Explore NMC leadership standards, registration requirements, revalidation process, CPD obligations and career pathways for nurses and midwives in the UK.
Written by Laura Bouttell • Mon 5th January 2026
The Nursing and Midwifery Council regulates approximately 760,000 nurses, midwives, and nursing associates across the United Kingdom, establishing professional standards that explicitly position leadership as fundamental obligation for all registrants, not merely those in designated management positions. Through the NMC Code's leadership requirements, three-yearly revalidation processes mandating continuous professional development, and oversight of educational programmes preparing future professionals, the NMC shapes how nursing and midwifery leadership develops, maintains competence, and evolves throughout careers.
For nursing and midwifery professionals, understanding the NMC's role in leadership development proves essential for maintaining registration, planning career progression, and fulfilling professional obligations. The organisation operates as independent regulator establishing standards for education, training, conduct, and performance whilst protecting public safety through registration systems, fitness-to-practice proceedings, and quality assurance of educational programmes. Leadership threads through all these regulatory functions—from Code requirements that every registrant provide leadership protecting wellbeing, through CPD expectations that professionals develop leadership capabilities, to educational standards ensuring graduating nurses and midwives possess foundational leadership competencies.
This guide examines leadership within the NMC regulatory framework comprehensively: the organisation's structure and functions, leadership standards within the NMC Code, registration and revalidation requirements affecting leadership development, career pathways for nurses and midwives in leadership roles, and how regulatory expectations inform both clinical practice and formal leadership positions.
The Nursing and Midwifery Council serves as the independent regulator for nurses, midwives, and nursing associates in the United Kingdom, established under the Nursing and Midwifery Order 2001 to protect the public by ensuring professionals maintain appropriate standards of education, training, conduct, and performance. The NMC operates across England, Wales, Scotland, and Northern Ireland, maintaining a unified register whilst respecting devolved healthcare systems.
The organisation's core statutory functions include:
Maintaining the professional register of qualified nurses, midwives, and nursing associates authorised to practise in the UK. Registration proves mandatory for using protected titles or practising professionally—unregistered individuals cannot legally identify as nurses or midwives or practise in regulated roles. The register currently comprises approximately 760,000 active registrants, making the nursing and midwifery register substantially larger than any other UK health professional register.
Setting standards for education and training that nursing and midwifery students must complete before qualifying for registration. The NMC approves educational institutions and programmes, ensuring curricula develop necessary knowledge, skills, and professional values. Over 1,000 nursing and midwifery education programmes operate across UK universities and practice placements, all meeting NMC standards. These educational standards increasingly emphasise leadership capabilities, recognising that even newly qualified professionals require foundational leadership skills.
Setting standards for professional conduct and practice through the NMC Code: Professional Standards of Practice and Behaviour for Nurses, Midwives and Nursing Associates. The Code establishes regulatory expectations for professional behaviour, clinical practice, continuing development, and leadership. All registrants must work within Code standards regardless of role, with breaches potentially resulting in fitness-to-practice action leading to registration restrictions or removal.
Investigating concerns about registrants through fitness-to-practice procedures assessing whether professionals' conduct, health, competence, or character falls below required standards. The NMC receives approximately 5,000 fitness-to-practice referrals annually, investigating concerns raised by employers, patients, police, or other healthcare professionals. Serious breaches may result in conditions on practice, suspension, or striking off—permanent removal from the register ending professional careers.
Maintaining quality assurance of education providers through regular monitoring ensuring approved institutions continue meeting standards. Quality assurance visits examine programme delivery, student support, practice placement quality, assessment rigour, and partnership working between universities and practice providers. Institutions failing to maintain standards may have programme approval withdrawn.
The NMC operates as independent statutory body, meaning it functions separately from government, NHS, or professional associations. This independence proves essential for public protection—the organisation can take necessary regulatory action without political interference or professional protectionism. Funding derives primarily from registrant fees (currently £120 annually), ensuring financial independence from government whilst creating accountability to the professionals the organisation regulates.
