The draft generic competency framework for pre-registration nursing education programmes

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1 Draft generic competency framework Option 1 11/08/09 The draft generic competency framework for pre-registration nursing education programmes Section 1 The domains and generic competencies Section 1 of this document is made up of four areas of practice referred to as domains. Each domain has an overall standard for generic competence meaning all nursing students irrespective of their field must achieve the standard. There are ten competencies/elements in each domain. This means all together there are four standard statements of competence and forty generic competencies/elements that must be achieved by all students by the end of the programme and before entry to the NMC register. A list of essential content is provided to identify only those areas of underpinning knowledge considered absolutely essential for public protection and to support achievement of all the competencies required within the generic competency framework. The framework is designed as an integrated approach to competence and will allow for the development of integrated, flexible curricula. Learning outcomes may span more than one domain where concepts are repeated. For example, person centeredness and team work are repeated themes as they relate to professional values, communication skills, nursing practice and leadership. Outcomes relating to these aspects may be integrated to reflect different aspects or may be at different levels depending on the stage of the programme and the context in which they are assessed. The four domains are supported with a set of essential skills clusters. These are some of the skills and behaviours that students will need to demonstrate in order to prove achievement of some of the competencies required within the domains. They have been developed in response to concerns about the level of competence of newly registered nurses in these areas. They will be evaluated and developed over time should other skills gaps be identified. They must be included and assessed in the programme. They are explained in section 2 of this document Domain: Professional values. Standard for generic competence. The graduate nurse must demonstrate a high level of professionalism, integrity and caring characterised by a willingness to work collaboratively and effectively with people and their carers and other health and social care professionals and agencies, within an ethical, legal and person centred framework, to provide compassionate, patient focused nursing care and interventions. Competencies/elements 1. Practises confidently within the context of political, professional, ethical, regulatory and legal codes, recognising and responding appropriately to situations in day-to-day practice. 2. Practises in a holistic, non-judgmental, caring and sensitive manner that recognises and respects diversity and the beliefs, rights and wishes of individuals of all ages, groups and communities and where necessary, challenges inequalities or exclusion from access to care.

2 Draft generic competency framework Option 1 11/08/09 3. Facilitates, supports and promotes the health, wellbeing, comfort and dignity of individuals, groups, communities and populations whose lives are affected by disability, mental capacity, ill health, distress, disease, ageing or death. 4. Works in partnership with patients, carers, groups, communities and other organisations, taking account of their strengths and needs, seeking to empower people to make choices and decisions to promote self-care and safety while managing risk and promoting health and wellbeing. 5. Within the scope of his/her professional practice and accountability, fully understands the different roles, responsibilities and functions of a nurse, and can adjust his/her role proactively to meet changing needs of individuals, communities and populations. 6. Understands the roles and responsibilities of other health and social care professionals and seeks to work with them collaboratively for the benefit of all people in need of care. 7. Practises at all times in accordance with principles, policies and within boundaries of confidentiality for people, carers and professional colleagues. 8. Accepts responsibility for keeping his/her own knowledge and skills up-to-date through continuing professional development and life-long learning, using evaluation, supervision and appraisal to reflect and improve upon his/her performance and to enhance the safety and quality of care and service delivery. 9. Reflects on and recognises the limits of his/her own competence and knowledge questioning practice and seeking appropriate advice from or referral to other professionals where required. 10. Practises autonomously within scope of own practice and applies relevant theoretical and research underpinnings to their professional practice recognising how different research methodologies are used to further knowledge in nursing.

3 Draft generic competency framework Option 1 11/08/09 Domain: Communication and interpersonal skills. Standard for generic competence. The graduate nurse must be able to communicate safely and effectively, demonstrating a variety of skills and interventions including the use of technologies. Communication must be characterised by respect for individual differences, care, compassion and the maintenance of dignity at all times. Competencies/elements 1. Uses communication skills safely and effectively to establish partnerships with people, family members and social groups, taking into account individual differences, capability and need, and responding in a non-discriminatory way. 2. Utilises a range of communication skills and technologies and applies them to support person centred care and enhance the quality and safety of healthcare. 3. Uses verbal, non-verbal and written communication skills to listen, recognise and interpret people s knowledge and understanding of their needs sharing information with others respecting individual rights to confidentiality. 4. Is aware and takes account of non-verbal communication and how this can be affected (for example by, disability, ill health, culture, age, ethnicity, gender, religious beliefs and socio-economic status) and responds in a helpful way towards people, their carers and their families. 5. Recognises and responds effectively, using therapeutic principles, to people who are anxious or in distress, in order to promote wellbeing and manage personal safety. Identifies when other specialist interventions may be needed and makes the necessary referral. 6. Uses therapeutic principles to engage, maintain and, where appropriate, disengage from professional caring relationships respecting professional boundaries at all times. 7. Recognises and meets the need for an interpreter to assist people whose first language is not English and for others who need support to communicate. 8. Identifies appropriate methods of communicating and promoting healthy behaviours including promoting positive behaviour change through health education activities with people, their families and local communities. 9. Maintains accurate, legible and complete written/electronic records using appropriate terminology, avoiding jargon, and using plain English in order to achieve shared meaning between all participants in the care process. 10. Maintains security and confidentiality of information in accordance with legislation and ethical and regulatory frameworks, taking account of local protocols, and information governance.

