New routes to nursing, along with changes in the way students are supported on placement, may present a challenge to nurses
Expansion of nursing roles along with changes in clinical placements may add to pressures on qualified staff
New ways into nursing, along with changes to the way students are supported on placement, could present a challenge to nurses
New routes into nursing – apprenticeships and nursing associates among them – are coinciding with the reform of education standards. Together, these reforms have implications for how nurses support students on clinical placement.
Nurse leaders are warning that these shake-ups could combine to overwhelm registrants, who will be required to assess and help the next generation become ready to practise.
One of the new routes into the profession is the nursing associate. The first 2,000 nursing associates will be registered by the Nursing and Midwifery Council (NMC) in January 2019.
What’s happening at a glance
- Nursing associates, nursing degree apprenticeships and Nurse First scheme are all new routes into nursing
- Less prescriptive NMC standards for supervising and assessing nursing students and nursing associate students will be introduced in January
- Education framework replaces existing model with a more flexible approach, but some nursing leaders are worried the new standards lack clarity
- Nursing students will have a practice supervisor, practice assessor and academic assessor and the demise of placement mentors will mean more nurses will be involved with supervising and assessing students
- The RCN and the Queen's Nursing Institute fear the existing workforce will need time to understand the changes – and adequate support and training at a time when CPD budgets are in decline
The role, which is designed to address a skills gap between healthcare assistants and nurses in England, provides a route to graduate level nursing. Around 40% of nursing associates have indicated they plan to go on to take a nursing degree, according to the Department of Health and Social Care.
number of roles that replace the nurse mentorship model: practice supervisor, practice assessor and academic assessor
Source: Nursing and Midwifery Council
But with plans for as many as 14,500 nursing associates in post by 2021 – joining a growing variety of pre-registration nursing students in education – questions remain over supervision and assessment because this is also an area where change is afoot.
Just two years before this, from 28 January 2019, new NMC standards for supervising and assessing nursing students and nursing associate students will be in force, placing the emphasis on a more collaborative and flexible approach between universities and placement providers.
The standards will replace the current model, in which students are supported and assessed by nurse mentors before being declared fit (or otherwise) to join the NMC register by a nurse sign-off mentor.
The new model spells the end of nurse mentorship, replacing it with a triad of roles: practice supervisor, practice assessor and academic assessor.
Practice supervisors are likely to be nurses but could be other registered health and social care professionals. Practice assessors will be nurses who practise in the students’ field of study such as learning disability nursing.
Nursing associate supervision
Draft standards for pre-registration nursing associate programmes seek to ensure they tie in with new measures overseeing undergraduate nursing students.
The nursing associate standards stipulate that support, supervision, learning and assessment provided by placement providers and educational institutions complies with those governing nursing student supervision and assessment.
Council of Deans of Health executive director Katerina Kolyva says: 'We have participated in the NMC's consultation exercise on supervision models for nursing associates and await the NMC’s decisions later this year.'
She adds that nursing degree apprentices will be required to meet the same standards as those on degree courses and will be supervised in the same way while they are being educated.
RCN head of professional learning and development Anne Corrin adds: 'Every student in training will have a practice supervisor, practice assessor and academic assessor.'
Burgeoning routes into the profession
RCN head of professional learning and development Anne Corrin cautions that the proliferation of routes into nursing is ‘a real issue’ for the current workforce, because more nurses will be required to supervise and assess students.
Forty students started on the new Nurse First scheme – a fast-track two-year accelerated nursing programme for graduates with relevant experience – last September.
There are more than 100 apprentices on nursing degree courses, with hopes of a growth in numbers after a much slower start than the government anticipated.
‘There are quite a lot of routes now and for somebody working out there in practice to understand and know all the different curricula will be a challenge and could affect implementation of the new supervision and assessment requirements,' Dr Corrin says.
Coping with parallel systems
Dr Corrin believes employers may have to think about recruiting to support practice supervisors and assessors, given the less prescriptive approach and lack of strict guidance on preparing those for supervision than the mentorship model offered.
‘It is all complex and requires a lot of thought. We are asking a lot of our existing workforce’
Anne Corrin, RCN head of professional learning and development
‘Mentorship is ingrained and all the rules around that will go,’ she says. ‘Employers have to think hard about how they are going to make sure the existing workforce is not totally overwhelmed by these new standards.
‘In the short-term we are going to have parallel systems running; students on the curriculum now with mentors, but then those mentors will have a new curriculum [and supervision requirements] running as well.
‘It is all complex and requires a lot of thought. We are asking a lot of our existing workforce.’
