The Nursing Midwifery Council (NMC)
This chapter brings together key information focused on upholding and maintaining your role as a registered nurse. You have successfully completed a programme of learning and practice through which you have demonstrated that you are safe and competent to undertake the role of a registered nurse within your chosen field of practice.
You are at the start of your professional career, a career that will offer a stimulating and exciting future with innumerable opportunities to develop. Also, you’ll achieve the job satisfaction of knowing that you are providing quality care and services to your patients, their families and the public.
There will be challenges, there will be high points and low points, there will be times when you wonder what the future holds. But being confident in knowing what good practice is, what your responsibilities and accountabilities for that practice are, and what resources exist to support you, will provide a sound foundation to your professional role as a registered nurse.
(NMC 2018) – Professional standards of practice and behaviour for nurses, midwives and nursing associates.
In order to practice safely and effectively and provide the highest standard of care to your patients and their families, you will need to continue to develop your confidence and competence in using your clinical judgement and making decisions.
The Code (NMC 2018) sets out the standards and behaviours required of registered nurses, and in relation to clinical judgement and decision making includes:
Standard 6. Always practise in line with the best available evidence.
Standard 11.Be accountable for your decisions to delegate tasks and duties to other people.
Standard 13. Recognise and work within the limits of your competence.
Standard 19 . Be aware of, and reduce as far as possible, any potential for harm associated with your practice. The Nursing Midwifery Council (NMC) rcn.org.uk 1. The foundations of good practice 14
Promote professionalism and trust:
Standard 25. Identify priorities, manage time, staff and resources effectively, and deal with risk to make sure that the quality of care or service you deliver is maintained and improved, putting the needs of those receiving care or services first.
Building sound clinical judgement, m/oving from novice to expert, is a long journey. As an NRN, your aim should be to broaden your knowledge and experience, so that you can make informed safe decisions and know where to turn when decision making proves difficult.
The NMC Future Nurse Standards are a resource to guide and support you in your development as a registered nurse.
Read through the Future Nurse Standards of Proficiency for Registered Nurses and plan the next stage of your development. It is good practice to return to these regularly so you can reflect on and recognise your professional development.
Every year, you will need to make a payment to remain on the NMC register. You must pay your annual fee before your retention date or your registration will lapse and you will automatically be removed from the register.
It is therefore vital you know when this date is. It will correspond with the month your application was submitted, so please check this. You will also receive emails from the NMC reminding you of your renewal. Please ensure these emails are not going into your spam folder and keep the NMC updated with your email address.
Nursing, in all its fields and areas of practice, is a continuous journey of learning and development.
Your professional development will be shaped by how you respond to situations and how role models within the teams in which you work inform your understanding, care skills and compassion for all those you interact with. Gaining feedback that enables you to reflect on your role as a nurse is an essential way of enabling professional development.
It may seem very early to be considering what you will need to achieve to remain on the NMC register, however the aim of revalidation is not simply to check every three years that you are still meeting the required level of practice hours or the standards of The Code (NMC, 2018). The aim is to promote continuous professional development and to be able to demonstrate this through the accumulation of evidence presented in a portfolio.
The NMC has set out the requirements for revalidation, providing detailed guidance and templates for recording your evidence.
The RCN has developed some resources to support you in your revalidation.
The RCN prides itself on the wealth of high-quality, evidence based CPD resources available to all members through the professional forums, networks, subject areas and clinical topics:.
RCNi Learning - Enhance your skills and expand your clinical knowledge
RCNi Learning is an interactive online learning resource, featuring more than 200 RCN-accredited learning modules designed to support you with your professional development and help bridge the gap between theory and practice. Try a module for free when you register. Visit: rcnilearning.com
The RCN prides itself on the wealth of high-quality, evidence-based CPD resources available to all members through the professional forums, networks, subject areas and clinical topics.
RCNi Decision Support - Make evidence-based decisions with confidence when assessing and treating patients
With over 100 topics to choose from, the UK’s first and only decision support tool for nurses helps to guide your thinking and supports you in delivering safe and effective patient care that meets the UK’s best practice guidelines. For more information and to subscribe, please visit: rcnidecisionsupport.com
There is a wealth of research that supports the importance of preceptorship for NRNs, as the transition from student to registered nurse has been found to be a very stressful period. The need for support and guidance that is responsive to these stressors has been shown to be of significant value.
Findings from the research highlight the key stressors and resulting support and learning that NRNs need to successfully transition.
