Cover Page



Title Page





Chapter 1: Entry to Nursing

Your university of choice


Meeting requirements

Starting nurse education



Chapter 2: The Nursing and Midwifery Council and Other Regulatory Bodies

Health profession regulation

The Health and Care Professions Council

The General Medical Council

The role and function of the Nursing and Midwifery Council

Education and conduct

The Code

Professional conduct: student nurses

Good health, good character and fitness to practise




Chapter 3: Nursing Education: the Standards for Pre-registration Nurse Education

A brief history of nurse education

Standards for pre-registration nurse education

The new standards and service provision

The standards for education




Chapter 4: Nursing, Health and Social Care


Social care

Partnership working

Health and social care reform

The vulnerable person

Speaking out




Chapter 5: Assessment Tools

The phases of the nursing process

Assessment tools




Chapter 6: The Essential Skills Clusters

The NHS Constitution

The essential skills clusters

Care, compassion and communication

Organisational aspects of care

Infection prevention and control

Nutrition and fluid management

Medicines management

Numerical assessment




Chapter 7: The University Setting

The university structure

Student support services

Student representative bodies

The anatomy of a programme of study




Chapter 8: Practice Learning Opportunities

The practice setting

Practice learning opportunities

Teaching, learning and assessment

Getting the most out of clinical learning opportunities: roles and responsibilities

Supernumerary practice

Simulation centre




Chapter 9: The Nursing Elective

The purpose of the nursing elective

Preparing for the nursing elective

Finding and funding an elective

Making contact

Risk assessment

Getting the most out of your elective placement




Chapter 10: Managing Self

Values and beliefs


Managing self and personal skills




Chapter 11: Terminology: Terms Used in Healthcare

The nursing handover

Talking the talk: the language

Anatomical landmarks

Prefixes and suffixes




Chapter 12: Evidence-Based Practice

Evidence-based practice

Defining evidence-based practice

Evidence-based practice and research

The evidence base cycle

Hierarchies of evidence

Accessing the evidence

Barriers to implementing evidence-based practice




Chapter 13: Reflective Practice

Defining reflection

Reflection: what it is and what it is not

Reflective models

The five Rs of reflection

The value of reflection




Chapter 14: Your Professional Portfolio


The professional portfolio

The need for a professional portfolio

The structure and content of a professional portfolio

Portfolio format




Chapter 15: Records and Record Keeping


Reasons for documentation

The principles of good record keeping

The use of abbreviations, acronyms and symbols

Maintaining the safety of records




Chapter 16: Protocols, Policies and Legal Matters

Protocols and policies

Duty of care






Chapter 17: Clinical Academic Careers

Transferrable skills

Modern nursing careers

Clinical academic careers




Chapter 18: Preceptorship and Continuing Professional Development

Transitions and expectations


Preceptorship framework

Continuing professional development




Chapter 19: What Do I Do If . . .? Questions You Did Not Want To Ask Out Loud

Entry to nursing

Nurse education: the standards for pre-registration nurse education

The NMC and other regulatory bodies

The university

Practice learning opportunities

Managing self

The portfolio

Policies, procedures and legal matters

Preceptorship and continuing professional development




Title Page


chaptertitle Dedication

This text is dedicated to the cohort of student nurses known as September 1997 who studied at the University of Hertfordshire and have now moved onto great things.

chaptertitle Acknowledgements

To my partner Jussi Lahtinen who puts up with me. My dear friend Frances Cohen who continues to support all of my endeavours. My brother Anthony Peate who produced all of the illustrations for this text. The staff at the Royal College of Nursing Library London.

chaptertitle Preface

This book has been written for those who are considering nursing as a profession and those who are on a programme of study. This includes students at all stages of their programme. There may be some of you reading this who are about to go into their first staff nurse job, in which case congratulations Staff Nurse. Some readers may be going to university for the first time and some may be going into the clinical area as a novice nurse excited and anxious: both at the same time (yuk!).

In this little book I hope you will be able to find some of the answers to your questions, some reassurance about issues you might be facing on your course. The book will not provide answers to all of the challenges you face (I am only human) and anyway, I believe you have it in you to seek the solutions to the challenges you encounter: you just need to be prodded sometimes. I have been so lucky in my nursing career. It's the best job in the world (the pay isn't so good, though). I was lucky with the people I have been privileged to care for and to study with.

