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NMC releases draft standards of proficiency for Nursing Associates

Published on

by James M.
NMC releases draft standards of proficiency for Nursing Associates

The Nursing and Midwifery Council have released the draft standards of proficiency for Nursing Associates.

The Nursing and Midwifery Council (NMC) has publically released the working draft of the standards of proficiency for the new Nursing Associate role.

Spit into six domains the document includes guidance on medications administration, behavioural standards, educational guidelines and the appropriate use of the role.

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But, the document fails to address the issue of accountability and delegation saying only it will be addressed "elsewhere" and going on to say "the nurse will make a judgement about what can be delegated to the nursing associate and the degree of oversight and supervision required".


NMC Draft Standard of Proficiency for Nursing Associates

1: Accountable for practice

Nursing associates, as qualified and skilled registered professionals, recognise and work within the bounds of their competence and are responsible for their actions. They act in the best interests of people, putting them first and providing nursing care that is safe and compassionate. They use their knowledge and experience to make evidence based decisions and solve problems.

At the point of registration, the nursing associate will:

1.1  Understand and act in accordance with the NMC’s Code of professional standards of practice and behaviour for nursing associates to fulfil all registration requirements.

1.2  Understand and apply relevant legal and regulatory requirements, governance requirements, policies, and ethical frameworks and guidelines to all areas of practice.

1.3  Understand and apply the principles of candour, courage and transparency, recognising and reporting any situations, behaviours or errors that could result in poor outcomes of care and treatment.

1.4  Acknowledge and articulate the demands of professional practice and demonstrate how to recognise signs of vulnerability in themselves or their colleagues and the action required to minimise risks to health.

1.5  Understand the professional responsibility for adopting a healthy lifestyle and maintain a level of personal fitness and wellbeing required to meet people’s needs for mental and physical care.

1.6  Understand and explain the meaning of resilience and emotional intelligence, and their influence on an individual’s ability to provide care.

1.7  Demonstrate effective communication using a range of skills and strategies with colleagues and with people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges.

1.8  Demonstrate the skills required to develop, manage and maintain appropriate relationships with people, their families and carers and colleagues.

1.9  Provide and promote non-discriminatory, person centred and sensitive care at all times, reflect people’s values and beliefs, diverse backgrounds, cultural characteristics, needs, and preferences, taking account of any necessary reasonable adjustments for people with disabilities.

1.10  Recognise and report external factors that may unduly influence care provision.

1.11  Demonstrate the literacy, digital literacy, technological literacy and numeracy skills required to ensure safe and effective practice.

1.12  Describe the principles of research and how research findings are used to inform evidence based practice.

1.13  Take responsibility for the continuous development of their professional knowledge and skills, seeking and responding to support and feedback.

1.14  Act as an ambassador for the nursing associate role and promote public confidence in health and care services.

2: Promoting health

Nursing associates play a key role under the delegation and supervision of a registered nurse in supporting the registered nurse and contributing to the agreed care plan to help individuals manage and improve their own health and wellbeing in the settings in which they work.

At the point of registration, the nursing associate will:

2.1  Understand the aims and principles of prevention of ill health, health improvement and promotion and contribute to the delivery of planned care for individuals, and families.

2.2  Be able to explain preventive health behaviours to people to help them make lifestyle choices to improve their mental, physical, cognitive and behavioural health and wellbeing.

2.3  Explain why health screening is important and identify those who are eligible for screening.

2.4  Have an awareness of genomics and how this may influence health and care.

2.5  Describe the contribution of social influences, health literacy, individual circumstances, behaviours and lifestyle choices throughout the life cycle, to health outcomes and explain how they shape an individual’s ability to achieve mental and physical health and wellbeing.

2.6  Understand the principles of immunisation and vaccination when engaging with individuals and families to promote health and avoid ill health.

2.7  Understand and apply the principles of infection prevention and control, antimicrobial resistance and communicable disease surveillance to help individuals avoid ill health.

3: Provide and monitor care

Nursing associates provide evidence based, compassionate and safe interventions, care and support to people in a range of care settings, in line with the care plan constructed by the registered nurse. They monitor the condition and health needs of people within their care on a continual basis in partnership with people, families, and carers and are able to recognise when a person’s condition has unexpectedly changed and where it is necessary to proactively refer to the registered nurse for reassessment and adaptation of the care plan. They demonstrate an understanding of when to seek expert help and advice to solve problems or achieve better outcomes of care.

In situations assessed by the registered nurse, to be of greater risk and complexity, they provide care in partnership with, and under more direct supervision of other registered professionals.

At the point of registration, the nursing associate will:

3.1  Have a basic understanding of human development from conception to death, to enable delivery of person centred care safely.

