CNO Summit 2017, Day 2, 12.30pm Professor Dame Jill Macleod Clark, Lead Advisor to the NMC for registered nurse education standards.

1. Creating the Future
Nurse: Implications for
Education and
Regulation
Professor Dame Jill Macleod Clark
Lead Advisor to the NMC for registered nurse education
standards
Dr Geraldine Walters CBE
Director, Education Standards and Policy NMC

2. Objectives of Session
• To provide an overview of the NMC strategic education programme
• To give brief outline of the draft education standards
• To indicate the next steps and proposed timeline for 2017-18
priorities
• To discuss the direction of travel, opportunities and challenges

3. Health and care
landscape changing
rapidly
More integrated care
delivery and
multidisciplinary team
working
Preventing ill health
and promoting self
care
Nurses taking on
additional
responsibilities
Nurses working
across a range of
settings
Leading Change, Adding Value
Nurses and
midwives need
to be fit for the
future
More complex care needs
Increase in people with both
physical and mental ill
health challenges
24/7 care More acute care delivered
in non-hospital settings
Maximising the potential of technology

4. What do we want?
• What is the view of the current position? (IFF
research)
• Existing framework and standards – process driven, content
uncontroversial, but lengthy, confusing and not future orientated
• Vulnerability around learning in practice
• Insufficient clarity around technical skills at the point of registration
• Changing stakeholder priorities
• Critical thinkers, leaders, able to work safely in a variety of settings
(hospital, community, acute physical illness and mental health)
• Confident and competent in terms of “technical ability”, now
• Implications for:
• Standards for learning and assessment in practice, interpretation of
hours in practice, use of simulation, interplay of this work with
degree apprenticeships, and nursing associates.

5. Education Programme
Future Midwife
Proficiencies
Standards for Medicines
management
Prescribing
Standards for learning
and assessment in
practice
Return to practice.
Education
Framework
Future Nurse
Proficiencies
Quality
assurance of
education
Communications and engagement

6. Darkened room……..

7. Future nurse –
education standards
and proficiencies

8. Recalibrating Education Standards
For Registered Nurses –
Development Principles (1)
The new standards documents will be transparent and succinct, providing
clarity to the public and the professions about the scope of practice of
registered nurses
The new standards will separate out the outcomes required of a registered
nurse on graduation from those required of education provider
partnerships
The content will be driven by what people/society need registered nurses
to provide in the future
The content will reflect changing patterns of health and illness and care
delivery
The approach to design will be collaborative and iterative with
engagement of consumers, the profession and all other stakeholders

9. Recalibrating Education Standards
For Registered Nurses -
Development Principles (2)
The new standards will be outcome based and amenable to objective
measurement
The new standards will articulate the key areas of responsibility and
accountability of registered nurses in providing, managing and leading
nursing care
The new standards will reflect ‘graduateness’ and the need for higher
order knowledge and skills including critical thinking, research and
technology literacy, advanced practice potential, preparation for clinical
leadership etc.
The new standards will map across all current fields of practice
The key practice skills and procedural proficiencies that the public can
expect all registered nurses to demonstrate will be explicitly stated

10. Structure of Draft Standards for
Newly Graduating Registered
Nurses
• Preamble/Introduction
• Seven main ‘outcome statement’ headings
• Being an Accountable Professional
• Promoting Health
• Assessing Needs and Planning Care
• Providing and Evaluating Care
• Leading Nursing Care and Working in
Teams
• Improving Safety and Quality of Care
• Co-ordinating Care
• Practice Skills and Procedures Annexes

11. 2. Promoting Health
Registered Nurses play a key role in improving and maintaining peoples
mental, physical and behavioural health and wellbeing. They support and
enable people at all stages of life and across all care settings to make
informed choices about how to prevent ill health, manage health
challenges, improve health and in order to maximise quality of life.
At the point of graduation, the registered nurse will:
2.3 Understand and explain the principles, practice and evidence base for
health screening when engaging with individuals, families and populations
in order to promote and improve health.
2.10 Demonstrate the use of up to date approaches to behaviour change
to enable people, families and populations to utilise their strengths and
expertise and make informed choices when making lifestyle changes and
managing their own health.

12. 4. Providing and Evaluating Care
Registered Nurses take the lead in providing evidence based and
compassionate nursing interventions, care and support to people of all
ages, across all settings. They ensure that delegated provision of nursing
care is of a consistently high standard and safe. They work in partnership
with people, families and carers to evaluate whether the goals of care
have been met in line with their wishes, desired outcomes and
preferences.
At the point of graduation, the registered nurse will:
4.4 Demonstrate the knowledge and skills required to meet peoples needs
related to nutrition, hydration and elimination, displaying clinical expertise
and acting as role model in providing evidence based nursing care
(Annex)
4.11 Demonstrate knowledge of pharmacology to inform safe prescribing
from an agreed formulary, recognising allergies, drug sensitivities, side
effects, contraindications and incompatibilities

13. 5. Leading Nursing Care and
Working in Teams
Registered Nurses provide nursing leadership by acting as a role model
for best practice in the delivery of nursing care. They are accountable for
the appropriate delegation and supervision of care provided by others in
the team including (nursing associates) and lay carers. They play an
active and equal role in multidisciplinary teams, collaborating and
communicating effectively with colleagues and others.
At the point of graduation, the registered nurse will:
5.2 Understand the principles and processes of performance management
and how these apply to leadership roles in nursing
5.8 Supervise students, appraising the quality of the care they deliver,
documenting performance, promoting reflection and providing effective
feedback.