I am totally committed to you, the student, to teaching and learning from and with you and I am also committed to having a good laugh. I am devoted to the students I have been truly delighted to help learn the art and science of nursing, this thing (nursing) that defies definition, this thing that once it is in your blood is impossible to get rid of (I have warned you).

In these pages you will find some features that have been planned to help break up the blocks of text, to bring the pages alive and speak to you. Throughout the book there are the voices of many people: students and registered nurses who have shared their experiences with me (some of them were my role models). Like a good nurse I have ensured that confidentiality has been respected (I could give you a reference for this but, I won't). I have included pearls of wisdom (not all mine) that are intended to drop a hint here and there to help get you through. Dotted throughout are student activities. It is not essential you complete them, but you may find them helpful (don't worry, you won't be assessed on them!). Most of the various sections all have their own section summaries; I have done this so that you can recall quickly what has just been said. At the end of each chapter is a list of resources, websites that I have used in the past and which I hope you will also find useful. The most important resources, however, are the human resources all around you: your peers, the staff nurse who becomes your mentor, your preceptor, your lecturer, the patient and your family. Make the most of these precious resources, try not to abuse them. They are nuggets of gold and should be cherished.

I use the various terms patient, service user and client interchangeably throughout the text. I know this comes across as ‘messy' but nursing can sometimes be like that, as can the people we care for, the most important thing (I think) is to remember that patients, clients, service users – whatever the term used – are people and they deserve the best and safest standards of care we can muster.

I hope this book provides a voice and context to the nursing experience in a way that is an easy read as well as an inspiration to you. I hope that you enjoy your nursing, the best job in the world . . ..

You know you are a nurse when you watch Casualty or Holby City and to the annoyance of your family you point out all the mistakes that they have made!

You know you are a nurse when you are in Chapel Market shopping and a patient shouts across the street ‘that's my nurse, he saved my life'.

Ian Peate

London, March 2013


chaptertitle Entry to Nursing

bullet An overview of the general entry requirements for
bullet pre-registration nurse education
bullet Pointers on helping you choose the right university
bullet Funding issues
bullet The selection process

“ After all these years if you asked me to do it all again I would. Nursing is the best job I have ever done. A recently retired registered nurse with over 40 years' nursing service

This chapter starts with a comment from a nurse who has just retired after a 40-year nursing career, and it is shown as a means to inspire you when you are thinking of choosing nursing as your future career. You must also be aware, however, that nursing is not for everyone and that things have changed since this nurse started her training (it is no longer a training programme, but an educational process). Many people, both inside and outside of the profession, might say the changes have been for the better; some would suggest that they have been for the worse.

Nursing is a varied, challenging and rewarding career for those who would like to make a difference to the lives of people locally, nationally and internationally. Nurses and nursing staff take responsibility for the care they provide and answer for their own judgements and actions. They constantly respond to new challenges and act as a leader, carer and clinician.

Experienced nurses find fulfilling careers in positions of responsibility, often running nurse-led clinics or taking leadership roles up to executive level. Nursing is changing rapidly, with increasing focus on public health and disease prevention. It is possible to develop career pathways in clinical, research, education and management roles.

Nurses don't just work in hospitals. There are opportunities to work in, among others, GP surgeries, clinics, nursing and residential homes, occupational health services, voluntary organisations that run hospices or residential care, and the pharmaceutical industry. Nurses also work in university education, on leisure cruise ships and in the military.

Some readers of this book will have embarked on a programme of nurse education already; this chapter aims to entice those who are thinking of nursing as a profession and provides information concerning the requirements needed to enrol successfully on a programme of study. For some this might seem like having to jump through hoops; however, knowing what hoops have to be jumped through is important!

There are over 90 universities (approved educational institutions) in the UK offering programmes of study that lead to registration. It takes 3 years to become a nurse unless a student is able to demonstrate that they have already met some of the course requirements (sometimes called advanced standing). Nurse education is based in the universities and is delivered in direct partnership with NHS Trusts and other organisations (for example, the independent and voluntary sector), which provides nursing students with practice learning opportunities in health and social care settings.

