Setting the Standards for Children's Nursing Education: Past Lessons and Future Visions Dr Helen Rushforth, Senior Lecturer, Programme Lead - MSc Advanced Clinical Practice. her@soton.ac.uk

Session Overview NMC in the early stages of developing new Standards for Pre- Registration Nursing Education. As a group of leading children’s nurses, educators and students we need our voices heard within the debate. Therefore my aim is to help us do this by: Drawing on some lessons from the past Thinking about the strengths and weaknesses in the current standards Think about what we can learn from the education standards of other professions Understanding what is driving the content, format and process in developing the new standards Exploring a range of questions that may help our discussions and contribution to the debate…

My background…. Children’s Nurse Educator with extensive experience in curriculum development Child Field Competency Development Consultant for Standards for Pre-Registration Nursing Education (2010) NMC Reviewer for Pre-Registration Child Programmes (Mott McDonald) Programme Lead MSc Advanced Clinical Practice Opportunity to meet Dame Professor Jill Macleod Clark who is leading the review of the new standards… But views expressed are my own – not those of Jill Macleod Clark or the NMC!

The 2010 Standards….. Five sections: introduction and aims standards for competence – generic and field specific - basis for competency development standards for education – requirements/guidance for approved educational institutions (AEIs) progression criteria – between the three parts of the curriculum essential skills clusters (ESCs) – guidance rather than requirements

Developing 2010 Standards: The Process Starting point – previous 2004 Standards: 17 standards of proficiency with standards for education integrated within the document. Fitness for practice, fitness for purpose, fitness for award Outcomes for each standard of proficiency to be achieved by end of 12 month Common Foundation Programme (CFP) and then by end of Branch Programme. Outcomes were generic – there were NO field specific outcomes All contained within a concise 37 page document

Developing the 2010 Standards – the Process… Initial key decision: removal of separate CFP and branches branches became fields CFP and branches/fields replaced with three parts all parts generic/field specific but with increasing field focus as the programme progressed.

Developing the Standards for Competence… Decided for the first time that standards should include field specific competencies: Generic Standards for Competency written first – 4 domains: Professional Values Communication and Interpersonal Skills Nursing Practice and Decision Making Leadership, Management and Team Working Four field teams – (4 education, 4 clinical, 4 lay, 1co-ordinator). Field specific standards added to generic standards ONLY where there was a key point of difference.

e.g. from draft Professional Values section 1. All nurses must practise confidently within the context of The code: Standards of conduct, performance and ethics for nurses and midwives (NMC 2008), and other ethical and legal codes, recognising and responding appropriately to situations in day-to-day practice.  1.1 Children’s nurses must demonstrate understanding of the laws relating to child and parental consent, including both giving and refusing consent, withdrawal of treatment and legal capacity.   8. All nurses must accept responsibility for keeping their own knowledge and skills up-to-date through continuing professional development and life-long learning, using evaluation, supervision and appraisal to reflect and improve upon their performance and enhance the safety and quality of care and service delivery.

Developing the Standards for Education, the Progression Points and The ESCs… Standards for Education – distinct section - much more detailed than the previous standards. Distinction between CFP and branch replaced by three parts – progression points between parts one and two and parts two and three – usually aligned to years. ESCs (added between 2004 and 2010) in response to concerns re essential care needs being overlooked – retained as written with almost no changes…. Arguably the key issue within these sections currently is their level of complexity….

STANDARDS FOR EDUCATION - 10 Standards, 51 clauses, 92 required sub-sub clauses, 51 guidance sub-sub clauses - 43 pages….. e.g. from Standard Three: Selection, admission, progression and completion.

4 Essential Skills Clusters, 42 clauses, 338 sub clauses across progression points…40 pages…

So in summary the 2010 Standards have….. 152 pages Overarching aim/background 34 generic standards for competence per field with 18 child field sub clauses 10 standards for education 51 clauses 143 sub clauses (92 required, 51 guidance). 20 progression criteria 4 essential skills clusters (ESCs), 42 clauses 338 sub clauses (all guidance)

How then do our Standards for Pre-Registration Nursing Education compare with the Standards for other professions?

Compared with for e.g. Medicine Outcomes for Graduates: Tomorrow’s Doctors. 20 pages with 17 outcomes: Doctor as scholar and scientist Doctor as practitioner Doctor as professional sub-statements – knowledge and practice competencies 32 practical procedures Promoting Excellence: Standards for Medical Education and Training 5 domains, 76 clauses Supporting documents including Good Medical Practice and Fitness to Practice.

