RCN Competences
Competences:
Specialist competences
for fertility nurses
1
Acknowledgements
Thank you to the committee members of the RCN
Midwifery and Fertility Nursing Forum who supported,
reviewed and commented on recent development within
the field of specialist fertility nursing practice, which are
reflected in this revised edition. Thank you also to
Maggy Wallace, Professional Development Adviser for
her work on the first edition, published in 2007.
Valerie Peddie
Chair of the RCN Midwifery and Fertility Nursing
Forum
RCN Legal Disclaimer
This publication contains information, advice and guidance to help members of the RCN. It is intended for use within the UK but readers are
advised that practices may vary in each country and outside the UK.
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made to ensure the RCN provides accurate and expert information and guidance, it is impossible to predict all the circumstances in which it
may be used.Accordingly, the RCN shall not be liable to any person or entity with respect to any loss or damage caused or alleged to be caused
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Published by the Royal College of Nursing, 20 Cavendish Square, London,W1G 0RN
© 2011 Royal College of Nursing. This publication may not be lent, resold, hired out or otherwise disposed of by ways of trade in any form of
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2
ROYAL COLLEGE OF NURSING
Competences:
Specialist competences for fertility nurses
Contents
Introduction
2
3. Conclusion
30
1. How to use the framework
3
4. References
31
Benefits of the framework
3
The competences
3
5. Appendices
32
The competence levels
3
Using the framework
4
The building blocks for professional
development
4
Patient/client pathway
4
Knowledge and skills framework
4
National occupational standards
5
Professional accountability
5
Producing evidence
5
What is evidence?
6
2. Competences
7
The causes/classification of infertility
7
Investigating the causes of infertility
9
Treatment for infertility
13
Follow-up care
21
Specific psychological/psycho-social
intervention
22
Generic competences
25
1
Appendix 1: KSF dimensions
32
Appendix 2: Role level descriptors
35
RCN COMPETENCES – FERTILITY
Introduction
Competence can be defined as:“The state of having the
knowledge, judgement, skills, energy, experience and
motivation required to respond adequately to the demands
of one’s professional responsibilities” (Roach, 1992).
Agenda for Change
Agenda for Change (AfC) was implemented in the NHS,
across the UK in December 2004. It was the biggest
overhaul of NHS-wide pay, terms and conditions in over 50
years. It applies to all NHS organisations and therefore sets
a UK framework for pay, terms and conditions of
employment.
The role of the fertility nurse is to provide an holistic
approach to fertility investigation, treatment, and early
pregnancy through compassionate, informed and
evidence-based practice. Fertility nurses work as part of
multi-professional teams whose focus is on delivering a
high standard of care. Research plays a fundamental part
in this process.
AfC and its Knowledge and Skills Framework (KSF) means
that all staff will have clear and consistent development
objectives; can develop in such a way that they can apply
the knowledge and skills appropriate to their level of
responsibility; and are helped to identify and develop
knowledge and skills that will support their career
progression.
The changing context
This field of nursing is highly specialised, and subject to
dramatic change as innovations and new techniques are
adopted - many, previously the responsibility of medically
qualified staff. The RCN Midwifery and Fertility Nursing
Group (FNG) believes that professional advice and support
are required for nurses developing their roles in a dynamic
and rapidly advancing field, which brings with it
challenging moral dilemmas (Barber, 1997).
Under AfC jobs are evaluated using a bespoke NHS job
evaluation scheme. This gives each job a 'weighting' that
then determines where each job slots into the new pay
bands. Common 'job profiles' continue to be developed
and are applicable across the UK, and where a job fits a
profile it is possible to place it straight onto an appropriate
new pay band. For the relatively few jobs that don't
automatically fit a profile, trained job evaluators drawn
from management and staff side carry out the evaluation
using a Job Analysis Questionnaire (JAQ). Each pay band
has a number of pay points. Staff below the maximum
point can expect to progress to the next point each year.
The competence framework has been developed in this
context, as well as taking into account other professional
and political factors such as:
✦
Agenda for Change (DH, 1999) including the
Knowledge and Skills Framework and the NHS Job
Evaluation Scheme
✦
need for leadership in specialist nursing
✦
need for the development of standards
✦
NHS Plan (DH, 2000) and its equivalent in Scotland,
Wales and Northern Ireland
✦
increased focus on work-based and lifelong learning
plus supervision
✦
changing focus towards professional rather than
academic accreditation
✦
national service frameworks
✦
increasing patient and user expectations
✦
Future Nurse (RCN, 2003).
There are two points on each pay band called gateways
where staff knowledge and skills are assessed using the
Knowledge and Skills Framework (KSF). Pay progression
at the gateways is linked to the demonstration of applied
knowledge and skills to support continuing professional
development. The presumption in the KSF is that staff will
pass through these gateways unless there are reasons as to
why they shouldn't.
For more comprehensive information on Agenda for
Change please refer to www.rcn.org.uk/agendaforchange/
This site is your guide to the ins and outs of the pay, terms
and conditions for the NHS. It will help you to understand
AfC, how it was developed, what you can expect from your
new pay, terms and conditions and how you can make the
most of the new system, particularly the KSF. To ask
questions and debate issues use the RCN's Discussion
Zone on the members-only area.
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ROYAL COLLEGE OF NURSING
1
How to use the framework
Competences: specialist competences for fertility nurses
complements the UK-wide RCN Core competence
framework (see the RCN website at www.rcn.org.uk). By
focussing on the specific care treatments used in fertility
nursing, the document gives nurses across the UK the
support they need to achieve the skills and knowledge
necessary to provide a high standard of care.You should
use the framework as a developing, empowering and
aspirational tool, as well as a means of managing
performance as a part of professional development and
appraisal schemes. The framework can also be used with
other frameworks that highlight core nursing skills and
competences.
✦
increased effectiveness to service provision
✦
improved access and choice for care provision.
The competences
The competences are aligned to the Skills for Health career
framework health levels. These are based on classifications
used in the KSF (DH, 2004) and the European qualification
framework for lifelong learning (SfH, 2006). The levels are
for guidance only and are not the same as the Agenda for
Change pay bands, which do not consider freedom to act
or managerial responsibility.
As a practitioner you will be required to produce evidence
for each competence in order to demonstrate that you have
achieved the competence at the identified/desired level.
Forms of evidence that you can use include case histories,
self-appraisal via a reflective diary, 360 degree feedback,
verification of practice and structured observation of
practice.
Given the specialist nature of fertility nursing, delineating
competences is challenging and depends on the
background, composition and ethos of individual teams.
In some fertility units the role of fertility nurses is
extensive. They have significant involvement in all aspects
of fertility work, demonstrating a high level of technical
ability and skill. In other organisations, the nurse’s role is
limited to assisting other team members.
Benefits of the framework
Our approach to describing competences has been to
accept that individuals’ knowledge and skills improve with
time, experience and education, or as their specific role
dictates. The competences described in each area need to
be considered as a guide rather than a prescription. The
role of the unregistered practitioner is limited in this
specialist field of care. For the comparatively new
consultant nurse the role is not yet well defined across
fertility nursing, so the competences described vary from
role to role.
The competence framework provides benefits for nurses,
their employers, patients and the public.
Nurses benefit because it helps you to:
✦
deliver consistently high standards of care
✦
identify your level of practice and plan your career in a
more structured way
✦
pinpoint personal education and development needs
✦
realise your potential more effectively
✦
seize opportunities to influence the direction of
nursing.
The competence levels
The framework has five levels of competence that can be
cross-referenced with the Career Framework for Health as
devised by Skills for Health (Skills for Health, 2006). The
competences are detailed for each specific intervention,
therapy or treatment.
Employers benefit because it provides:
✦
a model to ensure consistently high standards of care
✦
clearer insight into the expertise and competence of
staff. For example, in assessment of risk management.
The levels are:
Level 2: health care support worker
Patients and the public benefit because it makes it possible
to deliver:
✦
Level 5: competent nurse
consistently high standards of patient care
Level 6: experienced/proficient nurse
3
RCN COMPETENCES – FERTILITY
Level 7 senior practitioner/expert nurse
Causes of infertility
Level 8: consultant nurse.
There are a number of ways that you can use the
framework to develop your knowledge and skills, for
example, it can be used as a:
tool for individual nurses to assess their own
competence and training needs
✦
formal appraisal system to assess competence and
identify training needs
✦
means of planning an individual nurse’s career
pathway
✦
method of developing a comprehensive induction
programme for new staff
✦
framework for the development of individual
portfolios
✦
follow-up
In this way there is a visible coherence and logic to the
evolving competences that nurses need to support their
patient/clients. Each competence described builds on the
one before it because knowledge and skills are acquired
cumulatively. Research plays a major part in the role of the
fertility nurse and clinical applications change accordingly.
This is incorporated into each stage of the client pathway.
Using the framework
✦
investigations treatment
However, using this approach does mean that some
generic competences, for example, those relating to
documentation, are omitted. They are at the end of the
following text.
Fertility nurses working in the UK should be familiar with
all local protocols/standard operating procedures (SOP),
and national guidelines and regulation.
Knowledge and skills framework
Nurses should use the specialist competences with the
RCN Core competences that are relevant to their role.
Practitioners who work in the NHS should use the KSF
dimensions and levels of the core framework that relate to
the specific KSF outline for their current post.
source of information for nurses considering a career
in fertility nursing practice.
