Standards for Pre-Registration Nursing Education: Delivering Quality Care in the UK, Slides of Communication

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Nursing & Midwifery Council Standards for pre-registration nursing education Standards for pre-registration nursing education Contents Standards for pre-registration nursing education ............................................................ 1 Contents ......................................................................................................................... 2 Section 1: Introduction .................................................................................................... 4 Background and context......................................................................................... 4 Standards for competence ..................................................................................... 7 Standards for education ......................................................................................... 7 Section 2: Standards for competence........................................................................... 11 Context ................................................................................................................. 11 The competency framework ................................................................................. 11 Competencies for entry to the register: Adult nursing........................................... 13 Competencies for entry to the register: Mental health nursing ............................. 22 Competencies for entry to the register: Learning disabilities nursing ................... 31 Competencies for entry to the register: Children’s nursing................................... 40 Section 3: Standards for education............................................................................... 49 Standard 1: Safeguarding the public .................................................................... 49 Standard 2: Equality and diversity ........................................................................ 52 Standard 3: Selection, admission, progression and completion ........................... 54 Standard 4: Support of students and educators ................................................... 63 Standard 5: Structure, design and delivery of programmes ................................. 66 Standard 6: Practice learning opportunities.......................................................... 76 Standard 7: Outcomes ......................................................................................... 79 Standard 8: Assessment ...................................................................................... 82 Standard 9: Resources......................................................................................... 88 Standard 10: Quality assurance ........................................................................... 91 Annexe 1: Extract from Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications ............ 93 Article 31 .............................................................................................................. 93 Nursing and Midwifery Council 16 September 2010 Page 2 of 152 Standards for pre-registration nursing education solving approaches and evidence in decision-making, keep up with technical advances and meet future expectations. Professional values must underpin education as well as practice. All nurses and midwives are required to comply with The Code: Professional standards of practice and behaviour for nurses and midwives (NMC 2015). The Code is central to all education programmes, and educators must enable students to understand, commit to and uphold it. The public can be confident that all new nurses will: • deliver high quality essential care to all • deliver complex care to service users in their field of practice • act to safeguard the public, and be responsible and accountable for safe, person- centred, evidence-based nursing practice • act with professionalism and integrity, and work within agreed professional, ethical and legal frameworks and processes to maintain and improve standards • practise in a compassionate, respectful way, maintaining dignity and wellbeing and communicating effectively • act on their understanding of how people’s lifestyles, environments and the location of care delivery influence their health and wellbeing • seek out every opportunity to promote health and prevent illness • work in partnership with other health and social care professionals and agencies, service users, carers and families ensuring that decisions about care are shared • use leadership skills to supervise and manage others and contribute to planning, designing, delivering and improving future services. Nurses must be able to meet all NMC requirements when they qualify and then maintain their knowledge and skills. Newly qualified nurses cannot be expected to have extensive clinical experience, specialist expertise, or highly developed supervision and leadership skills. Opportunities will be needed to develop these through preceptorship and ongoing professional development. We are fully committed to promoting equality and diversity and this is reflected in the standards. Programme providers are reminded of the need to consider the learning needs of students with disabilities in both academic and practice settings. Standards and requirements We are required under the Nursing and Midwifery Order 2001 (the order) to establish standards – minimum requirements by which programme providers determine programme content, learning outcomes and assessment criteria. Our standards are Nursing and Midwifery Council 16 September 2010 Page 5 of 152 Standards for pre-registration nursing education underpinned by requirements; a standard will be fully met only when all the requirements have been demonstrated. All AEIs and their partner practice learning providers are required to comply fully with these standards and requirements in all UK pre-registration nursing programmes. The order also requires us to give and publish guidance on what we believe is best practice. Box 1 shows NMC descriptions of its standards and guidance. You will find it helpful to read the requirements and guidance in section 3 in conjunction with Advice and supporting information for implementing NMC standards for pre-registration nursing education. Box 1: NMC standards and guidance Standards The Nursing and Midwifery Council is required to establish standards. Requirements underpin the standards. Standards must be met and requirements must be demonstrated. A standard will be fully met only when all the requirements have been demonstrated. Guidance The order requires the Nursing and Midwifery Council to give guidance and publish that guidance. Guidance reflects what the Nursing and Midwifery Council believes is best practice and should be followed. There is some flexibility in how guidance is applied to education programmes. Where it is not followed precisely, programme providers will need to account for this and explain how an alternative approach will produce a similar outcome. These standards for pre-registration nursing education replace our 2004 Standards of proficiency for pre-registration nursing education.1 Many are based on previous rules, standards and guidance. Others have been introduced after extensive consultation with stakeholders, in accordance with article 3(14) of the order incorporating the findings of our review Nursing: Towards 2015 (NMC 2007), and key policies from the four UK government health departments including Modernising nursing careers (DH, 2006). Where appropriate, the standards are aligned with European Union Directive 2005/36/EC Recognition of professional qualifications (see annexe 1). Article 31 sets out the requirements for training nurses responsible for general care and establishes the baseline for general nursing in the EU. It includes specific requirements on programme length, content, and ratio of theory to practice, and the nature of practice learning and range of experience. 1 The Standards of proficiency for pre-registration nursing education (NMC 2004) will continue to apply to programmes approved under those standards. Nursing and Midwifery Council 16 September 2010 Page 6 of 152 Standards for pre-registration nursing education In the UK students qualify in a specific field of nursing practice and may apply to enter the NMC register as a nurse in one or more of four fields: adult, mental health, learning disabilities and children’s nursing. Those in the adult field must meet EU requirements for training in general care, including the definition of practice (annexe 1), which must include direct contact with service users across a range of client groups and clinical specialities. For consistency, we have also applied the EU requirements for minimum programme length and ratio of theory to practice to all four fields. New nurses will be expected to meet the essential mental and physical health needs of people of all ages and conditions, as well as in their own field of practice. Our standards are normally reviewed every five years, but we will also continue to seek ongoing feedback from nurses, the public and other stakeholders to ensure that they remain fit for purpose. As ever, we will work closely with the four UK government health departments, and with those who commission education and provide health services, to ensure that our standards are, and remain, sound and meet expectations. The standards for competence and standards for education are set out below. The standards for competence address what nursing students must do and achieve during their programme, while the standards for education concern the framework within which programmes must be delivered. Standards for competence The standards for competence in section 2 identify the knowledge, skills and attitudes the student must acquire by the end of the programme, as set out in the degree-level competency framework. This framework comprises four sets of competencies, one for each field of practice: adult, mental health, learning disabilities and children’s nursing. Each set comprises both generic competencies and field-specific competencies. The competencies are organised in four domains: • professional values • communication and interpersonal skills • nursing practice and decision making • leadership, management and team working. The context in which the competencies are acquired in relation to the field of nursing defines the scope of professional practice at the point of registration. Standards for education The standards for education in section 3 comprise 10 standards for programme approval and delivery. They provide the framework within which programmes are delivered, and specify the requirements that all programmes must meet, including those relating to the teaching, learning and assessment of nursing students (see also Standards to support learning and assessment in practice (NMC 2008). Nursing and Midwifery Council 16 September 2010 Page 7 of 152 Standards for pre-registration nursing education Every student who steps off the programme before completion will receive a transcript of training giving details of learning achievements in theory and practice. This may lead directly to an alternative academic or vocational award, or it may contribute to a future award. The transcript may also be helpful to students transferring from one AEI to another, rejoining a programme after a break, when starting afresh, or be used to access employment opportunities. Approval and monitoring of AEIs AEIs and their partner practice learning providers are required to meet these standards and requirements in all UK pre-registration nursing programmes. Their performance in programme development and delivery will be measured against the standards through our quality assurance processes. We ensure that programmes meet our standards through a robust procedure known as approval. Programmes are normally approved for up to five years. We check compliance before allowing the programme to run, following which it is subject to NMC monitoring. Nursing and Midwifery Council 16 September 2010 Page 10 of 152 Direct links should be made between what is assessed in practice and academic settings, with the processes overseen by external examiners to ensure that theory and practice remain integrated. The assessment of theory and practice learning is given equal weighting. AEIs will use a range of assessment methods to meet the programme’s academic requirements, including projects, essays, portfolios, assignments, formal tests and examinations. We encourage innovative ways of achieving practice learning outcomes and enable flexibility