Future nurse: Standards of proficiency for registered nurses

www.nmc.org.uk Standards of proﬁciency for registered nurses 1

Future nurse:

Standards of

prociency for

registered nurses

Published 17 May 2018

www.nmc.org.uk Standards of proﬁciency for registered nurses 2

Contents

Introduction 3

The role of the nurse in the 21st century 3

How the proﬁciencies have been structured 6

Platform 1

Being an accountable professional 7

Platform 2

Promoting health and preventing ill health 10

Platform 3

Assessing needs and planning care 13

Platform 4

Providing and evaluating care 16

Platform 5

Leading and managing nursing care and working in teams 19

Platform 6

Improving safety and quality of care 21

Platform 7

Coordinating care 24

Annexe A: Communication and relationship management skills 27

Annexe B: Nursing procedures 31

Glossary 38

www.nmc.org.uk Standards of proﬁciency for registered nurses 3

Future nurse:

Standards of

prociency for

registered nurses

Introduction

The Nursing and Midwifery Council has a duty to review the

standards of proﬁciency it sets for the professions it registers

on a regular basis to ensure that standards remain contemporary

and ﬁt for purpose in order to protect the public. In reviewing the

standards, we have taken into account the changes that are taking

place in society and health care, and the implications these have for

registered nurses of the future in terms of their role, knowledge

and skill requirements.

The proﬁciencies in this document therefore specify the knowledge

and skills that registered nurses must demonstrate when caring

for people of all ages and across all care settings. They reﬂect

what the public can expect nurses to know and be able to do in

order to deliver safe, compassionate and eective nursing care.

They also provide a benchmark for nurses from the European

Economic Area (EEA), European Union (EU) and overseas wishing

to join the UK register, as well as for those who plan to return to

practice aer a period of absence.

The role of the nurse in the 21st century

Registered nurses play a vital role in providing, leading and

coordinating care that is compassionate, evidence-based, and

person-centred. They are accountable for their own actions and

must be able to work autonomously, or as an equal partner with

a range of other professionals, and in interdisciplinary teams.

In order to respond to the impact and demands of professional

nursing practice, they must be emotionally intelligent and resilient

individuals, who are able to manage their own personal health and

wellbeing, and know when and how to access support.

Registered nurses make an important contribution to the

promotion of health, health protection and the prevention of

ill health. They do this by empowering people, communities and

populations to exercise choice, take control of their own health

decisions and behaviours, and by supporting people to manage their

own care where possible.

Registered nurses provide leadership in the delivery of care for

people of all ages and from dierent backgrounds, cultures and

beliefs. They provide nursing care for people who have complex

mental, physical, cognitive and behavioural care needs, those living

with dementia, the elderly, and for people at the end of their life.

They must be able to care for people in their own home, in the

community or hospital or in any health care settings where their

needs are supported and managed. They work in the context of

continual change, challenging environments, dierent models of

care delivery, shiing demographics, innovation, and rapidly evolving

technologies. Increasing integration of health and social care

services will require registered nurses to negotiate boundaries

and play a proactive role in interdisciplinary teams. The conﬁdence

and ability to think critically, apply knowledge and skills, and provide

expert, evidence-based, direct nursing care therefore lies at the

centre of all registered nursing practice.

www.nmc.org.uk Standards of proﬁciency for registered nurses 4

About these standards

These standards of proﬁciency apply to all NMC registered nurses.

They should be read with Realising professionalism: Standards for

education and training which set out our expectations

regarding delivery of all pre-registration and post-registration

NMC approved nursing and midwifery education programmes.

These standards apply to all approved education providers and are

set out in three parts: Part 1: Standards framework for nursing

and midwifery education; Part 2: Standards for student supervision

and assessment; and Part 3: Programme standards, which are the

standards speciﬁc for each pre-registration or post-registration

programme. Education institutions must comply with our standards

to be approved to run any NMC approved programmes.

Together these standards aim to provide approved education

institutions (AEIs) and their practice learning partners with the

ﬂexibility to develop innovative approaches to education for nurses,

midwives and nursing associates, while being accountable for the

local delivery and management of approved programmes in line with

our standards.

Standards

for education

and training

Standards

of proﬁ ciency

for nursing

and midwifery

professions

Pre Post

Standards

framework

for nursing

and midwifery

education

Standards

for student

supervision

and assessment

Programme

standards

www.nmc.org.uk Standards of proﬁciency for registered nurses 5

Legislative framework

Article 15(1) of the Nursing and Midwifery Order 2001

(‘the Order’) requires the Council to establish standards for

education and training which are necessary to achieve the

standards of proﬁciency for admission to the register, as required

by Article 5(2) of the Order. The standards for nursing and

midwifery education providers are established under the provision

of Article 15(1) of the Order.

Article 5(2) of the Nursing and Midwifery Order 2001 requires

the NMC to establish standards of proﬁciency necessary to be

admitted to each part of the register and for safe and eective

practice under that part of the register. The standards of

proﬁciency have been established under this provision.

www.nmc.org.uk Standards of proﬁciency for registered nurses 6

Future nurse:

Standards of

prociency for

registered nurses

How the proﬁciencies have been structured

The proﬁciencies are grouped under seven platforms, followed

by two annexes. Together, these reﬂect what we expect a newly

registered nurse to know and be capable of doing safely and

proﬁciently at the start of their career.

Key components of the roles, responsibilities and accountabilities

of registered nurses are described under each of the seven

platforms. We believe that this approach provides clarity to the

public and the professions about the core knowledge and skills that

they can expect every registered nurse to demonstrate.

These proﬁciencies will provide new graduates into the profession

with the knowledge and skills they need at the point of registration

which they will build upon as they gain experience in practice and

fulﬁl their professional responsibility to continuously update

their knowledge and skills. For example, aer they register with

us registered nurses will already be equipped to progress to the

completion of a prescribing qualiﬁcation.

