Nurse education: Now and in the future
The challenges for nursing in the 21st century
Nursing education now
In order to register, students have to follow an education programme that meets our current required Standards of proficiency for pre-registration nursing education (NMC 2004).
The standards set out what must be achieved at the point of registration. It takes at least three years to become a nurse, unless students can show that they have already met some of the course requirements.
At present, nursing students learn foundation knowledge and basic skills in the first year of the programme – the Common Foundation Programme (CFP).
In order to then move into their chosen two year specialism – adult, mental health, learning disabilities, or children’s nursing - they need to demonstrate that they have met certain ‘outcomes’, including certain essential skills. These essential skills are grouped in clusters known as Essential Skills Clusters (ESCs).
Although nurse education is based in universities, it is delivered in direct partnership with NHS Trusts and other organisations that provide practice learning opportunities for nursing and other health care students.
Half of the education programme is spent in practice, so that students can learn how to provide direct nursing care. They spend the other half learning about the knowledge and technical abilities needed to underpin and support practice.
Nursing students currently complete their education with at least a Diploma in Higher Education - the equivalent of two thirds of a degree.
So why change?
The current approach to nursing education has served us well for more than 10 years, with nurses largely being seen as well prepared to meet current service needs when they qualify.
However, the challenges for nursing in the 21st century are much more complex and healthcare delivery is changing. We need to look at what health services will be like in the future, and the depth of knowledge and level of skill people will expect nurses to have.
Nurses of the future will practise differently. For example, adult and children’s nurses will need to be better equipped to meet the needs of people with mental health problems, while mental health and learning disability nurses will need to be better able to care for people with complex physical needs.
New education programmes will aim to ensure that nurses, when they graduate in their field of practice, will have the high level skills needed to care for people in their particular field, while also having the knowledge and range of skills needed to provide essential care to anyone else in any setting.
In the future, nursing students will learn in hospitals and residential settings and increasingly in the wider community where care ranging from basic to highly complex is being provided more frequently.
In order to complete their education programmes successfully, nursing students will have to demonstrate knowledge and competence in practice at degree level. This means that they have to be able to justify their actions based on evidence.
Nursing education in the future
In the first phase of this review, we consulted on the principles needed for a new framework for pre-registration nursing education programmes.
Although the findings revealed a lot of support for retaining four specific fields of nursing - adult, mental health, learning disabilities and children’s nursing - many people thought that continuing with this approach might narrow our focus, restrict innovation and hamper joined-up care.
There was a general call for modernising the way nursing students learn. It was felt that, while future nurses must have the specialised skills to care for particular groups of people, they must also have the knowledge and skills needed to provide basic care to all client groups.
In September 2008, the NMC Council made a number of decisions concerning the future framework for pre-registration nursing education.
They decided that, in future, programmes would have a blend of generic learning and learning which is specific to the nurse’s chosen specialism (now known as field) with the proportion of field specific learning increasing over time.
The generic and field specific aspects of the programme will be combined to allow shared learning between fields. There will also be opportunities for shared learning with other healthcare professions.
These will give students a chance to meet the required generic and field competencies in a wide range of practice settings, in all places where nurses deliver care including walk-in clinics, GP surgeries and people’s own homes.
To meet the competencies, there are specific skills that nursing students should be able to demonstrate. These are included in the Essential Skills Clusters (ESCs) and they form part of existing programmes. For new programmes, ESCs will be used in a similar way and should be met at various points in the programme.
New programmes will still be at least three years’ long, with half the time spent learning how to give direct care in practice settings. There will be two progression points.
Normally, these will separate the programme into three equal parts, and each will have specific criteria that must be met before a student can move from part to the next.
For progression point one, students will have to meet criteria for basic care and safety, as well as demonstrating professional behaviours expected of a nursing student.
For progression point two, programme providers must set learning outcomes that allow the student to demonstrate an ability to work more independently, with less supervision, in a safe and increasingly confident manner.
If you would like more information about the principles that were agreed by the NMC Council in 2008, please visit our website.
What about degree?
In October 2008, we decided that the minimum academic level for pre-registration nursing education will be degree. By September 2013, there will only be degree level pre-registration nursing programmes offered in the UK.
The numbers of degree educated nurses have been increasing steadily over time, and some countries of the UK already only offer degree programmes.
The findings from the first phase of the consultation highlighted the need for critical thinking skills in the increasingly diverse and complex climate of future health care delivery.
Some evidence suggested that nurses who are educated to degree-level may be able to demonstrate analytical and problem-solving skills at a higher level.
Many people believed that raising the minimum level of nursing education to degree level would bring the UK in line with other countries and, importantly, with other health care professions. This could enable more inter-professional learning across pre-registration programmes.
We believe that degree-level nurses will be able to provide a better standard of care. We also foresee a workforce that is able to:
- be more independent and innovative and able to use higher levels of professional judgement and decision-making in an increasingly complex care environment;
- assess and apply effective, evidence-based care safely and with confidence, managing resources and working across service boundaries;
- be members, and often leaders, of multi-disciplinary teams where colleagues are already educated to at least graduate level; and
- provide leadership in promoting and sustaining change and developing clinical services.
Some of our views about raising the minimum level of nursing education have been influenced by the Tuning Project (LINK). This identifies higher level intellectual, practical, professional and academic competencies of graduate nursing.
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