23. Preceptorship - in the community?
Essex Branch
(MFD) That this meeting of RCN Congress discusses how preceptorship will be implemented within community services
Debate report
Sharon Tappin, RCN Essex Branch, invited Congress to discuss structured preceptorship, in particular, within community settings. She said that since its inception the role of the community nurse has been evolving as successive governments called for people to be cared for in their own environments. “Gone are the days when a district nurse popped in to give someone a bath or have a cup of tea,” she said.
She suggested that working in an acute setting is not adequate preparation for a community role. However, she questioned whether there would be enough experienced preceptors available for all nurses coming to work in the setting. Sharon told Congress that preceptorship is the best possible start for newly qualified nurses and that good quality preceptorship is essential.
Bernadette Medcalfe, Portsmouth Branch, said that the community is a really positive place to work due to the diversity of skills needed and opportunities available. Speakers highlighted how important it is for newly qualified nurses to understand how attractive a community role can be. In order to achieve this Helen Ballanger, Gloucester Branch said; “District nursing needs resuscitating across the country,” and an “injection of cash”.
Jean Richards suggested retaining older nurses as dedicated preceptors, allowing them to pass on expertise while reducing their busy workload. She also said that the independent sector was an untapped rich resource.
Laura Marshall of the Children and Young People: Continuing and Community Care Forum, said “The community is the best place to look after children and young people. Historically we have always had very experienced nurses, and we owe it to newly qualified nurses to get preceptorship right.”
In her right to reply, Sharon Tappin thanked Congress for an engaging discussion and said she looked forward to lots of opportunities for new recruits.
Background
Preceptorship is an important part of enabling newly qualified nurses to develop their confidence, practice, professionalism and careers. While the principles underpinning high quality preceptorship remain the same regardless of the health care setting in which the nurse is working, there are particular challenges which relate to implementing preceptorship in the community.
The considerable reorganisation that has taken place in community health services over the last decade, especially in England, has resulted in frequent managerial changes and a high turnover of senior nurses. It is widely recognised that community nurse leadership across the UK has diminished in many areas, and that this is having a negative impact on the quality and provision of preceptorship within the community nursing workforce.
Despite the present shift in the balance of care delivery and a growing third sector, there is a significant decline in the number of health visitors and district nurses. This is due to a combination of factors such as financial constraints; the focus on acute care and a lack of training and development for community nursing roles. In response, the Government in England has set a target of recruiting 4,200 more health visitors. While the RCN welcomes this initiative, it means the demand for preceptorship in the community is set to become even greater.
The health departments of Scotland, Wales, Northern Ireland and England all wish to see more nursing care provided in the community and less demand for hospital admission. Furthermore, newly qualified nurses are increasingly seeking to work in the community rather than taking the more traditional hospital career route. But this can only be achieved safely if adequate arrangements for preceptorship are implemented within community nursing services.
Implementing preceptorship in the community presents similar challenges for all four UK countries. For example, the RCN in Northern Ireland reports feedback from its members indicating that preceptorship needs to be better developed in the community, due to the lone working aspects of the role. There is also a need to provide protected time for role development, reflection and shadowing. Access to supervision and peer support also need to be planned.
The RCN was involved in the development of the Department of Health’s Preceptorship Framework (Department of Health, 2010) and provided input to the Nursing and Midwifery Council’s guidelines on preceptorship (Nursing and Midwifery Council, 2006).
References and further reading
Department for Health (2010) Preceptorship Framework for newly registered nurses, midwives and allied health professionals London: DoH Available at: www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_114073 (Accessed 02/03/12) (Web)
NHS Education for Scotland (2011) Flying Start NHS Edinburgh: NHS Education for Scotland Available at: http://www.flyingstart.scot.nhs.uk/ (Accessed 02/03/12) (Web)
Nursing and Midwifery Council (2006) Preceptorship guidelines London: NMC (NMC Circular 21/2006) Available at: http://www.nmc-uk.org/Documents/Circulars/2006circulars/NMC%20circular%2021_2006.pdf (Accessed 02/03/12) (Web)