The building blocks for
professional development
To help you apply the specialist competences to your role,
the relevant KSF dimensions and levels have been
identified against each area of competence. The KSF
abbreviated reference has been used, for example, HWB1
level 4. These are based on the dimensions and levels
identified in the RCN Core competences that relate to the
level of practitioner, and which refer to competent,
experienced and senior practitioners/nurses.Work on the
consultant nurse role will be completed shortly, and has yet
to start on the health care support worker.
The clearly defined competence levels make it possible for
fertility nurses to identify their level of practice. The
framework gives you the ability to plan your career in a
more structured way, and supports your continuing
professional development by pinpointing individual
development and training needs.
By developing competences for fertility and other nursing
specialisms, the RCN is providing the key building blocks
for improving professional practice in nursing. This will
raise the quality of care, and ensure that patients and
employers benefit from consistently high standards.
These competences can also be used with other
dimensions and levels where they are appropriate. For
example, where a competence involves undertaking an
intervention, the suggested KSF dimension would be
HWB7 (interventions and treatments).Although the
competence could also be appropriate for KSF dimension
HWB5 (provision of care to meet health and wellbeing
needs) if providing care is the main focus.We have to be
careful because many procedures, such as embryo transfer
or pregnancy scan, are undertaken by fertility nurses on
their own, and the care/intervention role boundaries are
demarcated. If we always assume the caring role, fertility
nurses may undersell themselves in the KSF framework.
Patient/client pathway
In describing the competences, we have used the
patient/client pathway as the framework for the work –
moving from the causes of infertility, through
investigation, into treatment and then follow-up:
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ROYAL COLLEGE OF NURSING
National occupational standards
Producing evidence
National Occupational Standards (NOS) and National
Workforce Competences (NWC) have been developed by
Skills for Health following consultation with experts across
the health care sector. They describe the scope of the
competence, the required knowledge and the standard of
performance needed to demonstrate competence. They
focus purely on health care functions, not the professional
approach such as attitudes and behaviours, or what a
person is like.Appropriate NOSs and NWCs have been
identified by reference alongside the relevant competences
we describe. This means that you can identify an
applicable NOS/NWC that may support your development
and attainment of competence in the relevant function.
The reference code for relevant NOS/NWC is given for each
competence.
You are responsible for gathering evidence for each
competence in order to demonstrate that you have
achieved it at the identified/desired level. Forms of
evidence that you can use include:
✦
case histories
✦
self-appraisal via a reflective diary
✦
360-degree feedback
✦
verification of practice and structured observation of
practice
✦
a log book
✦
up to date personal portfolio.
When you gather evidence it is important that you
consider the following:
Professional accountability
The NMC Code of professional conduct: standards for
conduct, performance and ethics (2004) states:
✦
what is the competence statement asking of you?
✦
is the existing evidence appropriate? For example,
certificates of attendance at training events are
insufficient to demonstrate knowledge or competence
in practice.You will need to demonstrate the
knowledge that you have gained and how you use this
in practice.Assessment of competence in practice also
requires supervised practice by a competent
practitioner until you both agree that competence has
been demonstrated
✦
what else do you need to do to develop evidence? For
example, consider reflection and feedback on practice
✦
do you have any further development needs, and how
could these be met?
✦
could the evidence that you have be used to cover
several competences? For example, one case study may
demonstrate that you have used a variety of knowledge
and skills in caring for a patient. In this instance you
should be able to measure the evidence against several
competences.
“As a registered nurse, midwife or specialist community
public health nurse, you are personally accountable for
your practice. In caring for patients and clients, you must:
✦
respect the patient or client as an individual
✦
obtain consent before you give and treatment or care
✦
protect confidential information
✦
co-operate with others in the team
✦
maintain your professional knowledge and competence
✦
be trustworthy
✦
act to identify and minimise risk to patients and
clients.”
The code goes on to state that as a practitioner:
“You are personally accountable for your practice. This
means that you are answerable for your actions and
omissions, regardless of advice or directions from another
professional.”
It also goes on to state:
“You have a duty of care to your patients and clients, who
are entitled to receive safe and competent care”, and that
“you must adhere to the laws of the country in which you
are practising.”
5
RCN COMPETENCES – FERTILITY
What is evidence?
There is a variety of material that you can collect to
capture evidence of competence. This may include:
✦
evidence of supervised practice such as signed
observation of undertaking a procedure
✦
work-based projects
✦
practice developments/changes in practice
✦
tape recordings
✦
critical incidents
✦
reflective diaries
✦
log books
✦
evidence of qualification
✦
assessments and appraisals
✦
publications and presentations
✦
audits
✦
teaching packages
✦
poster
✦
certificates of attendance with reflection on learning
✦
evidence of group work
✦
policy and protocol development
✦
standard operating procedures
✦
evidence of membership of advisory groups
✦
research and evidence-based reviews
✦
witness statements when focused and well structured.
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ROYAL COLLEGE OF NURSING
2
Competences
The causes/classifications of infertility
Core competence 1: Causes of infertility - primary, secondary, male, female
To support individuals you should be able to:
Role
Related KSF NWC/NOS
Competence
Health care
support
worker
(level 2)
• use a basic understanding of the reproductive system and causes of infertility in preparing
patients appropriately for investigations/clinical activities
• act in ways that recognise the client’s need for privacy and confidentiality
• prepare appropriate accommodation for client/user.
Core 1 level 2
Core 2 level 2
Core 3 level 2
Core 5 level 2
Core 6 level 2
HWB6 level 1
HWB7 level 1
GEN4
GEN6
HSC23
HSC24
HSC234
Competent
nurse
(level 5)
In addition to level 2:
• use knowledge of the normal structure and function of the reproductive system to identify the
common causes of male and female infertility
• provide opportunities for privacy and confidentiality
• implement relevant policies and procedures under supervision.
As level 2
Core 1 level 3
Core 2 level 3
Core 5 level 2
Core 6 level 3
HWB6 level 3
HWB7 level 3
As level 2
GEN13
GEN31
MH_1
HSC3111
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• use knowledge of the reproductive system to identify normal and abnormal structure and
function
• use knowledge of a wide range of possible causes of male and female infertility to undertake
appropriate investigations and discuss treatment options
• support client and partner through appropriate investigation and discussion of treatment options
• establish and maintain systems for privacy and confidentiality at all times with clients
• support other staff in their understanding of causes of infertility and their relation with assisted
conception treatment
• ensure appropriate nursing policies, procedures and guidelines are in place and adhered to
• awareness of Royal College of Obstetricians and Gynaecologists (RCOG) (2007) guidance for
managing fertility of male cancer patients (2004)
• run nurse-led infertility clinics
• awareness of the Human Fertilisation & Embyrology (HFEA) frequirements/consent for gamete
storage.
As level 5
Core 5 level 3
G5 level 3
As level 5
M&L_B8
ENTO_L9
M&L_D7
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• use expert knowledge in the whole investigation process
• advise and support clients in understanding the causes of infertility and the possible
investigations and treatment
• ensure facilities meet privacy and confidentiality requirements in normal and exceptional
circumstances.
• support client and partner through investigation and discussion of treatment options
• support, teach and assess junior staff in understanding causes of infertility
• manage caseload and nurse-led clinics
• provide management training opportunities for others*
• audit fertility policies and procedures with relevant staff and agrees changes as necessary.
As level 6
Core 1 level 4
Core 2 level 4
HWB6 level 4
G5 level 3
As level 6
HSC41
ENTO_L15
ENTO_L16
In addition to level 7:
• identify strategic direction for the fertility service across primary, secondary and tertiary care
• identify fertility service specific opportunities and deficits – for example, co-ordinating the
provision of nurse-led clinics
• identify education and training opportunities and provision, to ensure a skilled and competent
fertility workforce
• contribute to and implement relevant research in the fertility field and support research opportunities
• implement changes – actual and potential - in relevant national and EU legislation/guidance
such as HFEA that will affect fertility nursing activity
• prepare and develop strategies to prepare for legislative change
• establish and maintain good communication networks with local and national contacts.
As level 7
Core 4 level 4
Core 5 level 4
G2 level 4
G5 level 4
Consultant
nurse
(level 8)
* Indicates the KSF level identified to meet this criteria is higher than the KSF dimension level
indicated in the RCN Competences for nursing description for this level of practitioner.
7
G6 level 4
As level 7
GEN31
ENTO_L8
M&L_D2
PH09.02
ENTO_L17
R C N CR O
CM
N PCEOTM
EP
N EC TE ES N –C EF SE R–T IF LE IRTTYI L I T Y
The causes/classifications of infertility
Core competence 2: Referral and investigation for recurrent miscarriage
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• use a basic understanding of reasons for miscarriage to appropriately prepare the patient for
investigation
• show sensitivity and ensure privacy in dealing with clients being investigated.
Core 1 level 2
Core 2 level 2
Core 6 level 2
HWB7 level 1
GEN4
GEN6
HSC23
HSC24
HSC234
Competent
nurse
(level 5)
In addition to level 2:
• use knowledge of common and uncommon causes of miscarriage to prepare the patient
appropriately for investigation
• provide support for a woman during investigation
• manage the nursing care of a woman experiencing miscarriage
• provide support and information to a woman and her partner.
As level 2
Core 1 level 3
Core 2 level 3
Core 6 level 3
HWB5 level 3
HWB7 level 3
As level 2
GEN13
GEN31
MH_1
HSC3111
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• use knowledge and understanding of relevant immunological and haematological causes for
miscarriage to aid investigation
• manage the effects of recurrent miscarriage and implement appropriate support mechanisms
• provide support and expert knowledge to a woman and her partner.
As level 5
As level 5
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• manage nurse-led miscarriage clinics
• develop local nursing policies/protocols for the management of miscarriage
• implement training programmes on management of miscarriage.
