Recommendations

Given that one of the overarching aims of this project focused on the way in which the two key stakeholders, the NHS and HEIs worked in partnership to deliver Fitness For Practice programmes in Scotland, it is anticipated that these recommendations will be considered in a collaborative way. They have been organised around major themes in the report. Although the findings of this study are specific to a Scotland context many may resonate with practice in England, Ireland and Wales.

Preparation for Practice

1. Consideration should be given to a revised definition of fitness for practice with equivalent meaning for all stakeholders.

2. Given the NMC's emphasis on ‘character’, further thought and research should be devoted to the core values and attitudes (and altruistic behaviour) which should characterise good nursing and midwifery practice in the modern context.

3. Recruitment and selection approaches should ensure that, if possible, potential entrants are not lost to the profession by reason of competition for places.

4. Opportunities to practice drug administration vary considerably across programmes. Work should be done to determine the optimal preparation in this important respect, bearing in mind the key risk management principles.

5. Further work is needed on policies regarding recruitment and testing of students to detect problems in the skills in basic arithmetic operations necessary for midwifery and nursing practice. Work is also needed on the most effective means of improving and maintaining these skills.

6. Acknowledgement should be given to excellent work in Scotland in relation to assessment and development of numeracy skills in both nursing and midwifery education.

7. The extent to which students’ peers offer important support should be more formally investigated and recognised.

8. Work needs to be undertaken to ensure that the provision of education in responding to the needs of the increasingly ethnically diverse community develops consistently to meet local needs.

9. Whilst some good practice exists, opportunities to involve carers and users in the planning and delivery of education could be further exploited, but greater thought needs to be given to proper reward and remuneration or support for this.

10. A more explicit linking of self-management and self-care to carer and service user involvement should be considered for development as a core module in new curricula.

11. Consideration should be given to evaluating how the current provision of simulated clinical learning will be developed in response to the NMC guidance on inclusion in assessment of clinical practice, in particular given the very varied opportunities for students across the different HEIs in relation to access of high quality provision.

12. Consideration should be given to the rationale and differences in non-traditional skill acquisition, such as venepuncture, between nursing and midwifery professions.

Being in Practice

13. Care should be taken not to confuse an apparent lack of confidence in some newly qualified practitioners with a lack of competence, where this is, in fact, self-

awareness of accountability.

14. There remains a need to evaluate the current clinical learning experiences fully in terms of balance, length and quality. In particular, there is possibly too great attention on acute care given the future of the health economy and the shift in the balance of care from acute to community. A study of placement experiences, learning outcomes as they relate to the quality of in-practice teaching and learning and first destinations would be instructive.

15. Efforts should be made to include a suitable mechanism for including carer and service-user feedback on student performance.

16. Consideration should be need to be given to length and purpose of clinical placement learning in the light of the NMC recommendations for the future of pre-registration nursing and midwifery education.

17. Consideration should be given to how students can develop a work ethic that is possibly not being developed as a result of supernumerary status, but balanced with the need to ensure that students are not compromised in their learning by being given tasks to undertake to complete the expected work rota.

18. Consideration should be given to how HEI lecturers with nursing and midwifery registration can be involved in practice education, given that the PEFs have clearly in many cases taken over the mediation role between HEIs and practice and also mentor support in the student learning experience.

being provided to students by practitioners, either as named mentors or members of a mentor team. This, however, appears to be at a cost to mentors, in terms of balancing their responsibilities to their patients/clients with the responsibility to students.

20. Consideration should be given to how (primary) mentors can be given support in relation to time and professional development to undertake their role more effectively and with enhanced skills and knowledge.

21. There is a need to develop a more flexible model of practice-based mentorship roles.

22. Consideration should be given to establishing a common approach across the HEIs to meeting the NMC standards of proficiency for pre-registration nursing and midwifery in the practice assessment documents, acknowledging the need, however, for the HEIs to ensure their own fitness for award.

Partnership Working

23. Education providers and commissioners should consider the extent to which competence over a set of traditional (such as drug administration) or ‘advanced’ (such as venepuncture) skills should be mandatory in each programme. In determining essential skills, those of communication and emotional labour need to be fully recognised in all aspects of midwifery and nursing. Partnerships in which the teaching of clinical skills could be undertaken by current clinicians need to be more thoroughly investigated.

24. Consideration should be given to moving from a four to five year cycle of major curriculum reviews to an organic process in which change is built into the curriculum model. Changes in the curriculum must reflect new evidence on teaching and learning, stakeholder feedback and changes in care delivery. A Scotland-wide structure led by HEIs and involving SGHD, carer and service user groups and NES could contribute to this process. HEI curriculum development processes may benefit from the rapid change event methods currently employed in promoting evidence-based change in the NHS in

Scotland.

25. Mentor functions will grow and consequently consideration needs to be given to the selection of mentors. Mechanisms to provide incentives for mentors, perhaps through honorary positions with the HEIs should be considered. Mentors may benefit from a longer and more in-depth programme of preparation which would include assessment and dealing with ‘failure’.

26. Funding models for pre-registration education should explicitly recognise the major role played by mentors, PEFs and the NHS as a whole.

27. Research in nursing and midwifery education tends to be project-led and does not provide the cumulative and theoretically informed approaches that would optimise advances in the development of evidence-based teaching and learning. A sustained and science-led major programme of research to inform teaching and learning would provide Scotland with a world-leading capacity in nursing and midwifery education research. Given the limited education research capacity in Scotland this programme would be based within the Scottish HEI sector, but should involve the main internationally recognised researchers from across UK.