This year's Chief Nursing Officer for England's summit, which took place in Birmingham in March, provided the opportunity for the senior nursing, midwifery and care leadership community to share, listen and learn from each other, and to consider the challenges and opportunities that lie ahead. One of the areas highlighted was the vital and enabling role that nurses, midwives and care staff play in implementing the NHS Long-Term Plan (NHS England, 2019).
The Nursing and Midwifery Council (NMC) published new pre-registration standards in 2018: Future Nurse: Standards of proficiency for registered nurses (NMC, 2018a). The new standards are aligned with the objectives of the NHS Long-Term Plan, but their impact and contribution is dependent on successful implementation.
A session was therefore held at the summit to explore the implementation of the standards from different perspectives. Those contributing to the session were Andrea Sutcliffe CBE, Chief Executive and Registrar of the Nursing and Midwifery Council, Professor Dame Jill Macleod Clark, Chair of the Future Nurse Oversight Board, Emeritus Professor Dr Elaine Inglesby Burke CBE, Chief Nurse at Northern Care Alliance NHS Group, and Professor Margaret Rowe, Dean of Health & Society at the University of Salford.
Andrea Sutcliffe began by outlining the rationale for making such radical changes to the standards at this point in time. In summary, decisions were based on evidence and engagement across a wide number of stakeholders, which included professionals and people who use services. Key messages from engagement events included the need for nurses to have the knowledge and skills to deal with the needs of people across their lifespan, who may have multiple clinical problems and may be cared for in a variety of settings, and the need for nurses to have more educational and practice preparation in leadership, management, interprofessional working and political awareness. There was a call to raise the clinical ambition for nursing as a profession, making ‘top-of-licence’ practice the norm to which all nurses would aspire, while emphasising the importance of compassion, personalised care and a patient-centred approach.
As part of the standards review, the NMC also changed the nature of the standards, making them outcome-focused, rather than process-focused, and made changes to the standards for supervision and assessment in practice. These changes were designed to give education providers more freedom to deliver courses in innovative ways without being hampered by process requirements, to open up more placement opportunities and to encourage greater partnership working between education and placement providers.
The changes generate opportunities for registered nurses to demonstrate their unique contribution to health care and services. To do this effectively, we need to transform our approach to students, and invest in preparing existing staff to supervise and support the education and training of our next generation of nurses.
Jill Macleod Clark followed this by furthering the discussion around the inevitable challenges that implementation of the Future Nurse standards generates, as well as the opportunities they present. She emphasised that the new education standards were designed to ensure that future registered nurses are equipped with the knowledge, skills and proficiencies they will require to meet increasing and changing demands for expert nursing care in the UK. These include a growing elderly population, escalating multimorbidity and complex care needs, a technology explosion, an epidemic of lifestyle-related health problems as well as expectations of greater engagement of the public in healthcare decisions and choices.
Registered nurses will be playing a pivotal role in the delivery of health care in the future and, to maximise their contribution, they must be able to provide leadership across several care domains. The Future Nurse standards reflect this shift to higher levels of decision-making and intervention in relation to providing and supervising evidence-based nursing care, leading teams, coordinating and managing complex care demands, responding to mental, physical and cognitive care needs, working across health and social care boundaries, and demonstrating political awareness and acumen.
The challenges facing education provider partnerships in delivering transformed undergraduate curricula and practice learning opportunities to meet the new agendas are evident. However, there are even greater challenges associated with achieving profession-wide understanding of the new standards and strengthening public awareness of registered nurses' roles and responsibilities. At the same time, they offer the potential to attract students into a nursing career defined by leadership and greater career opportunities. Most importantly, achieving successful implementation of the Future Nurse standards is totally dependent on supporting and upskilling the existing clinical and academic nursing workforce, supporting new placement providers and preparing practice-based supervisors and assessors.
There is growing recognition of the central role that nurses will need to play if the ambitions set out in the NHS Long-Term Plan and other UK governments' healthcare priorities are to be met. This recognition does offer a unique opportunity to argue strongly for an appropriate infrastructure and the investment in existing staff required to ensure that the Future Nurse standards can be implemented successfully. There can be no doubt that registered nurses will require the knowledge and skills embedded in the new proficiencies to maximise their contribution to improving health outcomes and enhancing care delivery in the future.
