A higher education institution's response to the NMC Standards for Student Supervision and Assessment

In 2018, the Nursing and Midwifery Council (NMC) launched its national Standards Framework for Nursing and Midwifery Education (NMC, 2018a). This prompted a suspension of the traditional model of mentorship in nursing and midwifery practice placements, and identified new roles to support students in academic and practice environments. The supplementary guidance, Part 2: Standards for Student Supervision and Assessment (SSSA), triggered a paradigm shift in the way individual students are supported in practice.

The traditional mentorship model, where one ‘sign-off mentor’ supports a given student for at least 40% of their placement time (NMC, 2008) was dissolved, with the vision that teaching and assessing students in their clinical practice placements became much more of a collaborative process between the newly identified roles of practice supervisor (PS), academic assessor (AA) and practice assessor (PA).

Perhaps the most significant modification brought about by the new standards is the preparation requirements for PSs and PAs. As opposed to the more prescriptive requirements, which specified prerequisite credit and non-credit bearing programmes to prepare qualified clinicians for the mentorship role, the SSSA (NMC, 2018b) delivers a more creative and flexible approach, stating PAs require ongoing support, sufficient time to develop and perform their role, whilst undertaking training as required.

There is evidence that nurses have mixed emotions in relation to the SSSA. For example, Pearce (2019) reported that educators felt the standards were designed for students and not them; and, more recently, Whaley et al (2023) debated the results from an evaluative survey which collated educators' views, suggesting there has been slow acclimatisation to new models of assessment and supervision with varying levels of preparation.

While the new standards ensure a collaborative approach to student training in practice placements, observations from specialist community public health nursing (SCPHN) are in keeping with Whaley et al's (2023) findings. Practice of PAs and PSs is not standardised, which has the potential to cause an inequitable student experience. As NMC registrants, we are all committed to quality assurance measures in nursing and midwifery training, whether working in clinical practice or education. Significant numbers of health visitors, school nurses and district nurses who held the community practice teacher qualification have retired or moved into different roles, particularly during or after the Covid-19 pandemic.

Additionally, there is a recognition that students working towards the SCPHN or specialist practice qualifications are required to practise with a high level of autonomy and leadership as key professionals working on the frontline of public health. The NMC Standards for Post Registration Practice (NMC, 2022) have been updated to consider the changes in healthcare, and the implications for those working in specialist practice. The Institute of Health Visiting (iHV) has expressed the view that clinicians working in a PA or PS role in health visiting need preparation which exceeds that required for supporting and assessing pre-registration nursing students. Nettleton (2021) comments:

In addition, Nettleton (2021) observes that the SSSA standards make no reference to the word ‘teach’, although the term ‘learning experience’ is inadequate in encapsulating the requirement for active teaching alongside supervision and assessment which is necessary for effective SCPHN and SPQ practice.

Thus, as an AEI, it was identified that additional learning activities were required to ensure practice partners felt supported and prepared in their role of practice assessor and practice supervisor, particularly considering the publication of the new Standards for Post Registration Practice (NMC, 2022). The importance of ensuring that students undertaking a SCPHN/SPQ qualification have effective and equitable placement experiences was also recognised. It is proposed that there is a role for higher education and AEIs in the wider context of professional practice ensuring that the role of specialist community practice teaching is not devalued and eradicated.

Since the withdrawal of the NMC Community Nursing Practice Teacher Standards (NMC, 2018), the practice teacher qualification has ceased to be offered by many HEIs in the UK and this has had a significant impact on the SPQ/SCHPN practice experience and preparation for the role. The Queen's Nursing Institute (QNI) reports a ‘dilution of the practice teacher role and, historically, limited recognition of this higher level of teaching in practice’ (QNI, 2023: 2). The QNI responded with the publication of its own Standards for Community Practice Teaching Education and Practice (QNI, 2023) which was welcomed by academics grappling with the post Covid-19 stabilisation of SCPHN/SPQ curriculum delivery.