As level 6
Core 1 level 4
Core 4 level 3
G1 level 3
As level 6
M&L_D7
HI13
HI14
HI15
Consultant
nurse
(level 8)
In addition to level 7:
• develop training opportunities based on needs analysis of staff
• develop support networks, locally and more widely if necessary
• facilitate audit of quality of services
• establish and/or develop support mechanisms for effective follow-up.
As level 7
Core 4 level 4
Core 5 level 4
HWB4 level 4
G1 level 4
As level 7
GEN31
ENTO_L4
M&L_D2
ENTO_L1
ENTO_L17
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ROYAL COLLEGE OF NURSING
Investigating the causes of infertility
Core competence 1: General fertility investigations – male and female
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• use knowledge of the fertility investigations undertaken to prepare the patient/client and the
clinical area for fertility investigation.
Core 2 level 2
GEN4
GEN6
HSC23
Competent
nurse
(level 5)
In addition to level 2:
• provide clients with information regarding the range of fertility investigations available
• respect client autonomy.
As level 2
Core 2 level 3
Core 6 level 3
HWB6 level 3
As level 2
GEN13
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• use knowledge of the types of fertility investigations available to identify and undertake the
most appropriate investigations given the situation
• enable clients to make an informed choice.
As level 5
Core 1 level 3
HWB4 level 3
As level 5
HSC330
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• provide expert support to colleagues and clients on investigations and the interpretation of
results
• contribute to team decisions with regard to implications of results and provision of fertility
services
• develop and manage teaching programmes on investigation of infertility.
As level 6
Core 2 level 4
Core 4 level 3
IK2 level 2
G1 level 3
As level 6
ENTO_L3
ENTO_L4
ENTO_L6
ENTO_L7
ENTO_L8
Consultant
nurse
(level 8)
In addition to level 7:
• use expert knowledge of current practice and relevant research to enhance infertility nursing
practice
• provide training and educational support for staff in relation to investigations
• audit availability of services and identify need for change where relevant.
As level 7
Core 4 level 4
G1 level 4
As level 7
PH09.02
PH09.05
HI13
9
RCN COMPETENCES – FERTILITY
Investigating the causes of infertility
Core competence 2: Pelvic ultrasound-ovarian follicular tracking
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• prepare client and environment for pelvic ultrasound-ovarian follicular tracking
• chaperone clients undergoing pelvic ultrasound-ovarian follicular tracking.
Core 1 level 2
Core 3 level 2
Core 6 level 2
HWB6 level 1
HWB7 level 1
GEN4
GEN5
GEN6
GEN8
HSC23
Competent
nurse
(level 5)
In addition to level 2:
• use basic principles of ultrasound scanning to deliver appropriate care
• prepare to manage potential risks
• perform follicular tracking in accordance with local as SOP under supervision, ensuring
accurate documentation of findings
• reflect on own understanding of follicular monitoring to inform own practice.
As level 2
Core 2 level 3
Core 3 level 2
HWB6 level 3
HWB7 level 3
As level 2
GEN13
CI.C1
CI.C2
HCS_UPT6
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• undertake various types of ultrasound investigation relevant to investigation and treatment of
infertility. This should be done in accordance with local SOP and RCN (2006) guidance for
trans-vaginal ultrasound scanning and NMC, Code (2008): Standards of Conduct,
Performance & Ethics for Nurses & Midwives
• undertake uterine assessment; ovarian position and description; identify anatomical
landmarks; normal and abnormal pathology
• work towards accreditation of recognised ultrasound qualification.
As level 5
As level 5
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• provide supervision and mentorship to junior staff undertaking pelvic ultrasound-ovarian
follicular tracking
• undertake audits of ultrasound practice
• interpret scan findings in accordance with treatment management protocols.
As level 6
Core 2 level 4
Core 5 level 3
HWB6 level 4
HWB7 level 4
IK2 level 2
G6 level 4
As level 6
ENTO_L14
M&L_D5
M&L_D6
HI13
CI.C3
Consultant
nurse
(level 8)
In addition to level 7:
• advise on unusual features of ultrasound
• ensure practice is audited regularly and accurate records are kept
• facilitate the development of effective policies and quality assurance mechanisms
• ensure the provision of education and training to meet staff needs.
As level 7
Core 4 level 4
Core 5 level 4
G1 level 4
As level 7
M&L_D7
HI13
HI14
HI15
ENTO_L8
HSC41
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ROYAL COLLEGE OF NURSING
Investigating the causes of infertility
Core competence 3: Diagnostic ultrasound
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• prepare client and environment for diagnostic ultrasound procedures
• chaperone clients undergoing diagnostic ultrasound.
Core 1 level 2
Core 3 level 2
Core 6 level 2
HWB6 level 1
HWB7 level 1
GEN4
GEN5
GEN6
GEN8
HSC23
Competent
nurse
(level 5)
In addition to level 2:
• use understanding of the basic principles of pelvic ultrasound and knowledge of pelvic
anatomy to perform pelvic ultrasound under supervision
• identify ovaries, follicles, endometrial lining and record.
As level 2
Core 2 level 3
HWB6 level 3
As level 2
GEN13
CI.C1
CI.C2
HCS_UPT6
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• use understanding of pelvic pathology and recognition of the abnormal to undertake uterine
assessment; ovarian position and description; identify anatomical landmarks; identify
abnormalities.
As level 5
As level 5
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• undertake diagnostic imaging of the cavity and fallopian tubes
• identify normal and abnormal pathology and report findings
• supervise and support junior staff undertaking pelvic ultrasound.
As level 6
Core 2 level 4
HWB6 level 4
IK2 level 2
G6 level 4
As level 6
CI.C3
Consultant
nurse
(level 8)
In addition to level 7:
• facilitate the development of effective policies and quality assurance mechanisms specific to
diagnostic ultrasound
• ensure practice is audited regularly and maintain accurate records
• facilitate the development of effective policies, SOPs and quality assurance mechanisms
• ensure the provision of education and training to meet staff needs.
As level 7
Core 4 level 4
Core 5 level 4
G1 level 4
As level 7
M&L_D7
HI13
HI14
HI15
HSC41
11
RCN COMPETENCES – FERTILITY
Investigating the causes of infertility
Core competence 4: Trans-vaginal pregnancy scan
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• prepare client and environment for trans-vaginal pregnancy scanning
• chaperone clients undergoing trans-vaginal ultrasound for early pregnancy.
Core 1 level 2
Core 3 level 2
Core 6 level 2
HWB6 level 1
GEN4
GEN5
GEN6
GEN8
HSC23
Competent
nurse
(level 5)
In addition to level 2:
• use understanding of the basic principles of pelvic ultrasound to perform pelvic ultrasound
under supervision
• use knowledge of first trimester physiology and pelvic anatomy to identify pelvic pathology
and maintain accurate documentation.
As level 2
Core 2 level 3
HWB6 level 3
As level 2
GEN13
HCS_UPT6
CI.C1
CI.C2
CI.C3
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• recognise normal and abnormal pathology, and act appropriately in emergency situations
• awareness of appropriate referral mechanisms in cases of emergency.
As level 5
Core 2 level 3
Core 3 level 3
Core 5 level 3
HWB4 level 3
HWB6 level 3
As level 5
HSC330
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• undertake and/or supervise pelvic ultrasound sessions and manage emergency situations or
referrals as appropriate
• identify and manage complications of first trimester pregnancy
• prepare and maintain reports on findings
• identify and explain abnormal pathology
• manage links with day surgery/early pregnancy assessment unit as necessary.
As level 6
Core 1 level 4
Core 2 level 4
Core 3 level 4
HWB6 level 4
HWB7 level 4
As level 6
EUSC_17
Consultant
nurse
(level 8)
In addition to level 7:
• facilitate the development of effective policies and quality assurance mechanisms
• ensure the provision of education and training to meet staff needs.
As level 7
Core 4 level 4
Core 5 level 4
IK2 level 4
G1 level 4
G5 level 4
As level 7
M&L_D7
HI13
HI14
HI15
M&L_B8
12
ROYAL COLLEGE OF NURSING
Treatment for infertility
Throughout clinical treatments, nurses will provide information based on their level of knowledge, support the client and partner,
provide reassurance and offer advice on relevant health promotion (also see section on specific psychological/psycho-social support).
Core competence 1: Donor insemination (DI)/vaginal artificial insemination (AI)
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• prepare the physical and clinical environment appropriately
• provide basic emotional support to the client and partner during the process.
Core 1 level 2
Core 5 level 2
Core 6 level 2
HWB7 level 1
GEN4
GEN5
GEN6
GEN7
CHEM15
HSC23
Competent
nurse
(level 5)
In addition to level 2:
• use knowledge of the development of egg and sperm; basic genetics; the menstrual cycle; the
causes of male infertility; and the basics of donor screening and treatments to support the
client(s) through treatment
• use appropriate storage procedures in accordance with local SOPs.
As level 2
Core 1 level 3
Core 2 level 3
Core 6 level 3
HWB6 level 3
HWB7 level 3
As level 2
GEN13
GEN31
MH_1
HSC3111
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• participate in monitoring and investigations in accordance with local SOPs
• undertake the DI/AI inline with the unit’s SOPs using knowledge and understanding of the
indications for DI; Vs; ISCI/MESA or types of patients requiring DI/AI
• management and consent of cases in accordance with local SOPs
• provide counselling on the implications of the risks of treatment such as multiple pregnancies
• ensure policies and procedures reflect the requirements of HFEA Code of Practice and other
relevant bodies.
