Welcome to this first edition of Quality Matters, our e-news letter to keep you in touch with what is happening in NMC QA matters and share examples of effective practice that we observed in action. Firstly, however, a big thank you to all our reviewers for the contribution they have made to the QA of nursing and midwifery education and to the teams of staff in Education Providers who welcomed us and facilitated both approval and monitoring activities.

Last year was extremely busy with new processes to establish, the appointment of staff and the recruitment and training of Reviewers and Managing Reviewers, not to mention establishing new relationships with all Education Providers and the NMC. Having come to the end of the first year, it provides an opportunity to reflect on what has been achieved and what has been learned.


Approvals:
In all we have undertaken 300 approval events in England, Scotland and Northern Ireland of which 58 (19.3%) were approved with no Conditions, 241 (80.3%) were approved with Conditions and 1 (0.4%) programme had approval withheld. Some of the ‘not so good’ findings from these events include:

• Conjoint approval has at times been difficult to recognise where programmes have been approved internally and a subsequent event staged to obtain NMC approval with poor attendance of university representatives.
• Knowledge or understanding of standards is not always good, often related to lack of clarity and difficulty in accessing not only the standards but also circulars, guidance notes, QA Fact Sheets and FAQs which underpin, clarify and/or augment the published programme standards.
• Standards of programme documentation vary from the comprehensive and well ordered to volumes of ill-prepared, incoherent documents or less than minimum requirements.
• High number of approvals with Conditions (80%) calls into question how education provider’s internal QA systems operate.

These ‘not so good’ findings are balanced by some very positive findings:

• Involvement of service providers is especially noted at curriculum development and in their support of programmes through mentorship and a range of other resources which support student learning.
• Innovative learning methods, especially in terms of e-learning and enquiry-based learning.
• Inter-professional learning is being developed in a meaningful way which not only promotes learning but also prepares health professionals to work together as effective team members.
• Commitment of education and service provider partners to provide sound professional education.

Monitoring:
A total of 79 education providers were visited in England, Scotland and Northern Ireland in which 164 programmes were monitored. In addition, six universities were monitored by desk-top analysis of quality systems across all programmes offered, owing to recency of programme approvals and/or QAA major review. The outcome of these events being that 10% of programmes demonstrated Outstanding achievement, 70% of programmes demonstrated Good achievement, 16% of programmes demonstrated Satisfactory achievement and 4% of programmes demonstrated Unsatisfactory achievement. Some of the findings from these events include:

Practice: Strong partnership working with service providers with secondment of staff and the infrastructures to support partnership working.

Learning: The strengthening of meaningful inter-professional learning and the development of mental health modules in community nursing programmes in response to the needs of clients. Service user and carer involvement in curriculum development and delivery is mixed with a tendency to a higher involvement in curriculum development than in delivery.

Assessment: A range of assessment strategies appropriate to the learning outcomes was demonstrated with theoretical knowledge being examined by academic staff and clinical practice assessed by mentors and practice teachers. Whilst systems are in place for the moderation of examination of theoretical work, this is not usually the practice for clinical practice assessment. Similarly, it is unusual for external examiners to examine clinical practice and/or meet with students and mentors.

Selection and Admission: Whilst initial screening of ‘good character and health’ is generally completed well, systems and processes to ensure continuing compliance with this standard during and at the end of the programme are variable. The majority of universities operate an ‘honour’ system, whereby students are informed that it is their responsibility to inform the Programme Provider of any changes in their health or criminal record status.

Regulatory Requirements: These standards were generally well met but a number of education providers failed to demonstrate sufficiently robust systems and processes for ensuring that students are assigned to regularly updated mentors when gaining clinical experience.

Resources: All universities were well provided with library and IT based learning resources. Investment in e-learning has been considerable and is being developed further in most universities. Also of note is the provision of Clinical Skills Laboratories in many universities which were noted by students and mentors to enable students to practice both practical and communication skills in a safe environment. Determination of the quality of clinical learning environments in pre-registration programmes was generally undertaken in accord with NMC requirements. However, a number of education providers demonstrated significant lapses in the audit of clinical placements. Some of the system failures arose as a result of inadequate systems and processes; insufficient attention paid to auditing the systems or inadequate resources employed to ensure the appropriate operation of systems and processes.

Quality Enhancement: All education providers have clearly defined committee structures to support academic standards. However, internal audit of the work of these committees or of policy and processes does not usually appear to take place. At an operational level, the most significant method of programme quality assurance is the external examiner system.

Not all education providers appear to recognise the inter-relationship of clinical placement audits, the ‘live’ mentor database, student evaluations of placement learning and clinical placement allocation.

A great deal has been learned over the past year by all involved in the QA process. Where shortcomings have been identified, education providers have risen to the challenge of ensuring that their programmes meet specified standards and in several instances, the changes brought about have exceeded requirements and have re-invigorated partnership working. I am sure that we will all continue that learning as we move to introducing the first phase of the risk-based approach to programme monitoring.

Thank you all once again.

Janet Duberley, Director of Reviews

Janet.Duberley@hlsp.org

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