14. 6. Improving Safety and Quality of
Care
Registered Nurses make a key contribution to the continuous monitoring
and improvement of the quality of care and treatments in order to enhance
peoples experiences of care. They assess risks to patient safety and
take appropriate action, putting the best interests, needs and preferences
of people first.
At the point of graduation, the registered nurse will:
6.4 Accurately undertake risk assessments in a range of settings,
proactively using a range of contemporary assessment and improvement
tools
6.9 Be able to articulate the need to accept and manage uncertainty and
demonstrate awareness of strategies which develop resilience in
themselves and others

15. 7. Coordinating Care
Registered Nurses play a leadership role in coordinating the complex
nursing and integrated care needs of people at any stage of their lives,
across a range of organisations and settings.
At the point of graduation, the registered nurse will:
7.8 Articulate the principles of safe transition and understand the
processes involved to ensure the safe discharge and movement of people
across services, caseloads and settings
7.10 Demonstrate an understanding of the importance of exercising
political awareness throughout their career, in order to maximise the
impact of registered nursing care and safeguard patient safety, quality of
care and cost effectiveness

16. Recalibrating Education Standards
for Registered Nurses – Current
Status and Timeframe
• User testing of draft materials in progress
• Skills and procedures annexes being populated
• Final content revisions pre-consultation - March and April 2017
• Consultation questions being developed
• NMC Council asked to agree formal consultation – May 2017
• Consultation - June – early September 2017
• Projected publication of new standards – January 2018
• Early adoption by AEI’s and partners - September 2018
• Full adoption by December 2019

17. Education
framework

18. So far……
Much support for the direction of travel
Inclusion of “technical annexes” specifying practical skills that must be gained
in each field at the point of registration✔✔
• Higher ambition✔✔
• Continued emphasis on care and compassion alongside enhanced
expectations around advanced skills and leadership✔✔

19. ……..Anxiety about how

20. How can the NMC help implement
the new framework?
What we can’t easily do
• Make decisions about the length of registered nursing programmes
• Mandate preceptorship requirements
• Mandate how other bodies use funds
What we can do
• Use standards to leverage change in the interest of public protection
• Make sure our own requirements are fit for purpose, and reduce
burden

21. Education Framework high level
pillars
21
Learning environment and culturePillar 1
Educational governance and qualityPillar 2
Student learning and empowerment
Pillar 3
EducatorsPillar 4
Curricula and assessmentPillar 5

22. Education framework
Far less prescriptive:
• Higher level
• Outcomes focus with fewer process standards
• More freedom for education providers in relation to how programmes are
delivered
Consultation in June 2017 – what’s new?
• New model for student supervision and assessment
• Standardised Practice Assessment document
• Proposed changes to the interpretation of theory and practice hours
• Enhanced role for simulation and virtual learning approaches
• A change in Return to Practice requirements
• Redefinition of supernumery status
• …… Exploring end point assessment and lighter touch education quality
assurance

23. Example: Learning and Assessment
in Practice
• IFF research identified learning and assessment in practice as the most
vulnerable element of student education
• Frequently an issue in QA
• Insufficient mentors
• Quality of mentors is variable
• Less than the prescribed amount of time is spent with the mentor (difficult to
accurately assess)
• Mentor registers – labour intensive to manage
• New models of supervision and assessment in practice are emerging which
appear more successful

24. Proposal
• Remove the requirements for mentors, mentorship training, and 40% of time to be
spent with a mentor
• Include supervision competencies in pre- registration standards
• Mandate that all students should be supervised in practice
• All students should have a “go to” professional in case of problems
• Assessment of competence should be carried out by a separate professional who
has expertise in assessment and who should take into account the views of those
who have worked with the student in making their assessment
Principles:
• All students should be supervised
• All registrants should be responsible for supervision of students
• The assessor role is separate and carried out by a person with assessment skills
• No NMC process standards on who, what or how supervisors and assessors are
trained. (But organisations will have to assure systems are effective in meeting
outcomes)
• Freedom for organisations to develop their own models to suit local circumstances

25. Reactions mixed….

26. Summary
• New NMC standards are ambitious and support nurses to deliver the
aspirations of LCAV and FYFV
• The approach to the education framework will assist in the delivery of the
standards
• Both will be for consultation in June 2017, early adoption in Autumn
2018, nationwide implementation in September 2019
• What to we need to do now, to ensure successful implementation?

27. Thank you and
any questions?
Geraldine.Walters@nmc-uk.org