Practice Learning Support The Challenges Ahead Changes to the Curriculum Moving forward with Mentorship Looking forward Adele Kane Associate Head of School - Practice Learning School of Nursing and Midwifery

Government Priorities (HEE, 2015) 1. Excellence in nursing practice 2. Valuing and developing the care assistant workforce 3. Ensuring meaningful patient and public involvement 4. Flexibility in preregistration education 5. Standards for post registration education

Shape of Caring Review HEE model for education

Associate Nurse Band 4 Work along side HCA and Fully Qualified Nurses focusing on patient care Learning on the job Free RNs to use specialists training to focus on, leading clinical decisions about patient care Access RN education at yr 2 Study through FE –linked to PU

Nursing Apprentices alternative part-time route to RN Same entry requirements Could be at degree or M level Band 4 4 – 6 years Supernumerary Placements in student role in addition to HCA post No fees Will come from aprentiship levy

Comprehensive Spending Review Nursing and allied health professional undergraduate courses will be funded through the student loans company. Universities will be free to set their own numbers for these programmes. Attractive geographies and courses may see increased applications at the expense of less attractive ones Small and/or regional programmes may be at risk eg: LD Current average age of nursing cohorts is 26-28 years old ~ implications of student loans National 20-28% reduction in applicants SW slightly better

Implications for Placements What do you think What are the opportunities?

Evaluation of pre- registration nursing and midwifery education standards Use this as a section separator within a presentation

Key findings Most nurses and midwives are fully prepared for practice but variability exists in: availability of placement opportunities levels of responsibility and opportunity to practise clinical skills availability and quality of mentorship timeliness of theory to practice learning preceptorship.

NMC Consultation on Education Standards A need for clearer, outcome focused standards reflect increasing requirement for higher order skills, knowledge and proficiencies not open to interpretation, be flexible in their application but increase consistency in output acknowledge increased working in multi-disciplinary and multi-professional teams acknowledge increasing fluidity across care settings and between mental and physical health challenges

The graduate registered nurse One is an accountable, proactive and person-centred professional Two provides leadership in the promotion of mental, behavioural and physical health and wellbeing and in maximising health outcomes and benefits Three leads the assessment of need for nursing support and care with people facing mental, behavioural and physical health challenges, developing a prioritised plan for the delivery of safe, effective and evidence based nursing care across the life span and settings Four leads the provision and evaluation of compassionate, effective, safe, person centred, and evidence based nursing care and support across the lifespan Five provides effective leadership to the nursing team, taking accountability for the delegation and referral of care Six is risk aware and plays a lead role in maximising safety, minimising risk and enhancing the quality and experience of nursing and related care Seven provides leadership in the coordination and management of complex nursing and integrated care needs across organisations and settings

Evaluation of PU Pre-reg programmes (2017) 100 respondents 24 recent graduates – 65 Mentors Aspects of the course that was most effective Positives Benefits of learning from others Breadth of patient interaction Practical guidance and training Development of interpersonal skills Course content Transition differing opinion between graduates and mentors 100% graduates were proud of the skills they had developed and confident in their ability

Suggested Improvements More simulated experiences Dealing with challenging patients/conflict resolution teams, patients and family Verbal and written skills Skills such as Ivs, ANNT, catheterisation and IPL working

Changes to Curriculum for 2018 Integration of health and social care services across variety of care settings we need to consider how to reflect this in placement and skills teaching. Need for a practitioner that is fit for practice – to ensure that Practice is high profile within the curriculum Need to review and strengthen Host Placement Provider concept

Raising the Bar - Shape of Caring Review ( HEE Lord Willis 2015) Indicate that the clinical skills identified that Grad nurses should have across all fields can be found – as were not able to disclose New NMC Standards

Mentoring Good Mentoring (53%)- mixed opinions from students and mentors How can the quality of mentoring be improved? How can we improve feedback and support?

Can we do it differently? New Models of Mentoring Hub and Spoke CLiP . Can we do it differently? New Models of Mentoring Hub and Spoke CLiP .

