Leaving the European Union has allowed the Nursing and Midwifery Council (NMC) to reconsider the standards for nursing education, including the directive that requires 2300 practice hours.
The NMC has regularly been asked to consider a reduction in practice learning hours for pre-registration programmes. Equally, the workforce plans of the four countries of the UK address the need to increase student numbers to support the development of the future nursing and midwifery workforce.
Previously commissioned independent research from Harlow Consulting (2021) explored programmes in countries that require fewer practice learning hours, and concluded that there are some contextual differences in the way practice learning is delivered, including the use of simulation. The research concluded that a focused, good quality learning experience is seen as key to producing a nurse or midwife who is safe to practice. The key elements of a quality learning experience identified included:
- Integrating theory and practice learning
- High-quality simulation that complements both theory and practice learning
- Good-quality clinical teaching and learning, with well-trained instructors
- Focused learning experiences that optimise the effectiveness of hours spent in clinical placement and wider practice learning opportunities.
This discovery phase will use the recently published NMC (2024) evaluation of simulated practice learning for pre-registration nursing programmes
The NMC appointed the Nuffield Trust to undertake the independent research, due to be published later this month. The aim of the 6-month study was to explore the design, delivery and effectiveness of nursing and midwifery practice learning and understand:
- Current regulations and standards for practice learning in the UK
- Application of simulated practice learning
- Operationalisation of standards for student supervision and assessment, including protected learning
- The variety of learning opportunities, support, and appropriate resources
- Factors which enable or inhibit practice learning
- Equality, diversity and inclusion considerations.
The NMC shared the findings this month with the Council of Deans of Health at its recent conference, in advance of its formal publication. Research included a literature review. Qualitative information was gathered from more than 30 expert interviews, 10 focus groups with professionals and three with members of the public. It considered data from the NMC, the NHS and UCAS and held four workshops with stakeholders.
The current context of practice – including the difference between the four nations, the changing political landscape, the movement of students across the boundaries, and the heterogeneous student cohorts, jobs and roles – was also explored.
Discussion of the requirements for practice learning demonstrated a variety of opinions on what the optimal level would be and varied approaches across countries and professions. However, the consensus was that quality mattered more than quantity.
In terms of implementing the NMC standards, it was observed that there was confusion at times around interpreting requirements and protecting practice learning. A theme around the balance of proficiency standards (depth versus breadth) and risk of ‘taskification’ was emphasised, along with recognition of prior learning, understanding of the nursing associate role, system capacity and the administrative burden of proficiency signoff, and student health and wellbeing.
Evidence for simulation was difficult to generalise but it was agreed that it can be an invaluable tool. There was wide variation in international standards, and confusion over when it contributes to practice learning hours.
The design and delivery of practice learning, settings, services and environment were among the common determinants of quality of learning discussed. Equality, diversity and inclusion were identified as areas for consideration, including inequity, racism and discrimination, reasonable adjustments and financial barriers. Practice supervision and assessment was considered, along with opportunities for closer working between education and clinical practice.
Specific areas for action identified were:
- To further clarify the regulations to ensure consistency
- Primary research to evaluate impact of different methods/levels of simulation
- To look at mechanisms, including funding, for incentivising broad, high-quality opportunities
- Ensuring that practice learning is well co-ordinated
- How to recognise, protect and value practice supervisors, assessors and education roles
- To consider current model and methods of assessment.
The NMC will continue to progress this work with key lines of enquiry, and welcomes colleagues to join the community of practice to keep in touch at: r1.dotdigital-pages.com/p/129A-1B4W/practicelearning