These practice teaching standards make explicit the expectations required to support, supervise and assess a higher level of practice demonstrated by registered nurses and midwives who are completing an NMC-approved post-registration programme. There is recognition that practice assessors working with postgraduate nurses and midwives need to help prepare them to work autonomously and engage in complex decision-making, which by default implies that practice assessors and practice supervisors in these roles need robust support and professional development enabling them to successfully realise their responsibilities.

Following the publication of the QNI standards in January 2023, an HEI embarked on a process to enhance SCPHN students' learning encounters with regards to their supervision, teaching and assessment experiences in practice placements and to support practice partners in achieving this. It was important to engage all relevant clinicians as stakeholders in the mapping and design process, recognising that this was an enhancement of cross-disciplinary service provision which would have a positive impact on placement quality.

Currently, the SCPHN curriculum, which is approved against the NMC's (2004) Standards of Education for SCPHN Practice shares some theoretical module content with the district nursing students. Indeed, the Trust partnerships are entwined with SCPHN and district nursing students in many cases. Thus, it was essential that colleagues in district nursing teams across practice and HE were invited to be involved in the stakeholder engagement.

Towards the end of 2022, a Microsoft form questionnaire was circulated to all clinicians working in either a SCPHN (health visiting or school nursing) or SPQ (district nursing) who had a role (either directly or indirectly) in supporting students in their clinical placements. The consultation was extended to all of the seven NHS Trusts in which students enrolled on a SCPHN/SPQ post-qualifying programme are placed from the particular HEI. Respondents included clinical leads, students (past and present), and practitioners currently working in PA/PS roles. The results were analysed and presented at an online stakeholder co-design event, which outlined initial plans for the learning focus and activities in this new module of study. The multidisciplinary workshop aimed to shape the facilitation of an innovation in teaching and learning opportunities which would, ultimately, enhance the student placement experience.

Clinicians who completed the MS Form and who fed into the co-design workshop were from across the spectrum of key stakeholders and comprised of partner Trust colleagues (as outlined above) and key university colleagues, including multidisciplinary clinical academics.

Discussion focused on the aims of the module, whether the module should be accredited, the taught content and the method of assessment. There was considerable debate with regards to the module level; some felt that the nature of practice that SPQ/SCPHN students are engaged with meant it was necessary that a module aiming to support practice assessors was also pitched at level 7, providing the opportunity to complete an MSc award.

Others felt that offering a level 7 accredited module in order to ‘prepare’ practice assessors moved away from the philosophy of the NMC's (2018a; 2023) SSSA and could potentially be used as a barrier to students. This was articulated by one health visitor practitioner:

However, most stakeholders felt that it was essential that the proposed module was offered at level 7 and was accredited as part of continued professional development opportunities and a route towards achieving the full MSc.

The method of assessment was also a component that created significant discussion in the co-design workshop. Some clinicians felt that the proposed module should provide a teaching qualification recognised by the NMC, as the previous community practice teacher qualification had been. The discussion focused predominantly on the differences between specialist community practice nurse teaching and undergraduate nursing and midwifery practice teaching, acknowledging the specialist qualification and enhanced skill development. The competency and knowledge expected of newly qualified nurses and midwives have also been reviewed by the NMC. Newly qualified nurses are now assessed against seven key areas of proficiency, referred to as platforms, as the curriculum adheres to the Future Nurse Standards (NMC, 2018c). Similarly, newly qualified midwives are expected to achieve proficiencies against six domains with the Future Midwife Standards of Proficiency (NMC, 2019).

The new standards for pre-registration nursing and midwifery place a greater emphasis on leadership, evidence-based practice, multi-disciplinary working and scholarly activity as practitioners strive to understand and mitigate health and social inequalities. It could be argued that the NMC's vision is that registrants having completed the Future Nurse/Future Midwife curriculum are better prepared and enabled to embrace the philosophy of the Standards for Supervision and Assessment and the shift away from traditional mentorship.