4 Draft generic competency framework Option 1 11/08/09 Domain: Nursing practice and decision making. Standard for generic competence. The graduate nurse must be able to practise a range of technical skills from basic to highly complex, in a safe and confident manner and in a variety of care settings.. Delivery of all technical skills will be based on current evidence and up-to-date technological advances. Decisions will be made through a process of critical analysis and in collaboration with those involved in the care process. All nursing practise and decision making must be person focused and must be characterised by compassion and respect, while maintaining the dignity and wellbeing of all concerned. Competencies/elements 1. Uses a range of skills to work collaboratively with individuals, groups and carers to complete comprehensive, systematic and holistic assessments taking into account current and previous physical, social, cultural, psychological, spiritual and environment factors of relevance to the individual and/or their families. 2. Applies nursing skills when listening, recognising and responding to people s needs and through skilled intervention, plans, delivers and evaluates technically competent, person centred care in partnership with people and their carers, families and other professionals where relevant. 3. Uses a range of, technologies and innovations to confidently assess and respond to people s needs and improve their experiences of healthcare. 4. Is confident and safe in using and evaluating a range of technical nursing skills, activities, interventions and equipment in a variety of care settings, (including complex, technical, diverse environments) to provide effective person centred care for people of all ages and backgrounds,. 5. Recognises, and interprets signs of normal and changing health/ill health, distress, or capability and acts promptly to maintain or improve health status and/or the safety of others. 6. Improves the health care of individuals by utilising a range of information and data sources to facilitate decision making and to support people in making choices about their health care needs. 7. Recognises when any person of any age is at risk and in a vulnerable situation and in need of additional support and protection and acts to safeguard them against abuse of any kind. 8. Makes sound person centred, evidence based judgements and decisions to ensure quality care is delivered in partnership with others involved in the care process.

5 Draft generic competency framework Option 1 11/08/09 9. Selects up-to-date knowledge to inform decisions needed to deliver safe, evidence based care across the life span 10. Uses knowledge of research processes and current nursing and associated knowledge to evaluate care, communicate findings, influence change and promote best practice. Domain: Leadership, Management and Team Working. Standard for generic competence. The graduate nurse must be able to respond with autonomy to planned and uncertain situations confidently, manage themselves and others effectively, create and maximise opportunities to improve services and be prepared to develop further management and leadership skills during their preceptorship and beyond. Competencies/elements 1. Supports and improves the well-being and health care experience of people, communities and populations through quality improvement, leadership and collaborative working practices. 2. Works both as an autonomous practitioner and collaboratively as part of a team taking a leadership role when required. 3. Is self aware and recognises how their own values, principles and assumptions could impact on their practice and is able to learn from experience, feedback and through processes of reflection and evaluation. 4. Prioritises and manages time effectively ensuring quality care is maintained and enhanced and standards are met. 5. Engages in continuing professional development facilitating the professional and personal development of others, demonstrating leadership, reflective practice, supervision, quality improvement and teaching skills. 6. Plans and manages care applying the principles of health and social care funding, using resources effectively and efficiently to meet the needs of people, their families and carers, promoting cost consciousness in the provision of safe and effective care. 7. Uses own initiative and practises, autonomously and assertively either as an individual practitioner, or as part of a team, managing and prioritising competing demands and, where appropriate, acting as an agent of change to enhance and improve quality of care. 8. Works effectively across professional and agency boundaries, respecting and maximising the contributions made by others to achieve integrated person centred care.

