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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Your very own companion to any pre-registration nursing course!
Packed with advice, hints and tips, this essential, practical guide will orientate and guide you through your nursing course even before you start. Written in a straightforward, no-nonsense style, this Toolkit is full of strategies and help for surviving and succeeding on your pre-registration nursing course, and addresses all the key issues and concerns you may face, including:
- How to get the most out of your clinical placement
- The nursing terminology you need to know – including NMC standards
- How to create a professional Portfolio
- How to achieve a healthy work-life balance
- How to develop an effective relationship with your mentor
With case studies from real students, hands-on activities and suggestions for further reading, this is THE essential survival guide for your nursing course!
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Veröffentlichungsjahr: 2013
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Contents
Cover
Title Page
Copyright
Dedication
Acknowledgements
Preface
Chapter 1: Entry to Nursing
Your university of choice
Funding
Meeting requirements
Starting nurse education
Summary
Resources
Chapter 2: The Nursing and Midwifery Council and Other Regulatory Bodies
Health profession regulation
The Health and Care Professions Council
The General Medical Council
The role and function of the Nursing and Midwifery Council
Education and conduct
The Code
Professional conduct: student nurses
Good health, good character and fitness to practise
Summary
References
Resources
Chapter 3: Nursing Education: the Standards for Pre-registration Nurse Education
A brief history of nurse education
Standards for pre-registration nurse education
The new standards and service provision
The standards for education
Summary
References
Resources
Chapter 4: Nursing, Health and Social Care
Healthcare
Social care
Partnership working
Health and social care reform
The vulnerable person
Speaking out
Summary
References
Resources
Chapter 5: Assessment Tools
The phases of the nursing process
Assessment tools
Summary
References
Resources
Chapter 6: The Essential Skills Clusters
The NHS Constitution
The essential skills clusters
Care, compassion and communication
Organisational aspects of care
Infection prevention and control
Nutrition and fluid management
Medicines management
Numerical assessment
Summary
References
Resources
Chapter 7: The University Setting
The university structure
Student support services
Student representative bodies
The anatomy of a programme of study
Summary
References
Resources
Chapter 8: Practice Learning Opportunities
The practice setting
Practice learning opportunities
Teaching, learning and assessment
Getting the most out of clinical learning opportunities: roles and responsibilities
Supernumerary practice
Simulation centre
Summary
References
Resources
Chapter 9: The Nursing Elective
The purpose of the nursing elective
Preparing for the nursing elective
Finding and funding an elective
Making contact
Risk assessment
Getting the most out of your elective placement
Summary
References
Resources
Chapter 10: Managing Self
Values and beliefs
Self-awareness
Managing self and personal skills
Summary
References
Resources
Chapter 11: Terminology: Terms Used in Healthcare
The nursing handover
Talking the talk: the language
Anatomical landmarks
Prefixes and suffixes
Summary
References
Resources
Chapter 12: Evidence-Based Practice
Evidence-based practice
Defining evidence-based practice
Evidence-based practice and research
The evidence base cycle
Hierarchies of evidence
Accessing the evidence
Barriers to implementing evidence-based practice
Summary
References
Resources
Chapter 13: Reflective Practice
Defining reflection
Reflection: what it is and what it is not
Reflective models
The five Rs of reflection
The value of reflection
Summary
References
Resources
Chapter 14: Your Professional Portfolio
Confidentiality
The professional portfolio
The need for a professional portfolio
The structure and content of a professional portfolio
Portfolio format
Summary
References
Resources
Chapter 15: Records and Record Keeping
Documentation
Reasons for documentation
The principles of good record keeping
The use of abbreviations, acronyms and symbols
Maintaining the safety of records
Summary
References
Resources
Chapter 16: Protocols, Policies and Legal Matters
Protocols and policies
Duty of care
Negligence
Consent
Summary
References
Resources
Chapter 17: Clinical Academic Careers
Transferrable skills
Modern nursing careers
Clinical academic careers
Summary
References
Resources
Chapter 18: Preceptorship and Continuing Professional Development
Transitions and expectations
Preceptorship
Preceptorship framework
Continuing professional development
Summary
References
Resources
Chapter 19: What Do I Do If . . .? Questions You Did Not Want To Ask Out Loud
Entry to nursing
Nurse education: the standards for pre-registration nurse education
The NMC and other regulatory bodies
The university
Practice learning opportunities
Managing self
The portfolio
Policies, procedures and legal matters
Preceptorship and continuing professional development
Summary
References
Index
This edition first published 2013 © 2013 by John Wiley & Sons, Ltd
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Library of Congress Cataloging-in-Publication Data Peate, Ian. The student nurse toolkit : an essential guide for surviving your course / Ian Peate. p. ; cm. Includes bibliographical references and index. ISBN 978-1-118-39378-9 (softback : alk. paper)—ISBN 978-1-118-39389-5—ISBN 978-1-118- 39390-1 (Mobi)—ISBN 978-1-118-39391-8 (PDF)—ISBN 978-1-118-39392-5 (Pub)—ISBN 978-1-118-69030-7 I. Title. [DNLM: 1. Education, Nursing—methods. 2. Students, Nursing. 3. Vocational Guidance.WY 18] RT71 610.73071—dc23
2013013056
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: courtesy of Anthony Peate Cover design by Sarah Dickinson
Dedication
This text is dedicated to the cohort of student nurses known as September 1997 who studied at the University of Hertfordshire and have now moved onto great things.
