1. 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

2. 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

3. Shape of Caring Review
HEE model for education

4. 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

5. 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

6. 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 years old ~ implications of student loans
National 20-28% reduction in applicants SW slightly better

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

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

9. 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.

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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?

17. 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 .

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

19. 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.

20. 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

21. Examples

22. 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

23. 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

24. 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: weeks
Spoke: 1 week OPD/HR

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

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

27. 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

28. 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

29. 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

30. 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