The platforms are:

1. Being an accountable professional

2. Promoting health and preventing ill health

3. Assessing needs and planning care

4. Providing and evaluating care

5. Leading and managing nursing care and working in teams

6. Improving safety and quality of care

7. Coordinating care

The outcome statements for each platform have been designed

to apply across all four ﬁelds of nursing practice (adult, children,

learning disabilities, mental health) and all care settings. This is

because registered nurses must be able to meet the person-

centred, holistic care needs of the people they encounter in their

practice who may be at any stage of life and who may have a range

of mental, physical, cognitive or behavioural health challenges.

They must also be able to demonstrate a greater depth of

knowledge and the additional more advanced skills required to

meet the speciﬁc care needs of people in their chosen ﬁelds of

nursing practice.

The annexes to these standards of proﬁciency are presented in

two sections. The annexes provide a description of what registered

nurses should be able to demonstrate they can do at the point of

registration in order to provide safe nursing care.

Annexe A speciﬁes the communication and relationship management

skills required, and Annexe B speciﬁes the nursing procedures

that registered nurses must demonstrate that they are able to

perform safely. As with the knowledge proﬁciencies, the annexes

also identify where more advanced skills are required by registered

nurses, working in a particular ﬁeld of nursing practice.

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 7

Platform 1

Being an accountable

professional

Registered nurses act in the best interests of people,

putting them ﬁrst and providing nursing care that is

person-centred, safe and compassionate. They act

professionally at all times and use their knowledge

and experience to make evidence-based decisions

about care. They communicate eectively, are role

models for others, and are accountable for their

actions. Registered nurses continually reﬂect on

their practice and keep abreast of new and emerging

developments in nursing, health and care.

Being an

accountable

professional

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 8

1. Outcomes:

The outcomes set out below reﬂect the proﬁciencies for

accountable professional practice that must be applied across the

standards of proﬁciency for registered nurses, as described in

platforms 2-7, in all care settings and areas of practice.

At the point of registration, the registered nurse will be able to:

1.1 understand and act in accordance with the Code:

Professional standards of practice and behaviour

for nurses, midwives and nursing associates, and fulﬁl all

registration requirements

1.2 understand and apply relevant legal, regulatory

and governance requirements, policies, and ethical

frameworks, including any mandatory reporting duties, to

all areas of practice, dierentiating where appropriate

between the devolved legislatures of the United Kingdom

1.3 understand and apply the principles of courage,

transparency and the professional duty of candour,

recognising and reporting any situations, behaviours or

errors that could result in poor care outcomes

1.4 demonstrate an understanding of, and the ability to

challenge, discriminatory behaviour

1.5 understand the demands of professional practice and

demonstrate how to recognise signs of vulnerability in

themselves or their colleagues and the action required to

minimise risks to health

1.6 understand the professional responsibility to adopt a

healthy lifestyle to maintain the level of personal ﬁtness

and wellbeing required to meet people’s needs for mental

and physical care

1.7 demonstrate an understanding of research methods,

ethics and governance in order to critically analyse,

safely use, share and apply research ﬁndings to promote

and inform best nursing practice

1.8 demonstrate the knowledge, skills and ability to think

critically when applying evidence and drawing on

experience to make evidence informed decisions in

all situations

1.9 understand the need to base all decisions regarding care

and interventions on people’s needs and preferences,

recognising and addressing any personal and external

factors that may unduly inﬂuence their decisions

Being an

accountable

professional

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 9

1.10 demonstrate resilience and emotional intelligence and

be capable of explaining the rationale that inﬂuences

their judgments and decisions in routine, complex and

challenging situations

1.11 communicate eectively using a range of skills and

strategies with colleagues and people at all stages of

life and with a range of mental, physical, cognitive and

behavioural health challenges

1.12 demonstrate the skills and abilities required to support

people at all stages of life who are emotionally or

physically vulnerable

1.13 demonstrate the skills and abilities required to develop,

manage and maintain appropriate relationships with

people, their families, carers and colleagues

1.14 provide and promote non-discriminatory, person-

centred and sensitive care at all times, reﬂecting on

people’s values and beliefs, diverse backgrounds, cultural

characteristics, language requirements, needs and

preferences, taking account of any need for adjustments

1.15 demonstrate the numeracy, literacy, digital and

technological skills required to meet the needs of

people in their care to ensure safe and eective

nursing practice

1.16 demonstrate the ability to keep complete, clear, accurate

and timely records

1.17 take responsibility for continuous self-reﬂection, seeking

and responding to support and feedback to develop their

professional knowledge and skills

1.18 demonstrate the knowledge and conﬁdence

to contribute eectively and proactively in an

interdisciplinary team

1.19 act as an ambassador, upholding the reputation of their

profession and promoting public conﬁdence in nursing,

health and care services, and

1.20 safely demonstrate evidence-based practice in all skills

and procedures stated in Annexes A and B.

Being an

accountable

professional

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 10

Platform 2

Promoting health and

preventing ill health

Registered nurses play a key role in improving and

maintaining the mental, physical and behavioural health

and well-being of people, families, communities and

populations. They support and enable people at all

stages of life and in all care settings to make informed

choices about how to manage health challenges in

order to maximise their quality of life and improve

health outcomes. They are actively involved in the

prevention of and protection against disease and

ill health and engage in public health, community

development and global health agendas, and in the

reduction of health inequalities.

Promoting

health and preventing

ill health

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 11

2. Outcomes:

The proﬁciencies identiﬁed below will equip the newly registered

nurse with the underpinning knowledge and skills required for their

role in health promotion and protection and prevention of ill health.

