Revised pre-registration nurse training standards being developed by the Nursing and Midwifery Council will “raise the bar” of practice in the future, the regulator’s new head of education has said.
The standards could see students assessed on their mentoring ability, the possibility of their placement hours reduced, and potentially provide them with a prescribing qualification.
“This programme gives us the opportunity to change the face of education for the next generation”
Dr Geraldine Walters, the NMC’s recently appointed director of nursing and midwifery education, standards and policy, told Nursing Times the proposals being considered had the potential to “change the face of education of new nurses of the next generation”.
Dr Walters, who was also this month awarded a CBE for services to nursing and midwifery, said the driving force behind the revamp of nurse education standards – last updated in 2010 – was the need to keep up with the fast change of pace within the NHS.
Newly qualified nurses would in the future need more preparation in areas such as mental health, complex care in the community, and in the ability to lead and delegate to other members of the team, including new roles such as the forthcoming nursing associate, she said in an exclusive interview with Nursing Times.
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But the education changes would also need to deal with the fact many felt there was a lack of clarity about the exact set of clinical skills and tasks newly qualified nurses should be able to do, she said.
The system of placements and mentoring – which Dr Walters described as “time-expired and difficult to deliver” – also needed to be addressed.
“Many are ready for the challenge. That’s why we are raising the bar”
The regulator is drafting new standards for nurse training this year, ready for consultation with nurses in the spring, with the expectation that all universities will run new courses by September 2019 – though some may be given the option to begin a year earlier.
It also plans to revise midwifery training standards that should be introduced by September 2020, but work is only in the early stages, due to being delayed by forthcoming regulatory changes around midwifery supervision.
“The education of registrants is fundamental to the future of the professions. This programme does give us the opportunity to change the face of education of new nurses and midwives for the next generation,” said Dr Walters.
To this end, some elements of qualifications that are taught later on in a nurse’s career may be shifted forward into pre-registration training.
As part of this, Dr Walters said the NMC was “looking at everything to do with mentors, the role of mentors, preparation of mentors, how long students need to spend with their mentors”.
“All of those are up for questioning,” she said. “A really exciting bit would be whether we could include mentorship training within the pre-registration course and have third year students being assessed on their ability to support and mentor first year students, so that people come out of training expecting to be a supervisory supporter of more junior staff.”
“The current standards in relation to mentors are a bit time expired”
While additional qualifications may still be required for those mentors that are able to sign off other people’s work, student nurses could be expected to complete mentoring training that allowed them to be coaches, suggested Dr Walters, who joined the NMC from her role as nursing director at King’s College Hospital NHS Foundation Trust in November.
She said the regulator’s current requirements – which state students must spend at least 40% of their time on placement being supervised by a mentor – were “quite difficult” to achieve due to shift patterns and night duty considerations.
“Instead, what we need is to deliver coaching models where students get a grounding in what it is to coach and support people without all the trappings we attach to being a mentor,” suggested Dr Walters.
However, she said students had said they would still want to see some standards to safeguard learning in practice, which the NMC needed to work on.
“What we are hearing is that the current standards in relation to mentors are a bit time-expired and difficult to deliver. Some of what makes it difficult is that it is just one person’s responsibility,” she said.
Meanwhile, she said there was a “big spectrum of views” across the UK about how far prescribing should be brought into pre-registration training.
Dr Walters said the regulator was considering the possibility that students were trained so they were able to prescribe upon qualifying – though this could be from a reduced formulary.
But it was also considering whether a grounding in pharmacology during training would provide a sufficient level of knowledge for entering practice, with the added benefit that it would encourage students to achieve a prescribing qualification at a later point in their careers.
“It’s really difficult to predict just where the consultation is going to land on this issue”
Dr Walters said: “There’s a group of professionals at one end of the spectrum who say: ‘this is the way to go and in 10 years’ time we are going to need nurses to prescribe for the patient’s benefit’. There’s the other end with some saying: ‘we haven’t even got administration right yet, let’s do that before we think of putting prescribing into pre-registration education.
