NMC Circular 2/2004
This replaces
Registrars Letter 21/1992
NMC Circular
Dear Colleague
Requirements for nurses, qualified outside the United Kingdom (excluding the European Community), seeking a period of supervised practice and assessment in the United Kingdom, prior to Registration with the Council – Guidance for Individuals and Institutions
The Nursing and Midwifery Council receives tens of thousands of applications each year from nurses who have completed nursing education and training outside the United Kingdom and the European Community, and who wish to register in the United Kingdom. Each application is read to assess how it meets the standard required for registration in the United Kingdom. As a result many applicants are required to satisfactorily complete a period of supervised practice and assessment in the United Kingdom, prior to registration with the Council.
The Council recognises that further detailed guidance on the nature of this period of supervised practice would be helpful, both to overseas nurses and the institutions responsible for offering periods of supervised practice. I attach, as an Annexe to this letter, the Council’s requirements for a period of supervised practice and assessment in the United Kingdom prior to registration as a nurse with the Council.
The NMC wishes to improve its current systems in order to make sure that all applicants, and institutions offering supervised practice, are clear about the Council’s standards for registration. The Council has recently developed a standard for a proposed overseas nursing programme for UK registration. The standard and the proposed programme is currently the subject of consultation (January to April 2004).
It is anticipated that a final version of this standard will be approved in June 2004.
Approved programmes should be available from the beginning of January 2005.
The Council hopes that the guidance in the attached annexe will assist overseas nurses to achieve the Council’s standards for registration, those offering them periods of supervised practice in the United Kingdom and registrants acting as mentors. This guidance applies only to overseas nurses and does not apply to midwives applying from overseas.
The guidance in the attached annexe will be updated once the date for the start of the overseas nursing programme for UK registration has been confirmed.
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Any queries relating to this circular and annexe should be addressed in the first instance to the NMC Call Centre on 020 7333 6600.
Yours sincerely
Sarah Thewlis
Enclosure: Annexe 1 - Requirements for nurses, qualified outside the United
Kingdom (excluding the European Community), seeking a period of supervised
practice and assessment in the United Kingdom, prior to Registration with the Council
– Guidance for Individuals and Institutions
NMC Circular 2/2004
Requirements for nurses, qualified outside the United Kingdom (excluding the
European Community), seeking a period of supervised practice and assessment
in the United Kingdom, prior to Registration with the Council – Guidance for
Individuals and Institutions
Introduction
1 The following information has been prepared to make clear the Council’s
requirements when a period of supervised practice and assessment in the
United Kingdom is required for nurses qualified outside the United Kingdom
(but excluding the European Community). The information explains: the
reasons for requiring additional experience through supervised practice; what
is to be achieved during supervised practice; the practice settings approved for
supervised practice; what supervision means; the length of supervised
practice; assessment; reference for registration; the nature of employment; and
the requirements for English Language competence.
2 The Council expects the period of supervised practice to be properly planned,
using the following guidance which has been prepared to explain the purpose
and outcomes of the the period of supervised practice.
3 The fact that an applicant is required to complete further experience and
assessment in the United Kingdom is not intended to reflect adversely on the
quality of the applicant’s original professional education. It is recognised that
the original training was designed to prepare practitioners for practice in
another country and culture, where the delivery of health care may be very
different. The Council considers that in order to give safe and effective care
as a registered nurse in the United Kingdom, a period of experience in the
United Kingdom is often essential, prior to registration.
4 Applicants are advised that it can be very difficult to obtain a placement in
order to gain the necessary experience and that they should seek such a
placement as early as possible after the Council has given them a decision in
relation to their application.
The Reasons for Requiring Additional Experience through Supervised Practice
in the United Kingdom
5 All applications are read to assess how they meet the standards set by the
Council for registration in the United Kingdom. The authority for this is set
out in legislation in the Nursing and Midwifery Order 2001. Article 13(1)(c)
sets these requirements out allowing the Council to assess applications to
ensure that:
overseas applicants hold a qualification which the Council is
satisfied is comparable to that awarded in the UK for registration
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the length and content of the original training meet the Council’s
requirements and, where appropriate, the requirements of the
European Community Directive for ‘general’ nurses;
any subsequent post-registration experience is relevant to their
application, and
supporting references provide confirmation of the applicant’s good
health and good character.