At the point of registration, the registered nurse will be able to:

2.1 understand and apply the aims and principles of health

promotion, protection and improvement and the prevention of

ill health when engaging with people

2.2 demonstrate knowledge of epidemiology, demography,

genomics and the wider determinants of health, illness and

wellbeing and apply this to an understanding of global patterns

of health and wellbeing outcomes

2.3 understand the factors that may lead to inequalities in

health outcomes

2.4 identify and use all appropriate opportunities, making

reasonable adjustments when required, to discuss the impact

of smoking, substance and alcohol use, sexual behaviours, diet

and exercise on mental, physical and behavioural health and

wellbeing, in the context of people’s individual circumstances

Promoting

health and preventing

ill health

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 12

2.5 promote and improve mental, physical, behavioural and other

health related outcomes by understanding and explaining

the principles, practice and evidence-base for health

screening programmes

2.6 understand the importance of early years and childhood

experiences and the possible impact on life choices, mental,

physical and behavioural health and wellbeing

2.7 understand and explain the contribution of social inﬂuences,

health literacy, individual circumstances, behaviours and

lifestyle choices to mental, physical and behavioural

health outcomes

2.8 explain and demonstrate the use of up to date approaches to

behaviour change to enable people to use their strengths and

expertise and make informed choices when managing their own

health and making lifestyle adjustments

2.9 use appropriate communication skills and strength based

approaches to support and enable people to make informed

choices about their care to manage health challenges in order

to have satisfying and fulﬁlling lives within the limitations

caused by reduced capability, ill health and disability

2.10 provide information in accessible ways to help people

understand and make decisions about their health, life choices,

illness and care

2.11 promote health and prevent ill health by understanding

and explaining to people the principles of pathogenesis,

immunology and the evidence-base for immunisation,

vaccination and herd immunity, and

2.12 protect health through understanding and applying the

principles of infection prevention and control, including

communicable disease surveillance and antimicrobial

stewardship and resistance.

Promoting

health and preventing

ill health

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 13

Platform 3

Assessing needs and

planning care

Registered nurses prioritise the needs of people

when assessing and reviewing their mental, physical,

cognitive, behavioural, social and spiritual needs.

They use information obtained during assessments

to identify the priorities and requirements for

person-centred and evidence-based nursing

interventions and support. They work in partnership

with people to develop person-centred care plans that

take into account their circumstances, characteristics

and preferences.

Assessing

needs and

planning care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 14

3. Outcomes:

The proﬁciencies identiﬁed below will equip the newly registered

nurse with the underpinning knowledge and skills required for their

role in assessing and initiating person-centred plans of care.

At the point of registration, the registered nurse will be able to:

3.1 demonstrate and apply knowledge of human development

from conception to death when undertaking full and accurate

person-centred nursing assessments and developing

appropriate care plans

3.2 demonstrate and apply knowledge of body systems and

homeostasis, human anatomy and physiology, biology,

genomics, pharmacology and social and behavioural sciences

when undertaking full and accurate person-centred nursing

assessments and developing appropriate care plans

3.3 demonstrate and apply knowledge of all commonly

encountered mental, physical, behavioural and cognitive

health conditions, medication usage and treatments when

undertaking full and accurate assessments of nursing care

needs and when developing, prioritising and reviewing person-

centred care plans

3.4 understand and apply a person-centred approach to nursing

care, demonstrating shared assessment, planning, decision

making and goal setting when working with people, their

families, communities and populations of all ages

3.5 demonstrate the ability to accurately process all information

gathered during the assessment process to identify needs

for individualised nursing care and develop person-centred

evidence-based plans for nursing interventions with

agreed goals

3.6 eectively assess a person’s capacity to make decisions about

their own care and to give or withhold consent

3.7 understand and apply the principles and processes for making

reasonable adjustments

3.8 understand and apply the relevant laws about mental capacity

for the country in which you are practising when making

decisions in relation to people who do not have capacity

Assessing

needs and

planning care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 15

3.9 recognise and assess people at risk of harm and the situations

that may put them at risk, ensuring prompt action is taken to

safeguard those who are vulnerable

3.10 demonstrate the skills and abilities required to recognise

and assess people who show signs of self-harm and/or

suicidal ideation

3.11 undertake routine investigations, interpreting and sharing

ﬁndings as appropriate

3.12 interpret results from routine investigations, taking

prompt action when required by implementing appropriate

interventions, requesting additional investigations or

escalating to others

3.13 demonstrate an understanding of co-morbidities and the

demands of meeting people’s complex nursing and social care

needs when prioritising care plans

3.14 identify and assess the needs of people and families

for care at the end of life, including requirements for

palliative care and decision making related to their treatment

and care preferences

3.15 demonstrate the ability to work in partnership with people,

families and carers to continuously monitor, evaluate and

reassess the eectiveness of all agreed nursing care plans

and care, sharing decision making and readjusting agreed

goals, documenting progress and decisions made, and

3.16 demonstrate knowledge of when and how to refer people

safely to other professionals or services for clinical

intervention or support.

Assessing

needs and

planning care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 16

Platform 4

Providing and

evaluating care

Registered nurses take the lead in providing evidence-

based, compassionate and safe nursing interventions.

They ensure that care they provide and delegate is

person-centred and of a consistently high standard.

They support people of all ages in a range of care

settings. They work in partnership with people, families

and carers to evaluate whether care is eective

and the goals of care have been met in line with their

wishes, preferences and desired outcomes.

Providing and

evaluating care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 17

4. Outcomes:

The proﬁciencies identiﬁed below will equip the newly registered

nurse with the underpinning knowledge and skills required for their

role in providing and evaluating person-centred care.

