HEALTH FORUM

The Nursing & Midwifery Council has issued a consultation document about
the assessment of competancies for student nurses & how they should be
assessed.

Following various posts here and other places about students not being as
good as they were in my day, mentors dont care & dont know what they
should be doing, we dont have time to teach & assess students in clinical
areas & nurse education has gone downhill since it moved into
universities etc (I paraphrase) I would be interested in your views and
comments whether you are a student, newly qualified, been around for years
or even a lecturer.

I have selected a few items from the 24 pages which may be of interest (with
my comments/interpreatation in italics):

Whilst there are standards of proficiency for each part of the register, it
is essential that everyone knows what is expected of a new registrant for
entry to the register and how to identify where a student in training, or a
registered practitioner, lacks competence. This need for clarity has
prompted the NMC to look at how we might be better assured that new
registrants can practise safely and effectively.
what should every nurse be able to do & how do we check that they can do it?

An evaluation of pre-registration nursing programmes in England,
commissioned by the Department of Health, has identified deficits in the
nature and quality of clinical practice and the quality of mentor
preparation.
we aint got it right yet

The NMCs own quality assurance activities have identified issues relating
to practice learning and demands on mentors. Some institutions have failed
to meet NMC requirements for the auditing of practice placements, placement
availability, and preparation of mentors to supervise and assess nursing and
midwifery students in practice. An independent study Failing Students that
looked at programmes for initial registration has also identified concerns
about the reliability and validity of mentors judgements.
both educational institutions and placement areas need to get their act
together

Although not implicating students of nursing and midwifery, television
programmes such as Dispatches and Panorama raised issues about quality
of care and the role models to which students can be exposed. Both
programmes identified significant concerns in the provision of basic nursing
care and application of essential skills.
we dont like bad press

The five recommendations emerging from the policy review suggested that the
NMC should:
. systematically capture evidence about the competence of registrants;
. clarify the standards of proficiency;
. strengthen assessment policy and practice;
. improve the clinical learning environment;
. ease the transition from student to registrant.

The proposals and related questions are divided into five sections:

A Essential skills and competencies
B Assessing competence
C Signing off safe and effective practice
D Ensuring fitness for practice at the point of registration
E Supporting new registrants

There are some issues about consistency in relation to programme content
and outcome, in particular, for nursing programmes. Some lay Council members
have expressed surprise that the NMC does not set a final examination for
initial registration. The RCN Association of Nursing Students has called for
a national curriculum for pre-registration nursing to be put in place.
Consistency has been achieved in Wales for nursing through the All Wales
Fitness for Practice Initiative, which ensures that specific skills are
identified and assessed.
lets have a national curriculum & bring back the state final exam

The new requirements should ensure that the focus of mentor preparation is
on the skills needed to assess competence, to make difficult judgements, to
be confident in the outcome, and to be accountable for decisions made.
Strengthening the mentor standard, and ensuring that mentors are supported
in the role, will help to address the difficulties some mentors have in
failing students
mentors need particular preparation, knowledge & skills to be able to assess
students properly - practice education facilitators & similar titles are
also mentioned - are we going to get clinical teachers?

The NMC has also looked at setting student/mentor ratios. However, previous
work that considered the benefits and otherwise of setting ratios,
particularly staff/student ratios, suggested that it would be unwise to
adopt this approach. We propose instead that whilst giving direct care in
the practice setting, at least 40% of a students time should be spent being
supervised by their mentor or practice teacher (at least 15 hours within any
37.5 hour week, or pro rata). The benefit of requiring a minimum period of
direct supervision is that sufficient resources have to be in place to
ensure that each student is adequately supervised and assessed in practice
and this can be directly monitored.
how are increasingly busy clinical staff going to achieve this without some
reduction in their other work?