6 Draft generic competency framework Option 1 11/08/09 9. Works within local policy to assess and manage risk effectively reporting risk, while maintaining the rights, well being, security and safety of all people involved in the care process. 10. Draws on a range of resources to evaluate and audit care and uses this information to contribute to making continued improvements in people s experience and outcomes of care and the shaping of future services. Essential Content Knowledge underpinning practice This is a list of essential content which attempts to identify only those areas of underpinning knowledge considered absolutely essential for public protection and to support achievement of all the competencies required within the generic competency framework. This is intentionally minimal and will act as a regulatory benchmark to safeguard the public. The programme provider will be left to determine additional content through curriculum development determined by local need to support achievement of the programme outcomes, drawing on the most recent evidence bases. Theory and practice must be integrated within the new Standards, whilst realising that European Directive 2005/36 continues to make an artificial distinction between theoretical and clinical instruction. To provide a knowledge base for nursing practice, contemporary theoretical perspectives should be explored with regard to: Theories of nursing and nursing practice Professional codes, ethics, law and humanities Communication, technology and health care informatics Life sciences (including genetics, and pharmacology) Social, health and behavioural sciences - National and international health policy Principles of leadership and management Organisational structures, systems and processes Principles of research and enquiry In addition there will need to be specific reference to Annexe 5 (4.2.1) of Directive 2005/36 EU Training programme for nurses responsible for general care the requirements of which would also need to be met by students in the adult nursing field.

7 Draft generic competency framework Option 1 11/08/09 Section 2 Essential Skills Clusters and for their use The Essential skills clusters are a mandatory requirement and must be incorporated into all pre-registration nursing programmes. How they are incorporated into programmes is left to local determination. They can be translated into learning outcomes at different levels or mapped against existing programme learning outcomes. Some providers may wish to map them to specific competencies within the domains or use them to develop practice assessment tools. However they are used, programmes must clearly demonstrate the assessment and achievement of all the essential skills and behaviours by the specified progression point. The essential skills clusters are designed to support the achievement of the competencies listed under each of the four domains in the previous section. However, they are not an exhaustive list of all the skills and behaviours required of a registered nurse. Additional leaning outcomes will be needed to demonstrate achievement of all the required competencies under each of the four domains. Programme providers will, therefore, be required to demonstrate how the competencies have been achieved through assessment of the essential skills and behaviours and through other learning outcomes. The essential skills clusters will be evaluated and then amended and updated as necessary. Further clusters may need to be developed as the need arises. The current ESCs have been identified as essential in the context of current social and political drivers. It is recognised that these drivers change over time and it is for this reason this part of the framework will be subject to regular update and review. There are five Essential Skills Clusters: Care, Compassion and Communication Organisational Aspects of Care Infection Prevention and Control Nutrition and Fluid Management Medicines Management There is indicative content included for the Medicines Management cluster and there is also a column for on when reasonable adjustments may be allowed if a student is unable to demonstrate a skill due to disability. This column is for further discussion and development.

8 Draft generic competency framework Option 1 11/08/09 Specific Instructions related to numerical assessment: Summative health related numerical assessments are required to test skills identified (*) within the ESCs that encompass baseline assessment and calculations associated with medicines, nutrition, fluids and other areas requiring the use of numbers: Providers will use the ESCs to inform the nature and content of the assessment, including whether to assess through simulation. They will determine their own pass mark and number of attempts up to progression points 1 and 2. After progression point 2 and by entry to the register, programme providers will use the ESCs to inform the nature and content of numerical assessment where a 100% pass mark is required and all assessment must take place in the practice setting. The number of attempts is to be determined by the education provider. (*) Items requiring numerical assessment (9, 27, 28, 29, 31, 32, 33, 36, 38) Items requiring specific assessment (25 and 42) Under each cluster there are a number of statements which describe what people can trust and expect of a newly registered graduate nurse and under each of these are a number of associated essential skills and behaviours which are specified by the NMC and must be achieved at particular stages of the programme. Undergraduate nursing programmes will normally be divided into three parts: at the end of part one students must demonstrate achievement of all the essential skills specified By progression point one at the end of part two students must demonstrate achievement of all the essential skills specified By progression point two at the end of the programme students must demonstrate achievement of all the essential skills specified By entry to the register Individual programme providers and their partners may wish to incorporate additional progression points at other stages of the programme with other associated learning outcomes but the essential skills specified by the NMC in section 2 of this document must all be achieved by the specified points in the programme.

