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A new model of preregistration nursing education and training

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VOL: 96, ISSUE: 38, PAGE NO: 44

Godfrey Mazhindu, PhD, MSc, PGCEA, DipN, RGN, RNMH, is director of the Centre for Healthcare Education, University College Northampton

Jane Miles, MSc, BA, PGCEA RGN, is manager, Buckinghamshire and Northamptonshire Education and Training Consortium

Over the past few years there have been several critical reviews of the effectiveness of the current modes of preregistration nursing and midwifery education. This culminated in the publication of Fitness for Practice (UKCC, 1999) and Making a Difference (Department of Health, 1999), the key features of which include:

Over the past few years there have been several critical reviews of the effectiveness of the current modes of preregistration nursing and midwifery education. This culminated in the publication of Fitness for Practice (UKCC, 1999) and Making a Difference (Department of Health, 1999), the key features of which include:

- Providing more flexible career pathways into and within nursing and midwifery education;

- Increasing the level of practical skills within preregistration programmes;

- Recruiting more nurses and midwives;

- Delivering a nursing education system that is more responsive to the needs of the NHS;

- Strengthening leadership;

- Strengthening education and training;

In October 1999, the Centre for Healthcare Education at University College Northampton, in partnership with the Buckinghamshire and Northamptonshire Education and Training Consortium, successfully bid to be one of the 16 'pilot sites' for implementing proposed curricular changes. Locally, stakeholders involved in this initiative adopted the title PIPELINE (an acronym for Partnerships in Practice and Education Leading Initiative for National Endorsement), to describe the development and delivery of the new course and the ongoing dissemination of our experience.

This initiative has provided opportunity for a review of the experiences of local service users and carers, commissioners and purchasers of education and training, employers, clinical practitioners, nurse teachers, students and partners in further education who are involved in preregistration nursing programmes. Changes arising from these experiences have been incorporated into the course proposal and relationships between the different stakeholders have been strengthened.

Key structural features
The newly validated course, which leads to initial qualification and registration to practice in either adult, mental health, learning disability or children's nursing at either Diploma in Higher Education or Bachelor of Science (Honours) degree level, started this month. It has a one-year common foundation programme (CFP) followed by two-year branch programmes in the discipline of the student's choice, as opposed to the evenly split 18-month CFP and branch programmes of current courses. The structure of the course enables students to learn and experience care across all branches of nursing, meet the requirements of European Union directives for maternity care experience and make informed decisions about their choice of branch programme at the end of the one-year CFP.

We have built on the success of a locally piloted part-time, in-service pre-entry to preregistration nursing course for health care assistants and support workers, who are employed locally in the NHS and non-NHS health and social care sectors, and students on access courses at local colleges of further education. As a result, it has been established that at least 25% of each intake could reduce their first year of the course through accreditation of prior learning and/or experience (AP(E)L).

Students can achieve distinct theoretical and clinical practice outcomes accredited at the end of each year of the course. This includes accreditation of their academic achievements and clinical competence, thus enabling them to develop and build their portfolio of evidence incrementally throughout the course and afterwards. Students can 'step on' and 'step off' at different levels and stages of the course, having achieved demonstrable academic and vocational clinical practice credits. They may use these credits to enable them to make informed choices about which of the four branches of nursing they wish to follow at the end of the CFP, or AP(E)L and transfer to another vocational or academic programme either within University College Northampton (UCN), or transfer to another higher education institution at any stage.

Additionally, the framework for this course enables students initially enrolled on academic level 2 diploma pathways to access academic level 3 modules and 'fast-track' from diploma to degree qualification. Similarly, students initially enrolled on level 3 degree pathways may 'slow track' to level 2 diploma qualifications. Students who 'step off' or are unable to continue on their programme for a variety of reasons may leave the programme with accredited academic and clinical skills within their portfolio, which can be mapped against NVQ in Care units.