6 All pre-registration nursing programmes in the United Kingdom are
undertaken following secondary educationand comply with the relevany
European Community Directives. The required length of a pre-registration
nursing programme is 3 years of 4,600 hours. At least 2,300 hours of the
programme must be in clinical practice. The hours of theory must be directly
related to the practice of nursing. The study of any other subjects such as
politics, literature, foreign language, would be in addition to the 3-year
programme.
7 All nurses registered in the United Kingdom are required to re-register every
three years. There are standards to be met before a nurse may re-register.
They must have undertaken continuing professional development of at least 35
hours in the three-year period and have practised as a nurse for 750 hours in
the 5 years before the date for re-registration.
8 Applicants for Part 1 (Registered General Nurse) or Part 12 (adult nurse) of
the Register must meet the requirements of
European Community Directives(77/452/EEC and 77/453/EEC as amended by 89/595/EEC).
These require:
completion of a post-secondary education programme of 3 years or
4600 hours in length, of which at least one third of the hours are
theory and at least one half of the hours for practice
clinical experience must include:
- medicine
- surgery
- paediatrics
- geriatrics
- community
- psychiatry, and
- maternity care
9 When an application does not meet the standards required for registration as
set down by the Council, the Council can require an applicant to undertake
additional training or experience through supervised practice in order to meet
the standard and be able to apply for registration. These requirements will be
set out in a letter from the Council stating the length and nature of the
supervised practice.
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Learning outcomes of the period of supervised practice
10 The overall purpose of the period of supervised practice is to enable applicants
to:
understand and commit to the Code of Professional Conduct: NMC
standards for conduct, performance and ethics which sets the
Council’s requirements for professional practice
familiarise themselves with the health service and current nursing
practice in the United Kingdom
acquire the skills and competencies required of nurses registered in
the United Kingdom that were not required to be achieved during
their initial education and experience in their own country
demonstrate safe and effective care under supervision
so that they may be recommended for registration as a nurse in the United
Kingdom.
11 When considering an applicant’s ability to function as a Registered Nurse in
the United Kingdom, an applicant’s supervisor/assessor will refer to the
competencies required of the registered nurse, as set out in legislation and
which states that:
“The experience shall provide opportunities to enable the individual to
accept responsibility for his/her personal professional development and
to acquire the competencies required to:
(a) advise on the promotion of health and the prevention of illness;
(b) recognise situations that may be detrimental to the health and
well-being of the individual;
(c) carry out those activities involved when conducting the
comprehensive assessment of a person’s nursing requirements;
(d) recognise the significance of the observations made and use
these to develop an initial nursing assessment;
(e) devise a plan of nursing care based on the assessment, with the
co-operation of the patient, to the extent that this is possible,
taking into account the medical prescription;
(f) implement the planned programme of nursing care and where
appropriate, teach and co-ordinate other members of the caring
team who may be responsible for implementing specific aspects
of the nursing care;
(g) review the effectiveness of the nursing care provided, and
where appropriate, initiate any action that may be required;
(h) work in a team with other nurses, and with medical and paramedical
staff and social workers and
(i) undertake the management of the care of a group of patients
over a period of time and organise the appropriate support
services related to the care of the particular type of patient with
whom he/she is likely to come in contact when registered in the
Part of the Register for which the individual is applying’ (that
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is adult, mental health, paediatric or learning disabilities
nursing).”
Practice settings approved for a period of supervised practice
12 All nurses seeking to register with the NMC who are required to complete a
period of supervised practice, will need to have done so in an approved
practice setting. The practice setting must have been audited by a
college/faculty of nursing and midwifery within an approved educational
institution that provides pre-registration nursing education. This audit has to
be completed annually, stating clearly the number of places available. This
number must not be exceeded. We would advise you to check on this with the
practice settings before you start your period of supervised practice. The NMC
can only register those who have completed placements in settings that fulfil
this requirement.
13 The practice settings may be in:
hospitals
community settings, or
registered nursing homes –
either within the National Health Service or the independent sector.
14 Some applicants may be given a decision by the NMC to specifically
undertake their period of supervised practice in an acute hospital setting due to
the specific skills and/or experiences that they need to achieve before they can
apply for registration. All other applicants may choose an approved setting in
hospitals, community or nursing homes.
15 It is important that applicants wait until their application has been considered
by the Council and they have received the formal letter from the Council
setting out its decision before starting supervised practice. The Council will
not normally recognise any practice undertaken in advance of a decision being
made, as meeting the Council’s requirements for supervised practice.
16 An approved setting will provide the applicant with a supervisor (see
‘supervision’ below) whom we also call a mentor.
