A review of practice learning requirements for nursing and midwifery students has revealed highly varied learning experiences and supervision, and calls for action to ensure high quality education.

罢丑颈蝉听聽we produced with health think tank the Nuffield Trust, was commissioned by the Nursing and Midwifery Council (NMC). The NMC wanted to better understand what contributes to effective practice learning across the UK and in other countries. This research signals a key juncture within the regulator鈥檚聽.

The report examined the evidence relating to regulations and standards around students鈥� practice learning. It investigated how well NMC requirements are being implemented, and the challenges in providing optimal practice learning placements for the next generation of nurses, midwives and nursing associates.

The authors analysed existing UK and international research; held workshops with policy leaders from across the UK nations; conducted focus groups with registered nurses and midwives, students, higher education staff and members of the public; and carried out interviews with strategic leaders in health and social care both within UK and internationally.

They found that the pressured environment of many practice learning placements 鈥� and varied interpretation and implementation of the standards for practice learning, which includes the number of learning hours and births 鈥� can jeopardise the effectiveness and consistency in students鈥� learning experience.

A lack of clear evidence, variation between countries and professions, and differing expert opinions also means it鈥檚 difficult to reach a clear agreement about what the revised level of assessments and practice hours should be. However, the report highlights a consensus that quality should outweigh the quantity of practice learning.

The report further identifies areas where the NMC, along with approved education institutions and their practice learning partners, can strengthen learning experiences for students across a range of practice settings. This includes greater communication around practice learning requirements, further research about the impact of simulated practice learning on student learning, greater support for educators, and an expansion of community-based placements.

The NMC will consider these findings alongside two other key areas of work. One is its聽. The other is evidence from its recent work to聽聽programmes which includes insights and themes around practice learning. The collective findings will inform recommendations and next steps which the NMC will bring to its Council meeting in January 2025.

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This comprehensive study, commissioned by the Nursing and Midwifery Council (NMC), shows that advanced nursing and midwifery talent is being lost within the health and social care system. The report, which includes survey responses from over 1,500 IENMs and multiple focus groups, provides detailed insight into the experiences of IENMs at various stages of their advanced practice journey in the UK.

It comes at a crucial time as the NMC develops approaches for the additional regulation of advanced practice (AP) for nurses and midwives. Findings show that internationally educated professionals struggle to have their expertise recognised, but regulatory changes could transform the landscape for nurses and midwives practising at an advanced level.

The research reveals that the health and social care system is missing opportunities to utilise its international talent: two-thirds of internationally educated nurses and midwives (IENMs) report that their AP experience goes unrecognised.

鈥淚 have previously done a master鈥檚 in nursing with modules in advanced leadership, advanced pathophysiology, research methods, curriculum design and documentation, dissertation, health assessment, and decision-making. Yet I am unable to use these as most advanced practice roles require a band experience and I have been unsuccessful in securing that so far. This is making me feel I am rusting away and not giving my best to patients and my trust.鈥�

Nurse who obtained an AP qualification in the Philippines, now working in London

The study also uncovered significant barriers for IENMs interested in practising at an advanced level, including financial constraints (70 percent), a lack of knowledge about the pathway (61 percent), and workplace discrimination (23 percent).

However, there is also compelling evidence of success when the right support systems are in place. Among IENMs who completed UK advanced practice education, 66 percent reported positive experiences. The research identified several key enablers: strong employer support (cited by 82 percent of nursing and midwifery advanced practitioners who completed their education programmes), dedicated funding, and flexible training routes such as the innovative ePortfolio pathway (for professionals in England).

Key findings from the research:

• Two-thirds of internationally educated advanced practitioners reported that their UK employer does not or only slightly recognises their AP skills.
• More than 60 percent of nursing and midwifery professionals with international AP qualifications and/or roles describe a lack of opportunities in the UK to maintain their AP skills.
• Knowledge amongst IENMs in the UK about becoming an advanced practitioner is generally low, with significant confusion over its definition and access pathways.
• A quarter of those interested in pursuing AP roles felt hindered in accessing this opportunity due to their visa or immigration status.
• The majority of IENMs who obtained an AP qualification in the UK reported positive experiences and equal access to training opportunities.
• However, nearly a quarter who became advanced practitioners in the UK experienced workplace discrimination and bias during their education programmes.
• Key enablers for those who accessed AP education or roles in the UK included employer support and funding, flexible training routes and programmes, and credentialing.

