It has been 18 years since the Nursing and Midwifery Council (NMC) updated the Standards of Proficiency for Specialist Community Public Health Nursing (NMC, 2004). These standards identified 10 fundamental principles of public health practice. They were grouped into four domains: the search for health needs, stimulation of awareness of health needs, influence on policies affecting health and facilitation of health-enhancing activities (NMC, 2004).
The new Specialist Community Public Health Nurse (SCPHN) Standards for Proficiency (NMC, 2022) highlight the importance of meeting 21st-century health needs while understanding the determinants of health and seeking to address health inequalities across communities locally and nationally.
In recognising that public health nurses play a crucial role in safeguarding those who are most vulnerable in society (Institute of Health Visiting, 2024), the requirement was to embed Public Health England (PHE) guidance, Health Visiting and School Nursing Service Delivery Model (2020) and Working Together to Safeguard Children (2022) throughout our new SCPHN programme.
Organisation
Our SCPH team consisted of an academic portfolio lead, a programme leader, a senior teaching fellow and a school nurse lecturer practitioner who played a crucial role in shaping the school nursing component of the programme.
Our SCPHN team spent many weeks exploring the meaning behind each standard and considering how this could be incorporated into the curriculum. Meetings were scheduled whenever we found gaps in our day, ranging from 2-hour sessions to full-day gatherings. We often worked outside of regular hours to complete the tasks, especially when the document submission deadline was fast approaching.
The team shared three potential dates for the approval event with the NMC. We allowed ourselves plenty of time to complete the work, which started in June 2022 until the submission date of March 2023.
The new standards of proficiency
During discussions with NMC representatives, they emphasised that our new programme must be entirely distinct from the old one and should not bear any resemblance. As we contemplated where to begin, we concluded that mapping our current programme against the new standards would be the most appropriate starting point.
The mapping allowed us to understand the spheres and proficiencies that needed to be addressed in the new curriculum. We decided each team member would take on a specific aspect of the work, which they would later bring back to the broader team for further development. For example, one team member conducted the initial mapping of our old programme standards against the new standards so we could identify the areas that required further development.
Another team member designed the Practice Assessment Documents to incorporate discipline-specific proficiencies for the health visiting and school nursing programmes. Each team member took ownership by developing individual modules. Although we all had tasks to undertake, it remained a team effort through the regular meetings where we shared knowledge and expertise in each area.
Curriculum development
The new standards allowed us to adopt a less prescriptive approach in developing the new SCPHN programme as long as we could justify the balance of theory and practice learning. The SCPHN team had to consider that our programme would be undertaken at postgraduate level, so we needed to ensure that potential students were appropriately prepared to study at level 7. Therefore, we developed a 10-credit module focusing on academic literacy to prepare students for level 7 writing.
We identified specific aims and defined learning outcomes for our SCPHN programmes directly linked to the new standards. The curriculum integrated the study of health, policy, research, and evidence-based practice related to health visiting and school nursing within the public health context.
In designing the curriculum, we also wanted to enable students to access a range of teaching and learning approaches. The curriculum aimed to enhance the development of students critical thinking and reflective skills while maintaining a caring and compassionate approach to their practice.
The team embraced the prospect of designing a year-long curriculum that removed unnecessary stressors, balanced the academic and practice workload, and promoted a learning environment that supported the student's health and wellbeing.
Module development
Based on the programme learning outcomes, over the following weeks we worked on developing the modules at level 7, ensuring they aligned with the new standards and remained based around the Healthy Child Programme (Department of Health (DH), 2009a; 2009b), the ethos of the Health Visiting and School Nursing Service Delivery Model (PHE, 2021).
The team reviewed the NMC (2022) standards to identify which proficiencies could be met in practice and which could be linked to university-based learning experiences. Modules such as research, leadership, safeguarding, and others were developed.
The curriculum was designed to include the state-of-the-art simulation suite, simulation at home residence, classrooms, and clinic rooms. However, when the NMC representative highlighted that all standards needed to be met in practice, we had to revisit our initial plan and include all the proficiencies in the practice assessment documents. We considered appropriate assessments that would allow students to demonstrate their knowledge and understanding. Formative assessments would support students to practice their skills or test their knowledge before undertaking summative assessments.
Aligning with the university's policies, we determined the weighting and word count for assessments based on the number of credits for each module. At that point, we could share our draft programme with our stakeholders and service users to gather their ideas, opinions, and feedback on our proposals.
