Standards Of - Nursing And Midwifery Council
Standards ofproficiency forpre-registration nursingeducationProtecting the public through professional standards
IntroductionThis booklet has been developed from Requirements for pre-registration nursingprogrammes which was published by the former United Kingdom Central Council forNursing, Midwifery and Health Visiting (UKCC) in April 2001, and by incorporatingsome content previously published in Statutory Instruments and Council policy. Thepublication Requirements for preregistration nursing programmes was revised inApril 2002, following the establishment of the new Nursing and Midwifery Council(NMC), and again in August 2004 to bring it in line with changes to the rules broughtabout by the Nursing and Midwifery Order 2001. The standards and guidance forpre-registration nursing education, which are contained in this booklet, have beendeveloped by combining all of these resources into one comprehensive publication.ContentsSection 1 – Standards of proficiency for pre-registration nursing education. 3Section 2 – Standards for admission to, and continued participation in, pre-registrationnursing programmes. 8Standard 1 – Age of entry. 8Standard 2 – General entry requirements. 9Standard 3 – Accreditation of prior (experiential) learning (AP(E)L). 12Standard 4 – Admission with advanced standing. 13Standard 5 – Transfer with AP(E)L. 14Section 3 – Standards for the structure and nature of pre-registration nursingprogrammes. 15Guiding principles. 16Standard 6 – Structure and nature of educational programmes. 20European Directives. 25Section 4 – Standards of education to achieve the NMC standards of proficiency. 27Standard 7 – First level nurses. 32Standard 8 – Second level nurses. 472
Section 1 – Standards of proficiency for pre-registrationnursing educationIntroductionThe Nursing and Midwifery Council (NMC) is required by the Nursing and MidwiferyOrder 20011 (the Order) to establish and maintain a register of qualified nurses andmidwives [Article 5(1)], and from time to time to establish standards of proficiency tobe met by applicants to different parts of the register, being the standards it considersnecessary for safe and effective practice [Article 5(2)(a)].This booklet provides the standards of proficiency and standards of education requiredfor pre-registration nursing education programmes. These have been developed insupport of the Nursing and Midwifery Council (Education, Registration and RegistrationAppeals) Rules2 2004 (the Registration Rules). These rules and standards of proficiencyreplace all previous requirements for pre-registration nursing programmes of educationissued by the NMC or previously the UKCC and the four National Boards for Nursing,Midwifery and Health Visiting for England, Northern Ireland, Scotland and Wales(National Boards). Their status is mandatory, in accordance with statutory legislation.Establishment of the NMCThe NMC was established under the Order and came into being on 1 April 2002 as thesuccessor to the UKCC and the four National Boards. At that time the NMC adopted theexisting rules and standards of the UKCC and, where relevant, those of the NationalBoards. In addition to the Registration Rules, new rules for fees, midwifery and fitnessto practise3–5 have also been developed. These all came into force on 1 August 2004.The NMC registerThe NMC has determined that there shall be three parts to the register for nurses,midwives and specialist community public health nurses. Additionally that the nurses’part will be divided into two sub-parts to distinguish first and second level nurses, andthat a further distinction will be applied in respect of nursing registrants to indicate – bymark of the entry – the branch in which the standards of proficiency have been met.1The Nursing and Midwifery Order 2001 (SI 2002/253). The Stationery Office, Norwich,www.hmso.gov.uk2Nursing and Midwifery Council (Education, Registration and Registration Appeals) Rules 2004(SI 2004/1767). The Stationery Office, Norwich, www.hmso.gov.uk3Nursing and Midwifery Council (Fees) Rules 2004 (SI 2004/1654). The Stationery Office, Norwich,www.hmso.gov.uk4Nursing and Midwifery Council (Midwives) Rules 2004 (SI 2004/1764). The Stationery Office, Norwich,www.hmso.gov.uk5Nursing and Midwifery Council (Fitness to Practise) Rules 2004 (SI 2004/1761). The Stationery Office,Norwich, www.hmso.gov.uk3