in who can support and assess nursing students in practice settings, while maintaining continuity through the use of the nurse mentor system. A nurse mentor who has completed specific preparation in assessing students is normally responsible for ongoing supervision and assessment in practice settings and in simulation. Other registered professionals who have been suitably prepared can supervise and contribute towards the assessment of nursing students. During a period of at least 12 weeks practice learning towards the end of the programme, a sign-off mentor (a nurse mentor who has met additional criteria), who is registered in the field of practice that the student intends to enter, makes a final judgement of competence (see Standards to support learning and assessment in practice (NMC 2008)). The evidence must show that the student is safe and effective in practice at the end of the programme. Standards for pre-registration nursing education Section 2: Standards for competence Context Competence is a requirement for entry to the NMC register. It is a holistic concept that may be defined as “the combination of skills, knowledge and attitudes, values and technical abilities that underpin safe and effective nursing practice and interventions” (adapted from Queensland Nursing Council 2009). The standards in this section relate to the competence required of all nursing students at the end of their pre-registration nursing programme, when they are at the point of registration. The standards have been informed by the Royal College of Nursing definition of nursing as “the use of clinical judgement in the provision of care to enable people to improve, maintain or recover health, to cope with health problems, and to achieve the best possible quality of life, whatever their disease or disability until death” (Royal College of Nursing 2003). The standards have also been informed by the European Tuning project (Tuning 2009), which adopted this definition of the nurse in 2003: “A professional person achieving a competent standard of practice at first cycle level following successful completion of an approved academic and practical course. The nurse is a safe, caring, and competent decision maker willing to accept personal and professional accountability for his/her actions and continuous learning. The nurse practises within a statutory framework and code of ethics delivering nursing practice (care) that is appropriately based on research, evidence and critical thinking that effectively responds to the needs of individual clients (patients) and diverse populations.” The competency framework The competency framework sets out the standards for competence and the related competencies that every nursing student must acquire before applying to be registered at first level on the nurses’ part of the register. There are separate sets of competency requirements for each of the four fields of adult nursing, mental health nursing, learning disabilities nursing or children’s nursing. Each set is laid out under the following four domains: 1 professional values 2 communication and interpersonal skills 3 nursing practice and decision-making 4 leadership, management and team working. Each domain is comprised of a generic standard for competence and a field standard for competence. It also includes the generic competencies that all nurses must achieve and the field competencies to be achieved in each specific field. The number of field competencies varies in number in each domain and between nursing fields of practice. Nursing and Midwifery Council 16 September 2010 Page 11 of 152 Standards for pre-registration nursing education Before they can apply to be registered, nursing students must have acquired all the generic and field competency requirements within the context of their field at a minimum of degree level. Included within the nursing practice and decision making domain for each field we have identified the wider range of people who may come into the nurses’ care and the level at which we expect that care to be delivered. Specific knowledge and skills All nurses must apply knowledge and skills based on the best available evidence indicative of safe nursing practice. The knowledge and skills required have been integrated into the competencies throughout. Some are generic and some field-specific. Additional requirements and guidance are as follows: • Knowledge and related aspects of practice are set out as programme content in section 3, standard 5 – structure, design and delivery of programmes. • Theoretical and clinical instruction for general care, required for students undertaking the adult nursing field, is set out in EU Directive 2005/36/EC Annex V.2 (5.2.1). This can be found in annexe 1. • Criteria for safety and professional values that must be achieved at the first progression point are set out in annexe 2. • Essential skills clusters (ESCs) that should be reflected in learning outcomes at different points in the programme include skills for care, compassion and communication; organisational aspects of care; infection prevention and control; nutrition and fluid management; and medicines management (annexe 3). Nursing and Midwifery Council 16 September 2010 Page 12 of 152 Standards for pre-registration nursing education Domain 2: Communication and interpersonal skills Generic standard for competence All nurses must use excellent communication and interpersonal skills. Their communications must always be safe, effective, compassionate and respectful. They must communicate effectively using a wide range of strategies and interventions including the effective use of communication technologies. Where people have a disability, nurses must be able to work with service users and others to obtain the information needed to make reasonable adjustments that promote optimum health and enable equal access to services. Field standard for competence Adult nurses must demonstrate the ability to listen with empathy. They must be able to respond warmly and positively to people of all ages who may be anxious, distressed, or facing problems with their health and wellbeing. Competencies 1 All nurses must build partnerships and therapeutic relationships through safe, effective and non-discriminatory communication. They must take account of individual differences, capabilities and needs. 2 All nurses must use a range of communication skills and technologies to support person-centred care and enhance quality and safety. They must ensure people receive all the information they need in a language and manner that allows them to make informed choices and share decision making. They must recognise when language interpretation or other communication support is needed and know how to obtain it. 3 All nurses must use the full range of communication methods, including verbal, non-verbal and written, to acquire, interpret and record their knowledge and understanding of people’s needs. They must be aware of their own values and beliefs and the impact this may have on their communication with others. They must take account of the many different ways in which people communicate and how these may be influenced by ill health, disability and other factors, and be able to recognise and respond effectively when a person finds it hard to communicate. 3.1 Adult nurses must promote the concept, knowledge and practice of self- care with people with acute and long-term conditions, using a range of communication skills and strategies. 4 All nurses must recognise when people are anxious or in distress and respond effectively, using therapeutic principles, to promote their wellbeing, manage personal safety and resolve conflict. They must use effective communication strategies and negotiation techniques to achieve best outcomes, respecting the dignity and human rights of all concerned. They must know when to consult a third party and how to make referrals for advocacy, mediation or arbitration. Nursing and Midwifery Council 16 September 2010 Page 15 of 152 Standards for pre-registration nursing education 5 All nurses must use therapeutic principles to engage, maintain and, where appropriate, disengage from professional caring relationships, and must always respect professional boundaries. 6 All nurses must take every opportunity to encourage health-promoting behaviour through education, role modelling and effective communication. 7 All nurses must maintain accurate, clear and complete records, including the use of electronic formats, using appropriate and plain language. 8 All nurses must respect individual rights to confidentiality and keep information secure and confidential in accordance with the law and relevant ethical and regulatory frameworks, taking account of local protocols. They must also actively share personal information with others when the interests of safety and protection override the need for confidentiality. Nursing and Midwifery Council 16 September 2010 Page 16 of 152 Standards for pre-registration nursing education Domain 3: Nursing practice and decision-making Generic standard for competence All nurses must practise autonomously, compassionately, skilfully and safely, and must maintain dignity and promote health and wellbeing. They must assess and meet the full range of essential physical and mental health needs of people of all ages who come into their care. Where necessary they must be able to provide safe and effective immediate care to all people prior to accessing or referring to specialist services irrespective of their field of practice. All nurses must also meet more complex and coexisting needs for people in their own nursing field of practice, in any setting including hospital, community and at home. All practice should be informed by the best available evidence and comply with local and national guidelines. Decision-making must be shared with service users, carers and families and informed by critical analysis of a full range of possible interventions, including the use of up-to-date technology. All nurses must also understand how behaviour, culture, socioeconomic and other factors, in the care environment and its location, can affect health, illness, health outcomes and public health priorities and take this into account in planning and delivering care. Field standard for competence Adult nurses must be able to carry out accurate assessment of people of all ages using appropriate diagnostic and decision-making skills. They must be able to provide effective care for service users and others in all settings. They must have in-depth understanding of and competence in medical and surgical nursing to respond to adults’ full range of health and dependency needs. They must be able to deliver care to meet essential and complex physical and mental health needs. Competencies 1 All nurses must use up-to-date knowledge and evidence to assess, plan, deliver and evaluate care, communicate findings, influence change and promote health and best practice. They must make person-centred, evidence-based judgments and decisions, in partnership with others involved in the care process, to ensure high quality care. They must be able to recognise when the complexity of clinical decisions requires specialist knowledge and expertise, and consult or refer accordingly. 1.1 Adult nurses must be able to recognise and respond to the needs of all people who come into their care including babies, children and young people, pregnant and postnatal women, people with mental health problems, people with physical disabilities, people with learning disabilities, older people, and people with long term problems such as cognitive impairment. 2 All nurses must possess a broad knowledge of the structure and functions of the human body, and other relevant knowledge from the life, behavioural and social sciences as applied to health, ill health, disability, ageing and death. They must have an in-depth knowledge of common physical and mental health problems and treatments in their own field of practice, including co-morbidity and physiological and psychological vulnerability. Nursing and Midwifery Council 16 September 2010 Page 17 of 152 Standards for pre-registration nursing education Domain 4: Leadership, management and team working Generic standard for competence All nurses must be professionally accountable and use clinical governance processes to maintain and improve nursing practice and standards of healthcare. They must be able to respond autonomously and confidently to planned and uncertain situations, managing themselves and others effectively. They must create and maximise opportunities to improve services. They must also demonstrate the potential to develop further management and leadership skills during their period of preceptorship and beyond. Field standard for competence Adult nurses must be able to provide leadership in managing adult nursing care, understand and coordinate interprofessional care when needed, and liaise with specialist teams. They must be adaptable and flexible, and able to take the lead in responding to the needs of people of all ages in a variety of circumstances, including situations where immediate or urgent care is needed. They must recognise their leadership role in disaster management, major incidents and public health emergencies, and respond appropriately according to their levels of competence. Competencies 1 All nurses must act as change agents and provide leadership through quality improvement and service development to enhance people’s wellbeing and experiences of healthcare. 