Acknowledgements
To my partner Jussi Lahtinen who puts up with me. My dear friend Frances Cohen who continues to support all of my endeavours. My brother Anthony Peate who produced all of the illustrations for this text. The staff at the Royal College of Nursing Library London.
Preface
This book has been written for those who are considering nursing as a profession and those who are on a programme of study. This includes students at all stages of their programme. There may be some of you reading this who are about to go into their first staff nurse job, in which case congratulations Staff Nurse. Some readers may be going to university for the first time and some may be going into the clinical area as a novice nurse excited and anxious: both at the same time (yuk!).
In this little book I hope you will be able to find some of the answers to your questions, some reassurance about issues you might be facing on your course. The book will not provide answers to all of the challenges you face (I am only human) and anyway, I believe you have it in you to seek the solutions to the challenges you encounter: you just need to be prodded sometimes. I have been so lucky in my nursing career. It's the best job in the world (the pay isn't so good, though). I was lucky with the people I have been privileged to care for and to study with.
I am totally committed to you, the student, to teaching and learning from and with you and I am also committed to having a good laugh. I am devoted to the students I have been truly delighted to help learn the art and science of nursing, this thing (nursing) that defies definition, this thing that once it is in your blood is impossible to get rid of (I have warned you).
In these pages you will find some features that have been planned to help break up the blocks of text, to bring the pages alive and speak to you. Throughout the book there are the voices of many people: students and registered nurses who have shared their experiences with me (some of them were my role models). Like a good nurse I have ensured that confidentiality has been respected (I could give you a reference for this but, I won't). I have included pearls of wisdom (not all mine) that are intended to drop a hint here and there to help get you through. Dotted throughout are student activities. It is not essential you complete them, but you may find them helpful (don't worry, you won't be assessed on them!). Most of the various sections all have their own section summaries; I have done this so that you can recall quickly what has just been said. At the end of each chapter is a list of resources, websites that I have used in the past and which I hope you will also find useful. The most important resources, however, are the human resources all around you: your peers, the staff nurse who becomes your mentor, your preceptor, your lecturer, the patient and your family. Make the most of these precious resources, try not to abuse them. They are nuggets of gold and should be cherished.
I use the various terms patient, service user and client interchangeably throughout the text. I know this comes across as ‘messy' but nursing can sometimes be like that, as can the people we care for, the most important thing (I think) is to remember that patients, clients, service users – whatever the term used – are people and they deserve the best and safest standards of care we can muster.
I hope this book provides a voice and context to the nursing experience in a way that is an easy read as well as an inspiration to you. I hope that you enjoy your nursing, the best job in the world . . ..
You know you are a nurse when you watch Casualty or Holby City and to the annoyance of your family you point out all the mistakes that they have made!
You know you are a nurse when you are in Chapel Market shopping and a patient shouts across the street ‘that's my nurse, he saved my life'.
