Nursing And Midwifery Council Research Articles

Linkage and Demographic Indexing for Nursing Dynamics in the Integrated Data Service

Objective and ApproachThis project links UK Nursing and Midwifery Council (NMC) Registrant data to the 2021 England and Wales Census (“Census 21”). The Office for National Statistics (ONS) has composed a framework of index tables to facilitate linkage between prominent datasets in the UK. In linking person-level data to Census 21, ONS’ Demographic Index enables onward linkage to other administrative datasets that are indexed alike. NMC Register and Census 21 records have been initially linked using bespoke deterministic and probabilistic methods, with resulting matches being joined to the Demographic Index. ONS’ Demographic Index Matching Service (DIMS) will also be used to link NMC data to the Demographic Index to enable comparisons between methods. ResultsAnalysis of both approaches will compare quality metrics such as match rate, recall and precision and tools will be used to assess bias in matches made through each method. These metrics will provide an insight into how the index matching services have been designed and whether improvements can be made to account for any shortcomings in their performance. ConclusionsHybrid approaches using both bespoke and indexing methods are proving valuable where sole use of the matching services is not suitable. This research will help ONS to refine which methods will yield the highest quality linkage and when. ImplicationsAs ONS pursues an ‘indexing first’ approach to linkage, the outcomes of this and similar projects will influence the future of utilising indexes in varied capacities when creating or maximising the potential of linked data.

The occupational roles of nurses and midwives in the UK: an analysis of the Nursing and Midwifery Council-census England and Wales 2021 data linkage study

ObjectiveThe nursing and midwifery professions are facing challenges to recruitment and retention. Understanding the occupational choices of people registered as nurses and midwives can inform policy as to the potential of initiatives to encourage registrants back to practice. This study thus aims to ascertain the occupational roles taken by nurses and midwives in the UK in 2021 and the drivers behind choosing to work outside of direct clinical practice. ApproachThe Nursing and Midwifery Council (NMC) register contains information on everyone meeting required standards to practice in those professions in England and Wales (currently around 800 thousand people). Registrants must not only complete a course of study for registration but must revalidated every three years. The register has been linked to the 2021 census for England and Wales. The census includes questions ascertaining occupation. Information provided is categorised to provide indication of individuals’ main occupation. These include codes for nursing and for midwifery which provides indication not only to occupation but also to engagement in clinical practice. Analysis uses logistic regression to ascertain how socio-demographics influence engagement in clinical practice or otherwise. Conclusions and ImplicationsData linkage for this study is now completed with the conference being the first time results will be shared. This will be the first time there has been concrete evidence as to nurses and midwives actual occupational roles. A stakeholder group supporting this work includes individuals from Chief Nurses’ Offices to enable findings to feed into policy.

Registered nurses' perceptions of nursing associates' professional identity.

The nursing associate (NA) role was introduced in 2017 with a pilot programme of trainees, and in 2019 became regulated by the Nursing and Midwifery Council (NMC). The role bridges the gap between the healthcare assistant (HCA) and registered nurse (RN), allowing RNs to focus on complex care. With over 9000 NAs on the NMC register and more in training, it is important to understand RN perceptions of the NA professional identity. The findings of a qualitative survey of RNs (n=23) identified the following themes: NMC standards and scope of practice; The 'cheap nurse'; Skills development and progression; A supportive bridging role. Although valued, the role was perceived as a threat, ambiguous and inconsistently implemented. The implications are that the role ambiguity and lack of standardisation need addressing and a clear understanding of these must be articulated for the professions and public alike.

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.

What are the experiences of student nurses with online learning? Do they have the necessary digital and technological competencies?

