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Nurse training and education programmes have changed in recent years, moving from a ‘learning on the job’ process of training and learning to a much more structured and academic approach. As professionals in health, we must continually update and refresh our knowledge and skills ( Mann et al, 2009 ), a view supported by Fry et al (2003) who highlight that nurses are now encouraged to continue with lifelong learning. The Nursing and Midwifery Council (NMC) Code of Conduct 40 states: ‘You must keep your knowledge and skills up to date throughout your working life’. Code 41 states: ‘You must take part in appropriate learning and practice activities that maintain and develop your competence’ ( NMC, 2010 ). Within the hospital setting, most patients will receive some form of intravenous therapy (IV) treatment ( Peterson, 2002 : cited by RCN, 2010 ). Infusion therapy has therefore become an integral part of professional practice for most nurses, who must learn the initial skills in IV therapy and vascular access and achieve clinical competence. Education and clinical training by specialist teams in organisations must be delivered to ensure safe skills are learnt ( RCN, 2010 ). This education and training must incorporate both theoretical and practical elements, with appropriate means of assessment. The delivery methods should be diverse, recognising that individuals have different approaches to learning. Clinical competency assessment frameworks are widely used within nurse education. But are they the most appropriate method of assessment, or can other methods be used? An in-depth literature review in this paper will highlight different approaches to learning, assessment and clinical competence.

Any mentally competent adult has the right to give or refuse consent to treatment or nursing intervention. The ethical principle underpinning this free choice is respect for autonomy, and the nurse’s professional duty to respect the decision of the patient is enshrined within the NMC’s Code of Conduct (NMC, 2008). Capacity is paramount to consent and problems arise in practice when the patient is deemed to lack capacity. In this instance, the provisions of the code of practice of the Mental Capacity Act apply (2005). The aim of this article is to present the issues that arise when patients lack decision-making capacity, especially in relation to older adults with dementia who lack the capacity to consent to medication, as well as the covert administration of medication. In relation to consent and covert administration, the nurse is required to balance respect for the patient’s autonomy with their desire to act beneficently and in a non-maleficent manner and emphasis will be given to these underlying ethical principles throughout the article.

student nurse’s preparation for the responsibilities they will encounter in their first post as a registered nurse. The mentor (a registered nurse) guides the student’s practice, assesses progression and makes judgments concerning their competence for entry on the professional register. The delivery of effective mentorship is dependent on a set of complex interdependent roles and responsibilities involving the student, the mentor, the service provider and the higher education institution (HEI). The Nursing and Midwifery Council (NMC) Standards to Support Learning and Assessment in Practice (2008) were implemented to ensure all pre-registration nursing students would be assessed by mentors in practice who are knowledgeable, up to date and can ensure that students are safe practitioners at the time of registration. These standards are now over 8 years old and during this time there has been a sea change in the way health and social care is delivered. In 2012 the Health and Social Care Act brought about the biggest changes in the ways in which health and social care are to be delivered since the inception of the NHS. The ageing population, a change in public expectations of care delivery, technological advances and the cost of health and social care provision, along with ongoing modifications to the role and function of the nurse, are all factors to be considered in light of the issue of mentorship. In 2010 the NMC introduced new standards for pre-registration nursing (NMC, 2010) that are about to be revised; a new code of conduct was issued in 2015 (NMC, 2015) and revalidation is being implemented. All these factors mean that the NMC has to evolve in such a way that it is able to respond to changing landscapes; its approach has Mentorship and support

When deciding whether to act as patient advocate, the nurse is faced with a dilemma. If she advocates for the patient she may be in conflict with other healthcare professionals; however, if she does not she may conflict with herself, her code of conduct, and the patient.

Approximately 670 000 nurses and midwives in the UK are professionally accountable to the regulatory body, the Nursing and Midwifery Council (NMC). We also have a contractual accountability and responsibility to our employers and we are answerable to the law for our actions. The NMC sets out very clearly the role and responsibilities and our code of conduct makes clear our duty of care to our patients and their families/carers. The NMC Code is the foundation of good nursing and midwifery practice, and a key tool in safeguarding the health of the public. The people in our care must be able to trust us with their wellbeing. To justify that trust, we must make the care of people our first concern, treating them as individuals and respecting their dignity; work with others to protect and promote the health and wellbeing of those in our care, their families and carers, and the wider community; provide a high standard of practice and care at all times; be open and honest, act with integrity and uphold the reputation of our profession. As professionals, we are personally accountable for actions and omissions in practice and must always be able to justify our decisions. We must always act lawfully, whether those laws relate to our professional practice or personal life. Failure to comply with this code may bring a nurse’s fitness to practise into question and endanger their registration. There is a public expectation that individual nurses are up-to-date and are fit to practise. Over the last few years, there has been strong support from our patients and the public about ensuring our code of conduct is fit for purpose now and in the future. As you will be aware from previous columns, the NMC Council met in September 2013 to consider various revalidation models for nurses and midwives across the UK. The NMC is now coming towards the end of a two-stage, 6-month public consultation on the code of conduct, which will conclude in August 2014. The consultation as described by the NMC will address revising the Code (the standards of good nursing and midwifery practice) and implementing revalidation. However, this is all very ambitious. The NMC is only committed to delivering a proportionate and effective revalidation system and revised code of conduct by December 2015 and had prioritised this work in its corporate plan for 2013–16 (NMC, 2013). As a reminder, part one of the consultation, which ran during January–March 2014, focused on how the proposed model of revalidation could be implemented in a variety of employment settings and scopes of practice. This will help ensure the model launched in December 2015 is flexible and fit for purpose. The NMC also gathered information to draft a revised Code and develop guidance for Rory Farrelly Director of Nursing & Patient Experience, Abertawe Bro Morgannwg University Health Board, Swansea revalidation. However, part two of the consultation concentrates more on the draft Code and a number of focused engagement events have happened across all four countries—well done to those of you who contributed to these events. As we all know, the Code is central to all aspects of our nursing practice and will therefore be a key part of revalidation. The NMC is also consulting on key themes in the revalidation guidance, and will make use of focus groups here. As part of this consultation, the NMC is asking all UK-registered nurses and midwives, students, employers, managers, educators, professional bodies, trade unions, other regulators, government, service users, carers, members of the public and any other interested parties to make their views known by completing a response form. In formulating the final version of the Code and the NMC revalidation model, the NMC will take these responses into account along with a wide range of other information, such as monitoring data from regulatory processes, information from other relevant organisations, and recommendations from key reports, such as the Francis report and Keogh review. The main objective of this consultation exercise is to collect feedback on the draft revised Code and the proposed revalidation model. The findings will help the NMC to refine the proposed revalidation model, and will feed into the revised Code and supporting revalidation guidance. The NMC will also be undertaking a separate programme of qualitative research with participants from a variety of different groups to discuss aspects of the draft Code and revalidation model in more detail. It is crucial that we as registrants ask ourselves whether as individuals, or organisations, we have contributed to the consultation on the revised code of conduct and whether we should use this consultation to ensure that the revised code of conduct for us is realistic and proportionate. This revised code of conduct is undoubtedly part of a changing landscape for us all but remember we have vast experience when it comes to learning and implementing new ways of working. Collectively we are huge influencers—let’s not forget that. I encourage all of you to engage with this NMC consultation as this will be important for us all. Remember our views will count, and imagine the power and influence of 670 000 registrants. Full details can be found on the NMC website, including the draft revised Code. BJN