The Standards for Student Supervision and Assessment (NMC, 2018) set expectations for student learning, support and supervision across varied practice environments, including how their theory and practice learning is assessed. They set out the responsibilities of practice supervisors and assessors who support students during their learning and assessment in both theory and practice.
Practice supervision ensures safe and effective learning takes place. There should be sufficient coordination and continuity of support and supervision of students to meet their learning outcomes and the relevant standards of proficiency. Maintaining effective communication prior to, during and after any practice learning opportunity is key to ensuring its success.
Effective practice supervision empowers students to direct their own learning where possible, with the ability to plan, with their practice supervisor, the practice experiences that they need to enable them to meet the relevant standards of proficiency.
The AEI (Approved Education Institution), together with their practice learning partners, are responsible for ensuring that students are provided with a range of learning opportunities. Practice learning experiences will vary for students depending on their intended learning outcomes, their stage of learning and their area of practice. Students should be given the opportunity to learn and provide care across a range of different learning environments that will enable them to meet their learning outcomes.
We do not specify what constitutes a learning environment as care of people takes place in many settings, including virtually and via telephone. Practice learning environments will include hospital, community, primary and social care as well as other care environments. Learning experiences in the community in schools, prisons, or working with the armed forces, for example, can complement practice learning. Practice learning can also be simulated in AEIs and practice settings. [Simulated practice learning - The Nursing and Midwifery Council (nmc.org.uk)] The key to making practice learning a success is good supervision and support, well-structured learning, meaningful feedback and reflection on all these elements by the student.
The AEI, with its practice learning partners, must ensure that all placements and learning experiences have proper oversight and governance. When undertaking a learning experience in an environment , or where non-regulated staff work alongside and support registered professionals, the AEI, and their practice learning partners, should be able to evidence the relevance of the setting to their learning outcomes and how it will contribute to student learning, as well as what measures are in place to protect the safety of both students and the public. This includes the student having a nominated person for each practice setting to actively support students and address student concerns (SSSA 1.5). This person may not necessarily be based in that setting but must be accessible to the student so that if needed they can discuss items or raise any concerns about their learning or the safety of people receiving care or more widely.
Students should be supported by practice supervisors for all practice learning, including simulation-based learning experiences. Those who can be practice supervisors include NMC registered nurses, midwives, or nursing associates, and other registered health and social care professionals, such as doctors, physiotherapists or pharmacists. However, others who are not regulated health and social care professionals but are working in a practice learning environment, such as phlebotomists, teachers or other non-registered health care workers may contribute to student practice supervision.
Though students must be supervised for all practice learning, there may not be ‘practice supervisors’ within every practice environment. Students can be supervised in an indirect way, as long as our standards are met.
Placements with no health and care registrants - who can act as practice supervisors?
Some placements may be enrichment opportunities or in environments that provide the student an opportunity for insight into the support and care of people in settings such as social care, residential homes, food banks, charitable organisations or schools. There may not be a practice supervisor in this setting, and so indirect supervision should be provided. The safety of students and anyone they may be observing, supporting, providing care or coming into contact with is paramount, and therefore we recommend the following key principles for indirect supervision:
- Students should not be placed in a practice learning environment without suitable support and supervision.
- Students should not provide direct care without suitable support and supervision.
- AEIs together with their practice partners must ensure safe and effective learning takes place.
- A suitable person, appropriately prepared, should be identified in advance, during and afterwards to support the student and provide feedback, with oversight from practice supervisor(s) or practice assessor.
- A plan of learning and coordination with the student and those within the environment before, during and after the placement should be in place to formulate relevant learning outcomes and how they can be achieved. Student reflection should be integral to this.
- People supporting students must have the knowledge and skills necessary to support and help students meet the learning outcomes specified for that placement.
Practice assessment in non-health and care environments:
Students must have a named practice assessor who is a registered nurse, nursing associate or midwife with appropriate equivalent experience for the student’s intended area of practice for a placement or series of placements. Non-health and care colleagues may also contribute feedback and evidence to the overall assessment, depending on the learning outcomes and standards of proficiencies to be met, or the experience may constitute an enrichment opportunity.
