National Standards for

Critical Care Nurse

Education

A framework to improve
educational outcomes & quality of care
NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

Produced by Key intended audience

Andrea Baldwin: Chair, Critical Care Networks • Members of all healthcare professional groups
National Nurse Leads group (CC3N) on behalf of the • Commissioners of Critical Care Education
Critical Care Nurse Education Review Forum (CCNERF). and Services
email: [email protected] • Providers of Critical Care Services
Telephone: 01257 245483 • Employers of Critical Care Nurses
• Critical Care Networks
Acknowledgements • Higher Education Providers
This document has been produced by CC3N, • Deaneries and Workforce Development
with support from the British Association of Critical Directorates
Care Nurses, the Intensive Care Society Nursing AHP • Regulators, advisory groups, professional bodies
Committee, the Royal College of Nursing Critical and trade unions within the health sector
Care Inflight Forum, the Independent Healthcare • Patients and the lay public
Advisory Services and representatives from Higher
Published January 2012, review date 2014.
Educational Institutes. Copyright of these standards for CCN Education is owned by the
Thanks to all for their time and commitment in Critical Care Network National Nurse Leads.
the production of this document.

This booklet created for CC3N by Giraffics Ltd. [email protected]

 NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

Foreword

Since the emergence of intensive care units in the

United Kingdom it has been recognised that there is a need
to ensure the critically ill patient is cared for by a group of
professional nurses that have the appropriate specialist
knowledge and skill set to assess, implement and evaluate
patients and related care interventions.

To ensure equity of care delivery, it makes sense to strive

for a critical care nursing workforce that is developed to
common standards, so that the quality of that workforce
can be assured across geographical boundaries.

This document aims to provide a set of standards and

recommendations for post registered nursing critical care
education that should be considered and applied to
support that vision.

It should be view as guidance to aid discussion between

commissioners, healthcare and educational providers to
facilitate the development of local training and educational
programmes that meet today’s ever changing healthcare
demands.

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NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

Executive Summary Survey results validated CCNERF’s hypothesis that

fundamental differences in the quality and type of
critical care education programmes do indeed exist,
In 2008, the Critical Care Networks – National which can only result in a fragmented
Nurse leads (CC3N) established a Critical Care Nurse knowledgeable critical care nursing workforce; this
Education Review Forum (CCNERF) to identify and supported the need for the development of
articulate the concerns for adult critical care nurse standards related to critical care education.
education. There were perceived fundamental
differences in the quality of critical care educational CCNERF proceeded to set the required Standards
programmes and ensuing staff knowledge and and Principles for Critical Care Nurse Education
clinical competency. Service managers felt these through members engaging with colleagues within
were impacting on nurse recruitment, quality of care their sphere of expertise, and continues to support
delivery and importantly there was the inability to the idea that critical care nurse education should
rely on an overall standard of knowledge, which occur within HEIs. These standards when applied
prevented critical care educational awards being will:
transferable across geographical areas. • Provide a framework to guide the creation of
The overall aim of this document is to provide a critical care curricula.
framework to guide Critical Care Lead • Should be used to assist effective dialogue
Nurses/Managers, Higher Educational Institutes between academic institutes, commissioners of
(HEI’s) and Independent Sector organisations to education and purchasers of their services.
develop critical care educational programmes,
improve educational outcomes and ultimately quality • Ensure programmes are designed and delivered to
of care, by producing critical care nurses who can match clinical practice with theory.
demonstrate that they are competent to nationally Through this collaborative work, CCNERF hopes
agreed occupational standards. This document will it will create critical care educational programmes
also evidence and support the educational that guarantee a knowledgeable and competent
recommendations available from other global critical sustainable nursing workforce for the future.
care nursing organisations. By identifying and
articulating the core critical care educational It is not the purpose of this document to dictate
standards for post registered adult nurses; through a specific academic programme of education be
effective implementation they will facilitate the provided by HEI’s; however in order to work towards
development of equitable, competent, safe critical the goal of standardising knowledge and clinical
care nurse practitioners that have recognised competency for critical care nurses, CCNERF’s vision
transferability of knowledge and skills. is that the Core Curriculum should form the basis on
which to build critical care educational programmes.
The objectives of this paper were: It presents key areas for developing the critical care
1 To establish the current position with regard to nurse (Appendix 5). The intention is to ensure a
critical care nurse education, this was achieved transition from the variety of programmes and
through undertaking: clinical content, to one where provision of the
• A survey on the current education and training education and training systems for critical care is
programmes provided by HEIs and available to adult comparable. This will allow transferability of the
critical care unit staff in England (Appendix 1). workforce across conurbations and reassure
• A review of the critical care nursing educational healthcare managers and commissioners of the
competencies and standards employed in critical standard of critical care nurse education.
care units across England (Appendix 2). It is not within the remit of this paper to identify
• Analysis of the type of critical care nurse training the specific clinical competencies that may form part
programmes (Appendix 3). of educational programmes or how they should be
N.B. For the purposes of this paper the scope of this assessed, although these should be developed as a
review was limited to England, but is not exclusive matter of urgency; however CCNERF recognises the
to other areas within the United Kingdom. value of flexible and diverse learning environments
2 To agree a set of ‘Standards and Principles’ for and the need for greater parity in assessment
critical care education. processes.

3 To identify a core curriculum for programmes of

critical care education.
4 To make recommendations for action to secure a
competent critical care nursing workforce.

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 NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

This document presents seven key recommendations of knowledge and competency of those skills for the
to address the presenting issues. This are not nurses they are employing. Through working
presented in any specific order of priority, but should collaboratively and applying the recommendations
be viewed as a whole: we hope this document goes some way towards
Recommendation 1 – Post registration courses for making that a reality, although there is a recognition
critical care nurses should follow the set of key that work is required urgently to identify those
Standards and Principles. They should be utilised to national competencies that will ensure a truly
support other audit or review processes associated transferrable critical care nursing workforce.
with academic standards. In applying these there
will be the opportunity for equity in course delivery
and outcomes.
Recommendation 2 – The identified core critical
care curriculum should form part of all critical care
programmes.
Recommendation 3 – A nationally recognised
transferrable ‘Award in Critical Care Nursing’ should
be at least a graduate level award at academic Level
6 with a minimum of 60 credits, e.g. ‘Graduate
Certificate in Critical Care Nursing’.
Recommendation 4 – Nurses may be required to
meet critical care National Occupational Standards
and should work towards core clinical critical care
competencies as they emerge. These should be
developed as a matter of urgency to support the
educational standards and critical care curriculum,
and will be pivotal for ensuring a nationally
transferrable competent workforce. HEI’s are advised
to refer to the NOS and the up-and-coming critical
care competencies to support the development of
their critical care programmes.
Recommendation 5 – Assessors supporting a nurse
on a critical care programme of study need to be a
competent critical care nurse and to have completed
a programme of study that meets the requirements
for mentorship (NMC, 2008). As a minimum all
assessments should be made against the
performance criteria in emerging critical care
competencies and linked to NOS in order to ensure
consistency and to make assessments more
objective.
Recommendation 6 – Strategies to monitor the
success of changing critical care educational
programmes. Workforce knowledge and clinical
competency must match the requirements of the
service provided.
Recommendation 7 – Commissioners of
education are advised to review the Standards and
Principles for Critical Care Education and utilise the
content to aid and support the development of
national quality standards for critical care education.
CCNERF believe a need has been identified to
ensure that post registered nurses are trained and
educated by programmes of education that have the
appropriate specialist skills, which address the needs
of the critically ill patient. There is a need to ensure
we have a nursing workforce that allows
transferability of skills across conurbations, and that
critical care managers have confidence in the quality