At the point of registration, the registered nurse will be able to:

4.1 demonstrate and apply an understanding of what is important

to people and how to use this knowledge to ensure their needs

for safety, dignity, privacy, comfort and sleep can be met,

acting as a role model for others in providing evidence based

person-centred care

4.2 work in partnership with people to encourage shared decision

making in order to support individuals, their families and

carers to manage their own care when appropriate

4.3 demonstrate the knowledge, communication and relationship

management skills required to provide people, families and

carers with accurate information that meets their needs

before, during and aer a range of interventions

4.4 demonstrate the knowledge and skills required to support

people with commonly encountered mental health, behavioural,

cognitive and learning challenges, and act as a role model for

others in providing high quality nursing interventions to meet

people’s needs

4.5 demonstrate the knowledge and skills required to support

people with commonly encountered physical health conditions,

their medication usage and treatments, and act as a role

model for others in providing high quality nursing interventions

when meeting people’s needs

4.6 demonstrate the knowledge, skills and ability to act as a role

model for others in providing evidence-based nursing care

to meet people’s needs related to nutrition, hydration and

bladder and bowel health

4.7 demonstrate the knowledge, skills and ability to act as a role

model for others in providing evidence-based, person-centred

nursing care to meet people’s needs related to mobility,

hygiene, oral care, wound care and skin integrity

4.8 demonstrate the knowledge and skills required to identify

and initiate appropriate interventions to support people with

commonly encountered symptoms including anxiety, confusion,

discomfort and pain

Providing and

evaluating care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 18

4.9 demonstrate the knowledge and skills required to prioritise

what is important to people and their families when providing

evidence-based person-centred nursing care at end of

life including the care of people who are dying, families, the

deceased and the bereaved

4.10 demonstrate the knowledge and ability to respond proactively

and promptly to signs of deterioration or distress in mental,

physical, cognitive and behavioural health and use this

knowledge to make sound clinical decisions

4.11 demonstrate the knowledge and skills required to initiate and

evaluate appropriate interventions to support people who

show signs of self-harm and/or suicidal ideation

4.12 demonstrate the ability to manage commonly

encountered devices and conﬁdently carry out related

nursing procedures to meet people’s needs for evidence-

based, person-centred care

4.13 demonstrate the knowledge, skills and conﬁdence to provide

ﬁrst aid procedures and basic life support

4.14 understand the principles of safe and eective administration

and optimisation of medicines in accordance with local and

national policies and demonstrate proﬁciency and accuracy

when calculating dosages of prescribed medicines

4.15 demonstrate knowledge of pharmacology and the ability

to recognise the eects of medicines, allergies, drug

sensitivities, side eects, contraindications, incompatibilities,

adverse reactions, prescribing errors and the impact of

polypharmacy and over the counter medication usage

4.16 demonstrate knowledge of how prescriptions can be

generated, the role of generic, unlicensed, and o-label

prescribing and an understanding of the potential risks

associated with these approaches to prescribing

4.17 apply knowledge of pharmacology to the care of people,

demonstrating the ability to progress to a prescribing

qualiﬁcation following registration, and

4.18 demonstrate the ability to co-ordinate and undertake the

processes and procedures involved in routine planning and

management of safe discharge home or transfer of people

between care settings.

Providing and

evaluating care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 19

Platform 5

Leading and managing

nursing care and

working in teams

Registered nurses provide leadership by acting as a

role model for best practice in the delivery of nursing

care. They are responsible for managing nursing care

and are accountable for the appropriate delegation

and supervision of care provided by others in the

team including lay carers. They play an active and equal

role in the interdisciplinary team, collaborating and

communicating eectively with a range of colleagues.

Leading and managing

nursing care

and working in teams

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 20

5. Outcomes:

The proﬁciencies identiﬁed below will equip the newly registered

nurse with the underpinning knowledge and skills required for their

role in leading and managing nursing care and working eectively as

part of an interdisciplinary team.

At the point of registration, the registered nurse will be able to:

5.1 understand the principles of eective leadership,

management, group and organisational dynamics and culture

and apply these to team working and decision-making

5.2 understand and apply the principles of human factors,

environmental factors and strength-based approaches when

working in teams

5.3 understand the principles and application of processes

for performance management and how these apply to the

nursing team

5.4 demonstrate an understanding of the roles, responsibilities

and scope of practice of all members of the nursing and

interdisciplinary team and how to make best use of the

contributions of others involved in providing care

5.5 safely and eectively lead and manage the nursing care of a

group of people, demonstrating appropriate prioritisation,

delegation and assignment of care responsibilities to others

involved in providing care

5.6 exhibit leadership potential by demonstrating an ability

to guide, support and motivate individuals and interact

conﬁdently with other members of the care team

5.7 demonstrate the ability to monitor and evaluate the quality of

care delivered by others in the team and lay carers

5.8 support and supervise students in the delivery of nursing care,

promoting reﬂection and providing constructive feedback, and

evaluating and documenting their performance

5.9 demonstrate the ability to challenge and provide constructive

feedback about care delivered by others in the team, and

support them to identify and agree individual learning needs

5.10 contribute to supervision and team reﬂection activities to

promote improvements in practice and services

5.11 eectively and responsibly use a range of digital technologies

to access, input, share and apply information and data within

teams and between agencies, and

5.12 understand the mechanisms that can be used to inﬂuence

organisational change and public policy, demonstrating the

development of political awareness and skills.

Leading and managing

nursing care

and working in teams

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 21

Platform 6

Improving safety

and quality of care

Registered nurses make a key contribution to the

continuous monitoring and quality improvement of care

and treatment in order to enhance health outcomes

and people’s experience of nursing and related care.

They assess risks to safety or experience and take

appropriate action to manage those, putting the best

interests, needs and preferences of people ﬁrst.

Improving

safety and

quality of care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 22

6. Outcomes:

The proﬁciencies identiﬁed below will equip the newly registered

nurse with the underpinning knowledge and skills required for

their role in contributing to risk monitoring and quality of care

improvement agendas.