Ian Peate
London, March 2013
CHAPTER 1
Entry to Nursing
“ After all these years if you asked me to do it all again I would. Nursing is the best job I have ever done. A recently retired registered nurse with over 40 years' nursing service ”
This chapter starts with a comment from a nurse who has just retired after a 40-year nursing career, and it is shown as a means to inspire you when you are thinking of choosing nursing as your future career. You must also be aware, however, that nursing is not for everyone and that things have changed since this nurse started her training (it is no longer a training programme, but an educational process). Many people, both inside and outside of the profession, might say the changes have been for the better; some would suggest that they have been for the worse.
Nursing is a varied, challenging and rewarding career for those who would like to make a difference to the lives of people locally, nationally and internationally. Nurses and nursing staff take responsibility for the care they provide and answer for their own judgements and actions. They constantly respond to new challenges and act as a leader, carer and clinician.
Experienced nurses find fulfilling careers in positions of responsibility, often running nurse-led clinics or taking leadership roles up to executive level. Nursing is changing rapidly, with increasing focus on public health and disease prevention. It is possible to develop career pathways in clinical, research, education and management roles.
Nurses don't just work in hospitals. There are opportunities to work in, among others, GP surgeries, clinics, nursing and residential homes, occupational health services, voluntary organisations that run hospices or residential care, and the pharmaceutical industry. Nurses also work in university education, on leisure cruise ships and in the military.
Some readers of this book will have embarked on a programme of nurse education already; this chapter aims to entice those who are thinking of nursing as a profession and provides information concerning the requirements needed to enrol successfully on a programme of study. For some this might seem like having to jump through hoops; however, knowing what hoops have to be jumped through is important!
There are over 90 universities (approved educational institutions) in the UK offering programmes of study that lead to registration. It takes 3 years to become a nurse unless a student is able to demonstrate that they have already met some of the course requirements (sometimes called advanced standing). Nurse education is based in the universities and is delivered in direct partnership with NHS Trusts and other organisations (for example, the independent and voluntary sector), which provides nursing students with practice learning opportunities in health and social care settings.
The education programme is split 50/50: 50% is spent in practice, so that students are able to learn how to provide direct nursing care. The remaining 50% of the programme is spent learning the knowledge and technical abilities needed to underpin and support practice, usually on a university campus.
There are four fields of nursing and you need to decide upon the field in which you intend to register:
Your university of choice
Choosing the right university for your nursing studies will depend on a number of factors. Below is a list of what you may need to consider or take into account.
Remember that your choice of university can be a life-changing decision, so do as much research as you can: choose the right course and the right university for the right reason.
“ I went to six university open days before settling on the university I am at now; the thing that clinched it for me here was that they provide excellent practice learning opportunities. I go out working with the homeless sometimes and working with vulnerable families, it's a great opportunity. Second year mental health nursing student ”
Take time making you decision, think about where you will be happy. Do you want to be close to home or are you looking to live in a different part of the country? Be sure, however, that you do not take too much time pondering your choice: there are specific deadlines that must be met to ensure entry for the next academic year.
“ I had no choice really with my university. I have two young kids, so it was the local university for me. First year mental health nursing student ”
Funding
Current funding arrangements to undertake a BSc Nursing degree vary in the four countries of the UK. Since September 2012 English and Welsh funding arrangements have been to provide a non-means-tested grant and a means-tested bursary to new students.
Nursing students can access additional support in the form of a maintenance loan. In addition, students can apply for a number of extra allowances if they meet specific criteria. These allowances include support for disabled students and for those with dependent adults and children. The NHS will continue to pay all course fees. There are, however, certain requirements to qualify for this financial assistance. Applicants must:
Similar arrangements are in place for students studying in Scotland and Northern Ireland. You should check the appropriate websites and speak to the university of your choice for up-to-date information concerning fees and funding.
Meeting requirements
Once you have chosen a university you need to be accepted onto the course. There are a number of requirements that you must meet, some of which will be prescribed by the university and others by the NMC.
The NMC leave the entry requirements to each university. There are no national minimum academic entry requirements for entry into nursing programmes; each university sets its own criteria. All applicants have to be able to demonstrate evidence of literacy and numeracy.
