A review of practice learning requirements for nursing and
midwifery students has revealed highly varied learning
experiences and supervision, and calls for action to ensure high
quality education.
This new report from health think
tank the Nuffield Trust, in partnership with the nursing and
midwifery charity Florence Nightingale Foundation, was
commissioned by the Nursing and Midwifery Council (NMC). The NMC
wanted to better understand what contributes to effective
practice learning across the UK and in other countries. This
research signals a key juncture within the regulator's review into nursing and
midwifery students' practice learning.
The report examined the evidence relating to regulations and
standards around students' practice learning. It investigated how
well NMC requirements are being implemented, and the challenges
in providing optimal practice learning placements for the next
generation of nurses, midwives and nursing associates.
The authors analysed existing UK and international research; held
workshops with policy leaders from across the UK nations;
conducted focus groups with registered nurses and midwives,
students, higher education staff and members of the public; and
carried out interviews with strategic leaders in health and
social care both within UK and internationally.
They found that the pressured environment of many practice
learning placements - and varied interpretation and
implementation of the standards for practice learning, which
includes the number of learning hours and births - can jeopardise
the effectiveness and consistency in students' learning
experience.
A lack of clear evidence, variation between countries and
professions, and differing expert opinions also means it's
difficult to reach a clear agreement about what the revised level
of assessments and practice hours should be. However, the report
highlights a consensus that quality should outweigh the quantity
of practice learning.
The report further identifies areas where the NMC, along with
approved education institutions and their practice learning
partners, can strengthen learning experiences for students across
a range of practice settings. This includes greater communication
around practice learning requirements, further research about the
impact of simulated practice learning on student learning,
greater support for educators, and an expansion of
community-based placements.
The NMC will consider these findings alongside two other key
areas of work. One is its evaluation of simulated practice
learning for pre-registration nursing programmes. The other
is evidence from its recent work to quality assure nursing and
midwifery education programmes which includes insights and
themes around practice learning. The collective findings will
inform recommendations and next steps which the NMC will bring to
its Council meeting in January 2025.
Report findings and suggested areas for
action
-
Clearer guidance and consistent
standards
The UK's regulatory requirements around practice learning for
nursing and midwifery students are comprehensive but there are
inconsistencies in how requirements are interpreted. The report
recommends clearer communication around standards to support
consistency among students, approved education institutions,
and practice partners.
-
Better organisation and coordination of
placements
The report recommends that each UK nation agrees strategies to
ensure placements are accessible, high-quality, and
well-resourced, with enhanced support for placement supervisors
and assessors.
-
Strengthening supervision and
assessment
The report suggests expanding and supporting the pool of
qualified supervisors and assessors, and addressing their
workload and time pressures, in order to support students as
effectively as possible. As part of this, the findings
emphasise that the expectations and requirements on training
and support for practice supervisors, practice assessors and
educator roles are better understood.
-
Uncertainty around practice learning
requirements
There is confusion and conflicting interpretations around
practice learning requirements, and differing opinions about
the necessary number of practice learning hours. But there is
limited evidence and varying opinions about what the
appropriate number of practice hours, assessments and number of
births (for midwifery students) should be.
-
More evidence needed on simulated practice
learning
While simulation was identified as a valuable tool for
learning, the report suggests that more robust research
is needed in this area. Limited studies, and discrepancies
within nursing and midwifery education, mean there is little
evidence about the impact of simulated learning on outcomes for
people receiving care, or information on resource implications
and cost-effectiveness.
Billy Palmer, Workforce Lead at the Nuffield Trust and
one of the report's lead authors, said:
“On paper, practical education requirements for the
UK's nurses, midwives and nursing associates are comprehensive,
and in many areas go further than other countries. But in
reality, day-to-day pressures and a lack of supervisory capacity
are routinely leading to varied implementation and support for
students. Our review heard widespread consensus for more focus on
the quality of training, not just learning hours accrued or tasks
ticked off.
“The regulation and delivery of clinical education is hugely
complex and impacted by numerous issues, but our research has
shown an urgent need and appetite to revisit standards and
improve learning experiences for students. Some of our
recommendations require longer-term, system-wide actions, but in
the short-term the NMC and educational partners have a real
opportunity to gather better evidence into how practice learning
requirements determine patient care and safety.”
Natasha North, Director of Academy at the Florence
Nightingale Foundation, said:
“Practice learning placements are
the way that nursing and midwifery students learn the real-world
art and science of caring. High quality practice learning extends
the knowledge that students gain in the classroom, giving them
supervised opportunities to develop practical skills and
professional behaviours. The Florence Nightingale Foundation is
proud to have been able to inform this work through the insights
of our member and alumni networks.”
Commenting on the report findings, Sam Foster, Executive
Nurse Director of Professional Practice at the NMC,
said:
“We're grateful to authors at the Nuffield Trust and Florence
Nightingale Foundation for their extensive research and
engagement with the public, students, and stakeholders across the
sector. These findings will be instrumental on our journey to
review, and improve, students' practice learning experience. We
will now work with our independent steering group and
stakeholders to shape recommendations to bring to our
Council.
“This will be an invaluable opportunity to help shape future
proposals that ensure students join our register with the skills,
knowledge and behaviours they need, and meet the evolving demands
of health and social care. We'll continue to collaborate with the
public, students, education providers and our stakeholders across
the four nations going forward, as we work to shape the future of
nursing and midwifery education.”
Ends.
Further information:
- To read the embargoed report Practice learning in nursing
and midwifery education: An independent rapid review
click here.