As level 5
Core 5 level 3
As level 5
M&L_B8
CHEM10
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• nurse-led monitoring of the menstrual cycle in accordance with DI/IUI treatments
• undertake ultrasound investigations
• plan for insemination against ovulation
• nurse-led decisions on appropriate timing of treatments; supervise junior staff during difficult
procedures
• provide counselling on the implications of the risks of treatment and support junior staff in
this role.
As level 6
Core 1 level 4
Core 2 level 4
HWB6 level 4
HWB7 level 4
As level 6
HSC41
CI.C1
CI.C2
CI.C3
Consultant
nurse
(level 8)
In addition to level 7:
• identify strategic direction for the fertility service across primary, secondary and tertiary care
• identify service specific opportunities and deficits. For example, co-ordinating the provision of
nurse-led DI clinics
• identify education and training opportunities and provision to ensure a skilled and competent
workforce
• use awareness of relevant research and identify appropriate clinical application to enhance
fertility nursing practice
• identify and support research opportunities
• update and familiarise yourself with changes, and potential changes in relevant national and
EU legislation/guidance that will affect fertility nursing practice. For example, HFEA Code of
Practice
• prepare and develop strategies to plan for legislative changes such as consent
• provide expert advice on treatment options and shared decision-making
• establish and maintain good communication networks with local and national contacts
• audit policies and procedures in accordance with local SOPs with relevant staff and agrees
changes as necessary
• procurement of samples/vials of cryopreserved semen.
As level 7
Core 4 level 4
Core 5 level 4
IK2 level 4
IK3 level 4
G1 level 4
G2 level 4
As level 7
PH09.02
PH09.05
HSC399
ENTO_L8
ENTO_L17
HI85
HI83
13
RCN COMPETENCES – FERTILITY
Treatment for infertility
Core competence 2: Embryo/egg donation and egg sharing
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• prepare the physical and clinical environment appropriately to offer comfort and privacy and
dignity
• provide basic emotional support to the client and partner during the process.
Core 1 level 2
Core 3 level 2
Core 5 level 2
Core 6 level 2
GEN4
GEN5
GEN6
GEN7
CHEM15
HSC23
Competent
nurse
(level 5)
In addition to level 2:
• ensure correct storage requirements are implemented
• awareness for separate client interactions within confines of environment through the
appropriate scheduling of appointments.
As level 2
Core 1 level 3
Core 2 level 3
Core 6 level 3
As level 2
HSC24
HSC234
HSC3111
M&L_B11
HSC3116
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• use understanding of the concept and practicalities of this approach to assisted conception to
support the client and donor appropriately
• maintain donor anonymity where appropriate in accordance with current legislation
• ensure practice reflects relevant and current legislation such as the HFEA Code of Practice.
As level 5
As level 5
M&L_B8
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• manage the process through nurse-led clinics
• ensure best practice in the counselling provision of donors and recipients
• ensure documentation meets licensing and local SOP requirements
• advise colleagues on processes
• audit practice in accordance with local SOPs
• update and familiarise yourself with changes, and potential changes, in relevant national and
EU legislation/guidance that will affect fertility nursing practice. For example, HFEA Code of
Practice.
As level 6
Core 1 level 4
Core 2 level 4
Core 4 level 3
Core 5 level 3
Core 6 level 4
HWB7 level 4
IK2 level 2
G5 level 3
G6 level 4
As level 6
M&L_D6
HSC41
HI15
Consultant
nurse
(level 8)
In addition to level 7:
• prepare and develop strategies in preparation for legislative changes such as consent
• provide expert advice on treatment options and decision-making
• establish and maintain good communication networks with local and national contacts
• audit policies and procedures with relevant staff in accordance with local SOPs, and adopt the
‘change process’ where necessary
• management of national and international collaboration and contracts for satellite services
(egg donation/sharing programmes of care).
As level 7
Core 4 level 4
Core 5 level 4
IK2 level 4
IK3 level 4
As level 7
GEN31
HI14
M&L_B6
Ph09.02
HI85
14
ROYAL COLLEGE OF NURSING
Treatment for infertility
Core competence 3: Surrogacy
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• provide basic comforts for patient, client and partner.
Core 1 level 2
Core 5 level 2
Core 6 level 2
HSC24
Competent
nurse
(level 5)
In addition to level 2:
• use understanding of the nature of surrogacy to provide appropriate support to the patient,
client and partner
• ensure best practice complies with legislation.
As level 2
Core 1 level 3
Core 2 level 3
Core 6 level 3
As level 2
GEN13
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• advise clients in an appropriate manner demonstrating an understanding of the legislation in
relation to surrogacy and adoption.
As level 5
HWB4 level 3
As level 5
HSC330
HSC26
HI88
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• advise and provide counselling on the implications of treatment for clients on the physical
and psychological process of surrogacy and discuss potential risks involved
• demonstrate awareness of referral system to appropriate individuals where necessary such
as independent counselling services
• provide expert advice and guidance on surrogacy issues.
As level 6
Core 1 level 4
Core 2 level 4
Core 3 level 4
HWB4 level4
HWB7 level 4
As level 6
HSC234
HSC3111
Consultant
nurse
(level 8)
In addition to level 7:
• identify appropriate sources of information to ensure clients have access to relevant
information in relation to surrogacy issues
• identify and manage referral of clients where appropriate
• ensure best practice complies with legislation and local SOPs.
As level 7
HWB3 level 4
IK3 level 4
As level 7
HSC45
PH09.02
HI83
HI85
15
RCN COMPETENCES – FERTILITY
Treatment for infertility
Core competence 4: GIFT (gamete inter-fallopian tube transfer)
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• prepare the physical and clinical environment appropriately for procedure
• provide basic emotional support to the client and partner during the process.
Core 1 level 2
Core 3 level 2
Core 5 level 2
Core 6 level 2
GEN4
GEN5
GEN6
GEN7
CHEM15
HSC23
Competent
nurse
(level 5)
In addition to level 2:
• deliver appropriate associated nursing care, using understanding of the procedure being
undertaken
• prepare patient for theatre
• monitor patient on return from theatre maintaining accurate documentation.
As level 2
Core 1 level 3
Core 2 level 3
Core 6 level 3
HWB5 level 3
HWB7 level 3
As level 2
GEN13
PCS15
EUSC_49
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• manage treatment cycle and monitor progress under supervision
• provide assistance during the procedure where required
• manage post-operative care and follow-up.
As level 5
Core 3 level 3
G5 level 3
As level 5
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• co-ordinate process from admission to discharge
• advise on diagnosis and management of post-operative complications
• provision of implications counselling in relation to GIFT process; licensing and consent; and
risks of multiple pregnancy (where appropriate)
• co-ordinate the supervision of colleagues
• co-ordinate and supervise procedure with laboratory staff, where appropriate
• provide expert advice and support for staff in accordance with local SOPs
As level 6
Core 1 level 4
Core 2 level 4
Core 6 level 4
HWB2 level 4
HWB7 level 4
G5 level 3
G6 level 4
As level 6
M&L_D5
M&L_D6
M&L_B5
M&L_B6
Consultant
nurse
(level 8)
In addition to level 7:
• ensure training needs are assessed and met
• provide advisory role for laboratory and theatre staff in accordance with GIFT
procedure/implications.
As level 7
G1 level 4
As level 7
ENTO_L8
16
ROYAL COLLEGE OF NURSING
Treatment for infertility
Core competence 5: IVF treatment and procedure
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• prepare the physical and clinical environment appropriately
• provide basic emotional support to the client and partner during the process.
Core 1 level 2
Core 3 level 2
Core 5 level 2
Core 6 level 2
GEN4
GEN5
GEN6
GEN7
CHEM15
HSC23
HSC24
Competent
nurse
(level 5)
In addition to level 2:
• provide the appropriate nursing care use understanding of the basic investigations required
prior to commencing an IVF cycle
• use awareness of laboratory practice for timely investigation/procedures in accordance with
local SOPs
• administer drugs safely, in line with local SOP and in accordance with NMC Code (2008).
As level 2
Core 1 level 3
Core 2 level 3
HWB5 level 3
HWB7 level 3
As level 2
GEN13
EUSC_12
CHS3
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• ensure best practice in relation to handling of gametes and embryos
• explain to clients the rationale behind choice of drugs and treatment process, and educate
with regard to safe injection technique
• prepare patients for the procedure and assist where appropriate and in accordance with local
SOP
• demonstrate knowledge of the pelvic structures in order to recognise retroverted and
anteverted uterus, or associated anomalies documenting and reporting where appropriate.
As level 5
Core 3 level 3
Core 5 level 3
As level 5
M&L_B8
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• undertake procedures in accordance with local SOP
• maintain accurate documentation of process/procedures
• provide advice and implications counselling on follow-up
• identify poor ovarian response and eligibility for IUI (intrauterine insemination)
• determine whether luteal phase progesterone is required
• identify situations where IVF cycles may be rescued with agonists in case of above average
responses occur
• identify risks associated with OHSS, and liaise with multidisciplinary team as appropriate.
As level 6
Core 1 level 4
Core 2 level 4
Core 3 level 4
HWB1 level 3
HWB6 level 4
As level 6
HSC41
Consultant
nurse
(level 8)
In addition to level 7:
• provide expert advice and support for staff
• ensure training needs of all staff are assessed and met in accordance with local training
schedule (SOP)
• provide up-to-date advice/management of current legislation in accordance with RCOG
guidelines for management of OHSS and reporting to relevant bodies such as the HFEA.
