophy [2]. This unified approach meant both Health Board and HEI staff were being trained to delivery simulation in the same way, which was new for this HEI. Creating a faculty for simulation emulates a community of practice and also comprises essential networking with other simulationists [2]. It helps support Benner’s novice to expert theory as staff start of as novices and subsequently develop emulating that robust educational training for SBE faculty development is essential [3]. Importantly, it addresses quality assurance and governance frameworks in meeting the requirement of the International Nursing Association for Clinical Simulation Learning (INACSL) [3], Association for Simulated Practice in Healthcare (ASPiH), and Nursing and Midwifery Council (NMC) standards. The overall aim of this innovation was to implement a unified approach to faculty development training for academic staff within an HEI. Three training sessions were delivered in January and February 2022. HEI staff attended a one-day session. Health Board Simulation Educators facilitated the sessions for the HEI Academic Staff. Using a unified approach to this faculty development had a positive outcome in supporting HEI staff to be upskilled in the delivery of SBE. It has also resulted in the subsequent development and implementation of a 2-day training course comprising the following sessions: Session 1 – Introduction to clinical skills and simulation and writing learning outcomes and scenarios; Session 2: Technology supporting simulation; Session 3: Preparation, briefing, and debriefing; Session 4: Running an immersive simulation session. This in-house training programme will continue to be delivered to HEI staff undertaking SBE and evaluated. Using a unified approach enhances the quality and parity of the delivery of SBE within the HEI. A unified approach to faculty development within the HEI will continue to be delivered to upskill staff in SBE. Collaboration with clinical partners in faculty development is crucial in the delivery of SBE to ensure a unified evidence-based approach. 1. Bryant K, Aebersold ML, Jeffries PR, Kardong-Edgren S. Innovations in simulation: Nursing leaders’ exchange of best practices. Clinical Simulation in Nursing. 2020;41:33–40. 2. Peterson DT, Watts PI, Epps CA, White ML. Simulation faculty development: a tiered approach. Simulation in Healthcare. 2017;12(4):254–259. 3. Hallmark BF. Faculty development in simulation education. Nursing Clinics. 2015;50(2):389–397.

Professional reflections of a lecturer practitioner during the first COVID-19 surge

I have undertaken this opportunity to reflect on the delivery of intermittent haemodialysis (IHD) among adult critically ill COVID-19 positive patients. My role in facilitating the delivery of the service within an intensive care setting is presented using Rolfe et al's 2001 reflective model. The purpose of this article is to reflect on how the process of introducing and facilitating IHD affected the renal team and impacted patient care, as well as my personal feelings and learning needs at the time and now. IHD mimics some of the metabolic functions of the native kidneys. It reduces the accumulation of waste products, corrects biochemical and metabolic derangement, and helps to maintain fluid balance. Although IHD is an individually prescribed therapy, the intended outcome among critically ill adults presents multiple challenges, particularly in relation to intended fluid loss during the therapy. Nurses are expected to continually reflect on their practice to develop their knowledge and skills, as required by the Nursing and Midwifery Council (NMC) standards of proficiency. Therefore, reflecting on how my skills have been challenged and the potential areas for development, in the context of working as a nurse lead and facilitator, is an essential part of my professional development. In terms of implications for practice, having recently completed an online leadership course has made it clear that collaboration and synergy between the renal and intensive care teams must be developed should the need for IHD recur. Redeployed staff from the renal satellite unit must familiarise themselves within acute dialysis setting prior to their redeployment to intensive care. This will ensure that concerns regarding the management of the changing haemodynamic stability of patients are addressed. Formal staff feedback would be valuable in optimising renal-intensive care collaboration, as well as identifying personal development opportunities for leaders. Creating a psychologically safe environment and a ‘seek to understand’ mindset in relation to the workforce, while inspiring the team towards autonomous clinical decision making, are pivotal to continuous personal and professional development and the delivery of quality patient care.

Have the NMC educational standards become overly adult-centric?

Emeritus Professor Alan Glasper, from the University of Southampton, and Debbie Fallon, Chair of the Children's and Young People's Nursing Academics of the United Kingdom group, explore concerns raised by academic nurses regarding the Nursing and Midwifery Council standards for pre-registration nursing education.

