Important changes to pre-registration nurse education

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1 Important changes to pre-registration nurse education Simon Cassidy is a Practice Education Facilitator working with Abertawe Bro Morgannwg University Health Board. Simon is also a member of the All Wales Nursing and Midwifery pre-registration group. In this article he explains the important changes to preregistration nurse education and why this is especially important for the support offered by nurses to people with learning disabilities. Introduction From September 2012 there will be a number of changes to the way student nurses are prepared for registered nurse status in the United Kingdom. The Nursing and Midwifery Council (NMC 2010) have published new Standards for competence all pre-registration student nurses must achieve by the end of their preparation programme. All pre-registration student nurse programmes in Wales will reflect these NMC required competencies beginning with the first student cohort intakes in September Prospective student nurses across the UK can choose to embark either on Adult, Mental Health, Learning Disability or Child nurse preparation. Midwifery training is also available. There is currently an opportunity to become a registered nurse for people with learning disabilities (RNLD) in two Approved Educational Institutions in Wales (University of Glamorgan and Bangor University). The NMC has also published Standards for education (2010) which identifies particular requirements Universities across the UK will be measured against during annual monitoring and programme validation events. All Universities in Wales offering preregistration nursing programmes have recently been successfully validated during 2012 in readiness for the first cohorts of students later this year. Nursing degree programmes assess students academic work (exams, assignments, projects, simulated scenarios) as well as their competence in practice environments (direct work with clients and service users) where they are supervised by mentors. 14 AUTUMN 2012

2 Fifty per cent of the programme is assessed through students academic achievement and fifty per cent by students achievement of practice outcomes during practice learning experiences. This article provides a background as to why changes to preregistration nurse education have arisen, the essential skills required of student nurses by the end of their pre-registration programme and why this is especially important for the support offered by nurses to people with learning disabilities. The discussion will also highlight how collaboration between University personnel, health professionals, service users and carers as well as social and voluntary agencies has contributed to the development of a consistent approach across the whole of Wales. This collaboration has resulted in a consistent process of student nurse selection and interviewing for nursing courses, coherent strategies for assessing students knowledge, skills and attitudes during the pre-registration nursing programme, an educational audit document enabling practice learning environments to be monitored and mechanisms for student nurses to evaluate their experiences of the nurse education programme as a whole. These elements of the preregistration nursing programme are known as the All Wales Nursing and Midwifery Initiative. Why change the way nurses are prepared? There have been a series of changes to the way student nurses are prepared for becoming registered practitioners over the last three decades. In the 1980 s student nurses were included as part of the workforce, paid a wage and included in staffing numbers. A large proportion of student nurse education took place within clinical practice environments usually for three months at a time with periodic weeks in schools of nursing. Registered nurse qualification was at certificate level. For learning disability students, practice learning experiences were largely hospital based, reflecting the predominance of residential care at that time. During the 1990 s there was a significant shift in nurse preparation from vocational style training to University based education. In this Project 2000 era, nurse preparation programmes were offered at diploma and degree level (Wales has had all degree level graduate nursing programmes since 2002). Students became supernumerary when on clinical placements and were offered a bursary as opposed to a wage. Student nurses also experienced a range of community and residential placements during their preregistration preparation programme, mirroring the expansion at this time of changes to health care provision moves which have proved particularly important for health services offered to people with learning disabilities. AUTUMN

3 In 2002, as a result of recommendations by the Peach report (UKCC 1999) about student nurse competence at the point of registration, the Fitness for Practice pre-registration nursing programme was introduced across the UK. Student nurses needed to achieve proficiency in all academic course requirements as well as all practice learning outcomes. The preparation and support provided to clinical mentors was seen as a crucial aspect of Fitness for Practice, particularly that those individuals undertaking assessment of a student s practice competence understood their accountability for decision making. Throughout Project 2000 and Fitness for Practice programmes overall course assessment involves 50% academic work and 50% assessment by mentors in practice learning environments. Students currently engaged in pre-registration nursing programmes are following this structure of learning. The new 2012 pre-registration programmes provide further emphasis to the way students experience teaching and learning within both academic and practice learning environments. Universities across the UK have developed nurse preparation programmes which include increasing opportunities to experience learning alongside students enrolled in other nursing fields as well as with students engaged in related courses allied to health and social care. This inter-professional approach to learning is mirrored in practice environments where students will 16 AUTUMN 2012 be given opportunities to experience a range of services linked to their prime learning area. As a result, students will be encouraged to recognise how services are designed to meet the needs of all individuals that come into their care including those who are most vulnerable. The continuing evolution of student nurse preparation programmes has reflected crucial changes in service redesign especially in learning disability health services. The way students are prepared for registration will have a major impact on how these services continue to progress when those individuals register as qualified nurses. A vital aspect of student nurse preparation (and for all health practitioners) is an ability to critically reflect on the way service users experience health care services. Nurse preparation programmes in Wales continue to involve significant collaboration with service users and carers. For example, the University of Glamorgan s service user Teaching and Research Advisory Committee (TRAC) which is made up from members of a number of People First organisations has been involved in curriculum developments for the last 10 years. They meet once a month and contribute to teaching and interviewing of student nurses. Participation in research is a developing area which the group has helped with in developing good practice protocols and publishing their work. Bangor University also have close links with Conway Connect service user group particularly in developing the input of people with learning disabilities in participatory research, teaching and curriculum development. The Question-Aires group including core membership of people with learning disabilities, a representative from Learning Disabilities, Autism and Neurodevelopmental disorders network (LDAN), student volunteers, and facilitated by a member of Bangor University Healthcare Team meets every six weeks to discuss a research agenda. The group s current programme is exploring health eating. Partnership working with Betsi Cadwaladr University Health Board includes an individual with learning disability employed as a member of a Health Liaison Team providing teaching across health related courses at Bangor University. A group of students pictured with service users at a Glamorgan University teaching workshop

