Training without change is a waste of time and money

But times and resources are changing. When staff we manage undertake courses, further study and professional development we must be more focused on linking it to service improvements. Managers need to be able to see how, by developing one individual, others and patients in particular can benefit from their new knowledge and skills. There can be the cascading effect: if a person leads on a particular project, they will develop others along the way and so the service recoups great benefits.

Some courses provide excellent examples of making direct practical improvements in patient care and service delivery such as the non-medical prescribing course. As part of a trust’s governance arrangements, when considering an individual to become a non-medical prescriber, the manager supporting the application has to consider how this role will fit in with service delivery and benefit patients.

‘Although there are often criteria staff need to meet when applying for course funding, when it comes to assignments, they could be chosen to fit service needs’

A good example is from a nurse consultant in cardiology who set up a pre-admission clinic in which she prescribes medicines that patients must take before they are admitted. She also conducts nurse led ward rounds to discharge patients after percutaneous coronary intervention; this facilitates a more timely discharge. She reviews patients one or two days before discharge to prescribe and titrate medication in line with guidance from the National Institute for Health and Clinical Excellence for patients following myocardial infarction.

Although there are often criteria staff need to meet when applying for course funding, when it comes to assignments, they could be chosen to fit service needs. The individual’s manager who supports the study leave could be involved with deciding the subject areas on which the assignments are based.

When individuals choose courses they are often guided by their manager; if thought through this can be beneficial for both parties involved. This is because the manager knows the individual’s strengths and areas for development and also has experience and knowledge of the most appropriate courses. Once the course is completed, the manager can consider how the new knowledge fits with service developments in a future role, for example a staff nurse with an MSc in health promotion could lead the development of a health promotion programme for patients with heart disease.

However, when individuals undertake courses or complete assignments without being supported financially by their organisation, should it be expected that they consult their manager on their choice? My opinion is that it still benefits both parties and, as a health professional, ultimately affects patients. But one could argue that if an employer was not willing to support the individual then they should not expect a say in what is done - besides, the course may be one that is not at all related to the current job but a different career path that they plan to take.

Professional doctorates that enable individuals to address and critically evaluate a policy or practice related problem are an example of programmes designed to support and integrate the professional development of individuals to bring benefits to the service in which they work. Increasing numbers of universities are offering this - but let us not forget that PhDs have a track record (in my trust anyway) of clearly relating to a specialty and benefiting patients. For example, clinic staff gained a greater understanding of the complexities of involving families in shared decision making for children with chronic illness after a PhD that explored how children with moderate to severe asthma and their carers experience home management and hospital care. The findings illustrated how carers’ approaches to children’s decision making in their home management influenced the level of children’s involvement in the hospital clinic.

At the time of appraisal when focusing on objectives we need to think on two levels: how the service is going to benefit; and how the nurse’s development needs are going to be addressed. An example is when a nurse has an interest in clinical pathways and has years of experience in the specialty but little experience of leading a multidisciplinary team. The manager should utilise their knowledge and experience while recognising that the area for development is leadership skills. The manager can provide the right level of support and guidance for the nurse to lead on a pathway as an objective and potentially open new opportunities for the nurse and benefit patients.

If there was ever a time to ensure nurses contribute to the nursing strategy within their organisations and improve the care of patients, this is it. Managers could ask a nurse to design, audit and analyse an area of practice, introduce a change in practice based on evidence, or introduce a new educational resource, to name but a few initiatives. So I think we should step back when it comes to professional development, appraisal objectives, assignments and dissertations and think about what needs developing or implementing and how it can benefit patients.

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