Standards of proficiency for nursingThe standards of proficiency define the overarching principles of being able to practiseas a nurse; the context in which they are achieved defines the scope of professionalpracticea. Applicants for entry to the nurses’ part of the register must achieve thestandards of proficiency in the practice of adult nursing, mental health nursing, learningdisabilities nursing or children’s nursing. They are specified on the following page. Manage oneself, one’s practice, and that of others, in accordance with The CodeProfessional standards of practice and behaviour for nurses and midwives 10& recognising one’s own abilities and limitations. Practise in accordance with an ethical and legal framework which ensures theprimacy of patient and client interest and well-being and respects confidentiality. Practise in a fair and anti-discriminatory way, acknowledging the differences inbeliefs and cultural practices of individuals or groups. Engage in, develop and disengage from therapeutic relationships through the useof appropriate communication and interpersonal skills. Create and utilise opportunities to promote the health and well-being of patients,clients and groups. Undertake and document a comprehensive, systematic and accurate nursingassessment of the physical, psychological, social and spiritual needs of patients,clients and communities. Formulate and document a plan of nursing care, where possible in partnership withpatients, clients, their carers and family and friends, within a framework of informedconsent. Based on the best available evidence, apply knowledge and an appropriaterepertoire of skills indicative of safe nursing practice. Provide a rationale for the nursing care delivered which takes account of social,cultural, spiritual, legal, political and economic influences. Evaluate and document the outcomes of nursing and other interventions. Demonstrate sound clinical judgement across a range of differing professional andcare delivery contexts. Contribute to public protection by creating and maintaining a safe environment ofcare through the use of quality assurance and risk management strategies.aThe standards of proficiency for the first level of the nursing register were initially defined ascompetencies in SI 2004/25466Nurses, Midwives and Health Visitors (Training) Amendment Rules Approval Order 2000(SI 2004/2554). The Stationery Office, Norwich, www.hmso.gov.uk7The Code: Professional standards of practice and behaviour for nurses and midwives 10& Nursingand Midwifery Council, London, www.nmc org XN47
Demonstrate knowledge of effective inter-professional working practices whichrespect and utilise the contributions of members of the health and social care team. Delegate duties to others, as appropriate, ensuring that they are supervised andmonitored. Demonstrate key skills. Demonstrate a commitment to the need for continuing professional developmentand personal supervision activities in order to enhance knowledge, skills, valuesand attitudes needed for safe and effective nursing practice. Enhance the professional development and safe practice of others through peersupport, leadership, supervision and teaching.The second level of the nurses’ part of the register is open only for those nursespreviously qualified in the UK who continue to practise as second level nurses, and tosecond level nurses from the European Economic Area (EEA) who wish to exercisetheir right to freedom of movement. The Council no longer approves educationalprogrammes for entry to the second level of the nurses’ part of the register.The standards of proficiency for second level nursing are known as threshold standards;they enable second level nurses to undertake care under the direction of a first levelregistered nurse, but do not imply an immutable limit on the practice of second levelregistered nurses. The second level standards of proficiency provide opportunities forthese registrants to: assist in carrying out comprehensive observation of the patient and help inassessing their care requirements develop skills to enable them to assist in the implementation of nursing care underthe direction of a person registered as a first level nurse accept delegated nursing tasks assist in reviewing the effectiveness of the care provided work in a team with other nurses, and with medical and para-medical staff andsocial workers related to the care of the particular type of patient with whom theyare likely to come into contact when registered at this level of the nurses’ part of theregister. The standards of proficiency must have been achieved within the contextof the area of practice in which the student has qualified.Rules, standards and guidanceRules are established through legislation and they provide the legal strategic frameworkfrom which the NMC develops standards. The standards support the rules being putinto practice. The standards are mandatory and gain their authority from the legislation,in this case the Order and the rules. The guidance is provided by the NMC to enableinterpretation of the rules and standards, supporting their implementation.5