Preparation for practice
Understanding and being prepared for the post you have been appointed to. It is imperative that you fully understand all aspects of the registered nurse post that you will be doing. The interview, person specification and job description should provide you with some of the information. However, induction to your place of work, a meeting with your line manager to clarify roles, responsibilities, work schedules, team structures and what is expected of you throughout your initial induction and preceptorship period, and what support and learning is provided are all essential for you to know.
The reality of practice
The responsibilities and accountabilities of a registered nurse cannot be fully experienced until you start your first post. Issues of delegation, accountability and responsibility, competencies specific to the area of clinical practice, team working and communication will all ‘feel’ different to what you experienced as a student observing practice and being supervised whilst learning in practice.
Developing clinical practice
You have the knowledge, skills and competency to provide safe and effective care to a range of patients within your field of practice. The patients you are giving care to in your first post will have many additional care needs, require specialist interventions and decisions about their care that you may not have experience of before.
Developing professional relationships
It is likely that you will be a permanent registered nurse within the care team and this will be different to your previous experience as a student. You will need to utilise your communication skills, your understanding and skills of team work and your interpersonal skills to establish yourself as a respected member of team.
Developing relationships with patients and families
As a student you will have gained skills and developed effective approaches to building relationships with patients and their families. You will have experienced and witnessed some difficult and challenging situations, where experienced nurses and health professionals have effectively communicated and managed in these circumstances.
Breaking bad news is a good example of this, whether it is likely to have a brief or long-term impact on the patient or their family. Observing and learning from experienced nurses and health professionals communicating this is very different to finding the words and the confidence to do this effectively and compassionately yourself.
This may seem daunting as you take those first steps into your professional role, but there is growing understanding of the importance of preceptorship across all four UK countries, with policies, guidelines and frameworks published and implemented in many NHS organisations.
Good practice in the voluntary, independent and private sector promotes the importance of support for NRNs. If you are working in any of those sectors, or in an NHS organisation with no formal preceptorship provision, you should ensure that you have discussed preceptorship and what you would expect in terms of support and guidance before starting your first post. You could use The Code (NMC, 2018) to help you explore this with a prospective employer, using the specific requirements outlined in paragraph nine (practise effectively) and paragraph thirteen (preserve safety) to help focus your discussion.
There is strong evidence to support a period of preceptorship for NRNs, as it can:
- improve confidence
- increase job satisfaction
- offer a sense of being valued and respected by your employing organisation
- build a commitment to the organisation’s corporate strategy and objectives.
There is often a time gap between when a student nurse has completed their pre-registration nursing programme and before they receive notification from the NMC that they are a registered nurse (RN).
During this interim period, between completion of studies and receipt of NMC registration, student nurses may need, or wish to be, employed as NSWs. This may be continuing in a NSW role that the student has had during their studentship or it may be with the health or social care employer that the student nurse has secured an RN offer of employment with.
The NSW role may be at Band 2, 3 or 4, or equivalent. As a student waiting to receive confirmation of NMC registration, you have achieved the capabilities and competencies required to be a registered nurse. But until you receive your NMC registration you are not a registered nurse. and you are not employed as one, and therefore your duty of care is that of an NSW. An NSW, like all practitioners, has a duty of care to perform competently whatever activities they undertake and to ensure that they don’t work beyond their level of competence.
As an NSW you will have a job description that provides clear information about the roles and responsibilities of the post. You should be provided with detailed information about the scope of the work that you will be expected to undertake. You must not take on any role, responsibility or task that is outside of what is expected for any person working in that post.
Guidance on working as an NSW during this interim period:
- Read the job description.
- Ensure you understand the details of the role you are employed to do and the limitations of that role.
- Discuss any concerns that you have with the senior nurse. • Ensure that you are rostered as an NSW, not as a registered nurse.
- Wear the correct uniform for the NSW post.
- Raise your concerns immediately if you are asked to undertake any role or task that is not within the responsibility of an NSW’s duty of care.
Using this time positively
- Take this opportunity to familiarise yourself with the clinical environment.
- Get to know the team.
- Start to understand the routines and day-to-day work patterns.
- Shadow and work with the registered nurses to better understand the role you will be taking on.
- Complete induction tasks that are required for your current NSW post – many of these will be the same as those for a registered nurse post.
- Reflect on what you will need when you do make the transition from NSW to registered nurse, and discuss this with your senior nurse.