The NMC Council (governing board) comprises appointed members including registrant and lay (public) representatives. This balanced composition ensures both professional expertise and public perspective inform governance decisions. The Professional Standards Authority oversees the NMC's performance, reviewing fitness-to-practice decisions, examining governance quality, and reporting to Parliament on regulatory effectiveness.
The organisation's independence creates distinctive accountability structure: the NMC answers to Parliament and public rather than to nursing and midwifery professions themselves. This public protection primacy means regulatory decisions prioritise patient safety over professional interests when these conflict—an essential principle for maintaining public trust in professional regulation.
Leadership permeates the NMC's regulatory framework, from explicit Code requirements that registrants provide leadership, through educational standards ensuring graduates possess leadership capabilities, to fitness-to-practice expectations that professionals demonstrate leadership in protecting public welfare.
The NMC Code contains several standards directly addressing leadership obligations. Standard 25 requires registrants to "provide leadership to make sure people's wellbeing is protected and to improve their experiences of the healthcare system." This leadership standard establishes that every nurse, midwife, and nursing associate bears responsibility for championing quality, protecting patients, and driving improvement regardless of hierarchical position.
Standard 25's sub-requirements specify that registrants must identify priorities, manage time and resources effectively whilst putting care recipients first; and support any staff they're responsible for to follow the Code, ensuring they have necessary knowledge and skills for safe practice and understand how to raise concerns. These requirements create cascade accountability—leaders must enable and support others' Code compliance whilst maintaining their own standards.
Standard 20.8 requires registrants to "be a model of integrity and leadership for others to aspire to," establishing leadership as universal professional expectation rather than role-specific function. This aspiration framing recognises that all professionals influence colleagues, students, and patients through their conduct—making intentional positive modelling an ethical obligation.
Standard 9 creates accountability for delegation decisions, establishing leadership framework for managing teams and maintaining responsibility for care quality even when specific tasks are performed by others. Standard 16 requires raising concerns immediately when risks to patient safety exist, positioning registrants as safety leaders championing quality improvement and challenging substandard practice.
These leadership standards apply universally—newly qualified staff nurse and director of nursing both bear obligation to provide leadership protecting wellbeing, model integrity, hold themselves accountable for delegation, and raise safety concerns. The scope and complexity of leadership opportunities differ across career stages, but fundamental obligation remains constant.
NMC standards for pre-registration nursing and midwifery education explicitly require developing leadership capabilities before qualification. The Standards of Proficiency for Registered Nurses specify that newly qualified nurses must be able to "demonstrate leadership potential in supervising and assessing the practice of others," "take responsibility for continuous self-reflection, seeking and responding to support and feedback," and "take responsibility for professional development."
Nursing curricula must therefore incorporate leadership development throughout training rather than treating it as advanced topic reserved for experienced practitioners. Students learn foundational leadership concepts—team working, delegation, accountability, raising concerns, improvement methodologies—integrated with clinical skill development. Practice placements provide opportunities to observe and practise leadership behaviours under supervision.
The Standards for Student Supervision and Assessment (SSSA) establish requirements for clinical practice learning, including expectations that students develop leadership capabilities through progressive responsibility. Practice supervisors and practice assessors support this development by providing feedback on leadership behaviours, creating opportunities for appropriate delegation, and discussing leadership challenges students encounter.
Midwifery education standards similarly emphasise leadership development, recognising midwives' autonomous professional practice requires strong leadership capabilities from qualification. Newly qualified midwives must demonstrate ability to work autonomously, make complex decisions, lead care provision, and coordinate multi-disciplinary involvement—all requiring leadership competence.
Beyond initial qualification, NMC standards for post-registration education and continuing professional development maintain leadership expectations throughout careers. Specialist practice qualifications in areas like district nursing, health visiting, or specialist community public health nursing include leadership competencies reflecting these roles' increased autonomy and responsibility.