“It’s really good that it’s out there. It’s really difficult to predict at the moment just where the consultation is going to land on this issue,” she added.
To prepare students for the increasing amount of care they will be expected to provide in the community in the future, the NMC is also considering bringing some elements of the specialist community public health nursing training – undertaken by health visitors and school nurses – into pre-registration education.
“Wherever you are working, if the aspiration is that an increasing amount of complex care will be provided closer to patients’ homes, nurses working in the acute setting need to know more about delivery of care out of hospital,” said Dr Walters.
Underlining her previous comments about student placement hours potentially being reduced to allow for more time spent completing simulation activities, she said there was a “mixed bag” of support.
She said many people working in education were in favour of the idea, but that some employers were “very worried” about decreasing the time students spent on placements.
However, Dr Walters noted the European legislation requirement for 2,300 hours of nurse training to be spent in practice was not always being met by student beings on placements and that some flexibility already existed.
“We’ve got to be really clear about their technical abilities”
For instance, she had heard of one case where students used attendance at a professional conference to count towards these hours. The key thing for students was to ensure their practice hours provided high quality learning, she said.
“We’ve got to really look at how could we provide the best quality in practice areas. If we had fewer placement hours to provide, could we improve the quality?,” she asked.
It would be “foolish” not to look at how far simulation could be used instead, which could take some of the strain off placements that are struggling under demand and also provide a safer learning environment for learning some clinical tasks, such as cannulation, said Dr Walters.
As well as looking at new ways of learning, the NMC is investigating how it can clearly define a standard set of clinical tasks all students should be able to do by the end of their training – while also emphasising the need for registrants to be critical thinkers.
It follows research by the NMC at the start of 2016 that found the current education standards resulted in a perceived variation of skills among registrants.
“One of the main things since I first came to the NMC was to look at the whole issue of training people to be critical thinkers, to be research-aware, to be leaders. But for the purposes of a new registrant’s own competence, we’ve got to be really clear about their technical abilities as well,” said Dr Walters.
She suggested the new set of defined skills would cover both physical and mental health, and would be applied to students’ training across all fields of nursing. It could include administration of IV medication, catheterisation and nasogastric tube insertion, advanced mental health assessment and lifestyle advice.
“We shouldn’t ignore these things. We don’t do our new registrants a service if they are knowledgeable about what it is that patients need – which they are – but don’t feel adequately prepared and confident in some of the technical skills required to deliver care,” said Dr Walters.
When asked how far the new standards would ensure the role of nurses was clearly defined in relation to others, such as health care assistants and the new nursing associate post, Dr Walters said the NMC wanted to underline that registered nurses would become leaders of multi-disciplinary teams.
“We want to make it very clear in our standards that registered nurses of the future are leaders of teams, that they will be working with other registered professionals and unregistered professionals. They need the competence to delegate to people appropriately and they will have enhanced ability to assess and plan care,” she said.
She acknowledged that leading care in the future was “going to be difficult” due to the “very mixed environment” of care settings and workforce, and the high complexity of patients. But she said it was “not beyond the ability of the graduate professional nurse”.
“We think nurses can do this, and our experience suggests that many are ready for the challenge. That’s why we are raising the bar around the standards,” added Dr Walters.
CV: Geraldine Walters
November 2016 – present: NMC’s director of nursing and midwifery education, standards and policy
2009-16: executive director of nursing, midwifery and infection control at King’s College Hospital NHS Foundation Trust
2004-09: director nursing, patient involvement, infection prevention and control at St George’s Healthcare NHS Trust
2002-04: director of nursing and care standards, Epsom and St Helier NHS Trust
1999-2002: assistant regional nurse director for London, NHS
1997-99: director of nursing, Harefield Hospital NHS Trust, later director of operations at Royal Brompton and Harefield NHS Trust
1992-97: deputy director of nursing at Bromley Hospitals NHS Trust
1975-79: trained in Leeds undertaking one of the early combined nursing degree courses at Leeds Polytechnic and St James Hospital Leeds, later specialising in cardiac nursing