You will recall from my previous columns the sharing of progress of the Nursing and Midwifery Council (NMC) review of undergraduate nursing and midwifery practice learning. The NMC commissioned independent research into students' practice learning requirements in January 2024, with the aim of recognising and acknowledging innovation, and ensuring that NMC requirements continue to equip students with the knowledge and skills to deliver the best possible care for people across a diverse range of care settings.
The research undertaken by the Nuffield Trust (Palmer et al, 2024) detailed:
- No clear evidence to determine the optimal number of practice hours needed to ensure safe and effective practice, or support the current requirement of 2300 hours
- Limited evidence and mixed stakeholder views on the number of births, assessments and other learning objectives required for midwifery students
- Confusion about what counts as practice learning, differences in the way this is managed by institutions, and how student's experiences were affected by system pressures and capacity within the wider health and care context
- Many students felt that there was insufficient protection of their ‘supernumerary status’ and protected learning time
- In many cases, the specific practice learning requirements led to anxiety for students, with reports of ‘taskification’, often meaning that task-orientated care is promoted and assessed over continuity of care and holistic care.
In January 2025, the NMC council approved five key lines of enquiry for the next phase of the review. This work is critical for the profession to support the aims of the NHS Long Term Workforce Plan (NHS England, 2023), including to ‘significantly increase education and training to record levels’ that will require action from stakeholders. The need for a significant increase was highlighted in July 2024, with the Royal College of Nursing (RCN) citing the latest UCAS figures (RCN, 2024a). These showed that, by the 30 June deadline, the number of applicants to study nursing in England was 33 560, a decrease from 36 400 (8%) in the previous year, and from 45 740 in 2021, or 27% in 3 years, This, the RCN stated, will threaten the delivery of the long-term workforce plan.
In December last year, RCN CEO Professor Nicola Ranger said (RCN, 2024b):
‘To deliver the government's NHS reforms we need to supercharge recruitment into nursing, but we can't do that with a broken education model or more real terms pay cuts.’
The NMC review aims to ensure that future changes to standards for practice education continue to equip students with the skills to deliver safe and effective care on programmes that retain people. The approved proposals are to:
- Further examine the practice learning experiences of students with protected characteristics (including those who require reasonable adjustments), to understand whether these are considered as part of students' learning and whether they impact student retention
- Expand the type of support the NMC offers students, practice supervisors and practice assessors, including strengthening requirements for protected learning time for nursing associate students
- Develop indicators and metrics to measure the quality of students' practice learning.. This will help the NMC to understand where they can better support students to achieve the proficiencies they need to deliver the best care for people
- Evaluate key aspects of the midwifery curricula to understand students' practice learning experiences. This will help the NMC understand how they can be best supported to achieve midwifery-specific proficiencies
- Evaluate key aspects of nursing curricula including what works well and what could be improved. This will help the NMC understand students' relationships with education standards, and how to support them best to gain proficiencies in their intended field.
Following some of the earlier diagnostic work, the NMC is also developing three new enabling policies to support the sector, focusing on the use of simulated practice learning within pre-registration nursing programmes, and the use of reflection time within pre-registration nursing and midwifery.
The stakeholder consensus thus far is that the quality of practice learning mattered more than its duration, and that current requirements need to be revisited to better assure quality and reduce inconsistencies in students' experiences. Maintaining the status quo is not an option.
The approved recommendations for the concluding phase will enable the NMC to resolve remaining evidence gaps and build consensus for decision-making on future outcomes. If you'd like to be kept up to date with NMC progress, and be notified of any opportunities to get involved, there is the option to join the community of practice via: https://r1.dotdigital-pages.com/p/129A-1B4W/practicelearning.