Closer links between educators and placement providers
Queen's Nursing Institute programme manager Sharon Aldridge-Bent, an expert in mentorship and clinical supervision, says changes to supervision and assessment will need time to bed in.
Ms Aldridge-Bent adds that the flexibility that has been introduced to the standards will mean placement providers and higher education institutions will have to work more closely with each other.
However, she adds: ‘It is unclear how the [new supervision and assessment] roles will be trained and educated as there is no clarity on who does what.'
Advice on implementation
The NMC says it recognises how important it is that employers and nurses with supervisory roles understand what is needed of them and says it is making information available on its website, as well as holding implementation events.
years to train a nursing associate
A spokesperson says: ‘Education providers and practice placement providers are ultimately responsible for implementation locally and need to work in partnership to implement the new standards.'
The regulator also says that while it does not stipulate the creation of new roles to train or retrain existing mentors to become practice supervisors or assessors, it recognises some organisations may wish to adopt that approach.
The NMC spokesperson adds: ‘Existing mentors will already have received training in supervision and assessment. This means that practice placement providers can decide from their existing mentors, sign-off mentors and practice teachers who will be a practice supervisor, practice assessor or both. They will also identify the preparation needed for those new to supervision and assessment.
years to train as a nursing degree apprentice. One year longer than a standard pre-registration university nursing degree course
‘Equally, whenever we renew our pre-registration nursing proficiencies, it is in the interests of all registrants to become familiar with the new standards, but it is not our role to dictate how this should be done.’
Ms Aldridge-Bent is concerned that recruitment and retention difficulties in the community setting mean there are fewer good nurses left to support student learning.
She says: ‘The pressures left on people are huge when there are fewer people in practice.’
There were 34,727 nursing and midwifery vacancies advertised in England between 1 January and 31 March 2018, according to NHS Digital figures.
Dr Corrin adds: ‘The new standards provide a much more flexible way to do things but that is quite scary in a way, taking away one framework and putting in a much looser one.
‘We need to ensure principles and standards are being met and we need quite skilled people to do these evaluations and assessments.
‘The key to all of that will be in ensuring there is consistency across the UK and to make sure we have got a good quality assurance framework.’
Nursing associate programme lets me earn while I study
Anna Rose is four months into the two-year nursing associate training at Queen Victoria Hospital NHS Foundation Trust (QVH) in East Grinstead, West Sussex.
'I've been interested in nursing for a long time,' says Ms Rose. 'Moving into a healthcare assistant role last year confirmed for me that this was what I wanted to do.
'As a mum working part-time, a full-time nursing degree wasn't an option, not just financially but also because of needing to balance family and work life.
'The nursing associate programme lets me study and train while I earn. It’s an exciting opportunity, and I'm thoroughly enjoying training and developing my skills here,' says Ms Rose, pictured, with fellow nursing associate trainee Yasmin Eager.
QVH outpatients department matron Ros Waters, who oversees Ms Rose, says: 'I am happy to support the nursing associate role as we are able to grow our own workforce of the future.
'Anna and Yasmin are especially valuable as they are training on the job and are already part of the team.'
'We need a defined structure'
Susie Scales is clinical lead for public health nurses covering young people aged five to 19 years old at Derbyshire Community Health Services NHS Foundation Trust. She is also a mentor, practice teacher and clinical supervisor.
Ms Scales feels the wording of the new supervision standards is imprecise.
‘We have worked hard to have a set of standards for what we expect from students and a set of rules and levels we need to reach,' she says. ‘The standards are quite woolly, using words that are broad in meaning. We are all busy and it is easier to have a structure that is already defined than have to go out and make it [ourselves].’
Cuts to CPD budgets
An additional issue that might pose major challenges in implementing student supervision is cuts to continuing professional development (CPD).
CPD budgets fell from £205 million to £83 million between 2015-16 and 2017-18, according to Health Education England.
Katerina Kolyva of the Council of Deans of Health says: ‘CPD for existing staff will remain an important factor in developing the future workforce. Increased investment in CPD would help support the education of nursing associates and student nurses.’
Nursing workforce needs more support, not less
number of hours the NMC wants nursing associates to spend on formal learning in theory and practice
Dr Corrin adds: 'When implementing something new, more – not less – training support is needed, and I hope some of the new money [£20.5 billion a year promised for the NHS up to 2024] will be used to reinstate CPD funding.'
One thing is clear: alongside existing challenges in recruitment, retention and training investment in nursing, the implementation of such a complex new system of supervision and assessment will need more support from employers and nurses’ professional bodies.