Hub & SPOKE PLACEMENTS Caroline Jamison Academic Placement Lead – Cornwall March 2016

Definitions: Hub Placement: Spoke Placement:   This is the setting where the student has been allocated for the main part of their placement It is where their assessment will take place, and the student is supervised by a Mentor on the live register Spoke Placement:  As part of the ‘hub’ placement, students may undertake a series of ‘spoke’ or ‘satellite’ placements overseen by a range of mentors/RN’s who feedback to the ‘hub’ Spoke placements are between 1 – 4 weeks long. Spoke placements are generally formative assessment or observational. Spoke placements are ideal for adding a breadth to the student’s experience A spoke placement can also be a hub placement Spoke Placement:   As part of the ‘hub’ placement, students may undertake a series of ‘spoke’ or ‘satellite’ placements overseen by a range of supervisors who feedback to the ‘hub’ assessor. Spoke placements are between 1 – 4 weeks long. All spoke placements are deemed to be a formative assessment or observational. Spoke placements are ideal for adding a breadth to the student’s experience There is the expectation that the ‘hub mentor’ and ‘spoke mentor’ will communicate with each other regarding the student progress.

Advantages Added breath of experience for the student Increase in student capacity at the hub Potential for more mentors meeting NMC standards Increases inter-assessor reliability Can be used for short or long placements Increases sense of belonging for the student Increase in student confidence Assist in future workforce planning

Examples

Hub & Spoke - Across year 1: Community focused Placement 1: Hub: 6 weeks Spoke :1 week EIT/OPD Spoke :1 week Palliative Hub: 1 week Placement 2: Hub: 2 weeks Spoke : 4 weeks Hospice Spoke : 2 weeks DN & PN

Hub & Spoke – Across year 2: Acute Care focused Placement 1 Hub: 6 weeks Spoke: 2 week IC & OPD Spoke :2 week Placement 2 Hub: 2 weeks Spoke: 4 weeks Hospice Spoke: 2 weeks SSN Hub: 1 week Placement 3 Hub: 1 week Spoke: 4 weeks oncology Spoke: 4 weeks T&R Hub: 2 weeks

Hub & Spoke : Speciality/HD placement (8 - 12weeks) Speciality/HDU: 11 week placement: Hub: 2 weeks Spoke: 1 week CCL Spoke: 1 week: CR/CP Spoke: 2 weeks: CCU Hub: 4 weeks Spoke: 1 week OPD/HR

Challenges: Communication between hub & spoke Increased administrative time required for allocation Travel for students Cross trust/site communication Finance

Collaborative (Team) Mentoring SOM Placement Leads – Link Lecturer Mentors Year 3 Year 2 Peer support and teaching Year 1 Peer learning support

CLiP Proposed 1 coach : 3 students Coaching model What does it mean for the Coach To supervise students delivering care Observes, questions, encourages Patient allocation Can sign off specific outcomes/competencies Proposed 1 coach : 3 students Coaching model 1 student : 1-3patients Min of 14 students on ward What does it mean for the mentor May not work with student all time Overall accountability May have a sense of loss Regulate review meetings Signs of placement What does it mean for organisation Preparation is Key More confident staff Newly qualified nurses better prepared for practice Shorter preceptorship Current model 1mentor:1student Expert : Apprentice Work together as much as possible Capacity variable CLiP What does it mean for patients Not all cared for by students They have choice Will get more time to care Greater patient contact Excellent care delivery What does it mean for student Take responsibility for own learning Prepare daily to achieve goals Learn by doing Peer learning More time to care, more time to learn

Preparing students to be ‘coach ready’ (NMC 2017) The model is underpinned by a philosophy of student-led and peer learning. Students: normally have not more than three patients allocated to them but this would be in relation to their developmental stage, their competency and the complexity of the patient’s needs. be afforded some flexibility in order for them to achieve learning outcomes of management and leadership. Second and third year students will be involved in supporting and facilitating learning through coaching for other more junior students

What we propose from 2017 Prepared during prep for practice/bridging weeks Builds on existing model of PALS Taught coaching/mentoring skills Provided with a Portfolio of coaching/log Evidence fits Leadership and management domains Take forward into preceptorship practice Foundation for mentorship development

Supporting a coaching and learning culture in clinical practice new curriculum Bedded into year 1 – peer coaching supported and developed in simulation Continues through year 2 but expected to use coaching skills with junior students Prominent in year 3 expectation to coach on a day to day basis Transfer into Preceptorship – coaching year 3 Preceptor coaching preceptees Mentor This Is The Future