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Succeeding on Your Nursing Placement Get the most out of your practice placement with this handy guide Every nursing programme requires placements where nursing students and trainee nursing associates can spend the required hours in practice-based learning, on the pathway to registration with the Nursing and Midwifery Council (NMC). In recent years, the introduction of new assessment standards and the massive disruption caused by the COVID-19 pandemic has created new challenges for nursing students and placement instructors. Now more than ever, it is essential that nursing students are able to make the most of their placement experience. Succeeding on your Nursing Placement provides indispensable guidance, built carefully around the 2018 Standards for Student Supervision and Assessment and their deployment in practice settings. This book provides students with the tools and best practices required to succeed in their practice placement and achieve registration, emphasising relationships with patients, supervisors, fellow placement students, and others. * Twelve chapters covering a range of subjects including equality and diversity, feedback, learning in practice, and more * A specific section focusing on the practice assessment document * Boxed activities in each chapter encouraging further learning and development Succeeding on your Nursing Placement is a must-have book for nursing students and trainee nursing associates looking to position themselves well at this crucial stage of their education.
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Veröffentlichungsjahr: 2023
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Contributors
Preface
References
Acknowledgements
CHAPTER 1: Your course, your programme of study
Introduction
The Nursing and Midwifery Council
The Code
Preserve safety
Promote professionalism and trust
Using social media
Professional regulation and the professional register
How to search the register
Programme validation and approval
Quality assurance
Standards framework for nursing and midwifery education
The standards of proficiency
University programme approval
Registration with the Nursing and Midwifery Council
Summary
References
CHAPTER 2: The Nursing and Midwifery Council standards
Introduction
The standards
The nursing workforce
Apprenticeships and nursing associates
The proficiencies
Standards of proficiency for registered nurses and registered nursing associates
The platforms
The annexes
The standards for student supervision and assessment
Summary
References
CHAPTER 3: Learning to learn
Introduction
Active and passive learning
Active learning: the flipped classroom
Active learning: simulation
Becoming a self‐directed learner
Summary
References
Further reading
CHAPTER 4: Equality and diversityneeds
Background to equality, diversity and inclusion
Discrimination
Unconscious bias
Institutional position on equality, diversity and inclusion
Higher education organisations
Culturally sensitive care
Summary
Acknowledgements
References
Further Reading
CHAPTER 5: Learning in practice
Introduction
How learning in practice differs from learning in the classroom or online
The Willis Report
Collaborative learning in practice
Where learning might take place
Types of learning opportunities in practice
Summary
Ways of teaching and facilitating learning in practice
Role modelling
Reflective practice
Use of reflective models
See one, do one, teach one: the medical training model
Mentoring/supervision
Summary
References
CHAPTER 6: Getting ready for practice
Introduction
Practice learning
Key requirements prior to going into placement
Your health and wellbeing
Summary
References
Useful resources
Learning activities outline answers
CHAPTER 7: Getting the most out of the practice experience
Introduction
My own journey as a student nurse
Hints and tips
The two Rs
After/ending placement
Summary
References
CHAPTER 8: Standards for student supervision and assessment
Introduction
An overview of the standards
Learning environments (organisation of practice learning)
Practice supervision and the role of the student
Practice supervisor's roles and responsibilities
Practice supervisors: contribution to assessment and progression
Assessor's roles
Practice assessor responsibilities
Academic assessor responsibilities
Role preparation
Summary
References
CHAPTER 9: The practice assessment document
Practice assessment documents
Guidance on using the practice assessment document
Assessment in practice
Those involved in assessment
Criteria for assessment in practice
Components of the practice assessment document
Placement orientation
Completing your orientation
Mid‐point interview
Active participation in care with minimal guidance and increasing confidence
Practice assessor's comments
Learning and development needs
Professional values
Who assesses the professional values?
Proficiencies
Episodes of care
Medicines management
Patient/service user/carer feedback form
Feedback as part of the assessment process
Additional feedback on practice placement
Recording of working with and learning from others/interprofessional working
Record of communication and additional feedback
Record of peer feedback
Ongoing achievement record
Action plan
Electronic practice assessment document
Record of practice hours
Your role in supporting your learning in practice
Acknowledgements
References
CHAPTER 10: Receiving feedback and feedforward
Introduction
The assessment process and partnerships in feedback
Feedforward within the feedback process
Simulated practice
Feedback via complaints and compliments
Some useful suggestions for you
Clinical governance
External regulated agencies
Compliments
Awards scheme
Identifying and managing underperformance in student nurses: the action plan
Summary
References
CHAPTER 11: The student as a teacher
Introduction
The student teacher and the Nursing and Midwifery Council
Supervising and teaching
Learning
Theories of teaching
Approaches to teaching
Learning objectives
Delegation
Summary
References
CHAPTER 12: Lifelong learning
Introduction
Lifelong learning
The Francis Report
Revalidation
Additional requirements for revalidation
Summary
References
Index
End User License Agreement
List of Tables
Chapter 1
TABLE 1.1 Glossary of terms used to describe a person's registration status....
TABLE 1.2 The standards framework.
Chapter 2
TABLE 2.1 The NMC.
TABLE 2.2 A full time nursing student and a nursing apprentice.
TABLE 2.3 Standards of proficiency for registered nurses.
TABLE 2.4 Annexes A and B.
Chapter 4
TABLE 4.1 How to: some questions to ask patients and families.
Chapter 8
TABLE 8.1 Sections of the Standard for Student Supervision and Assessment....
TABLE 8.2 Criteria for role assignment.
TABLE 8.3 Example of preparation for those with no previous experience of su...