2 All nurses must systematically evaluate care and ensure that they and others use the findings to help improve people’s experience and care outcomes and to shape future services. 3 All nurses must be able to identify priorities and manage time and resources effectively to ensure the quality of care is maintained or enhanced. 4 All nurses must be self-aware and recognise how their own values, principles and assumptions may affect their practice. They must maintain their own personal and professional development, learning from experience, through supervision, feedback, reflection and evaluation. 5 All nurses must facilitate nursing students and others to develop their competence, using a range of professional and personal development skills. 6 All nurses must work independently as well as in teams. They must be able to take the lead in coordinating, delegating and supervising care safely, managing risk and remaining accountable for the care given. Nursing and Midwifery Council 16 September 2010 Page 20 of 152 Standards for pre-registration nursing education 7 All nurses must work effectively across professional and agency boundaries, actively involving and respecting others’ contributions to integrated person-centred care. They must know when and how to communicate with and refer to other professionals and agencies in order to respect the choices of service users and others, promoting shared decision making, to deliver positive outcomes and to coordinate smooth, effective transition within and between services and agencies. Nursing and Midwifery Council 16 September 2010 Page 21 of 152 Standards for pre-registration nursing education Competencies for entry to the register: Mental health nursing Domain 1: Professional values Generic standard for competence All nurses must act first and foremost to care for and safeguard the public. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights. They must show professionalism and integrity and work within recognised professional, ethical and legal frameworks. They must work in partnership with other health and social care professionals and agencies, service users, their carers and families in all settings, including the community, ensuring that decisions about care are shared. Field standard for competence Mental health nurses must work with people of all ages using values-based mental health frameworks. They must use different methods of engaging people, and work in a way that promotes positive relationships focused on social inclusion, human rights and recovery, that is, a person’s ability to live a self-directed life, with or without symptoms, that they believe is meaningful and satisfying. Competencies 1 All nurses must practise with confidence according to The Code: Professional standards of practice and behaviour for nurses and midwives (NMC 2015), and within other recognised ethical and legal frameworks. They must be able to recognise and address ethical challenges relating to people’s choices and decision-making about their care, and act within the law to help them and their families and carers find acceptable solutions. 1.1 Mental health nurses must understand and apply current legislation to all service users, paying special attention to the protection of vulnerable people, including those with complex needs arising from ageing, cognitive impairment, long-term conditions and those approaching the end of life. 2 All nurses must practise in a holistic, non-judgmental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognises and respects individual choice; and acknowledges diversity. Where necessary, they must challenge inequality, discrimination and exclusion from access to care. 2.1 Mental health nurses must practise in a way that addresses the potential power imbalances between professionals and people experiencing mental health problems, including situations when compulsory measures are used, by helping people exercise their rights, upholding safeguards and ensuring minimal restrictions on their lives. They must have an in depth understanding of mental health legislation and how it relates to care and treatment of people with mental health problems. Nursing and Midwifery Council 16 September 2010 Page 22 of 152 Standards for pre-registration nursing education 4 All nurses must recognise when people are anxious or in distress and respond effectively, using therapeutic principles, to promote their wellbeing, manage personal safety and resolve conflict. They must use effective communication strategies and negotiation techniques to achieve best outcomes, respecting the dignity and human rights of all concerned. They must know when to consult a third party and how to make referrals for advocacy, mediation or arbitration. 4.1 Mental health nurses must be sensitive to, and take account of, the impact of abuse and trauma on people’s wellbeing and the development of mental health problems. They must use interpersonal skills and make interventions that help people disclose and discuss their experiences as part of their recovery. 5 All nurses must use therapeutic principles to engage, maintain and, where appropriate, disengage from professional caring relationships, and must always respect professional boundaries. 5.1 Mental health nurses must use their personal qualities, experiences and interpersonal skills to develop and maintain therapeutic, recovery-focused relationships with people and therapeutic groups. They must be aware of their own mental health, and know when to share aspects of their own life to inspire hope while maintaining professional boundaries. 6 All nurses must take every opportunity to encourage health-promoting behaviour through education, role modelling and effective communication. 6.1 Mental health nurses must foster helpful and enabling relationships with families, carers and other people important to the person experiencing mental health problems. They must use communication skills that enable psychosocial education, problem-solving and other interventions to help people cope and to safeguard those who are vulnerable. 7 All nurses must maintain accurate, clear and complete records, including the use of electronic formats, using appropriate and plain language. 8 All nurses must respect individual rights to confidentiality and keep information secure and confidential in accordance with the law and relevant ethical and regulatory frameworks, taking account of local protocols. They must also actively share personal information with others when the interests of safety and protection override the need for confidentiality. Nursing and Midwifery Council 16 September 2010 Page 25 of 152 Standards for pre-registration nursing education Domain 3: Nursing practice and decision-making Generic standard for competence All nurses must practise autonomously, compassionately, skilfully and safely, and must maintain dignity and promote health and wellbeing. They must assess and meet the full range of essential physical and mental health needs of people of all ages who come into their care. Where necessary they must be able to provide safe and effective immediate care to all people prior to accessing or referring to specialist services irrespective of their field of practice. All nurses must also meet more complex and coexisting needs for people in their own nursing field of practice, in any setting including hospital, community and at home. All practice should be informed by the best available evidence and comply with local and national guidelines. Decision-making must be shared with service users, carers and families and informed by critical analysis of a full range of possible interventions, including the use of up-to-date technology. All nurses must also understand how behaviour, culture, socioeconomic and other factors, in the care environment and its location, can affect health, illness, health outcomes and public health priorities and take this into account in planning and delivering care. Field standard for competence Mental health nurses must draw on a range of evidence-based psychological, psychosocial and other complex therapeutic skills and interventions to provide person- centred support and care across all ages, in a way that supports self-determination and aids recovery. They must also promote improvements in physical and mental health and wellbeing and provide direct care to meet both the essential and complex physical and mental health needs of people with mental health problems. Competencies 1 All nurses must use up-to-date knowledge and evidence to assess, plan, deliver and evaluate care, communicate findings, influence change and promote health and best practice. They must make person-centred, evidence-based judgments and decisions, in partnership with others involved in the care process, to ensure high quality care. They must be able to recognise when the complexity of clinical decisions requires specialist knowledge and expertise, and consult or refer accordingly. 1.1 Mental health nurses must be able to recognise and respond to the needs of all people who come into their care including babies, children and young people, pregnant and postnatal women, people with physical health problems, people with physical disabilities, people with learning disabilities, older people, and people with long term problems such as cognitive impairment. 2 All nurses must possess a broad knowledge of the structure and functions of the human body, and other relevant knowledge from the life, behavioral and social sciences as applied to health, ill health, disability, ageing and death. They must have an in-depth knowledge of common physical and mental health problems and treatments in their own field of practice, including co-morbidity and physiological and psychological vulnerability. Nursing and Midwifery Council 16 September 2010 Page 26 of 152 Standards for pre-registration nursing education 3 All nurses must carry out comprehensive, systematic nursing assessments that take account of relevant physical, social, cultural, psychological, spiritual, genetic and environmental factors, in partnership with service users and others through interaction, observation and measurement. 3.1 Mental health nurses must be able to apply their knowledge and skills in a range of evidence-based individual and group psychological and psychosocial interventions, to carry out systematic needs assessments, develop case formulations and negotiate goals. 4 All nurses must ascertain and respond to the physical, social and psychological needs of people, groups and communities. They must then plan, deliver and evaluate safe, competent, person-centred care in partnership with them, paying special attention to changing health needs during different life stages, including progressive illness and death, loss and bereavement. 4.1 Mental health nurses must be able to apply their knowledge and skills in a range of evidence-based psychological and psychosocial individual and group interventions to develop and implement care plans and evaluate outcomes, in partnership with service users and others. 5 All nurses must understand public health principles, priorities and practice in order to recognise and respond to the major causes and social determinants of health, illness and health inequalities. They must use a range of information and data to assess the needs of people, groups, communities and populations, and work to improve health, wellbeing and experiences of healthcare; secure equal access to health screening, health promotion and healthcare; and promote social inclusion. 5.1 Mental health nurses must work to promote mental health, help prevent mental health problems in at-risk groups, and enhance the health and wellbeing of people with mental health problems. 