All of the content of the standards in this booklet has either been consulted on, inaccordance with article 3(14) of the Order, or has been transferred from previous rules,standards and guidance. Where appropriate, terminology has been updated to bring it inline with the requirements of the Order.The standards reflect the requirements of the European Community (EC) SecondNursing Directive 77/453/EEC (updated by 89/595/EEC) in relation to those intending toregister as adult nurses. Detailed information of such requirements is in Schedule 1 ofthe Registration Rules, and within Standard 6 in this booklet.The standards of proficiency should be read in conjunction with the Registration Rules,and the relevant Schedules to these rules. The relevant part of Rule 3, educationleading to registration and re-registration, is reproduced below:3 – (1) Where an approved programme of education leads to the award of aqualification listed in the Annex to the Nursing Directive or Midwifery Directive,it shall comply with the training requirements in articles 1 and 2 of the secondNursing Directive or articles 1 and 3 of the second Midwifery Directive (therequirements of which are reproduced in paragraphs 1, 2(b), 3, 4, A and B ofSchedule 1 and paragraphs 1, 2, 3, 4, A and B of Schedule 2).(2) The requirements for entry to an approved programme of education shallinclude the requirements of article 1.2(a) of the second Nursing Directive orarticle 1.2 of the second Midwifery Directive, (the requirements of which arereproduced in paragraph 2(a) of Schedule 1 and paragraph 2 of Schedule 2).Summary of the standards for pre-registration nursingThere are eight standards related to pre-registration nursing education. These coveradmission to, and continued participation in, educational programmes; the structure andnature of programmes and standards of proficiency. The standards, and the section ofthis document in which they may be found, are as follows:Standards for admission to, and continued participation in, pre-registrationnursing programmes: in Section 2Standard 1Age of entryStandard 2General entry requirements for admission to approvedpre-registration programmes for nursing education and entry tothe registerStandard 3Accreditation of prior (experiential) learning (AP(E)L)Standard 4Admission with advanced standingStandard 5Transfer with AP(E)L6
Standards for the structure and nature of pre-registration nursing programmes:in SectionStandard 6Structure and nature of educational programmesStandards of education to achieve the NMC standards of proficiency: inSection 4Standard 7First level nurses – nursing standards of education to achieve NMCstandards of proficiencyStandard 8Second level nurses – nursing standards of proficiency7
Section 2 – Standards for admission to, and continuedparticipation in, pre-registration nursing programmesIntroductionThis section provides the standards and guidance related to admission to, andcontinued participation in, NMC approved pre-registration nursing programmes, inaccordance with Article 15(1)(b) of the Order, which requires the NMC from time to timeto establish:‘the requirements to be satisfied for admission to, and continued participation in,such education and training which may include requirements as to good health andgood character;’Standard 1 – Age of entryUK and overseas applicants, including from the EEA, must meet the Council’srequirements for age of entry. This is in keeping with the requirements of the EEA.StandardsThose entering a programme ofpre-registration nursing education at anapproved educational institution shall benot less than 17 years and six months ofage on the first day of the commencementof the programme.GuidanceThe current age of entry has beenagreed to comply with the completion ofsecondary education, which is set at17 years and six months in England,Wales and Northern Ireland and 17 yearsin Scotland.In exceptional circumstances, and relatedto specific programmes, the Council mayagree to an earlier age of entry, but thismay not be less than 17 years of age.The minimum age is in keeping withthe European Directive 77/453/EEC,applicable to those following the adultbranch, that states that applicants musthave completed secondary schooleducation, and be able to show that theyhave acquired the relevant qualificationsbefore entering a nursing educationprogramme (see Standard 6). The NMC isrequired to comply with the EC Directivesas they change from time to time.8