The education programme is split 50/50: 50% is spent in practice, so that students are able to learn how to provide direct nursing care. The remaining 50% of the programme is spent learning the knowledge and technical abilities needed to underpin and support practice, usually on a university campus.

There are four fields of nursing and you need to decide upon the field in which you intend to register:

bullet learning disabilities,
bullet mental health,
bullet children,
bullet adult.

There are four fields of nursing. All nursing programmes are offered to degree level. Nursing is practised where ever there are people, so the notion of nursing being solely hospital-based is outdated.

h1 Your university of choice

Choosing the right university for your nursing studies will depend on a number of factors. Below is a list of what you may need to consider or take into account.

bullet Does the university offer the field in which I intend to register?
bullet Is the geographical location suitable?
bullet What placement opportunities are on offer?
bullet Do I have the right entry requirements? (i.e. UCAS points.)
bullet Does it have good quality assurance processes? (Include the university's reputation.)
bullet What does the Nursing and Midwifery Council (NMC) say about the university? (Go and look at their website.)
bullet What do the various quality assurance bodies say about the university? (For example, the Quality Assurance Agency.)

Remember that your choice of university can be a life-changing decision, so do as much research as you can: choose the right course and the right university for the right reason.

“ I went to six university open days before settling on the university I am at now; the thing that clinched it for me here was that they provide excellent practice learning opportunities. I go out working with the homeless sometimes and working with vulnerable families, it's a great opportunity. Second year mental health nursing student

Take time making you decision, think about where you will be happy. Do you want to be close to home or are you looking to live in a different part of the country? Be sure, however, that you do not take too much time pondering your choice: there are specific deadlines that must be met to ensure entry for the next academic year.

“ I had no choice really with my university. I have two young kids, so it was the local university for me. First year mental health nursing student

Be sure to do your homework and to check out the universities to which you are thinking of applying. Do they offer what you want? Consider carefully the field of nursing that you are going to apply for and, most importantly, the reasons for your choice.

h1 Funding

Current funding arrangements to undertake a BSc Nursing degree vary in the four countries of the UK. Since September 2012 English and Welsh funding arrangements have been to provide a non-means-tested grant and a means-tested bursary to new students.

Nursing students can access additional support in the form of a maintenance loan. In addition, students can apply for a number of extra allowances if they meet specific criteria. These allowances include support for disabled students and for those with dependent adults and children. The NHS will continue to pay all course fees. There are, however, certain requirements to qualify for this financial assistance. Applicants must:

bullet have been resident in the UK throughout the 3 years preceding the first day of the academic year of the course, other than for the purpose of receiving full-time education,
bullet have settled status in the UK within the meaning of the UK Immigration Act 1971, on the first academic year of the course,
bullet be ordinarily resident in the UK on the first day of the first academic year of the course.

Similar arrangements are in place for students studying in Scotland and Northern Ireland. You should check the appropriate websites and speak to the university of your choice for up-to-date information concerning fees and funding.

h1 Meeting requirements

Once you have chosen a university you need to be accepted onto the course. There are a number of requirements that you must meet, some of which will be prescribed by the university and others by the NMC.

The NMC leave the entry requirements to each university. There are no national minimum academic entry requirements for entry into nursing programmes; each university sets its own criteria. All applicants have to be able to demonstrate evidence of literacy and numeracy.

For numeracy this includes evidence of the ability to accurately manipulate numbers as applied to volume, weight and length (including addition, subtraction, division and multiplication, and use of decimals, fractions and percentages). For literacy you must provide evidence of the ability to read and comprehend English (or Welsh, as applicable) and to communicate clearly and effectively in writing, including using a word processor. If you have a disability then the above can be met through the use of reasonable adjustments.

It is important that you check with each university prior to applying to see whether your qualifications meet its entry criteria. As a general guide, most universities are looking for the following qualifications or their equivalent: you will usually need a minimum of five GCSEs at grade C or above (usually this includes English language or literature and a science subject), plus two A levels or their equivalent (in reality you may need three A levels, so you must check with the university directly).