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NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

Standards and Principles 2.6 Typically enable attainment of ‘qualification’

within 12 months/academic year, up to a max. of 2
for Post Registration years under extenuating circumstances. (This may be
agreed between healthcare & academic providers to
Critical Care Courses meet local regulations)
2.7 Be matched locally against QAA descriptors.
2.8 Be supported by Critical Care Networks, where
CC3N and contributing organisations recommend they exist.
that these Standards and Principles be used as a
reference point to audit/review critical care 3. Assessment Processes should:
educational programmes available from HEIs. They 3.1 Include theory and practice / competence
should be viewed as a framework to reassure both elements
healthcare and academic providers that educational 3.2 Have a standard framework of nationally
provision is meetings the needs of the critical care recognised occupational standards/competencies
workforce, and as such are not restrictive or totally 3.3 Include robust local strategies that address issues
inclusive. related to student & mentor failure
3.4 Have clinical mentors who are qualified assessors
1. Educational Programmes should: with a critical care course and / or appropriate
1.1 Be accessible to post registered professionals experience.
(nurses) working in a critical care environment
1.2 Be responsive to the needs of the service 4. Quality Monitoring procedures should
through a modular & flexible approach include:
1.3 Include all stakeholders in development and 4.1 Audits of courses and their outcomes by HEIs
delivery strategies 4.2 Local formal stakeholder meetings to evaluate
1.4 Ensure continuity, consistency and sustainability course content and ensuing workforce development
1.5 In accordance with the Framework for Higher 4.3 Educational audits to assess suitability of the
Education Qualification (FHEQ) provide a graduate learning environment (NMC 2004)
certificate at academic Level 6 with a minimum of
60 credits, to be recognised as a nationally
transferrable ‘award’ or equivalent title, in critical 5. SPECIFIC RESPONSIBILITIES OF INDIVIDUALS
care nursing. For bachelor's degree with honours, at 5.1 Academic Providers should:
level 6, the qualification should also meet the 5.1.1) Be proficient in theory, including research and
expectation of the degree with honours qualification evidenced based practice .. And/or
benchmark. 5.1.2) Be clinically safe & competent with relevant
1.6 Work towards delivery of post graduate practical expertise.
certificates at academic level 7 post 2012 in
accordance with national recommendations 5.2 Students must:
1.7 Allow delivery by a variety of methods 5.2.1) Hold a professional post-registration
1.8 Allow opportunities for recognition of previous certificate in nursing.
education, knowledge or skills through Accreditation 5.2.2) Successfully complete a period of
of Prior and Experiential Learning (AP(e)L) processes preceptorship, as locally agreed, in a relevant area
1.9 Take into account any nationally recognised prior to commencing a critical care programme of
competency frameworks. Prepare students to meet education
nationally recognised occupational standards for 5.2.3) Complete a minimum number of clinical
critical care. hours during the course of the programme (18
NB. CCNERF is aware other critical care programmes hours a week).
may be provided by HEIs at Level 6 with less than 60 5.2.4) Self funding staff should provide academic
credits. providers with formal recognition from their critical
2. The Curriculum should: care manager on their suitability for study.
2.1 Consist of a standard core content of learning,
designed to achieve set learning outcomes
2.2 Assess both theoretical knowledge and practical
skills
2.3 Generate transferable evidence
2.4 Have holistic content which is speciality specific
2.5 Have the ability to be mapped against the
Knowledge & Skills Framework (KSF)

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 NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

5.3 Sponsoring Organisations should strive

towards:
5.3.1) Providing support mechanisms
1 Provide learners with supernumerary study time.
2 40% of learners clinical practice hours should
allow for contact with a mentor/supervisor over the
duration of the programme. This will allow for
supported clinical practice, review and assessment of
personal progress for the duration of study.
3 CCNERF recommends 200 hours of study leave
for a 60 credit course, which equates to 7.14
hours/week over a 28 week period of academic
study. Specifically in academic terms for a 60 credit
programme, the normal study time for a module is
150 hours per 15 credits. This equates to 600 hours
of student study per academic year for the
recommended 60 credit course. It is likely that there
will be approximately 25 hours / 15 credits of
classroom/tutorial time and 25 hours/ 15 credits of
directed study with a blended learning approach,
reinforced by another 100 hours of student self-
directed study.
5.3.2) Ensuring learners, under normal
circumstances, have a minimum of 80% attendance
on educational programmes
5.3.3) A tripartite selection process which includes a
collaborative approach between the sponsoring
organisation, academic provider and learner
5.3.4) Securing funding from appropriate NHS
organisations and other educational sponsors,
where this is available.
5.3.5) Supporting clinical placement to facilitate
learner development and achievement of outcomes
5.4 Mentors/Assessors must:
5.4.1) Meet the standards of regularity bodies
(NMC, 2008)
5.4.2) Demonstrate ongoing professional
development / competency within critical care
5.4.3) Be approved by managers
5.5 Healthcare Managers/Employers should:
5.5.1) Support a programme of professional
development
5.5.2) Participate in workforce Training Needs
Analysis exercises
5.5.3) Have an identified workforce development
strategy specifically for critical care staff
5.5.4) Designate a Lead Nurse with responsibility for
developing and implementing a critical care
educational strategy. Ideally a supernumerary
Practice Educator or equivalent.

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NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

Introduction Supporting Evidence

Since the demise of the English National Board United Kingdom Developments
(ENB) in 2002, there have been growing concerns In April 1999, the Department of Health (DOH)
voiced across the critical care community of the established a review of adult critical care services,
variability and types of awards available between and invited an expert group to develop a framework
post registration critical care courses, their outcomes for the future organisation and delivery of critical
and the increasing difficulties in transferability of the care. The group reported their findings in
nursing workforce across conurbations. Comprehensive Critical Care (DOH 2000) and
identified the need to redesign and improve the
The ENB was disbanded when the Nursing &
standard of critical care services, and central to this
Midwifery Council (NMC) was formed. Statutory
was the need for a competent workforce. The
responsibility for quality assurance of education
report highlighted the difficulties in the recruitment
programmes was assumed by the NMC and
and retention of the necessary trained staff and in
although the ENB was responsible for the
having professional training and development
framework of professional development
programmes that do not match the needs of
programmes, the NMC has no such accountability
individuals or the service.
and this has passed directly to the Higher Education
Institutions (HEIs); these institutions primarily decide Further more it stated, “Human resource issues
upon the content and format of educational lie at the very heart of the provision of critical care
programmes within their localities and hence may services. No amount of equipment can compensate
vary. Students completing courses generally receive for the lack of appropriately trained staff.” They
an award from the respective HEI. These concluded, “…each critically ill patient, wherever
programmes of education are not endorsed or they are located in the hospital should have skilled
recorded by the NMC, nor is there any other central critical care nursing available either to care directly
organisation that holds information regarding where for them, or to advise on the care required to meet
or how critical care programmes are offered and their needs.”
importantly to what standard.
In 2005 the DOH followed this up with the
Intensive Care Units (ICUs) relied on the ENB100 publication of best practice guidance produced by
General Intensive Care Course to provide a robust The Critical Care Stakeholder forum ‘Quality Critical
standard of education for its nursing staff, which Care - Beyond Comprehensive Critical Care’ (DOH
was recognised as transferable and could be 2005), which again emphasised the need for an
depended on to inform recruitment and appropriately trained and competent workforce,
promotional decisions, as well as to reassure stating “an effective, quality service can only be
managers and patients that staff were trained to an delivered by an appropriately skilled workforce”.
acknowledged level of competence. Ten years on This report also emphasised the importance of
and it is still this course that critical care managers agreed competencies for critical care staff and that
refer to as the ‘educational standard’ to aspire to. by having agreed standard competencies, providers
and commissioners will be able to identify whether
Through collaboration between critical care
their staff are skilled, trained and equipped to
organisations and relevant stakeholders this report
provide care in increasingly demanding situations.
validates these issues and provides
The Skills for Health (SfH) work on establishing a
recommendations for adult critical care nurse
competency framework supports this report, and
education, which should be referred to in order to
work is in progress to identify a set of National
meet today’s modern healthcare services.
Occupational Standards (NOS) that could be aligned
to critical care staff.
The Cheshire and Mersey Critical Care Network
(CMCCN) were one of many who considered the
presenting issues to be an unsatisfactory and
potentially unsafe situation. Employers had no way
of knowing the level of competency of staff who
had attended critical care courses from a variety of
geographical sites across the country. Like all the
Critical Care Networks they identified the need to
improve the quality, productivity and effectiveness of
the service to critically ill patients, which could be
achieved through an appropriately educated
workforce.
Continued on next page