Chapter 9
TABLE 9.1 Example to illustrate parts with progression points of pre‐registr...
TABLE 9.2 The three levels of performance to be met by the end of each part....
TABLE 9.3 Levels of participation.
TABLE 9.4 SMART goals.
Chapter 10
TABLE 10.1 Some methods related to electronic feedback.
TABLE 10.2 An example of an action plan.
Chapter 11
TABLE 11.1 Most influential theories of learning.
TABLE 11.2 The SMART acronym.
TABLE 11.3 Some methods of assessment.
Chapter 12
TABLE 12.1 Recommendations from the Francis Report (nursing training and lea...
TABLE 12.2 The three roles associated with lifelong learning and continuing ...
TABLE 12.3 The three roles associated with lifelong learning and continuing ...
TABLE 12.4 The three roles associated with lifelong learning and continuing ...
TABLE 12.5 The three roles associated with lifelong learning and CPD (princi...
TABLE 12.6 The three roles associated with lifelong learning and CPD (princi...
TABLE 12.7 Practice hours.
TABLE 12.8 Continuous professional development.
TABLE 12.9 Examples of continuing professional development activity.
TABLE 12.10 Practice‐related feedback.
TABLE 12.11 Reflective accounts.
TABLE 12.12 Practice related feedback.
TABLE 12.13 Additional requirements.
List of Illustrations
Chapter 2
FIGURE 2.1 Future nurse proficiencies.
Chapter 3
FIGURE 3.1 Bloom's taxonomy.
FIGURE 3.2 Gibbs' reflective learning cycle.
FIGURE 3.3 Cycle of self‐directed learning.
Chapter 8
FIGURE 8.1 The concept of a spoke placement.
Chapter 9
FIGURE 9.1 Summary of orientation – best practice.
FIGURE 9.2 Action plan.
Chapter 10
FIGURE 10.1 Feeding back and feeding forward.
FIGURE 10.2 NHS England complaints process.
Chapter 11
FIGURE 11.1 Simple approach to teaching planning.
FIGURE 11.2 Adapted approach to teaching planning.
Chapter 12
FIGURE 12.1 Safe and effective practice.
Guide
Cover Page
Title Page
Copyright Page
Contributors
Preface
Acknowledgements
Table of Contents
Begin Reading
Index
Wiley End User License Agreement
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Succeeding on your Nursing Placement
SUPERVISION, LEARNING AND ASSESSMENT FOR NURSING STUDENTS
Edited by
Ian Peate OBE FRCN
Editor in Chief British Journal of Nursing Visiting Professor St Georges University ofLondon and Kingston University London; Visiting Professor Northumbria University; Professorial Fellow Roehampton University; Visiting Senior Clinical Fellow Universityof Hertfordshire, UK
This edition first published 2024© 2024 John Wiley & Sons Ltd
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Library of Congress Cataloging‐in‐Publication Data applied for:[PB ISBN: 9781119819660]
Cover Design: WileyCover Image: © Reza Estakhrian/Getty Images, FS Productions/Getty Images
CONTRIBUTORS
Sebastian BirchRMN, FHEA
Sebastian is a senior clinical nurse specialist working in a child and adolescent mental health services team in South‐West London as the risk and self‐harm lead. He is adept at delivering psychosocial interventions (based on dialectical behavioural therapy and mentalisation‐based therapy). He has also been a senior lecturer at Roehampton University and continues to work as a visiting lecturer. He works to bring philosophical concepts into nursing to deepen our understanding of care. He has studied for a masters in continental philosophy, which he uses to critique and expand the foundations of care.
Claire CamaraRN
Claire is a lecturer in children and young people's nursing at Northumbria University. She is currently undertaking a PhD aiming to understand the lived experience of young people who have a chronic illness and are currently taking part in a clinical trial. Previously, Claire worked as a paediatric research nurse supporting children, young people and their families throughout their research journey. Claire has also cared for patients and their families in paediatric oncology, forensic units and in‐patient eating disorders. Her research interests include the lived experiences of children and young people, the student experience, and end of life care provision. Claire is also co‐lead of the health and life sciences student equality, diversity and inclusion group at Northumbria University and is working with students on different initiatives within that group.
Luke CoxRN, BSc (Hons), PGDE, FHEA
Luke qualified as a nurse in 2005 and has experience in cardiology and emergency department settings. He has worked as a clinical educator, focusing on using simulation as a teaching methodology. He is currently a senior lecturer in clinical skills and simulation at the University of Roehampton.
Jane FishRN, RCNT, RNT, DipN (Lond), DipN Ed (Lond), MBA
Jane has her own successful consultancy business in management, education and training. Jane started nursing in 1979 and undertook three years of student nurse training at the Thomas Guy School of Nursing in London. She completed post‐registration courses in intensive care and care of the elderly and was a ward sister at Guy's Hospital in medicine and rehabilitation of the elderly. Moving into nurse education in 1988, she studied at the Institute of Advanced Nurse Education at the Royal College of Nursing in 1989 and 1991, completing the Diploma in Nurse Education with distinction. In 1994, Jane graduated from the Open Business School with a Master's in Business Administration. Since 1993, Jane has established her consultancy business. She has collaborated with multiple stakeholders in NHS trusts, universities, the Department of Health, CapitalNurse and Health Education England, working at a national, regional and local level. Jane has extensive project management experience and was project manager on the first Pan London Practice Assessment Document (PLPAD) project for pre‐registration nursing students in 2013 and project managed the second PLPAD from 2017 to 2019 to prepare future nurses, with the document being used by most universities across England.