Next steps and recommendations

In light of the challenges, the study found strong support amongst IENMs (69 percent) for the NMC to take a stronger approach towards AP regulation. The report therefore recommends several actions:

• A consistent framework for assessing internationally acquired AP skills and experience, alongside flexible pathways to ensure international qualifications meet UK standards.
• Entry requirements for AP education programmes should be redesigned to focus on core competencies, with a review of language proficiency requirements to ensure appropriateness.
• Improving the transparency of qualification routes, including clear steps, timelines, and costs, and clarifying the responsibilities of universities and employers in supporting IENMs.
• Mentorship programmes and support networks should be implemented to support IENMs during their education. Ongoing professional development opportunities should be created to help IENMs maintain and update their AP skills, with cultural competence incorporated into any future AP framework.
• Employer guidelines should be developed to improve the experience of workplace integration for international AP professionals, and the implementation of anti-discrimination policies in health and care settings.

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The early recognition and treatment of deterioration in patients in clinical settings can help reduce avoidable deaths. NHS England recently commissioned 黑料视频 (FNF) to examine the barriers which prevent worries and concerns being raised about a deteriorating patient. Evidence suggests that organisational culture, professional hierarchies, and the nature of leadership in healthcare environments are the three key factors behind this reluctance. Our findings highlight the importance of psychological safety which is highly influenced by authentic leadership in overcoming these barriers.

Clinical staff often recognise deterioration in patients by using their intuition. This frequently involves them expressing worries and concerns about a patient based on a 鈥榞ut feeling.鈥� Since family members, non- clinical team members, health care assistants and nurses have more consistent, direct contact with patients they are often the best placed to raise or escalate any intuitively based concerns.

However, these groups often face barriers to raising or escalating these kinds of concerns. To better understand these, NHS England鈥檚 Acute Deterioration Board (ADB) convened a national 鈥淲orry and Concern鈥� Task and Finish Group (WCG). As part of this, the WCG and Nursing Directorate commissioned FNF to working in partnership with The Kings Fund to carry out a qualitative study with clinical staff, patients, family members and carers to understand their experiences of raising worries and concerns, and to identify interventions or actions that can be taken to address obstacles.

The findings highlight elements of the healthcare environment that influence the quality of the care delivered to the patient. Leadership that role models multi-disciplinary team working, values the expertise of all stakeholders, and champions person-centred practice can create a psychologically safe working culture. This culture creates an environment in which clinical staff, patients, carers, and family members feel confident and less hesitant in raising worries and concerns.

In healthcare environments where these characteristics are not present, staff training and development alongside access to, and the availability of feedback avenues can provide the right conditions for all to escalate concerns and improve patient safety.

Recommendations

1. Provide adequate avenues for feedback
2. Ensure closure of feedback loops
3. Promote and facilitate patient involvement in their own care
4. Provide and promote opportunities for patients, carers, and family members feedback
5. Provide and promote patient safety partner involvement
6. Provide training sessions for all clinical staff, relevant non-clinical staff, and students on detecting and escalating recurrent and major patient deterioration incidents
7. Prioritise staff wellbeing in healthcare environments
8. Empower newly registered staff and students practice
9. Commission further research to explore cultural background influences
10. Commission further research to explore generational differences
11. Commission further research to explore consultants鈥� perspectives.

Next steps

NHSE is now funding seven pilot sites 鈥� one in each region 鈥� to participate in a national Worry and Concern Improvement Collaborative. The collaborative aims to catalyse two changes:

1. The systematic incorporation of patient worry and concern into early warning and diagnostic tools; and
2. Contribution to a shift in culture and practice that empowers patients/families/carers to speak up about deterioration and clinicians to listen to and communicate more effectively about these matters.

FNF presented our research findings to these pilot sites to inform their implementation processes and we continue to be involved with the programme.

We will also be continuing to strengthen and grow our leadership development work, to support nurses and midwives to have the confidence and skills to speak out and share concerns.