Future nurse standards in nursing education

The Nursing and Midwifery Council (2018) future nurse standards of proficiency for registered nurses consider current societal and healthcare changes, acknowledging the skills a registered nurse must have to serve and protect the public. The document specifies the proficiencies that nurses must demonstrate when caring for patients across a variety of healthcare settings.

Registered nurses are vital in providing coordinated, compassionate, evidence-based person-centred care (NMC, 2018). Nurses work autonomously and are accountable for their own practices while collaborating with other healthcare professionals in a range of interdisciplinary teams.

To respond to the impact and demands of nursing practice, student nurses must be prepared to manage their own health and wellbeing as well as identify personal support networks. Students must be taught health promotion, health protection and prevention of ill health in order to contribute to the health and wellbeing of individuals, communities and populations.

These standards are outcome-focused, rather than process-focused, and are supported by the NMC standards for supervision and assessment in practice. In addition, the changes in the NMC simulated practice learning hours allow for more innovative learning and placement opportunities, encouraging greater partnership between education and placement providers. Simulated practice learning can replicate, support and complement clinical placements through a variety of innovative and creative methodologies to ensure the fulfilment of NMC practice learning core principles for standards of supervision, evidence of hours and achievement of learning outcomes (NMC, 2023). Simulated practice learning environments allow students to practice, repeat, evaluate and reflect on experiences in preparation for delivering safe and effective nursing care as registered professionals (NMC, 2023).

Implementation of the standards

The standards require all pre-registration nursing students to develop knowledge, skills and proficiency in their chosen field of practice as well as all other fields of nursing, and demonstrate an understanding of how these overlap in integrated care. For example, mental health nursing students are required to demonstrate proficiency in a range of clinical nursing procedures (some of which are less common in mental health placements), such as catheterisation and nasogastric tube insertion. Adult nursing students must demonstrate skills in maintaining mental, physical and behavioural health and addressing health inequalities.

Assessment of these skills should take place in the student’s chosen field of practice or in simulated practice learning environments. Simulated practice learning must align with the core proficiencies, using a variety of modalities to create authentic learning environments supported by practice assessors and practice supervisors.

The standards are presented as seven distinct platforms and two annexes. Each platform describes the standards that need to be met across all four fields of nursing:

The annexes describe communication and relationship skills, as well as clinical nursing procedures, which new registrants must be able to demonstrate proficiency in. The seven platforms are:

1. Being an accountable professional – acting in the best interests of patients and providing safe, compassionate and patient-centred care
2. Promoting health and preventing ill health – working with patients to maintain mental, physical, behavioural health and wellbeing for themselves, communities and populations
3. Assessing needs and planning care – assessing and reviewing the mental, physical cognitive, behavioural and spiritual needs of individuals and their families
4. Providing and evaluating care – providing evidence-based, safe and compassionate nursing interventions, which are in partnership with patients and families to reflect individual goals for care
5. Leading and managing nursing care and working in teams – playing an active and equal part in interdisciplinary teams, being a role model for best practices, supervising, mentoring and communicating effectively
6. Improving safety and quality of care – monitoring and taking part in quality improvement of care to enhance health outcomes and patient experiences
7. Coordinating care – playing a leadership role in managing complex nursing and integrated care needs across patients’ lifespans (NMC, 2018)

Annexe A: Communication and relationship management skills

Annexe A outlines the communication and relationship management proficiencies required of a new nursing registrant. Effective communication is essential for the provision of safe, effective person-centred care. Nurses across all fields must be able to demonstrate good communication skills for patients, families and carers with a diverse range of mental, physical, cognitive and behavioural health challenges. These skills are essential to ensure that the patient’s voice is heard and that their needs, priorities and values are considered and respected. In order to achieve these proficiencies, nurses must consider reasonable adjustments for patients with specific communication needs or disabilities to ensure that communication and information are shared in an appropriate manner, promoting clear understanding for all those involved (NMC, 2018).

Annexe B: Nursing procedures

Annexe B outlines the nursing procedures that a newly registered nurse must be able to demonstrate in order to meet the proficiency outcomes. This requires nursing procedures to be undertaken in an effective, compassionate, evidence-based and person-centred manner. Proficiency reflects culturally-competent communication, awareness of cultural diversity and self-efficacy in diverse cultural situations across a patient’s lifespan. Registered nurses in all fields of practice must be able to demonstrate the ability to care for patients with mental, physical, cognitive and behavioural health challenges; to provide nursing interventions, assessment, diagnosis, treatment and care. Nurses should also take into consideration any reasonable adjustments to ensure all procedures are undertaken safely and effectively (NMC, 2018).

Challenges for implementation

The implementation of the future nurse standards presents a few challenges, both in clinical practice and higher education. There is a need to ensure profession-wide understanding of the standards and increase public awareness of registered nursing roles and responsibilities. Successful implementation is dependent on supporting and upskilling the existing academic and clinical workforce, and appropriately allocating infrastructure and investment. It is important that higher education institutes and healthcare organisations collaborate creatively for interprofessional supervision and interdisciplinary work. Higher education institutions must consider how the implementation of the standards through simulated practice learning is assessed and evaluated, as well as how it empowers students, models leadership and develops political awareness.

Attainment of the proficiencies can be more challenging for those in fields such as mental health nursing, as physical health skills are less often used in these settings. Students must rely on simulated practice learning opportunities and spoke placements to practice skills and meet the requirements of the practice assessment document. Once nurses have gained their registration, they must ensure these skills are practiced and updated regularly to maintain competence.

Applying the NMC proficiencies to education

Immersive simulations using high-fidelity manikins and/or simulated patients provide a realistic, authentic learning environment for students to practice skills and proficiencies. A ward-based simulation with multi-patient scenarios requires the students to assess patients; diagnose, plan, implement and evaluate care, and links to platforms 1–6 in the future nurse standards and annexe A proficiencies. The addition of practical skills to these simulations, such as venepuncture/cannulation, catheterisation and injection technique, link to the annexe B proficiencies. Students can practice these skills as part of their simulated practice learning hours, in a safe environment with the opportunity to evaluate, reflect and re-try applying their skills several times.

The future nurse standards are core to nursing practice, particularly when responding to current challenges. New registrants must be emotionally intelligent and resilient individuals, who are able to demonstrate proficiencies across all fields of nursing in clinical placements, as well as simulated practice learning environments.