As level 7
Core 4 level 4
G1 level 4
17
RCN COMPETENCES – FERTILITY
Treatment for infertility
Core competence 6: Semen production
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• prepare the physical and clinical environment for semen production appropriately
• ensure privacy and demonstrate awareness of appointment system where appropriate.
Core 1 level 2
Core 3 level 2
Core 5 level 2
Core 6 level 2
GEN4
GEN5
GEN6
GEN7
CHEM15
HSC23
HSC24
Competent
nurse
(level 5)
In addition to level 2:
• demonstrate understanding of the guidelines for semen production in support of the
individual prior to the procedure
• demonstrate awareness of correct labeling/witnessing of sample
• demonstrate awareness of optimum time of abstinence for satisfactory semen analysis.
As level 2
Core 1 level 3
Core 6 level 3
HWB7 level 3
As level 2
GEN13
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• ensure consent for correct type of treatment liaising with laboratory staff where appropriate
• demonstrate awareness of laboratory commitments in relation to timing of semen production.
As level 5
HWB4 level 3
As level 5
HSC234
HSC3111
HSC26
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• identify problems and offer appropriate advice/referral
• demonstrate awareness of history of semen analysis and implications for treatment outcome
such as AI, IVF or ICSI
• awareness of donor/recipient cycle coordination and need for confidentiality of donor at time
of egg collection
• demonstrate knowledge of the WHO parameters for semen analysis.
As level 6
Core 1 level 4
HWB4 level 4
HWB6 level 4
IK3 level 4
As level 6
HSC330
HI88
Consultant
nurse
(level 8)
In addition to level 7:
• provide expert advice and support for staff
• ensure training needs of all staff are assessed and met in accordance with local training
schedule (SOP)
• provide up-to-date advice/management of current legislation in accordance with RCOG
guidelines for semen analysis.
As level 7
Core 4 level 4
IK3 level 4
G1 level 4
As level 7
HI83
M&L_B6
ENTO_L1
18
ROYAL COLLEGE OF NURSING
Treatment for infertility
Core competence 7: IUI (intrauterine insemination)
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• prepare the physical and clinical environment appropriately
• provide basic emotional support to the client and partner during the process.
Core 1 level 2
Core 3 level 2
Core 5 level 2
Core 6 level 2
GEN4
GEN5
GEN6
GEN7
CHEM15
HSC23
HSC24
Competent
nurse
(level 5)
In addition to level 2:
• use understanding of the reasons for the procedure to prepare the individual physically and
psychologically
• use basic knowledge of ovulation and normal semen parameters.
As level 2
Core 1 level 3
Core 2 level 3
Core 6 level 3
HWB7 level 3
As level 2
GEN 13
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• demonstrate knowledge of cervical position in relation to angle of uterus. For example,
anteverted, retroverted
• undertake manipulation of catheter through the cervical canal and awareness of different
catheter types available
• manage follow-up procedure post-insemination.
As level 5
Core 5 level 3
As level 5
EUSC_49
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• undertake trans-abdominal ultrasound where appropriate and in relation to difficult cervical
cannulations
• use in-depth knowledge to manage actual and potential complications
• undertake manipulation of catheter through convoluted canal.
• demonstrate competence in application of vulsellum forceps where cervix extremely mobile
and cannulation difficult.
As level 6
Core 2 level 4
HWB6 level 4
HWB7 level 4
As level 6
CI.C1
CI.C2
CI.C3
EUSC_17
Consultant
nurse
(level 8)
In addition to level 7:
• identify strategic direction for the fertility service across primary, secondary and tertiary care
• identify service specific opportunities and deficits; for example, co-ordinating the provision of
nurse-led AI clinics
• identify education and training opportunities and provision, to ensure a skilled and
competent workforce
• use awareness of relevant research and identify appropriate clinical application to enhance AI
services
• identify and support research opportunities
• update and familiarise yourself with changes, and potential changes, in relevant national and
EU legislation/guidance that will affect fertility nursing and AI practice. For example, the HFEA
Code of Practice
• prepare and develop strategies to prepare for legislative changes such as consent
• provide expert advice on treatment options and shared decision-making
• establish and maintain good communication networks with local and national contacts
• audit AI policies and procedures in accordance with local SOPs with relevant staff and agree
changes as necessary.
As level 7
Core 5 level 4
IK3 level 4
G1 level 4
As level 7
HI83
M&L_B6
ENTO_L1
19
RCN COMPETENCES – FERTILITY
Treatment for infertility
Core competence 8: Embryo transfer
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• prepare the physical and clinical environment appropriately
• provide basic emotional support to the client and partner during the process.
Core 1 level 2
Core 3 level 2
Core 5 level 2
Core 6 level 2
GEN4
GEN5
GEN6
GEN7
CHEM15
HSC23
HSC24
Competent
nurse
(level 5)
In addition to level 2:
• use understanding of the process of embryo transfer and demonstrate basic knowledge of
embryonic and endometrial development required to facilitate implantation
• undertake manipulation of catheter through cervical canal under supervision
• demonstrate awareness of physiological requirement for luteal phase progesterone support
where pituitary downregulation has been achieved.
As level 2
Core 1 level 3
Core 2 level 3
Core 6 level 3
HWB5 level 3
As level 2
GEN 13
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• demonstrate sound knowledge of embryonic and endometrial development in relation to
optimum time in IVF cycle for ET
• demonstrate knowledge of pelvic anatomy in relation to ET procedure
• undertake manipulation of catheter through cervical canal without supervision according to
the RCN guidance on performing intrauterine insemination and embryo transfer (2004) and
NMC Code for Standards (2008)
• manage post-embryo transfer.
As level 5
Core 5 level 3
HWB5 level 3
HWB7 level 3
As level 5
EUSC_49
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• undertake trans-abdominal ultrasound where indicated and in relation to difficult cannulation
• use in-depth knowledge to manage potential and actual complications during the procedure
• undertake manipulation of catheter through convoluted canal without supervision
• provide expert advice and support for staff in relation to ET procedures and in accordance
with local SOP.
As level 6
Core 2 level 4
HWB6 level 4
HWB7 level 4
As level 6
CI.C1
CI.C2
CI.C3
EUSC_17
Consultant
nurse
(level 8)
In addition to level 7:
• ensure that training needs are assessed and met, through facilitation of access to ET Training
Accreditation course
• initiate research and audit in relation to best practice for ET.
As level 7
G1 level 4
As level 7
HI83
M&L_B6
ENTO_L1
20
ROYAL COLLEGE OF NURSING
Follow-up care
Core competence 1: Ovarian Hyperstimulation Syndrome (OHSS)
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• report anything brought to your attention, demonstrating awareness that treatment can have
side-effects.
Core 1 level 2
Core 2 level 2
HSC23
HSC24
Competent
nurse
(level 5)
In addition to level 2:
• provide appropriate, supervised care, based on a basic knowledge and understanding of the
causes and progression of OHSS
• demonstrate awareness of RCOG Green Top guideline (2007) for management of OHSS
• demonstrate awareness of RCN guidelines for management of OHSS
As level 2
Core 1 level 3
Core 2 level 3
Core 3 level 2
HWB5 level 3
As level 2
GEN13
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• provide appropriate care based on an awareness of aetiology of OHS and OHSS, its causes
and treatment
• demonstrate understanding and implementation of RCOG guidelines, HFEA Code of Practice
and the Care Quality Commission national standards
• maintenance of accurate documentation.
As level 5
Core 3 level 3
Core 5 level 3
As level 5
M&L_B8
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• advise and provide counselling for individuals on the implications of treatment who are
potentially at risk of OHSS at different stages of treatment
• implement local policy in accordance with SOPs in cycle cancellation or elective
cryopreservation of embryos
• co-ordinate test results (serum assays) with ultrasound findings in aiding diagnosis of OHSS
• co-ordinate referral of individuals to relevant departments, such as gynaecology, for
admission where appropriate.
As level 6
Core 1 level 4
HWB1 level 3
HWB5 level 4
As level 6
Consultant
nurse
(level 8)
In addition to level 7:
• identify strategic direction for service across primary, secondary and tertiary care
• identify education and training opportunities and provision to ensure a skilled and competent
workforce
• demonstrate a sound and current knowledge of OHSS research and guidelines
• support OHSS research opportunities
• provide expert advice on management options in line with local SOPs
• audit policies and procedures for OHS and OHSS with relevant staff, and agree changes as
necessary
• establish and maintain good communication networks with local and national agencies.
As level 7
Core 4 level 4
Core 5 level 4
IK3 level 4
G1 level 4
As level 7
GEN31
HI13
HI14
HI15
HI83
M&L_B6
ENTO_L1
HSC45
21
RCN COMPETENCES – FERTILITY
Specific psychological/psychosocial interventions
Counselling skills should be integrated throughout the competences at each stage: referral; investigation; diagnosis; and treatment.
Specialist skills will be needed in some instances, such as recurrent miscarriage, donor insemination, cancelled cycles, failed
fertilisation, gamete donation and posthumous use of gametes and embryos.
Core competence 1: Provision of emotional support
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• ensure privacy and confidentiality in all patient/relative interactions
• recognise when emotional support is needed and refer if necessary.
Core 1 level 2
Core 2 level 2
Core 6 level 2
HSC23
HSC24
HSC234
Competent
nurse
(level 5)
In addition to level 2:
• provide basic emotional support for client(s), appropriate to their needs and care
• work towards a certificate in counselling skills in accordance with HFEA requirements
• demonstrate awareness of local (independent counsellor) and national support agencies in
relation to fertility counselling.
