1. 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

2. 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

3. 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

4. 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

5. 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.

6. 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 years old ~ implications of student loans

7. 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

8. Evaluation of pre- registration nursing and midwifery education standards
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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, and
preceptorship.

10. 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.

11. 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).

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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)

18. 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

19. 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

20. .
Can we do it differently? Hub and Spoke model Collaborative Mentoring Doing it differently….. .

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

22. 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

23. Hub & SPOKE PLACEMENTS

24. 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.

25. 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

26. 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

27. 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

28. 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

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