1 NMC Standards of Competence required by all Nurses to work in the UK
2 NMC Standards of Competence Required by all Nurses to work in the UK The Nursing and Midwifery Council (NMC) is the nursing and midwifery regulator for England, Wales, Scotland and Northern Ireland. We exist to protect the public. We achieve this by: maintaining a register of nurses and midwives; setting standards for education, training and conduct; ensuring that registered nurses and midwives keep their skills and knowledge up to date; and having clear and transparent processes to investigate nurses and midwives who fall short of our standards or breach their professional code. Introduction We publish the NMC Standards for pre-registration nurse education (NMC, 2010) which includes standards for competence that clearly state what nurses must achieve before being registered with us. This is achieved by undertaking an NMC-approved three-year degree programme which includes learning taking place equally in the university and practice-placement settings. In the UK, nurses study a specific field of practice as part of their nursing degree and each field has a specific type of registration with us. There are four fields of nursing: adult nursing children s nursing learning disabilities nursing mental health nursing. Although these are different fields of nursing, registered nurses will be expected to meet the essential mental and physical health needs of people of all ages and conditions including those needing end-of-life care. Some nurses qualify in multiple fields and so will be registered with us in more than one field. Nurses must maintain these standards for competence throughout their careers to remain on our register. Nurses must also practice in line with the most recent version of The Code: Standards of conduct, performance and ethics for nurses and midwives (NMC, 2008). We are currently reviewing the Code and a revised version will be launched in December Failing to consistently meet our standards can result in us investigating a nurse s or midwife s fitness to practice and whether they are suitable to remain on our register. We are now making the standards for competence its own document. We are doing this to make these Standards for competence for registered nurses standards more accessible to the public and nurses to make it clear that these are the standards that nurses must meet when they qualify. This will also reinforce that all nurses must maintain these standards by keeping their knowledge and skills up to date as long as they are on our register.
3 This is to respond to calls made by the More Care, Less Pathway report into the workings of the Liverpool Care Pathway (Department of Health, 2013). This report called for information about the standards that patients and the public should expect from nurses in areas such as end-of- life care, hydration and nutrition to be published as its own document. Publishing this document also meets our commitments in response to the Francis report (Department of Health, 2012) and other recent reports on a range of healthcare issues that focused on patient safety and improving communication with patients and the public. It also comes as a result of ongoing contact with our key stakeholders representing patients and the public across the four countries to improve access to information on the standards for competence expected of nurses. It is important to note that the standards for competence have not changed and remain exactly the same as those outlined in Standards for pre-registration nursing education (NMC, 2010).
4 About the Standards for competence : The standards for competence apply to all fields of nursing and are set out in four main areas of professional nursing practice. These are: professional values; communication and interpersonal skills; nursing practice and decision making; and leadership, management and team working. Within these four areas there are two main aspects to the standards. All nurses must demonstrate their knowledge and competence in both in order to register as a nurse. These aspects are: the competencies that all nurses across all fields must know and demonstrate; and the specific competencies of each field that an individual nurse is registered in. The combination of both aspects across all four areas is in place to ensure that patients and the public can be confident that all registered nurses will: deliver high quality essential care to all persons in their care; deliver complex care to service users in their field of practice; act to protect 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; practice in a compassionate, respectful way, maintaining dignity and wellbeing and communicating effectively; act on their understanding of how people s lifestyles, environments and where care is delivered 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; and use leadership skills to supervise and manage others and contribute to planning, designing, delivering and improving future services.