3.2  Demonstrate and apply an understanding of what is important to people and how their needs for dignity, privacy, sleep, safety and comfort can be met, and know when to refer to the registered nurse for expert help and advice.

3.3  Work in partnership with people, to encourage shared decision making, in order to support individuals and their families and carers to manage their own care when appropriate.

3.4  Demonstrate the knowledge, communication and relationship management skills required to provide people, families and carers with accurate information that meets their needs before, during and after a range of interventions.

3.5  Demonstrate the knowledge, skills and ability required to provide compassionate care in order to meet people’s needs related to nutrition, hydration and elimination in line with the care plan developed by the registered nurse.

3.6  Demonstrate the knowledge, skills and ability to act as required to meet people’s needs related to mobility, hygiene, oral care, wound care and skin integrity in line with the care plan developed by the registered nurse. Demonstrate knowledge of when to escalate to the registered nurse for expert help and advice.

3.7  Demonstrate the knowledge and skills required to support people with a range of mental health, behavioural, cognitive and learning challenges and physical symptoms including anxiety, confusion and pain, escalating appropriately to others where review or change in the nursing care plan is indicated.

3.8  Demonstrate the ability to deliver sensitive and compassionate end of life care, information and support for people who are dying, families, carers, the deceased and others who are bereaved.

3.9  Demonstrate the ability to recognise, promptly respond to and accurately record the signs of deterioration or distress in mental, physical, cognitive and behavioural health, and escalate appropriately to others where a change in care plan or treatment may be required.

3.10  Demonstrate the knowledge and ability to perform a range of nursing procedures and manage devices, in accordance with their proven competence, to meet people’s needs for effective interventions and person centred care.

3.11  Understand the principles underpinning first aid procedures and immediate life support, and demonstrate the ability to perform these effectively.

3.12  Demonstrate the principles of safe and effective optimisation and administration of medications. Recognise signs of allergy, drug sensitivity and adverse reaction.

3.13  Understand the different mechanisms whereby medicines can be prescribed.

3.14  Demonstrate the ability to safely administer specified medications by a variety of different routes, for example inhalation, topical, oral, subcutaneous, per rectum)1

3.15  Demonstrate the ability to work in partnership with people, families and carers to continuously monitor the effectiveness of all agreed nursing care plans. Document progress and report outcomes to the registered nurse or wider multidisciplinary team who can make decisions and readjust goals as necessary, in partnership with those receiving care.

3.16  Understand and apply the principles underpinning partnership in care, allowing people to share in decision making about how care is delivered, for them to participate in self-care.

3.17  Demonstrate the ability to recognise changes in a person’s capacity which might affect their ability to continue to make sound decisions about their own care and to give or withhold consent. Where people do not have capacity, understand where and how to seek guidance and support from others to ensure that the best interests of those receiving care are upheld.

3.18  Recognise the signs of deterioration in relation to mental distress, vulnerability and physical symptoms and understand how these could be anticipated. Know what immediate actions to take in order to reduce the risk of harm to the person and others and when and how to seek further support.

3.19  Undertake basic health monitoring, in order to ascertain when a person’s condition has deviated from their normal condition. Interpret and share findings as needed and seek advice when reassessment, care plan review, or intervention(s) may be required. Medication administration routes to be considered as part of the consultation.

3.20  Demonstrate an understanding of co-morbidities and the demands of meeting people’s needs when prioritising care delivery.

3.21  Demonstrate knowledge of when and how to refer people safely to other health and care professionals and how to escalate concerns where there is a risk to patient safety or public protection.

3.22  Demonstrate and apply knowledge of body systems and homeostasis, human anatomy and physiology, pharmacology, social and behavioural sciences, in order to continuously monitor a person’s condition. The nursing associate will ensure the ongoing applicability of the nursing care plan to identify whether a further assessment of the person and a care plan review by the registered nurse is required.

3.23  Recognise commonly encountered biomedical, mental, physical, cognitive and behavioural health conditions to determine the ongoing applicability of the care plan, and identify whether a further assessment of the individual and care plan review by the registered nurse is required.

3.24  Recognise people at risk of harm and situations that may put themselves and others at risk. Take personal responsibility to ensure that relevant information is shared according to local policy and that appropriate action is taken to provide adequate safeguarding.

4: Working in teams

Nursing associates are members of multidisciplinary teams which may include a range of registered health and care professionals of other disciplines, unregistered workers from the health sector or other sectors, volunteers and lay carers. They work predominantly with registered nurses who are responsible for delegating appropriately to them. They play an active role in the multidisciplinary team, collaborating and communicating effectively with a range of colleagues.

At the point of registration, the nursing associate will:

4.1  Understand and describe ways in which they can improve their own personal performance and the quality of care they provide.