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 NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

Working in partnership with SfH, CMCCN guidance to support the development of critical care
identified a framework of NOS that could be used educational programmes and associated educational
not only for the nursing workforce, but also the standards. Like CCNERF these numerous
wider non-medical critical care team. SfH believe organisations also recognised the importance of
“the NOS will provide the foundation of a core standards and competencies in ensuring
transferable education and training package, with effective delivery of safe patient care by competent
clear standards, to support the development of a critical care nurses.
competent critical care workforce” (Jordan and This document has been produced by CC3N,
Glennon, 2010). NOS focus’ on what an individual with contributions by the British Association of
needs to be able to do in practice, not only the Critical Care Nurses (BACCN) and the Royal College
knowledge and understand to work effectively, and of Nursing (RCN: Critical Care and In Flight Nursing
are indicatively linked to the Knowledge and Skills Forum). It supports the recommendations made by
Framework (KSF). HEI’s are advised to refer to the the WfCCN, EfCCNa and other critical care
NOS to aid the development of their critical care colleagues; furthermore they identified the
programmes. Further information on career importance of specialised programmes of
framework levels and related NOS, is available at development for critical care nurses, which should
www.skillsforhealth.org.uk be created, delivered and commissioned
collaboratively by government, professional and
In light of National Health Service (NHS) reforms,
educational bodies and critical care nurse employers.
critical care has a number of challenges in ensuring
it has the ability to deliver services fit for purpose. Critically ill patients have a right to receive safe,
Undoubtedly there is a need to ensure sound high quality care from skilled competent
development and delivery of education and training practitioners, however a ‘competent practitioner’ is
if organisations are to meet the requirements of the not clearly defined. CCNERF defines critical care
National Institute for Clinical Excellence (NICE) in competence as “the combination of skills,
delivery of safe quality care; However ‘there also knowledge and attitudes, values and technical
needs to be closer matching of the learner’s needs, abilities that underpin safe and effective critical care
values and aspirations with those of service nursing practice and interventions”. Across the
providers and workforce planners’ (Scholes and critical care community it was once generally
Endacott, 2002). accepted that a nurse who had completed the ENB
100 programme of learning, was ‘competent’ to
More recently the NHS has specifically recognised
practice as a critical care nurse; however, since the
the need for change to the education and training
demise of the ENB 100 there is no recognised
of the healthcare workforce, aiming for a system
standard for critical care courses. Nurses are able to
that is driven by employers where staff development
attend courses that vary in length, level of
is ‘critical to the delivery of safe, high quality care’
competence, number of academic credits and
(Field, 2011).
outcome; importantly on completion there is the
Global Standards Development inability to compare nurses who undertake similar
Critical or Intensive Care is a complex specialty courses across England.
developed to serve the diverse health care needs of
In order to address these issues an educational
patients and their families with actual or potential
review forum was formed, which agreed that a
life threatening conditions (World Federation of
definition of competence to operate as a critical care
Critical Care Nurses, WfCCN 2005). Concerns
nurse was required and importantly how that level
related to critical care nursing standards of
of competence could be acquired.
education have been raised across the world; the
intention of this document is to evidence and
support the recommendations available from other
global critical care nursing organisations.
The Canadian Association of Critical Care Nurses
(CaACCN, 2004) stated, ‘Standards are vital to
support nurses in other areas of their professional
development such as career development, research,
and leadership opportunities’. The Australian
College of Critical Care Nursing (ACCCN)
(Underwood et al, 1999) and the European Network
of Nurses Organisations (2000) previously endorsed
these standards. The European Federation of Critical
Care Associations (EfCCNa) published their position
statement on Post-registration Critical Care Nursing
Education within Europe (2004), and also provided

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NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

Critical Care Nurse Education Review Forum (CCNERF)

Following a number of discussions between lead and challenges in developing a nursing cohort fit
nurses at the Critical Care National Network Nurses for practice and were thus, ideally placed to lead
(CC3N) group a subgroup was established, the this work.
Critical Care Nurse Educational Forum (CCNERF) and
Critical care nurse educational programmes occur
invitations were extended for appropriately qualified
at the post registration level and are usually
experts and leaders from practice and academia to
determined by the needs of healthcare employers
undertake a review on the extent of the problem,
and the services they provide. Following educational
and identify possible solutions for improvement. This
surveys (appendices 1 and 2) CCNERF noted that
subgroup of expert professionals aimed to
currently, healthcare trusts and independent sector
collaborate with other critical care organisations and
organisations supply nurses with educational
professional groups to identify and articulate core
programs either independently or in association with
educational standards for adult critical care nurses,
local HEIs. Since these programs vary across the
which would meet the needs of service providers
country, it is assumed that staff completing training
and ensure delivery of safe quality care for the
may not all achieve the same outcomes, which
critically ill patient.
results in inequitable competency and knowledge
The overall purpose of CCNERF was to improve with the same bands. CCNERF quickly recognised
educational outcomes and ultimately quality of care, that in addition to the Standards and Principles that
by identifying and articulating the core educational would guide course development and delivery,
standards for adult critical care nurses. a standardised generic educational curriculum, much
It identified the need for national standards related like the former ENB 100, would further align
to course delivery and content by which educational national critical care educational standards and core
programmes for critical care nurses could be competency; although work was in progress by SfH
measured. It was agreed that the Critical Care with CMCCN in developing critical care
Networks had knowledge related to the educational competencies aligned to NOS, there was still a gap
and workforce nursing needs of provider in having a clear curriculum and set of standards by
organisations, were aware of the current issues which critical care educational programs should be
both commissioned and delivered.

