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Prescribing mooted for revamped nurse training standards


Prescribing, more skills in leadership and emotional resilience, and knowledge of how to prevent and manage errors should all be features of revamped standards for training nurses, according to suggestions from UK universities.

The Council of Deans of Health, which represents nursing and midwifery university faculties across the UK, has outlined how the new pre-registration standards should be developed ahead of their introduction in 2019.

“[The standards review is an] important opportunity to discuss the place of prescribing skills… within pre-registration nursing education”

Council of Deans

The Nursing and Midwifery Council confirmed earlier in 2016 it would start revising its standards this year, with a draft version completed by summer 2017 and university courses meeting the new requirements from September 2019.

In a briefing published today, academics said the review of the standards was an “important opportunity to discuss the place of prescribing skills and exposure to prescribing practice within pre-registration nursing education”.

It said there were differences of opinion about the extent to which prescribing should be included in nurse training but that “this should be teased out and the evidence base examined as part of the detailed standards development”.

Skills such as delegation, negotiation, and problem-solving, as well as an awareness of policy, organisational change and management skills will also need to feature in the standards because future registered nurses will be required to take an increasingly strong leadership role, said the briefing.

“[Future nurses will need a] comprehensive understanding of mental health, learning needs and physical health across the lifespan”

Council of Deans of Health

As a result of increasing leadership responsibilities and likely pressures on services in the future, student nurses will also need to learn emotional resilience and self-confidence to speak up about the role of nursing, it added.

Knowledge of how to prevent and manage errors when they happen is also important, said the academics, both in relation to patients and at a wider systemic level “so that registered nurses are equipped to identify and start to develop wider change as leaders”.

The body of academics also noted future registered nurses will require a “comprehensive understanding of mental health, learning needs and physical health across the lifespan, whether working with adults or children”.

“They will need to be able to work across an increasing variety of care contexts and organisational boundaries – including working between primary and community care and hospitals, often in an integrated care context,” it added in today’s report called Educating the Future Nurse.

This will mean nurses increasingly work on their own in the future, sometimes without a structured team around them, said the Council of Deans, which stated this would “need to be reflected back into pre-registration programmes”.

However, it also recognised the intention of the NHS to develop specialised services and suggested this should also be considered when discussing how to make nurses more flexible.

“Any changes to the standards must be looked at in the round with improving practice learning, reflection on mentorship and the role of those who supervise practice education”

Council of Deans

The Council of Deans also noted “particular attention” should be paid in the new standards around how to secure the future supply of nursing academics to educate the workforce.

It also warned that despite any changes made to pre-registration standards that reflect the future role of nurses, clinical learning through placements and mentors “will often continue to be delivered in an environment delivered along fairly traditional lines”. It noted there had been only a 1% increase in community nurses between 2001 and 2014.

“Any changes to the standards must therefore be looked at in the round with improving practice learning, reflection on mentorship and the role of those who supervise practice education, and work on the range and quality of practice placements available,” it added.

Professor Jan Draper, chair of the Council of Deans’ advisory group on the role of the future nurse, said: “The review [of standards] presents an opportunity to stimulate debate on the future direction of nurse education and the ways in which universities and practice organisations work together to design models of practice learning, including how to best develop high quality practice educators to ensure nurses have the requisite skills and competencies needed at the start of their careers”.

“It is encouraging that the vision for the future graduate registered nurse set out in this paper is very much aligned with our direction of travel”

Jackie Smith

NMC chief executive and registrar Jackie Smith said: “We welcome this helpful report from the Council of Deans of Health. It is encouraging that the vision for the future graduate registered nurse set out in this paper is very much aligned with our direction of travel, as we continue to develop our new standards for pre-registration nursing education.”

“Ensuring that nurses and midwives are equipped for the future in the context of a rapidly changing health and care environment is critical to our role in protecting the public,” she said.

“We will continue to work closely with the Council of Deans of Health, universities, practice organisations and other stakeholders to develop education standards that are fit for the future as part of our education strategic plan,” she added.


Readers' comments (4)

  • Universities don't even teach pharmacology, I doubt prescribing is the right way to go when students don't have a fundamental understanding of medication.

    I would love to see a more advanced nursing approach added to university curriculum's, but maybe if the NMC noticed that the high social science based courses are not necessarily providing nurses with the appropriate understanding of pathophysiology, medical microbiology, anatomy etc, then they would be able to implement more advanced nursing education.

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  • michael stone

    When I was at university - chemistry, 1970s - there was a joke that about the Social Sciences'. The joke was that it was 50% correct - that the 'social' was true, but the 'science' bit wasn't.

    PIPPI's 'the high social science based courses' made me think of that.

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  • I have always thought nursing education in the UK could borrow a leaf from the US and Canadian model. Yes patient care is not just biomedical, however I think we have taken the psychosocial model too far. If Nurses are going to be taken seriously by other allied health professionals especially in our new roles as Advanced Nurse Practitioners, Nurse Consultants etc , then indeed we must embrace tutorship in the fundamentals of biomedical medicine like pharmacology, pathophysiology, anatomy and clinical laboratory science . In a world of increasingly super informed patients,we must brace up for the intellectual challenges of being a 21st century Nurse.

    I should add however that this increasing responsibility and expectation must be matched with a comensurate NHS pay structure. The current agenda for change pay structure has outlived it's shelf life.Without a dignified remuneration that reflects the depth and complexity of the Bsc Nursing degree and the intense front line nature of the work nurses do, then am afraid we will fail to inspire a new generation of nurses to pursue nursing as a career.

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  • michael stone


    There is a retired doctor, who often e-mails me when either of us posts a rapid response on theBMJ. I posted a response titled 'What differentiates doctors from nurses if each is diagnosing and prescribing?' recently, and he e-mailed me with 'agree with you' - the piece I posted is at:

    We both had a suspicion, that one 'differentiation' is that nurses are often paid less for performing the same task: he said he had always argued that was wrong before he retired, and neither of us think that (putting nurses into roles once occupied by doctors, but paying nurses less) is right.

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