9 Draft generic competency framework Option 1 11/08/09 Progression points The NMC is required by law to safeguard the public and has set absolute minimum essential skills and behaviours to be achieved by the first progression point. These are associated with patient safety and appropriate professional attitudes and standards expected and required of a student nurse. Students unable to demonstrate these skills and behaviours by progression point one, through assessment procedures determined by the programme providers and their partners, will not be allowed to progress to the second part or stage of the programme. The NMC specified essential skills and behaviours that must be achieved by the second progression point allow educational providers to set learning outcomes in a progressive way and must be achieved before a student can progress into the third and final part or stage of the programme. This is designed to protect and safeguard the public and ensure students are prepared and able to practise safely with greater independence in the final part or stage of the programme. This will enable students to be confident and fit for practice by entry to the register The NMC specified essential skills and behaviours in the final part or stage of the programme must be achieved by entry to the register It is important to note that some NMC specified outcomes to be achieved by the second progression point or by entry to the register may be achieved by some students earlier in the programme. This will be determined by programme design where students may be required to demonstrate certain skills before being allowed into a particular practice environment. Programme providers may also choose other essential skills and behaviours they require the student to achieve by progression points in their individual programmes. Again, this will be based on local need, programme design and organisation of learning in practice and will ensure a student is adequately prepared for clinical experience in order to safeguard people who the student will engage with during their learning process. This will be assured through NMC quality assurance mechanisms at approval and annual monitoring visits.

10 Draft generic competency framework option 1 08/11/09 Care, Compassion and Communication Essential Skills Cluster: Care, Compassion and Communication The newly qualified graduate nurse must demonstrate the following skills and behaviours. They will not be able to progress until they have successfully demonstrated all the skills and behaviours required by the first progression point, the second progression point and for entry to the Register. 1. As partners in the care process, people can trust a newly registered graduate nurse to provide collaborative care based on the highest standards, knowledge and competence. By the first progression point By the second progression point By entry to the register Reasonable Adjustment Guidance i. Articulates the underpinning values of the NMC Code of professional conduct (2008) ii. Works within limitations of the role and recognises own level of competence iii. Promotes a professional image iv. Shows respect for others v. Is able to engage with people and build caring professional relationships vi. Forms appropriate and constructive professional relationships with families and other carers vii. Uses professional support structures to learn from experience and make appropriate adjustments viii. Demonstrates clinical confidence through sound knowledge, skills and understanding relevant to Field. ix. Is self aware and self confident, knows own limitations and is able to take appropriate action x. Acts as a role model in promoting a professional image xi. Acts as a role model in developing trusting relationships, within professional boundaries xii. Recognises and acts to overcome barriers in developing effective relationships with patients/clients xiii. Initiates, maintains and closes professional relationships with patients/clients and carers xiv. Uses professional support structures to develop self awareness, challenge own prejudices and enable professional relationships, so that care is delivered without compromise.

11 Draft generic competency framework option 1 08/11/09 Care, Compassion and Communication 2. People can trust the newly registered graduate nurse to engage in person centred care empowering people to make choices about how their needs are met when they are unable to meet them for themselves. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Actively empowers people to be involved in the assessment and care planning process ii. Determines people s preferences to maximise comfort & dignity iii. Actively supports people in their own care/self care iv. Considers with the person and their carers their capability for self care v. Provides personalised care, or makes provisions, for those who are unable to maintain their own activities of living vi. Is sensitive and empowers people to meet their own needs and make choices and considers with the person and their carer/s their capabilities for self care vii. Ensures access to independent advocacy viii. Recognises situations and acts appropriately when a person s choice may compromise their safety or the safety of others ix. Uses strategies to manage situations where a person s wishes conflict with nursing interventions necessary for the person s safety. x. Acts to ensure that people who are unable to meet their activities of living have choices about how these are met and are empowered to do as much as possible for themselves, maintaining dignity and respect for the person at all times xi. Works autonomously, confidently, and in partnership with people, their families and other carers to ensure that needs are met through empowerment of the individual in planning and delivering care,

12 Draft generic competency framework option 1 08/11/09 Care, Compassion and Communication including strategies for self care and peer support xii. Actively helps people to identify and use their strengths to achieve their goals and aspirations. 3. People can trust the newly registered graduate nurse to respect them as individuals and strive to help them the preserve their dignity at all times. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Takes a person-centred, personalised approach to care. ii. Demonstrates respect for diversity and individual preference, valuing differences, regardless of personal view. iii. Engages with people in a way that ensures dignity is maintained through making appropriate use of the environment, self and skills and adopting an appropriate attitude. iv. Acts professionally to ensure that personal judgements, prejudices, values, attitudes and beliefs do not compromise care. v. Is proactive in promoting and maintaining dignity vi. Acts autonomously to challenge situations/others when someone s dignity may be compromised vii. Uses appropriate strategies to empower and promote people s choice

