In a thought-provoking presentation, Professor Paula Holt MBE DL, Senior Nursing Adviser at the Nursing and Midwifery Council (NMC), provided a compelling overview of the evolving landscape of nursing education and practice, as well as outlining the perspective of the regulatory bodies on the latest sector developments.
From the growing importance of simulated practice learning to the systemic challenges facing both students and seasoned professionals, her insights highlighted the pivotal crossroads the sector faces and the importance of adapting and rising to these new challenges.
The Evolution of Simulated Practice Learning
Simulated practice learning, while not new, has evolved dramatically in recent years. Professor Holt reflected on this evolution by outlining her own experiences of training including learning by injecting oranges and undertaking peer practice. She compared that to simulated practice today with sophisticated virtual reality (VR) environments, high fidelity mannequins, and actor led communication simulations designed to facilitate exposure to challenging scenarios, in some cases prior to even entering a first practice placement.
What was once a supplementary adjunct to practice learning is now proving an invaluable inclusion within nursing education. The NMC now allows up to 600 of the required 2,300 practice learning hours to be delivered via simulation. Initially driven by necessity during the COVID 19 pandemic, this change is now shaping a longer-term shift in educational and curricular design.
Importantly, Professor Holt emphasised that simulated practice learning must meet the same standards as traditional placements, including standards of supervision and assessment, in order to count toward practice hours. She also highlighted that the most effective simulation is that which is co-produced with patients and carers, enhancing realism, authenticity and contextual integrity.
Contextual Pressures in Nursing and Education
While simulation and its integration into education is a welcome development to enhancing practice experiences for learners in health and care environments, for some it is supplementing practice learning hours where provision of placements is most challenging.
The broader context for nursing and midwifery at the moment is far from straightforward with staff retention, both among early career professionals and international recruits, a pressing concern. Citing data from the Health Foundation, Professor Holt noted that many internationally educated nurses are opting to leave the UK for destinations like the US, Canada, and Australia. This exodus signals deeper issues around integration, support, and perceived value in the workplace.
Meanwhile, newly qualified nurses working in sectors outside the NHS such as social care or private healthcare, report inconsistencies in preceptorship experiences. Some find transition into their first roles fraught with insufficient support and limited continuing professional development (CPD) opportunities. As Professor Holt highlighted, too often CPD invitations are declined by staff due to shortages on wards or within other care settings that prevent them being released. Likewise, recruitment into the professions remains a challenge with ongoing discussions around pay and working conditions unfolding very publicly.
Equally, universities are facing parallel challenges. With over 40% of universities in the UK facing financial deficits, investments in simulation technologies, faculty recruitment, and curriculum innovation can be limited. The academic workforce is under pressure, with many institutions struggling to attract and retain academic staff generally, and specifically those with a special interest in the technologies required to keep pace with a rapidly modernising profession and care environment.
Student Experience and Retention
Students themselves are navigating a complex and often contradictory reality. The intensity of an, on average, 45 week per year, full time curriculum leaves many financially and emotionally stretched. Many must juggle paid work with studies, placing additional strain on their ability to engage fully in academic and practice learning.
The NMC’s Practice Learning Review, currently underway, is evaluating the quality and consistency of practice learning. Preliminary findings reveal significant variability in student experiences, ranging from enriching placements to those that are less well supported, and some learning environments that are more task focused than person-centred. A term that emerged from the review was "taskification" where some students focus more on achieving proficiencies than delivering holistic care.
Simulated practice has shown potential to mitigate some of these challenges. When integrated strategically, it can offer a psychologically safe environment for students to develop confidence, contextual understanding, and communication skills. Many students view it as an equitable approach, offering more consistent exposure to proficiencies that are less commonly seen in practice, or complex scenarios that may be difficult to engage with during placements.
Simulation as a Bridge to Modern Nursing Competencies
The benefits of simulated learning go beyond the development of technical skills. Increasingly, universities are using this type of learning to educate students in other areas including communication, prioritisation, and relational care, areas often cited in fitness to practice referrals. In particular, simulations provide a safe environment for students to engage with difficult topics such as mental health, domestic violence, and discrimination, enhancing their readiness for real world complexities.
By creating enriching simulated scenarios with input from patients, service users and carers, learners can immerse themselves in realistic situations that not only help develop their competencies but also support them in areas such as showing empathy, ultimately giving them a deeper understanding of delivering holistic, person-centred care.
The timing of simulations within the curriculum is also becoming more strategic. Common models include simulation blocks before the first placement to build foundational confidence, and prior to final placements to prepare students for leadership and delegation roles.
A Tool for Lifelong Learning and Workforce Resilience
Beyond pre-registration education, simulated practice offers untapped potential for ongoing professional development. Practicing nurses across settings express a strong desire for more simulation based CPD to keep up with evolving technologies and contemporary care. However, as Professor Holt cautioned, limited protected time for learning and funding are reported as significant barriers to many nurses and midwives being able to undertake this CPD.
Simulation could also play a vital role in supporting internationally educated nurses and addressing gaps in their transition experiences. Used effectively, it has the potential to improve retention, confidence, and integration.
The Digital Shift: AI, Wearables, and Virtual Nursing
Beyond simulated practice, Professor Holt also took some time to focus on the future of the healthcare sector more generally including the accelerated integration of digital health technologies. From AI-assisted clinical decision making to wearable health monitors and remote patient management, the profession is entering an era of unprecedented complexity but also huge opportunity.
She described personal experiences with hybrid closed loop systems for diabetes care and questioned whether today's workforce is adequately prepared to engage with such technology. Many clinicians remain unfamiliar with tools that increasingly patients are using to help them manage their conditions, and by extension bringing into care environments, making a working knowledge of modern health technologies fundamental to future practice.
The emergence of virtual nursing, already evident in parts of the US and soon to be piloted in the UK, is another interesting development. These models involve remote nurses monitoring patients via AI-enabled video feeds, offering both clinical oversight and mentorship for less experienced nurses who are in the room with the patient. For retired or remote practitioners, this model presents new career possibilities, while simultaneously enhancing bedside care.
As the NMC prepares to update the code and revalidation, it must consider how to accommodate new developments like this as well as consider what could emerge in future. For example, clear guidance on delegation, accountability, and the ethical use of AI will be crucial to its successful integration into the healthcare sector.
Challenges Ahead: Funding, Culture, and Curriculum Reform
Despite the promise of simulation and digital transformation, the path forward is strewn with challenges that both the higher education and health and care sectors will need to navigate. Key among them are:
Despite these challenges, Professor Holt emphasised that modern curricula can and should adapt. Regulatory bodies like the NMC are not barriers to innovation; rather, they aim to support creative, evidence-based transformation.
Embracing Opportunity Through Evidence and Collaboration
Professor Holt’s presentation painted a picture of a profession with challenges, but rich with potential. The expansion of simulated practice, the growing sophistication of digital tools, and a renewed focus on student and staff experience present a unique opportunity for renewal.
However, capitalising on these opportunities will require evidence, investment, cross sector collaboration, and a cultural shift toward valuing time to learn. Whether it's preparing the next generation of nurses or upskilling the existing workforce, simulation, AI and emerging technologies offer exciting opportunities to enhance care of people and complement health and care environments.
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