Recommendation F186: Practical hands-on training and experience

While the NMC understood the basis for this recommendation, it was their position that these concerns had been addressed through the introduction of the UK-wide pre-registration education standards for nurse and midwives since. Under these changes, all education programmes last at least three years and require 50 percent of time to be spent in practice learning and 50 percent in academic study. The first progression point cannot be passed unless the student takes a period of practice learning and assessment. The NMC felt that this met the spirit of the recommendation.

Whilst its requirements for practice learning remain the same today, the NMC have kept these under regular review, ensuring they reflect best available evidence, and that people are safe and fit to practise at the point of entry.

In particular, in July 2014 the NMC commissioned IFF Research to evaluate its pre-registration standards. With regards to practice-based learning, this identified a broad consensus that the split between academic and practice-based elements of undergraduate programmes is appropriate so long as the quality of placements (and mentorship) is high and effectively facilitates the attainment of skills. Whilst some stakeholders wanted to see an increased emphasis on practice, pushing it up closer to 60-70%, it was acknowledged that this is unlikely to be feasible in a context of limited placement opportunities as well as limited mentor numbers. A further review of the NMC’s education and training standards was undertaken in September 2021.

Considering the number of academic theory and practice hours, the review found that there is no agreement on the type, quality or quantity of hours necessary. In 2022 the NMC also undertook specific research to understand more about practice hours in other countries and whether alignment with EU law is appropriate. This found that the number of practice hours were often lower in other countries when compared to the UK, but that this was a result of political or pragmatic reasons as opposed to evidence on the number of hours required for safe and effective practice. All sets of research provided us with assurance as to the level of practice hours set.

The NMC’s education standards were updated in 2023 following the UK’s withdrawal from the EU. The amount of practice learning hours remains the same - all education programmes must meet the equivalent minimum length of three (academic) years for full time programmes which consist of a minimum of 4,600 hours. 50 percent of time (2,300 hours) must be spent in practice learning, of which a maximum of 600 hours can be simulated practice learning. The number of practice learning hours are in line with those mandated by EU law.

The NMC first introduced emergency standards during covid to allow education institutions to deliver a proportion of practice learning through simulation. Following extensive review, the NMC has made this a permanent standard in recognition that simulated practice learning methods are becoming increasingly sophisticated and help students build their confidence and skills in a range of situations they may not otherwise encounter frequently in practice. Following changes made to its education programme standards in 2023, the NMC has committed to reviewing its nursing and midwifery practice learning to ensure requirements support students to deliver the best possible person-centred care for people across a range of practice learning environments. This will also consider how changes to simulated practice learning are being delivered.

The Nursing and Midwifery Council has commenced the evaluation of their standards for pre-registration education for nurses and midwives. Central to the evaluation are questions about the effectiveness of standards in preparing nurses and midwives for their professional roles and responsibilities which include care, compassion and leadership. The Nursing and Midwifery Council is in the final stages of appointing an independent evaluation supplier will proactively share any interim findings with Health Education England to tie into the Shape of Caring Review. The Nursing and Midwifery Council’s final report should be available in September 2015. The outcomes of the evaluation will provide an evidence base for future reviews of their pre registration standards for education so that they can, where necessary, enhance the UK standards for nurse and midwifery competence and education.