13 Draft generic competency framework option 1 08/11/09 Care, Compassion and Communication 4. People can trust a newly qualified graduate nurse to engage with them and their family/carers within their cultural environments in an acceptant and anti-discriminatory manner free from harassment and exploitation. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Demonstrates an understanding of how culture, religion, spiritual beliefs, gender and sexuality can impact on illness and disability. ii. Respects people s rights iii. Adopts a principled approach to care underpinned by the NMC Code of professional conduct. iv. Upholds people s legal rights and speaks out when these are at risk of being compromised v. Is acceptant of differing cultural traditions, beliefs, UK legal frameworks and professional ethics when planning care with people and their families and carers vi. Acts autonomously and proactively in promoting care environments that are culturally sensitive and free from discrimination, harassment and exploitation. vii. Manages and diffuses challenging situations effectively

14 Draft generic competency framework option 1 08/11/09 Care, Compassion and Communication 5 People can trust the newly registered, graduate nurse to engage with them in a warm, sensitive and compassionate way. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Is attentive and acts with kindness and sensitivity ii. Takes into account people s physical and emotional responses when engaging with them iii. Interacts with the person in a manner that is interpreted as warm, sensitive, kind and compassionate, making appropriate use of touch iv. Provides person centred care that addresses both physical and emotional needs and preferences v. Evaluates ways in which own interactions affect relationships to ensure that they do not impact inappropriately on others vi. Anticipates how people might feel in a given situation and responds with kindness and empathy to provide physical and emotional comfort vii. Makes appropriate use of touch viii. Listens to, watches for, and responds to verbal and nonverbal cues ix. Engages with people in the planning and provision of care that recognises personalised needs and provides practical and emotional support x. Has insight into own values and how these may impact on interactions with others xi. Recognises circumstances that trigger personal negative responses and takes action to prevent this compromising care. xii. Recognises and acts autonomously to respond to emotional discomfort / distress in self and others xiii. Through reflection and evaluation demonstrates commitment to personal and professional development and life-long learning

15 Draft generic competency framework option 1 08/11/09 Care, Compassion and Communication 6. People can trust the newly registered graduate nurse to engage therapeutically and actively listen to their needs and concerns, responding using skills that are helpful, providing information that is clear, accurate, meaningful and free from jargon. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Communicates effectively both orally and in writing, so that the meaning is always clear ii. Records information accurately and clearly on the basis of observation and communication iii. Always seeks to confirm understanding iv. Responds in a way that confirms what a person is communicating v. Effectively communicates people s stated needs / wishes to other professionals vi. Uses strategies to enhance communication and remove barriers to effective communication minimising risk to people from lack of or poor communication. vii. Consistently shows ability to communicate safely and effectively with people providing for others viii. Communicates effectively and sensitively in different settings, using a range of methods and skills ix. Provides accurate and comprehensive written and verbal reports based on best available evidence x. Acts autonomously to reduce and challenge barriers to effective communication and understanding xi. Is proactive and creative in enhancing communication and understanding xii. Uses the skills of active listening, questioning, paraphrasing and reflection to support a therapeutic intervention xiii. Uses appropriate and relevant communication skills to deal with difficult and challenging circumstances e.g. responding to emergencies, unexpected occurrences, saying no, dealing with complaints, resolving disputes, de-

16 Draft generic competency framework option 1 08/11/09 Care, Compassion and Communication escalating aggression, conveying unwelcome news 7. People can trust the newly registered graduate nurse to protect and keep as confidential all information relating to them By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Applies the principles of confidentiality ii. Protects and treats information as confidential except where sharing information is required for the purposes of safeguarding and / or public protection iii. Applies the principles of data protection iv. Distinguishes between information that is relevant to care planning and information that is not v. Acts professionally and autonomously in situations where there may be limits to confidentiality e.g. public interest, protection from harm vi. Recognises the significance of information and who does / does not need to know vii. Acts appropriately in sharing information to enable and enhance care (carers, MDT and across agency boundaries) viii. Works within the legal frameworks for data protection including access to and storage of records ix. Acts within the law when confidential information has to be shared with others

