In March 2019 Newcastle upon Tyne Hospitals NHS Foundation Trust trialled a coaching approach to learning on four wards within our organization. This approach was adapted from the Collaborative Learning in Practice (CLiP) model adopted by several trusts in the UK and highlighted in the Shape of Caring review (2014).
Coaching empowers students, allowing them to take responsibility for their learning in a non-traditional environment. The new NMC Standards for Student Supervision and Assessment (2019) state that the student will actively participate in their own learning, “students are empowered to be proactive and to take responsibility for their learning”. The coaching model supports this aspect of the standard as the practice supervisor uses a coaching strategy to allow the learner to identify solutions to practice based problems in a safe environment.
The new standards have moved away from a mentorship approach to a practice supervisor and assessor method. Using a coaching approach replicates these changes, this differs from a traditional 1:1 mentoring role, allowing larger groups of students to work together delivering total patient care under the supervision of a registered nurse which changes daily. The practice assessor (currently sign-off mentor) meets with the students regularly to assess their progress, review feedback and tailor their learning plan to ensure the learning outcomes are attainable and completed in a timely manner.
One of the many benefits of this approach is to combat the escalating concerns from patients that staffing levels are affecting the quality and safety of care delivered. Initial findings from similar projects have demonstrated an improvement in student development which leads to a better prepared and more competent qualified practitioner. We wanted to explore the impact of students working together and directing care.
Overall project objectives include:
- To measure the impact of the introduction of a coaching model on patient safety, particularly in relation to falls, pressure ulcer incidences and rates of infection.
- To pilot a model of practice learning based on coaching which reflects the new NMC standards for student supervision and assessment.
- To increase student placement capacity and monitor the impact of student placement evaluations.
- To explore the educator experience of the introduction of a coaching model.
Within each ward, three to four students, of varying experience, were allocated to care for up eight patients under the supervision of a registered nurse. All care for these patients was planned, prioritised, delegated and delivered by the students with the 'coach' (registered nurse) supporting and guiding the process. The pilot ran for four weeks. Safety data from incident reports for the duration of the pilot was compiled. Post placement evaluations were taken using the standard online placement management system. In addition to this, the coaching lead held weekly sessions with the students to explore issues, reflect and share experiences. A weekly ward visit allowed registrants to discuss any challenges they had experienced.
The Trust recognised the importance of capturing the patient experience as part of the evaluation process of the coaching project, enquiring if the presence of more students on the ward affected the patient experience in terms of privacy, safety and overall experience. A short semi-structured questionnaire was developed and members of the Patient Experience Team visited the pilot wards, once per week over a three week period. The survey was carried out with both patients where students were present in the bays and where they were not, in order that any differences in the experience could be identified. Patients were asked to complete the survey and were given support to do this if required. The purpose of the survey was explained and those taking part were assured that their anonymity would be maintained.
Learning and future work:
Results data is still being collated and analysed, 102 surveys were successfully completed, 72 were from patients where students were present and 30 were from areas without students. Initial findings from patient experience feedback are positive. Patients 'feel' safer using this method as staff are present and visible more often than before. This is possibly due to the practice supervisor being present in the student-led learning bay, supervising and coaching the students. There were a larger number of students on the ward and this may have also impacted on the visibility of ward personnel.
Patients reported that with the introduction of the learning bays (designated areas in which the coaching model of student led care took place) their needs were being met earlier, and students appeared more confident and knowledgeable in this setting. We will be presenting other patient safety data at the 5th Commonwealth Nurses and Midwives Conference 6th and 7th March 2020 and hope to incorporate ongoing data.
In collaboration with Northumbria University we are undergoing further research into the student experience of the coaching model.