As level 2
Core 1 level 3
Core 2 level 3
Core 6 level 3
As level 2
GEN13
HSC3111
MH_1
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• work towards/possession of a certificate in counselling skills
• use appropriate interpersonal skills in supporting client(s) emotionally during investigations,
treatment and follow-up
• demonstrate awareness of requirements of referral to other health care team members as
appropriate
• demonstrate competence in discussing relevant support agencies.
As level 5
HWB6 level 3
HWB7 level 3
As level 5
HSC26
HSC226
HSC330
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• provide support for junior members of staff during complex situations
• hold recognised counselling certificate.
As level 6
Core 1 level 4
Core 2 level 4
Core 6 level 4
G6 level 4
As level 6
GEN31
ENTO_L9
ENTO_L14
M&L_D1
HSC45
ENTO_L15
Consultant
nurse
(level 8)
In addition to level 7:
• identify strategic direction for service across primary, secondary and tertiary care
• identify service specific opportunities and deficits
• identify education and training opportunities and provision (in relation to counselling skills)
to ensure a skilled and competent workforce
• demonstrate awareness of relevant research in the area of psychology/counselling in
infertility
• support local research opportunities
• manage administration of independent counselling service in accordance with local SOP.
As level 7
Core 4 level 4
IK3 level 4
G1 level 4
As level 7
M&L_D2
M&L_D6
HI83
ENTO_L1
HSC399
M&L_B6
22
ROYAL COLLEGE OF NURSING
Specific psychological/psychosocial interventions
Core competence 2: Information giving regarding implications of treatment
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• ensure privacy and confidentiality in all patient/relative interactions.
Core 1 level 2
Core 2 level 2
Core 6 level 2
HSC24
HSC234
Competent
nurse
(level 5)
In addition to level 2:
• demonstrate sensitivity to the patient/client’s needs for privacy and confidentiality
• provide suitable surroundings
• demonstrate awareness of HFEA requirement for independent counsellor and discuss
potential referral with colleagues.
As level 2
Core 1 level 3
Core 2 level 3
Core 6 level 3
HWB4 level 2
As level 2
HSC3111
HSC26
HSC226
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• use basic counselling skills, from an informed knowledge base, with patients/clients
• recognise situations where referral to independent counselling services may be appropriate
• use knowledge of basic embryology, implications of failed fertilisation, implantation rates,
psychological effects of treatment failure, miscarriage, and ectopic pregnancy to support the
individual appropriately.
As level 5
HWB4 level 3
As level 5
HSC330
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• ensure a range of counselling services are available as required to meet client need
• provide expert advice on treatment options, counselling services and shared-decision making
in relation to post-treatment follow-up.
As level 6
Core 1 level 4
Core 2 level 4
Core 6 level 4
HWB4 level 4
IK3 level 4
As level 6
PH06.03
HSC45
HI85
Consultant
nurse
(level 8)
In addition to level 7:
• establish and maintain good communication networks with local and national contacts such
as BICA and Infertility Network UK
• audit counselling policies and SOPs with relevant staff, and agree changes as necessary.
As level 7
Core 2 level 4
Core 4 level 4
Core 5 level 4
HWB7 level 4
As level 7
GEN31
HSC399
PH09.02
HI83
23
RCN COMPETENCES – FERTILITY
Specific psychological/psychosocial interventions
Core competence 3: Diversity
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• use awareness that different cultures will have different approaches and needs in relation to
fertility issues and preparation of different investigations/treatments.
Core 2 level 2
Core 6 level 2
HSC24
HSC234
Competent
nurse
(level 5)
In addition to level 2:
• recognise the sensitivities of managing fertility care across a range of cultures
• demonstrate awareness of the local diversity and equality strategies and policies and local
interpreter services.
As level 2
Core 2 level 3
Core 6 level 3
As level 2
HSC3111
M&L_B11
GEN13
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• use awareness of common concerns in relation to issues such as gender, blood-borne viruses
(BBV) and their management
• co-ordinate services of interpreter where necessary.
As level 5
HWB4 level 3
As level 5
HSC330
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• use an in-depth understanding of diversity issues and apply to fertility nursing
• co-ordinate multidisciplinary services where appropriate such as in HIV/Hepatitis +ve cases.
As level 6
Core 2 level 4
Core 6 level 4
As level 6
HSC45
Consultant
nurse
(level 8)
In addition to level 7:
• ensure and maintain current SOPs are in place to reflect national policies on diversity
• support staff attendance at local BBV screening and diversity training days.
As level 7
As level 7
HI83
HI85
PH06.03
24
ROYAL COLLEGE OF NURSING
Generic competences specific to fertility nursing
Core competence 1: Knowledge of the relevant legislation
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• use awareness of current legislation to ensure individuals are supported appropriately
throughout investigations into the causes of infertility.
Embedded
throughout
HSC24
HSC234
Competent
nurse
(level 5)
In addition to level 2:
• use a working knowledge of the current legislation relevant to assisted reproductive
techniques to support individuals appropriately throughout required infertility investigations
and/or treatment
• demonstrate awareness of relevant consent forms required for specific treatments.
As level 2
Core 6 level 3
As level 2
HSC3111
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• use understanding of the relevant legislation and the role of statutory and regulatory bodies
in relation to the investigation of causes of infertility.
As level 5
Core 5 level 3
As level 5
M&L_B8
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• advise colleagues and clients on general and specific aspects of the relevant national and EU
legislation and standards of practice that relate to infertility investigations, treatment and
research (where this is appropriate).
As level 6
IK3 level 4
As level 6
PH09.02
HI83
HI85
Consultant
nurse
(level 8)
In addition to level 7:
• facilitate the development of effective policies and quality assurance mechanisms
• advise colleagues and clients on actual and potential changes to the legislation that affect
clinical application of infertility investigations, treatment and research activity
• develop strategies to prepare for legislative change in relation to the investigation and
management of infertility
• implement changes – actual and potential - in relevant national and EU legislation/guidance
pertinent to the investigations, treatment and research associated with management of
infertility.
As level 7
As level 7
25
RCN COMPETENCES – FERTILITY
Generic competences specific to fertility nursing
Core competence 2: Obtaining consent for investigation and treatment
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• Ensure appropriate consent forms for any investigation or treatment required (in accordance
with local SOPs and HFEA Code of Practice) have been filed in medical records.
Core 6 level 2
HSC24
HSC234
Competent
nurse
(level 5)
In addition to level 2:
• Obtain consent for any investigation or treatment undertaken in accordance with local SOP,
HFEA Code of Practice and remit of responsibility (job description)
• ensure appropriate informed consent is obtained in relation to any investigation, treatment,
research (contact and non-contact) undertaken
• awareness of requirement for patient held copies of consents.
As level 2
Core 6 level 3
As level 2
HSC3111
M&L_B11
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• obtain informed consent for treatment and investigations, in line with departmental protocols
and SOPs
• demonstrate knowledge of consenting procedures and legislation relating to specific consent
for investigation/treatments.
As level 5
Core 5 level 3
As level 5
M&L_B8
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• implement local and national policies in relation to consent; data protection and issues
specific to investigation and treatment
• ensure departmental protocols/SOPs are developed and assume responsibility for updating
• advise colleagues on non-compliance with the consent process.
As level 6
Core 6 level 4
HWB6 level 4
As level 6
HSC45
CHEM10
Consultant
nurse
(level 8)
In addition to level 7:
• implement national advice and guidance on consent
• ensure local practice is regularly audited to determine compliance
• facilitate development of effective policies and quality assurance mechanisms
• facilitate risk management strategies in accordance with consent procedures.
As level 7
Core 5 level 4
As level 7
HI13
HI14
HI15
PH09.02
26
ROYAL COLLEGE OF NURSING
Generic competences specific to fertility nursing
Core competence 3: Safe and effective administration of pharmaceutical products
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• demonstrate awareness of different pharmaceutical products used in fertility treatments.
Competent
nurse
(level 5)
In addition to level 2:
• use understanding of local treatment plans/SOPs in relation to pharmaceutical products used
in infertility nursing
• demonstrate competence in being able to explain known side-effects to the patient and
potential effects on their treatment
• demonstrate safe administration of drugs, in line with local SOP and NMC standards.
Core 1 level 3
Core 2 level 3
Core 3 level 2
Core 5 level 2
HWB5 level 3
HWB7 level 3
EUSC_12
CHS3
GEN13
HSC24
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• use knowledge and understanding of the management of individual drug schedules, and
support clients and their partners in managing their treatment regimes
• demonstrate awareness of range of pharmaceutical products used in the management of
infertility.
As level 5
Core 3 level 3
Core 5 level 3
As level 5
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• provide supervision and support for junior staff in managing client’s drug regimes
• demonstrate involvement in devising local SOPs in accordance with evidence based practice
and pharmaceutical products used in the management of infertility
• be an expert resource for staff on the administration of relevant pharmaceutical products
• provide expert advice and support for staff.
As level 6
Core 2 level 4
Core 3 level 4
Core 6 level 3
G6 level 4
As level 6
M&L_D5
M&L_D6
Consultant
nurse
(level 8)
In addition to level 7:
• use awareness of the changes to pharmaceutical usage to inform fertility nursing practice
• ensure training needs for pharmaceutical administration are assessed and met
• liaise with appropriate pharmaceutical companies/local pharmacist in relation to local
contracts for pharmaceutical products.