For numeracy this includes evidence of the ability to accurately manipulate numbers as applied to volume, weight and length (including addition, subtraction, division and multiplication, and use of decimals, fractions and percentages). For literacy you must provide evidence of the ability to read and comprehend English (or Welsh, as applicable) and to communicate clearly and effectively in writing, including using a word processor. If you have a disability then the above can be met through the use of reasonable adjustments.
It is important that you check with each university prior to applying to see whether your qualifications meet its entry criteria. As a general guide, most universities are looking for the following qualifications or their equivalent: you will usually need a minimum of five GCSEs at grade C or above (usually this includes English language or literature and a science subject), plus two A levels or their equivalent (in reality you may need three A levels, so you must check with the university directly).
Having satisfied yourself (and ultimately the university) that you meet the minimum criteria you need to submit your application form. Universities receive thousands of applications from able candidates wishing to undertake nursing programmes, but they all have a specific target number of students to recruit. Your application needs to stand out from the crowd and make an impact so that it is put on the invite-to-interview pile rather than the rejected pile.
The application form
The application form is the only thing your prospective university will have to judge you on, so it is important to take your time over this aspect of the application (remember that the application form is only one part of the whole process). The form will have several pages and some of the questions may seem daunting. Admissions tutors (the people who make the initial decision to proceed or not with your application) receive thousands of applications to sift through: yours has to catch their eye. Application forms are designed to give you an opportunity to sell yourself and you should keep this in mind at all times when deciding how to answer the questions posed.
“ I spend 4 to 6 hours a day looking at application forms and I can spot a good one a mile off and a bad one five miles off.Admissions tutor, BSc(Hons) Nursing ”
Selection day
Well done, you have been successful at getting an interview, but there are still a number of other hoops through which you must jump. The best piece of advice for you at this stage is to be prepared. You have to do your homework. Usual guidance would include:
Nursing selection days require more of candidates than conventional interviews. Selection days are run differently at different universities; some may require you to do some preliminary work, maybe online, prior to the face-to-face meeting. The aim of the selection day is to ensure that you are suitable for the programme of study, that you understand that you are about to commit yourself to 3 years' hard work and that you can manage the demands of the programme. You must be able to communicate with the selection panel that you know that nursing is not what you see on Holby City or ER. The selection day is also your opportunity to see whether the university is good enough for you. This means you have to have attitude, good attitude. Having done your homework you will have discovered:
All universities are required to ensure that applicants to pre-registration nursing programmes are of good health and good character sufficient for safe and effective practice as a nurse. You will be required to undergo a criminal records check; some universities do this before the programme commences and some do it when you have accepted a place on the programme. The check is carried out by the Criminal Records Bureau (or its equivalent) and you must confirm on your application that you agree to this being done; the provisions covered by the Rehabilitation of Offenders Act 1974 do not apply.
If you have a criminal conviction or a police caution you will not be barred automatically from securing a place on the programme and ultimately working in the NHS, as each conviction is considered in the light of all relevant circumstances. However, you must make known any criminal convictions or police cautions. You are usually asked to provide personal references vouching for your good character.
All applicants are subject to satisfactory health clearance prior to commencing any clinical placements. If you have a particular problem that you think may affect your ability to work or study, or if you have any questions about health requirements, you should contact the university to which you plan to apply.
The interview
Again, different universities use different techniques to interview and select their potential students. It is usual for a marking system of some sort to be used so that those interviewing (the panel) can make an objective decision concerning selection. You might be asked to take part in group interviews, individual interviews, or both.
Group interviews
Often four to six candidates are asked to discuss a topic, for example ‘people with HIV should be isolated when being nursed'. Your discussion, as a group and as an individual, will be monitored by the interviewers, who could be university staff, clinical staff and service users. The purpose is to observe how you interact with others, how you listen and communicate verbally and, importantly, non-verbally, as well as what your opinions are and how you express them. The technique is to ensure that you are confident but not cocky, that you are articulate but respectful of others and that you have the capacity to work as a member of a team. Nurses are often asked to act as someone's advocate. To do this effectively – acting in a person's best interests – you have to be able to speak up for them. Remember this when you are being interviewed.
Individual interviews
These interviews will challenge your perception of nursing. The panel, made up of academics, clinicians and service users, will ask you questions designed to elicit your knowledge and insight, your ability to be caring and compassionate and your commitment to the proposed programme of study.