4 What skills are required of student nurses? The new Standards for competence published by the United Kingdom Nursing and Midwifery Council (2010) outline expected competencies for all students at the point of registration as a qualified nurse. Students will have opportunities to experience care across a range of residential and community settings and with a variety of professional, voluntary and client groups. An important principle of new pre-registration nursing programmes is that all students are able to offer support to all individuals who come into their care. So irrespective of which field of nursing a student embarks on, they will be equipped at the point of registration with skills enabling them to provide safe and effective immediate care to all people prior to accessing or referring to specialist services (NMC 2010). This essential aspect of new preregistration student nurse programmes takes inspiration from the Michael s report (2008) findings that health care staff have misconceptions about the cognitive, health and communication needs of people with learning disabilities. Endorsing more proactive and enlightened philosophies of care are equally vital for both pre and post registration professional development as recent reports have highlighted (Mencap 2012a; 2012b). In addition to the generic competencies all student nurses must achieve throughout the preregistration nursing programme, the NMC has also specified a number of field competencies which students need to achieve depending on their chosen registration. The field competencies recognize the particular skills involved in learning disability, mental health, child or adult nursing. A learning disability student nurse for example will need to achieve the generic competencies as well as the learning disability field specific competencies enabling them to develop the additional specialist skills to become a learning disability nurse. The competencies are arranged within four domains: Professional values Communication and interpersonal skills Nursing practice and decision making Leadership, management and team working. The numbers of field competencies a learning disability student nurse would be expected to attain increase as the programme continues. The level of competence a student nurse is required to demonstrate also increases throughout the programme. At the point or registration for instance, students must be able to justify their decision making and critically evaluate the care they are offering in partnership with service users and others. Collaboration and the All Wales Initiative The new pre-registration nursing programmes validated in Wales have developed as a result of collaboration between Universities, Health Boards, voluntary groups, service users and carers. An All Wales Nursing and Midwifery preregistration group has met regularly between September 2010 and November 2011 to oversee generic and field specific competence development. Three all day workshops and additional field groups held at Llandrindod Wells in 2011, including involvement of service user groups across Wales, were invaluable in contributing to the final published versions of practice competencies referred to as the Ongoing Record of Achievement of Practice Competence. As a result, there is consistent assessment of practice documentation wherever a student nurse chooses to undertake their pre-registration programme in Wales. This consistency extends to other documentation further developed by the All Wales Nursing and Midwifery group relating to the AUTUMN

5 principles of how students are selected and admitted onto preregistration programmes, how students evaluate these programmes and the way in which practice learning environments are audited. The new pre-registration nursing programme is characterized by particular emphasis on graduate skills such as students leadership qualities, the transferability of skills across a range of health care settings and students recognition of safeguarding vulnerable individuals. A number of essential skill clusters have been mapped into the learning outcomes which concentrate on students communication and interpersonal skills and organizational abilities as well as competence in nutrition and fluid maintenance, infection prevention and control and medicines management. A suitably prepared mentor is assigned to a student during their practice learning experiences and is accountable for assessing the student s competence. Mentors are required to undertake an NMC validated mentor preparation programme prior to acting as a mentor as well as keeping up to date annually about developments in mentorship and nurse education (NMC 2008). A sign-off mentor is responsible for assessing students at the point of registration as a nurse. These individuals must meet additional NMC sign-off criteria relating to their clinical currency and capability in the field in which the student is being assessed and an in-depth understanding of their accountability for decisions to pass or fail a student at the end of the pre-registration nursing programme. Why are changes to preregistration nursing programmes important for people with learning disabilities? Being able to respond to the needs of people with learning disabilities as a registered nurse involves a human capacity for sophisticated communication and inter-personal relationships as well as technical skills. People with learning disabilities may seek support for a range of health needs such as epilepsy, mental health, palliative and end of life care, dementia and challenging behaviour. Nurses need to adept in offering support based on best evidence which enables people with learning disabilities, their families and carers to be at the centre of values-driven, integrated and co-ordinated care (Longley et al. 2007; Mencap 2007; 2012a; 2012b; Mansell 2010). These issues have significant implications for pre-registration nursing programmes and particularly how all students make sense of their experiences when supporting people with learning disabilities. It is essential that students develop competence which reflects contemporary thinking in learning disability services based on inclusive and holistic philosophy and which emphasises client dignity and respect, human rights, empowerment and selfdetermination (DOH 2001). Whilst this approach to care is critical for pre- learning disability nurses, all nurses have these responsibilities irrespective of their chosen field. The NMC generic and field specific competencies in the new pre-registration programmes reflect this key understanding for all nursing students preparing to become a registered nurse. Conclusion This article offers an insight into current changes in nurse education with the introduction of UK Nursing and Midwifery generic and field specific competencies as well as NMC Standards for monitoring and approving preregistration education programmes. Collaboration between education, health, service user and carer groups across Wales has resulted in a consistent approach to the preparation of nursing students. The changes reflect the importance that nurses at the point of registration are able to provide immediate care to all people who come into their care. For learning disability nursing, it is critical that new registrants are able to demonstrate leadership qualities in health care settings founded on contemporary thinking of person- centred dignity and respect. It is vital also that people with learning disability continue to have a strong presence within pre-registration nursing programmes. Simon Cassidy Practice Education Facilitator (Pre-Registration nursing) Abertawe Bro Morgannwg University Health Board Practice Education Team Room 7b, Administration Corridor, Singleton Hospital Swansea SA2 8QA. Tel: Ext 8701 References are available on request 18 AUTUMN 2012

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