At the point of registration the registered nurse will be able to:

6.1 understand and apply the principles of health and safety

legislation and regulations and maintain safe work and

care environments

6.2 understand the relationship between safe stang levels,

appropriate skills mix, safety and quality of care, recognising

risks to public protection and quality of care, escalating

concerns appropriately

6.3 comply with local and national frameworks, legislation and

regulations for assessing, managing and reporting risks,

ensuring the appropriate action is taken

6.4 demonstrate an understanding of the principles of

improvement methodologies, participate in all stages

of audit activity and identify appropriate quality

improvement strategies

6.5 demonstrate the ability to accurately undertake risk

assessments in a range of care settings, using a range of

contemporary assessment and improvement tools

6.6 identify the need to make improvements and proactively

respond to potential hazards that may aect the safety

of people

6.7 understand how the quality and eectiveness of nursing care

can be evaluated in practice, and demonstrate how to use

service delivery evaluation and audit ﬁndings to bring about

continuous improvement

6.8 demonstrate an understanding of how to identify, report

and critically reﬂect on near misses, critical incidents, major

incidents and serious adverse events in order to learn from

them and inﬂuence their future practice

Improving

safety and

quality of care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 23

6.9 work with people, their families, carers and colleagues

to develop eective improvement strategies for quality

and safety, sharing feedback and learning from positive

outcomes and experiences, mistakes and adverse outcomes

and experiences

6.10 apply an understanding of the dierences between risk

aversion and risk management and how to avoid compromising

quality of care and health outcomes

6.11 acknowledge the need to accept and manage uncertainty, and

demonstrate an understanding of strategies that develop

resilience in self and others, and

6.12 understand the role of registered nurses and other health

and care professionals at dierent levels of experience and

seniority when managing and prioritising actions and care in

the event of a major incident.

Improving

safety and

quality of care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 24

Platform 7

Coordinating care

Registered nurses play a leadership role in coordinating

and managing the complex nursing and integrated care

needs of people at any stage of their lives, across a

range of organisations and settings. They contribute

to processes of organisational change through an

awareness of local and national policies.

Coordinating

care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 25

7. Outcomes:

The proﬁciencies identiﬁed below will equip the newly registered

nurse with the underpinning knowledge and skills required for their

role in coordinating and leading and managing the complex needs of

people across organisations and settings.

At the point of registration, the registered nurse will be able to:

7.1 understand and apply the principles of partnership,

collaboration and interagency working across all

relevant sectors

7.2 understand health legislation and current health and social

care policies, and the mechanisms involved in inﬂuencing policy

development and change, dierentiating where appropriate

between the devolved legislatures of the United Kingdom

7.3 understand the principles of health economics and their

relevance to resource allocation in health and social care

organisations and other agencies

7.4 identify the implications of current health policy and future

policy changes for nursing and other professions and

understand the impact of policy changes on the delivery and

coordination of care

Coordinating

care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 26

7.5 understand and recognise the need to respond to the

challenges of providing safe, eective and person-centred

nursing care for people who have co-morbidities and complex

care needs

7.6 demonstrate an understanding of the complexities of

providing mental, cognitive, behavioural and physical care

services across a wide range of integrated care settings

7.7 understand how to monitor and evaluate the quality of

people’s experience of complex care

7.8 understand the principles and processes involved in

supporting people and families with a range of care needs

to maintain optimal independence and avoid unnecessary

interventions and disruptions to their lives

7.9 facilitate equitable access to healthcare for people who are

vulnerable or have a disability, demonstrate the ability to

advocate on their behalf when required, and make necessary

reasonable adjustments to the assessment, planning and

delivery of their care

7.10 understand the principles and processes involved in planning

and facilitating the safe discharge and transition of people

between caseloads, settings and services

7.1 1 demonstrate the ability to identify and manage risks and

take proactive measures to improve the quality of care and

services when needed

7.1 2 demonstrate an understanding of the processes involved in

developing a basic business case for additional care funding

by applying knowledge of ﬁnance, resources and safe stang

levels, and

7.1 3 demonstrate an understanding of the importance of

exercising political awareness throughout their career, to

maximise the inﬂuence and eect of registered nursing on

quality of care, patient safety and cost eectiveness.

Coordinating

care

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 27

Annexe A:

Communication

and relationship

management skills

Introduction

The communication and relationship management skills that a newly

registered nurse must be able to demonstrate in order to meet the

proﬁciency outcomes outlined in the main body of this document

are set out in this annexe.

Eective communication is central to the provision of safe

and compassionate person-centred care. Registered nurses in

all ﬁelds of nursing practice must be able to demonstrate the

ability to communicate and manage relationships with people of

all ages with a range of mental, physical, cognitive and behavioural

health challenges.

This is because a diverse range of communication and relationship

management skills is required to ensure that individuals, their

families and carers are actively involved in and understand care

decisions. These skills are vital when making accurate, culturally

aware assessments of care needs and ensuring that the needs,

priorities, expertise and preferences of people are always valued

and taken into account.

Where people have special communication needs or a disability,

it is essential that reasonable adjustments are made in order to

communicate, provide and share information in a manner that

promotes optimum understanding and engagement and facilitates

equal access to high quality care.

The communication and relationship management skills within this

annexe are set out in four sections. For the reasons above, these

requirements are relevant to all ﬁelds of nursing practice and

apply to all care settings. It is expected that these skills would be

assessed in a student’s chosen ﬁeld of practice.

Those skills outlined in Annexe A, Section 3: Evidence-based,

best practice communication skills and approaches for providing

therapeutic interventions also apply to all registered nurses, but

the level of expertise and knowledge required will vary depending

on the chosen ﬁeld of practice. Registered nurses must be able to

demonstrate these skills to an appropriate level for their intended

ﬁeld(s) of practice.

Annexe A:

Communication

and relationship

management skills

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 28

At the point of registration, the registered nurse will be able to

safely demonstrate the following skills:

1. Underpinning communication skills for assessing, planning,

providing and managing best practice, evidence-based

nursing care

1.1 actively listen, recognise and respond to verbal and

non-verbal cues

1.2 use prompts and positive verbal and non-verbal

reinforcement

1.3 use appropriate non-verbal communication including

touch, eye contact and personal space

1.4 make appropriate use of open and closed questioning

1.5 use caring conversation techniques

1.6 check understanding and use clariﬁcation techniques

1.7 be aware of own unconscious bias in communication

encounters

1.8 write accurate, clear, legible records and documentation

1.9 conﬁdently and clearly present and share verbal and

written reports with individuals and groups

1.10 analyse and clearly record and share digital information

and data

1.11 provide clear verbal, digital or written information

and instructions when delegating or handing over

responsibility for care

1.12 recognise the need for, and facilitate access to,

translator services and material.

