Developing new standards for the future graduate registered nurse

31 August 2016

Professor Dame Jill Macleod Clark, lead advisor on the development of new NMC pre-registration nursing standards

In January 2016 the Nursing and Midwifery Council (NMC) approved plans to undertake a review of the competencies for new nurses entering the profession. The current pre-registration standards for nurse education were published in 2010, and an independent evaluation of these found varying levels of understanding, with consensus that they were overly complex and too focused on processes rather than outcomes.

The NMC is undertaking this work as part of a wider strategic programme of change for education, which is already underway and will run until 2020. Also on the agenda is the development of new standards of proficiency for midwives, the development of an education framework setting out the requirements for institutions delivering nursing and midwifery education programmes, and an independent review to inform the future model for the NMC’s quality assurance processes.

As the professional regulator the NMC has a duty to protect the public by ensuring that they set education standards that equip newly qualified graduate nurses with the knowledge, skills and professional behaviours they need when they join the register.

I was asked to act as lead advisor on the development of new standards for nurses and this work has taken me across the length and breadth of the UK over the last ten months. I have been working with the Council of Deans of Health (CoDH), who sit on the project sponsorship board, as well as speaking to a huge range of other stakeholders about what they feel the roles and responsibilities of the future registered nurse will be, and what these new standards should look like. There has been tremendous support across each of the four countries, with a great deal of lively discussion and debate so far!

A key aim of this engagement is to identify areas of consensus on the potential proficiencies required of the future nurse. Many areas of agreement which have emerged resonate strongly with those highlighted in the CoDH’s excellent and provocative Educating the Future Nurse paper.  This paper offers some extremely helpful insights, particularly into the tensions that underpin this work and has given me plenty to reflect on.

Everyone agrees that the health and care landscape is changing at an unprecedented pace, resulting in increased use of evolving technologies, blurring of professional boundaries and multi-agency team working. Graduate registered nurses will need to work flexibly and accountably across care settings, with a continuing shift in focus on care delivered in non-hospital environments. Expert communication and relationship management skills will become even more essential as the registered nurse takes a lead role in managing complex care packages. The demand for evidence based, compassionate nursing care will escalate, and the ability to delegate care to unregistered members of teams safely and effectively will be crucial.

People across the UK are now living longer and with a range of co-morbidities. The future registered nurse must be equipped to support people at all stages of the life course, from birth through to the end of life. They must also be able to meet the needs of those facing commonly encountered mental and physical health challenges and/or intellectual disability.

Consensus has also emerged around the importance of person-centered nursing care, of empowering individuals to manage their own health and of encouraging healthy lifestyles and behaviours. The new standards must reflect this growing focus on the population health and wellbeing agenda.

A picture is emerging which tells us that the future registered nurse must be equipped with the transferrable skills that underpin critical thinking, problem solving and decision making. This requires a confident knowledge base, encompassing both behavioural and biosciences, in order to undertake assessments of mental and physical health status, interpret data and make evidence based decisions about nursing care requirements. That said, I have been struck by how often stakeholders have highlighted the importance of emphasising that the point of registration is just the starting point on the nursing career continuum. The new standards must strike a balance between preparing new nurses with the technical skills and knowledge they will need to practise as a new registrant, whilst also equipping them with the attributes they will need to embark on a lifelong career of learning and development.

My engagement with a wide range of stakeholders is ongoing across all four countries of the UK and all four fields of nursing. It includes deans, academics, practice educators, directors of nursing, ward managers, students, new registrants, chief nurses, unions, patients and the public. I particularly look forward to continuing our work with the CoDH as we take the project forward.

We have also established thought leadership groups who meet regularly, either virtually or face to face, to inform the new standards and offer advice and challenge as the project progresses. The membership of these groups reflects the stakeholders above, with expertise in a range of care delivery settings and includes Deans from each of the four countries.

We are currently developing a draft version of the new standards which embraces the principles articulated above and which will be shared widely and improved accordingly. My, admittedly ambitious, aim is that there should be no surprises when the standards are released for consultation!

Drafting of the new standards will progress throughout 2016 and we are asking you and our other stakeholders to continue to provide input and support. The NMC will formally consult on the standards between April and June 2017, and the final set of standards is due to be published by early 2018. There will be an option for early adopters to implement the new standards from September 2018, and the NMC anticipates that all institutions will adopt the new standards by September 2019.

This is a hugely exciting, not to mention daunting, piece of work to be involved in! The opportunities it affords the nursing profession to define what the public can expect of a graduate nurse are immense. If you would like to know more about the project, or find out how you can be involved in shaping these new standards, please contact Kate Lettin (Senior Stakeholder Engagement Officer, NMC) for more information.

Jill Macleod Clark

5 responses to “Developing new standards for the future graduate registered nurse”

  1. This sounds like a very daunting but exciting current role as a preceptorship developent managet brings me in contact with many graduate MH nurses and I have found myself asking, “Do current degree courses really prepare and produce a well rounded practices given the complexities of patient need?”

    I work in the independent sector.

    Good luck with this endeavour. It’s exciting!

  2. Joanne Keeling says:

    Having just developed a revised curriculum for pre-registration nursing I look forward to the consultation and revised standards. I have struggled with the 2010 standards in terms of practice and theory hour requirements and feel that this rigidity effects creativity in educational approach. I hope that the revised standards consider a true integration of theoretical and practical learning that enable creativity and reflect a holistic approach to learning and nursing education. Good luck on this vital project!

  3. Betsy Scott says:

    The London Association of Mental Health Nursing Practice (LAMP) are happy to give their support and contribute to future consultation and discussion. The safe and compassionate delivery of care to service users remains paramount for all nurses, but major change often triggers high levels of anxiety in existing staff who may have supported several major changes over the years, our membership will be keen to help facilitate a smooth transition when the new standards are available.

  4. Alison Twycross says:

    I read this report with interest. Much of what is in the report I agree with but I would have liked to see more attention paid to the needs of children and young people – given how the health inequalities there are with other countries in Europe. The new standards need to insure that there are nurses who can care for children and young people whatever their illness (physical or mental health) and wherever they are being cared for.

  5. Exciting times! It’s good to see the multi-agency working context acknowledged. Effective interprofessional learning to develop graduate capability for managing relationships with other professionals will be essential. CAIPE can offer advice and support.

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