Peta Jane GreavesRGN, PhD
Jane Greaves is an associate professor in the Faculty of Health and Life Sciences at the University of Northumbria, where she has worked for 14 years. She is a registered nurse with 13 years' experience of working in critical care. Subsequently, she worked for six years as a lecturer practitioner promoting interprofessional education in the context of patient deterioration, particularly between doctors and nurses, when managing acute deterioration. Jane has continued to pursue interests in interprofessional education and its role in patient safety. In her doctoral thesis, she studied the use of early warning scores. Jane is a trustee and honorary treasurer of the National Confidential Enquiry into Patient Outcome and Death. More recently, she has investigated the application of early warning scores in the community and learning disability sectors.
Sue Jackson PhDRNT FHEA
Sue Jackson is an associate professor in adult nursing at Northumbria University, Newcastle upon Tyne. She is a registered nurse with 37 years working within clinical nursing, healthcare research and nurse education. Her doctoral thesis examined ‘Student nurse professionalism: repertoires and discourses used by university students and their lecturers’. This work explores the student journey to professional socialisation through the language they use. Her research interests aim to enhance the student's experience in both the academic and clinical setting. As departmental director for equality, diversity and inclusion, Sue is committed to ensuring that students from minority and widening participation groups have a voice at all stages of their education journey.
Catherine JonesRN, BA (Hons), DipHE (Nurs), PGCE HealthcareProfessionals, FHEA
Catherine's nursing career began as a staff nurse in a busy London teaching hospital in 1997. After gaining some useful experiences, she joined the critical care team and gained specialist qualifications in intensive care nursing in 2003. Later, Catherine was fortunate to be able to work as a junior sister on a general surgery ward and senior staff nurse in an intensive care setting. Supporting students in practice was integral to her nursing practice throughout these years and in 2014 Catherine became practice educator and team leader on the general intensive care unit. Catherine joined the team at the University of Roehampton in August 2020 as a senior lecturer in nurse education and enjoys teaching pre‐registration nursing students. Her interests include critical care, non‐technical skills, simulation, workforce development and lifelong learning.
Serena Khoury
Serena is a third‐year student mental health nurse and programme representative for the same course at the University of Roehampton. She has completed placement in a plethora of mental health services during her time at Roehampton, including the Priory, Change Grow Live and Barnes Hospital. She is interested in the exploration of trauma in childhood and how that affects people in adulthood. When she graduates, she would like to work in eating disorder services for adults and hopes to open a mental health clinic in West Africa one day.
Kim LewinRN, MSc, Specialist Practitioner, DipHE (Nursing), Independent and Supplementary Prescriber, FHEA, Queen's Nurse
In her nursing career, Kim has worked in a variety of roles including those of practice nurse, nurse practitioner, community matron, specialist nurse and lead for case management. She has worked across acute hospital care, general practice and community settings. After spending many years supporting and assessing students in clinical practice, she moved into the role of senior lecturer in nurse education at the University of Roehampton in 2020, where she teaches BSc adult and mental health students and MSc dual field (adult/mental health) students. Her professional interests include pharmacology, community nursing, complex case management and lifelong learning.
Ashley LuchmunRN, DN, MA Ed, PG Dip
Ashley began his nursing journey in 2003 registering with the Nursing and Midwifery Council in 2006. He has worked exclusively in community nursing in different roles: community staff nurse, district nurse team manager, community matron and community specialist respiratory nurse. Ashley has always had an inclination for education and joined nursing higher education in 2014. She has since worked in three London universities, teaching mainly on pre‐registration and other health care associated programmes. His areas of interest are public health, management of long‐term conditions and evidence‐based practice. His research area is the use of virtual reality and technology in health education.
Siobhan McGuckinRGN, MSc, FHEA
Siobhan qualified in 1986 in Belfast, Northern Ireland, and initially worked in the general intensive care unit at the Mater Infirmorum Hospital in Belfast. She then spent time in a nursing home in Rochdale, Lancashire, caring for young disabled patients and patients with multiple sclerosis. Siobhan moved to London, where she commenced her cancer nursing career, especially within haematology. She was the clinical nurse specialist for patients with rare blood disorders: thrombotic microangiopathies at University College Hospital, London. Siobhan has always been involved with teaching and eventually moved into undergraduate nurse education in University College Hospital, London, as a practice educator. From here, she moved into her first academic position at the University of Roehampton in January 2021. Siobhan's key areas of interest are haematology, person‐centred care and preventing and managing deterioration.
Ian PeateOBE, FRCN
Ian is Editor in Chief British Journal of Nursing, Visiting Professor St Georges University, University of London, and Kingston University, London, Visiting Professor Northumbria University, Professorial Fellow University of Roehampton, Visiting Senior Clinical Fellow University Hertfordshire. He has worked in nurse education since 1989. His key areas of interest are nursing practice and theory. Ian has published widely. Ian was awarded an OBE in the Queen’s 90th Birthday Honours List for his services to nursing and nurse education and was granted a fellowship from the Royal College of Nursing in 2017.
Paulette RaganRN, BA (Hons), PGCE (Lond)
Paulette started out as an auxiliary nurse in elderly care and commenced training at Westminster Hospital, London, in 1990. Her nursing career has spanned over 30 years of clinical practice in numerous settings in London, Bristol and across Australia. She has worked as a clinical nurse specialist in homelessness and as a community‐based practice development nurse as well as a community practice educator. She currently works as a senior lecturer in adult nursing in the nursing and life sciences department at the University of Roehampton Croydon Campus. Her areas of specific interest are public health, marginalised groups, pharmacology and professionalism.