Elective placements may be international, or in areas with no NMC registered professional present. An elective placement in the UK in a practice setting outside the home AEI's usual placement providers would be subject to the usual standards for student supervision and assessment. Effective planning and communication between the practice supervisor (within the out of area placement), practice assessor and academic assessor are key to assuring that safe, effective student learning takes place that contributes to meeting the relevant standards of proficiency.
The practice learning environment should be determined as appropriate and practice supervisor/s and practice assessor appropriately prepared for their role. The environment needs to be declared through QA processes as a new practice learning partner if it is based in the UK. International placements that are ‘one-off experiences’ for students need not be declared as new practice learning partners.
Other arrangements may need to be made with the local AEI to ensure they have oversight and audit of the practice learning experience, including data sharing and access to records to engage further and seek feedback if any enquiries relating to such an elective at a later date.
The home AEI will have their own risk assessment processes to complete prior to any placement and these will apply to overseas placements or electives in just the same way as they do to regular placements. The host AEI or practice learning setting where the learning experience is taking place may also have their own risk assessment processes to complete prior to commencement.
Some practice settings may require the student to have an honorary contract to be able to undertake the placement.
Learning outside the UK:
This includes international placements as well as any theoretical learning that may be undertaken by the student. International learning opportunities can offer unique and rich insights and experiences for students.
Such opportunities can add value to and enhance student learning as they experience different approaches to health and care. Any practice placement where proficiencies are to be met and programme hours achieved must meet the requirements of the NMC’s Standards framework for nursing and midwifery education, demonstrating that the safety of people is a primary consideration in all learning environments, and students should not be placed in a practice learning environment, or provide direct care, without suitable support and supervision.
If a student is to undertake an international placement the learning outcomes aligned to the standards of proficiency must be clear and Standards for student supervision and assessment must be met.
Practice learning experiences in international environments may contribute evidence to the overall practice assessment.
Students must be made aware of the nominated person for their international practice setting to whom they can raise concerns and seek support regarding their learning experience.
Effective planning and communication between the practice supervisor (within the international placement), nominated practice supervisor in the UK, practice assessor and academic assessor (both based in the UK) are key to assuring that safe, effective student learning takes place that contributes to meeting our standards of proficiency. Someone from the student’s home AEI, such as the academic assessor or any other suitable person, should have oversight of learning within the international environment.
Reflection, documentation and evidence for assessment
The requirements for documentation to be kept and evidence to be provided to allow for assessment of whether learning outcomes have been met will be the same for international and elective placements as they would be for regular placements. The student should also be allowed time to reflect on what they have learnt in the same way.
What about public protection/safeguarding concerns?
Public protection and safeguarding are an essential consideration for all learning opportunities – this subject is covered in more detail in 2.8 of our Standards framework for nursing and midwifery education.
Managing absences or pausing the placement
All AEIs must have processes and procedures in place for managing absences from academic and practice learning for whatever reason. The home AEI is responsible for liaising with the host AEI for managing student absences. If it is felt to be necessary to interrupt or pause a placement for whatever reason, again, this should be dealt with in the same manner as if a student’s placement in the UK that had been arranged via their home AEI was being paused.
NMC standards of particular relevance:
SSSA 2.7: all students on NMC approved programmes are supervised in practice by NMC registered nurses, midwives, nursing associates, and other registered health and social care professionals. Nurses/midwives registered in their own country fall under the category of ‘other registered professionals’.
Those supervising students must have the knowledge and skills necessary to help students meet the learning outcomes to be achieved.
Practice assessment and academic assessment:
6.3 nursing students are assigned to practice and academic assessors who are NMC registered nurses with appropriate equivalent experience for the student’s field of practice
6.4 midwifery students are assigned to practice and academic assessors who are NMC registered midwives
6.5 specialist community public health nurse (SCPHN) students are assigned to practice and academic assessors who are NMC registered SCPHNs with appropriate equivalent experience for the student’s field of practice
6.6 nursing associate students are assigned to practice and academic assessors who are either an NMC registered nursing associate or an NMC registered nurse
6.7 students studying for an NMC approved post-registration qualification are assigned to practice and academic assessors in accordance with relevant programme standards