The Standards Framework for Nursing and Midwifery Education establishes principles applying across all NMC-approved programmes, including expectation that education develops leadership capabilities appropriate to qualification level. Advanced practice standards (though not yet formally established by NMC at time of writing) will likely include explicit advanced leadership competencies.
Revalidation requirements—discussed extensively below—create ongoing expectation that registrants engage in continuing professional development including leadership skill enhancement. The 35 hours of CPD required every three years should address registrants' developmental needs, which for many includes leadership capability building.
Achieving and maintaining NMC registration represents gateway to professional nursing and midwifery practice in the UK, with leadership considerations threading through both initial registration and ongoing maintenance requirements.
Nurses and midwives gain initial UK registration through one of several pathways:
UK pre-registration education involves completing NMC-approved nursing or midwifery programme at UK university, typically three years full-time. These programmes combine academic learning with practice placements totalling at least 50% of programme time, ensuring graduates develop both theoretical knowledge and clinical competence. Leadership development integrates throughout curricula as described above.
Upon programme completion, graduates apply for registration with the NMC, declaring good health and good character (criminal record checks), and paying initial registration fee. Educational institutions confirm graduates have met programme standards, and once NMC approves applications, graduates receive Personal Identification Numbers (PINs) enabling professional practice.
International registration enables nurses and midwives qualified outside the UK to join the NMC register if they meet equivalency requirements. Applicants from outside European Economic Area must demonstrate English language competency through IELTS or OET tests, pass computer-based test of nursing knowledge, and complete objective structured clinical examination (OSCE) assessing clinical skills. These requirements ensure international registrants possess competence equivalent to UK-trained professionals.
Return to practice programmes support nurses and midwives who left the register but wish to resume practice after breaks exceeding permitted periods. These programmes refresh knowledge and skills, address practice changes since previous registration, and rebuild confidence before returning to professional roles.
Registration requires annual renewal, with registrants paying £120 annual fee and confirming continued good health and character. Every third year, annual renewal incorporates revalidation—substantially more comprehensive process requiring demonstration of continued professional competence through evidence portfolio. Failing to renew or revalidate results in registration lapse, preventing professional practice until restoration achieved.
The annual fee funds NMC operations including registration systems, fitness-to-practice investigations, educational quality assurance, and standard-setting. Reduced fees apply for registrants not in practice, on maternity/paternity leave, or retired and not practising. However, even reduced-fee registrants must complete revalidation when due, as maintaining registration signifies ongoing fitness to practise if opportunity arises.
All registrants must maintain good health and good character throughout their careers, not merely at initial registration. Good character relates to honesty, integrity, trustworthiness, and behaviour consistent with professional standards. Criminal convictions, cautions, fraud, dishonesty, or serious professional misconduct can indicate character concerns warranting fitness-to-practice investigation.
Good health means being capable of safe and effective practice. Health conditions affecting practice don't automatically preclude registration—registrants with managed health conditions often practise safely with appropriate adjustments. However, conditions impairing judgment, creating patient safety risks, or preventing effective practice require declaration and may result in registration conditions or suspension until health stabilises.
Leadership roles carry particular good health and character expectations. Those supervising staff, making clinical governance decisions, or holding organisational accountability must demonstrate especially high standards of conduct and reliability, as their influence extends beyond personal practice to others they lead.
Revalidation represents the NMC's mechanism for ensuring registrants remain fit to practise throughout careers, requiring demonstration of continued professional competence every three years through evidence portfolio and reflective practice discussions. Understanding revalidation proves essential for all registrants, as failure to revalidate results in registration lapse.
Revalidation comprises six interconnected requirements:
1. Practice Hours (450 hours over three years): Registrants must complete minimum 450 hours of registered practice in the three-year revalidation period. Practice hours can occur anywhere globally—not restricted to UK—and across any setting using nursing or midwifery skills. Multiple registrations (holding both nursing and midwifery registration, for instance) don't multiply practice hour requirements, though registrants should ensure hours reflect all registered professions.