4.2  Understand and explain the roles, responsibilities and scope of practice of all members of the nursing and multidisciplinary team, the four fields of nursing and their role within it.

4.3  Demonstrate an ability to support and motivate other members of the care team and interact confidently with them.

4.4  Effectively and responsibly access, input, share and apply information and data using a range methods including digital technologies within multidisciplinary teams.

4.5  Demonstrate an ability to prioritise and manage their own workload, and recognise where elements of care can safely be delegated to other non-registered colleagues, carers and family members.

4.6  When a nursing associate has delegated aspects of care to others, demonstrate the ability to monitor and review the quality of care delivered, provide challenge and constructive feedback.

4.7  Support and coach nursing associate students, health care support workers and those new to care roles, appraising the quality of the care they provide, promoting reflection and providing constructive feedback.

4.8  Contribute to team reflection activities, to promote improvements in practice and services.

4.9  Discuss the influence of policy and political drivers that impact health and care provision.

5: Improving safety and quality of care

Nursing associates ensure that risks are identified, quality of care is continuously monitored, and people’s experience of care is continually improved, putting the best interests, needs and preferences of people first.

At the point of registration, the nursing associate will:

5.1  Participate in data collection to support audit activity, and contribute to the implementation of quality improvement strategies.

5.2  Demonstrate the ability to work with people, their families, carers and colleagues, implementing any improvement strategies, sharing feedback and taking time to reflect on their practice, learning from mistakes, contributing to incident reviews, adverse events and positive experiences.

5.3  Accurately undertake risk assessments, using established assessment and improvement tools.

5.4  Understand and apply the principles of health and safety regulations in maintaining safe work and care environments, identifying the need to make improvements and proactively responding to, and escalating, potential hazards.

5.5  Recognise inadequate staffing levels and escalate concerns appropriately.

5.6  Understand and act in line with local and national organisational frameworks, legislation and regulations to assess, manage and report risks, and implement actions as instructed, following up and escalating as required.

5.7  Understand what constitutes a near miss, a critical incident, a major incident and a serious adverse event.

5.8  Understand when to seek more senior advice to manage a risk appropriately to avoid compromising quality of care and health outcomes.

5.9  Recognise uncertainty, and demonstrate an awareness of strategies to develop resilience in themselves and how to seek support to help deal with uncertain situations.

5.10  Understand their own role and the roles of all other staff at different levels of experience and seniority, in the event of a major incident.

6: Contributing to integrated care

Nursing associates contribute to the provision of care for people, including those with complex needs. They understand the roles of a range of professionals and carers from other organisations and settings who may be participating in the care of a person and their family, and the responsibilities in relation to communication and collaboration.

At the point of registration, the nursing associate will:

6.1  Explain the roles of the different providers of health and care. Demonstrate the ability to work collaboratively and in partnership with professionals from different agencies in multidisciplinary teams.

6.2  Understand and explore the challenges of providing safe nursing care for people with complex co-morbidities and multiple care needs.

6.3  Demonstrate an understanding of the complexities of managing the provision of mental, cognitive, behavioural and physical care needs across a wide range of care settings.

6.4  Demonstrate an understanding of their own role and contribution, and the issues which require management by themselves and others, when involved in the care of a person who is undergoing a transition of care between professionals, settings and services.

6.5  Be able to identify when people need help to facilitate their right to equal access to care, support and report concerns appropriately.

6.6  Demonstrate ways of supporting people and families to maintain their independence and to avoid unnecessary interventions and disruptions to their lives. 

You can view the complete draft document here

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Nursing & Midwifery Council

NMC launches consultation on proposed standards for nursing associates

Under the plans nursing associates would also be subject to the same revalidation requirements as nurses and midwives when renewing their registration with the NMC as well as the same fitness to practise processes should something go wrong.

Published on

by Matt Bodell.
NMC launches consultation on proposed standards for nursing associates

The Nursing and Midwifery Council has announced the launch of the consultation the proposed approach to the regulation of nursing associates.

The Nursing and Midwifery Council (NMC) have outlined an approach to education including ambitious standards of proficiency for the role that will enable nursing associates to deliver first-class care.

According to Health Education England (HEE), the Nursing Associate role is a new support role which will sit alongside existing healthcare support workers and fully-qualified registered nurses to deliver hands-on care for patients. The role is designed to bridge the gap between healthcare assistants (HCAs) and registered nurses.

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2,000 trainee nursing associates are currently just over half-way through their two-year training programmes to become registered nursing associates and HEE has announced 45,000 extra places before 2027.

The NMC has set out how they expect the existing Code, with a new introduction, to apply to nursing associates as well as nurses and midwives, ensuring that the same high standards of professional behaviour and conduct will apply to everyone on the register.