Thus, the nurses and midwives enrolling on the SCPHN/SPQ postgraduate programmes should be better placed to develop their skills and expertise required for complex decision making and autonomy within multidisciplinary public health nursing. This awareness contributed towards the decision-making process with regards to the proposed modules summative assessment. The workshop offered insight relating to the proposed modules' indicative content. Feedback following the circulation of the MS Form indicated that practitioners valued a range of taught content deemed pertinent to their role as practice assessors for students undertaking the SCPHN/SPQ course. Figure 1 presents a diagrammatic representation of survey respondents views regarding the module indicative content.

Following the workshop, time was spent designing and planning the module content to include the module specification, indicative content, module learning outcomes and assessment criteria. Considering Nettleton's (2021) observations regarding the omission of the word ‘teach’ and the implications of the impact this deletion could have upon the concept of the practice assessor role, a conscious decision was made to capture the word in the module title. The summative assessment aims to ensure that the submission is meaningful and relevant to the clinician's continued professional development. At the end of the module, the student is required to submit a critical reflection focusing on their role in teaching and assessing students in practice and demonstrate via a Portfolio of Evidence how they have facilitated a lesson, provided constructive feedback, and evaluated the impact their teaching has had upon the student's development.

It is felt that this assessment is relevant in measuring the clinician's learning and engagement throughout the module and in gaging their professional skills in relation to teaching and assessing students within their placements. The module content is designed to facilitate work-related learning to ultimately enhance placement quality and to ensure equity in student experiences, both within and across NHS Trusts. Clinicians can utilise their transferable skills, and work towards the summative assessment alongside meeting their CPD revalidation requirements.

Clarke (2021: 713) acknowledges that ‘the NMC has adjusted its revalidation process to ensure it is positioned within a reflective discourse with other NMC registrants'. Thus, completing a piece of academic writing that allows the student to engage with a guided reflective discussion aims to develop the module participant's personage, subject knowledge and professional skill.

Time was spent exploring the wider literature in relation to the indicative content and the relevant evidence base. Almost 30 hours of lesson content has been developed, which has been delivered synchronously. To ensure that busy clinicians can access the module, the weekly taught sessions have been facilitated online via a virtual classroom. The module leader worked to develop an effective learning environment for the enrolled clinicians/students, making sure breakout rooms were incorporated for discussion and peer-to-peer feedback opportunities, recognising the social constructivist theory of learning. Additionally, informal and formal feedback was provided regarding the student's progress throughout the theory and their work towards the summative assessment. The students appreciated this learning community, as revealed by one of the enrolled clinicians:

The module Moodle page (online learning platform) is engaging and easy to navigate, with a wealth of resources designed to enhance the student's knowledge and skills. For example, the NMC social media platforms are embedded to help ensure students have an interactive page with which to share their resources and ideas while remaining up to date with the most recent guidance from the professional body.

This is crucial in helping to facilitate underpinning knowledge and information in relation to professional role in a fast-paced changing policy landscape. The external examiner reviewed the module and the Moodle page prior to the first cohort delivery and provided positive feedback:

For some of the enrolled clinicians this was their first exposure to level 7 writing, and perhaps their first engagement with taught theoretical sessions and assessment in a university setting for many years. As the module progressed, it was apparent through informal feedback that the students were apprehensive about getting started with their writing. Thus, during the last week of timetabled content, a ‘writing hour’ was offered. This was a virtual space with one instruction: ‘Do not get it right, get it written’ (Wellington et al, 2005: 44).

The writing hour used the Pomodoro technique, providing the students with permission to just write, making a start with putting their thoughts on to paper, which could then be re-worked and edited with fresh eyes. The content has evaluated well. When asked what the best aspect of the module was, one participant answered:

The enrolled clinicians now feel more prepared in their role of teaching and assessing students in clinical practice placements. As more and more clinicians from partnering Trusts complete the module, it is anticipated that practitioners working primarily in post-qualifying healthcare practice will feel more confident in the role of either PS/PA, incorporating the NMC Standards and the Standards of Proficiency for Post Qualifying Practice.