Framework for
Critical Care Education Educational Outcomes
In order to articulate the various
activities in progress by different A suite of competencies built
National Occupational around the acutely ill patient
organisations reviewing Standards (NOS) pathway. These should cover all
this topic, CCNERF created & other Competencies levels of care as defined in
Comprehensive Critical Care (2000)
a framework that illustrated
how its work would
Core Curriculum
complement, and not
replicate the Standards and Priciples
work of others. for Critical Care Education

Educational Outcomes:
• Recommendations from CCNERF Core Curriculum:
• Determined in partnership between local • Recommendations by CCNERF on a core curriculum
educational providers and purchaser organisations. for critical care education, which should inform HEI
Competencies: critical care programme development (appendix 4).
• Skills for Health, NOS (appendix 6). Standards and Principles:
• Locally developed competencies. Competency to • Recommendations from CCNERF on the
be based on ’proficiency’ and aligned to the development, delivery and management of critical
Knowledge and Skills Framework (KSF). care educational programmes.
• HEI’s developed competencies. Competency may • Recommendations from WfCCN, EfCCNa and
be assessed up to ‘expert’ level, but should be other global critical care colleagues
aligned to KSF.
• National set of critical care competencies led by
CC3N in collaboration with key stakeholders.

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 NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

National Occupational England, of those, 4 critical care units and 2 HEIs did
not identify the Network in which they resided.
Standards for Critical Care Forum members discussed their in-house critical
care nurse training programs, including
CCNERF were asked to consider the suite of NOS preceptorship programs, which provided some
devised by the SfH who have identified those that indication of the variability of in-house critical care
could be applied to demonstrate competence to training programs throughout England.
work efficiently as a critical care nurse at different
levels of the SfH career framework (appendix 6). Survey Results
CMCCN have utilised the NOS to create a critical Key findings from these surveys demonstrated:
care competency template (appendix 7). The NOS • Variation in critical care programme content
are by no means exhaustive, but provide a sound • Variation in programme delivery
foundation towards identifying what exactly the • Variation in assessment strategies and assessor
critical care practitioner should be able to criteria
demonstrate in practice. These could form part of • Inconsistent academic/non-academic level achieved
in-house development, orientation and • Time taken to complete programme varied
preceptorship programmes or be provided by HEIs as More detail of survey results can be found in
part of their programmes for post-registration appendix 3
critical care education. These results validate CCNERF’s original
It was identified that more work is required to develop hypothesis that fundamental differences in the
a set of national critical care competencies, which quality and type of critical care educational
would support programmes of education and also programmes do indeed exist, which can only result
reassure critical care leaders and managers in practice, in a fragmented knowledgeable critical care nursing
that there is a truly transferrable standard by which workforce and consequently supported the need for
critical care nurse have been assessed in practice. the development of standards related to critical care
education.

Review of Current
Practice Standards & Principles for
Methodology
Critical Care Education
As part of the education review it was decided to In order to address the concerns voiced across the
undertake snapshot surveys looking at the use of critical care community on the educational
competency based standards and current training discrepancies and variable critical care nursing
programs/methods in adult critical care units across competencies, CCNERF therefore recommends a set
England. of Standards & Principles by which programs of
The aim of this piece of work was to provide a critical care education should be developed,
clear understanding of the current provision of delivered and measured; furthermore it recommends
critical care nurse training and education, and to a core curriculum be employed to ensure a minimum
ascertain if the presumed disparities across the standard of educational content is in place within
country truly existed. critical care programmes (appendix 4). The creation
Two surveys were distributed via CC3N using a of these national standards and the recommended
web based data collection tool. The first survey core curriculum should not restrain local flexibility or
used questionnaires to ascertain what training discussions to make courses address local need, but
programs took place within critical care units across there needs to be clear expectations from all
England and the standards and core competency stakeholders of what will be delivered, under what
documents used (Appendix 2). The questionnaire conditions and the outcomes to be achieved. The
was distributed to Lead Nurses from the Critical overall intent is to standardise critical care nurse
Care Networks, who in turn distributed it to education and practice that would meet today’s
hospitals known to have critical care units and the modern healthcare needs and satisfy healthcare
questionnaire was completed by Lead Nurses or unit providers that they have a nursing workforce fit for
Educators. The second survey distributed to HEIs purpose.
was an audit of university-based critical care nurse CCNERF believe there are a number of reasons for
training programs and aimed to review the variety developing educational standards for critical care
across the country (Appendix 1). Universities with nursing.
critical care programs were identified through the
Networks. Responses were received from 91 critical Continued
care units and 23 Higher Education Institutes across

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NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

• Application of standards will ensure that nursing

practice is consistent across the country, impacting Recommendations
positively on recruitment, transferability of the
nursing workforce and effective delivery of critical CCNERF presents seven key recommendations to
care services. address the issues presented in this document:
• Standards can provide a valuable insight for Recommendation 1 – Post registration courses for
healthcare providers, commissioners and the public critical care nurses should follow the set of key
on the quality of care to be expected from critical Standards and Principles. They should be utilised to
care nursing practitioners support other audit or review processes associated
• When implemented effectively they can function with academic standards. In applying these there
as a valuable indicator of quality with identified will be the opportunity for equity in course delivery
measurable outcomes. and outcomes.
HEI critical care programmes of education should Recommendation 2 – The identified core critical
be reviewed in future to determine whether the care curriculum should form part of all critical care
‘Standards and Principles’ are being applied. The programmes.
Critical Care Networks, Workforce Directorates or
other existing body that consists of critical care Recommendation 3 – A nationally recognised
nursing experts could undertake this quality transferrable ‘Award in Critical Care Nursing’ should
assurance mechanism. be at least a graduate level award at academic Level
6 with a minimum of 60 credits, e.g. ‘Graduate
It was agreed that it was not within the remit of Certificate in Critical Care Nursing’.
CCNERF to determine how the HEIs and the critical
care units ensure nurses attain both the theoretical Recommendation 4 – Nurses may be required to
knowledge to support competency and the practical meet future National Occupational Standards and
skills to perform the competencies; this is best should work towards core critical care clinical
determined through local collaboration between competencies as they emerge. These should be
service managers and providers of education. developed as a matter of urgency to support the
educational standards and critical care curriculum,
and will be pivotal for ensuring a nationally
Future Considerations transferrable competent workforce. HEI’s are advised
to refer to the NOS and critical care competencies to
The Critical Care Networks in collaboration with support the development of their critical care
other key stakeholders will consider collecting future programmes.
information on a number of nursing workforce Recommendation 5 – Assessors supporting a nurse
indicators to evaluate the progress of organisations on a critical care programme of study need to be a
in implementing the ‘Standards and Principles’ and competent critical care nurse and to have completed
curriculum recommendations. More importantly a programme of study that meets the requirements
CCNERF hopes they will have contributed for mentorship (NMC, 2008). As a minimum, all
successfully to elimination of the original issues assessments should be made against the
identified, those being difficulties with critical care performance criteria in emerging critical care
nurse recruitment, quality of care delivery and the competencies and linked to NOS in order to ensure
inability to rely on an overall standard of knowledge, consistency and to make assessments more
which prevented critical care educational awards objective.
being transferable across geographical areas.
Recommendation 6 – Strategies to monitor the
The indicators may include the following: success of changing critical care educational
• Student attrition rates programmes. Workforce knowledge and clinical
• Percentage of critical care course pass rates competency must match the requirements of the
• Number of nurses with an ‘award’ in critical care service provided.
practice
• Number of hours of paid educational time Recommendation 7 – Commissioners of education
• Nurse turnover in the ICU are advised to review the Standards and Principles
• Number of whole time equivalent (WTE) nursing for Critical Care Education and utilise the content to
vacancies in critical care support the development of national quality
• Staff and patient experience in Critical Care standards for critical care education.
• Measure of nursing satisfaction of critical care as
an effective learning environment