For those in leadership or management roles with limited direct clinical practice, hours spent using nursing or midwifery knowledge and skills in management, education, research, or policy work count toward requirements. Leadership, whilst potentially non-clinical, remains professional practice when grounded in nursing or midwifery expertise.
2. Continuing Professional Development (35 hours over three years, including 20 hours participatory learning): Registrants must undertake 35 hours of CPD relevant to their practice scope. At minimum 20 hours must involve participatory learning—interactive activities with other professionals like conferences, workshops, courses, or journal clubs. Remaining 15 hours can include independent learning such as reading journals, online learning modules, or reviewing practice guidelines.
CPD should address genuine developmental needs rather than accumulating arbitrary hours. For nurses and midwives in or aspiring to leadership roles, CPD might include leadership programmes, management training, improvement methodology courses, or executive coaching. The NMC Code's leadership requirements create legitimate CPD need for all registrants to develop leadership capabilities appropriate to their roles and career aspirations.
3. Practice-Related Feedback (five pieces): Registrants must obtain five instances of feedback on their practice from colleagues, patients, managers, or other stakeholders. Feedback can take multiple forms: colleague testimonials about teamwork, patient comments about care experiences, 360-degree feedback from leadership programmes, performance appraisals, or thank-you notes from service users.
The feedback requirement encourages seeking external perspective on practice quality rather than relying solely on self-assessment. For leaders, feedback might address management effectiveness, communication, decision-making, team development, or organisational impact alongside clinical competence.
4. Written Reflective Accounts (five accounts): Based on CPD undertaken and feedback received, registrants must write five reflective accounts exploring what they learned, how it relates to the NMC Code, and how it influenced or could influence their practice. Each reflective account must reference at least one Code standard, creating explicit linkage between continuing development and regulatory expectations.
Reflection proves particularly valuable for leadership development—examining leadership successes and failures, considering alternative approaches, identifying learning from challenging situations, and committing to behaviour change. The reflective accounts requirement formalises this valuable developmental practice.
5. Reflective Discussion (one discussion with another NMC registrant): Registrants must participate in reflective discussion about revalidation evidence with another NMC registrant. This discussion provides opportunity to articulate learning, receive peer perspective, consider different interpretations, and deepen reflection beyond written accounts alone.
The discussion partner can be colleague, friend, or practice supervisor—anyone holding current NMC registration. For leaders, discussing leadership challenges and development with leadership peers often proves particularly valuable, as they share understanding of leadership complexities that clinical-only practitioners may not fully appreciate.
6. Confirmation (signed confirmation from appropriate confirmer): Finally, registrants require confirmation from appropriate person (typically line manager or professional lead) that they've met revalidation requirements. The confirmer reviews evidence portfolio, participates in confirmation discussion exploring revalidation content, and signs declaration attesting to registrant's good character, good health, and completion of revalidation requirements.
Confirmation doesn't involve independent verification of all evidence—confirmers rely largely on registrants' honesty. However, the requirement creates accountability moment where registrants must present evidence to professional peer and confirm its accuracy.
Nurses and midwives in primarily non-clinical leadership roles face particular revalidation considerations. The 450 practice hours must involve nursing or midwifery work, but this includes management, education, research, or policy work drawing on professional expertise. Pure general management or administrative work without nursing or midwifery content doesn't qualify.
For director of nursing managing organisational nursing services, practice hours clearly accrue—the role fundamentally involves nursing leadership even without direct patient care. For nurse working in pharmaceutical company, health technology firm, or management consultancy, establishing that work constitutes nursing practice requires demonstrating how professional expertise informs the role.
CPD for those in leadership positions should address both leadership capability development and maintenance of nursing or midwifery knowledge. Leaders removed from clinical practice often undertake clinical updates ensuring they understand current care delivery realities, treatment innovations, and professional challenges. Combining leadership development with clinical currency maintains credibility with staff whilst building strategic capabilities.
