Can nursing students be register-ready after fewer practice hours?

Nurse numbers might improve if NMC rules placed less emphasis on students’ practice learning hours, universities suggest. But there’s a more obvious solution

Nursing student delivers bedside care to a man in hospital, under supervision of a registered nurse
‘Timed served’ on clinical placements is a flawed indicator of competence, University Alliance suggests Picture: Neil O'Connor

Should nursing students to be allowed to qualify based on competence regardless of how many clinical placement hours they have completed?

A report by University Alliance (UA), an association of universities that trains 30% of England’s nurses, has reignited debate over the number of placement hours required for Nursing and Midwifery Council (NMC) registration.

The authors recommend students be assessed on competence rather than ‘time served’ – the current NMC threshold is 2,300 placement hours.

The report has sparked discussion on social media about education versus training, the quality of clinical placements and supernumerary status of nursing students, where they should not be counted – and counted on – as part of workforce numbers while on placement.

Nursing students’ clinical placements depend on adequate staffing

This isn’t new debate, but the UA report has prompted timely discussion at a time when RCN and Unison members in the NHS are taking strike action by over short-staffing and pay.

With around 46,000 current vacancies in England, the UA report rightly says the NHS needs more nurses now. It suggests one lever for achieving this could be reforming undergraduate assessment along with improving the funding for clinical placements – providers currently receive £5,000 per nursing student compared to £30,750 per medical student.

This is a little bit of chicken-and-egg situation, as the provision of placements is dependent on staff numbers, and vice-versa. Yet, you can see how organisations such as UA are keen to identify solutions.

Simulation in nurse education

Simulated practice learning for a nursing student in a neonatal education setting
Simulated preregistration learning can now replace a proportion of required practice hours Picture: Neil O’Connor

The NMC now accepts simulated education for up to 600 of the prescribed 2,300 preregistration practice learning hours. And this, like the UA’s suggestion to reduce reliance on clinical placement hours, is raising concern among those who insist there is simply no substitute for the unpredictability and pressures experienced through ‘real-life’ learning.

All ideas about how we can safeguard the future and quality of nursing care must be welcome.

And the most obvious place to start is to invest in the existing workforce through better pay to stop an exodus of experienced nurses who teach, educate and inspire the next generation.

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