Background and objective: Student Nurses have been conventionally and predominantly taught face to face for several decades. A recent surge in teaching student nurses online in the last decade has been expedited by the onset of the covid-19 pandemic. A significant number of research on online learning, focuses on its effectiveness from an educator’s perspective. Exploring student nurses’ experiences with online learning in relation to their digital and technology skills readiness is pertinent to informing a student-led pedagogy. The research aims to explore the experiences of student nurses with online learning and if they are digital and technology skills ready for online learning or not.Methods: The study is a descriptive qualitative research, which utilises Interpretative phenomenological analysis and hermeneutic Interpretative phenomenology. Four pre-registration student nurses in a university in the South-East of England were recruited for the study. Individual face-to-face tape recorded semi-structured interviews were conducted with verbal and written consent from participants. Data collected was concurrently transcribed and analysed. Preliminary codes were given to the collected data to describe the contents. Interviews were then searched for patterns in the given codes from the transcripts. The themes that emerged were reviewed and refined with written up verbatim quotations from participants to support interpretations. A reflexive diary was kept by the researcher throughout the research, to reduce the likelihood of biases. Results: The themes that emerged from the collected and analysed data indicated that student nurses were digital and technology skills competent to engage in online learning. Online learning was deemed beneficial by all students although a preference for face-to-face learning was reported. Factors that inhibited students from fully engaging with online learning included internet hitches and the inability of nurse educators to use technology. A lack of effective communication between lecturers and students during online learning also marred the experiences of students. Environmental distractions at home and a lack of support from peers and lecturers during online learning were further cited as inhibitors for online learning.Conclusions: The Nursing and Midwifery Council (NMC) requires qualified nurses to have sound technology skills for care delivery. Considerations for online learning must include a prior technology skills competence assessment. The approach will ensure a level playing field for all students who engage in online learning. The appropriate support and interventions can be put in place for students who may not have the prerequisite level of technology skills to engage in online learning. Findings supports a blended learning approach with a student led digital and technology skills baseline assessment, prior to online learning. The approach will ensure a successful co-creation with an amalgamation with pedagogy.

Impact of the Nursing and Midwifery Council Future Nurse Standards on children's nursing: A critical discussion

Edge et al explore the current concerns and ongoing debate around the Nursing and Midwifery Council (NMC) Future Nurse: Standards of proficiency for registered nurses (2018). This article looks at the impact of the standards on changes to pre-registration children's nursing education, exploring the impact on ensuring students are equipped with the right knowledge and skills to meet children, young people and their families' needs. Central to the discussion is the importance of hearing the voice of children and young people, and families are considered central to the ongoing discussion that is integral in shaping our future nursing workforce.

MIDWIFERY CARE FOR TRANS AND GENDER DIVERSE PEOPLE

Research shows that many healthcare professionals lack knowledge of the unique reproductive needs of trans and gender diverse people, leading to possible bias. This opens potential for reduced information sharing, lack of trust and disempowerment.1 Midwives are bound by the Nursing and Midwifery Council (NMC) Code2 to provide care to the best available evidence, keep up-to-date and maintain knowledge and skills to provide safe, holistic care. However, ‘transgender’ is not yet a health research analytic category. Thus, there is a poor evidence base, making it more challenging to understand trans-specific health concerns due to lack of data.3

Non-medical prescribing in nursing: the history and evolution of independent and supplementary prescribing.

Non-medical prescribing has been shown to be beneficial to both service users and practitioners spanning all care sectors. Nurse prescribing has developed significantly in its short existence, and is set to continue to push the boundaries of practice as the role and education of nurses changes and adapts to current population healthcare needs. This article details the origins and evolution of non-medical prescribing, the variety of annotations found on the Nursing and Midwifery Council (NMC) register involved and how these affect nursing practice, as well as the expansion of roles. It also discusses supervision and assessment requirements in line with the NMC standards for prescribing programmes, and the Royal Pharmaceutical Society competence framework.