17 Draft generic competency framework option 1 08/11/09 Care, Compassion and Communication 8. People can trust the newly registered graduate nurse to gain their consent based on sound understanding in order to allow an informed choice prior to any intervention and that their rights in decision making and consent will be respected and upheld. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Seeks consent prior to sharing confidential information outside of the professional care team, subject to agreed safeguarding / protection procedures ii. Applies principles of consent in relation to restrictions relating to specific client groups and seeks consent for care iii. Ensures that the meaning of consent to treatment and care is understood by the patient/client iv. Uses helpful/therapeutic strategies to enable people to understand treatments and other interventions in order to give informed consent v. Works within legal frameworks when seeking consent vi. Assesses and responds to the needs and wishes of carers and / or relatives in relation to information and consent vii. Demonstrates respect for the autonomy and rights of people to withhold consent in relation to treatment within legal frameworks and in relation to patient safety

18 Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care Essential Skills Cluster: Organisational Aspects of Care The newly qualified graduate nurse must be assessed and pass the following skills and behaviours. They will not be able to progress until they have successfully passed all the skills and behaviours required by the first progression point, by the second progression point and for entry to the Register. 9. People can trust the newly registered graduate nurse to treat them as partners and work with them to make a holistic and systematic assessment of their needs; to develop a personalised plan that is based on mutual understanding and respect for their individual situation promoting health and well-being, minimising risk of harm and promoting their safety at all times. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. When faced with sudden deterioration in people s physical or psychological condition or emergency situations (e.g. abnormal vital signs, patient/client collapse, cardiac arrest, self harm, extremely challenging behaviour, attempted suicide), responds appropriately by seeking assistance from a senior colleague ii. Accurately undertakes and records a baseline assessment of weight, height, temperature, pulse, respiration and blood pressure using manual and electronic devices (*) iii. Understands the concept of public health and the benefits of healthy lifestyles and the potential risks involved with various lifestyles or behaviours e.g. substance misuse, smoking, obesity iv. Recognises indicators of unhealthy lifestyles v. Contributes to care based on an understanding of how illness and disability impact on people and carers at different stages vi. Measures and documents vital signs under supervision and responds appropriately to findings outside the normal range (*) vii. Performs routine, diagnostic tests e.g. urinalysis under xii. In partnership with the person, their carers and their families, makes a holistic, person centred and systematic assessment of physical, emotional, psychological, social, cultural and spiritual needs, including risk, and together, develops a comprehensive personalised plan of nursing care xiii. Acts autonomously and takes responsibility for collaborative assessment and planning of care delivery with the person, their cares and their family xiv. Applies research based evidence to practice xv. Works within the context of a multi-professional team and works collaboratively with other agencies when needed, to enhance the care of people, communities and populations xvi. Promotes health and wellbeing, self care and

19 supervision as part of assessment process (near patient/client testing) viii. Collects and interprets routine data, under supervision, related to the assessment and planning of care from a variety of sources ix. Undertakes the assessment of physical, emotional, psychological, social, cultural and spiritual needs, including risk factors by working with the person and records, shares and responds to clear indicators and signs x. With the person and under supervision, plans safe and effective care by recording and sharing information based on the assessment xi. Where relevant, applies knowledge of age and condition-related anatomy, physiology and development when interacting with people Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care independence through teaching and empowering people and carers to cope with their treatment and the consequences of their condition xvii. Uses a range of therapeutic techniques to discuss treatment options with people xviii. Discusses sensitive issues in relation to public health and provides appropriate advice and to individuals, communities and populations e.g. contraception, substance misuse, smoking, obesity xix. Refers to specialists when required xx. Acts autonomously and appropriately when faced with sudden deterioration in people s physical or psychological condition or emergency situations e.g. abnormal vital signs, patient/client collapse, cardiac arrest, self-harm, extremely challenging behaviour, attempted suicide xxi. Measures, documents and interprets vital signs and acts autonomously and appropriately on findings xxii. Works within a public health framework to assess needs and plan care for individuals, communities and populations

20 Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care 10. People can trust the newly registered graduate nurse to deliver nursing interventions and evaluate their effectiveness against the agreed assessment and care plan. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Acts collaboratively with people and their carers enabling and empowering them to take a shared and active role in the delivery and evaluation of nursing interventions ii. Works within the limitations of own knowledge and skills to question and provide safe and holistic care iii. Prepares people for clinical interventions as per local policy iv. Actively seeks to extend knowledge and skills using a variety of methods in order to enhance care delivery v. Detects, records, reports and responds appropriately to signs of deterioration and /or improvement vi. Provides safe and effective care in partnership with people and their carers within the context of people s ages, conditions and developmental stages vii. Prioritises the needs of groups of people and individuals in order to provide care effectively and efficiently viii. Detects, records and reports if necessary, deterioration/improvement and takes appropriate action autonomously ix. Implements strategies for evaluating the effect of interventions, taking account of people s and carers interpretation of physical, emotional, and behavioural changes x. Reviews and makes adjustments to the care plan with the person and in response to evaluation, communicating these changes to colleagues