Jo RixonRGN, MA Ed, SFHEA
Jo commenced her career in 1986, training at the Hammersmith Hospital School of Nursing. Her clinical career spanned a number of years, primarily remaining within North West London, with a focus on surgical and intensive care nursing. A move to practice development, supporting pre‐registration learners within clinical practice, preceded a subsequent move to nurse education in 2006. Jo's initial focus was adult nursing until 2015 when she became head of practice learning and, in 2021, head of nursing. Jo has particular interests in widening participation and supporting career progression, management and leadership and practice learning.
Scott RoddenRN, BSc (Hons), PGCLT, FHEA
Scott has worked as a staff nurse in cardiology and neurosurgery and has since moved into nurse education. He moved into nurse education in 2021 taking up a nurse lecturer post at BPP University and has since moved to the University of Roehampton as a lecturer in adult nursing. Scott is currently undertaking his master's degree in education, policy and society at Kings College London. His key areas of interest are social justice in nursing and nurse education.
Mariama Seray‐WurieRN(A), MA, SFHEA
Mariama is head of practice learning, University of Roehampton, responsible for strategic and operational oversight of practice learning, ensuring effective practice learning processes for the nursing programme that meet the university and regulatory body requirements. She became a registered nurse in 1989 and her clinical background was in infectious diseases and haematology. She moved into higher education in 2000, starting her career in nurse education as a clinical skills facilitator. Mariama has been a lecturer at the University of West London, a senior lecturer for adult nursing and a director of programmes at Middlesex University. She graduated with an MA in learning and teaching in healthcare in 2005. Mariama's teaching focus is mainly with pre‐registration nursing curriculum development and programme management, simulated practice learning and international exchanges in nursing.
Lucy TylerRN, MSc, FHEA
Lucy has been a qualified nurse since 2004. Her clinical career has been spent mainly in neurology and emergency nursing. She has always had a passion for facilitating the learning of others either in clinical practice or in recent years within higher education, where she has been involved in a variety of education innovations in undergraduate nursing education. Lucy has a keen interest in clinical skills and simulation‐based education, integrating mental and physical health and interprofessional learning within nurse education.
Laura Wasey
Laura is a student nurse.
Kathy WilsonRN, PhD (Professional Studies), Dip N, PGCHE
Kathy is director of professional practice at Middlesex University, London. She started her nursing career in 1983. Kathy has spent much of her academic career in roles that have focused on practice learning and assessment as this is where her passion lies. As chair of the Pan London Practice Learning Group (PLPLG), Kathy has overseen the development of the second Pan London Practice Assessment Document (PAD), with the support of a project manager, funded by Health Education England and a large group of pan‐London HEI and practice partner colleagues. This work led to the creation of a range of online resources to support the development of practice assessors and practice supervisors and these e‐modules can be accessed via the PLPLG website. Following the successful implementation of the PAD, Kathy secured further funding to support the development of an electronic PAD, which is transforming the student and supervisor/assessor experience across London. She chairs the Pan London ePAD steering group.
PREFACE
Succeeding on your Nursing Placement helps students of nursing and other health and social care students understand the principles required to learn effectively and make the most out of the learning experience in various health and care settings. The contributors are academics and clinicians with an ability to draw on many years' experience in nursing practice and nurse education.
Pre‐registration nursing students and trainee nursing associates are required by the Nursing and Midwifery Council (NMC) to achieve a minimum number of practice hours during their programme of study. The NMC introduced new education standards in 2018 these new standards (also known as the Future Nurse Standards; NMC 2018a) reflect the scope and requirements of contemporary nursing practice. For the first time, the NMC also produced Standards of Proficiency for Nursing Associates (NMC 2018b). These standards impact nursing students, nurse apprenticeships and trainee nursing associates. The standards also affect those nurses who wish to return to practice, all registered nurses, nursing associates, higher education institutions such as universities, and practice placement providers.
With the introduction of the new NMC education standards, the way in which practice‐based learning is assessed and delivered has also changed. Students are still required to undertake a prescribed number of practice‐based learning hours before they can be registered with the NMC. There has been a significant change to practice‐based learning. Mentors and sign‐off mentors have now been replaced with practice supervisors, practice assessors and academic assessors. The Standards for Student Supervision and Assessment were also introduced in 2018 (NMC 2018c). Nurse education, as noted, has and is changing dramatically, as students, practitioners and academics respond to challenges faced locally, nationally and internationally. Over the past few years there has been significant disruption to the provision of nurse education. The COVID‐19 pandemic has seen care provision and nurse education adapt, with the art and science of caring remaining central to all that is taught.
We acknowledge, from the outset, that there are many names used in the literature to describe those who would share their illness experience with students of nursing, including patients, clients, consumers, stakeholders, service users, patient educators, patient instructors, clinical teaching associates, supervisors and mentors. For the sake of clarity and conciseness, we have chosen to use the term ‘patient’ to denote those with illness experience and their caregivers who may participate in health profession education. We accept the understanding that the history and etymology of the word ‘patient’ can be challenging, and that the term can be associated with passivity and being acted upon.
Succeeding on your Nursing Placement gives much consideration to the Standards for Student Supervision and Assessment (NMC 2018c), which are applicable to all students, and how they are used in practice settings. Learning in practice is a fundamental part of every student's formal education, often presenting challenges to all who are involved in practice‐based learning. Some students report that they encounter a range of difficulties as they try to fit into the practice environment, for a number of reasons. As a result, they must be prepared for their role through the development of appropriate skills as they learn in practice.