The creation of a confidence scale: the confidence in managing challenging situations scale.

BackgroundSelf-confidence and self-efficacy are vital psychological constructs that can affect a student’s performance.AimsTo measure the level of confidence in nursing students in managing challenging situations in clinical practice settings.MethodsIn order to develop the scale three focus groups were conducted: with registered nurses, third year student nurses and service users. Focus group frameworks included: challenging behaviours, managing challenging situations and preparing students to manage challenging situations. Themes in relation to challenging situations that emerged from the focus groups, in conjunction with Nursing and Midwifery Council standards and expert discussions were used to create the confidence scale. The Confidence in Managing Challenging Situations Scale consists of two parts with 21 items in total. Both parts were measured by way of a five-point Likert scale. The scale was utilised to determine the level of confidence of students both pre and post a teaching intervention.ResultsThe confidence in managing challenging situations scale had good internal consistency, with a Cronbach’s alpha coefficient reported of 0.86. Exploratory factor analysis was used to support the scale validation process.ConclusionsThe Confidence in Managing Challenging Situations Scale is a successful measure of confidence for nursing students in healthcare settings. It can be applied in alternative healthcare settings for the identification of confidence levels in those student nurses learning in care settings.

Challenges and opportunities: the role of the district nurse in influencing practice education.

The responsibility of the district nurse (DN), alongside complex case management and leadership, is to ensure Specialist Practitioner Qualification District Nurse (SPQDN) education continues to create practitioners delivering quality evidence-based care. DN leadership and its importance have come to the fore during the COVID-19 crisis, where hospital discharges have increased rapidly to make way for highly complex admissions (HM Government, 2020). This paper examines the importance of the SPQDN qualification, exploring the role of the DN within practice education. Continuation of the vital DN qualification will ensure that the numbers of qualified DNs increase, ultimately protecting community capacity. With a move towards an apprenticeship model to achieve the SPQDN, DNs must engage with and influence curriculum development to confirm courses deliver requirements of the workplace, commissioners and the 2019 NHS Long Term Plan. Expectations of the DN role within practice education have changed, moving away from the practice teacher standards to the new Nursing and Midwifery Council Standards for Student Support and Assessment. This poses new challenges in DN education in practice. The implications of this transition threaten to de-value the quality of the assessment process by removing the high standards of preparation previously demanded; ultimately, this is a risk to the provision of the quality practice education that previously existed.

Understanding the role of the academic assessor.

Publication of the Nursing and Midwifery Council's standards for student supervision and assessment introduced the role of academic assessor. However, there has been little research into the role and what it entails. This article examines the role of academic assessor and discusses who can become an academic assessor, their responsibilities, and the potential challenges and benefits associated with the role. The article also explains how effective feedback and communication between academic assessors and practice assessors can support the academic progression of nursing students.

An alternative placement model for nursing students: discovering new horizons

This article explores the use of an alternative placement model in conjunction with the Nursing and Midwifery Council standards for education and training. Traditionally in nurse education, students were supported on placement on a one-to-one basis by a qualified nurse mentor. This could be a very intense relationship and could limit placement learning as students were only allocated to areas that have a qualified nurse mentor, exacerbating competing demands on placement capacity to support students. A higher education institute trialled an alternative placement model that used several healthcare-related services traditionally not used for nursing placements. Some of these placements were allocated by the higher education institute, but students were also responsible for securing a number of placements for themselves. The students were supported with their learning by appropriate healthcare staff in practice but were assessed by academic members of staff at the higher education institute acting as practice assessors. The project was evaluated positively overall by the vast majority of students and staff. Students found it to be an empowering experience, which encouraged autonomous practice.

Operationalising Domain 4: Additional Care for Women and Newborn Infants with Complications

In this ninth article of The Practising Midwife’s education series, Domain 4 from the new Nursing and Midwifery Council (NMC) standards for proficiency is discussed. Domain 4 emphasises the midwife’s role as a coordinator of women and neonate’s care where additional care may be required. Highlighting curriculum changes at the University of Bedfordshire, Anna Madeley provides insights to how this domain has been implemented.

