In May, Thomas (2023) wrote a piece for the Independent, claiming that a leaked government report showed plans for major changes to shorten medical and nursing degrees in a bid to plug NHS shortages. A ‘source’ was quoted as saying:
‘There's a push to get as many nurses through as possible. I despair, the reason a [nurses' degree] programme is three [years] is because this is how we are regulated. The change in education that is needed is going to require a regulatory body to approve that, and that is a consultation process and that can't be done overnight.’
Thomas' source is right, it is not government who will decide what educational requirements a registered nurse, midwife or nursing associate requires to gain entry to the register. It is our professional regulator, the Nursing and Midwifery Council (NMC), that has a statutory duty to maintain and revise the standards for education and training to ensure that they are fit for purpose and continue to protect the public.
The important background to consider is that, while the UK was a member of the European Union (EU), the NMC was required to incorporate the requirements of the Mutual Recognition of Professional Qualifications Directive (2005/36/EC) in its education programme standards. The content of the directive is therefore reflected in current pre-registration programme standards for nursing and midwifery in the following areas: selection, admission and progression, curriculum, practice learning, and supervision and assessment. The UK's departure from the EU has provided the scope to consider if, and how, the directive remains incorporated within the education programme standards.
During 2021, the NMC commissioned independent reviews, which were shared in the January 2023 Council papers, to enable consideration of options for change (NMC, 2023). These changes to the standards went through a public consultation in 2022 and were approved by the NMC in January 2023. Included in these changes was the flexibility for nursing to allow up to 600 hours of the 2300 hours of practice learning to be delivered as simulated learning.
Further research was undertaken on behalf of the NMC by Harlow Consulting (2021) exploring the context of programmes in countries where these programmes are delivered in fewer practice learning hours. This work concluded that there are some contextual differences in the way practice learning is managed and supported, including the additional use of simulation. It was also concluded that a focused, good quality learning experience is seen as key to producing a nurse who is safe to practice. The key elements of a quality learning experience identified included:
- Integrating theory and practice learning
- High-quality simulation that complements both theory and practice learning
- Good quality clinical teaching and learning, with well-trained instructors who can concentrate on providing students with a good clinical experience
- Focused learning experiences, which optimise the number of hours spent in clinical placement.
As part of my new role, I will now be leading on the next phase of work, which will explore the minimum hours set for theory and practice learning. In this next phase, we at the NMC will also need to explore the impact of such a change, including the contextual differences internationally raised in the research, and consider ways the sector and we ourselves can mitigate any risks posed by reducing the minimum practice learning hours. We will now start to plan to recruit a new independent chair to work alongside me to consider:
- Wider stakeholder engagement
- An evaluation of the current experience of implementing up to 600 hours of simulated practice learning through the recovery standard
- Exploration of any unintended consequences including the shift in hours to approved education institutions
- Exploration of ways in which quality practice learning experiences can be assured and optimised.
The research from Harlow Consulting suggested that a move to fewer practice learning hours in pre-registration programmes in some countries is driven by several factors, including political pressures caused by the worldwide nursing shortage. I am clear that it is the NMC who will progress the work needed to consider our options for UK nursing and midwifery education standards, which will be driven towards public safety, and aim for education standards that promote safe, kind and effective care – not political need.