The only way to succeed at interview is to prepare. Do your homework. Ask questions. Be yourself. Do not undersell yourself. The panel want to get to know you: they already like you otherwise they would not have asked you to interview. Make it really clear why you want to study nursing. Be confident and demonstrate that you are the type of person who has the ability and the skills to make a positive difference to the lives of the people you will be caring for and the communities in which they live.
There are no trick questions at interview; the panel know and will expect you to be nervous. There are, however, questions that will test you. You will certainly be asked why you have chosen nursing and the specific field of nursing you have applied for.
Other questions may include:
The panel may refer back to your performance at group interview; you may even be asked to elaborate on comments you made there, so be ready to do this. Remember that there are no trick questions: they are genuinely interested in your responses and how you present yourself. Be ready to convince the panel that you have the personal attributes that will help you make a success of the programme. Let them know how you are prepared to cope with the physical and intellectual demands such a programme requires, but remember to be realistic in your responses: do not make things up, and be honest. If during any stage of the interview you are unsure of the question being asked, then request that the question be repeated.
You may be given the outcome of your interview there and then. Some universities take longer to inform you of their decision; your offer will always be conditional on:
Other conditions may apply; for example, you may have to achieve certain grades in specific subjects. You may be allowed to commence the programme on the understanding that you meet these conditions, and be asked to leave if you don't. It is your responsibility to meet the conditions.
Starting nurse education
Congratulations! You have been offered a place on your chosen programme in your chosen field. This is going to be the first day of the rest of your life.
“ I qualify at the end of this year. It's been hard work but worth it. I can't say I have enjoyed all of it but, I am really glad I did it. Third year learning disabilities student ”
You have come this far and now the next steps are ensuring that you get through the programme having developed the skills and qualities required to care for people safely, competently and compassionately.
Nursing provides a varied, challenging and rewarding career to those who would like to make a difference to the lives of people who live locally, nationally and internationally. Nurses are responsible for the care they provide and they have to answer for their own judgements, actions and omissions: this is called being accountable.
Summary
To conclude this chapter the reader should look back to the quote at the beginning: nursing is the best job in the world. To undertake nursing education you really do have to want to do it: the work of the nurse is so varied and each day really is so different, but you only get out of it what you put into it. The roles and functions of the nurse have changed and will continue to change, and there are a number of career opportunities available to you in the UK and internationally once you have completed your programme and registered with the NMC.
There are many really important things to consider prior to making your application for a place at a university. Think about the field of nursing you want to apply for, weigh up the pros and cons associated with the various universities and always remember that this is a two-way process: does that university offer you what you want? Becoming familiar with the entry criteria and the selection processes can help you progress onto a programme of study: aim to be selected, not rejected.
Resources
Bursary Administration Unit Northern Ireland
www.delni.gov.uk
Offers various types of funding support for the individual, employer or training organisations.
NHS Student Awards Wales
www.wales.nhs.uk/sitesplus/829/page/36092
The NHS Wales Student Award Unit implements the NHS Wales Bursary Schemes, which provides funding for healthcare students on NHS-funded courses in Wales.
NHS Student Grants Unit England
www.nhsbsa.nhs.uk/Students/3259.aspx
Provides all the information needed when applying for an NHS Bursary in England.
Students Awards Agency for Scotland
https://www.saas.gov.uk/student_support/special_circumstances/nursing_midwifery.htm
A Scottish Government agency, paying grants and bursaries to Scottish students in higher education.
UCAS (Universities and Colleges Admissions Service)
www.ucas.com/students/choosingcourses/specificsubjects/nursing
UCAS is the organisation responsible for managing applications to higher education courses in the UK.
CHAPTER 2
The Nursing and Midwifery Council and Other Regulatory Bodies
Health profession regulation
The provision of health and social care across the UK is regulated by a number of different organisations that work in a variety of different ways. There are some regulators, such as the Care Quality Commission in England or the Regulation and Quality Improvement Agency in Northern Ireland, that are responsible for checking the quality and safety of services. The Medicines and Healthcare Products Regulatory Agency, for example, works on the quality and safety of medicines and medical devices.