All students who undertake a nursing programme must complete practice placements. These placement hours are an essential requirement for registration. Practice placements can cause students stress and this can compromise learning. Thorough preparation by the student and an understanding of the myriad of opportunities that are available in the practice learning environment accompanying a placement can reduce anxiety and enhance the learning experience, which will ultimately result in better, safer patient care.
A student's exposure to the practice learning environment is one of the most important factors affecting the teaching and learning process in health and care settings. Helping students to navigate the sometimes complex learning environments to which they are exposed could improve practice education and also reduce the rates of student attrition.
The key issues that students are likely to face during the practice learning experience are the focus of this text. Succeeding on your Nursing Placement is arranged over 12 chapters. The text offers support and advice to encourage students to get the most out of the practice‐based placement. The chapters concentrate on helping students as they engage in their practice placements, encouraging them to think about their part in the process and their obligations, as well as the roles and responsibilities of others (NMC 2018d). They are urged to explore what they bring to the placement and what they can expect from the learning experiences. There is an emphasis on acknowledging and recognising one's own responsibilities as well as understanding the responsibilities of the higher education institutions (universities) and the various practice‐based partners. The text includes an explanation about how practice‐based learning is organised and why; putting the pieces of the jigsaw together. Understanding these issues may help the reader to enjoy a better learning experience.
Our aim is to the engage the reader with a range of interactive activities, so students are able to understand and apply the knowledge to their practice. Where appropriate, there are a number of interactive activities to encourage the reader to take stock and carry out a variety of activities. Succeeding on your Nursing Placement adopts a practical approach and where relevant practice exercises are incorporated encouraging students to apply what they are reading to the practice placement experience (wherever this may be). To enhance understanding, the chapters have several summary sections interspaced, enabling the reader to digest the bite‐sized discussions. Each chapter begins with an aim and learning outcomes, permitting the reader to contextualise and concentrate on the chapter content.
Succeeding on your Nursing Placement has the potential to help students to seek out and create learning opportunities located within the care environment, and to develop skills related to practice learning, which can help them to reach proficiency and gain confidence. This book is, more than anything else, a practical guide for students who wish to develop skills for learning when in practice placements.
We hope that students will find the content useful as they engage with and in the amazing world of nursing and health care. Nurse education and nursing practice are constantly changing and evolving to meet a multitude of changes and developments, students play a key part in those changes and we wish them much success as they undertake their nursing programmes.
References
Nursing and Midwifery Council (2018a) Future Nurse: Standards of Proficiency for Registered Nurses.
https://www.nmc.org.uk/globalassets/sitedocuments/education‐standards/future‐nurse‐proficiencies.pdf
(accessed September 2022).
Nursing and Midwifery Council (2018b). Standards of Proficiency for Nursing Associates.
https://www.nmc.org.uk/globalassets/sitedocuments/education‐standards/nursing‐associates‐proficiency‐standards.pdf
(accessed September 2022).
Nursing and Midwifery Council (2018c). Realising Professionalism: Standards for Education and Training. Part 2: Standards for Student Supervision and Assessment.
https://www.nmc.org.uk/globalassets/sitedocuments/education‐standards/student‐supervision‐assessment.pdf
(accessed September 2022).
Nursing and Midwifery Council (2018d). Standards for Pre‐registration Nursing Education.
https://www.nmc.org.uk/Programme‐standards‐nursing
(accessed December 2020).
ACKNOWLEDGEMENTS
I would like to thank my partner, Jussi Lahtinen, for his constant support. I also owe recognition to the chapter contributors and students who, despite tumultuous times, supported me in their contributions to the text – thank you all.
CHAPTER 1Your course, your programme of study
Ian Peate and Scott Rodden
AIM
This chapter provides the reader with insight into how healthcare programmes of study (nursing) are devised and developed, together with regulatory requirements that must be met.
LEARNING OUTCOMES
Having read this chapter, the reader will:
Be able to outline the role and function of the Nursing and Midwifery Council.
Understand how a programme of study is constructed.
Have an awareness of the essential requirements that are associated with a Nursing and Midwifery Council approved programme.
Be able to describe the purpose of regulation and the Nursing and Midwifery Council's professional register.
Introduction
You have enrolled on an educational programme that will prepare you to become a member of a profession that is respected by people around the globe, and which brings with it great privilege and responsibility. As a student, be proud of the profession you are preparing to enter. Throughout your programme of study, aim to uphold the values and standards that have made the UK's nurses so well regarded around the world. It is crucial that, even as a student, you conduct yourself professionally at all times so as to defend the trust that the public places in our profession. Throughout your programme, you will be learning about the behaviour and conduct that the public expects from nurses. On more than one occasion, you will be assessed on the knowledge, skills and behaviours required to become a registered nurse.
In your practice placement (your placement experience), your knowledge, skills, and behaviours are assessed against the personal and professional conduct expected of you as a nursing student to determine whether, after completion of your programme, you will be deemed fit to practice. You will be working towards the standards enshrined in the Code (NMC 2018a) during your pre‐registration programme, so it is important that you are aware of and understand these standards, these benchmarks.
The Nursing and Midwifery Council
In the UK, nursing is one of two professions regulated by the Nursing and Midwifery Council (NMC), the other is midwifery. The regulation of nurses and midwives by statute has been in place for over 100 years. This chapter focuses predominantly on nurses. There are other health and social care professions that are also regulated by law; for example, paramedics and operating department practitioners are regulated by the Health and Care Professions Council (HCPC).
Complete this activity now
How many health and care professions does the HCPC regulate?
