Practical hands-on training and experience

Accepted.
The Nursing and Midwifery Council has already taken steps to address this.
The Nursing and Midwifery Council published new standards for all pre-registration nursing programmes in 2010 which must be followed at all the universities they approve to run nursing courses. The previous 2004 standards were updated and strengthened as a result of the findings of the first Francis Inquiry and emerging evidence at that time. The first nurses to have followed programmes approved against the new standards will commence practice in 2014.
These national pre-registration nursing standards include the content and practice/study time ratios required by European Directive. All the nursing programmes last at least three years and require 50 per cent of time to be spent in practice learning and 50 per cent in academic study. The first progression point cannot be passed unless the student undertakes a period of practice learning and assessment. Currently formal learning and supervised work as a healthcare support worker can be counted through accredited prior learning routes.
The Nursing and Midwifery Council will be undertaking a full evaluation of these new education standards, commencing in 2014, and will have particular regard to these issues of caring and compassion. This will give a proper evidence base for any further revisions to these new standards, and the Nursing and Midwifery Council will consider this recommendation in parallel with their evaluation.
Although the overarching national standards are in place, the detail of the nursing curriculum is dynamic. Employers, service providers and universities are now brought together in Local Education and Training Boards, as part of the Health Education England system, to ensure all NHS funded courses are fit for purpose and reflect service needs. We expect this new part of the system to recognise the importance of Compassion in Practice, the vision and strategy for nursing in England and the values and behaviours it describes in the ‘6Cs’ to be part of the local review of courses and incorporated into the detailed undergraduate nursing curriculum.
Health Education England and the Nursing and Midwifery Council will continue to collaborate on ensuring the undergraduate nursing curriculum meets patient need.

While the NMC understood the basis for this recommendation, it was their position that these concerns had been addressed through the introduction of the UK-wide pre-registration education standards for nurse and midwives since. Under these changes, all education programmes last at least three years and require 50 percent of time to be spent in practice learning and 50 percent in academic study. The first progression point cannot be passed unless the student takes a period of practice learning and assessment. The NMC felt that this met the spirit of the recommendation.

Whilst its requirements for practice learning remain the same today, the NMC have kept these under regular review, ensuring they reflect best available evidence, and that people are safe and fit to practise at the point of entry.

In particular, in July 2014 the NMC commissioned IFF Research to evaluate its pre-registration standards. With regards to practice-based learning, this identified a broad consensus that the split between academic and practice-based elements of undergraduate programmes is appropriate so long as the quality of placements (and mentorship) is high and effectively facilitates the attainment of skills. Whilst some stakeholders wanted to see an increased emphasis on practice, pushing it up closer to 60-70%, it was acknowledged that this is unlikely to be feasible in a context of limited placement opportunities as well as limited mentor numbers. A further review of the NMC’s education and training standards was undertaken in September 2021.

Considering the number of academic theory and practice hours, the review found that there is no agreement on the type, quality or quantity of hours necessary. In 2022 the NMC also undertook specific research to understand more about practice hours in other countries and whether alignment with EU law is appropriate. This found that the number of practice hours were often lower in other countries when compared to the UK, but that this was a result of political or pragmatic reasons as opposed to evidence on the number of hours required for safe and effective practice. All sets of research provided us with assurance as to the level of practice hours set.

The NMC’s education standards were updated in 2023 following the UK’s withdrawal from the EU. The amount of practice learning hours remains the same - all education programmes must meet the equivalent minimum length of three (academic) years for full time programmes which consist of a minimum of 4,600 hours. 50 percent of time (2,300 hours) must be spent in practice learning, of which a maximum of 600 hours can be simulated practice learning. The number of practice learning hours are in line with those mandated by EU law.

The NMC first introduced emergency standards during covid to allow education institutions to deliver a proportion of practice learning through simulation. Following extensive review, the NMC has made this a permanent standard in recognition that simulated practice learning methods are becoming increasingly sophisticated and help students build their confidence and skills in a range of situations they may not otherwise encounter frequently in practice. Following changes made to its education programme standards in 2023, the NMC has committed to reviewing its nursing and midwifery practice learning to ensure requirements support students to deliver the best possible person-centred care for people across a range of practice learning environments. This will also consider how changes to simulated practice learning are being delivered.

The Nursing and Midwifery Council has commenced the evaluation of their standards for pre-registration education for nurses and midwives. Central to the evaluation are questions about the effectiveness of standards in preparing nurses and midwives for their professional roles and responsibilities which include care, compassion and leadership. The Nursing and Midwifery Council is in the final stages of appointing an independent evaluation supplier will proactively share any interim findings with Health Education England to tie into the Shape of Caring Review. The Nursing and Midwifery Council’s final report should be available in September 2015. The outcomes of the evaluation will provide an evidence base for future reviews of their pre registration standards for education so that they can, where necessary, enhance the UK standards for nurse and midwifery competence and education.

This recommendation was accepted by the Government.

In the January 2014 Hard Truths report, the Government said that the Nursing and Midwifery Council had introduced new education standards (see above). The Nursing and Midwifery Council also undertook a review of the new education standards in 2014-15. The review concluded that the standards were broadly effective, but that there were points of consideration for future development or revision of standards, including revision of use of language to reduce ambiguity; improvement in the structure of standards; further promotion of awareness of their content among key audiences; some outcomes to be added to the standards; and further entry criteria.