The Professional Standards Authority for Health and Social Care (PSA) aims to promote the health, safety and well-being of patients and other members of the public as well as independently promoting the voice for patients in the regulation of health professionals throughout the UK. Until December 2012 the PSA was known as the Council for Healthcare Regulatory Excellence (or CHRE).
The values and principles of the PSA act as a framework for decision making.
The values of the PSA
Its principles are:
Understanding the role and function of the various regulatory bodies can help you ensure that the care you provide to people is benchmarked against the standards that have been set. The PSA oversees the nine health professional regulators:
It oversees the activities of these professional regulators to ensure the promotion of the health, safety and well-being of patients and the public. It does this by:
The PSA has legal powers to:
It does this through:
The Health and Care Professions Council
The HCPC, like the NMC, is a regulatory body but whereas the NMC regulates two professions, nurses and midwives, the HCPC has responsibility for regulating 15 health professions (see Table 2.1). The General Social Care Council (GSCC) has been abolished. This provided the regulation of social workers in England and, from July 2012, has now become the responsibility of the renamed Health and Care Professions Council (HCPC).
The HCPC maintains a register of properly qualified health professionals for the public to check who meet HCPC standards for training, professional skills and good practice. Each of these professions has at least one professional title that is protected by law, including those shown in Table 2.1. This would mean, for example, that anyone using the titles ‘physiotherapist' or ‘dietitian' must be registered with the HCPC.
It is a criminal offence for anybody to say that they are registered with the HCPC when they are not.
Table 2.1 The professional bodies regulated by the HCPC
ProfessionRoleArts therapistAn art, music or drama therapist encourages people to express their feelings and emotions through art, such as painting and drawing, music or drama.Biomedical scientistsBiomedical scientists analyse specimens from patients to provide data to help nurses, doctors and other healthcare professionals diagnose and treat disease.Chiropodist/podiatristA chiropodist/podiatrist diagnoses and treats disorders, diseases and deformities of the feet. They also work to promote good health and prevent disease.Clinical scientistA clinical scientist oversees specialist tests for diagnosing and managing disease. They offer advice to nurses, doctors and other healthcare professionals on using tests and interpreting data and they also carry out research to understand diseases and devise new therapies.DietitianDietitians use the science of nutrition to devise eating plans for patients to treat medical conditions. They also work to promote good health, helping to facilitate a positive change in food choices among individuals, groups and communities.Hearing aid dispenserHearing aid dispensers work in private practice and assess, fit and provide aftercare in the dispensing of hearing aids. They also work to promote good health and prevent disease.Occupational therapistOccupational therapists use a number of activities to limit the effects of disability and promote independence in all aspects of daily living.Operating department practitionerOperating department practitioners participate in the assessment of the patient prior to surgery and provide individualised care in a number of settings.OrthoptistAn orthoptist specialises in diagnosing and treating visual problems involving eye movement and alignment. They also work to promote good health and prevent eye disease.ParamedicParamedics offer specialist care and treatment to people who are acutely ill or injured. They can administer a range of drugs and carry out certain surgical techniques.PhysiotherapistPhysiotherapists deal with human function and movement and help people to achieve their full physical potential. They use physical approaches to promote, maintain and restore well-being.Practitioner psychologistPsychologists work with people to attempt to understand the role of mental functions in individual and social behaviour.Prosthetist/othotistProsthetists and orthotists have responsibility for all aspects of supplying prostheses and orthoses for patients. A prosthesis is a device that replaces a body part that is missing. An orthosis is a device fitted to an existing body part with the intention of improving its function or to reduce pain.RadiographerTherapeutic radiographers plan and deliver treatment using radiation; for example, cancer treatments. Diagnostic radiographers produce and interpret high-quality images of the body with the intention of diagnosing injuries and diseases. For example, X-rays, ultrasound or CT scans carried out in hospital.Speech and language therapistSpeech and language therapists assess, treat and help to prevent speech, language and swallowing difficulties.The duties of HCPC registrants are outlined in their code of conduct (Health Professions Council, 2004). Each registrant must confirm that they have read and agree to adhere to the standards described in the HCPC's The Standards of Conduct, Performance and Ethics.
