Following the changes to the Nursing and Midwifery Council (NMC) education programme standards in 2023, a programme of work commenced to explore further how practice learning can be supported (NMC, 2024). The plan is for this to include the outcome of the NMC review of simulated practice learning (SPL), led by Professor Paula Holt and due for publication in late September.
As a reminder, in November 2021 the NMC approved a recovery (discretionary) standard RN6(D), permitting up to 600 hours of SPL for those approved education institutions (AEIs) who could demonstrate that they have appropriate resources and infrastructure to implement this effectively and safely while still meeting the requirements of the NMC's (2023) education and training standards. It is an alternative means of delivering practice learning to placements and can be included (when approved) as up to 600 of the 2300 practice learning hours required in pre-registration nursing curricula.
The review report will summarise the experience of 19 AEIs who were approved to deliver up to 600 of the 2300 hours of practice learning through simulation within pre-registration nursing programmes that were committed to being part of this formal evaluation process. The report will also highlight strong examples of co-production and collaboration between AEI academic teams and patient user groups, practice learning partners and students. Student feedback has been used effectively to support a process of continual improvement of activities and scenarios, assuring that learning reflects student needs and contemporary practice.
Overwhelmingly, students valued SPL for providing a safe, supportive environment in which to practise and reflect, improving their confidence. Many referenced the equitable practice learning experience it offered, which meant a cohort of students had the same opportunity to practise scenarios and proficiencies that may be opportunistic in a placement learning setting. Students across all fields of nursing, but particularly the mental health, children's and learning disabilities fields, valued SPL that provided the opportunity to practice proficiencies they did not experience in their allocated placements. SPL was also found to enable student nurses to experience practice and care scenarios from fundamental care through to those that are more sensitive and highly complex.
Although student and stakeholder feedback was incredibly positive about the multiplicity of opportunities that SPL enables, a key challenge is the resource-intensive nature of this provision. Financial sustainability was a concern across the higher education sector, and many AEIs are apprehensive about being able to continue to deliver and further develop SPL as part of the practice learning experience for student nurses without significant investment and ongoing funding streams being secured.
It was also helpful to see the simulated practice learning journey that these AEIs have travelled, developing infrastructure, governance, pedagogies and future plans, and putting the student voice at the heart of development. It is also evident that AEIs are at different stages on this journey, with some challenged in their ability to develop further by limited resources.
The evaluation has highlighted that although SPL may have started out as a means of assuring student progression when placement capacity was negatively impacted by the pandemic, at many AEIs it has become an approach to practice learning that adds significant value to the students' practice learning experience. and has been effective in ‘bridging gaps’ in proficiencies not experienced in practice learning placements, particularly evident in terms of field-specific practice.
Sustainability of SPL is a key risk for most AEIs in the context of financial constraints facing many institutions across the UK. In England practice healthcare education and the training tariff can offset some of the costs, but devolved nations do not have the benefit of payments for delivering SPL. Resourcing of education and training is not within the NMC's regulatory remit, however the report will be shared with NHS England, NHS Scotland, Northern Ireland Practice and Education Council for Nursing and Midwifery and Health Education and Improvement Wales for their consideration.
All AEIs who include SPL in their nursing curricula needed to educate and train staff in the pedagogies that support it, the technologies that they use, and considerations for implementation, including psychological safety. Some AEIs have education and training delivered as part of, or a whole, postgraduate certificate. Working together and sharing education and training resources across AEIs and practice learning partners would grow expertise in the education and training of staff around SPL and could support the growth and development of this specialist workforce.
As we know, practice learning is not all about hours, and the wider review of practice learning is focused on the quality of learning. This evaluation of simulated practice learning is a key evidence base for consideration alongside the wider evidence base being considered for wider engagement and consensus building for future education programmes.