Nursing students are required to achieve a range of proficiencies and competencies in accordance with the Nursing and Midwifery Council (NMC) (2018) standards.
In Cheshire and Merseyside Integrated Care System, a lack of consistency in assessment was formerly identified, with the potential to prevent achievement of the Annexe A and B procedures, and thereby impact students' progress in their programmes of study. In response, we have developed and disseminated a Guidance for the Assessment of Proficiencies (GAP) toolkit for pre-registrant nurses. This toolkit comprises a rigorous integrated framework for supporting student skill acquisition – including relevant documents for each field (adult, child, learning disability, and mental health) – while facilitating a consistent system-wide approach, and subsequently bridging the gap in proficiencies.
Student rationales for quitting, or considering leaving, their programmes of study in nursing predominantly relate to being overwhelmed, stressed, and doubting their clinical ability (Health Education England, 2022). Hence, our development of the GAP toolkit sought to enhance quality practice learning experiences across the pre-registration learning journey, with an intent that the toolkit would help mitigate student concerns around meeting the requirements in the NMC annexes.
This toolkit outlines roles and responsibilities, alongside listing the requirements for student supervision, and providing the documentation of learning and experience, particularly in regard to the more challenging proficiencies (such as nasogastric tube insertion/management, and venepuncture/cannulation). Embedded resources in the toolkit are used to illustrate these challenging skills, facilitating parity of access. The toolkit promotes equivalence of assessment across the integrated care system, and consequently mitigates long-term risks to patient safety. It likewise benefits organisational effectiveness by supporting learners in the transition from nursing education to employment, while aligning with workforce workstreams, preceptorship programmes, and continuing professional development journeys.
The development of the toolkit has been mapped to relevant sources of online theory such as elearning for healthcare and clinicalskills.net, and was successfully piloted with several student groups and educators. Providing feedback on the GAP toolkit, one pre-registrant nurse stated that ‘I personally felt more confident approaching practice assessors regarding certain proficiencies, knowing I had this guidance document to refer to’. The toolkit can be used to support learners in either developing or maintaining their knowledge, helping to ensure that they remain contemporaneous as they approach registration, and providing a theoretical baseline for practice learning.
Aptitude in a particular skill may typically be taught or require assessment later in the programme, but the toolkit ensures that students have the opportunity to practise or sign-off particular skills at their own pace. It is anticipated that the GAP toolkit will serve as a blueprint and root infrastructure for students from other professions – we are currently supporting adapted versions nationally. We note particular potentials for the toolkit to be developed further to incorporate resources for midwifery and allied health professional pre-registrants, who are also required to demonstrate standards of proficiency in accordance with relevant professional regulators such as the Health and Care Professions Council.