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 NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

Conclusion
CCNERF has identified a need to ensure that
nurses are trained and educated by programmes of
education that have the appropriate specialist skills
set that address the needs of the critically ill patient.
There is a need to ensure we have a nursing
workforce that allows transferability of skills across
conurbations, and that clinical leaders and critical
care managers have confidence in the quality of
those skills for the nurses they are employing.
Competent, confident critical care nurses that are
effectively prepared both clinically and academically
for the demands of the critical care environment can
deliver quality safe care. Appropriately qualified
educators should deliver programmes that are
offered by HEIs, and these programmes should carry
a comparable nationally recognised award that is
accepted by healthcare provider trusts and
independent sector healthcare organisations. This
document provides recommendations to address
those fundamental differences that exist in the
quality of critical care educational programmes.
CCNERF values those individuals and
organisations that are willing to collaborate to
develop high quality critical care educational
programmes, which will impact directly on the
quality of care received by critically ill patients.
Healthcare managers and clinical leaders need to
be assured that the educational programmes they
access are fit for purpose and do not compromise
the financial constraints that prevail upon the
workforce for education and training.
Notably there is still a requirement to develop a
fully comprehensive set of nationally recognised
competencies for critical care that can be utilised by
all. CC3N supports this future work, which will
enhance the standards and recommendations made
within this document and is committed in its
collaborative efforts to improve the quality of
critical care services.

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Definitions Critical Care:

Critical Care refers to the actual facilities or discrete
units within a hospital where adult critical care
Award in Critical Care Nursing: services are provided. A Critical Care Unit (CCU) is
This certificate/qualification is awarded to post an umbrella term for an HDU or an ICU, or indeed a
registered nurses by universities who have accessed unit combining both these services (BACCN 2009).
and successfully completed a critical care program.
The number of credits obtained for the award should Higher Educational Institute (HEI) a generic term
be a minimum of 60 credits at academic level 6. referring to providers of higher education.

Academic Study: In-House Critical Care Nurse Training Program:

Academic study refers to the theoretical component This is a program to train post registered nurses to
of learning. A lecturer, who is an experienced and work in the critical care setting, which is designed
knowledgeable educator, instructs students in a and taught in the hospital where they will be
classroom setting using tools such as overheads, working. The program is completely hospital
power point slides, or other multi-media specific, therefore, the length of training, both
technologies. theory and clinical, depends on the training needs
and resources of the hospital. Often these are
Competence:
termed ‘preceptorship programmes’ and may be
In keeping with other frameworks related to critical
used to support APeL processes.
care practice, competence is defined within a pro-
fessional context as ‘the broad ability with which a Mentorship:
professional person is able to practice to the required Mentorship occurs during periods of orientation
standards in a predetermined range of clinical fields and and development and is intended to support
across a range of situations’. Competences therefore individuals perhaps for several months while
are the elements performed to a pre-determined ‘expertise’ develops. The objectives of critical care
standard, which combine to create professional mentorship programs include:
competence in a defined role (Stuart 2003). 1) Providing education and support to post
registered critical care nurses,
The NMC booklet Standards for pre-registration
2) Fostering pathways to clinical excellence,
nursing education (2010) defines competence as
3) Educating critical care nurses on evidence-based
“the combination of skills, knowledge and attitudes,
medicine best practices.
values and technical abilities that underpin safe and
effective nursing practice and interventions”. Preceptorship:
This is a period of practical experience and develop-
CCNERF has defined critical care competency as,
ment for post-registered nurses, whose practice is
‘the combination of skills, knowledge and attitudes,
supervised by an expert or specialist in a particular
values and technical abilities that underpin safe and
field. Many critical care training programs support
effective critical care nursing practice and
preceptorship for part or all of their educational
interventions’.
programmes. Perceptorship allows nurses to
Competencies: participate in hands-on critical care training to gain
Competencies are statements describing behaviours important knowledge and skills through experiences,
that nurses believe are important for providing safe, while still under the safety of supervised care.
effective, and ethical care. They reflect the practice Practice Based Learning:
expectations described in standards of practice, and This refers to learning in the clinical setting whereby
the professional attributes required in a given nurses learn through hands-on experience in the
nursing role, situation, or practice setting. care setting. It includes direct interaction with both
Professional attributes include, but are not limited critical care nurses and the wider members of the
to, knowledge, skill, judgment, values, and beliefs. multidisciplinary team. An experienced healthcare
(College of Nurses of Ontario, 2003) professional or clinical educator should provide
Critical Care Nurse: support for safe practice.
A critical care nurse is a registered practitioner who University-Based Critical Care Nurse Programmes:
enhances the delivery of comprehensive patient This is a program of education to enable nurses to
centred care, for acutely ill patients who require work effectively in the critical care setting. They are
complex interventions in a highly technical designed to encompass both theoretical and clinical
environment; bringing to the patient care team a components for development. Content and prog-
unique combination of knowledge and skills. The ramme length may vary and are generally dependent
roles of critical care nurses are essential to the on the local provider. Theoretical study generally
multidisciplinary team who are needed to provide takes place in the university setting, with clinical
their expertise when caring for patients and their development taking place within the hospital setting.
relatives (WFCCN 2005).

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 NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

Glossary
AACCN American Association of Critical Care Nurses

ACCCN Australian College of Critical Care Nurses

AP(e)L Accreditation of Prior & Experiential Learning

BACCN British Association of Critical Care Nurses

CACCN Canadian Association of Critical Care Nurses

CC3N Critical Care Networks – National Nurse leads

CCNERF Critical Care Nurses Educational Review Forum

CCSF Critical Care Stakeholder Forum

CMCCN Cheshire & Mersey Critical Care Network

DOH Department of Health

EfCCA European Federation of Critical Care Associations

ENB English National Board

FHEQ Framework for Higher Education Qualifications

HEI Higher Educational Institute

ICS Intensive Care Society

IHAS Independent Healthcare Advisory Services

KSF Knowledge and Skills Framework

NHS National Health Service

NICE National Institute of Clinical Excellence

NMC Nursing and Midwifery Council

NOS National Occupational Standards

RCN Royal College of Nursing

SfH Skills for Health

WFCCN World Federation of Critical Care Nurses

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NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

