Independent report finds varied learning experiences for nursing & midwifery students

We commissioned this new report from health think tank the Nuffield Trust, in partnership with the nursing and midwifery charity Florence Nightingale Foundation (FNF) to better understand what contributes to effective practice learning across the UK and in other countries. This research signals a key juncture within our review into nursing and midwifery students’ practice learning.

The report examined evidence relating to regulations and standards around students’ practice learning. It investigated how our requirements are being implemented, and the opportunities and challenges in providing optimal practice learning placements for the next generation of nurses, midwives and nursing associates.

It also identifies areas where we, along with our approved education institutions and their practice learning partners, can strengthen learning experiences for students across a range of practice settings. This includes greater communication around practice learning requirements, further research about the impact of simulated practice learning on student learning, greater support for educators, and an expansion of community-based placements.

We’ll consider these findings alongside two other key areas of work. One is our recent evaluation of simulated practice learning for pre-registration nursing programmes. The other is evidence from our recent work to quality assure nursing and midwifery education programmes which includes insights and themes around practice learning. The collective findings will inform recommendations and next steps which we’ll bring to our Council meeting in January 2025.

Report findings and suggested areas for action

Clearer guidance and consistent standards

The UK’s regulatory requirements around practice learning for nursing and midwifery students are comprehensive but there are inconsistencies in how requirements are interpreted. The report recommends clearer communication around standards to support consistency among students, approved education institutions, and practice learning partners.

Better organisation and coordination of placements

The report recommends that each UK nation agrees strategies to ensure placements are accessible, high-quality, and well-resourced, with enhanced support for placement supervisors and assessors.

Strengthening supervision and assessment

The report suggests expanding and supporting the pool of qualified practice supervisors and assessors, and addressing their workload and time pressures, in order to support students as effectively as possible. As part of this, the findings emphasise that the expectations and requirements on training and support for practice supervisors, practice assessors and educator roles are better understood.

Uncertainty around practice learning requirements

There is confusion and conflicting interpretations around practice learning requirements, and differing opinions about the necessary number of practice learning hours. But there is limited evidence and varying opinions about what the appropriate number of practice hours, assessments and number of births (for midwifery students) should be.

More evidence needed on simulated practice learning

While simulation was identified as a valuable tool for learning, the report suggests that more robust research is needed in this area. Limited studies, and discrepancies within nursing and midwifery education, mean there is little evidence about the impact of simulated learning on outcomes for people receiving care, or information on resource implications and cost-effectiveness.

Commenting on the report findings, Sam Foster, NMC Executive Nurse Director, said:

“We’re grateful to authors at the Nuffield Trust and Florence Nightingale Foundation for their extensive research and engagement with the public, students, and stakeholders across the sector. These findings will be instrumental on our journey to review, and improve, students’ practice learning experience. We will now work with our independent steering group and stakeholders to shape recommendations to bring to our Council.

“This will be an invaluable opportunity to help shape future proposals that ensure students join our register with the skills, knowledge and behaviours they need, and meet the evolving demands of health and social care. We’ll continue to collaborate with the public, students, education providers and our stakeholders across the four nations going forward, as we work to shape the future of nursing and midwifery education.”

Billy Palmer, the Nuffield Trust’s Workforce Lead and one of the report’s lead authors, said:

“On paper, practical education requirements for the UK’s nurses, midwives and nursing associates are comprehensive, and in many areas go further than other countries. But in reality, day-to-day pressures and a lack of supervisory capacity are routinely leading to varied implementation and support for students. Our review heard widespread consensus for more focus on the quality of training, not just learning hours accrued or tasks ticked off.

“The regulation and delivery of clinical education is hugely complex and impacted by numerous issues, but our research has shown an urgent need and appetite to revisit standards and improve learning experiences for students. Some of our recommendations require longer-term, system-wide actions, but in the short-term the NMC and educational partners have a real opportunity to gather better evidence into how practice learning requirements determine patient care and safety.”

Natasha North, the FNF’s Director of Academy, said:

“Practice learning placements are the way that nursing and midwifery students learn the real-world art and science of caring. High quality practice learning extends the knowledge that students gain in the classroom, giving them supervised opportunities to develop practical skills and professional behaviours. The Florence Nightingale Foundation is proud to have been able to inform this work through the insights of our member and alumni networks.”

More information about the NMC’s review of nursing and midwifery practice learning is available here.

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