Blog: NMC standards: a holistic approach to nursing care

As nurses, we’re all guided by the NMC’s standards of proficiency every day. But how do the standards come to be? Why are they the way they are, and what’s your say in them?

You might imagine that someone from the NMC locks themselves in a room for a week and emerges with the standards written. But in fact, we ‘co-produce’ all our regulatory standards, which means we view our professions, stakeholders and the public as being equal partners in the development of the standards. We keep all our standards under regular review, and we have a public duty to consult on any significant changes we propose.

For instance, we’re currently reviewing our education programme standards following the UK’s departure from the EU. This is an example of how we take account of the evolving health and social care landscape when reviewing our standards. From the very earliest stages we’ve involved a wide range of stakeholders in the co-creation of these standards, including representation from the four fields of nursing and the four countries of the UK. This has made sure we consider everything from a range of perspectives, which allows us to base our decisions on robust evidence and experience.

Another example is the Future Nurse standards. We consulted on these new standards in 2017 and we published the final version in 2018. This year the first cohort of students graduated from programmes approved against these standards and joined our register. Now, we’re planning further collaboration with our stakeholders to evaluate these standards, in keeping with our dynamic approach to setting standards.

So that’s how we go about producing our standards. But what are we aiming for?

Our standards of proficiency for registered nurses are high level and outcomes focused by design. They set out the knowledge and skills that nurses studying in any of the four fields must demonstrate in order to join our register. That’s because people who use services need to know what they can expect from all nurses on our register.

There’s always a balance around the level of commonality there needs to be between the different fields of nursing practice. There does need to be a specialist component which indicates the knowledge and skills required for a particular field of nursing practice. We also need to reflect what all nurses need to know and be able to do, to be competent practitioners able to care for people with various needs. For example, physical health conditions cause the majority of deaths among people with severe mental illness, and physical disease among those with mental illness is rising¹.

Importantly, we acknowledge that this approach to caring for the whole person doesn’t negate the requirement for specialist, field-specific knowledge and skills, which are crucial to effective and compassionate mental health, learning disabilities, children’s and adult nursing care.

Taking an approach to standards that promotes holistic care enables approved education institutions (AEIs) to develop curricula with the creativity and innovation that abound across the education sector. These nursing curricula also support students to develop graduate level attributes, such as critical thinking, decision making and problem-solving to facilitate delivery of their knowledge and skills in interdisciplinary contexts.

Relevance across fields of practice

Proficiencies are grouped under seven platforms, followed by two annexes. Annexe A focuses on communication and relationship management skills, while Annexe B details procedures that a newly registered nurse must be able to demonstrate. Both annexes ensure the all-important holistic approach to care, and are relevant across all four fields.

Some practitioners have questioned the relevance of Annexe B procedures across all fields of nursing, particularly mental health nursing. But mental health nurses have a role to play in improving the physical health of people living with serious mental illness². People living with mental illness also haver poorer access to health and care services³, which means their interactions with mental health nurses needs to support their holistic health and wellbeing as far as possible.

It’s not acceptable for those people to receive poorer physical health care than mental health care, or vice versa, because their nurse’s knowledge and skills are limited by their chosen field of practice. Every nurse in every setting must be equipped with the knowledge and skills to meet people’s care needs holistically, and that is what our standards support.

Being able to understand and carry out these Annexe B procedures in practice or through simulated practice, also supports continuity of care and carer. This demonstrates the importance of mental health nurses being the ones delivering or supporting clinical procedures as the person trusted most by the people in their care. Physical health deficits and mortality rates for people with mental health issues are well documented, as are the unmet psychological needs of people with physical illness.

We also know some students are concerned about not meeting all these skills as they’re not exposed to them within some practice learning settings. We’ve been pleased to see AEIs approach these challenges in innovative ways through simulated practice learning. This takes place in a safe environment, allowing for supervised practise, repetition and reflection.

As registered nurses, we all work in the context of continual change, challenging environments, different models of care delivery, shifting demographics, innovation and rapidly evolving technologies. And many of us have long, interdisciplinary careers that take us through multiple specialisms and settings.

We don’t always know what people will ‘present with’ when they are referred to our services. We are providing care for and with people who have increasingly complex and varied health and wellbeing needs.

That’s why it’s so important for our NMC standards to offer a foundation level of knowledge and skills which promote person-centred, holistic care. The standards are a basis on which to grow and develop professionally, whichever area or field of practice we work in.

About Paula

Paula is the NMC’s Senior Nursing Adviser. She started her career as a Registered General Nurse, specialising in medicine, then became a Registered Mental Health Nurse working in acute and dementia services. She served as an Army Officer for eight years, heading up mental health services for Forces personnel and their families.

Paula enjoyed a 19-year career in Higher Education, leaving the sector last year as a Pro Vice Chancellor and Dean. She has championed widening participation, and strongly supports social mobility through health careers.

About Julie

Julie joined the NMC in 2021 to advise and support the ongoing review, development and implementation of NMC education standards and standards of proficiency for nurses and nursing associates.

Registering as a mental health nurse in 1996, Julie started her career as a Community Mental Health Nurse, progressing to Team Leader in 2002. She has more than 20 years’ academic experience, having moved into higher education in 2003.

^{1 Management of physical health conditions in adults with severe mental disorders}

^{2 Mental health nursing and physical health care: A cross-sectional study of nurses' attitudes, practice, and perceived training needs for the physical health care of people with severe mental illness}

^{3 The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness}

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