References
America Association of Critical Care Nurses (2000). Standards for Acute and Critical Care Nursing Practice.
Australian College of Critical Care Nurses (1999) Critical Care Nursing Education Advisory Committee: Position Statement on
postgraduate critical care nursing education. Australian Critical Care, vol 12, No 4. p160-164
Audit Commission (1999). Critical to Success. Audit Commission.
Australian College of Critical Care Nurses (1999). Postgraduate Critical Care Nursing Education.
Available at www.acccn.com.au
Australian College of Critical Care Nurses (2003).
Intensive Care Nursing Staffing.
British Association of Critical Care Nurses (2009) Standards for Nurse Staffing in Critical Care.
Canadian Association of Critical Care Nurses (2004). Standards for Critical Care Nursing Practice.
Critical Care Nurse Training Standards Task Group Final Report (2006). Critical Care Secretariat; Ontario.
Department of Health (2000). Comprehensive Critical Care. Department of Health HMSO.
Department of Health (2000). The Nursing Contribution to the Provision of Comprehensive Critical Care for Adults:
A Strategic Program of Action. Department of Health, HMSO.
Department of Health (2004). The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process.
Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4090843
Department of Health (2008). Modernising Nursing Careers. Department of Health, London
Critical Care Stakeholder Forum (2005) Quality Critical Care - Beyond ‘Comprehensive Critical Care’.
Department of Health, London
European Foundation of Critical Care Associations (2004) Post-registration Critical care Nursing Foundation
European Network of Nurses Organisations (2000) Recommendations for a European Framework for specialist
Nursing education, ENNO, Paris, France
Field S. (2011) NHS Future Forum: Summary report on proposed changes to the NHS. DOH, London.
Available at: www.dh.gov.uk/prod_consum_dh/groups/dh.../dh_127540.pdf
Jordan M. and Glennon J. (2010) Critical for Care. A Vision for Post Graduate Critical Care Education and Training in
Cheshire and Mersey: Designed by Professionals for Professionals.
Available at www.skillsforhealth.org.uk
National Institute for Health & Clinical Excellence (2007). The Care of the Acutely Ill. NICE Clinical Guidance 50.
Available at www.nice.org.uk
National Institute for Health & Clinical Excellence (2010). Rehabilitation After Critical Illness. NICE Clinical Guidance 83.
Available at www.nice.org.uk
Nursing and Midwifery Council (2008). Standards to support learning and assessment in practice. NMC, London.
Available at www.nmc-uk.org
The Quality Assurance Agency for Higher Education 2008: The framework for higher education qualifications in England,
Wales and Northern Ireland (FHEQ) can be accessed at:
http://www.qaa.ac.uk/Publications/InformationAndGuidance/Documents/FHEQ08.pdf
Royal College of Nursing (2004) The future nurse: The future of nurse education, a discussion paper.
Available at www.rcn.org.uk/downloads/futurenurse/nurse-education.doc
Scholes J. and Endacott R (2002) Evaluation of the effectiveness of educational preparation for critical care nursing.
Research Highlights: English National Board for Nursing, Midwifery and Health Visiting.
Scholes J (2006) Developing Expertise in Critical Care Nursing. Blackwell Publishing. Oxford.
Stuart, CC (2003) Assessment, Supervision and Support in Clinical Practice, Churchill Livingstone, Edinburgh
The NHS Career Framework. Available at www.skillsforhealth.org.uk/careerframework
World Federation of Critical Care Nurses. (2005).
Declaration of Madrid: Position Statement on the Provision of Critical Care Nursing Education.
Available at www.wfccn.org

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APPENDIX 1

Higher Educational Institute (HEI) Critical Care Programme Questionnaire

1 Is your program offered full-time or part-time? ______________________

2 How long is your program (total hrs)? ______________________

3 How long does it take to complete the program (receive critical care certification)? ______________________

4 On average how many students are in the program (per class/entire program)? ______________________

5 What are the prerequisites? ______________________________________________________________________________

6 What is the cost of the program? ______________________

7 How long is the clinical component? ______________________

8 How long is the theoretical component? ______________________

9 Do you have any other comments? ______________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

APPENDIX 2

Critical Care Unit Competencies and Standards Questionnaire

1 Which of the following would best describe the type of critical care unit the questionnaire is being
completed for?

Medical ICU Burns Unit Surgical ICU Trauma Unit Comb. Medical/Surgical ICU

Other (Please specify)

2 What is the total number of beds in this unit? ______________________

3 Which of the following training programs does this unit use to prepare nurses new to critical care for
practice in that setting? (Please include the duration in weeks of theoretical and clinical training)

Weeks - Theoretical _______________ Clinical _______________

College Certification In-House Orientation

Preceptorship Other (Please specify)

4 Do you have written standards of practice for nurses in your unit?

Yes (go to question 5) No (go to question 8)

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5 If yes:
a. How often does your unit update these specific standards? _______________________________________________

b. Which national or local standards are most reflected in your documents? (Check all that apply)

British Association of Critical Care Nurses Royal College of Nursing

Other: Please specify ________________________________________________________________ None

c. Are your documents inclusive of competency statements?

Examples:
• I set priorities according to the urgency of the patient's presentation.
• I interact effectively with the interdisciplinary team.
• I plan interventions in collaboration with patients, families, and other members of the healthcare team to
formulate the overall plan of care.
Yes No

d. Are your documents inclusive of an evaluation component? Yes No (go to question 7)

6 If yes:

a. How frequently are nurses evaluated? ______________________________________

b. Is documentation provided at that time? Yes No

c. Is written peer review a required component? Yes No

7 Would you be willing to share your document(s)?

Yes, I have enclosed the document(s)

Yes, I will supply the document(s) on this date: (Please specify) __________________________

No

8 We welcome any specific feedback you may have about critical care nursing core competencies and
standards. Please share your top three comments or suggestions with us.

1.

2.

3.

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APPENDIX 3

As part of the education review it was decided to undertake a snapshot survey looking at the use of
competency based standards and current training programs/methods in adult critical care units across England.
The aim of this piece of work was to provide a clear understanding of the current provision of critical care nurse
training and education, and to identify the disparities that exist across the country. The survey used was based
on a previous study carried out by the Critical Care Secretariat in Ontario, Canada 1.
Surveys were distributed via the Critical Care Network Lead Nurses using a web based data collection tool.
Of the 27 geographical areas associated with clinical networks, a number do not have a formal critical care
network structure, as a consequence parts of London and the South West Peninsular are not represented within
the results. Responses were received from 91 critical care units and 23 Higher Education Institutes across
England, of those 4 critical care units and 2 HEIs did not identify the network in which they resided.

Table 1: Breakdown of Critical Care Unit and HEI responses by Critical Care Networks

Table 2: General Information - Critical Care Units Demographics

68% of respondents to the survey were categorised as from general critical care units and 73% were
combined level 2/3 services. The vast majority of units had 20 beds or less.

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Table 3: Information gathered from Higher Education Institutes

The academic level for the majority of current critical care programmes was reported as degree level (81%),
although a number of HEI’s delivered their programme at diploma, degree and masters level. Selection criteria
to access the critical care programmes was predominantly based on completion of Trust and Independent Sector
orientation/preceptorship programmes and students having worked for greater than 12 months in a critical care
environment.

Table 4: Breakdown of Course Delivery

The information relating to how courses are delivered by HEI’s demonstrated there was a general agreement
that 50 – 99 hours were aimed at direct contact teaching. In general the spectrum of time allocated to private
study was wide and varied and most courses were delivered in a 12 month period or less.

Table 5: Teaching and Assessment Strategies

It’s clear from the information gathered that all responding organisations use a
blended approach to course delivery.

Table 6: Student Numbers Table 7: Strategies used to Prepare Staff

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Table 9: More detailed information from Critical Care Units

100% of units stated they had a written competency based package on their unit. However, responses
showed that there was a less cohesive approach to the review process, the professional standards used to
underpin competencies and the general mapping to Trust Key Skills Framework.

Table 10: Defining Competence

There appears to be difficulty in defining competency, although there is clear indication that this is linked to
completing a set of clinical competencies.