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 dynamics of the nursing and midwifery professions: Initial findings from analysis of longitudinal registrant data

ObjectivesTo ascertain geographical differences in retention of nurses and midwives across the United Kingdom using registrant data.
 MethodsThe Nursing and Midwifery Council (NMC) are responsible for holding a register of all nurses and midwives in the United Kingdom. Registrants are required to revalidate every three years. Linking together resulting data creates a longitudinal dataset that follows registrants over time. The NMC is providing anonymised data through the ONS Safe Researcher Service (SRS). Data sharing agreements have been signed off and data is in process of being ingested by ONS. Initial analysis will focus on geographical differences in retention by for nurses by field of practice (adult, mental health, children, and learning disability) and midwifery.
 ResultsThere are estimated to be around 750 thousand nurses and midwives currently registered. Processes used to take this work forward will be described including public and stakeholder engagement. Early findings will be presented comparing demographic profiles of the professions and, for nursing, fields of practice in 2018 and 2021. Cox proportional hazard models will enable comparison of geographical differences in retention between England, Scotland, Wales, and Northern Ireland.
 ConclusionRegistrant data provides a basis that can inform policy. This is especially important given current challenges with regard to recruitment and retention in the nursing and midwifery professions. Future work will be outlined that will utilise registrant data including linkage to other administrative and census data sources.

What It’s Like Being A Midwife With Attention Deficit Hyperactivity Disorder

Some women with attention deficit hyperactivity disorder (ADHD) may go their entire lives without receiving a diagnosis. This diagnosis gap exists in part because the disorder was once assumed to mostly afflict men but also because women typically exhibit less socially disruptive symptoms than men.1 Most ADHD clinic referrals for nearly a century were for young, hyperactive boys.2 The data characterising boys’ behaviours served as the foundation for early diagnostic standards. Since hyperactivity was demonstrated to be the hallmark, only rarely were young females diagnosed. The primary symptoms of inattention that most girls with ADHD encountered did not meet the diagnostic criteria, therefore ADHD was thought to be a typically male condition. The Nursing and Midwifery Council (NMC) recorded that 99.7% of midwives in the UK are women, while 3.7% of midwives have disclosed a disability.3 This could be suggestive of high numbers of UK midwives working and living with undiagnosed (therefore untreated) ADHD. This article explores the personal experience of being a midwife with ADHD with guidance on how colleagues can be supportive of each other.

Analysis of a nursing survey: Reasons for compromised quality of care in inpatient mental health wards.

Current evidence suggests understaffing is related to poor quality and missed care in a global context, but this relationship is complex. There is also a research gap for quality in mental health care in the United Kingdom that includes a wider set of patient outcomes. This paper aims to investigate RMN's perception of quality of care on their last shift, their self-reported reasons for compromised care and potential impact on patient outcomes. A mixed methods approach, we used descriptive statistics to create a framework within which to qualitatively analyse data from the 2017 Royal College of Nursing (RCN) employment survey to consider the complex relationship between understaffing and care quality. We established three themes: 'Understaffing', 'Professional Code Expectations and Moral Distress' and 'Management'. In line with the current evidence; lack of resources and understaffing were consistently present throughout. Nurses also felt pressure from the Nursing and Midwifery Council (NMC) code of conduct which in turn instilled shame and fear for their registration when they were unable to achieve the standards expected. This was further exacerbated by poor management and supervision; leading nurses to reflect on poor outcomes for patients which compromised not only legal rights but safety of patients and staff alike. We conclude that focusing on staffing numbers alone is unlikely to improve care quality.

NMC Series 1. Support from the NMC

The Nursing and Midwifery Council (NMC) regulates midwives – but are also there for student midwives during their midwifery programmes. This new series of four articles will explore the role of the NMC in supporting students and their practice.