Having satisfied yourself (and ultimately the university) that you meet the minimum criteria you need to submit your application form. Universities receive thousands of applications from able candidates wishing to undertake nursing programmes, but they all have a specific target number of students to recruit. Your application needs to stand out from the crowd and make an impact so that it is put on the invite-to-interview pile rather than the rejected pile.

h2 The application form

The application form is the only thing your prospective university will have to judge you on, so it is important to take your time over this aspect of the application (remember that the application form is only one part of the whole process). The form will have several pages and some of the questions may seem daunting. Admissions tutors (the people who make the initial decision to proceed or not with your application) receive thousands of applications to sift through: yours has to catch their eye. Application forms are designed to give you an opportunity to sell yourself and you should keep this in mind at all times when deciding how to answer the questions posed.

“ I spend 4 to 6 hours a day looking at application forms and I can spot a good one a mile off and a bad one five miles off. Admissions tutor, BSc(Hons) Nursing

1 First do your research about the university, the programme, the profession and the practice learning opportunities.
2 When registering online remember your username and answers to any security questions; for example, passwords.
3 Be sure to read all aspects of the application and any instructions provided.
4 When you are asked to make your choices, think carefully: choose the correct institution and the correct course.
5 Include all of your employment and educational details; if there are any gaps be prepared to account for them.
6 The personal statement, it could be suggested, is the most important aspect of the form. Do not type your statement straight into this section: write it first with a word processor or similar, using the spell-check facility, and copy and paste it into the form when you are ready. Use Times New Roman, font size 12.
7 Be concise, do not waffle and be sure that it is all your own work. Plagiarism is easily detected using specialised software.
8 When you think it is finished, click Preview to see what it will look like when an admissions tutor sees it. Edit it if you want to make any changes.
9 Ensure your application is submitted before the set deadline.
10 Fill in all parts of the form: if any sections are not relevant to you then write ‘not applicable'.
11 Proofread the form carefully before you submit it: pressing the Send button has the ability to change the rest of your life.
12 Make sure that your e-mail address is appropriate: remember the admissions tutor and others will see it, so do not use anything crude or rude.

Here are 10 things not to put on your CV.
1 You pet's name
2 Your favourite colour
3 Somebody else's details (copy and pasting)
4 Hobbies: getting drunk and singing karaoke
5 The fact that you once won a strawberry-eating contest
6 The ability to say the alphabet backwards in under 4 seconds
7 I am a perfectionist and rarely, if ever, forget details
8 Languages: speak fluent English and Spinach
9 Reason for leaving my last job: pushed out so the new boss could give the job to her boyfriend.
10 References: please do not contact my immediate line manager at my current job. My colleagues will provide me with a better reference.

h2 Selection day

Well done, you have been successful at getting an interview, but there are still a number of other hoops through which you must jump. The best piece of advice for you at this stage is to be prepared. You have to do your homework. Usual guidance would include:

bullet know where the interview is being held (the address and building),
bullet know where the interview will take place (the room in the building),
bullet be on time,
bullet dress appropriately (no jeans or trainers): be smart and professional,
bullet avoid multiple earrings, nose rings, or lip and tongue piercings,
bullet bring the appropriate original documentation (not photocopies).

Nursing selection days require more of candidates than conventional interviews. Selection days are run differently at different universities; some may require you to do some preliminary work, maybe online, prior to the face-to-face meeting. The aim of the selection day is to ensure that you are suitable for the programme of study, that you understand that you are about to commit yourself to 3 years' hard work and that you can manage the demands of the programme. You must be able to communicate with the selection panel that you know that nursing is not what you see on Holby City or ER. The selection day is also your opportunity to see whether the university is good enough for you. This means you have to have attitude, good attitude. Having done your homework you will have discovered:

bullet the fields of nursing offered,
bullet the timetable for the selection day (they usually last at least 4 to 6 hours),
bullet the documentation you have been asked to bring with you,
bullet the methods of selection being used, such as aptitude test(s) (these may include psychometric testing), group interview and face-to-face interview,
bullet the placement opportunities available,
bullet information about the university.