2. Evidence-based, best practice approaches to communication

for supporting people of all ages, their families and carers in

preventing ill health and in managing their care

2.1 share information and check understanding about

the causes, implications and treatment of a range of

common health conditions including anxiety, depression,

memory loss, diabetes, dementia, respiratory disease,

cardiac disease, neurological disease, cancer, skin

problems, immune deﬁciencies, psychosis, stroke

and arthritis

2.2 use clear language and appropriate, written materials,

making reasonable adjustments where appropriate in

order to optimise people’s understanding of what has

caused their health condition and the implications of

their care and treatment

2.3 recognise and accommodate sensory impairments during

all communications

2.4 support and manage the use of personal

communication aids

Annexe A:

Communication

and relationship

management skills

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 29

2.5 identify the need for and manage a range of alternative

communication techniques

2.6 use repetition and positive reinforcement strategies

2.7 assess motivation and capacity for behaviour change and

clearly explain cause and eect relationships related to

common health risk behaviours including smoking, obesity,

sexual practice, alcohol and substance use

2.8 provide information and explanation to people, families

and carers and respond to questions about their

treatment and care and possible ways of preventing ill

health to enhance understanding

2.9 engage in dicult conversations, including breaking bad

news and support people who are feeling emotionally or

physically vulnerable or in distress, conveying compassion

and sensitivity.

3. Evidence-based, best practice communication skills and

approaches for providing therapeutic interventions

3.1 motivational interview techniques

3.2 solution focused therapies

3.3 reminiscence therapies

3.4 talking therapies

3.5 de-escalation strategies and techniques

3.6 cognitive behavioural therapy techniques

3.7 play therapy

3.8 distraction and diversion strategies

3.9 positive behaviour support approaches

Annexe A:

Communication

and relationship

management skills

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 30

4. Evidence-based, best practice communication skills and

approaches for working with people in professional teams

4.1 Demonstrate eective supervision, teaching and

performance appraisal through the use of:

4.1.1 clear instructions and explanations when

supervising, teaching or appraising others

4.1.2 clear instructions and check understanding when

delegating care responsibilities to others

4.1.3 unambiguous, constructive feedback about

strengths and weaknesses and potential

for improvement

4.1.4 encouragement to colleagues that helps them to

reﬂect on their practice

4.1.5 unambiguous records of performance

4.2 Demonstrate eective person and team management

through the use of:

4.2.1 strengths based approaches to developing teams

and managing change

4.2.2 active listening when dealing with team members’

concerns and anxieties

4.2.3 a calm presence when dealing with conﬂict

4.2.4 appropriate and eective confrontation strategies

4.2.5 de-escalation strategies and techniques when

dealing with conﬂict

4.2.6 eective co-ordination and navigation

skills through:

4.2.6.1 appropriate negotiation strategies

4.2.6.2 appropriate escalation procedures

4.2.6.3 appropriate approaches to advocacy.

Annexe A:

Communication

and relationship

management skills

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 31

Annexe B:

Nursing procedures

Introduction

The nursing procedures that a newly registered nurse must be able

to demonstrate in order to meet the proﬁciency outcomes, outlined

in the main body of this document, are set out in this annexe.

The registered nurse must be able to undertake these procedures

eectively in order to provide compassionate, evidence-based

person-centred nursing care. A holistic approach to the care of

people is essential and all nursing procedures should be carried out

in a way which reﬂects cultural awareness and ensures that the

needs, priorities, expertise and preferences of people are always

valued and taken into account.

Registered nurses in all ﬁelds of practice must demonstrate the

ability to provide nursing intervention and support for people of

all ages who require nursing procedures during the processes of

assessment, diagnosis, care and treatment for mental, physical,

cognitive and behavioural health challenges. Where people are

disabled or have speciﬁc cognitive needs it is essential that

reasonable adjustments are made to ensure that all procedures

are undertaken safely.

The nursing procedures within this annexe are set out in two

sections. These requirements are relevant to all ﬁelds of nursing

practice although it is recognised that dierent care settings

may require dierent approaches to the provision of care. It is

expected that these procedures would be assessed in a student’s

chosen ﬁeld of practice where practicable.

Those procedures outlined in Annexe B, Part I: Procedures for

assessing needs for person-centred care, sections 1 and 2

also apply to all registered nurses, but the level of expertise

and knowledge required will vary depending on the chosen ﬁeld(s)

of practice. Registered nurses must therefore be able to

demonstrate the ability to undertake these procedures at an

appropriate level for their intended ﬁeld(s) of practice.

Annexe B:

Nursing procedures

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 32

At the point of registration, the registered nurse will be able to

safely demonstrate the following procedures:

Part 1: Procedures for assessing people’s needs

for person-centred care

1. Use evidence-based, best practice approaches to take a

history, observe, recognise and accurately assess people

of all ages:

1.1 mental health and wellbeing status

1.1.1 signs of mental and emotional distress

or vulnerability

1.1.2 cognitive health status and wellbeing

1.1.3 signs of cognitive distress and impairment

1.1.4 behavioural distress based needs

1.1.5 signs of mental and emotional distress including

agitation, aggression and challenging behaviour

1.1.6 signs of self-harm and/or suicidal ideation

1.2 physical health and wellbeing

1.2.1 symptoms and signs of physical ill health

1.2.2 symptoms and signs of physical distress

1.2.3 symptoms and signs of deterioration and sepsis.