Levelling the playing field for the international migration of nurses: the India English Language Programme

BackgroundThis article presents evaluation findings of the India English Language Programme, an innovative programme aimed at providing Indian nurses with an opportunity to participate in an ethical and mutually beneficial learning programme aimed at supporting migration into the United Kingdom’s National Health Service (NHS). The programme provided 249 Indian nurses wishing to migrate to the NHS on an ‘earn, learn, and return’ basis with funding to support English language learning and accreditation sufficient to apply for Nursing and Midwifery Council (NMC) registration. The Programme provided English language training and pastoral support to candidates, in addition to the availability of remedial training and examination entry for those not meeting NMC proficiency requirements on their first attempt.MethodsDescriptive statistical analysis of programme examination results and cost-effectiveness analysis is presented to demonstrate programme outputs and outcomes. Descriptive economic analysis of programme costings is presented alongside programme results to investigate the value-for-money provided by this programme.ResultsA total of 89 nurses were successful in meeting NMC proficiency requirements, representing a pass rate of 40%. Those undertaking OET training and examination(s) were more successful, compared to those undertaking British Council provision, with over half of candidates passing at the required level. This equates to an overall programme cost-per-pass of £4139 and represents a model to support health worker migration, in line with WHO guidelines, delivering individual learning and development, mutual health system gain, and value-for-money.ConclusionsTaking place during the coronavirus pandemic, the programme evidences the effective delivery of online English language training to support health worker migration during a highly disruptive period for global health. This programme demonstrates an ethical and mutually beneficial pathway for English language improvement amongst internationally educated nurses to facilitate migration to and global health learning in the NHS. It provides a template through which healthcare leaders and nurse educators, working in policy and practice environments in the NHS and other English-speaking countries, can design future ethical health worker migration and training programmes to strengthen the global healthcare workforce.

Racialised experiences of Black and Brown nurses and midwives in UK health education: A qualitative study

BackgroundInstitutional racism within the United Kingdom's (UK) Higher Education (HE) sector, particularly nurse and midwifery education, has lacked empirical research, critical scrutiny, and serious discussion. This paper focuses on the racialised experiences of nurses and midwives during their education in UK universities, including their practice placements. It explores the emotional, physical, and psychological impacts of these experiences. MethodsThis paper draws on qualitative in-depth interviews with participants from the Nursing Narratives: Racism and the Pandemic project. Of the 45 healthcare workers who participated in the project, 28 participants obtained their primary nursing and midwifery education in UK universities. Interviews with these 28 participants were selected for the analysis reported in this paper. We aimed to employ concepts from Critical Race Theory (CRT) to analyse the interview data in order to deepen our understanding of the racialised experiences of Black and Brown nurses and midwives during their education. FindingsThe interviews revealed that the healthcare workers' experiences coalesced around three themes: 1) Racism is an ordinary, everyday experience; 2) Racism is operationalised through power structures; and 3) Racism is maintained through denial and silencing. Experiences often touch on a series of issues, but we have highlighted stories within specific themes to elucidate each theme effectively. The findings underscore the importance of understanding racism as a pandemic that we must challenge in response to a post-pandemic society. ConclusionThe study concludes that the endemic culture of racism in nurse and midwifery education is a fundamental factor that must be recognised and called out. The study argues that universities and health care trusts need to be accountable for preparing all students to challenge racism and provide equitable learning opportunities that cover the objectives to meet the Nursing and Midwifery Council (NMC) requirements to avoid significant experiences of exclusion and intimidation.

The registered nursing associate: an overview

Registered nursing associates have obtained a nursing associate foundation degree that has been endorsed by the Nursing and Midwifery Council (NMC) through an approved educational institution. This usually involves 2 years of higher-level study, enabling the registered nursing associate to undertake more complex and significant tasks than a healthcare assistant would, but without the scope of a registered nurse. It is not the intention to replace the registered nurse with a registered nursing associate. The role is used and regulated in England, with the aim of addressing a skills gap between healthcare assistants/support workers and registered nurses - it can also provide a progression route into graduate-level nursing. This article, the first in a series, provides an overview of the registered nursing associate role.

