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The Nursing and Midwifery Council (NMC) has launched a new consultation giving the public the chance to have their say on proposed changes to the English language requirements.
This is very welcome news, especially to a cohort of nurses who have been trapped in the preregistration for more than a decade.
“These overseas educated nurses have been taught and examined in English, but in a non-English speaking country”
The NMC wants to seek views from the public about the clubbing of test scores and about the period of time that should be allowed between tests.
The other change the NMC is requesting the public to give their opinions on whether NMC can accept non-nursing or midwifery post-graduate qualifications taught and examined in English as proof of language proficiency.
The NMC will also seek views from various stakeholders on how they might recognise non-registered practice in health and care, as in the case of our cohort of nurses who have been in this country for the past 16 or 17 years but working as health care support workers.
These overseas educated nurses have been taught and examined in English, but in a non-English speaking country.
Some of them have come over here on a student visa, or on a carer visa and have been working in low-paid roles (as band 2, 3 or 4). Some of them are British citizens.
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To be registered, these nurses have to pass the Test of Competence 1 and 2. Test of Competence 1 is a 3- hour, computer-based exam in is made up of two parts. Part A consists of 15 numeracy questions, Part B consists of 100 clinical multiple-choice questions.
If you cannot read ad comprehend the usual nursing scenarios/treatment/guidelines/ with at least ‘adequate’ command of English, it's quite unlikely that you can pass this Test of Competence 1.
Test of Competence 2 is an OSCE – Objective structured clinical examination. This exam, which consists of 10 stations, assesses the clinical skills as well as the candidate’s values and behaviours, and evidence-based practice.
The Test of Competence measures candidates against the current UK pre-registration standards for nursing1.
The nurses must be familiar with the ethical and professional standards expected of registered nurses, as outlined in NMC (2018) ‘The Code’ 9. These are the required standards, which underpin professional nursing practice.
The 2001 NMC Test of Competence booklet states: “All healthcare professionals must work in partnership with patients, obtaining their consent and respecting their dignity and privacy. It is unacceptable for your words or actions to imply or express disapproval of any patient’s lifestyle.
“You must not discriminate in any way against those in your care. Patients and the public expect high standards of professional practice from nurses. Nurses work in partnership with other healthcare professionals. Nurses are expected both to contribute and to lead in areas of care where they have expertise.
“Many organisations are recruiting nurses, using ‘the 6 Cs’ – care, compassion, competence, communication, courage and commitment – and you should be familiar with these and be able to demonstrate them throughout Part 2 of the test of competence (the OSCE).”
The Test of Competence booklet reiterates that communication is central to nursing practice and will be assessed continually during the OSCE.
It states: “We assess the full range of communication skills (verbal, non-verbal and written) by observing the interaction between the candidate and a simulated patient (this may be an actor or a manikin) and also by assessing your nursing documentation in each station.”
Further on, the booklet explains how the assessor will assess these skills. It states: “The assessor will assess your approach to the patient throughout the examination, and will assess your communication skills”, such as:
- clearly explaining care, diagnosis, investigations and/or treatments
- involving the patient in decision-making
- communicating with relatives and healthcare professionals
- seeking and obtaining informed consent
- active listening
- dealing appropriately with an anxious person or anxious relatives
- providing clear instructions on discharge
- providing advice on lifestyle, health promotion or risk factors
- demonstrating compassion and care during communication
- clear documentation that meets the requirements of NMC (2018) ‘The Code’
- professional behaviour
- professional attitude.
The handbook further explains the examination process:
| Approaching the patient/manikin |
• Introduce yourself and explain or clarify the purpose of the nursing encounter. • Check what the patient wants you to call them. • Be polite, respectful and non-judgemental, and maintain the patient’s dignity. • Be empathic, acknowledge the patient’s emotions or concerns, and show sensitivity to any discomfort. • Ensure that you gain consent from the patient (or carer/guardian for children or certain people with disabilities) prior to undertaking any procedures. • Be sensitive to personal space, stand or sit at an appropriate distance from the actor/manikin, and be aware of their body language. You are too close if the actor moves back or recoils. |
|
Explaining and advising
|
Establish what the patient already knows and/or wants to know. • Explain clearly what you are going to do and why, so that the patient can understand. • Remember always to check whether the patient understands or has any questions. • Offer appropriate reassurance. • Do not alarm the patient but you must be able to explain the need for urgent action if it is required. • Do not routinely oversimplify names for parts of the body. It is reasonable to expect that most people will know common body names such as ‘bladder’, ‘ovary’, ‘womb’ and ‘vein’. If you doubt a patient’s understanding, check and alter your communication to meet their individual needs. • Treat the manikin as you would a real person.
|
| Involving the patient in management |
Respect the patient’s autonomy, and help them to make a decision based on the available evidence-based information. • Explain information and its implications so that the patient can make an informed choice about their care. • Check the patient’s understanding and feelings about the proposed nursing interventions. They may not always agree with your proposed plan of care.
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| Nursing assessment |
You should be able to undertake an accurate nursing assessment and develop a plan of care. • Identify the patient’s nursing care needs accurately. • Listen attentively to the patient’s problems and concerns. • Use clear language, and question at a comfortable pace. • Clarify and check information and summarise understanding. • Be able to plan safe and effective person-centred care, based on your nursing assessment and evidence-based best practice. |
It is very unlikely that a candidate can easily pass the OSCE, if they do not have adequate command of the English language.
Most of these nurses have completed these Tests of Competence, and it is only after they pass these tests, they can request/seek employer reference as (additional) proof of their communication skills.
Let’s also not forget that in practice the practice assessors sign off the nursing students that they think can communicate safely.
It is, therefore, quite welcome and reassuring that the NMC is now open to public consultation.
All can share their thoughts by filling out the online survey, which takes about 15 to 20 minutes. The consultation is open until 12 August 2022.
Dr Agimol Pradeep, liver transplant coordinator, Kings College Hospital, London, and Dr Dilla Davis, lecturer in nursing, University of Salford; Peter Mount, former chair of Central Manchester University Hospitals NHS Foundation Trust, and Salford Royal NHS Foundation Trust; Andrew Foster, chair of Manx Care and former chief executive of Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust
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