Furthermore, the course is accommodated within a specifically designed interdisciplinary, multiprofessional framework which enables students to share their experiences of teaching and learning with those completing preregistration health care courses in nursing, midwifery and professions allied to medicine. We hope that undergraduate medical students may participate in this initiative in the future. UCN is currently setting up a multiprofessional training centre in collaboration with the consortium, local NHS trusts and primary care groups.

Course content
The course team considered the themes that underpin the development of course content:

- The user perspective - this focuses on the nature of lay knowledge, values, beliefs and perceptions of health, illness and disability;

- Leadership - focuses on identification and articulation of the nurse's role in partnerships and teams, professional responsibility, accountability and autonomy, and ethical frameworks for practice as well as personal and professional behaviour. It also focuses on preceptorship and clinical development, on health policy and its implications for service developments, management of change and the implications of national service frameworks and the National Institute for Clinical Excellence;

- Public health - local and national health promotion strategies for screening, meeting patients' and clients' nutritional needs, lifestyle issues, healthier options and compliance, sexual health and HIV/AIDS, and patterns of inequality in health;

- Research - concentrates on questioning sources of knowledge, exploring underpinning political and professional agendas, methods of inquiry and research and their relationship to practice. It also develops skills in accessing and using source material and implementing evidence-based practice as well as examining quality assurance, standard setting, clinical audit and governance, and ethical dimensions of research;

- Ethnicity - culture and diversity in individuals and communities, non-judgemental approaches and professional value-base, local provision and support, and accessibility of services for vulnerable groups;

- Information management and technology - knowledge for evidence-based practice using all available technologies.

Innovation in learning, teaching and assessment
The course aims to develop independent, learning, critical thinkers by adopting 'student active' approaches to learning and teaching such as: inquiry-based learning, action learning and reflection.

These approaches combine a problem-solving approach and strategies to improve nursing practice through resolving dilemmas and raising awareness of one's own strengths and weaknesses.

Theoretical and practice components of the course are demonstrably linked through competencies, course content, theory-and-practice learning outcomes, and support systems. The course places specific emphasis on the acquisition of clinical and transferable skills, underpinned by an appropriately broad and deep knowledge-base. Half of students' time is spent in clinical practice, and long clinical placements of at least 12 weeks are introduced at the start of the course. The nature and extent of the practice focus has been determined by all the stakeholders involved in the course.

Ultimately, the innovative approaches adopted will ensure that graduates of the new course are fit for practice and meet the requirements of current and future health care agendas, through the achievement of academic and professional awards that are underpinned by inquiry- and practice-based experiential learning.

The new model provides a number of important benefits to all involved. These are:

- The partnership approach adopted extends to all stakeholders the opportunity for meaningful involvement and the ability to influence the outcomes of course development and delivery;

- Local policies on social inclusion, wide access and participation extend opportunities to prospective students of different abilities from all sectors of society;

- Students have the opportunity to 'step on' and 'step off' the course at various stages and levels, having accumulated academic and vocational credits. Also students initially enrolled on the diploma level course may 'fast track' to qualify with an undergraduate degree. Conversely, students initially enrolled on the latter may 'slow track' to qualify with the former;

- The portfolio - a competency-based approach to the assessment of practice, underpinned by early introduction of long clinical-practice placements, enables students to demonstrate the level of their clinical, technical and transferable skills and competency to practice with confidence at various stages and levels of the course;

- Recognition of prior learning and experience enables eligible students to be exempt from parts of the course;

- The multiprofessional course framework fosters the interprofessional learning necessary for shared understanding of roles and care situations encountered within the practice setting;

- Ultimately, the course produces a knowledgeable, skilled, competent, flexible and adaptable registered nursing workforce able to meet the UK population's changing health needs.

- Interested readers may obtain specific details from the relevant course documentation, which is published by University College Northampton. Regular updates are also available at:

- The next article in the series will describe the role of and contribution made by local service users and carers involved in the development and delivery of this course

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