The University of Salford perspective
Contextualising NMC national strategy, Dr Elaine Inglesby Burke and Professor Margaret Rowe then described their experiences of developing and implementing a new undergraduate nursing curriculum based on the Future Nurse standards. Within the context of the Greater Manchester Combined Authority (GMCA) a Future Nurse curriculum needed to complement the vision for the Greater Manchester Nurse and The Greater Manchester Strategy that sets out a collective vision to make Greater Manchester one of the best places in the world (GMCA, 2017). The strategy has 10 priority areas:
The development of a University of Salford Strategic Advisory Board for the Future Nurse curriculum made up of chief nurses and directors of nursing across Greater Manchester provided the platform for its curricula co-production journey and strategy. This advisory board—representing health and social work, acute care, primary care, clinical commissioning groups, private, local authority, and voluntary sector viewpoints—steered the curriculum to ensure that the developing and future nursing workforce would be agile, flexible to the changing demands of health care, and prepared to work in different clinical areas, particularly place-based care. The importance of innovation and digital fluency is embedded throughout the curriculum.
The nursing role within the curriculum is required in part to positively contribute towards delivering on the greatest and fastest possible improvement to the health and wellbeing of the 2.8 million people of Greater Manchester (GMCA, 2017). Key elements are early intervention and prevention, the need to transform community-based care and providing support at work within neighbourhoods. A correlation is recognised between providing good jobs, with opportunities for people to progress and develop, and promoting safer and stronger communities. Tackling ill health in isolation from wider environmental and sociological detriments such as unemployment and poor housing is fast becoming an outdated concept.
Weekly curriculum development group meetings and design teams were strategically led and implemented to promote the future curriculum cognoscente of political and professional policy and the needs of the NHS, equipping future University of Salford nurses to demonstrate high-level knowledge and skills and decision-making abilities.
These meetings—attended by service users and carers, current students, practice representatives, programme leaders, practice learning lead, director of placements and other workstream leads such as interprofessional education and simulation—ensured innovative approaches to engagement and communication with people who use services, the public, and professionals and partners. Drop-in events provided the platform for wider academic staff to listen to people's ideas. The philosophy was one of ‘co-created’ curricula, positioning the patient at the centre of their health and social care journey.
Effective use of simulation has provided the opportunity for participation in different skills for the different fields of nursing practice, leading to parity of esteem between physical and mental health skills. It has provided a curriculum with increased focus on public health and developing greater depth of knowledge and proficiency where field-specific emphasis is required. There are opportunities for opening-up new routes into nursing through increasing non-traditional pathways into the programme such as apprenticeships and Trainee Nursing Associates (TNA).
Implementing a University of Salford nursing curriculum that truly complements the vision for the Greater Manchester Nurse and The Greater Manchester Strategy has required all involved to think differently and creatively about the practice learning environment for students. Subsequently, practice learning is looking very different, with increased student empowerment achieved through co-designing experiential practice learning opportunities. This is achieved through weighting theory and practice within the curriculum differently (increasing practice hours year on year to achieve the NMC 2300-hour programme requirements); and thinking creatively about how practice learning should look and feel for students and their supervisors and assessors. Students have an opportunity at the end of each year to undertake an experiential learning opportunity within a voluntary service or choose their own placement, such as the international experience. Integrated placements are being created that capitalise on the whole health and social care landscape and the effective partnership formed between the University of Salford, NHS, local care organisations, Primary Care Academy, and private, independent and voluntary organisations. Key, for example, is the creation of social prescribing practice learning opportunities that realise the person-centred nursing curricula philosophy.
Taking into consideration Salford's modern and creative approach to practice learning, work is also taking place alongside the curriculum development, to radically change how practice learning areas are identified and continuously quality checked. The wider role of practice-based educators (university link lecturer) is also changing, as their remit needs to complement the University of Salford vision for the Greater Manchester nurse.
Addressing the traditional issues associated with mentor models of student support (Leigh and Roberts, 2017; 2018) is achieved through working in partnership with health and social care organisations to implement the NMC Standards for Student Supervision and Assessment (NMC, 2018b). Currently the University of Salford is providing supervisor and assessor workshops that prepare practitioners for their new role of practice supervisor and practice assessor. The workshops, which are co-delivered with practice education facilitators, embed a philosophy of real-world clinical practice learning that incorporates coaching techniques. These techniques are used to support student nurses meet NMC programme proficiencies and to enhance their clinical leadership development in preparation for ultimate NMC registration.
The workshops provide opportunities to explore and co-create a new culture for practice learning that capitalises on the Greater Manchester approach for increasing opportunities for wider health and social care professional support for students when learning from within the empowered practice environment. These workshops complement the wider Greater Manchester approach to operationalising the NMC Standards for Supervision and Assessment.
In conclusion, the emergent national challenges and subsequent opportunities created by the system-wide change when implementing the Future Nurse standards need to be addressed taking into consideration the local context. Through working collaboratively with its practice health and social care partners, the University of Salford is co-creating an innovative curriculum that meets NMC strategy for the future of nursing that protects the public needs for and right to safe, effective, compassionate and high-quality nursing care.