As level 7
Core 5 level 4
G1 level 4
G6 level 4
As level 7
HI15
HSC45
M&L_D6
ENTO_L17
27
RCN COMPETENCES – FERTILITY
Generic competences specific to fertility nursing
Core competence 4: Working with others (internal and external)
To support individuals you should be able to:
Role
Related KSF
Competence
NWC/NOS
Health care
support
worker
(level 2)
• contribute actively to team working.
Core 4 level 2
Competent
nurse
(level 5)
In addition to level 2:
• contribute to effective team working, using understanding of the multidisciplinary team roles
and how they are interrelated
• identify and use patient pathways appropriately, in accordance with communication.
As level 2
HWB5 level 3
As level 2
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• play a significant part in team activity, in identification of appropriate referral of clients while
demonstrating excellent communication skills
• contribute to the development of patient pathways, demonstrating a clear understanding of
funding pathways and mechanisms
• contribute to effective communication for receiving treatment in other centres (UK and rest of
Europe) in accordance with UK and EU legislation for fertility treatment.
As level 5
Core 6 level 3
G5 level 3
G6 level 1
As level 5
M&L_D1
M&L_D2
M&L_B11
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• lead the team as appropriate
• set up and maintain good systems of communication and referral
• monitor the use and effectiveness of patient pathways to ensure the patient journey is
effectively co-ordinated
• manage nurse-led clinics and liase appropriately with the multidisciplinary team.
As level 6
Core 1 level 4
Core 4 level 3
HWB5 level 4
G4 level 1
G6 level 4
As level 6
HSC41
M&L_B5
Consultant
nurse
(level 8)
In addition to level 7:
• identify strategic direction for service across primary, secondary and tertiary care
• manage financial resources effectively
• identify service specific opportunities and deficits. For example, co-ordinate the provision of
nurse-led clinics
• exercise appropriate budgetary controls.
As level 7
Core 4 level 4
G4 level 3
G5 level 4
As level 7
M&L_B6
28
ROYAL COLLEGE OF NURSING
Generic competences specific to fertility nursing
Core competence 5: Documentation
To support individuals you should be able to:
Role
Competence
Related KSF
NWC/NOS
Health care
support
worker
(level 2)
• complete any records accurately and in accordance with local SOPs and remit of responsibility
(job description)
• report all information to appropriate team members in accordance with policies and SOPs.
Core 1 level 2
Core 5 level 2
Core 6 level 2
HSC24
HSC234
Competent
nurse
(level 5)
In addition to level 2:
• complete the necessary documentation accurately for basic procedures in the field of fertility
nursing, and in line with NMC guidelines for records and record keeping, DH and HFEA Code
of Practice.
As level 2
Core 1 level 3
Core 5 level 2
Core 6 level 3
HWB2 level 3
HWB5 level 3
HWB6 level 3
HWB7 level 3
As level 2
Experienced
proficient
nurse
(level 6)
In addition to level 5:
• understand and implement DH, NMC and HFEA guidelines for record keeping
• demonstrate knowledge of appropriate forms for specific investigations/treatment and
complete the necessary documentation
• awareness and competence in generating electronic data forms in accordance with the HFEA
Code of Practice
• act in an advisory capacity for junior colleagues on necessary documentation for specific
investigations/treatment.
As level 5
Core 3 level 3
Core 5 level 3
As level 5
M&L_B8
M&L_D1
M&L_D2
Senior
practitioner/
expert nurse
(level 7)
In addition to level 6:
• ensure that documentation is appropriately understood and accurately completed
• ensure that records are kept in accordance with current legislation
• manage training for junior nursing staff on record keeping and documentation issues.
As level 6
Core 1 level 4
Core 2 level 4
Core 3 level 4
Core 6 level 4
HWB7 level 4
IK3 level 4
As level 6
HSC41
HSC45
HI13
HI14
HI15
ENTO_L6
M&L_D5
M&L_D7
Consultant
nurse
(level 8)
In addition to level 7:
• identify education and training in relation to standards of record keeping to ensure a skilled
and competent workforce
• apply relevant audit and research in area of record keeping where appropriate
• facilitate and support audit and research opportunities in relation to standards of record
keeping
• provide expert advice on standards of record keeping
• establish and maintain good communication networks with local and national agencies such
as RCN, HFEA, BFS, RCOG in relation to standards of record keeping
• audit policies and SOPs in relation to documentation with relevant staff, and agree changes
as necessary
• attendance or delegation of level 6/7 at annual HFEA meeting in accordance with current
documentation.
As level 7
Core 4 level 4
Core 5 level 4
IK3 level 4
G1 level 4
As level 7
GEN31
ENTO_L1
HSC399
M&L_D6
29
RCN COMPETENCES – FERTILITY
3
Conclusion
Fertility nursing is undergoing even more rapid change
than other branches of specialist nursing. New approaches,
new techniques and changing legislation all combine to
keep the field of practice in a state of flux. It is recognised
that these competences will evolve over time – as they are
used in practice and also as practice changes to reflect new
thinking. The role of the consultant nurse, in particular,
will evolve and expand.
The RCN Midwifery and Fertility Nursing Forum
continues to develop guidance to support nurses and
midwives as they develop new roles in this field. This
guidance should be referred to when developing
competences. Titles to date include:
✦
Caring for patients with ovarian hyperstimulation
syndrome (2006). Publication code 002 796
✦
Performing trans-vaginal ultrasound scanning (2006).
Publication code 002 795
✦
Performing ultrasound-guided oocyte retrieval (2004).
Publication code 002 425
✦
Performing IUI and embryo transfer (2004).
Publication code 002 424
✦
Managing the fertility of male cancer patients (2004).
Publication code 002 426
The above guidance can be downloaded at
www.rcn.org.uk/publications
The RCN Midwifery and Fertility Nursing Forum would
welcome your feedback on the competences as you use
them in your professional practice. Please visit the RCN
Midwifery and Fertility Nursing Forum community pages
at www.rcn.org.uk/communities or contact Carmel
Bagness, RCN Midwifery and Women’s Health Adviser at
carmel.bagness@rcn.org.uk
30
ROYAL COLLEGE OF NURSING
4
References
Royal College of Nursing (2004) Performing IUI and
embryo transfer, London: RCN. Publication code 002 424.
Association of Clinical Embryologists (2000) Accreditation
of standards and guidelines for IVF laboratories, London:
ACE.
Royal College of Nursing (2004) Performing ultrasoundguided oocyte retrieval. RCN guidance for fertility nurses,
London: RCN. Publication code 002 425.
Allan H and Barber D (2004) Nothing out of the ordinary:
advanced fertility nursing practice, Human Fertility, 7 (4),
pp. 277-284.
Royal College of Nursing (2003) The future nurse: the
future for nurse education. A discussion paper, London:
RCN. http://www.rcn.org.uk/downloads/futurenurse
/nurse-education.doc
Barber D (1997) Research into the role of fertility nurses
for the development of guidelines for clinical practice,
Human Reproduction, 12, pp.195 – 197.
Skills for Health (2006) Career framework for health:
methodology testing report, London: SfH.
Department of Health (2004) The NHS knowledge and
skills Framework (NHS KSF) and the development review
process, London: DH.
Department of Health (2003) Guidance on tackling junior
doctors’ hours, London: DH.
United Kingdom Central Council (2002) Report of the
higher level of practice pilot and project (executive
summary), London: UKCC.
Human Fertilisation and Embryology Authority Code of
practice (sixth edition), London: HFEA.
United Kingdom Central Council (1998) The future of
professional regulation, London: UKCC.
Human Fertilisation and Embryology Authority (2005)
Guide to infertility, London: HFEA
United Kingdom Central Council (1992) The scope of
professional practice, London: UKCC.
Human Fertilisation and Embryology Authority (2005) EU
tissues and cells directive newsletter, London: HFEA. For
all newsletters and patient information see www.hfea.gov.uk
Manley K and Garbett R (2000) Paying Peter and Paul:
reconciling concepts of expertise with competence for a
clinical career structure, Journal of Clinical Nursing, 9,
pp.347-359.
Nursing & Midwifery Council (2004) The NMC code of
professional conduct: standards for conduct, performance
and ethics, London: NMC.
Nursing & Midwifery Council (2002) Guide to records and
record keeping, London: NMC.
Royal College of Nursing (2006) Caring for patients with
ovarian hyperstimulation syndrome, London: RCN.
Publication code 002 796.
Royal College of Nursing (2006) Performing transvaginal
ultrasound scanning, London: RCN.
Publication code 002 795.
Royal College of Nursing (2004) Managing the fertility of
male cancer patients. RCN guidance for oncology and
haematology nurses, London: RCN.
Publication code 002 426
31
RCN COMPETENCES – FERTILITY
5
Appendices
Appendix 1: KSF dimensions
The related KSF dimensions and levels referred to in the
competences are indicative levels only. They can be used if
they fit the locally agreed role. NOS/NWC references and
titles will be subject to change as part of Skills for Health
rationalisation project. During the first few months of 2007
Skills for Health will be making changes to their database
of competences to replace ‘old for new’. This means that if
you have saved your work from any of the tools, for
example role/team profiles, you will be told what has
altered next time you open your saved profile.