2. Use evidence-based, best practice approaches to undertake

the following procedures:

2.1 take, record and interpret vital signs manually and via

technological devices

2.2 undertake venepuncture and cannulation and blood

sampling, interpreting normal and common abnormal

blood proﬁles and venous blood gases

2.3 set up and manage routine electrocardiogram (ECG)

investigations and interpret normal and commonly

encountered abnormal traces

2.4 manage and monitor blood component transfusions

2.5 manage and interpret cardiac monitors, infusion pumps,

blood glucose monitors and other monitoring devices

2.6 accurately measure weight and height, calculate body

mass index and recognise healthy ranges and clinically

signiﬁcant low/high readings

2.7 undertake a whole body systems assessment including

respiratory, circulatory, neurological, musculoskeletal,

cardiovascular and skin status

2.8 undertake chest auscultation and interpret ﬁndings

2.9 collect and observe sputum, urine, stool and vomit

specimens, undertaking routine analysis and

interpreting ﬁndings

Annexe B:

Nursing procedures

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 33

2.10 measure and interpret blood glucose levels

2.11 recognise and respond to signs of all forms of abuse

2.12 undertake, respond to and interpret neurological

observations and assessments

2.13 identify and respond to signs of deterioration and sepsis

2.14 administer basic mental health ﬁrst aid

2.15 administer basic physical ﬁrst aid

2.16 recognise and manage seizures, choking and anaphylaxis,

providing appropriate basic life support

2.17 recognise and respond to challenging behaviour, providing

appropriate safe holding and restraint.

Part 2: Procedures for the planning, provision

and management of person-centred nursing care

3. Use evidence-based, best practice approaches for meeting

needs for care and support with rest, sleep, comfort and the

maintenance of dignity, accurately assessing the person’s

capacity for independence and self-care and initiating

appropriate interventions

3.1 observe and assess comfort and pain levels and rest and

sleep patterns

3.2 use appropriate bed-making techniques including those

required for people who are unconscious or who have

limited mobility

3.3 use appropriate positioning and pressure-relieving

techniques

3.4 take appropriate action to ensure privacy and dignity

at all times

3.5 take appropriate action to reduce or minimise pain

or discomfort

3.6 take appropriate action to reduce fatigue, minimise

insomnia and support improved rest and sleep hygiene.

Annexe B:

Nursing procedures

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 34

4. Use evidence-based, best practice approaches for meeting

the needs for care and support with hygiene and the

maintenance of skin integrity, accurately assessing the

person’s capacity for independence and self-care and

initiating appropriate interventions

4.1 observe, assess and optimise skin and hygiene status and

determine the need for support and intervention

4.2 use contemporary approaches to the assessment of skin

integrity and use appropriate products to prevent or

manage skin breakdown

4.3 assess needs for and provide appropriate assistance

with washing, bathing, shaving and dressing

4.4 identify and manage skin irritations and rashes

4.5 assess needs for and provide appropriate oral, dental,

eye and nail care and decide when an onward referral

is needed

4.6 use aseptic techniques when undertaking wound care

including dressings, pressure bandaging, suture removal,

and vacuum closures

4.7 use aseptic techniques when managing wound and

drainage processes

4.8 assess, respond and eectively manage pyrexia

and hypothermia.

5. Use evidence-based, best practice approaches for meeting

needs for care and support with nutrition and hydration,

accurately assessing the person’s capacity for independence

and self-care and initiating appropriate interventions

5.1 observe, assess and optimise nutrition and hydration

status and determine the need for intervention

and support

5.2 use contemporary nutritional assessment tools

5.3 assist with feeding and drinking and use appropriate

feeding and drinking aids

5.4 record ﬂuid intake and output and identify, respond to

and manage dehydration or ﬂuid retention

5.5 identify, respond to and manage nausea and vomiting

5.6 insert, manage and remove oral/nasal/gastric tubes

5.7 manage artiﬁcial nutrition and hydration using oral,

enteral and parenteral routes

5.8 manage the administration of IV ﬂuids

5.9 manage ﬂuid and nutritional infusion pumps and devices.

Annexe B:

Nursing procedures

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 35

6. Use evidence-based, best practice approaches for meeting

needs for care and support with bladder and bowel health,

accurately assessing the person’s capacity for independence

and self-care and initiating appropriate interventions

6.1 observe and assess level of urinary and bowel continence

to determine the need for support and intervention

assisting with toileting, maintaining dignity and privacy

and managing the use of appropriate aids

6.2 select and use appropriate continence products; insert,

manage and remove catheters for all genders; and assist

with self-catheterisation when required

6.3 manage bladder drainage

6.4 assess bladder and bowel patterns to identify and

respond to constipation, diarrhoea and urinary and

faecal retention

6.5 administer enemas and suppositories and undertake

rectal examination and manual evacuation when

appropriate

6.6 undertake stoma care identifying and using appropriate

products and approaches.

7. Use evidence-based, best practice approaches for meeting

needs for care and support with mobility and safety,

accurately assessing the person’s capacity for independence

and self-care and initiating appropriate interventions

7.1 observe and use evidence-based risk assessment

tools to determine need for support and intervention

to optimise mobility and safety, and to identify and

manage risk of falls using best practice risk assessment

approaches

7.2 use a range of contemporary moving and handling

techniques and mobility aids

7.3 use appropriate moving and handling equipment to

support people with impaired mobility

7.4 use appropriate safety techniques and devices.

8. Use evidence-based, best practice approaches for meeting

needs for respiratory care and support, accurately assessing

the person’s capacity for independence and self-care and

initiating appropriate interventions

8.1 observe and assess the need for intervention and

respond to restlessness, agitation and breathlessness

using appropriate interventions

Annexe B:

Nursing procedures

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 36

8.2 manage the administration of oxygen using a range of

routes and best practice approaches

8.3 take and interpret peak ﬂow and oximetry measurements

8.4 use appropriate nasal and oral suctioning techniques

8.5 manage inhalation, humidiﬁer and nebuliser devices

8.6 manage airway and respiratory processes and

equipment.

