Practice Learning Support The Challenges Ahead Changes to the Curriculum Moving forward with Mentorship POPPI Developments Looking forward Adele Kane Associate Head of School - Practice Learning Francis Thompson Associate Professor in Mental Health Nursing School of Nursing and Midwifery

Recent changes Publications that will make a major change on how and what we do. These are: Raising the Bar - Shape of Caring Review (2015) Comprehensive Spending Review (Nov 2015) Delivering the Forward View: NHS Planning Guidance 2016/17 – 2020/21

2 yr whole person core training Shape of Caring Review Pathway into Nursing for Care assistants Associate Nurse Remove constraints of four strand education 2 yr whole person core training 1 year chosen field Community LD Child MH Adult Preceptorship Registration

Associate Nurse Work along side HCA and Fully Qualified Nurses focusing on patient care. Can also be new route to RN. Part of developing a contemporary workforce Free RNs to use specialists training to focus on, leading clinical decisions about patient care Learning on the job Study through FE –linked to PU Band 4

Comprehensive Spending Review From 2017 HEE will no longer have funds nor have responsibility for commissioning education for healthcare for England From that date 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. In addition HEE will:- Take the role of quality assurer relating to placements.

Implications for Placements No HEE funding restrictions on places offered by HEIs – may still be informed by workforce modelling Move to the student loan company – so no additional availability to support supply Risks: 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: SALTs / LD Current average age of nursing cohorts is 26-28 years old ~ implications of student loans

Implications for Placements Opportunities: Employers able to offer increased placements can do so Employers will be able to develop closer relationships with HEIs both within and outside of their current area Potential development of different training modalities eg training wards Attractive geographies will be able to attract more applicants south west seen as attractive? may need to work on developing this – there maybe competition Supply and demand and workforce planning activities underway

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, and preceptorship.

Mentorship Uncertainty about definitions of various competencies Students not being assessed consistently across the system. Different interpretations mean that students’ opportunities to practise skills vary. Pressures on mentors due to staffing levels and student to mentor ratio There is often: insufficient time to perform the role within working hours, and insufficient time devoted to mentorship training and CPD. Strong feeling that there needs to be greater recognition of the role. Quality of mentor training varies SLAiP standards and PEFs felt to have improved mentoring and mentor training but there are still issues.

Preceptorship The best: The worst: span an extensive time period (at least six months, up to 9–12 months) allocate new registrants with a dedicated preceptor offer a structured assessment programme allow time for reflection, and foster a supportive atmosphere. The worst: 1–2 weeks Little or no interaction with preceptor (or no allocated formal preceptor) Seen as an opportunity to develop confidence, leadership and autonomy but also used to hone clinical skills and practical knowledge Most would like preceptorship to be mandatory rather than an NMC recommendation. There are mixed views on whether it should be regulated (and if so, by who).

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

A stronger focus on nursing leadership and managing complex care in non-hospital settings Standards which apply across healthcare settings and fields of practice Greater emphasis on underpinning bioscience knowledge Standards that stress the importance of care being research and evidence led A focus on the role of the nurse in the wider population health agenda

The need for knowledge of the determinants of health and illness A focus on life course issues and in particular the perspective of children and young people, care of the older person, dementia, vulnerability, safeguarding, and end of life care Focus on key technical skills for all nurses such as venepuncture, managing intravenous infusions, drug administration and parenteral nutrition

Overarching principles Seven principles reflect consensus about what will be required of the future graduate registered nurse Provide potential framework for identifying and organising new core standards Reflect what the public can expect from a nurse at the point of entering the profession The seven overarching headings reflect the consensus which has emerged from our engagement with a wide range of stakeholders to date about what they believe will be required of registered general nurses in the future (eg. 2025). They provide a potential framework for identifying and organising the new core standards which will articulate the competency outcomes required at the point of registration. The standards will reflect what the public can expect at that point of entry to the profession, when the newly qualified nurse begins their career

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

Changes to Curriculum to Enhance Placement learning Rationale 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. Shape of Caring Review (2015) and expected New NMC Standards 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 Need to complete programme by the end of July (Commissioner)

Changes for September 2016 Ready for employment July SOM development Length of Programme and readiness for employment Balance of Theory and Practice To be ready for registrant Practice: Demonstrate achievement of competence/ proficiency in care management for entry onto the register. Development of Optional Placements and Preceptorship Ready for employment July Clear Theory and Practice Blocks Improve Preparation for Placements Undertake 2 placements of good length in final year Develop mentors and placement configurations SOM development Opportunity to take 3 week Optional Placements in area where they have secured jobs Host can commence Preceptorship during this period

Moving forward Mentorship 3 day Face to Face course over 12 weeks for all Submit Portfolio to meet NMC Standards to Support Learning and Assessing in Practice including set reflections (Revalidation ethos) –Non Credited Option to submit for credits up to 1 yr after completion

. Can we do it differently? Hub and Spoke model Collaborative Mentoring Doing it differently….. .

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

Poor communication structure can lead to problems Relies upon the structure used to manage care If the RN’s work in teams Learners can work under direct supervision of RN. Each RN recognises the duty of care to the student Arrangements for supervision with Team Leader/SOM Can provide support for Mentor Key mentor is responsible for assessment process Accessible for 40% of placement time Advantages Can create a community of learning and mentoring improving standards of patient care Disadvantages Poor communication structure can lead to problems Everyone thinks everyone else is managing the student – weak can slip through

Hub & SPOKE PLACEMENTS

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

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