At the beginning of this year I dipped my toe into Masters level study by undertaking my Practice Teachers Course. Thankfully, after 6 months of solid teaching, mentoring students and completing a difficult essay on adult learning theories I am pleased to say that I passed. Sadly, this was one of the last NMC validated teaching courses with 2019 seeing the end of Standards to Support Learning in Practice (SLAiP). The whole process has got me thinking about how to best support student nurses in practice and how to apply the new standards in line with Core Skills Level 1, GNP 5 of your RCN Competency Framework
Back when I was a student nurse in 2002 I had a task book. This task book would go with me from placement to placement and I would take great pleasure in completing an element, getting that signature in the box from my mentor and turning the dog eared pages to plan what I would do next. My student peers and I were like butterfly collectors, eagerly hovering around the nurse’s station, ears pricked at the slightest mention of a procedure which could be netted. We diligently trailed the observation machine around each patient 4 hourly, at 0800, 1200 and 1800 we checked and handed out medicines while our mentors asked us questions like ‘what is a major side effect of Ibuprofen or Aspirin?’ We placed catheters and NG tubes, we bed bathed patients and redressed wounds; we were task junkies all in anticipation of our final management placement where we would put it all together and get to boss around the first years.
Nursing education has gone through some massive changes over the years. Since the adoption of ‘Project 2000’ in 1986 saw nursing schools and higher education merge, supernumerary status for student nurses and the end to enrolled nurses. The professions aspirations for a fully graduate workforce continue. With time being split 50% clinical and 50% theoretical, nurse education saw a steady increase in essay writing, literature appraising and nursing research. In the early 2000s, the media backlash began with nursing getting a bad reputation for being too academic. ‘Nurses are too posh to wash’ spouted news headlines and increasing scrutiny of the NHS saw nurses and doctors alike having to justify their training, their roles and their responsibilities.
Jump back to 2019 and the NMC changes to nurse education and mentoring are just as massive as they were back in the day. The Future Nurse: Standards of Proficiency for Registered Nurses (NMC, 2018) document sets out the skills which student nurses are to be proficient in so that they may meet the challenges of nursing in the 21stcentury. There are 7 platforms which students will now be assessed against, these include; health promotion, leading and managing nurse teams, evaluating care and care coordination.
The part that intrigued me the most was Annexe B: Nursing Procedures. The task book has returned! The best bit about Annexe B is the statement at the start of each subtitle which says “use evidence-based best practice approaches to undertake….” This statement is key to the new nursing workforce bridging the gap between practice and theory.
Take the procedure ofchest auscultation and interpreting findingsas an example. The student nurse arrives on their medical ward and wishes to auscultate a chest, their mentor, a nurse with 10 years’ experience does not routinely listen to chest sounds. Skills which may have once been classed as ‘advanced nursing’ skills such as venepuncture and cannulation, interpreting ECGs, catheter insertion for both genders and interpreting venous blood gases, now form part of the standard curriculum. As the mentors out in the clinical arena, we are going to have to up our game.
Speaking of mentors, did you know that there will no longer be a NMC mentorship course and that all registered nurses can be expected to support students? Practice supervisors and practice assessors will replace the old mentor and sign off mentor roles with individual trusts deciding who will best fulfil these roles and whether additional training is required. It is up to the practice supervisor to assess whether their own knowledge and experience can meet the needs of the student.
From January 2019, approved NMC courses will work to the new standards and in my hospital, we will see our first intake into clinical practice in September. In the same way as the staff nurses of the 1980s may have struggled to teach and assess the project 2000 students in clinical practice, the registered nurses of today will be challenged to meet the needs of students; some of whom may be studying at Masters level. The bottom line is that student nurses may well come to nursing with greater life experience, an existing degree and they may be asking more challenging questions as the focus switches from task oriented to evidence based care. Add to this the fact that future students will be ‘paying customers’ at their academic institute who will be looking for value for money in both their chosen university and their clinical placements and practice supervision will not be the same as mentoring once was.
Clinical education is now more important than ever and documents like the RCN Competency Framework are vital to not only improving and validating your own practice but also preparing yourself to support student nurses. I think it is an exciting future for nursing and highlights the importance of education for all.