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NMC releases draft standards of proficiency for Nursing Associates

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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

Professional Regulation

NMC apologises after misleading Morecambe Bay investigators

Up to 19 babies and mothers died between 2004 and 2012 as a result of mistakes by staff.

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The regulator has apologised over how it handled a Fitness to Practice investigation.

The Nursing and Midwifery Council (NMC) has apologised over how it handled a Fitness to Practice (FtP) investigation following the tragic death of newborn Joshua Titcombe at Morecambe Bay.

The independent review by Verita was commissioned by the NMC after the Professional Standards Authority (PSA) raised concerns over how the regulator handled the fitness to practice investigation.

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The report was initially commissioned by Jeremy Hunt, the then Secretary of State for Health and Social Care, after up to 19 babies and mothers died at the hospital between 2004 and 2012 as a result of mistakes by the staff of its maternity unit.

Jackie Smith, the former Chief Executive and Registrar of the NMC, resigned on the eve of the PSA report.

‘Incorrect and misleading statements’.

Investigators highlighted concerns over a chronology that was submitted as evidence by Joshua’s parents. They commented that they regulator failed to include the chronology in the evidence gathering process and also failed to “consider and understand the significance of this evidence and its relevance to a central issue in the case.”

The NMC then went on to make “incorrect and misleading statements” to Joshua’s parents, the PSA and the Secretary of State for Health about how it handled and reviewed the chronology.

Verita also commented that the regulator failed to treated witnesses “with the respect and sensitivity they deserved”.

Investigator on to recommend that the “NMC should make it a priority to ensure that it treats families and patients with respect and is honest and open with them” and “ensure that Panel Chairs are fully briefed about the importance of showing respect to bereaved relatives, perhaps by using this example as a case study.”

The total cost of Verita’s report was £151,742.22.

‘I am very sorry’.

Andrea Sutcliffe CBE, the current NMC Chief Executive and Registrar, said: “Throughout these fitness to practise cases the way we treated Mr Titcombe and his family was unacceptable. Our actions made an awful situation much worse and I am very sorry for that. I am also very sorry that our communications with Mr Titcombe, the PSA and the Secretary of State for Health and Social Care contained incorrect and misleading information about our handling of this evidence.”

“This investigation highlights a number of failings at the NMC at that time. We did not properly understand the significance of this important piece of evidence, in particular to Mr Titcombe and his family, and we did not put it before the panel when we should have done. This reflected a culture at the NMC at that time that prioritised process over people.”

“Since the events at Morecambe Bay we have made significant changes, including much improved record keeping, the introduction of a new public support service, and additional training for panel members to help them better understand the needs of witnesses.

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Newsroom

Hospital charity launches Christmas gift appeal for patients

Those wishing to help the campaign can buy a gift or donate online.

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Send a smile

The Send a Smile with Santa campaign delivers presents to patients who are unable to celebrate Christmas at home.

A campaign to deliver more than 1,000 gifts for inpatients at the Norfolk and Norwich University Hospital on Christmas Day has begun.

The N&N Hospitals Charity’s Send a Smile with Santa campaign delivers presents donated by the public to patients, both young and old, who are unable to celebrate Christmas at home with their families.

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Those wishing to help the campaign can choose an item from our Send a Smile with Santa list on Amazon or make a donation which will be used exclusively to purchase a gift.

Donations can also be dropped off by Sunday 8 December at the West Atrium Inpatient reception, Cromer Hospital, the Archant offices on Rouen Road, Norwich, and Greater Anglian Norwich Railway Station Customer Service.

The charity says that any donated presents should remain unwrapped so staff can ensure that presents are individually tailored for each patient, as well as protecting against potential infection.

‘Overwhelmed by kindness’.

Prof Nancy Fontaine, NNUH Chief Nurse, said: “We were overwhelmed by the kindness of people last year and we were able to deliver a lovely present to each of our patients.

“Nobody wants to spend time in hospital, and Christmas is so often a special time for people to be with family, and this is why we like to do something to make it a little nicer for our patients.

“We really hope that the people of Norfolk will once again support our appeal and help put a smile of the faces of our patients during the festive period.”

Louise Cook, Head of Fundraising at NNUH, added: “We know from our patients how lovely and unexpected it is to receive a gift on Christmas Day. They don’t need to be expensive gifts – toiletries, puzzle books, chocolates or socks are always greatly received.

“We have heard from people who would like to donate a gift but are unable to get out, so we this year we have an Amazon Wish List with small items which can be purchased and will be delivered directly to us, or a JustGiving page where a donation can be made and we will use that to purchase a gift for a patient.”

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