The Nursing and Midwifery Council (NMC) is legally required to set standards of proficiency, education and training for nursing and midwifery professionals seeking to join the register. Article 15(1) of the Nursing and Midwifery Order 2001 requires the NMC to establish standards for education and training necessary to achieve the standards of proficiency for admission to the register, as required by Article 5(2) of the Order.
The NMC standards for pre-registration midwifery programmes follow the student journey from selection, through curriculum, practice learning, supervision, and assessment through to qualification. The current standards for pre-registration nursing programmes (NMC, 2018) have been in effect since 28 January 2019. These are now under review, with the earliest expected date to introduce any changes to programmes being September 2023. One of the drivers for the review relates to the previous content requirements being underpinned by EU law as the UK's departure from the EU has presented an opportunity to review these.
The NMC is considering new evidence, changes taking place in society and changes in health care as part of the review. To support the evidence for the review, the NMC commissioned two pieces of research from Harlow Consulting and Traverse, which gathered views from stakeholders to evaluate the advantages to changing the standards, and the degree of consensus about making any changes to the programme (Harlow Consulting, 2021; Harlow Consulting and Traverse, 2021; Traverse, 2021). They considered:
- Education length and qualifications
- Shortened courses
- Recognition of prior learning
- Knowledge and skills for nursing and midwifery
- Practice learning hours and use of simulation
- Programme length and number of hours
- Impact of the EU Directive.
- Further considerations for future work.
The results showed limited evidence or consensus for change, except for simulation. The research confirmed that simulation is a topic worthy of further consideration, including research into impacts of simulation on registrants' competence to deliver health care in real-life contexts, and evaluation of current approaches to simulated learning and assessment to identify best practice. The stakeholders noted that there will be a need to provide assurance that simulation is being considered as supplementary and supportive of learning, not a wholesale substitute for learning through contact with real patients. The evidence base is more limited for midwifery and stakeholders may be more cautious.
On balance, there were mixed views and limited evidence to change education requirements for programmes, or recognition of prior learning. For both nursing and midwifery stakeholders, the findings report that the skills and knowledge content specified in the EU Directive was appropriate but in line with the findings of the evidence review, it was felt that there were gaps in the knowledge and skills and the language needed to be modernised. In the UK, these knowledge and skills gaps are already met and are often exceeded within the standards of proficiency.
There were conflicting views among stakeholders about the specific numbers of occasions when a skill is performed. Although evidence from the desk research and the views of stakeholders strongly indicated that setting specific numbers is desirable, there is no evidence and little consensus on what these should be. Both the stakeholder research and desk research found some support for a more outcomes-focused approach.
On balance, there did not appear to be a strong argument for changing programme length, for either nursing or midwifery. In relation to hours there was more of a case for further consideration of change, based on what appears to work in comparator countries and on the views of many stakeholders that outcomes should take precedence over number of hours in terms of assessing competency. Any reduction in practice hours would need to be explored sensitively, given concerns about potential implications for patient care and public perception.
Following the research stage, a consultation on the proposed changes ran until September 2022. The NMC has been reviewing all feedback received, to refine, change or amend draft proposals, continuing to work with subject matter groups, undertake survey work and gather feedback from key groups before taking proposals to council in January 2023.
It is a real opportunity to ensure that considerations from both practice and education are fed into the groups to realise the potential for our future nurses and midwives – consideration also needs to be given to our current workforce needs, to ensure that we are providing practice environments that are fit for purpose.