Peripheral intravenous cannulation: reducing pain and local complications.

Caring for patients with peripheral intravenous cannulas/catheters (PIVCs) is an important part of the nurse's role and insertion of PIVCs has traditionally been a post-registration nursing skill. With the introduction of the Nursing and Midwifery Council Standards of Proficiency for Registered Nurses in 2018, insertion of PIVCs is to be incorporated in pre-registration nursing programmes for all four fields of nursing practice. Although IV cannulation is a commonly performed clinical procedure, it is associated with significant risks and complications, which can cause pain for patients. This article outlines the factors that can cause pain for adult patients requiring a PIVC and recommends that the use of local anaesthetics be more widely considered when inserting a cannula. The identification, prevention and clinical management of commonly occurring painful local complications that can arise post-PIVC insertion are also discussed.

Operationalising Domain 3: Universal Care for all Women and Newborn Infants

In this eighth article of The Practising Midwife’s education series, we discuss the new Nursing and Midwifery Council (NMC) standards for midwifery proficiency – Domain 3: ‘universal care for all women and newborn infants’. This article focuses on providing universal healthcare (UHC) for all women and newborn infants. Through inter-professional learning, UHC can be embedded across different disciplines and gives students the opportunity to consider the holistic needs of women, birthing people and babies.

An evaluation of nurses' experiences of mentoring pre-registration students.

Nurse education in the UK has undergone a radical change over the past 30 years. The integration of nursing students within practice has evolved from an apprenticeship style to bespoke mentoring support. To act as mentors, registered nurses must have met stage 2 outcomes of the Nursing and Midwifery Council (NMC) Standards to Support Learning and Assessment in Practice, which clearly stipulate that mentors should have a reduced clinical commitment when supporting students, with one hour per week being protected, in addition to the 40% of time through direct or indirect supervision with their mentor/sign off mentor when facilitating a student on their final 12-week experience. However, this does not seem to be the case in reality. A qualitative study comprising six semi-structured interviews was undertaken across one health and social care trust. Data were analysed using Braun and Clarke's thematic analysis. A number of themes and subthemes were identified: engagement (barriers versus strategies), support (inclusivity versus exclusivity), and lack of recognition (strategic versus organisational). Due to the expected changes of supervising and assessing nursing students in practice, it is imperative that an innovative, collaborative and engaged approach is facilitated from all key stakeholders to ensure the sustainability of supporting and assessing students by registered nurses and the safeguarding of the public within clinical practice.

‘Thinking like a nurse’. Changing the culture of nursing students′ clinical learning: Implementing collaborative learning in practice

This article reports a study evaluating the implementation of Collaborative Learning in Practice models at a university School of Nursing and Midwifery with practice partners across the South West of England. We conducted four focus group interviews with 40 students with experience of Collaborative Learning in Practice placements, and two focus groups with eight clinical practice staff with responsibility for implementing and supporting such models in their areas. Data were transcribed and analysed using the Framework Method. Key themes were ‘Real time’ Practice of Collaborative Learning Implementation, Collaborative Learning as Preparation for Registrant Practice, and the Student/Mentor Relationship. We conclude that Collaborative Learning in Practice utilising models of coaching and peer support, offers benefits to students who are exposed to the reality of nursing practice from the beginning of their placement experiences, enabling them greater responsibility and peer support than under normal mentoring arrangements. Furthermore, there are benefits to the registrants because the burdens of supervising students are spread more widely. This is timely given the review of Nursing and Midwifery Council standards for programmes and student support and the need to increase placement capacity as a response to global nursing shortages.

Applying transformational leadership in nursing practice.

The updated Nursing and Midwifery Council (NMC) standards of proficiency for nurses emphasise the importance of nurse leadership, while the NHS has also developed models to support leadership development. There are several approaches to leadership that are applicable in nursing practice. Transformational leadership is an approach that focuses on the attributes and behaviours of the leader required to empower and motivate team members. This article outlines the four elements of transformational leadership - idealised influence, inspirational motivation, intellectual stimulation and individualised consideration - and discusses these in relation to the NMC standards. It also describes the advantages and disadvantages of transformational leadership, and suggests ways that this approach can be applied in nursing practice.