Within the land of higher education there has been a flurry of excitement and enthusiasm. Why is this, you may ask? It is because the Nursing and Midwifery Council (NMC) has started the approval process for programmes that will deliver its new standards for the education of future nurses.
Since 28 January 2019 all approvals have been judged against the new benchmarks (NMC, 2018). The nursing regulator has also stipulated that after 1 September 2020 only programmes approved against these standards will be able to accept new students and meet requirements for award and registration. The NMC's mission for the new education standards is to ‘shape the next generation of nurses’ and ensure that they ‘will learn to deliver world class care’ (Ford, 2018).
Having contributed to multiple curriculum developments within nursing at a couple of higher educational institutions in my role as a senior lecturer and external examiner, in my view this opportunity feels truly different. I believe that the NMC has recognised the urgent need for registered nurses to use their expert knowledge and skills differently, and to be able to work more autonomously from the point of registration.
Inclusive
This may be a scary thought for some qualified staff. However, collaborative and inclusive theory, and practice education that is completely different from what has so far been the standard will create an end product that is fit for purpose within the landscape of contemporary health care.
We already know that undergraduate nurses must now study pharmacology throughout the new curriculum and should be prescriber ready by the point of qualification. This does not mean that all nurses will prescribe, but it does mean that nurses will have an improved level of pharmacology knowledge that has been assessed theoretically and practically to graduate level.
We also know that successful continuing professional development courses, covering history taking, physical examination skills and advanced assessment skills, are a requirement of the new undergraduate curriculum. This is potentially preparing an undergraduate student to use advanced practice skills that will be tested through OSCEs [objective structured clinical examinations] and viva [oral exam] prior to them qualifying.
This means that the new undergraduate curriculum will potentially change the landscape of not only the calibre of nurses, but the expectation and level at which registered nurses practise.
Rationale for change
So, why is the new nursing curriculum having to change? According to a mass of literature, there are many reasons why this had to happen. But, in summary, it is because healthcare provision and the nursing arena are changing rapidly. This is because:
‘Contemporary health care dictates the need for registered nurses to embrace a new identity and suggests the need for a cultural shift’
No other health professional does what a registered nurse does. Think about the professional identity of the registered nurse: this is the only registered health professional who is always with a patient. All others are generally accessed for their expertise via referrals, but inevitably leave the patient within the care of the registered nurse once patients are discharged from their care.
Registered nurses support patient mobilisation, walking and strength exercises, which would have traditionally all been the responsibility of a physiotherapist. In addition, they support dietary management, such as eating and drinking, feeding, administering nasogastric and orogastric feeds, administer total parenteral nutrition, and intravenous (IV) fluids, with many nurses now prescribing treatment and medications.
In the community, registered nurses may be lone workers, working independently to assess patient risk and support independent living, actively making clinical decisions and initiating treatment to avoid hospital admissions, sometimes performing acute and complex care such as IV administration, rapid response and making safeguarding decisions.
Some rehabilitation nurses co-ordinate the introduction of equipment into people's homes and make equipment referrals, which have traditionally been within the remit of the occupational therapist. Advanced nurse practitioners (ANPs) are seeing patients independently from admission to discharge, utilising advanced clinical decision-making skills, history taking, undertaking physical examinations, and acting as independent, non-medical prescribers.
There is also the development of the roles of healthcare assistant (HCA), senior HCA, nursing associate, nursing assistant, nursing auxiliary and trainee nursing degree apprentice. In the wider context outside our nursing bubble, there is the creation of physician associates and advanced clinical practitioners, advanced critical care practitioners, among many other new roles.
Therefore, rightly or wrongly, the time has come for the registered nurse role to evolve. In many areas, registered nurses are already performing advanced practice, making complex decisions and doing exceptional work, sometimes without the public realising that this is the case.
Multidisciplinary working, interprofessional working, public engagement, and student engagement are, without question, key to the new education standards and essential for patient safety, as well as being in the interests of best patient care.
New identity
Contemporary health care dictates the need for registered nurses to embrace a new identity and suggests the need for a cultural shift, changes in attitudes and behaviours, and an expected level of autonomy within all clinical roles and responsibilities. According to Geraldine Walters, head of education for the Nursing and Midwifery Council (NMC), ‘new education standards will transform nursing’ and ‘raise the bar’ for nursing practice in the future (Merrifield, 2017).
At first glance, it appears that the new education standards follow a didactic medical model like that of US nursing programmes. For example, all registered nurses—including adult, child, mental health and learning disabilities—must be able to perform clinical tasks that are currently not necessarily within each field's remit.
According to the new NMC standards, Part 4, section 4.11 (NMC, 2018), nursing students must ‘demonstrate the knowledge and skills required to initiate and evaluate appropriate interventions to support people who show signs of self-harm and/or suicidal ideation’. In the past, this was debatably within the role of the mental health nurse, rather than all fields.
Part 2, section 6.5, mentions rectal examination and manual evacuation, and part 1, section 2.3, requires nurses to be able to set up and manage routine electrocardiogram (ECG) investigations and be able to interpret normal and commonly encountered abnormal traces. This was previously considered to be within the remit of the adult nurse role.
A final example is Part 1, section 2.8, which requires nurses to be able to undertake chest auscultation and interpret findings. Again, interpretation of chest auscultation and findings is not something that all fields of nursing have done up till now as part the curricula.
To conclude, I believe that all health professionals are doing their best to provide best patient care. The evolution of health professional education and clinical skills, and an inclusive curriculum design provides an excellent opportunity to raise the profile of registered nurses and showcase the skills that nursing can offer within contemporary health care.