11. Quality placements

Resolution submitted by RCN Students

That RCN Congress urges Council to lobby for all students to be given appropriate quality placements leading to a minimum of a one year position with preceptorship upon registration

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Progress reports

Submitted by: Students Committee
Council lead and committee assigned: Andrea Spyropoulos, Nursing Practice and Policy Committee
Committee decision: Integrate project into ongoing work stream
Members involved: Jayne Parker, Brighton and Hove Branch and RCN Students Committee

Final Summary at May 2012

This resolution saw Congress discuss the importance of quality placements in nursing education, especially the need for quality mentors and ongoing preceptorship.

The RCN Nursing Practice and Policy Committee placed the work around this resolution into the RCN Education Commission, which is a work stream of This is Nursing, an RCN project which looks at seven key areas of nursing.

The RCN Education Commission will use evidence-based research to look closely at nursing education. The commission involves both RCN staff and external contributors.

One of the Commission’s projects has been to examine the importance of the partnership between higher education institutions (HEIs) and practice settings. This project is looking at the impact of this partnership in preparing students to be fit for practice, and will make recommendations for the future.
A second project has examined the expectations and experiences newly-registered nurses have of preceptorship programmes. This was researched by conducting focus groups with newly-registered nurses.

The final outcomes of these projects were not available at the time of print, but will be presented to the RCN Education Commission in Spring 2012.

Update at November 2011

An RCN-wide education scoping exercise is being carried out examining principles and RCN position on nurse education - both pre- and post registration.  On the advice of the committee further work with the NMC and a position statement from the RCN on the desirability and value of preceptorship in any setting would be one of the outcomes from this work.

The terms of reference for the project have been worked on with RCN Education Forum committee and other stakeholders.
Out of this work will come position statements on various aspects of education and one of these will be preceptorship. The RCN Students Committee and Education Forum will be involved in this work. 

Work on the review continues and has now been subsumed into the education workstream of Future Nurse Future Workforce.

One of the projects feeding into the proposed RCN Commission on Nurse Education will examine the importance of the partnership between Higher Education Institutions (HEIs) and practice settings and will explore the difference that makes in preparing students to be fit for practice. It will make recommendations as to what makes up the components of that partnership when it is working at its best.

A second project will look at the Newly Qualified Nurse (NQN) experience around the four countries – taking into account preceptorship programmes such as Flying Start in Scotland.

Using focus groups of 3rd year students, preceptors, ward managers and newly qualified nurses this study will:

Debate report

After a plea to allow the RCN Students Committee to present their resolution on Students’ Day, Congress heard a debate full of support for the next generation of nurses.

Jayne Parker, representative for the south east of England on the RCN Students Committee, called for more support for those training for the profesion. She said: “The education of nurses represents a significant investment both by the state and the student. In these cash-strapped times we need to make sure this investment reaps the maximum return.”

Jayne was supported by fellow students who criticised the quality and amount of mentors available to support them. Shona Gray, a student information officer from Greater Glasgow said: “We don't want to be placed with mentors who have lost the passion for nursing that we, as students, seek. We appreciate busy ward environments, we appreciate heavy workloads, but we are desperate for support, guidance and clinical expertise. We are the future of nursing."

Emma Eccles from the Lothian branch added: “Too many students are allocated to mentors. They don’t have the time to support us. Mentors have the ability to either inspire or discourage appointed students in their training. We propose that mentors should have to undergo further regulation and training to ensure that only those with a passion to teach are allowed to have the role."

The resolution also called for placements to result in an offer of a one year position with guaranteed preceptorship. Jayne informed Congress: "The Department of Health and NMC agree that newly registered nurses should receive preceptorship. But a lack of jobs means that they are forced into accepting bank shifts, agency roles or band 4 posts, none of which provide preceptorship."

Paula Hancock from the RCN’s Education Forum urged caution: "Jobs need to be given to qualified nurses first or there will be no mentors or preceptorship to support you on your way."

Students were told that they can improve their experiences by taking ownership of their placements. Laura Faulkner, a newly registered nurse, said: "Students need to take more control, make the most of your placement rather than blaming it on poor mentorship."

Result

For:         92.89% (431)
Against:   7.11% (33)
Abstain:   (25)

Background

In June 2008 the NMC launched its updated standards for supporting learning and assessment in practice. However, concerns have been expressed by students who feel that mentors often have too many students or too high a case load to adequately teach clinical skills to consolidate the theory learned. This may lead to newly qualified nurses feeling ill-prepared for the role they are about to face.

Since 2006, the NMC has strongly recommended that all ‘new registrants’ have a period of preceptorship on commencing employment (Nursing and Midwifery Council, 2006) - this applies to those newly admitted to the NMC Register who have completed a pre-registration programme in the UK for the first time. However, this appears to be somewhat differently applied throughout the UK, with some trusts offering a highly comprehensive preceptorship programme while others struggle to provide the preceptors required. The potential risk of clinical area closures and the loss of mentors and preceptors, resulting from the current drive to cut costs may perpetuate these difficulties.

In addition, trusts and employers are increasingly asking newly qualified staff to complete pre-employment tests involving numeracy, literacy and clinical skills. Anecdotally we know many staff struggle with this – and high quality and competent placements would have helped both mentors and students sort out any problems before the student progressed that far.

For many years Scotland has led the way on preceptorship. NHS Education for Scotland (NES) has developed practice placement standards which set the benchmark for the quality of placements on offer for students.  These outline responsibilities and expectations in relation to practice placement learning for students, HEIs and health care organisations, and are supported by an infrastructure of practice education facilitators (PEFs) who are based within all health boards in Scotland. The Scottish Flying start preceptorship programme (NHS Education for Scotland, 2011) , giving newly qualified staff access to a mentor and learning resources, has now been operating for several years and is linked to the NHS Knowledge and Skills Framework development review cycle. In addition a 12-month guarantee scheme provides employment to all NQNs experiencing difficulty securing a post in the NHS. (Scottish Government, 2010).

In Northern Ireland each trust runs a Practice Education Coordinator (PEC) system, linking practice education facilitators to specific trusts/clinical areas. PECs are responsible for mentors and any student mentorship issues and regularly meet with university placement coordinators.

In Wales an agreement has been in place since 2003/4 on placements, with ongoing educational audits. The RCN in Wales has also called for the Scottish model of a guaranteed NHS job on graduation to be implemented in Wales.

The RCN completely endorses the NMC recommendations and recognises that the profession has a responsibility to support its newly qualified staff through their first few months. We support the Flying start programme and are involved in work looking at the one year guarantee for all students.

References and further reading

NHS Education for Scotland (2011) Flying Start NHS, Edinburgh: NHS Education for Scotland. Available from: http://www.flyingstart.scot.nhs.uk/  (Accessed 02/02/11) (Web)

Nursing and Midwifery Council (2006) Preceptorship guidelines, London: NMC. (NMC Circular 21/2006 SAT/gl) Available from: http://www.nmc-uk.org/Documents/Circulars/2006circulars/NMC%20circular%2021_2006.pdf
(Accessed 02/02/11) (Web)

Scottish Government (2010) One year guarantee more nurses and midwives: guidance for 2010 - 2011, Edinburgh: Scottish Government. Available from: http://www.scotland.gov.uk/Publications/2010/08/one-year-job-guarantee (Accessed 02/02/11) (Web)