NMC launches consultation on proposed standards for nursing associatesJackie Smith Chief Executive and Registrar of the NMC said: “This is a hugely exciting step on the road to regulation for this new profession and we want to hear the views of all those with an interest in the role.

“We think that our proposals will ensure that nursing associates are equipped with the skills they need to deliver excellent patient care and to support registered nurses and other health and care professionals throughout their careers.”

Under the plans nursing associates would also be subject to the same revalidation requirements as nurses and midwives when renewing their registration with the NMC as well as the same fitness to practise processes should something go wrong.

Over the coming weeks, the NMC will be holding workshops across the country for trainees, registered nurses, employers, patients and the public. There will also be regular twitter chats and webinars with lots of opportunities for people to learn more about what regulation means for the new role and share their views.

The Consultation on the regulation of a new profession will run until 2nd July 2018.

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Nursing associates set to administer medications under PGDs

Published on

by James M.
Nursing associates set to administer medications under PGDs

Health Education England recommends that nursing associates be allowed to administer medications under patient group directions.

New medicines advisory guidance by Health Education England (HEE) has revealed that nursing associates should be allowed to administer medications without a specific patient-named prescription under patient group directions.

The news comes only days after the Nursing and Midwifery Council (NMC) revealed a list of clinical skills nursing associates should be competent in.

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What is a PGD? Patient Group Directions (PGDs) currently allow nurses to supply and administer prescription-only medicines (POMs) to patients using their own assessment of patient need, without necessarily referring back to a doctor for an individual prescription.

Nursing associates set to administer medications under PGDs

PGDs are used in both primary and secondary care settings, usually by nurses or pharmacists, for commonly used medications that pose a low clinical risk to patients.

Commonly included medications include; paracetamol, flu vaccinations, salbutamol nebulisation, oxygen, peptic and various laxatives - but included medications are dependent on the area of clinical practice and the scope of the practitioner.

Currently, Nursing Associates, as a new profession, are not on the list of professions lawfully allowed to administer medicines under a PGD but HEE guidelines say this is likely to change.

In the document from Health Education England they state;

Providers consider Nursing Associates should be able to administer some medicines under PGDs as this would be advantageous to patient care without compromising on safety.

Once regulated, a Case of Need15 would need to be made by NHS England through the Department of Health Non-Medical Prescribing Board, to seek agreement from Ministers for a public consultation.

HEE added however that nursing associates cannot be added to the approved list until they formally become a regulated role and a public consultation should need to first take place.

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NMC reveals 90 skills nursing associates should be trained in

Published on

by James M.
NMC reveals 90 skills nursing associates should be trained in

The Nursing and Midwifery Council has unveiled a list of ninety skills that nursing associates should be trained in.

The NMC's draft skills annexe contains around 30 communication skills and 60 clinical procedures, including medicines management, drug calculations, and clinical assessment skills that nursing associates should be competent in.

2,000 trainee nursing associates are currently half-way through their two-year training programmes to become registered nursing associates.

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In October 2017, the NMC released the draft standards of proficiency for nursing associates which will work alongside the annexe.

NMC reveals 90 skills nursing associates should be trained in

According to Health Education England (HEE), the controversial new role is intended to act as a bridge between healthcare assistants and registered staff. HEE has plans to train a further 45,000 nursing associates before 2027.

The list of skills include;

  • Manage the administration of oxygen.
  • Use appropriate nasal and oral suctioning techniques.
  • Manage inhalation, humidifier and nebuliser devices.
  • Manage airway and respiratory equipment.
  • Carry out drug calculations for a range of medications.
  • Administer drugs via oral, enteral, topical and inhalation routes.
  • Administer injections using subcutaneous and intradermal routes.
  • Observe and reassess a patients' skin and hygiene status.
  • Manage catheters for both genders.
  • Provide stoma care.
  • Recording and interpreting vital signs.
  • Complete and interpret urinalysis results.
  • Complete and interpret blood glucose results.
  • Undertaking venepuncture and cannulation.
  • ECG recording.
  • Administer basic mental health and physical first aid.
  • Undertake wound care using aseptic techniques.
  • Appropriate escalation of clinical concerns.
  • Understand 'DNACPR' decisions and verification of expected deaths.

Other skills include the management of end of life care patients, infection prevention and management, managing falls and supporting nutrition, hydration and sleep and providing holistic care.

Finally, nursing associates will be expected to have a knowledge of common conditions including anxiety, depression, diabetes, dementia, asthma, cardiac disease, chronic obstructive pulmonary disease, cancer, skin problems, immune deficiencies, psychosis, stroke and arthritis.

The NMC has reiterated that these are draft plans and remain subject to change - a new version for consultation is expected in April 2018

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