The big story: Raising standards for students

By Juliette Astrup on 25 May 2018 Student midwives NMC - Nursing and Midwifery Council Midwives Magazine

New NMC standards are set to usher in a new era of flexibility and local decision-making. What exactly is changing and how will it impact on midwives and students?

The NMC is midway through a radical overhaul of its education programme for midwifery and nursing. As Midwives went to press, the NMC was set to launch new standards of proficiency for nurses, and of education and training for midwives and nurses.

While work is still underway to develop new standards of proficiency for midwives, these education standards have already heralded an important new direction.

Flexibility and Innovation

The new framework for midwifery and nursing education, and standards for student supervision and assessment, are outcome-focused and provide flexibility to allow for local innovation.

Geraldine Walters, NMC director of education, standards and policy, says: ‘This is about trying to take away the process requirements on the regulatory side, which are seen as old-fashioned and restrictive. We want the right outcomes, but we don’t want to be so prescriptive about how people get to those – one size doesn’t fit all.

‘We are trying to modernise our approach, to allow people to make their own services easier to run and their own practice environment easier to manage.’

The uncoupling of assessment and supervision, and an end to the role of sign-off mentor is a major move.

Now, new ‘practice supervisors’ will provide a student’s day-to-day support and training, and ‘practice assessors’, drawing on feedback from those supervisors, will make the final assessment.

This separation is designed to address, among other things, concerns about ‘failing to fail’ students – those who don’t reach sufficient levels of clinical competence but are passed anyway – an issue that can arise when mentors’ close relationship working alongside students impairs their ability to be objective.

Practice Supervisors

Formal supervision under the new regulations is likely to be shared among a wider pool of people.

Carmel Lloyd, RCM head of education and learning, explains: ‘The requirement that they work with a named mentor for a minimum period of time isn’t stated in the new standards.

‘What you will have on the ground is midwives on registration also becoming supervisors. We are anxious about NQMs still trying to build their own confidence and taking on a student.’

Jacqueline Williams, the NMC’s interim senior midwifery advisor, says: ‘Organisations will be able to make their own decisions on when midwives become supervisors. All supervisors and assessors will need some preparation, but that can be locally determined.

Continuity and Support

Concerns have already been raised that, without a named practice supervisor, there will be less continuity and a greater risk of students falling through the net.

The new standards specify that there should be ‘sufficient coordination and continuity of support and supervision of students to ensure safe and effective learning experiences’. But what that means will again be determined locally.

Geraldine foresees that placements could be organised on the basis of individual midwives, who may be ‘confident of supervising certain skills but not others’.

In keeping with the new flexible approach, practice assessors will no longer be required to complete an NMC-approved preparation programme.

Carmel says: ‘Our concern is that areas that haven’t been so good at providing mentorship will, with less restriction and standardisation, be more at risk of not putting in place adequate supervision and assessment arrangements.

While any change is controversial, the NMC is confident this is the right response to the concerns raised under the old system.

‘This gives people more freedom, not less,’ says Geraldine. ‘I would expect organisations to organise their supervision and assessment to make them more bespoke and fit for purpose, not trying to shoehorn them into rules established for everybody.’

Until the new standards of proficiency for midwives are launched, expected to be in 2020, Geraldine says the door has been left open on the education standards ‘in case a different approach is required in the midwife proficiencies’.

The New Supervisor And Assessor Roles

Supervisors

• Supervisors are registered health and social care professionals who will serve as role models for safe and effective practice. They will also support learning in line with their scope of practice.
• They will engage with practice assessors and academic assessors to share relevant observations on students’ conduct, proficiency and achievement.
• They are expected to appropriately raise and respond to student conduct and competence concerns and should be supported in doing so.

Assessors

• Assessors are NMC-registered midwives who have been suitably prepared and receive ongoing support to perform their role.
• They are not permitted to be simultaneously a practice supervisor or academic assessor for the same student.
• They will assess and confirm the achievement of student learning in line with the NMC’s programme-learning outcomes and standards of proficiency.

Credit: iStock/Sarah Auld