Outcomes for Graduates: Tomorrow’s Doctors – example of outcome statement and knowledge/competency statements

Outcomes for Graduates: Tomorrow’s Doctors – example of practical procedures

Compared with for e.g.….. Allied Health Professions.. Standards for Proficiency 20 pages 15 Standards of Proficiency 86 subclauses Standards for Education 16 pages 6 standards 57 subclauses

Thus many questions emerge… Size - less is (almost certainly) more….? Clarity – one integrated document or two separate documents? How can we simplify content and layout? Standards for Competence – can these be clearer and more concise? Should they be locally adaptable? Generic vs field specific standards - how do we balance these? Should we keep the field specific standards? Standards for Education – how can we simplify these to make them clearer and more concise Parts one, two and three – do we need these? ESCs – How can we simplify them? Should they be recommendations, guidance, or incorporated within the competencies?

New Standards: Progress to date - what do we know so far… Separate standards for competence and standards for education are being planned –separate working groups. Development of standards for competence being led by Dame Professor Jill Macleod Clark. Working party of national leaders – including CNOs, Directors of Nursing, NMC, RCN, Council of Deans’ etc. Aim to create a ‘radically different approach’ to the Pre Registration Nursing Standards… No current mandate to discontinue the four fields of practice Wide consultation via NMC currently planned for early 2017…..

Progress to date (cont.) Public protection = NMCs central focus and prime purpose Standards need to be clear, concise and outcome focused. Set of high level outcome statements accessible to the public and to future nurses, based on key themes. Themes under development, but key emphasis on essential skills in physical and mental health across the lifespan for practitioners in all four fields of practice. Themes also focused on areas such as public health, health promotion, illness prevention, assessment skills, fundamentals of care, complex care, leadership, and communication – congruence with Willis is clear. No plans for a new community pathway – community of key importance for all.

Emergent thinking – other key issues under debate Progression points – what benefits do they confer and do we need them? 2300 hours of practice – EU requirement so ‘Brexit’ unlikely to influence this – but currently 2000/2300 must be in practice = scope for debate? Enhanced skills – potential to include skills such as venesection, cannulation, advanced health assessment, ECG, etc. into pre-registration training? How do we view this? What are the benefits? What are the risks? Should we see this as ‘advanced practice’? Genericism vs Field focus – many key questions..…..

Fields of Practice Possible that we may revert to having generic outcome statements and competencies locally applied to the field by HEIs and/or assessors – how would we view this if so? Shape of Caring advocates 2 years generic, 1 year field specific, and 1 year preceptorship – but no decision at this stage whether this will be the approach. ‘Shape of Caring’ and other consultations clear that ALL nurses must be equipped to give fundamental care to people across the lifespan and from both a physical and a mental health perspective, and in AND across a variety of settings i.e. prepared to work much more flexibly….

Fields of practice So what can we learn from previous approaches – and how might this work in practice…..? Project 2000 – 18 month ‘CFP’ and 18 month branch 2004 Standards – 1 year ‘CFP’ and 2 year branch 2010 Standards - generic and field specific across three years but with an increasing field focus – the aim being : Nurses deliver high quality essential care to all Nurses deliver complex care in their field of practice…. 2017 – Future registered nurse will need to be more effectively prepared to work more flexibly across the lifespan and beyond their own designated field – arguably we need to vision a nurse with particular skills in caring for children, not ONLY equipped to care for children i.e. the 2010 intention must become reality…

How do we get the generic and field specific balance right? How do we design our competencies and our curricula to get the generic and field specific balance right? How do we get the message across that a children’s nurse isn’t prepared JUST to care for children, but to care for all people with particular skills in caring for children? How within generic elements of the curriculum can we avoid adult centricity? How can we ensure all students get placements in all fields, and yet enable children’s nursing students get sufficient experience within their own field? If we only have three years, what must we leave out? Is the key combining ‘focused field specific education’, with ‘truly generic, transferable learning’, effective preceptorship and a strong lifelong learning ethos?

31st August 2016 – Educating the Future Nurse: Council of Deans Outlines a very similar content focus for future curricula to ‘Shape of Caring’ Questions ‘tick box’ competency education Suggests future standards need to allow ‘disruptive, uncomfortable innovation’ (p8) Notes need to balance ‘technical skills’ with skills for ‘lifelong learning’ Pre registration education the ‘start’ of a registered nurses learning/development Questions hours as a proxy for quality… Refers to the ‘ongoing debate’ regarding the four fields….

Concluding Comments New set of standards at fairly early stages of development. Radically different approach (to 2010 Standards) – simplified, clearer, but preparing practitioners fit for the future Requirement to balance equipping our future nurses with both generic and field specific knowledge, skill and competence, enabled to work much more flexibly and with increasing autonomy = key Key opportunities to get involved – hopefully early 2017 but potentially beforehand. Lots to debate ..but lets stand together and ensure our voices are heard!