21 Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care 11. People can trust the newly registered graduate nurse to safeguard children and adults from vulnerable situations and support and protect them from harm. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Acts within legal frameworks and local policies in relation to safeguarding adults and children who are in vulnerable situations ii. Shares information with colleagues and seeks advice from appropriate sources where there is a concern or uncertainty iii. Uses support systems to recognise, manage and deal with own emotions iv. Documents concerns and information about people who are in vulnerable situations v. Recognises and responds when people are in vulnerable situations and at risk, or in need of support and protection vi. Shares information safely with colleagues and across agency boundaries for the protection of individuals/the public vii. Makes effective referrals to safeguard and protect children and adults requiring support and protection viii. Works collaboratively with other agencies to develop, implement and monitor strategies to safeguard and protect individuals and groups who are in vulnerable situations ix. Supports people in asserting their human rights x. Challenges practices which do not safeguard those in need of support and protection

22 Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care 12. People can trust the newly registered graduate nurse to respond to their feedback and a wide range of other sources to learn, develop and improve services. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Responds appropriately to compliments and comments ii. Responds appropriately when people want to complain, providing assistance and support iii. Uses supervision and other forms of reflective learning to make effective use of feedback iv. Takes feedback from colleagues, managers and other departments seriously and shares the messages and learning with other members of the team v. Shares complaints, compliments and comments with the team in order to improve care vi. Actively responds to feedback vii. Supports people who wish to complain viii. As an individual team member and team leader, actively seeks and learns from feedback to enhance care and own and others professional development ix. Works within ethical and legal frameworks and local policies to deal with complaints, compliments and concerns

23 Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care 13. People can trust the newly qualified, graduate nurse to promote continuity when their care is to be transferred to another service or person By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Assists in preparing people and carers for transfer / transition through effective dialogue and the provision of accurate information ii. Reports issues and people s concerns regarding the transfer / transition iii. Assists in the preparation of records and reports to facilitate safe and effective transfer 14. People can trust the newly registered graduate nurse to be autonomous and confident in his/her role within the multidisciplinary/multi agency team and to inspire confidence in others By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Works within the NMC Code of professional conduct and adheres to the on professional conduct for nursing and midwifery students ii. Supports and assists others appropriately iii. Values others roles and responsibilities within the team and interacts appropriately iv. Reflects on own practice and discusses issues with other members of the team to enhance learning v. Communicates with colleagues verbally, face-to-face and by telephone, and in writing and electronically in a way that the vi. Actively consults and explores solutions and ideas with others to enhance care vii. Challenges the practice of self and others across the multiprofessional team viii. Takes effective role within the team adopting the leadership role when appropriate ix. Act as an effective role model in decision making, taking action and supporting others x. Works inter-professionally and

24 Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care meaning is clear, and checks that the communication has been fully understood autonomously as a means of achieving optimum outcomes for people xi. Safeguards the safety of self and others and adheres to lone working policies when working in the community setting and in people s homes 15. People can trust the newly registered graduate nurse to safely delegate to others and to responds appropriately when a task is delegated to them. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Accepts delegated activities knowledge, skill within limitations of own role ii. Works within the requirements of the NMC Code of professional conduct in delegating care and when care is delegated to them iii. Takes responsibility and accountability when delegating care to others iv. Prepares, supports and supervises those to whom care has been delegated v. Recognises and addresses deficits in knowledge and / or skill in self and others and takes appropriate action

25 Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care 16. People can trust the newly registered graduate nurse to safely lead, co-ordinate and manage care. By the first progression point By the second progression point By entry to the register Reasonable Adjustment Guidance i. Inspires confidence and provides clear direction to others ii. Takes decisions and is able to answer for these decisions when required iii. Bases decisions on evidence and uses experience to guide decision-making iv. Acts as a positive role model for others v. Manages time effectively vi. Negotiates with others in relation to balancing competing/conflicting priorities