What supervision means
17 The applicant seeking registration must be supervised by a named and
experienced registered nurse during the period of supervised practice. The
nature of the clinical practice and the knowledge and experience of the
applicant will influence the type of supervision required.
18 The supervisor must be someone who is recognised as competent at assessing
and who is fully aware of the standards required for a registered nurse in the
United Kingdom. They will have been prepared for their role by meeting the
NMC outcomes for a mentor. The supervisor should have prior experience of
‘mentoring’ pre-registration nursing students and therefore be able to make a
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judgement on the applicant’s fitness to practise. Supervisors will arrange
regular meetings with the applicant to agree the applicant’s learning needs,
provide feedback on how well they are achieving them and to assess their
competence.
19 At no time should the applicant be placed in a position of responsibility for
which they have not been prepared. It is important that supervisors recognise
that the applicant is a qualified practitioner in his/her own country and is now
undertaking experience in the United Kingdom in order for them to be
assessed as competent to work safely and effectively as a registered nurse in
the United Kingdom. It is expected that the supervisor will actively assess the
applicant and may be asked to verify this to the Council.
Length of supervised practice
20 Each applicant comes with a different range of knowledge and experience and
therefore the length of the period for supervised practice can vary from
applicant to applicant. The Council can ensure that those who need more time
are given it and that the time required for the more experienced applicant takes
account of their experience. The most important issue for the Council is,
whatever time length is given, that safe standards for patients and clients are
ensured.
21 The Council believes that the necessary competence would not be assessed in
less than one month however experienced the individual applicant. The
average length of supervised practice is likely to be between 3 and 9 months.
The Council will make clear in its letter to the applicant the number of months
of supervised practice that is required.
22 The Council uses the following table to describe how many hours are required
to meet the requirements of 3, 6 and 9 months:
3 months = 400 hours
6 months = 800 hours
9 months = 1200 hours
23 Some applicants will have work visas that restrict the number of hours that
they can work in a week. In those cases it is important that the equivalent
hours are completed in order to meet the time requirement for the period of
supervised practice.
Assessment
24 The person planning the period of supervised practice must ensure that the
applicant is assessed for their ability to function as a registered nurse, even
though they may be employed in a variety of ways, for example, as a health
care assistant.
25 The Council expects that supervisors will use an appropriate range of
assessments to ensure that the learning outcomes described in paragraph 11
have been met. Such assessments could range from informal observation in
the work place to more formal assessment of specific elements of competence
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The methods of assessment must be made clear to the applicant at the start of
the period of supervised practice. The results of all assessments must be
formally documented and signed by the nurse and the supervisor.
Reference Recommending Registration
26 On satisfactory completion of the period of supervised practice, a reference
must be completed by the supervisor recommending the applicant for
registration with the Council. Those completing the reference must take into
account the responsibilities that registration confers and consider their own
accountability under the Code of Professional Conduct; NMC standards for
conduct, performance and ethics before completing the form. From April
2004 all applicants for registration will be required to declare that they are of
sufficiently good health and good character to practise safely and effectively.
This also applies to overseas applicants and the supervisor will be required to
sign to confirm this information.
Nature of employment
27 It is for the applicant and the institutions to agree the terms and conditions of
service for the duration of the period of supervised practice. These should be
agreed in advance of the commencement of the period of supervised practice.
The applicant would find it helpful if the contract specified the details of the
experience to be undertaken and supervision to be provided, in order to meet
the learning outcomes set out in paragraph 11).
English Language Testing
28 The NMC requires all registered practitioners to be proficient in reading,
writing and speaking English and able to receive and issue instructions
concerning the care of patients without risk of misunderstanding.
29 The NMC reserves the right to request a test for any overseas applicant at any
point during the application process. Applicants from countries where the
main mode of expression is not English are advised to undertake an Engliah
test acceptable to the NMC
prior to submitting an application. Applicants arestrongly advised to pass the test before they send in an application form and at
least before undertaking a period of supervised practice. This can prevent the
applicant from being disappointed that they cannot register with the NMC if
they fail the test after they have undertaken supervised practice.
30 Applicants will be required to achieve a satisfactory score in the International
English Language Testing System (IELTS) administered by the British
Council. A satisfactory score is not less than 5.5 in any of the four individual
bands of the general tester and not less than 6.5 in the overall band. Details of
test centres in your country can be obtained from the British Council Office.
Once confirmation of a satisfactory score is received, your application can
proceed without delay.
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