All universities are required to ensure that applicants to pre-registration nursing programmes are of good health and good character sufficient for safe and effective practice as a nurse. You will be required to undergo a criminal records check; some universities do this before the programme commences and some do it when you have accepted a place on the programme. The check is carried out by the Criminal Records Bureau (or its equivalent) and you must confirm on your application that you agree to this being done; the provisions covered by the Rehabilitation of Offenders Act 1974 do not apply.

If you have a criminal conviction or a police caution you will not be barred automatically from securing a place on the programme and ultimately working in the NHS, as each conviction is considered in the light of all relevant circumstances. However, you must make known any criminal convictions or police cautions. You are usually asked to provide personal references vouching for your good character.

All applicants are subject to satisfactory health clearance prior to commencing any clinical placements. If you have a particular problem that you think may affect your ability to work or study, or if you have any questions about health requirements, you should contact the university to which you plan to apply.

h2 The interview

Again, different universities use different techniques to interview and select their potential students. It is usual for a marking system of some sort to be used so that those interviewing (the panel) can make an objective decision concerning selection. You might be asked to take part in group interviews, individual interviews, or both.

h3 Group interviews

Often four to six candidates are asked to discuss a topic, for example ‘people with HIV should be isolated when being nursed'. Your discussion, as a group and as an individual, will be monitored by the interviewers, who could be university staff, clinical staff and service users. The purpose is to observe how you interact with others, how you listen and communicate verbally and, importantly, non-verbally, as well as what your opinions are and how you express them. The technique is to ensure that you are confident but not cocky, that you are articulate but respectful of others and that you have the capacity to work as a member of a team. Nurses are often asked to act as someone's advocate. To do this effectively – acting in a person's best interests – you have to be able to speak up for them. Remember this when you are being interviewed.

h3 Individual interviews

These interviews will challenge your perception of nursing. The panel, made up of academics, clinicians and service users, will ask you questions designed to elicit your knowledge and insight, your ability to be caring and compassionate and your commitment to the proposed programme of study.

You should ask questions at an interview. Remember that it is also about you determining whether the university is suitable for you: you have a choice in which university to attend. Your questions may be:
bullet what are the shift patterns?
bullet how much time is spent in the community setting versus the hospital setting?
bullet what are the bursary payments?
bullet please tell me about the assessment strategies used,
bullet what key areas of research are the department involved in?
bullet what support systems are in place for students?
bullet if appropriate, ask about student accommodation.

The only way to succeed at interview is to prepare. Do your homework. Ask questions. Be yourself. Do not undersell yourself. The panel want to get to know you: they already like you otherwise they would not have asked you to interview. Make it really clear why you want to study nursing. Be confident and demonstrate that you are the type of person who has the ability and the skills to make a positive difference to the lives of the people you will be caring for and the communities in which they live.

There are no trick questions at interview; the panel know and will expect you to be nervous. There are, however, questions that will test you. You will certainly be asked why you have chosen nursing and the specific field of nursing you have applied for.

It would be unwise to respond to this question by saying you have always admired the nurses on Casualty or Holby City, or that you like the uniform.

Other questions may include:

bullet what do you think is the role of a nurse?
bullet what are the qualities of a good nurse?
bullet of those qualities, what is the most important quality in a nurse?
bullet where do you think nursing takes place? (Remember, it is wherever people are, not just in hospitals.)
bullet what is it you intend to get out of your studies at this university?
bullet what made you choose this university?
bullet what skills do you have that may make you suitable for this course?
bullet what experience of health and social care have you had?
bullet what are your strengths and weaknesses?
bullet how do you intend managing your time; what are your time-management skills like?
bullet how do you cope with stress?
bullet how do you handle criticism and cope with authority?

The panel may refer back to your performance at group interview; you may even be asked to elaborate on comments you made there, so be ready to do this. Remember that there are no trick questions: they are genuinely interested in your responses and how you present yourself. Be ready to convince the panel that you have the personal attributes that will help you make a success of the programme. Let them know how you are prepared to cope with the physical and intellectual demands such a programme requires, but remember to be realistic in your responses: do not make things up, and be honest. If during any stage of the interview you are unsure of the question being asked, then request that the question be repeated.

What is wrong with this question: 'Hi, oh you're a nurse, what hospital do you work in?'
Make a list of the places where nurses work.
What skills do you think a nurse needs to do the job effectively, safely and compassionately?
How do you manage your time?