26 Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care 17. People can trust the newly registered graduate nurse to work safely under pressure and maintain patient safety at all times. By the first progression point By the second progression point By entry to the register Reasonable adjustment i. Recognises when situations are becoming unsafe and reports appropriately ii. Understands and applies the importance of rest for effective practice iii. Contributes as a team member iv. Demonstrates professional commitment by working flexibly to meet service needs to enable quality care to be delivered v. Uses supervision as a means of developing strategies for managing own stress and for working safely and effectively vi. Adheres to safety policies when working in the community and in people s homes e.g. lone worker policy vii. Demonstrates effective time management viii. Prioritises own workload and manages competing / conflicting priorities ix. Appropriately reports concerns regarding staffing / skill-mix and acts to resolve issues that may impact on patient safety within local policy frameworks x. Recognises stress in others and provides appropriate support or ensuring safety to people at all times xi. Enables others to identify and manage their stress xii. Works within local policies when working in the community setting including in people s homes and ensures the safety of others

27 Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care 18. People can trust a newly registered graduate nurse to enhance patient safety and identify and actively manage risk and uncertainty in relation to people, the environment, self and others. By the first progression point By the second progression point By entry to the register Reasonable Adjustment Guidance i. Under supervision, works within clinical governance frameworks ii. Reports patient/client safety incidents to senior colleagues iii. Under supervision assesses risk within current sphere of knowledge and competence iv. Follows instructions and takes appropriate action, sharing information to minimise risk v. Under supervision works within legal frameworks for protecting self and others vi. Knows and accepts own responsibilities and takes appropriate action vii. Contributes to promote safety and positive risk taking viii. Under supervision works safely within the community setting taking account of local policies e.g. lone worker policy ix. Reflects on and learns from patient safety incidents as an autonomous individual and as a team member and contributes to team learning x. Participates in clinical audit to improve patient safety xi. Assesses and implements measures to manage, reduce or remove risk that could be detrimental to people, self and others xii. Assesses, evaluates and interprets risk indicators and balances risks against benefits, taking account of the level of risk people are prepared to take xiii. Works within legal and ethical frameworks to promote safety and positive risk taking xiv. Works within policies to protect self and others in all care settings including in the home care setting xv. Takes steps not to cross professional boundaries and put self or colleagues at risk

28 Draft generic competency framework option 1 08/11/09 Organisational Aspects of Care 19. People can trust the newly registered graduate nurse to work to prevent and resolve conflict and maintain a safe environment. By the first progression point By the second progression point By entry to the register Reasonable Adjustment Guidance i. Recognises signs of aggression and responds appropriately to keep self and others safe ii. Assists others or obtains assistance when help is required iii. Selects and applies appropriate strategies and techniques for conflict resolution, de-escalation and physical intervention in the management of potential violence and aggression 20. People can trust the newly registered graduate nurse to select and manage medical devices safely. By the first progression point By the second progression point By entry to the register Reasonable Adjustment Guidance i. Safely uses and disposes of medical devices under supervision and in keeping with local and national policy ii. Works within legal frameworks and applies evidence based practice in the safe selection and use of medical devices iii. Safely uses and maintains a range of medical devices appropriate to the area of work, including ensuring regular servicing, maintenance and calibration iv. Keeps appropriate records in relation to the use and maintenance of medical devices and the decontamination processes required as per local and national guidelines v. Explains the devices to people and / or carers and checks understanding

29 Draft generic competency framework option 1 08/11/09 Infection prevention and control Essential Skills Cluster: Infection prevention and control The newly qualified graduate nurse must be assessed and pass the following skills and behaviours. They will not be able to progress until they have successfully passed all the skills and behaviours required by progression point one, by progression point two and for entry to the Register. 21. People can trust the newly registered graduate nurse to identify and take effective measures to prevent and control infection in accordance with local and national policy. By the first progression point By the second progression point By entry to the register Reasonable Adjustment Guidance i. Participates in assessing and planning care appropriate to the risk of infection thus promoting the safety of patients ii. Participates in completing care documentation and evaluation of interventions to prevent and control infection iii. Aware of the role of the Infection Control Team and Infection Control Nurse Specialist, and local guidelines for referral iv. Recognises potential signs of infection and reports to relevant senior member of staff v. Discusses the benefits of health promotion within the concept of public health in the prevention and control of infection for improving and maintaining the health of the population vi. Works within NMC Code of professional conduct and in keeping with the on professional conduct for nursing and midwifery students and in collaboration with people and their carers to meet responsibilities for prevention and control of infection vii. In partnership with people and their carers, plans, delivers and documents care that demonstrates effective risk assessment, infection prevention and control viii. Identifies, recognises and refers to the appropriate clinical expert ix. Explains risks to people, relatives, carers and colleagues and educates them in prevention of infection and infection control x. Recognises infection risk and reports and acts in situations where there is need for health promotion / protection and public health strategies

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