Make a list of them:
It is important that future generations of nurses have an understanding of how nursing as a profession and other health and social care professions have developed and how we have been brought to this point in our evolution as we continue to move forward. Locally, nationally and internationally, we need nurses who practise to the highest of standards, providing patient care that is safe, effective, dynamic and responsive to the changing needs of individuals, communities and nations; this is the hallmark of our profession.
Established by Parliament and with a UK‐wide remit, the NMC was formed under the Nursing and Midwifery Order 2001. As the statutory regulator for over 700 000 nurses, nursing associates and midwives (NMC 2022a,b,c), the NMC's core function is to protect the public by setting standards of practice for the professions and to ensure that standards are maintained. Those nurses, nursing associates and midwives whose name appears on the professional register are known collectively as registrants.
The Code
The Code (NMC 2018a) clearly sets out to registrants the professional standards that are required of them as they undertake their professional responsibilities. Although students are not registered with the NMC, it is expected that they keep to the principles expressed within the Code. All registrants must act in line with the Code, whether they are providing direct care to individuals, groups or communities or bringing their professional knowledge to impact on nursing practice in other roles, for example, leadership, education, or research.
Protection of the public is the key concern of the NMC. The NMC's duties to society are to serve and protect, and this is done by:
Maintaining a register that lists all nurses, nursing associates, and midwives.
Setting standards and guidelines for nursing and midwifery education, practice and conduct (this also includes nursing associates).
Ensuring quality assurance related to nursing and midwifery education.
Considering allegations of misconduct or unfitness to practise as a result of registrant's ill health.
Within the Code is a series of statements that, when considered together, represent what good nursing practice should look like. With the interests of patients and service users paramount, care should be safe and effective and the actions of the nurse should promote trust through professionalism. There are four themes in the Code that describe what nurses are expected to do:
prioritise people
practise effectively
preserve safety, and
promote professionalism and trust.
Prioritise people
You are required to put the interests of those people who are using or needing nursing services first. You have to ensure that their care and safety is your main concern and that dignity is preserved and their needs are acknowledged, assessed and responded to. Those who are recipients of care are to be treated with respect, ensuring that their rights are defended and that if there are any discriminatory attitudes and behaviours directed towards those receiving care, they are challenged.
Practise effectively
When practising in an effective manner, you will assess needs and deliver or advise on treatment or offer help (this also includes preventative or rehabilitative care) without too much delay and to the best of your abilities and on the foundation of the best available evidence and best practice. You must communicate in an effective manner, ensuring that you keep clear and accurate records and sharing your skills, knowledge and experience where this is appropriate. You must reflect and act on any feedback that you receive with the intention of improving your practice.
Try this on placement
Within your practice assessment document there is opportunity for patients/service users/carers/relatives to provide feedback:
With the Code uppermost in your mind, how can you use the feedback provided to help you improve your practice?
Patient/service user/carer feedback form
Practice supervisors/practice assessors should obtain consent from patients/service users/carers who can if they wish decline to participate. We would very much like to hear your views about the way the student has supported your need. The feedback you provide will not change the way you are cared for; it will help to develop the student's learning.
What did the student do well?
What could the student have done differently?
Practice supervisor/assessor:
Name: Signature: Date:
Student
'
s Name: Signature: Date:
Preserve safety
There is a requirement in the Code to keep the public and patients safe from harm. As a registered practitioner you must work within the limits of your competence, using your professional ‘duty of candour’, raising concerns immediately whenever you come across any situation that will put patients or public safety at risk and you take necessary action to deal with any concerns where appropriate. These are the foundations of patient safety and, as a student, you also have a role to play in maintaining safety.
Write here
What do you think might be the possible reasons for lapses in safety? Can you list them, thinking about human and material issues that could lead to a breach in safety?
Human error
Material issues
Both
Promote professionalism and trust
At all times you must uphold the reputation of your profession, displaying a personal commitment to the standards of practice and behaviour that are laid out in the Code. You should be a model of integrity and leadership, so others can aspire to these qualities. When you display commitment, integrity and leadership, this often leads to trust and confidence in the profession from patients, those who are receiving care, other health and care professionals as well as the public.
Green flag
The fundamentals of care
The fundamentals of care cover the essential aspects of caring for a patient. They include but are not limited to nutrition, hydration, bladder, and bowel care, physical handling, and making sure that those people receiving care are kept in clean and hygienic conditions. Furthermore, you must ensure that those receiving care have adequate access to nutrition and hydration, and you must make sure that you offer and provide assistance to those people who cannot feed themselves or drink fluids unaided.
The duty of candour requires nurses to be open and honest with colleagues, patients and healthcare regulators when things go wrong. All healthcare professionals must be open and honest with patients when something goes wrong with their treatment or care which causes, or has the potential to cause, harm, or distress (General Medical Council et al. 2014). You must raise concerns immediately if you are aware of a threat to the safety of a patient or a danger to public protection.
In an emergency situation, as a registered nurse, you have a professional duty to take action. This action may need to be taken even when a nurse is off‐duty; the nurse must only act within the limits of their competence. The nurse must arrange, wherever possible, for emergency care to be accessed and provided promptly, taking account of their own safety, the safety of others and the availability of other options for providing care.
Using social media
The NMC has provided guidance on the use of social media which is underpinned by the Code (NMC 2019). Social media should be used responsibly and aligned to NMC guidance as well as any guidance issued by your university or employer.