5 The diagram below shows how this all fits together. The rest of this document will explain: the standards for competence which all registered nurses must meet in their professional nursing practice. Standards for competence that apply to all fields of nursing : All nurses in all four fields of nursing must demonstrate competencies across the four areas; professional values, communication and interpersonal skills, nursing practice and decision making and leadership, management and team working. All areas (known formally as domains) are explained fully for clarity. Standards for competence that apply to all fields of nursing
6 Professional values All nurses must act first and foremost to care for and safeguard the public. They must practice 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. Professional values competencies that all nurses will demonstrate All nurses must: practice with confidence according to The code: Standards of conduct, performance and ethics for nurses and midwives (NMC 2008), 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. practice 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. 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. 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. 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. 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. 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. practice 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. 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. Standards for competence that apply to all fields of nursing
7 Leadership, management and team working Leadership, management and team working competencies that all nurses will demonstrate 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. 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. 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. be able to identify priorities and manage time and resources effectively to ensure the quality of care is maintained or enhanced. 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. facilitate nursing students and others to develop their competence, using a range of professional and personal development skills. 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. 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 practice and decision making All nurses must practice 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.
8 Decision-making must be shared with service users, carers, 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. Nursing practice and decision making competencies that all nurses will demonstrate 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. 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 indepth knowledge of common physical and mental health problems and treatments in their own field of practice, including co-morbidity and physiological and psychological vulnerability. 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. 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. 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. practice 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.
9 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. provide educational support, facilitation skills and therapeutic nursing interventions to optimise health and wellbeing. They must promote selfcare 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. 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. 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. Communication and interpersonal skills 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, Communication and interpersonal skills competencies that all nurses will demonstrate 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. use a range of communication skills and technologies to support personcentred 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. 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. 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.
10 use therapeutic principles to engage, maintain and, where appropriate, disengage from professional caring relationships, and must always respect professional boundaries. take every opportunity to encourage health-promoting behavior through education, role modelling and effective communication. maintain accurate, clear and complete records, including the use of electronic formats, using appropriate and plain language. 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. Standards for competence that apply to specific fields of nursing: Adult Professional values competencies that adult nurses will demonstrate Adult nurses must also be able at all times to promote the rights, choices and wishes of all adults and, where appropriate, children and young people, paying particular attention to equality, diversity and the needs of an ageing population. They must be able to work in partnership to address people s needs in all healthcare settings. Adult nurses must also: 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. Communication and interpersonal skills competencies that adult nurses will demonstrate 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. Adult nurses must also: 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. Nursing practice and decision-making competencies that adult nurses will demonstrate 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.
11 Adult nurses must also: 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. safely use a range of diagnostic skills, employing appropriate technology, to assess the needs of service users. safely use invasive and non-invasive procedures, medical devices, and current technological and pharmacological interventions, where relevant, in medical and surgical nursing practice, providing information and taking account of individual needs and preferences. recognise and respond to the changing needs of adults, families and carers during terminal illness. They must be aware of how treatment goals and service users choices may change at different stages of progressive illness, loss and bereavement. Standards for competence for registered nurses recognise the early signs of illness in people of all ages. They must make accurate assessments and start appropriate and timely management of those who are acutely ill, at risk of clinical deterioration, or require emergency care. understand the normal physiological and psychological processes of pregnancy and childbirth. They must work with the midwife and other professionals and agencies to provide basic nursing care to pregnant women and families during pregnancy and after childbirth. They must be able to respond safely and effectively in an emergency to safeguard the health of mother and baby. work in partnership with people who have long-term conditions that require medical or surgical nursing, and their families and carers, to provide therapeutic nursing interventions, optimise health and wellbeing, facilitate choice and maximise self-care and self-management. Leadership, management and team competencies that adult nurses will demonstrate Adult nurses must be able to provide leadership in managing adult nursing care, understand and coordinate inter-professional 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.
12 Essential skills clusters Essential skills clusters support the achievement of the standards for competence. There are five essential skills clusters: care, compassion and communication organisational aspects of care infection prevention and control nutrition and fluid management medicines management. Each essential skill cluster provides further detail to assist the development of the nursing degree programme and further details can be found at essential skills clusters. 23 Portland Place, London W1B 1PZ T F The nursing and midwifery regulator for England, Wales, Scotland, Northern Ireland and the Islands Registered charity in England and Wales ( ) and in Scotland (SC038362)
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