9. Use evidence-based, best practice approaches for meeting

needs for care and support with the prevention and

management of infection, accurately assessing the person’s

capacity for independence and self-care and initiating

appropriate interventions

9.1 observe, assess and respond rapidly to potential

infection risks using best practice guidelines

9.2 use standard precautions protocols

9.3 use eective aseptic, non-touch techniques

9.4 use appropriate personal protection equipment

9.5 implement isolation procedures

9.6 use evidence-based hand hygiene techniques

9.7 safely decontaminate equipment and environment

9.8 safely use and dispose of waste, laundry and sharps

9.9 safely assess and manage invasive medical devices

and lines.

10. Use evidence-based, best practice approaches for meeting

needs for care and support at the end of life, accurately

assessing the person’s capacity for independence and self-

care and initiating appropriate interventions

10.1 observe, and assess the need for intervention for

people, families and carers, identify, assess and respond

appropriately to uncontrolled symptoms and signs of

distress including pain, nausea, thirst, constipation,

restlessness, agitation, anxiety and depression

10.2 manage and monitor eectiveness of symptom relief

medication, infusion pumps and other devices

10.3 assess and review preferences and care priorities of the

dying person and their family and carers

10.4 understand and apply organ and tissue donation

protocols, advanced planning decisions, living wills and

health and lasting powers of attorney for health

10.5 understand and apply DNACPR (do not attempt

cardiopulmonary resuscitation) decisions and veriﬁcation

of expected death

10.6 provide care for the deceased person and the bereaved

respecting cultural requirements and protocols.

Annexe B:

Nursing procedures

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 37

Annexe B:

Nursing procedures

11. Procedural competencies required for best practice,

evidence-based medicines administration and optimisation

11.1 carry out initial and continued assessments of people

receiving care and their ability to self-administer their

own medications

11.2 recognise the various procedural routes under which

medicines can be prescribed, supplied, dispensed and

administered; and the laws, policies, regulations and

guidance that underpin them

11.3 use the principles of safe remote prescribing and

directions to administer medicines

11.4 undertake accurate drug calculations for a range

of medications

11.5 undertake accurate checks, including transcription

and titration, of any direction to supply or administer a

medicinal product

11.6 exercise professional accountability in ensuring the safe

administration of medicines to those receiving care

11.7 administer injections using intramuscular, subcutaneous,

intradermal and intravenous routes and manage

injection equipment

11.8 administer medications using a range of routes

11.9 administer and monitor medications using vascular

access devices and enteral equipment

11.10 recognise and respond to adverse or abnormal reactions

to medications

11.11 undertake safe storage, transportation and disposal of

medicinal products.

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 38

Annexe B:

Nursing procedures

Glossary

Abuse: is something that

may harm another person, or

endanger their life, or violate

their rights. The person

responsible for the abuse may

be doing this on purpose or may

not realise the harm that they

are doing. The type of abuse

may be emotional, physical,

sexual, psychological, material

or ﬁnancial, or may be due

to neglect.

Cognitive: The mental

processes of perception,

memory, judgment,

and reasoning.

Co-morbidities: the presence

of one or more additional

diseases or disorders that

occur with a primary disease

or disorder.

Demography: the study of

statistics such as births,

deaths, income, or the incidence

of disease, which illustrate

the changing structure of

human populations.

Evidence-based person-

centred care/nursing care:

making sure that any care and

treatment is given to people, by

looking at what research has

shown to be most eective.

The judgment and experience of

the nurse and the views of the

person should also be taken

into account when choosing

which treatment is most

likely to be successful for

an individual.

Genomics: branch of molecular

biology concerned with the

structure, function, evolution,

and mapping of genomes.

Health economics: a branch

of economics concerned with

issues related to eciency,

eectiveness, value and

behaviour in the production

and consumption of health

and healthcare.

Improving

safety and

quality of care

Being an

accountable

professional

Assessing

needs and

planning care

Providing and

evaluating care

Leading and managing

nursing care

and working in teams

Promoting

health and preventing

ill health

Coordinating

care

Annexe A:

Communication

and relationship

management skills

Annexe B:

Nursing procedures

www.nmc.org.uk Standards of proﬁciency for registered nurses 39

Annexe B:

Nursing procedures

Health literacy: the degree to

which individuals can obtain,

process, and understand basic

health information and services

needed to make appropriate

health decisions.

Human factors: environmental,

organisational and job factors,

and human and individual

characteristics, which inﬂuence

behaviour at work in a way which

can aect health and safety.

Interventions:

any investigations,

procedures, or treatments

given to a person.

People: individuals or groups

who receive services from

nurses, midwives and

nursing associates, healthy

and sick people, parents,

children, families, carers,

representatives, also including

educators and students and

other within and outside the

learning environment.

Person-centred: an approach

where the person is at the

centre of the decision making

processes and the design of

their care needs, their nursing

care and treatment plan.

Self-Reﬂection/Reﬂection:

to carefully consider actions or

decisions and learn from them.

Strength-based approaches:

strength-based practice is a

collaborative process between

the person supported by

services and those supporting

them, working together to

reach an outcome that draws

on the person’s strengths

and assets.

Vulnerable people: those who

at any age are at a higher

risk of harm than others.

Vulnerability might be in relation

to a personal characteristic or

a situation. The type of harm

may be emotional, physical,

sexual, psychological, material

or ﬁnancial, or may be due

to neglect.

www.nmc.org.uk Standards of proﬁciency for registered nurses 40

The role of the

Nursing and

Midwifery Council

What we do

We regulate nurses and midwives in the UK, and nursing

associates in England. We exist to protect the public. We set

standards of education, training, conduct and performance so

that nurses, midwives and nursing associates can deliver high

quality care throughout their careers.

We make sure nurses, midwives and nursing associates

keep their skills and knowledge up to date and uphold our

professional standards. We have clear and transparent

processes to investigate professionals who fall short of our

standards.

We maintain a register of nurses and midwives allowed to

practise in the UK, and nursing associates allowed to practise

in England.

These standards were approved by Council at their

meeting on 28 March 2018.