The Academic PMA....Supporting the Future Midwifery Workforce

Development of the A-EQUIP model followed recommendations suggesting that statutory supervision of midwifery, for a variety of reasons, was not fit for purpose.1,2 A culture of blame and accountability, poor teamwork and ineffective leadership were identified as key elements of failings in the previous midwifery supervision model.1,2 These were accepted by the Nursing and Midwifery Council (NMC) and statutory changes were made.3 The statutory changes meant that supervision and regulation of midwives should be divided with the NMC solely controlling all regulatory activity.1 This resulted in statutory midwifery supervision ceasing in April 2017 and changed to an employer-led model of support and supervision.4

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.

True distance learning – an evaluation of a virtual simulated placement (VSP) for Indonesian nursing students

VSP uses browser-based virtual environments to simulate life-like and challenging clinical scenarios. They are an innovative and creative way to develop proficiency capabilities of healthcare professionals as an adjunct to their studies and practice placement. Evidence suggests that a simulated environment can better equip nursing and allied health professional students for practice [1–3]. The concept of VSP may have been brought forward by the COVID-19 pandemic but was inevitable with the increasing access to technology-enhanced learning and the emerging evidence of its benefit. This VSP was a collaboration between UK simulationists and Indonesian academics with a two-month deadline. Work was completed online using videoconferencing and translation services, the evaluation (with ethical approval) was completed using a JISC online survey in March 2022. The Indonesia VSP consists of four patient scenarios, one scenario from each of the fields of children and young people, adult, mental health and learning disability nursing and is set within the emergency department and is aimed at learners in their final year of a nursing programme in Indonesia. The Indonesia VSP scenarios were designed in line with the UK Nursing and Midwifery Council (NMC) proficiencies and the Indonesian equivalents and were designed based on clinical scenarios that are not commonly seen in clinical practice or may be particularly challenging to enhance learners’ skills and build their confidence with managing such situations. The VSP was designed for 10 hours of learning and was made available to adult nursing students from 37 Poltekkes across the Indonesian continent. The VSP project was delivered on time with the evaluation from the pilot group being overwhelmingly positive with 82% of respondents being satisfied with the quality of VSP (response rate of 30% n=51/171) The key themes identified were: ‘real-life patient scenarios based on holistic and patient-centered care’ and the VSP enabling learners to use ‘critical thinking skills and relate the content to previous knowledge’ gained on their course so far. VSP is a meaningful way of enhancing exposure to experiences that are not guaranteed for all learners leading to greater equity of experience. The reflective and blended nature of the VSP leads to a better understanding of difficult topics. The VSP platform enables knowledge transfer that allows our team to take our in-house digital innovations to a global platform to support the training of the future nursing workforce of Indonesia. 1. Akselbo I, Olufsen V, Ingebrigtsen O, Aune I. Simulation as a learning method in public health nurse education. Public Health Nurs. 2019;36(2):226–232. 2. Bogossian FE, Cant RP, Ballard EL, Cooper SJ, Levett‐Jones TL, McKenna LG, Ng LC, Seaton PC. Locating ‘gold standard’ evidence for simulation as a substitute for clinical practice in prelicensure health professional education: a systematic review. J Clin Nurs. 2019;28(21–22):3759–3775. 3. Mills BW, Carter OB, Rudd CJ, Ross NP, Claxton LA. 2015. Clinical placement before or after simulated learning environments? A naturalistic study of clinical skills acquisition among early-stage paramedicine students. Simul Healthc. 2015;10(5):263–269.

Finding the Future Midwife: How the revised Standards of Proficiencies for Midwives support pre-registration midwifery programme admissions processes

Pre-registration midwifery education programmes are quietly undergoing a revolution. In 2019, the Nursing and Midwifery Council (NMC) published an ambitious set of proficiencies for the future midwife, defining a framework of skills, knowledge and behaviours that midwives are required to demonstrate at the point of qualification and subsequent entry to the register.1 The revised Proficiencies for Midwives were required to reflect the demands of contemporary maternity services and were based on the framework produced by Renfrew et al. within the Lancet midwifery series.