Demonstrating and confirming clinical competence should be through direct
observation of a students delivery of care in the practice setting. As part
of the review we considered the use of simulation, which is valuable in
introducing new skills and enabling students to gain confidence before
consolidating their skills in
practice. The use of Objective Structured Clinical Examinations (OSCEs)
undertaken in simulation is becoming a valid and reliable way of assessing a
students progress but we believe that the final assessment of competence
should mostly take place in practice. Exceptions to this could include
critical skills, which the student would not normally have the opportunity
to rehearse in the practice setting, for example, resuscitation, or
complications associated with childbirth.
anyone of a similar vintage to me may remember the 4 practical assessments
eg wound care, drug round, totla patient care &?

The NMC values highly the increased involvement of lay people, service
users and carers in its work. The NMC proposes to explore ways of involving
lay people in the assessment of practice. This could involve patients and
carers providing feedback directly on the care received from a particular
student, or indirectly through membership of moderating panels and
assessment boards.
lets ask the patients what they think of the care students delivered - why
stop at students? if student feedback can be used to influence the pay their
lecturers receive why cant patients be involved in setting the pay their
nurses (& drs, physios etc) get?

We propose that experienced mentors should undertake the role of an
assessor at the points when the students competence has to be confirmed
(end of CFP & end of 3 years). If this is supported, we will detail the
additional requirements needed for an experienced mentor. We anticipate
that requirements will include being an experienced practitioner who has
regularly mentored and assessed students in the previous three years. The
NMC intends to identify criteria for an experienced mentor to include
being an experienced practitioner, and which recognise further development
and consolidation of knowledge and skills within a practitioners specific
role.
are there enough people who meet this criteria to assess the number of
students? will they have time to do anything else?

Supporting new registrants
For the nurses part of the register we considered a number of ways of
achieving this, including lengthening the programme and providing more time
to learn in practice, or having a probationary year which would enable a
student to adjust to new responsibilities in their first post.

Appendix 2

Essential skills clusters

These are competencies that are grouped together and which focus on a
specific priority area, e.g. communication, medicines management. The
following clusters are those currently being considered in relation to
nursing and midwifery programmes and may change as work progresses.

Examples for nursing might include:
. communication
. care and compassion
. hygiene and infection control
. nutrition and fluid maintenance
. medicines management
. management of care

are these the right essential skills for all nurses?

The full details of the consultation & an online questionnaire are available
at
http://www.nmc-uk.org/(njijev45mib1s3r00m3wms45)/aArticle.aspx?ArticleID=1815
& the closing date is: 2nd Dec 2005

Sorry this has turned into a really long post - Id be interested in your
comments on any particulars or the overall tone.

Rod wrote:
Hi Rod

Having just completed 40 years as a nurse, nurse tutor, trainer and
lecturer, I could write a book, one chapter on each paragraph in your post.
Placement audits are a farce; we have to use every available placement,
irrespective of the learning climate, to cope with the large numbers of
students. When placements arent available some universities issue students
with directed study in lieu of placements. Those of us in teaching who have
personal students, and who listen to what they say about their placements,
know that the situation is desperate. Many students are used as a pair of
hands most of the time in most hospital-based placements. Any acquisition of
new knowledge or skills, any opportunities to learn from a good role model,
and any opportunities to integrate theory with practice, are rare. We have
maintained this pretence of supernumerary status post-1990 - fifteen years
of knowing that it is largely a myth. The pressures that many NHS nurses and
other health care professionals are working under mean that morale is at an
all-time low, and student teaching is an unwelcome burden. Many students who
successfully complete their programme have no intention of going in to
practice; doesnt that say volumes about their perception of the realities
of nursing and about how ill-prepared they feel for practice? Why does the
NMC appear indifferent to this? For the NMC to talk about experienced
mentors, OSCEs, competencies, assessment and essential skills clusters, when
clinical practice is in such a sorry state, seems to me to completely miss
the point. I cant see anything in that NMC online questionnaire that
remotely addresses the underlying problems. The NMC proposals seem to
concentrate on mentors working better and harder, without considering
the climate in which they work. What is the point of setting even higher
standards that NHS trusts and universities would find impossible to meet in
the current climate, whilst placement experiences can be so dire? Where are
these super mentors who have somehow survived the system and are competent
in a range of attributes that were, and still are, absent during their
educational programme? Is the NMC fiddling while Rome burns?

Eddie
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