This month, I joined a panel to discuss NHS England's NHS Long Term Workforce Plan (NHS England, 2023). The chair of the panel welcomed the plan, highlighting that significant funding was available to support its delivery. Professionally, we have challenges and opportunities to consider, for example, responding to current and increasing practice placements.
The plan sets out the intention to have 24 000 more nurse and midwife training places a year by 2031. The Nursing and Midwifery Council (NMC) sets the pre-registration standards and has come under pressure from stakeholders and politicians to make changes, specifically, reducing the number of hours set as a requirement for nursing and midwifery programmes in the UK. This is currently set at 4600 hours and consists of 2300 theory hours and 2300 practice learning hours. Since January, 600 hours can be used for simulated nursing practice learning.
The plan outlines that NHS England will work with the NMC to explore the potential for further changes to nursing degrees. This includes considering how graduate nurses can join the register after fewer practice hours – 1800 rather than 2300 hours, citing different models globally.
The Harlow report, published by the NMC in 2021, found contextual differences in the way practice learning is managed globally (Harlow Consulting, 2021). Countries that require fewer hours make additional use of simulation for practice learning and specific and enduring support for student learning in practice. Their emphasis is often on focused, high-quality learning support and experience being key to developing professionals who are safe to practise, rather than relying on the completion of a set number of practice hours.
Via the NMC Quality Assurance mechanisms, we are seeing an increase in critical concerns being raised in relation to education programme delivery, with practice placements being the focus of these concerns.
Reports published in the nursing press indicate that due to workforce challenges it is often difficult for nursing students to maintain their supernumerary status, and more rather than less time in practice is necessary for proficiency.
Palmer et al (2023), writing for The Nuffield Trust Waste Not Want Not report, found that 42% of nursing students and 58% of midwifery students had considered leaving their programme of study. The main reasons given for this included placement experience, stress and lack of support.
The Council of Deans of Health (2023) highlighted the importance of expanding and diversifying placements to support a growth in healthcare students in their recent paper, and recently two university groups have laid out the need for reform in nursing education in terms of practice learning. The University Alliance (2023) seeks an outcome-focused approach based purely on competence and not hours, implying a reduction in the required practice learning hours.
In February 2023, Million Plus (2023) called for the UK and Scottish governments to urgently reform the practice learning/placements system to ensure a healthy supply of nurses across the NHS. Its focus is that the 2300 hours of practice learning present a large barrier to student recruitment.
The NMC exists to protect the public and public safety is central to our outcome-focused standards that already promote innovation and flexibility. Therefore, the next stage of our work includes commissioning a UK-wide review of practice learning approaches and support for the student journey across a range of practice learning settings.
In addition, we are commissioning a comparative review of international practice placement learning models and approaches and the feasibility of adopting those approaches in the UK. This will review existing evidence, looking at practice learning in nursing and midwifery programmes internationally to establish the criterion to explore the feasibility of identifying and establishing pilot sites. These will explore innovative approaches to support, supervise and assess nursing and midwifery students in health and care environments in each of the four countries of the UK.
This exciting work will provide us with an evidence base for future changes to nursing education.