6 All nurses must practise safely by being aware of the correct use, limitations and hazards of common interventions, including nursing activities, treatments, and the use of medical devices and equipment. The nurse must be able to evaluate their use, report any concerns promptly through appropriate channels and modify care where necessary to maintain safety. They must contribute to the collection of local and national data and formulation of policy on risks, hazards and adverse outcomes. 6.1 Mental health nurses must help people experiencing mental health problems to make informed choices about pharmacological and physical treatments, by providing education and information on the benefits and unwanted effects, choices and alternatives. They must support people to identify actions that promote health and help to balance benefits and unwanted effects. 7 All nurses must be able to recognise and interpret signs of normal and deteriorating mental and physical health and respond promptly to maintain or improve the health and comfort of the service user, acting to keep them and others safe. Nursing and Midwifery Council 16 September 2010 Page 27 of 152 Standards for pre-registration nursing education 6 All nurses must work independently as well as in teams. They must be able to take the lead in coordinating, delegating and supervising care safely, managing risk and remaining accountable for the care given. 6.1 Mental health nurses must contribute to the management of mental health care environments by giving priority to actions that enhance people's safety, psychological security and therapeutic outcomes, and by ensuring effective communication, positive risk management and continuity of care across service boundaries. 7 All nurses must work effectively across professional and agency boundaries, actively involving and respecting others’ contributions to integrated person-centred care. They must know when and how to communicate with and refer to other professionals and agencies in order to respect the choices of service users and others, promoting shared decision making, to deliver positive outcomes and to coordinate smooth, effective transition within and between services and agencies. Nursing and Midwifery Council 16 September 2010 Page 30 of 152 Standards for pre-registration nursing education Competencies for entry to the register: Learning disabilities nursing Domain 1: Professional values Generic standard for competence All nurses must act first and foremost to care for and safeguard the public. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights. They must show professionalism and integrity and work within recognised professional, ethical and legal frameworks. They must work in partnership with other health and social care professionals and agencies, service users, their carers and families in all settings, including the community, ensuring that decisions about care are shared. Field standard for competence Learning disabilities nurses must promote the individuality, independence, rights, choice and social inclusion of people with learning disabilities and highlight their strengths and abilities at all times while encouraging others do the same. They must facilitate the active participation of families and carers. Competencies 1 All nurses must practise with confidence according to The Code: Professional standards of practice and behaviour for nurses and midwives (NMC 2015), and within other recognised ethical and legal frameworks. They must be able to recognise and address ethical challenges relating to people’s choices and decision-making about their care, and act within the law to help them and their families and carers find acceptable solutions. 1.1 Learning disabilities nurses must understand and apply current legislation to all service users, paying special attention to the protection of vulnerable people, including those with complex needs arising from ageing, cognitive impairment, long-term conditions and those approaching the end of life. 2 All nurses must practise in a holistic, non-judgmental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognises and respects individual choice; and acknowledges diversity. Where necessary, they must challenge inequality, discrimination and exclusion from access to care. 2.1 Learning disabilities nurses must always promote the autonomy, rights and choices of people with learning disabilities and support and involve their families and carers, ensuring that each person’s rights are upheld according to policy and the law. 3 All nurses must support and promote the health, wellbeing, rights and dignity of people, groups, communities and populations. These include people whose lives are affected by ill health, disability, inability to engage, ageing or death. Nurses must act on their understanding of how these conditions influence public health. Nursing and Midwifery Council 16 September 2010 Page 31 of 152 Standards for pre-registration nursing education 3.1 Learning disabilities nurses must use their knowledge and skills to exercise professional advocacy, and recognise when it is appropriate to refer to independent advocacy services to safeguard dignity and human rights. 4 All nurses must work in partnership with service users, carers, groups, communities and organisations. They must manage risk, and promote health and wellbeing while aiming to empower choices that promote self-care and safety. 4.1 Learning disabilities nurses must recognise that people with learning disabilities are full and equal citizens, and must promote their health and wellbeing by focusing on and developing their strengths and abilities. 5 All nurses must fully understand the nurse’s various roles, responsibilities and functions, and adapt their practice to meet the changing needs of people, groups, communities and populations. 6 All nurses must understand the roles and responsibilities of other health and social care professionals, and seek to work with them collaboratively for the benefit of all who need care. 7 All nurses must be responsible and accountable for keeping their knowledge and skills up to date through continuing professional development. They must aim to improve their performance and enhance the safety and quality of care through evaluation, supervision and appraisal. 8 All nurses must practise independently, recognising the limits of their competence and knowledge. They must reflect on these limits and seek advice from, or refer to, other professionals where necessary. 9 All nurses must appreciate the value of evidence in practice, be able to understand and appraise research, apply relevant theory and research findings to their work, and identify areas for further investigation. Nursing and Midwifery Council 16 September 2010 Page 32 of 152 Standards for pre-registration nursing education Domain 3: Nursing practice and decision-making Generic standard for competence All nurses must practise autonomously, compassionately, skilfully and safely, and must maintain dignity and promote health and wellbeing. They must assess and meet the full range of essential physical and mental health needs of people of all ages who come into their care. Where necessary they must be able to provide safe and effective immediate care to all people prior to accessing or referring to specialist services irrespective of their field of practice. All nurses must also meet more complex and coexisting needs for people in their own nursing field of practice, in any setting including hospital, community and at home. All practice should be informed by the best available evidence and comply with local and national guidelines. Decision-making must be shared with service users, carers and families and informed by critical analysis of a full range of possible interventions, including the use of up-to-date technology. All nurses must also understand how behaviour, culture, socioeconomic and other factors, in the care environment and its location, can affect health, illness, health outcomes and public health priorities and take this into account in planning and delivering care. Field standard for competence Learning disabilities nurses must have an enhanced knowledge of the health and developmental needs of all people with learning disabilities, and the factors that might influence them. They must aim to improve and maintain their health and independence through skilled direct and indirect nursing care. They must also be able to provide direct care to meet the essential and complex physical and mental health needs of people with learning disabilities. Competencies 1 All nurses must use up-to-date knowledge and evidence to assess, plan, deliver and evaluate care, communicate findings, influence change and promote health and best practice. They must make person-centred, evidence-based judgments and decisions, in partnership with others involved in the care process, to ensure high quality care. They must be able to recognise when the complexity of clinical decisions requires specialist knowledge and expertise, and consult or refer accordingly. 1.1 Learning disabilities nurses must be able to recognise and respond to the needs of all people who come into their care including babies, children and young people, pregnant and postnatal women, people with mental health problems, people with physical health problems and disabilities, older people, and people with long term problems such as cognitive impairment. 2 All nurses must possess a broad knowledge of the structure and functions of the human body, and other relevant knowledge from the life, behavioural and social sciences as applied to health, ill health, disability, ageing and death. They must have an in-depth knowledge of common physical and mental health problems and treatments in their own field of practice, including co-morbidity and physiological and psychological vulnerability. Nursing and Midwifery Council 16 September 2010 Page 35 of 152 Standards for pre-registration nursing education 3 All nurses must carry out comprehensive, systematic nursing assessments that take account of relevant physical, social, cultural, psychological, spiritual, genetic and environmental factors, in partnership with service users and others through interaction, observation and measurement. 3.1 Learning disabilities nurses must use a structured, person-centred approach to assess, interpret and respond therapeutically to people with learning disabilities, and their often complex, pre-existing physical and psychological health needs. They must work in partnership with service users, carers and other professionals, services and agencies to agree and implement individual care plans and ensure continuity of care. 4 All nurses must ascertain and respond to the physical, social and psychological needs of people, groups and communities. They must then plan, deliver and evaluate safe, competent, person-centred care in partnership with them, paying special attention to changing health needs during different life stages, including progressive illness and death, loss and bereavement. 5 All nurses must understand public health principles, priorities and practice in order to recognise and respond to the major causes and social determinants of health, illness and health inequalities. They must use a range of information and data to assess the needs of people, groups, communities and populations, and work to improve health, wellbeing and experiences of healthcare; secure equal access to health screening, health promotion and healthcare; and promote social inclusion. 5.1 Learning disabilities nurses must lead the development, implementation and review of individual plans for all people with learning disabilities, to promote their optimum health and wellbeing and facilitate their equal access to all health, social care and specialist services. 6 All nurses must practise safely by being aware of the correct use, limitations and hazards of common interventions, including nursing activities, treatments, and the use of medical devices and equipment. The nurse must be able to evaluate their use, report any concerns promptly through appropriate channels and modify care where necessary to maintain safety. They must contribute to the collection of local and national data and formulation of policy on risks, hazards and adverse outcomes. 7 All nurses must be able to recognise and interpret signs of normal and deteriorating mental and physical health and respond promptly to maintain or improve the health and comfort of the service user, acting to keep them and others safe. 8 All nurses must provide educational support, facilitation skills and therapeutic nursing interventions to optimise health and wellbeing. They must promote self- care and management whenever possible, helping people to make choices about their healthcare needs, involving families and carers where appropriate, to maximise their ability to care for themselves. 