Nurses work in teams and with a number of other health and social care workers and as such you need to know their various roles and functions. Understanding each other's role can help to enhance the patient experience and above all ensures that care delivery is safe and effective. Working as a team helps clinicians and patients put the pieces of the jigsaw together: making sense of the bigger picture can set the direction.
The General Medical Council
Another statutory body, the General Medical Council (GMC), an organisation independent of the NHS and of Government, has responsibility for maintaining the medical register for the UK. Just as the NMC has statutory powers, statutory powers under the UK Medical Act 1983 allow the GMC to take action where there are concerns about the fitness to practice of a registered medical practitioner (likewise, the General Dental Council regulates dentists and dental nurses).
If the GMC determines that a doctor is not fit to practise, it has powers to erase that doctor's name from the medical register (striking off), to suspend the doctor from the register or to place conditions on the doctor's practice. These actions are applicable to practice in any sector of employment in any part of the UK.
The GMC publishes the duties of a doctor registered with the GMC (General Medical Council, 2006). This guidance outlines the principles and values on which good practice is based, describing good medical professionalism in action.
The role and function of the Nursing and Midwifery Council
The Nursing and Midwifery Council (NMC) does not advocate for or represent nurses: this is undertaken by the unions. The NMC's role as regulator is to protect the public through the setting of standards and the regulation of those who are on the professional register. The titles nurse, midwife and health visitor are protected in law.
The NMC and its predecessor bodies have been in existence since 1919. The NMC is the regulator for the largest group of healthcare professionals, as there are 660 000 registered nurses and midwives. Like its predecessors the General Nursing Council (GNC) and the UK Council for Nursing, Midwifery and Health Visiting (UKCC), the NMC has a statutory duty to set standards and regulate the nursing, midwifery and health visiting professions. The NMC was established under the Nursing and Midwifery Order 2001 and came into being on 1 April 2002. It is accountable, through the Privy Council, to Parliament and members of the public.
The NMC's key purpose is to safeguard the health and well-being of the public and this is enshrined in law in the Nursing and Midwifery Order 2001. This aspect of law (and other associated elements of legislation) governs the work of the NMC. The NMC carries out a number of statutory obligations, which means that much of its work (its duties) has been set out in law.
The various pieces of legislation that direct and guide nurses and nursing can be confusing. Trying to make sense of them all can take some time.
The NMC:
The NMC regularly consults with nurses on issues that will have a direct or indirect impact on the profession, providing those nurses who wish to voice their opinions with the opportunity to do so. The NMC communicates with registrants and the public in a variety of ways. Its website contains much information that is easily accessible, aiming to ensure that everyone on the register is kept up to date about the new standards and guidance, information about current and upcoming consultations, details about new activities and initiatives and how they will affect nurses, as well as an assortment of other relevant information.
The NMC also communicates with registrants through its publication NMC Review, as well as communicating directly when necessary. For example, it contacted every nurse on the professional register to inform them of the various ways in which they could, if needed, raise and escalate concerns regarding care (whistleblowing).
Education and conduct
Standards for education and conduct are also set by the NMC with the aim of ensuring that nurses have the appropriate skills and qualities when they commence work. The previous sentence mentions two important things: skills and qualities. The skills you require as a nurse to carry out your job effectively are multifaceted, encompassing interpersonal skills and technical skills. Both are required to ensure safe, effective care: they are called psychomotor skills.
“ I was learning how to draw up an injection, it looked so easy on television, on Casualty. I didn't just need an extra pair of hands to draw up the fluid, get the dose right, be sure it was the right drug, maintain sterility, make sure I was safe and didn't stab anyone – I needed to be an octopus, this was such a difficult procedure. First year adult student nurse ”
The technical skills that are required to draw up an injection are essential, so too are the interpersonal skills. The nurse needs to communicate effectively to ensure that the patient is safe and understands the reason for the injection and the potential side effects, and to give consent.
Performing effectively means that the nurse has to perform to the standards set by the NMC and the NMC makes known these standards through the Code (Nursing and Midwifery Council, 2008; more about this in the next section).
Managing concerns and allegations
Another important function of the NMC is the management of concerns or allegations that may have been made about a nurse, midwife or health visitor. If an allegation has been made about a nurse whereby it is felt that the NMC's standards for skills, education and behaviour have not been met, or that there is a problem with the nurse's work, the NMC has to carry out an investigation. If needed, it will act by removing the nurse from the register, either permanently or for a specific period of time.