Competence prefixes
CI = Clinical imaging
CHEM = Chemotherapy
CHS = Clinical health skill
EUSC = Emergency, urgent and scheduled care
GEN = Generic
HCS = Health care scientist
HI = Health informatics
HSC = Health and social care
ENTO = Learning and Development (formerly the
Employment National Training Organisation)
MH = Mental health
M&L = Management and leadership
PCS = Perioperative care support
PH = Public health
32
ROYAL COLLEGE OF NURSING
KSF dimensions
Reference
Title
Indicative KSF
CI.C1
Acquire, interpret and report on ultrasound examinations of the abdomen
and pelvis
HWB6 level 3
CI.C2
Acquire, interpret and report on ultrasound examinations of trans-abdominal
gynaecological structures
HWB6 level 3
CI.C3
Acquire, interpret and report on ultrasound examinations to determine and monitor pregnancy
HWB6 level 3
CHEM10
Obtain informed consent for clinical interventions, diagnostic investigations and treatment
HWB6 level 4
CHEM15
Monitor and manage the environment and resources during and after clinical/therapeutic activities
HWB7 level 1
CHS3
Administer medication to individuals
HWB5 level 3
EUSC_12
Prepare for the administration of medication
HWB7 level 3
EUSC_17
Manage emergency clinical situations that occur as a result of an intervention
HWB7 level 4
EUSC_49
Provide care for individuals as they recover from the intervention
HWB5 level 3
GEN 4
Prepare individuals for clinical/therapeutic activities
HWB7 level 1
GEN 5
Support individuals during and after clinical/therapeutic activities
HWB7 level 1
GEN 6
Prepare environments and resources for use during clinical/therapeutic activities
HWB7 level 1
GEN 7
Monitor and manage the environment and resources during and after clinical/therapeutic activities
HWB7 level 1
GEN 8
Assist the practitioner to implement clinical/therapeutic interventions
HWB7 level 1
GEN13
Synthesise new knowledge into the development of your own practice
Core 2 level 3
GEN31
Initiate, and participate in, networks and discussion groups
Core 1 level 3
HCS_UPT6 Perform and assist with clinical ultrasound procedures
HWB7 level 1
HI13
Manage continuous quality improvement
Core 5 level 4
HI14
Implement quality assurance systems
Core 5 level 4
HI15
Monitor compliance with quality systems
Core 5 level 4
HI83
Search information, evidence and knowledge resources and communicate the results
IK3 level 3
HI85
Appraise information and knowledge resources
IK3 level 4
HI88
Enable individuals to access and use information
IK3 level 2
HSC23
Develop your knowledge and practice
Core 2 level 1
HSC24
Ensure your own actions support the care, protection and well-being of individuals
Core 6 level 2
HSC26
Support individuals to access and use information
HWB4 level 2
HSC41
Use and develop methods and systems to communicate record and report
Core 1 level 4
HSC45
Develop practices which promote choice, well-being and protection of all individuals
Core 6 level 4
HSC226
Support individuals who are distressed
HWB4 level 2
HSC234
Ensure your own actions support the equality, diversity, rights and responsibilities of individuals
Core 6 level 2
HSC330
Support individuals to access and use services and facilities
HWB4 level 3
HSC399
Develop and sustain effective working relationships with staff in other agencies
G7 level 1
HSC3111
Promote the equality, diversity, rights and responsibilities of individuals
Core 6 level 3
HSC3116
Contribute to promoting a culture that values and respects the diversity of individuals
HWB1 level 2
ENTO_L1
Develop a strategy for learning and development
G1 level 4
ENTO_L3
Identify individual learning aims and programmes
G1 level 3
ENTO_L4
Design learning programmes
G1 level 3
ENTO_L6
Develop training sessions
G1 level 2
ENTO_L7
Prepare and develop resources to support learning
G1 level 3
ENTO_L8
Manage the contribution of other people to the learning process
G6 level 2
ENTO_L9
Create a climate that promotes learning
Core 2 level 3
ENTO_L12
Enable individual learning through coaching
Core 2 level 3
ENTO_L14
Support learning by mentoring in the workplace
Core 2 level 3
ENTO_L15
Support and advise individual learners
G1 level 3
ENTO_L16
Monitor and review progress with learners
G1 level 3
ENTO_L17
Evaluate and improve learning and development programmes
G1 level 4
33
RCN COMPETENCES – FERTILITY
KSF dimensions
Reference
Title
Indicative KSF
MH_1
Promote effective communication and relationships with people who are troubled or distressed
Core 1 level 3
M&L_B5
Provide leadership for your team
G6 level 2
M&L_B6
Provide leadership for your area of responsibility
G6 level 3
M&L_B8
Ensure compliance with legal, regulatory, ethical and social requirements
Core 5 level 3
M&L_B11
Promote equality of opportunity and diversity in your area of responsibility
Core 6 level 3
M&L_D1
Develop productive working relationships with colleagues
Core 5 level 3
M&L_D2
Develop productive working relationships with colleagues and stakeholders
Core 5 level 3
M&L_D5
Allocate and check work in your team
G6 level 2
M&L_D6
Allocate and monitor the progress and quality of work in your area of responsibility
G6 level 3
M&L_D7
Provide learning opportunities for colleagues
Core 2 level 3
PCS15
Assist in the preparation of patients for operative procedures
HWB7 level 1
PH06.03
Work in partnership with others to develop policies to improve health and wellbeing
HWB1 level 4
PH09.02
Develop and maintain a strategic overview of developments in knowledge and practice
IK3 level 4
PH09.05
Contribute to the evaluation and implementation of research and development outcomes
G2 level 2
34
ROYAL COLLEGE OF NURSING
Appendix 2: Role level descriptors
The levels identified in the tables below, developed by Skills for Health, are those referred to in Competences: specialist
competences for fertility nurses.
Skills and Knowledge
Supervision
Regulation, professional and
vocational competence
2
Recall and comprehend basic knowledge of a field, the
range of knowledge involved is limited to facts and main
ideas. Use skills and key competences to carry out tasks
where action is governed by rules defining routines and
strategies. Select and apply basic methods, tools and
strategies.
Work under close, but not
continuous supervision. Take limited
responsibility for improvement in
performance in work or study in
simple contexts and in familiar,
homogeneous groups.
Not regulated, but usually subject to police
check if working with children. Seek
guidance on learning. Solve problems
using information provided.
5
Use broad theoretical and practical knowledge that is
often specialised in a field and show awareness of limits
to knowledge base. Develop strategic and creative
responses in researching solutions to well defined
concrete and abstract problems. Demonstrate transfer
of theoretical and practical knowledge in creating
solutions to problems.
Manage projects independently
that require problem solving
where there are many factors,
some of which interact and lead to
unpredictable change. Show
creativity in developing projects.
Manage people and review
performance of self and others.
Train others and develop team
performance.
Clinical staff will be regulated health care
professionals. Evaluate own learning and
identify learning needs necessary to
undertake further learning. Formulate
responses to abstract and concrete
problems. Demonstrate experience of
operational interaction in a field. Make
judgements based on knowledge of
relevant social and ethical issues.
6
Use detailed theoretical and practical knowledge of a
field. Some knowledge is at the forefront of the field and
will involve a critical understanding of theories and
principles. Demonstrate mastery of methods and tools
in a complex and specialised field and demonstrate
innovation in terms of methods used. Devise and
sustain arguments to solve problems.
Demonstrate administrative design,
resource and team management
responsibilities in work and study
contexts that are unpredictable and
require that complex problems are
solved where there are many
interacting factors. Show creativity
in developing projects and show
initiative in management processes
that includes the training of others
to develop team performance.
Clinical staff will be regulated health care
professionals. Evaluate own learning and
identify learning needs consistently. Gather
and interpret relevant data in a field to
solve problems. Demonstrate experience of
operational interaction in a complex
environment. Make judgements based on
social and ethical issues that arise in work
or study.
7
Use highly specialised theoretical and practical
knowledge some of which is at the forefront of
knowledge in the field. This knowledge forms the basis
for originality in developing and/or applying ideas.
Demonstrate critical awareness of knowledge issues in
the field and at the interface between different fields.
Create a research-based diagnosis to problems by
integrating knowledge from new or interdisciplinary
fields and make judgements with incomplete or limited
information. Develop new skills in response to emerging
knowledge and techniques.
Demonstrate leadership and
innovation in work and study
contexts that are unfamiliar,
complex and unpredictable, and
that require solving problems
involving many interacting factors.
Review strategic performance of
teams.
Clinical staff will be regulated health care
professionals. Demonstrate autonomy in
the direction of learning and a high level
understanding of learning processes. Solve
problems by integrating complex
knowledge sources that are sometimes
incomplete and in new and unfamiliar
contexts. Demonstrate experience of
operational interaction in managing
change within a complex environment.
Respond to social, scientific and ethical
issues that are encountered in work or
study.
8
Use specialised knowledge to critically analyse,
evaluate and synthesise new and complex ideas that
are at the most advanced frontier of a field. Extend or
redefine existing knowledge and/or professional
practice in a field or at the interface between fields.
Research, conceive, design, implement and adapt
projects that lead to new knowledge and new
procedural solutions.
Demonstrate substantial
leadership, innovation and
autonomy in work and study
contexts that are novel and require
the solving of problems that
involve many interacting factors.
Clinical staff will be regulated health care
professionals. Demonstrate capacity for
sustained commitment to development of
new ideas or processes and a high level
understanding or learning processes.
Critical analysis, evaluation and synthesis
of new and complex ideas and strategic
decision-making based on these
processes. Demonstrate experience of
operational interaction with strategic
decision-making capacity in a complex
environment. Promote social and ethical
advancement through actions.
Level
35
The RCN represents nurses and nursing,
promotes excellence in practice and shapes
health policies
July 2008, Second edition October 2011
RCN Online
www.rcn.org.uk
RCN Direct
www.rcn.org.uk/direct
0345 772 6100
Published by the Royal College of Nursing
20 Cavendish Square
London
W1G 0RN
020 7409 3333
Publication code 003 135
ISBN 978-1-904114-37-6
36