8.1 Learning disabilities nurses must work in partnership with people with learning disabilities and their families and carers to facilitate choice and Nursing and Midwifery Council 16 September 2010 Page 36 of 152 Standards for pre-registration nursing education maximise self-care and self-management and co-ordinate the transition between different services and agencies. 9 All nurses must be able to recognise when a person is at risk and in need of extra support and protection and take reasonable steps to protect them from abuse. 10 All nurses must evaluate their care to improve clinical decision-making, quality and outcomes, using a range of methods, amending the plan of care, where necessary, and communicating changes to others. Nursing and Midwifery Council 16 September 2010 Page 37 of 152 Standards for pre-registration nursing education Competencies for entry to the register: Children’s nursing Domain 1: Professional values Generic standard for competence All nurses must act first and foremost to care for and safeguard the public. They must practise autonomously and be responsible and accountable for safe, compassionate, person-centred, evidence-based nursing that respects and maintains dignity and human rights. They must show professionalism and integrity and work within recognised professional, ethical and legal frameworks. They must work in partnership with other health and social care professionals and agencies, service users, their carers and families in all settings, including the community, ensuring that decisions about care are shared. Field standard for competence Children’s nurses must understand their role as an advocate for children, young people and their families, and work in partnership with them. They must deliver child and family-centred care; empower children and young people to express their views and preferences; and maintain and recognise their rights and best interests. Competencies 1 All nurses must practise with confidence according to The Code: Professional standards of practice and behaviour for nurses and midwives (NMC 2015), and within other recognised ethical and legal frameworks. They must be able to recognise and address ethical challenges relating to people’s choices and decision-making about their care, and act within the law to help them and their families and carers find acceptable solutions. 1.1 Children’s nurses must understand the laws relating to child and parental consent, including giving and refusing consent, withdrawal of treatment and legal capacity. 2 All nurses must practise in a holistic, non-judgmental, caring and sensitive manner that avoids assumptions, supports social inclusion; recognises and respects individual choice; and acknowledges diversity. Where necessary, they must challenge inequality, discrimination and exclusion from access to care. 2.1 Children’s nurses must recognise that all children and young people have the right to be safe, enjoy life and reach their potential. They must practise in a way that recognises, respects and responds to the individuality of every child and young person. 3 All nurses must support and promote the health, wellbeing, rights and dignity of people, groups, communities and populations. These include people whose lives are affected by ill health, disability, inability to engage, ageing or death. Nurses must act on their understanding of how these conditions influence public health. Nursing and Midwifery Council 16 September 2010 Page 40 of 152 Standards for pre-registration nursing education 3.1 Children’s nurses must act as advocates for the right of all children and young people to lead full and independent lives. 4 All nurses must work in partnership with service users, carers, groups, communities and organisations. They must manage risk, and promote health and wellbeing while aiming to empower choices that promote self-care and safety. 4.1 Children’s nurses must work in partnership with children, young people and their families to negotiate, plan and deliver child and family-centred care, education and support. They must recognise the parent’s or carer’s primary role in achieving and maintaining the child’s or young person’s health and wellbeing, and offer advice and support on parenting in health and illness. 5 All nurses must fully understand the nurse’s various roles, responsibilities and functions, and adapt their practice to meet the changing needs of people, groups, communities and populations. 6 All nurses must understand the roles and responsibilities of other health and social care professionals, and seek to work with them collaboratively for the benefit of all who need care. 7 All nurses must be responsible and accountable for keeping their knowledge and skills up to date through continuing professional development. They must aim to improve their performance and enhance the safety and quality of care through evaluation, supervision and appraisal. 8 All nurses must practise independently, recognising the limits of their competence and knowledge. They must reflect on these limits and seek advice from, or refer to, other professionals where necessary. 9 All nurses must appreciate the value of evidence in practice, be able to understand and appraise research, apply relevant theory and research findings to their work, and identify areas for further investigation. Nursing and Midwifery Council 16 September 2010 Page 41 of 152 Standards for pre-registration nursing education Domain 2: Communication and interpersonal skills Generic standard for competence All nurses must use excellent communication and interpersonal skills. Their communications must always be safe, effective, compassionate and respectful. They must communicate effectively using a wide range of strategies and interventions including the effective use of communication technologies. Where people have a disability, nurses must be able to work with service users and others to obtain the information needed to make reasonable adjustments that promote optimum health and enable equal access to services. Field standard for competence Children’s nurses must take account of each child and young person’s individuality, including their stage of development, ability to understand, culture, learning or communication difficulties and health status. They must communicate effectively with them and with parents and carers. Competencies 1 All nurses must build partnerships and therapeutic relationships through safe, effective and non-discriminatory communication. They must take account of individual differences, capabilities and needs. 1.1 Children’s nurses must work with the child, young person and others to ensure that they are actively involved in decision-making, in order to maintain their independence and take account of their ongoing intellectual, physical and emotional needs. 2 All nurses must use a range of communication skills and technologies to support person-centred care and enhance quality and safety. They must ensure people receive all the information they need in a language and manner that allows them to make informed choices and share decision making. They must recognise when language interpretation or other communication support is needed and know how to obtain it. 2.1 Children’s nurses must understand all aspects of development from infancy to young adulthood, and identify each child or young person’s developmental stage, in order to communicate effectively with them. They must use play, distraction and communication tools appropriate to the child’s or young person’s stage of development, including for those with sensory or cognitive impairment. 3 All nurses must use the full range of communication methods, including verbal, non-verbal and written, to acquire, interpret and record their knowledge and understanding of people’s needs. They must be aware of their own values and beliefs and the impact this may have on their communication with others. They must take account of the many different ways in which people communicate and how these may be influenced by ill health, disability and other factors, and be able to recognise and respond effectively when a person finds it hard to communicate. Nursing and Midwifery Council 16 September 2010 Page 42 of 152 Standards for pre-registration nursing education 2 All nurses must possess a broad knowledge of the structure and functions of the human body, and other relevant knowledge from the life, behavioural and social sciences as applied to health, ill health, disability, ageing and death. They must have an in-depth knowledge of common physical and mental health problems and treatments in their own field of practice, including co-morbidity and physiological and psychological vulnerability. 3 All nurses must carry out comprehensive, systematic nursing assessments that take account of relevant physical, social, cultural, psychological, spiritual, genetic and environmental factors, in partnership with service users and others through interaction, observation and measurement. 3.1 Children’s nurses must carry out comprehensive nursing assessments of children and young people, recognising the particular vulnerability of infants and young children to rapid physiological deterioration. 4 All nurses must ascertain and respond to the physical, social and psychological needs of people, groups and communities. They must then plan, deliver and evaluate safe, competent, person-centred care in partnership with them, paying special attention to changing health needs during different life stages, including progressive illness and death, loss and bereavement. 5 All nurses must understand public health principles, priorities and practice in order to recognise and respond to the major causes and social determinants of health, illness and health inequalities. They must use a range of information and data to assess the needs of people, groups, communities and populations, and work to improve health, wellbeing and experiences of healthcare; secure equal access to health screening, health promotion and healthcare; and promote social inclusion. 5.1 Children’s nurses must include health promotion, and illness and injury prevention, in their nursing practice. They must promote early intervention to address the links between early life adversity and adult ill health, and the risks to the current and future physical, mental, emotional and sexual health of children and young people. 6 All nurses must practise safely by being aware of the correct use, limitations and hazards of common interventions, including nursing activities, treatments, the calculation and administration of medicines, and the use of medical devices and equipment. The nurse must be able to evaluate their use, report any concerns promptly through appropriate channels and modify care where necessary to maintain safety. They must contribute to the collection of local and national data and formulation of policy on risks, hazards and adverse outcomes. 6.1 Children’s nurses must have numeracy skills for medicines management, assessment, measuring, monitoring and recording which recognise the particular vulnerability of infants and young children in relation accurate medicines calculation. Nursing and Midwifery Council 16 September 2010 Page 45 of 152 Standards for pre-registration nursing education 7 All nurses must be able to recognise and interpret signs of normal and deteriorating mental and physical health and respond promptly to maintain or improve the health and comfort of the service user, acting to keep them and others safe. 8 All nurses must provide educational support, facilitation skills and therapeutic nursing interventions to optimise health and wellbeing. They must promote self- care and management whenever possible, helping people to make choices about their healthcare needs, involving families and carers where appropriate, to maximise their ability to care for themselves. 8.1 Children’s nurses must use negotiation skills to ensure the best interests of children and young people in all decisions, including the continuation or withdrawal of care. Negotiation must include the child or young person, their family and members of the multidisciplinary and interagency team where appropriate. 9 All nurses must be able to recognise when a person is at risk and in need of extra support and protection and take reasonable steps to safeguard them against abuse. 