You may be given the outcome of your interview there and then. Some universities take longer to inform you of their decision; your offer will always be conditional on:

bullet an acceptable occupational health screen,
bullet a satisfactory criminal records check,
bullet suitable references.

Other conditions may apply; for example, you may have to achieve certain grades in specific subjects. You may be allowed to commence the programme on the understanding that you meet these conditions, and be asked to leave if you don't. It is your responsibility to meet the conditions.

If you have not already applied to and been interviewed for a nursing programme you should go back over this section again and think about each subsection carefully, and how you will respond during the application process and when you attend for selection. Failure to adhere to the requirements or to meet the selection criteria will result in your application being rejected. You should always remember that the selection process is a two-way process and you are also assessing the university to determine whether it meets your needs.

h1 Starting nurse education

Congratulations! You have been offered a place on your chosen programme in your chosen field. This is going to be the first day of the rest of your life.

Depending on how much time you have prior to commencing the programme it might be a good idea to do some preparatory work. You might have been given some guidance by the panel who conducted your interview: think about what this was and carry it out.
The programme you are about to embark on is going to be both intellectually and physically stimulating. If you do not do so already then start reading the broadsheet newspapers, particularly the health and social care sections. This will inform you about contemporary health and social care issues, and it can also improve your vocabulary.
If the opportunity arises and you are given the chance to work in a health or social care setting (paid or unpaid) then make the most of this: it will give you valuable work experience.
There are several weekly or fortnightly nursing journals available that you should read. This will offer an insight into some of the contemporary issues impacting on care delivery.
Meet other nursing, health and social care students.

Think of a nurse. What images came to mind?
bullet The sex object
bullet The buxom blonde
bullet The battleaxe
bullet An angel
bullet A gay man
bullet The murderer
bullet The professional
bullet The doctor's handmaiden
What do you think about this statement: ‘No, I couldn't be a nurse, all that blood'.
Think about this statement: ‘It doesn't matter if the nurse is male or female so long as they do their job well.' What are your comments?
Why are stereotypes damaging to the nursing profession?
How can negative stereotypes be changed?
Nursing is another branch of medicine: discuss.
How does the following statement make you feel? ‘I am just a nurse.'
Do you want to fit the commonly held stereotype of a nurse or do you want to help change that stereotype?

“ I qualify at the end of this year. It's been hard work but worth it. I can't say I have enjoyed all of it but, I am really glad I did it. Third year learning disabilities student

You have come this far and now the next steps are ensuring that you get through the programme having developed the skills and qualities required to care for people safely, competently and compassionately.

Nursing provides a varied, challenging and rewarding career to those who would like to make a difference to the lives of people who live locally, nationally and internationally. Nurses are responsible for the care they provide and they have to answer for their own judgements, actions and omissions: this is called being accountable.

h1 Summary

To conclude this chapter the reader should look back to the quote at the beginning: nursing is the best job in the world. To undertake nursing education you really do have to want to do it: the work of the nurse is so varied and each day really is so different, but you only get out of it what you put into it. The roles and functions of the nurse have changed and will continue to change, and there are a number of career opportunities available to you in the UK and internationally once you have completed your programme and registered with the NMC.


There are many really important things to consider prior to making your application for a place at a university. Think about the field of nursing you want to apply for, weigh up the pros and cons associated with the various universities and always remember that this is a two-way process: does that university offer you what you want? Becoming familiar with the entry criteria and the selection processes can help you progress onto a programme of study: aim to be selected, not rejected.

h1 Resources

Bursary Administration Unit Northern Ireland

Offers various types of funding support for the individual, employer or training organisations.

NHS Student Awards Wales

The NHS Wales Student Award Unit implements the NHS Wales Bursary Schemes, which provides funding for healthcare students on NHS-funded courses in Wales.

NHS Student Grants Unit England

Provides all the information needed when applying for an NHS Bursary in England.

Students Awards Agency for Scotland

A Scottish Government agency, paying grants and bursaries to Scottish students in higher education.

UCAS (Universities and Colleges Admissions Service)

UCAS is the organisation responsible for managing applications to higher education courses in the UK.