Table 11: Competency Assessment

Critical Care Units were asked to state the minimum qualifications/experience required to be an assessor.
A number of themes evolved when grouping this information:
• Band of staff
• Experience in critical care quantified in years
• Completion of critical care qualification
• Completion of teaching qualification
• Completion of mentors/assessor training
Although emergent themes are evident, the detail provided indicates there is large variation in what is
considered to be minimum requirements for assessors.
References
1. Critical Care Nurse Training Standards Task Group Final Report. Critical Care Secretariat; Ontario.

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APPENDIX 4

Recommended Core Critical Care Curriculum

In order to work towards the goal of standardising educational provision and outcomes for critical care
nurses, CCNERF recommend that providers of education develop programmes around a core curriculum of
content. The vision is to ensure a transition from the variety of programme content, to one where provision of
the education and training systems for critical care are comparable.
This will allow transferability of the workforce across conurbations and reassure healthcare managers of the
standard of critical care nurse education.
CCNERF recognises the importance of having curricula that are designed to prepare students to meet
national occupational standards in critical care, which will be the foundation for ensuring transferability of
qualifications.
Aims for Educational Centres:
1) Educational programmes should be aligned to achieve service requirements which underpin NHS strategic goals
2) Embrace the concepts of quality and progressive innovation in learning, teaching and assessment
3) Programmes should be developed using a blended learning approach
4) All programmes should disseminate current research and stimulate practice development
5) A non-discriminatory learning environment should be provided for all learners
6) The learning experience should enhance skills and theoretical knowledge
7) All programmes should support and encourage student potential
8) Programmes should be developed and delivered by a combination of individuals who are academically and
clinically credible
Critical Care Learning Outcomes:
Programme learning outcomes should allow for the integration of various learning experiences, both within
the academic and clinical setting. The resulting critical care award/qualification should develop graduates with
high-level analytical skills and a specific range of competences related to the critical care environment. These are
further defined in the 3 areas below, but CCNERF recognises that each HEI may have differing programme
outcome ‘headlines’, hence these sections are not mandatory but the related content should be incorporated as
part of all course outcomes.
1) Knowledge and Skill
Demonstrate and critically reflect on the application of critical care nursing skills which are theoretically
underpinned.
2) Research
Critically evaluate evidence based practice in context to critical care practice.
3) Decision Making
Critically appraise and apply relevant theory to support clinical decision making within a critical care team setting.
The Programme of study should prepare learners to demonstrate:
• Knowledge of relevant anatomy and physiology • Ability to recognise health abnormalities
• Competence to assess, plan, implement and evaluate care for patients with health abnormalities
• Knowledge relating to pharmacology and pharmacokinetics
• Knowledge of investigations and application of results • Knowledge of treatment modalities
• Safe and effective use of equipment • Competence to manage related emergency situations
• Ability to demonstrate leadership, management and team skills
All of the above elements should be applied to the following 6 systems and content related to an
appropriate evidence base:
1. Respiratory system 2. Cardiovascular system 3. Renal System
4. Gastrointestinal System (inclusive of liver and bilary systems) 5. Neurological System 6. Integumentary System

Supporting Areas for Development

There are other key areas of development that are integral within the critical care nursing curriculum namely
Communication and teamwork, Law and Ethics and Holistic care. Although nurses may have had exposure to
these subjects these should be addressed with specific reference to the critical care environment.
Communication and Teamwork. The student will demonstrate:
• Knowledge of the importance of team working • Participation in effective team working
• The need for clear and accurate documentation
• Effective communication techniques and identify barriers to communication

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 NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

Law and Ethics. The student will demonstrate:

• The legal responsibility of their role • Knowledge of ethical principles
• Knowledge of Acts of Parliament that influence care delivery • Principles of consent and mental capacity
• Knowledge of withdrawal of treatment, end of life care, DNAR and advanced directives
• Awareness of the need for defensible documentation • Knowledge of professional responsibilities
• Knowledge of ethical dilemmas
Holistic care: The student will demonstrate:
• The ability to manage the critically ill patient along the patient pathway
• Psychosocial care of the patient and their family • The ability to provide essential physical care
• The ability to maintain privacy and dignity • The ability to manage End of Life, bereavement and sudden loss
• The ability to recognise and instigate opportunities for rehabilitation
NB. CCNERF makes special mention that leadership, management & team skills should be recognised as core areas of
development to enable effective practice with the critical care setting, and these should be applied to each of the systems
studied.

EXAMPLE OF CURRICULUM CONTENT:

To prepare learners to meet the requirements identified in the elements of learning in relation to the
Respiratory System, the programme of study should include:

Continued on next page

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 NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

APPENDIX 5

Summary of Attributes and Definitions

for Career Framework Levels
These summaries have been distilled from the Career Framework Descriptors used in
the process of levelling jobs onto the Career Framework since 2006.
They are used when describing Nationally Transferable Roles, and describe the Better Skills
Better Jobs
level of autonomy and responsibility and the kind of decision making required by a Better Health
job. They provide additional, essential information about a job, alongside National
Occupational Standards. The definitions of the more specific job titles have been
informed by publications and work from the Department of Health and Professional bodies.
Each summary is applicable to all jobs across the health sector at a given level including clinical,
administration, management etc. The examples may be applied to both clinical and non clinical roles.
CAREER FRAMEWORK LEVEL 8
People at level 8 of the career framework require highly specialised knowledge, some of which is at the
forefront of knowledge in a field of work, which they use as the basis for original thinking and/or research.
They are leaders with considerable responsibility, and the ability to research and analyse complex processes.
They have responsibility for service improvement or development. They may have considerable management
responsibilities and be accountable for service delivery or have a leading education or commissioning role.
For example: Consultant Practitioner, Career Framework Level 8
The consultant practitioner is an expert practitioner with a high level of responsibility for the development
and delivery of services. There is a strong element of research within the role. They will carry out research, and
may have overall responsibility for the coordination of R&D programmes as well as ensuring that current
research findings are used by all staff to inform their practice. The consultant practitioners will lead by example
in developing highly innovative solutions to problems based on original research and inquiry.
They will apply a highly developed theoretical and practical knowledge over a wide range of clinical,
scientific, technical and /or management functions.
CAREER FRAMEWORK LEVEL 7
People at level 7 of the career framework have a critical awareness of knowledge issues in the field and at
the interface between different fields.
They are innovative, and have a responsibility for developing and changing practice and/or services in a
complex and unpredictable environment.
For example: Advanced Practitioner, Career Framework Level 7
Advanced practitioners are experienced professionals who have developed their skills and theoretical
knowledge to a very high standard, performing a highly complex role and continuously developing their
practice within a defined field and/or having management responsibilities for a section/small department. They
will have their own caseload or work area responsibilities.
CAREER FRAMEWORK LEVEL 6
People at level 6 require a critical understanding of detailed theoretical and practical knowledge, are
specialist and /or have management and leadership responsibilities. They demonstrate initiative and are creative
in finding solutions to problems. They have some responsibility for team performance and service development
and they consistently undertake self development.
For example: Specialist or Senior Practitioner, Career Framework Level 6
Specialist practitioners have developed a high level of knowledge and skill in a specific area of practice. They
have a depth of knowledge and understanding which enables them to perform at a high level of practice, take
a leadership role, use and develop evidence to inform their practice, and deal with complex, unpredictable
environments. They will have their own caseload or work area responsibilities.
CAREER FRAMEWORK LEVEL 5
People at level 5 will have a comprehensive, specialised, factual and theoretical knowledge within a field of
work and an awareness of the boundaries of that knowledge.
They are able to use knowledge to solve problems creatively, make judgements which require analysis and
interpretation, and actively contribute to service and self development. They may have responsibility for
supervision of staff or training.
For example: Practitioner
Practitioners have a broad knowledge base in a particular field of practice which enables them to work with
a considerable degree of autonomy.