9.1 Children’s nurses must understand their central role in preventing maltreatment, and safeguarding children and young people. They must work closely with relevant agencies and professionals, and know when and how to identify and refer those at risk or experiencing harm. 10 All nurses must evaluate their care to improve clinical decision-making, quality and outcomes, using a range of methods, amending the plan of care, where necessary, and communicating changes to others. Nursing and Midwifery Council 16 September 2010 Page 46 of 152 Standards for pre-registration nursing education Domain 4: Leadership, management and team working Generic standard for competence All nurses must be professionally accountable and use clinical governance processes to maintain and improve nursing practice and standards of healthcare. They must be able to respond autonomously and confidently to planned and uncertain situations, managing themselves and others effectively. They must create and maximise opportunities to improve services. They must also demonstrate the potential to develop further management and leadership skills during their period of preceptorship and beyond. Field standard for competence Children’s nurses must listen and respond to the wishes of children and young people. They must influence the delivery of health and social care services to optimise the care of children and young people. They must work closely with other agencies and services to ensure seamless and well-supported transition to adult services. Competencies 1 All nurses must act as change agents and provide leadership through quality improvement and service development to enhance people’s wellbeing and experiences of healthcare. 1.1 Children’s nurses must understand health and social care policies relating to the health and wellbeing of children and young people. They must, where possible, empower and enable children, young people, parents and carers to influence the quality of care and develop future policies and strategies. 1.2 Children’s nurses must ensure that, wherever possible, care is delivered in the child or young person’s home, or in another environment that suits their age, needs and preferences. 2 All nurses must systematically evaluate care and ensure that they and others use the findings to help improve people’s experience and care outcomes and to shape future services. 3 All nurses must be able to identify priorities and manage time and resources effectively to ensure the quality of care is maintained or enhanced. 4 All nurses must be self-aware and recognise how their own values, principles and assumptions may affect their practice. They must maintain their own personal and professional development, learning from experience, through supervision, feedback, reflection and evaluation. 5 All nurses must facilitate nursing students and others to develop their competence, using a range of professional and personal development skills. 6 All nurses must work independently as well as in teams. They must be able to take the lead in coordinating, delegating and supervising care safely, managing risk and remaining accountable for the care given. Nursing and Midwifery Council 16 September 2010 Page 47 of 152 Standards for pre-registration nursing education Requirement Guidance G1.2.1.b Programme providers should refer to guidance, including: • Guidance issued by the UK health departments and other organisations on students’ access to service users in all settings • Health and safety guidance and legislation. R1.3 Programme providers must have clear processes in place to deal with any concerns about the safety of service users. R1.3.1 Programme providers must have systems in place to safeguard service users during student learning activities. G1.3.1 Programme providers should have systems in place to allow prompt action to be taken where there are concerns that a student may not be receiving adequate supervision, or where the quality of the student’s experience is in doubt. If necessary, the student should be withdrawn from that learning activity and their competence re-evaluated. R1.3.2 Programme providers must make sure that students understand their responsibilities and know how to raise concerns when they believe the safety of service users is at risk. Nursing and Midwifery Council 16 September 2010 Page 50 of 152 Standards for pre-registration nursing education Requirement Guidance R1.4 Programme providers must have effective policies and procedures on fitness to practise. R1.4.1 Programme providers must have systems in place to identify and address any concerns about the conduct or health of any nursing student. Nursing and Midwifery Council 16 September 2010 Page 51 of 152 Standards for pre-registration nursing education Standard 2: Equality and diversity Purpose To address key aspects of equality and diversity including access and participation, provision of information, promotion of inclusion, and making reasonable adjustments for people with a disability. Responsibility Programme providers. Standard Nursing and midwifery education must address key aspects of equality and diversity and comply with current legislation. Requirement Guidance R2.1 Programme providers must ensure that information about programmes is clear and easily obtainable, and gives sufficient information to allow an applicant to make an informed choice. G2.1a Programme providers should include information about access to programmes for people with disabilities. G2.1b Programme providers should offer guidance on what to do when a student’s culture or religion might create difficulties in meeting programme requirements, for example, dress codes; caring for people of all genders; and the scheduling of learning activities, assessments and examinations. R2.1.1 Programme providers must treat all students fairly, and ensure equality of opportunity regardless of race, gender, disability, age, religion or sexual orientation. Nursing and Midwifery Council 16 September 2010 Page 52 of 152 Standards for pre-registration nursing education Requirement Guidance R3.1.2 AEIs must ensure that selection and admission criteria include evidence of ability to communicate clearly and effectively in writing, including using a computer. G3.1.2a When applicants from outside the European Economic Area (EEA) offer the International English Language Testing System (IELTS) as evidence of literacy, AEIs should apply NMC requirements for overseas applicants to the register. In these cases, the NMC will accept IELTS examination results (academic or general) where the scores are at least 7.0 in the listening and reading sections and at least 7.0 in the writing and speaking sections, and where the overall average score is at least 7.0. G3.1.2b AEIs should ensure that, wherever possible, applicants are given feedback on their level of literacy in relation to their application to support their developmental needs. R3.2 AEIs must ensure that selection and admission criteria include evidence of capacity to develop numeracy skills sufficient to meet the competencies required by the programme. R3.2.1 AEIs must ensure that selection and admission criteria provide evidence of basic numeracy skills, such as the ability to use numbers accurately in respect of volume, weight and length. These skills must include addition, subtraction, division and multiplication; use of decimals, fractions and percentages; and the use of a calculator. G3.2.1 AEIs should ensure, wherever possible, that applicants are given feedback on their level of numeracy in relation to their application to support their developmental needs. R3.3 AEIs must specify appropriate academic and professional entry requirements. Nursing and Midwifery Council 16 September 2010 Page 55 of 152 Standards for pre-registration nursing education Requirement Guidance R3.3.1 AEIs must ensure that selection and admission criteria for all programmes include certificated evidence of completion of general education of 10 years, as defined for nurses responsible for general care in article 40(2)(a)(b) of Directive 2005/36/EC on the recognition of professional qualifications. R3.4 AEIs must ensure that students meet NMC requirements for good health and good character. R3.4.1 AEIs must check evidence of students’ good health and good character when they enter the programme. They must also check evidence of good health and good character at progression points and on completion. Good health and good character must also be checked when transferring from a nursing programme elsewhere, or when rejoining a programme after a lengthy break. AEIs must require students to immediately declare any cautions and convictions they receive, including charges pending, before entering and throughout the programme. R3.4.2 AEIs must ensure that students already registered as nurses or midwives, who are undertaking a further programme leading to a mark on the nurses’ part of the register, comply with NMC requirements for good health and good character. Nursing and Midwifery Council 16 September 2010 Page 56 of 152 Standards for pre-registration nursing education Requirement Guidance R3.4.3 AEIs must ensure that applicants from outside the UK meet the same requirements for good health and good character as UK applicants. Non-EU students must also meet UK government requirements for healthcare workers from overseas. R3.5 Programme providers must ensure that programmes include opportunities for accreditation of prior learning (APL). R3.5.1 Programme providers must have rigorous processes for accrediting both theory and practice learning. G3.5.1a AEIs should apply APL when accrediting previous learning in theory or practice for students who are: • starting a programme • transferring from one AEI to another • moving from one nursing field to another • returning to a programme after a lengthy break. G3.5.1b AEIs should develop their own APL procedures based on best practice (for example Guidelines on the accreditation of prior learning (Quality Assurance Agency 2004) to be endorsed at programme approval. G3.5.1c AEIs should show for each student how previous learning is mapped to programme outcomes and requirements. AEIs should determine the amount of learning accredited in both theory and practice (up to the permitted NMC maximum). Nursing and Midwifery Council 16 September 2010 Page 57 of 152 Standards for pre-registration nursing education Requirement Guidance R3.9.1 AEIs must ensure that they have in place processes to manage interruptions to the study of programmes for whatever reason. G3.9.1 AEIs should note that ‘interruptions’ mean any absence from a programme of education other than statutory and public holidays and annual leave. R3.9.2 AEIs must have arrangements in place for students who leave a programme early. R3.9.3 AEIs must provide students who leave a programme early with a transcript of their achievements in both theory and practice. G3.9.3a AEIs should ensure that the transcript is suitable for mapping previous learning against vocational and other awards. G3.9.3b AEIs should ensure that, when a student has been asked to leave a programme, the reasons are included in the transcript. R3.9.4 AEIs must have APL processes in place to consider whether a student may return to a programme in the same or a different field of nursing. R3.10 AEIs must make explicit any arrangements for student progression. R3.10.1 AEIs must ensure that, in normal circumstances, students can meet all required outcomes, including extra attempts, within the assessed period for that part of the programme. Nursing and Midwifery Council 16 September 2010 Page 60 of 152 Standards for pre-registration nursing education Requirement Guidance R3.10.2 AEIs must ensure that, where exceptional circumstances prevent all outcomes being achieved within the assessed period for that part of the programme, any outstanding outcomes are met and confirmed within 12 weeks of the student entering the next part of the programme. The 12-week period includes holidays and any absences. Reasonable adjustments may be applied for students with a disability. R3.10.3 AEIs must ensure that students who fail to achieve the outstanding outcomes within the 12-week period must, depending on local assessment policy, either return to the previous part of the programme to meet the shortfall or be discontinued. R3.11 AEIs must have processes in place to confirm achievement of all programme requirements. R3.11.1 AEIs must ensure that students have met all theory and practice requirements before confirming that they have successfully completed the programme. R3.11.2 AEIs must ensure that programme leaders confirm to the AEI examination or assessment board that all NMC requirements have been met for each individual student by the end of the programme. This must include evidence of a sign-off in practice from a sign-off mentor or practice teacher. Nursing and Midwifery Council 16 September 2010 Page 61 of 152 Standards for pre-registration nursing education Requirement Guidance R3.12 AEIs must inform students