Nurses and midwives pursuing leadership careers follow diverse pathways depending on whether they maintain clinical practice, transition fully to management, combine roles, or pursue specialist leadership domains. Understanding typical trajectories helps aspiring leaders plan development whilst recognising individual journeys often deviate from standard patterns.
Many nurse and midwife leaders maintain significant clinical practice alongside increasing leadership responsibility. This pathway preserves clinical credibility and expertise whilst developing leadership capabilities through progressively responsible roles:
This pathway's strength involves clinical credibility enabling peer influence and deep understanding of care delivery realities informing leadership decisions. Challenges include time pressures balancing clinical and management work, identity transitions from clinician to leader, and capability gaps in finance, strategy, or general management requiring deliberate development.
Some nurses and midwives transition from clinical practice into general management, progressing through operational, divisional, and executive leadership with decreasing clinical involvement. This pathway builds comprehensive management capability and strategic leadership skills:
The general management pathway enables broader organisational impact beyond nursing or midwifery domains. Former clinical professionals bring valuable perspective on care delivery, patient experience, and professional workforce whilst developing commercial acumen, financial expertise, and strategic capability. Maintaining NMC registration requires ensuring work continues drawing on nursing or midwifery knowledge rather than becoming pure general management.
Beyond direct service management, nurses and midwives pursue leadership roles in specialist domains leveraging professional expertise:
Education leadership: Lecturer, programme lead, dean of nursing at universities or clinical education roles developing workforce capability. Education leaders shape future professionals through curriculum design, teaching excellence, research, and placement quality.
Quality and safety leadership: Chief Quality Officer, patient safety lead, clinical governance director positions focusing on improvement, risk management, and safety culture. These roles suit clinicians passionate about eliminating harm and driving excellence.
Research and innovation leadership: Leading research programmes, implementing evidence-based practice, championing innovation. Research leaders advance nursing and midwifery knowledge whilst influencing practice through generating and translating evidence.
Policy and system leadership: Working at integrated care systems, national bodies, government departments, or professional organisations shaping healthcare policy, standards, and strategic direction. Policy leaders apply professional expertise toward system-level impact.
Professional regulation and governance: Roles within NMC, Care Quality Commission, NHS England, or professional bodies overseeing standards, conducting quality assurance, or investigating fitness to practise. Regulatory leaders protect public through maintaining professional standards.
Each specialist domain requires distinctive capabilities whilst building on clinical foundation and professional values. Transitioning successfully involves developing specialist expertise through targeted CPD, establishing credibility within the new domain, and maintaining currency with nursing or midwifery developments.
The Nursing and Midwifery Council (NMC) is the independent regulator for nurses, midwives, and nursing associates in the United Kingdom, established under the Nursing and Midwifery Order 2001 to protect the public. The NMC maintains the professional register of approximately 760,000 registrants, sets standards for education and training, establishes professional conduct standards through the NMC Code, investigates fitness-to-practice concerns, and quality-assures educational institutions. Registration with the NMC is mandatory for practising nursing or midwifery professionally in the UK.
NMC registration costs £120 annually for practising registrants. Reduced fees apply for certain circumstances: registrants not currently practising pay reduced rates, as do those on maternity/paternity leave or retired from practice. Even reduced-fee registrants must complete revalidation every three years. The annual fee funds NMC operations including registration systems, fitness-to-practice investigations, educational quality assurance, and standard-setting. Failing to pay annual fees results in registration lapse, preventing professional practice until restoration achieved.
NMC revalidation requires demonstration of continued fitness to practise every three years through six components: 450 practice hours over three years; 35 hours of CPD (including 20 hours participatory learning); five pieces of practice-related feedback; five written reflective accounts linking learning to the NMC Code; one reflective discussion with another NMC registrant; and confirmation from appropriate person (typically line manager) that requirements are met. Revalidation ensures registrants maintain professional competence throughout careers. Failing to revalidate results in registration lapse.