Standard 2 – General entry requirements for admission to approvedpre-registration programmes for nursing education and entry to theregisterUK and overseas applicants, including from the EEA, must meet the Council’s generalentry requirements for literacy, numeracy, good health and good character as shall fromtime to time be determined. Approved educational institutions shall set the educationalrequirements for entry and these should be comparable to entry to other diploma ofhigher education programmes or meet an institution’s requirements for non-standardentrants. Approved educational institutions and their service partners must havesystems in place that can be quality assured by the NMC, to satisfy the NMC thatapplicants meet the following requirements:StandardsLiteracy and numeracyGuidanceLiteracy and numeracyApproved educational institutions arerequired to ensure that applicants forpre-registration education have providedevidence of literacy and numeracysufficient to undertake nursing educationand practice at a minimum of diploma ofhigher education level.Evidence of literacy and numeracy maybe deduced from academic or vocationalqualifications, through evidence tomeet key skills abilities, or throughthe approved educational institutions’own processes, which may includeportfolios or tests for those without formalqualifications.bThe NMC requires access to informationabout, and evidence of application of, thesystems and policies developed to assessliteracy and numeracy of applicantsto nursing pre-registration educationprogrammes for quality assurancepurposes.Applicants to pre-registration programmeswho hold an existing NMC registrationmay be deemed to have met the Council’srequirements at their initial registration.Where the International English LanguageTesting System (IELTS) is offeredas evidencec, programme providersshould apply the NMC requirements foroverseas applicants to the register. Forthese applicants, the NMC accepts theIELTS examination (academic or generalversion) with an overall score of 6.5 andnot less than 5.5 in any one section.The NMC requirements are to ensure,in the interests of public protection, thatentrants to pre-registration programmeshave a foundation of literacy andnumeracy skills from which to develop, forexample, proficiency in communicationdand drug calculation skills relevant toprofessional requirements.Approved educational institutionsare entitled to set their own specificeducational entry requirements.bThese examples are for guidance only, approved educational institutions have the right to set their ownstandards but must satisfy the NMC that there is sufficient evidence to meet its requirementscThis would only apply to overseas applicants outside of the EEAdThose wishing to practise in Wales must be able to demonstrate proficiency in the use of Welshlanguage where this is required9
Good health and good characterGood health and good characterApplicants must demonstrate that theyhave good healthe and good character,sufficient for safe and effective practiceas a nurse, on entry to, and for continuedparticipation in, programmes leading toregistration with the NMC.The NMC requires programme providersfto ensure that processes are in place forassessment of an applicant’s/student’sgood health and good character atadmission to, during, and on completion ofpre-registration nursing programmes.Applicants must declare any conviction orcaution related to criminal offences thatthey might hold.Such processes may involve acombination of self-assessment healthquestionnaires, self-declaration of goodcharacter, routine health screening,occupational health assessment,character references, Criminal RecordBureau checks and other measuresagreed between the programmeproviders.Approved educational institutions shallobtain evidence of the applicant’s goodhealth and good character as part oftheir selection, admission and ongoingmonitoring processes.Students who declare on applicationthat they have a disability should submita formal assessment of their conditionand specific needs, from a GP or othermedical or recognised authority, to therelevant Occupational Health department.The programme providers should applylocal policy in accordance with theDisability Discrimination Act 1995g8, forthe selection and recruitment of students/employees with disabilities. Whereappropriate, the institution’s studentsupport services should also be involved.The NMC would require evidence of howsuch students would be supported in bothacademic and practice environmentsto ensure safe and effective practicesufficient for future registration.eOverseas applicants must meet the good health and good character requirements as defined for UKapplicants and additionally those requirements set by the UK government for health care workers fromoverseasfThe approved educational institutions and their service partnersgAmended by the Special Educational Needs and Disability Act 20019 with effect from October 2004 Disability Discrimination Act 1995. The Stationery Office, Norwich, www.hmso.gov
Nursing, Midwifery and Health Visiting (UKCC) in April 2001, and by incorporating some content previously published in Statutory Instruments and Council policy. The publication Requirements for preregistration nursing programmes was revised in April 2002, following the establishment of the new Nursing and Midwifery Council
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