The Code
TheCode: Standards of Conduct, Performance and Ethics for Nurses and Midwives (shortened to the Code; Nursing and Midwifery Council, 2008) is a key tool in safeguarding the health and well-being of the public. It is the foundation on which good nursing practice is based and applies to all registered nurses and midwives. The opening lines of the Code states that:
The people you care for must be able to trust you with their health and well-being.
The Code was first published in 2008 and is subject to change and reform as time passes. The Code should not be seen as a stick with which to beat registrants (those nurses on the professional register). It should be used as a tool for nurses to enhance and promote safe and effective nursing care. The Code is written with input from nurses in the four countries of the UK, along with other stakeholders including service users.
Professional conduct: student nurses
Often members of the public cannot distinguish students from qualified nursing staff. It is essential that students uphold the reputation of the profession: while studying as well as in their personal lives. The NMC has produced guidance on professional conduct for nursing students (Nursing and Midwifery Council, 2010) based on the strict standards laid out in the Code (Nursing and Midwifery Council, 2008). The aim of this guidance is to help students act with integrity and to work or emulate working in a professional manner as they prepare to enter the profession that brings with it great privileges and responsibilities. It helps student nurses demonstrate fitness to practise. The guidance provides information to students concerning:
As well as the guidance produced by the NMC your own university will also provide you with advice about the standards expected of you during the 3 years of your course. Most universities also provide an overview of your privileges as a student with the intention of helping you succeed in your studies. This is often produced in the form of a students' charter and is usually adapted specifically for students who are studying health and social care-related programmes due to the unique relationship such students have with the people in their care.
“ I was a first year student working in a hospital in Staffordshire. The standard of care was so bad I agonised for days – should I say something or not? Eventually I did. I spoke to the link teacher; he was great made me feel safe and I thought if I feel safe so too should the patients. I was petrified, but it was absolutely the right thing to do. Belinda, third year adult student ”
Being aware of the various codes of conduct, the many regulatory bodies and the requirements demanded by your university can help ensure that you are starting your nursing career with the intention of becoming a professional and a highly skilled practitioner. The codes of conduct provide you with guidance and describe the standards required.
Good health, good character and fitness to practise
The Nursing and Midwifery Council (2010) provides guidance on good health, good character and fitness to practise (Chapter 1 of this book also addresses these issues). To practise as a nurse effectively, safely and without supervision you must have good health. A number of people with a disability and long-term health conditions are practising, some of whom need reasonable adjustment and some of whom do not; therefore, good health is more than the absence of any disability or health condition.
Just as important is good character; the public must be assured that nurses are honest and trustworthy. Good character incorporates issues such as a person's behaviour and their attitude. The NMC also take into account and consider any convictions or cautions that are not deemed compatible with your role as a registered nurse or that may bring the profession into disrepute. Character must be considered sufficiently good for the nurse to be capable of providing safe and effective care without supervision.
Having the appropriate skills knowledge, good health and good character to offer safe and effective care is associated with fitness to practise. Throughout your nursing education you will be assessed continually in association with your fitness to practise. Any concerns arising about this will be investigated and addressed by the university.
Each university implements its own processes associated with good health, good character and fitness to practise. Some universities do this annually.
Summary
The public deserve to be cared for by nurses who have demonstrated that they are safe and effective. This is also true of other health and social care professionals; for example, social workers, paramedics, pharmacists and doctors.
The activities of regulatory bodies such as the NMC, HCPC and GMC are overseen by the PSA, which has a number of powers enabling it to ensure that the health and social care regulators are doing their job effectively.
A student's code of conduct in the form of guidance has been produced by the NMC and addresses important issues such as good health, good character and fitness to practise.
References
General Medical Council (2006) The Duties of a Doctor Registered with the GMC. General Medical Council, London
Health Professions Council (2004) The Standards of Conduct, Performance and Ethics. Health Professions Council, London
Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. Nursing and Midwifery Council, London
Nursing and Midwifery Council (2010) Guidance on Professional Conduct for Nursing and Midwifery Students, 2nd edn. Nursing and Midwifery Council, London
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