When social media (e.g. social networking sites) is used in a responsible and appropriate way it provides a number of benefits for nurses and students. It can be used to build and maintain professional relationships, to create or access nursing support networks to enable the discussion of specific issues, interests, research, and clinical experiences with other healthcare professionals locally, nationally, and internationally. It should be noted that the principles that have been outlined in the NMC's guidance can also generally be applied to other forms of online communication; for example:
personal websites and blogs
discussion boards
general content shared online, including text, photographs, images, video, and audio files.
Go online
Access the Code online: www.nmc.org.uk/standards/code. Within the Code there are a number of statements that can be applied to the use of social media. Consider the four components taken from the Code and make notes on the implication they have for you and for the people to whom you offer care to specifically related to the use of social media.
Paragraph
Component
Your notes
1.1
Treat people with kindness, respect and compassion.
5
As a nurse, midwife or nursing associate, you owe a duty of confidentiality to all those who are receiving care.
20.6
Stay objective and have clear professional boundaries at all times with people in your care (including those who have been in your care in the past), their families and carers.
20.10
Use all forms of spoken, written, and digital communication (including social media and networking sites) responsibly.
McGrath et al. (2019) note that the use of online social media among students is popular, with some creating online platforms for peer support and influence. Health and social care students have to be aware of the potential risks related to how they share information and communicate online. The risks can include misconduct investigations and may conclude in exclusion from studies, resulting in the student being prevented from joining the professional register (Box 1.1).
Box 1.1 How to use social media responsibly
Familiarise yourself with how individual social media applications work and be clear about their advantages and disadvantages.
Think before you post; it is important to realise that even the strictest privacy settings have limitations.
Once something is online, it can be copied and redistributed.
If unsure whether something you have posted online could compromise your professionalism or your reputation, think about what the information means for you in practice and how it affects your responsibility to adhere to the Code.
It is important to consider who and what you associate with on social media; for example, acknowledging someone else's post could suggest that you endorse or support their point of view.
Consider the possibility of other people mentioning you in inappropriate posts.
Think, in relation to the Code, what you have posted online in the past.
Source: Adapted NMC (2019).
If you have any concerns about your fitness to practise or your ability to aspire to the tenets within the Code and other guidance, you should seek support and help from your practice assessor, academic assessor (university tutor) or practice supervisor straight away. They can provide you with the support and advice that you may need before the matter becomes a more serious issue. Support services may include confidential counselling, disability advisers, supervisors, occupational health services, personal tutors, professional bodies or trade unions, student groups or unions, or student health services.
Over to you
Ask for help if needed.
To make sure that you are always able to access all the help and advice you need, be sure to familiarise yourself with the student support services available within your university and those located within the clinical placement.
Professional regulation and the professional register
Professional regulation is intended to protect the public, making sure that those who practise a health or care profession are doing so safely. Employers have a duty to check the registration of healthcare professionals with the relevant regulatory body. It is usually a contractual condition of employment that the health or care professional has registration throughout their term of employment. The NMC can provide registration information on registered nurses and midwives and will inform an employer if a practitioner has the following status:
removed
restored
conditions of practice
cautioned
suspended
lapsed
effective.
The NMC register shows who can practise as a nurse or midwife in the UK, or in England as a nursing associate. Anyone can search the NMC register. The details of registrants include those who:
Have effective registration with no restrictions and cautions, with registration fees having been paid and registration is up to date.
Are on the register but have restrictions on their practice or a caution order.
Have been suspended or removed from the register since 1 January 2008 and are not currently permitted to practice.
The parts of the register
The legislation governing the NMC is set out in the Nursing and Midwifery Order 2001. It requires that the NMC establishes and maintains a register and determines the standards of proficiency that are required to be admitted to the different parts of that register. The NMC register is divided into parts, each of which has a title indicative of the qualifications, education or training necessary to be on that part. When a name is entered on the register, this permits the nurse, midwife or nursing associate to use the title corresponding to the part in which they are registered.
Red flag
It an offence for someone to falsely represent themselves as being on the register, or on a part of it, to use a title to which they are not entitled or to falsely represent themselves as having qualifications in nursing or midwifery.
These provisions, when taken together, make it a legal requirement for any nurse or midwife who is practising in the UK or any nursing associate practising in England to be on the NMC register. There are three broad parts to the register:
Nurses part of the register subpart 1:
Adult nurse, level 1
Mental health nurse, level 1
Learning disabilities nurse, level 1
Children's nurse, level 1
Nurses part of the register subpart 2:
Adult nurse, level 2
Mental health nurse, level 2
Learning disabilities nurse, level 2
General nurse, level 2
Fever nurse, level 2
Nursing associates part of the register:
Nursing associate
Midwives part of the register:
Midwife
Specialist community public health nursing part of the register:
Health visitor
School nurse
Occupational health nurse
Family health nurse
Specialist community public health nurse.
There is also a range of qualifications that are known as recordable qualifications.
How to search the register
Searching the register is free. All those on the register are given a unique registration code: their personal identification number or PIN. A nurse, midwife or nursing associate is required to provide details of their PIN by a person who is using their services when asked. If, when searching the register, the PIN is not known the search can be made by using the first and last name, this could however, return more than one result.
The following details are shown for the person being searched for:
name
registration status
geographical location
expiry date
register entry
start date
recorded qualifications.
Different terms are used by the NMC to describe the registration status of those on the register (Table 1.1).
TABLE 1.1 Glossary of terms used to describe a person's registration status.
Source: Adapted from NMC (2020).
Term
Meaning
Registered
The nurse, midwife or nursing associate is on the register with no restrictions or cautions.
Not currently practising
The nurse, midwife, or nursing associate has informed the NMC that they are no longer practising, however, they remain on the register until their current registration period expires.