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NATIONAL STANDARDS for CRITICAL CARE NURSE EDUCATION

They may have line management responsibilities but will not be responsible for service delivery. They
underpin their practice. A practitioner is competent in their area of practice and will seek opportunities to
improve the service they offer.
CAREER FRAMEWORK LEVEL 4
People at level 4 require factual and theoretical knowledge in broad contexts within a field of work.
Work is guided by standard operating procedures, protocols or systems of work, but the worker makes
judgements, plans activities, contributes to service development and demonstrates self development. They may
have responsibility for supervision of some staff.
For example: Assistant/Associate Practitioner
Assistant practitioners have a required level of knowledge and skill enabling them to undertake tasks that
may otherwise have been undertaken by a practitioner. They will have developed specific technical skills and
have a high degree of technical proficiency. They will exercise a degree of autonomy and undertake well
defined tasks requiring limited judgement. They may have line management responsibility for others.
CAREER FRAMEWORK LEVEL 3
People at level 3 require knowledge of facts, principles, processes and general concepts in a field of work.
They may carry out a wider range of duties than the person working at level 2, and will have more
responsibility, with guidance and supervision available when needed. They will contribute to service
development, and are responsible for self development.
For example: Senior Healthcare Assistants/Technicians
Senior healthcare assistants or technicians support the work of practitioners at all levels and may work as
part of a team. They demonstrate an ability to carry out tasks, solving straightforward problems and making
some judgements, with guidance and supervision available. They have skills in specific focussed aspects of
service delivery.
CAREER FRAMEWORK LEVEL 2
People at level 2 require basic factual knowledge of a field of work.
They may carry out clinical, technical, scientific or administrative duties according to established protocols or
procedures, or systems of work.
For example: Support Worker
Support workers work to agreed protocols and procedures. They are able to solve routine problems and
make straightforward judgements. They have general skills across a range of aspects of service delivery and
work under close supervision.

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APPENDIX 6

National Occupational Standards

(Competences)
Skills for Health and National Occupational Standards
Skills for Health has lead responsibility for developing National Occupational
Better Skills
Standards (NOS) for the health sector. NOS, more commonly known as competences, are Better Jobs
relevant to the whole of the UK and apply to the healthcare sector in its entirety, rather Better Health
than exclusively to the NHS. All Skills for Health competences are UK Commission for
Employment and Skills (UKCES) approved National Occupational Standards.
Skills for Health works collaboratively with the relevant stakeholders, practitioners
and experts to write NOS, which describe performance as outcomes of a person's work
and set out the required knowledge and understanding required to underpin that performance. NOS are
developed to meet rigorous internal quality systems and the NOS Quality Criteria set down by the UKCES.
Once the internal quality assurance requirements and the NOS Quality Criteria have been met, the draft NOS are
submitted to UKCES who are responsible for approving all Sector Skills Councils' National Occupational Standards.
Once approved they become National Occupational Standards (NOS), and are used across the four countries;
England, Northern Ireland, Scotland and Wales.
NOS focus on what the person needs to be able to do, relating to individual performance, as well as what
they must know and understand to work effectively. They can be grouped together into frameworks, for
example, they can be specifically relevant to a particular condition, or can be grouped in other ways, such as
qualification or role.
The template used by Skills for Health for presenting NOS has evolved over the years and is reviewed and
updated based on continuing evaluation. NOS have a review date and are reviewed by Skills for Health on a
project basis.
NOS could be reviewed because:
Feedback has been received that a competence no longer reflects current practice.
Where the competence is identified as being part of the 'scope' of a new project the
National Reference Group may decide that the National Occupational Standards (NOS) needs to be updated.
Use of National Occupational Standards
National Occupational Standards are designed to allow people to assess and be assessed against them. In
order to do that, they must be:
a single task able to be undertaken by one individual measurable observable.
NOS define what has to be done, not who does it.
They describe:
what the required standard is for a particular activity
the performance criteria against which competence can be assessed
the underpinning knowledge that is needed.
Each NOS is currently written in a set format which includes:
Title - active tense with a range of context/conditions Scope/overview - further defines range
Performance criteria - measures of successful performance (the minimum standard required)
Knowledge and understanding required to underpin the performance criteria
National Occupational Standards (NOS) are a tool to help individuals, organisations and training providers to
improve performance. The use of NOS related to the requirements of the care pathways and the service user
when designing education and training ensures education provision is relevant to employer and workforce needs.
NOS can be used to:
Inform the development of national qualifications
Design tailored training packages and assess relevance and effectiveness
Define learning outcomes and assessment criteria Provide clear goals for structured learning.
In addition, evidence used to demonstrate competence against a National Occupational Standard (NOS) can
also be used to demonstrate how an individual meets their NHS KSF profile. Each NOS has a code for
identification, e.g. Gen 97, the full text of each NOS can be found at www.skillsforhealth.org.uk
All National Occupational Standards/ competences available through the Skills for Health website are the intellectual
property of Skills for Health and are protected by relevant copyright legislation. Any use of the National Occupational
Standards/ competences within any publications without express permission of Skills for Health and relevant references to
the originator could be viewed a breach of copyright. Amending Skills for Health National Occupational Standards/
competences in any way is not permissible without a complete change to the text.

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APPENDIX 7

Example of a Critical Care Competency

The competency below has been mapped against NOS CHS78

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Members of the Critical Care

National Education Review Forum
The contributions and ongoing support of the following individuals
and organisations throughout the development of this document
are sincerely acknowledged.

Andrea Baldwin Lancs and South Cumbria Critical Care Network

Andrea Berry Greater Manchester Critical Care Network
Lorraine Burgess ICS Representative / John Moore’s University Liverpool
Margaret Clark West Yorkshire Critical Care Network
Sarah Clarke Cheshire & Mersey Critical Care Network
Deborah Cheetham North East Critical Care Network
Lee Cutler North Trent Critical Care Network
John Dean Wessex Critical Care Network
Lesley Durham NOrF representative & North of England Critical Care Network
Alison Eddleston University of Central Lancashire
Alison East Herts & Bedfordshire Critical Care Network
Ifor Evans Wales Critical Care Network
Pauline Freeman University of Hertfordshire
Helen Friend Herts & Beds Critical Care Network
Jane Glennon Skills for Health
Lene Gurney IHAS Representative
Angela Himsworth Central England, Birmingham and Black Country, and
NW Midlands Critical Care Networks
Mary Jordan Cheshire & Mersey Critical Care Network
Sheila Kinoulty Critical Care Networks of Northern Ireland
Colette Laws-Chapman BACCN Representative
Jacqueline Lowe-Berry University of Central Lancashire
Lorraine Marsons Birmingham City University
Gerri Nevin RCN Representative
Deborah Slade Thames Valley Critical Care Network
Keith Young Department of Health Representative

OTHER CONTRIBUTORS
Juliet Anderson BACCN
Rachel Binks RCN Critical Care Inflight Forum
This document has been produced with support from these organisations and is available through their websites.

www.baccn.org.uk www.ics.ac.uk www.independenthealthcare.org.uk www.rcn.org.uk