A raft of changes to pre-registration nurse education, student assessment and prescribing have been approved, following a “historic decision” by the Nursing and Midwifery Council.
At an NMC council meeting yesterday, the regulator signed off changes that will see all nurses in the future trained in the same set of procedures and communication skills regardless of their field of practice.
“What we have resolved to do is not specify the number of hours that can be spent in simulation”
The NMC’s director of education, Geraldine Walters, told the meeting there had been some resistance to the proposal but said the new standards of proficiency for registered nurses were designed to ensure all nurses could meet the fundamental care needs of people with a range of conditions.
However, she stressed students would need to demonstrate varying levels of expertise depending on their field of practice – either adult, children’s, learning disability or mental health nursing.
Meanwhile, the NMC agreed to remove its cap on the number of hours students can spend on simulation activities, despite concerns this would reduce the amount of time on placements.
However it has not raised the cap to 1,150 hours as it had originally intended. Currently the NMC stipulates a maximum of 300 hours can be used for simulation out of the 2,300 clinical practice hours required during undergraduate nurse training.
“What we have resolved to do is not specify the number of hours that can be spent in simulation – either in theory or in practice – but we acknowledge that simulation is becoming increasingly more advanced,” said Ms Walters.
“If these standards stand for the next 10 to 15 years, by 2030 we don’t want to reduce the amount of simulation that can be used,” she said. ”We also don’t want people to think this means they can do all their clinical practice [in this way].”
But she said the NMC would be monitoring universities’ use of simulation to ensure it met training requirements.
Major changes to mentoring have also been agreed, meaning students will now be supported by supervisors and assessors in both practice and academic settings.
Ms Walters said splitting the mentorship role into supervisors and assessors would help to tackle problems with “failure to fail”, which had occurred in the past when conflicts of interest led to mentors signing off students who they supervised, but when they had not met the standard.
She said the NMC hoped the introduction of two assessor roles would forge links between universities and practice.
This would mean “we don’t have situation where someone is doing fantastically in practice, and the person who is assessing them in practice doesn’t realise they don’t do very well in university, and vice versa,” she said.
Practice supervisors will be required to be any registered health and social care professional – but the NMC has now clarified they must be providing support in line with their competence.
As per the original proposal, practice assessors and academic assessors must be registered with the NMC.
But following consultation, the regulator has clarified assessors must be on the same part of the register as the student – as either nurses, midwives or specialist community public health nurses – though they will not be required to be from the same field of nursing.
The regulator has also confirmed it will go ahead with its plan not to approve training programmes for supervisors and assessors, which is contrast to the current situation for mentors.
But in response to concerns about potentially inconsistent approaches to assessment, the NMC has now set out the minimum preparation required by those who will assess trainees.
Ms Walters said the NMC had also found from its consultation that some students thought they were “too heavily overseen” on placement, meaning they were not as prepared as they could be.
As a result, the regulator has decided to redefine the supernumerary status of trainees to highlight that, while they should not be included in staffing numbers, they should be able to carry out tasks without direct oversight once they are proficient.
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Ms Walters told the council meeting on Wednesday that the changes to student learning represented a “fundamentally different” approach, and that “quite a lot of thought” would be required by universities and placement providers to revise programmes.
Outgoing NMC chair Janet Finch described the council’s agreement to the changes as a “historic decision”.
The NMC council also went on to agree changes to prescribing, meaning newly qualified nurses and midwives will be able to gain prescribing qualifications at earlier points in their careers.
Registrants will be able to go on a community prescribing course – a V150 programme – straight after their initial training, instead of waiting two years, due to the decision by the NMC to include more prescribing theory in undergraduate education.
In addition, the NMC agreed that nurses and midwives should be allowed to go on a more advanced prescribing course – the V300 programme – after only one year of experience in practice, instead of the current three.
This was despite concerns about the “contentious” proposal, due to belief among some members of the profession that the NMC wanted all nurses to prescribe immediately after qualifying.
Ms Walters said the NMC had since clarified that the inclusion of additional prescribing theory in undergraduate programmes did not mean new registrants would automatically be able to prescribe.
In response to additional concerns that employers would require nurses to gain a prescribing qualification before they felt ready, Ms Walters said the NMC had included “stronger entry requirements” to courses stating registrants must be able to demonstrate they are competent.
As part of the changes, the NMC confirmed it will adopt the Royal Pharmaceutical Society’s framework as its standards of proficiency for nurse and midwife prescribers.
Universities will be required to update their programmes in line with all new standards by September 2020.
As planned, the NMC has also agreed to withdraw its medicines management standards by July 2018 – though it said it will produce cross-professional guidance with the RPS about safe medicines management in response to concerns.