when they complete a programme that they have five years in which to register or record a qualification leading to a mark on the NMC register. R3.13 AEIs must ensure that students comply with NMC requirements for good health and good character at completion. R3.13.1 The AEI must identify a designated person who is a registered nurse responsible for directing the educational programme at the AEI. Their name, or that of their designated registered nurse substitute, must be given to the NMC. The designated person must confirm the student’s good health and good character in support of the student’s own self-declaration required for registration The designated person must know the student and be accountable for the decision to sign the declaration. R3.13.2 AEIs must inform applicants of additional requirements where there is a delay of six months or more between them completing the programme and applying to register. In these circumstances, their application must also be supported by a nurse registered in the same part of the register to which the applicant is applying. The registered nurse must have known the applicant for at least a year, and have been in contact with them during the previous six months. This is in addition to the confirmation of good health and good character supplied by the designated person at the AEI. Nursing and Midwifery Council 16 September 2010 Page 62 of 152 Standards for pre-registration nursing education Requirement Guidance R4.6.1 Programme providers must ensure that students are supernumerary during all practice learning. Supernumerary means that the student will not, as part of their programme of preparation, be contracted by any person or body to provide nursing care. R4.7 Programme providers must provide nurse and midwife teachers with time for professional development to enable them to remain up to date in their field of practice. R4.7.1 Programme providers must ensure that nurse and midwife teachers meet the relevant requirements in Standards to support learning and assessment in practice (NMC 2008) as part of their professional development. Nursing and Midwifery Council 16 September 2010 Page 65 of 152 Standards for pre-registration nursing education Standard 5: Structure, design and delivery of programmes Purpose To ensure that students are prepared to meet the outcomes, competencies and proficiencies of the approved programme required by the NMC. Responsibility Programme providers and partners. Standard The programme must be structured, designed and delivered to meet NMC standards and requirements. Requirement Guidance R5.1 AEIs must ensure that programme development and delivery involves key stakeholders. R5.1.1 AEIs must work in partnership with service providers, commissioners, disability specialists and others to design and deliver programmes. R5.1.2 Programme providers must clearly show how users and carers contribute to programme design and delivery. R5.2 AEIs must specify the required hours, days or weeks of learning. R5.2.1 AEIs must ensure that all pre-registration nursing programmes are no less than three years and 4,600 hours. R5.2.2 AEIs must ensure that full and part-time programmes meet the same requirements. R5.2.3 AEIs must ensure there are at least 2,300 hours of practice learning. Nursing and Midwifery Council 16 September 2010 Page 66 of 152 Standards for pre-registration nursing education Requirement Guidance R5.2.4 AEIs must ensure that no more than 300 hours of the 2,300 hours of practice are used for clinical training in a simulated practice learning environment. This environment must support the development of direct care skills, and be audited by the AEI before it is used. R5.2.5 AEIs must ensure that the minimum length of programmes leading to registration in two fields of nursing is 6,133 hours over at least four years. R5.2.6 AEIs must ensure that in a programme leading to nursing registration together with registration in another profession, the nursing component takes at least 4,600 hours over at least three years, and that all outcomes are achieved in a nursing context. R5.3 Programme providers must clearly set out the structure of the programme. R5.3.1 AEIs must ensure that programmes lead to a mark on the nurses’ part of the register indicating the field of practice as adult, mental health, learning disabilities or children’s nursing. R5.3.2 Programme providers must ensure that there are two progression points, normally separating the programme into three equal parts. R5.3.3 Programme providers must ensure that there is a period of at least four weeks of continuous practice learning towards the end of the first and second parts of the programme. Nursing and Midwifery Council 16 September 2010 Page 67 of 152 Standards for pre-registration nursing education Requirement Guidance G5.3.8b AEIs should ensure that the period undertaken outside of the UK does not form any part of a period of continuous practice learning required to determine whether a student can progress from one part of the programme to another, or required to confirm that the student is safe and effective in practice at the end of the programme. G5.3.8c AEIs should, wherever practicable, fully meet the Standards to support learning and assessment in practice (NMC 2008). Where adjustments are required to take account of the local context, these should be previously agreed by the programme board, fully documented and the detail made available for NMC monitoring. Nursing and Midwifery Council 16 September 2010 Page 70 of 152 Standards for pre-registration nursing education Requirement Guidance G5.3.8d AEIs should have arrangements in place for the safety of service users, students and staff ensuring that: • risk assessments have been completed and all identified risks addressed • audits of the learning environment confirm adequate levels of supervision and mentorship and that planned experience supports the intended programme outcomes • a suitable and experienced named person(s) is available to support the student throughout the period of learning in relation to the outcomes to be achieved • students have the essential language skills needed to participate in learning activities, and where relevant have the level of language required to safely and effectively engage in direct care • students are prepared for the environment in which learning is to be undertaken • students work within the scope of their UK approved programme and fitness to practise requirements, complying with the NMC Standards for pre-registration nursing. • measures are in place to act promptly where there are concerns about a students conduct or progress, or where safety, or learning is Nursing and Midwifery Council 16 September 2010 Page 71 of 152 Standards for pre-registration nursing education Requirement Guidance compromised. • students have in place appropriate and adequate insurance against major risks including: professional liability, personal health and travel and where appropriate for vicarious liability. R5.4 Programme providers must state what teaching and learning methods will be used to support achievement of outcomes. G5.4 Programme providers should ensure that teaching and learning methods address individual learning styles in order to achieve competence and safe and effective practice. R5.5 Programme providers must ensure that learning opportunities are offered at an appropriate academic level using evidence-based sources. R5.5.1 AEIs must ensure that the minimum programme award is a degree (see R7.2.1). R5.6 Programme providers must specify essential content of the programme. Nursing and Midwifery Council 16 September 2010 Page 72 of 152 Standards for pre-registration nursing education Requirement Guidance • infection prevention and control • clinical observation, assessment, critical thinking and decision-making • symptom management, such as anxiety, anger, thirst, pain and breathlessness • risk management • medicines management • information management • supervising, leading, managing and promoting best practice. R5.6.3 Programme providers must ensure that the content for general care in Directive 2005/36/EC Annex V.2. (4.2.1) is included in programmes leading to the adult field of practice (annexe 1). R5.6.4 Programme providers must ensure that content is developed and delivered at a suitable level for each part of the programme. They must also ensure it is sufficient to enable the student to acquire competencies at degree level in their chosen nursing field by the end of the programme. R5.7 Programme providers must ensure that students have the opportunity to learn with, and from, other health and social care professionals. G5.7 Where possible programme providers should give students opportunities to learn with, and from, other health and social care students in practice and academic settings. Nursing and Midwifery Council 16 September 2010 Page 75 of 152 Standards for pre-registration nursing education Standard 6: Practice learning opportunities Purpose To facilitate practice learning opportunities for students. Responsibility Programme providers. Standard Practice learning opportunities must be safe, effective, integral to the programme and appropriate to programme outcomes. Requirement Guidance R6.1 AEIs must provide students and those supporting practice learning with information that includes dates, outcomes to be achieved, and assessment documents for each period of practice learning. R6.2 Programme providers must ensure that mentors and practice teachers meet the relevant requirements within the Standards to support learning and assessment in practice (NMC 2008). R6.3 Programme providers must ensure that local registers of mentors and practice teachers are maintained according to Standards to support learning and assessment in practice (NMC 2008), including sign-off status of mentors, record of updates and date for triennial review. R6.4 Programme providers must use objective criteria and processes for approving new practice learning environments, and audit them at least every two years. Nursing and Midwifery Council 16 September 2010 Page 76 of 152 Standards for pre-registration nursing education Requirement Guidance R6.4.1 Programme providers must ensure that audits of practice learning environments show how the nature, scope and quality of the learning experience supports programme outcomes. R6.5 Programme providers must ensure that students have access to a range of practice learning opportunities sufficient to meet programme outcomes. R6.5.1 Programme providers must ensure that the 2,300 hours of practice learning gives students the opportunity to learn in direct contact with healthy and ill people and communities. Students will be required to use this experience to organise, deliver and evaluate their nursing care on the basis of the knowledge and skills they have acquired. Simulation may be used for up to 300 hours of practice learning (R5.2.4). R6.5.2 Programme providers must ensure that practice learning opportunities take place across a range of community, hospital and other settings. G6.5.2 Programme providers should ensure that practice learning opportunities enable programme outcomes to be achieved in different settings with a range of service users over the duration of the programme. Wherever possible, there should be practice learning opportunities in hospital and community settings in each part of the programme. R6.5.3 Programme providers must ensure that practice learning throughout the programme provides students with experience of 24-hour and 7-day care. G6.5.3 Programme providers should take account of students’ individual needs and personal circumstances when allocating their practice learning including making reasonable adjustments for students.with disabilities. Nursing and Midwifery Council 16 September 2010 Page 77 of 152 Standards for pre-registration nursing education Requirement Guidance G7.1.2b Programme providers should create opportunities for shared generic and field-specific learning where appropriate. R7.1.3 Theory and practice learning outcomes must take account of the essential physical and mental health needs of all people, including babies, children and young people, pregnant and postnatal women, adults and older people. This includes people with acute and long term conditions, people requiring end of life care, people with learning disabilities and people with mental health problems. G7.1.3 Programme providers should find ways to enable students to have contact with all specified client groups. R7.1.4 Providers of adult nursing programmes must have specific learning outcomes for theoretical and clinical instruction that meet the requirements of EU Directive 2005/36/EC Annex V.2 (5.2.1) (annexe 1). R7.1.5 Programme providers must develop learning outcomes that incorporate NMC criteria at the first and second progression points (annexe 2). G7.1.5a Programme providers should ensure that the criteria for the first progression point are normally met in practice, but may use simulation to meet some of the criteria where appropriate (annexe 2). G7.1.5b Programme providers should use essential skills clusters (ESCs) when developing learning outcomes for the first and second progression points and those to be achieved by the end of the programme (annexe 3). R7.1.6 AEIs must ensure that all the competencies are met in full by the end of the programme (section 2). Nursing and Midwifery Council 16 September 2010 Page 80 of 152 Standards for pre-registration nursing education Requirement Guidance R7.2 AEIs must make explicit requirements for the conferment of academic awards where applicable. R7.2.1 AEIs must ensure that the minimum outcome award for a pre-registration nursing programme is nursing registration with a degree. It must deliver the programme hours in Directive 2005/36/EC (annexe 1) and be at least equal to a first cycle (end of cycle) qualification of the European Higher Education Area (EHEA). G7.2.1 AEIs should ensure that the degree is at least a: • Scottish bachelor’s degree of at least 360 SCOTCAT points, 60 of which must be at level 9 in the Framework for qualifications of higher education institutions in Scotland (SQA 2001) • bachelor’s degree of at least 300 academic credits, 60 of which must be at level 6 in the Framework for higher education qualifications in England, Wales and Northern Ireland (QAA 2008a), and takes account of the HE credit framework for England (QAA 2008b). R7.2.2 AEIs must ensure that there is no option to register if a degree level outcome cannot be achieved. Nursing and Midwifery Council 16 September 2010 Page 81 of 152 Standards for pre-registration nursing education Standard 8: Assessment Purpose To ensure that the outcomes, competencies and proficiencies of the approved programme are tested using valid and reliable assessment methods. Responsibility Programme providers, mentors and practice teachers. Standard Programme outcomes must be tested using valid and reliable assessment methods. Requirement Guidance R8.1 Programme providers must ensure that a variety of assessments are used to test the acquisition of approved outcomes, with reasonable adjustments for students with a disability. R8.1.1 Programme providers must include at least one unseen invigilated examination in the assessment process. R8.1.2 Programme providers must ensure that there is equal weighting in the assessment of practice and theory in contributing to the final award. R8.1.3 AEIs must not compensate between theory and practice assessment. R8.1.4 Programme providers must make it clear how service users and carers contribute to the assessment process. Nursing and Midwifery Council 16 September 2010 Page 82 of 152 Standards for pre-registration nursing education Requirement Guidance R8.2.2b Programme providers must ensure that assessment decisions regarding achievement of practice requirements at the first progression point are normally made by a mentor who is a nurse registered in any of the four fields of practice. G8.2.2b Programme providers should apply the following criteria where the registered professional designated to assess achievement of all practice requirements needed for progression to the second part of the programme is not a registered nurse. The professional must • have been suitably prepared for the role • have had preparation to ensure they fully understand all the requirements for progression in the context of nursing – this may include undertaking the relevant parts of an NMC approved mentor programme • be listed on a register which confirms their ability to act in this capacity • be subject to similar requirements as those for mentors who are registered nurses, including annual updating and triennial review. R8.2.2c Programme providers must ensure that assessment decisions regarding achievement of practice requirements at the second progression point are made by a mentor who is a nurse registered in any of the four fields of practice. Nursing and Midwifery Council 16 September 2010 Page 85 of 152 Standards for pre-registration nursing education Requirement Guidance R8.2.2d Programme providers must ensure that assessment decisions regarding achievement of competence in practice for entry to the register must be made by a registered nurse sign-off mentor from the same nursing field as that which the student intends to enter. R8.2.3 Programme providers must ensure that an ongoing record of achievement, including comments from mentors, is passed from one named mentor to the next so that the student’s progress can be judged. These requirements must be met: • Programme providers must obtain the student’s consent to process or share confidential data between successive mentors and education providers when assessing fitness for practice. • Programme providers must ensure that processes are in place to address issues or concerns about a student’s progress, and that these are dealt with fully and quickly. • Programme providers must help students deal with any issues and concerns using a clear, time-limited development plan within or across periods of practice learning. • Programme providers must ensure that where reasonable adjustments are made for students with disabilities, they are assessed appropriately and receive the support they need to meet the requirements of any development plan. G8.2.3a Programme providers should ensure that the ongoing record of achievement: • is part of the assessment of practice document • contains the detail needed to support safe judgments about overall achievement of the outcomes for each part of the programme at progression points, and for entry to the register. Nursing and Midwifery Council 16 September 2010 Page 86 of 152 Standards for pre-registration nursing education Requirement Guidance G8.2.3b Practice learning providers should ensure that mentors do not keep their own separate student progress records; everything should be recorded in the assessment of practice document. R8.2.4 Programme providers must ensure that judgments about the overall assessment of practice outcome at the end of a part of the programme are based on all the learning achieved in that part. The ongoing achievement record and the assessment of practice document must be used to support the judgment. G8.2.4 Programme providers should ensure that, where a sign-off mentor has concerns about a student’s overall competence at the end of the programme, they draw on evidence from the ongoing achievement record and the assessment of practice document for the whole programme to make their final assessment decision. R8.3 AEIs must appoint external examiner(s) who can demonstrate currency in education and practice with due regard and engage with assessment of both theory and practice. Nursing and Midwifery Council 16 September 2010 Page 87 of 152 Standards for pre-registration nursing education Requirement Guidance R9.4.1 AEIs must make sure that all students can access similar learning resources, in different academic and practice learning environments (including IT and library), to help them achieve the programme outcomes. G9.4.1 These resources should be fully accessible to students with disabilities. Nursing and Midwifery Council 16 September 2010 Page 90 of 152 Standards for pre-registration nursing education Standard 10: Quality assurance Purpose To identify the quality management systems of education providers in AEIs and practice learning areas. Responsibility Programme providers at local and strategic level. Standard Programme providers must use effective quality assurance processes in which findings lead to quality enhancement. Requirement Guidance R10.1 Programme providers’ quality assurance processes must be aligned with the programme specification, programme evaluation and enhancement. R10.1.1 AEIs must ensure that: • commissioners fully support the intention to develop, approve and deliver the programme • feedback from students and mentors is used to inform the programme and enhance the practice learning experience • partners at all levels are committed to and will contribute to quality assurance and enhancement • all practice learning experiences are of the same high standard • theory and practice are equally important, and external examiners consider and report on the quality of theory and practice learning. Nursing and Midwifery Council 16 September 2010 Page 91 of 152 Standards for pre-regist Nursing and Midwifery Council ration nursing education 16 September 2010 Page 92 of 152 Requirement Guidance R10.2 AEIs must demonstrate that they use effective quality assurance processes including conjoint programme approval, approval of minor or major modifications, endorsement and annual monitoring. R10.3 Programme providers must allow the NMC and its agents access to monitor programmes. Standards for pre-registration nursing education – Annexe 1 Annex V.2. Nurse responsible for general care 5.2.1. Training programme for nurses responsible for general care The training leading to the award of a formal qualification of nurses responsible for general care shall consist of the following two parts. A. Theoretical instruction a. Nursing: • Nature and ethics of the profession • General principles of health and nursing • Nursing principles in relation to: • general and specialist medicine • general and specialist surgery • child care and paediatrics • maternity care • mental health and psychiatry • care of the old and geriatrics b. Basic sciences: • Anatomy and physiology • Pathology • Bacteriology, virology and parasitology • Biophysics, biochemistry and radiology • Dietetics • Hygiene: • preventive medicine • health education • Pharmacology Extract from Directive 2005/36/EC 16 September 2010 Page 95 of 152 Standards for pre-registration Extract from Directive 2005/36/EC nursing education – Annexe 1 16 September 2010 Page 96 of 152 c. Social sciences: • Sociology • Psychology • Principles of administration • Principles of teaching • Social and health legislation • Legal aspects of nursing B. Clinical instruction • Nursing in relation to: • general and specialist medicine • general and specialist surgery • child care and paediatrics • maternity care • mental health and psychiatry • care of the old and geriatrics • home nursing. One or more of these subjects may be taught in the context of the other disciplines or in conjunction therewith. The theoretical instruction must be weighted and coordinated with the clinical instruction in such a way that the knowledge and skills referred to in this Annex can be acquired in an adequate fashion. Standards for pre-registration nursing education – Annexe 2 Annexe 2: Progression criteria The NMC has set minimum requirements that must be met by the first and second progression points. In addition to these, programme providers will identify their own outcomes that students must achieve by each progression point. These will be based on local need, programme design and organisation of learning in practice. They will make sure that a student is safe and adequately prepared to take part in the full range of practice learning opportunities without risk to the public. NMC quality assurance processes will confirm this through approval and monitoring. First progression point The NMC has identified skills and professional behaviours that a student must demonstrate by the first progression point. These criteria must normally be achieved during the student’s practice learning but some may be met through simulation. These criteria cover: • safety, safeguarding and protection of people of all ages, their carers and their families • professional values, expected attitudes and the behaviours that must be shown towards people, their carers, their families, and others. The criteria reflect public expectations about nurses’ basic skills and their ability to communicate effectively with people in vulnerable situations, ensuring their dignity is maintained at all times. The essential skills clusters in annexe 3 also address some of these concerns and form guidance within these standards. If a student is unable to demonstrate these skills and behaviours by progression point one, through the assessment procedures set by the programme provider and their partners, they will not normally be allowed to progress to the second part of the programme. Most of the assessment will take place when providing direct care but some may be through simulation. Progression criteria 16 September 2010 Page 97 of 152