‘The stakeholders discussed various aspects, such as whether to include prescribing (V300) into the new programme’
Wider engagement
Stakeholder and service user engagement was crucial throughout the process. Service users included parents, grandparents and individuals who had contact with health visiting and school nursing services. Before meetings, we sent electronic links signposting to the new proficiency standards, allowing stakeholders/service users to review the information.
The SCPHN team held several meetings to discuss the role of health visitors and school nurses, and explore how the SCPHN programme could be shaped to meet the demands of the 21st century. Service user feedback was gathered using anonymous online tools such as Mentimeter, summarising their engagement.
We consulted with education leads, practice assessors and practice supervisors regarding developing the new curriculum. We explored each proficiency's meaning when applied to the practice setting and how students could achieve them. The stakeholders discussed various aspects, such as whether to include prescribing (V300) into the new programme, programme length, consolidated practice, supernumerary status, alternative practice days and the programme year planner.
Whether to include the V300 in the programme was an important topic of discussion, and stakeholders, service users, and students were consulted. Ultimately, it was decided (based on feedback) that the V300 would not be included.
We also explored the number of practice hours, potential areas for innovation, and how to incorporate digital technology into the programmes. Due to the NMC requiring a self-funded/self-employed pathway onto the SCPHN programme, the team explored this option with stakeholders to agree on a straightforward and transparent way to manage this. A simple flow chart was designed to demonstrate the path a self-funded/self-employed student would take to register for the programme.
Recognising the importance of the student's contribution, we contacted and engaged with our previous and current students to co-create the new curriculum. Based on student feedback, we made a conscious effort to provide opportunities for students to identify and reflect on factors that supported their well-being and how this could be managed throughout the programme. The SCPHN team carefully documented all the stakeholders, service users and student engagements as evidence of collaborative curriculum design and development.
Documentation
The SCPHN team decided the best course of action was to complete the numerous documentation requirements early. We jointly discussed and worked through the university's quality assurance documentation, which was an extensive piece of work. We produced a programme handbook, a practice assessment document for school nurses and health visitors, a student guide to practice, a practice assessor/supervisor guide and portfolio of evidence templates.
Collaborating with our school nurse lecturer practitioner, we developed a clear pathway for school nursing, ensuring the standards were addressed. We reviewed our documentation with the broader school team throughout the process, ensuring accuracy and consistency. We worked diligently to complete this important work, ensuring all evidence was included to meet the submission deadline of March 2023. To complete the required NMC online processes, we progressed through the gateway stages, focusing on the five standards for post-registration programmes outlined by the NMC.
We worked closely with the Faculty Quality Team, meeting with them before the NMC approval event. The SCPHN team were pleased to receive positive feedback that all documentation was clear, well-written, and of an excellent standard. In addition, we followed the guidance provided in the Quality Assurance Handbook and incorporated the standards of proficiency for education and training standards into our preparation.
We attended pre-meetings with the NMC to ensure we were ready for the approval event. These meetings reassured us that we were fully prepared and that the event would proceed smoothly.
Reflection
As nurses, we are well-versed in reflecting on our clinical practice, and this continues to apply to our teaching and learning activities (Advance HE, 2023), while the NMC (2019) encourages us to reflect on both positive and negative experiences.
Our work as a team to develop the new programme has been a significant and positive event. It has generated meaningful opportunities to reflect on our experience of the NMC approval process and how it has enhanced our ability to develop a new curriculum.
Based on our experience, we offer some tips for others embarking on a similar journey: start preparing early; organise regular meetings; utilise all team members to focus on different aspects for development; complete documentation early in the process; consider the student journey through the programme and provide evidence such as flow charts and guidance documents. In addition, align module learning outcomes with the proficiencies. Write in plain English ensuring each sentence is meaningful and proofread. Finally, attend all NMC meetings to stay updated on the standards.
Our efforts paid off, and the University of Greenwich achieved a successful NMC approval outcome in May 2023. We were unaware that we had joined a small number of universities that had successfully approved against the new standards at such an early stage.
The willingness and commitment shown by each member of the SCPHN team to prepare for the event was positive. We all worked hard to contribute to the development of the new programme.
This experience has allowed us to tell our story, hoping it will benefit academics facing their own NMC approval events in the coming months.