Removed by a fitness to practise (FtP) panel
The nurse, midwife or nursing associate is not permitted to practise if they have been struck off or removed from the register.
Suspended by an FtP panel
The nurse, midwife or nursing associate is not permitted to practise if they have been suspended from the register for a fixed period. The suspension order will be reviewed prior to it expiring and it may be replaced or revoked.
Voluntarily removed
The nurse, midwife or nursing associate is not permitted to practise if they have admitted that their fitness to practise is impaired and they have no intention of practising again. They can request to have their name voluntarily removed from the register.
Interim suspension order
The nurse, midwife or nursing associate is not permitted to practise, following the making of an interim suspension order by an FtP panel. This remains in place while the NMC is investigating allegations about the person's fitness to practise or pending an appeal. This interim suspension order will be regularly reviewed and may be replaced or revoked.
Conditions of practice order
The circumstances under which the nurse, midwife or nursing associate on the register can practise are restricted following a final order by an FtP panel. These conditions may be in place for one to three years. They are reviewed before they expire and may be replaced, varied or revoked.
Interim conditions
The circumstances under which someone on the register can practise are currently restricted following the making of an interim conditions of practice order. This will remain while the NMC investigate allegations about the person's fitness to practise or pending an appeal. These conditions will be regularly reviewed and may be replaced, varied or revoked.
Undertakings
Undertakings are agreed measures to address areas of practice which cause a current clinical risk to patients. Undertakings include steps that should be taken within defined time periods to demonstrate remediation. If undertakings are agreed, they will be published on the register in all cases, together with a brief summary of the regulatory concern (except in cases relating to health).
Sanction pending
This is where a nurse, midwife or nursing associate has had a final sanction imposed on them by a fitness to practise panel but it will not take effect until the end of a 28‐day appeal period or the outcome of any appeal. The person's practice may be restricted by an interim order in the meantime.
Caution order
A caution order is where someone on the register is permitted to practise without any restriction but has been made the subject of a caution order following a final order by an FtP panel. This can last from between one and five years.
Warnings
This is a public marking (on the register) of serious concerns about someone on the register without the need for a hearing. Warnings are only appropriate where the individual shows insight, remediation, and there is no risk to patients. Warnings will be published for 12 months on the register, including a short summary of the regulatory concern.
No recorded qualifications found
This means an individual has no additional qualifications added to their registration, for example, lecturer/practice educator, teacher, V200, nurse independent prescriber
Go online
Go online and search the NMC register: www.nmc.org.uk/registration/search‐the‐register.
Enter the details:
First name: Ian
Last name: Peate
What is this practitioner's geographical location?
When is the expiry date?
What is this practitioner's registration status?
Detail the register entries
What recorded qualifications are listed?
Programme validation and approval
It has been discussed previously that your name will only be entered onto the professional register when you have successfully completed all parts of the NMC approved programme and met all of the conditions required. There are a number of complex and robust procedures that approved institutions must complete prior to the NMC approving a programme that leads to registration.
A series of ambitious standards were published by the NMC in May 2018, as part of the regulator's new standards for education and future nurse plans (Chapter 2 of this text provides more detail of these standards). The introduction of these standards has resulted in significant changes to the education and preparation of those undertaking NMC approved programmes of study.
While the standards impact on students and those who provide education (practice partners and universities), they will also have implications for the people who nurses care for and will affect the whole of the nursing workforce. The changing demographics (locally, nationally and internationally) and developments in healthcare priorities prompted a change and the standards of proficiency needed to be ambitious to meet the needs of populations now and in the future; they needed to be future proofed. The standards are the blueprint for how universities devise and develop curricula.
Try this on placement
When you are in placement, take some time to consider, within that area of care, what are the key demographic changes. For example, has this care area seen an increase in older people accessing this service? Has there been an increase in people generally accessing the service?
The programme you are currently undertaking would not have been able to run until it had successfully passed through the NMCs approval processes and the NMC had confirmed in writing that it had been approved. The educational institution offering the programme would also have had to have gone through a number of internal processes of its own so as to ensure that it meets all of the university's specifications.
The NMC will make an approval based on whether education institutions, as well as their practice learning partners, can meet the education and training standards and also the relevant programme standards. Approval comes after a four‐part process has been undertaken and the education institution has demonstrated that it has met the NMC's demanding standards. Once approved the institution becomes known as an approved education institution (AEI).
An AEI is the status that is awarded to an institution, part of an institution or combination of institutions working in partnership with practice placements and work placed learning providers. AEIs are required to have provided the NMC with assurance that they are accountable and able to deliver NMC approved education programmes.
Go online
Using the dropdown menu, go online and search for an approved nursing or nursing associate education programme: www.nmc.org.uk/education/approved‐programmes.
This search facility shows programmes that offer a formal qualification from the NMC's approved education providers.
While the NMC sets the standards that AEIs must keep, as well as the standards that student nurses must meet to enter and stay on the register, it does not set the curriculum that students follow; individual AEIs are responsible for designing and developing these curricula. The NMCs pre‐registration nursing standards include:
The minimum length of nursing pre‐registration programmes.
The criteria to be met at various progression points.
The core proficiencies that all students must meet for them to progress through their programme and gain entry into the register.
The pre‐registration nursing standards include specific guidance that are related to each of the four pre‐registration nursing specialisms:
adult
children
learning disabilities
mental health.
As well as the standards relating to the four nursing specialisms (fields; field specific), all pre‐registration nursing programmes include standards for students to care for all patient groups (generic). All registered nurses are expected to be able to deal with the majority of nursing roles regardless of field.