No, the NMC is a regulator rather than training provider. The NMC sets standards that nursing and midwifery professionals must meet, including leadership expectations within the NMC Code, but doesn't deliver leadership programmes directly. Leadership training comes from universities, NHS organisations like the NHS Leadership Academy, professional associations like the Royal College of Nursing, or commercial training providers. However, NMC standards influence curriculum design, ensuring approved programmes develop leadership capabilities. Registrants access leadership development through multiple channels whilst the NMC maintains regulatory oversight ensuring competence.
The NMC Code contains explicit leadership requirements applicable to all registrants. Standard 25 requires providing leadership to protect wellbeing and improve healthcare experiences. Standard 20.8 requires being a model of integrity and leadership for others to aspire to. Standard 9 creates accountability for delegation decisions. Standard 16 requires raising concerns about patient safety immediately. These standards establish leadership as fundamental professional obligation regardless of hierarchical position. The Code frames every nurse, midwife, and nursing associate as leader responsible for championing quality, supporting colleagues, and demonstrating exemplary conduct.
Yes, NMC registration can be maintained whilst working internationally. The 450 practice hours required for three-yearly revalidation can be completed anywhere globally—practice location doesn't affect eligibility. Similarly, CPD undertaken internationally counts toward the 35-hour requirement. However, registrants working abroad must still complete revalidation including finding another NMC registrant for reflective discussion and obtaining confirmation from appropriate confirmer. Some find these requirements challenging when geographically distant from other UK-registered professionals. Annual registration fees continue regardless of work location.
Failing to complete revalidation by the required date results in automatic registration lapse—registrants are removed from the register and cannot legally practise or use protected titles (nurse, midwife, nursing associate). Lapsed registrants can apply for registration restoration if they act within specific timeframes and meet requirements, which may include undertaking return-to-practice programmes if the lapse extended beyond permitted periods. Practicing without valid registration constitutes criminal offence potentially resulting in prosecution. The NMC sends multiple reminders about revalidation deadlines, so failure typically involves conscious choice rather than mere forgetfulness.
The Nursing and Midwifery Council shapes nursing and midwifery leadership fundamentally through regulatory frameworks establishing professional expectations, educational standards developing capability, and accountability mechanisms ensuring standards maintenance. By explicitly positioning leadership as universal professional obligation within the NMC Code, requiring educational programmes develop leadership competencies before qualification, and creating continuing development expectations through revalidation, the NMC influences how leadership develops, manifests, and evolves throughout nursing and midwifery careers.
This regulatory approach proves distinctively empowering—rather than limiting leadership to formally designated positions, the NMC establishes that every registered professional bears responsibility for leading within their sphere of influence. Newly qualified staff nurse and director of nursing both must provide leadership protecting wellbeing, model integrity, maintain accountability, and raise safety concerns. The scope and complexity differ, but fundamental leadership obligation remains constant.
For nursing and midwifery professionals, understanding the NMC's regulatory framework proves essential for maintaining registration, planning career development, and fulfilling professional obligations. The organisation's standards create both baseline expectations and aspirational goals—minimum requirements below which practice falls into fitness-to-practice territory, and ideals toward which excellent professionals strive. Leadership threads through these standards as both regulatory requirement and professional ideal.
Whether you're student preparing for registration, newly qualified professional establishing practice patterns, experienced clinician considering leadership roles, or established leader maintaining registration whilst working primarily in management, research, or policy, the NMC's regulatory framework shapes your professional journey. By engaging thoughtfully with Code requirements, maintaining meaningful continuing development, participating authentically in revalidation, and embracing leadership as universal professional responsibility, you contribute to nursing and midwifery's collective capability whilst advancing your career.
The NMC exists fundamentally to protect the public through maintaining professional standards. Its leadership expectations serve this protective function—professionals who champion quality, raise concerns, support colleagues, model integrity, and drive improvement create safer, more effective, more compassionate healthcare than those who limit their responsibility to narrow technical competence. By embracing the leadership expectations within NMC regulation, you fulfil your professional obligations whilst maximising your contribution to patient welfare and healthcare excellence.
Sources: