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Experience counts

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VOL: 97, ISSUE: 41, PAGE NO: 36

Rachel Hardyman, MSc, BSc, CertEd, is research associate, the nursing research unit, King's College, London

Sarah Robinson, BA, is senior research fellow, the nursing research unit, King's College, London

There was a great deal of controversy last year when a university decided it would no longer offer learning disability and mental health placements for nursing diploma students on the adult and child branches. Instead, students would visit the relevant areas and complete workbooks.

There was a great deal of controversy last year when a university decided it would no longer offer learning disability and mental health placements for nursing diploma students on the adult and child branches. Instead, students would visit the relevant areas and complete workbooks.

The decision was justified on the grounds that it was difficult to secure these placements and that they were unnecessary as the students would not be practising in either specialty once qualified (Munro, 2000).

Critics said that making visits and completing workbooks did not constitute adequate experience in these areas of practice; that students needed experience in all branches of nursing to make an informed decision on which field they wanted to pursue; and that the policy ran counter to the development of a holistic approach to nursing (Nursing Times, 2000).

This article considers the impact of learning disability and mental health clinical placements on branch choice. It reviews previous work and presents findings from a current study of nurse diplomates' careers.

Informed choice
In its original proposals for Project 2000, the UKCC (1986) proposed that students should not choose their branch programme before completing the common foundation programme (CFP). It was thought that by this time they would have had clinical placements in all four branches of nursing, enabling them to make an informed choice on which area they wished to specialise in.

However, intakes for each branch are now determined by the workforce development confederations that commission places. Most colleges therefore require students to choose their branch before starting their preregistration programme, although there is some opportunity to switch for those who subsequently change their minds (Pye and Whyte, 1996; Ferguson, 1998). It has been argued that if students are not given the opportunity to change branch, those who are not happy with their original choice may leave either during the programme or soon after (Pye and Whyte, 1996; Ferguson, 1998).

Previous research has revealed the importance of clinical placements in influencing students who change to the mental health branch. In a study of 30 students on one institution's three-year degree programme, Pye and Whyte (1996) found that six had changed from the adult to the mental health branch. All six reported that the main factor to influence their decision was their enjoyment of the mental health placement.

Similar findings are reported by Ferguson (1998), who studied degree students at an institution that allowed branch choice to be finalised at the end of the CFP. Of the 10 students who opted for the mental health branch, four did so before starting on the degree programme and had prior experience of working with people with a mental illness or a learning disability. The other six students had no such experience, but having initially opted for the adult branch they subsequently changed to the mental health branch, mainly on the basis of positive experiences during their mental health placement.

More recently, White (1999) reviewed the direction of branch change in degree and diploma courses over a four-year period in one institution. The most influential factors in students' decisions were related to experiences during clinical placements.

The study
As part of a longitudinal study investigating the careers of nurse diplomates, we obtained information on changing branch during the programme and the influence of clinical placements on this decision.

Preregistration students in England were recruited to the study between August 1997 and July 1998, shortly before they qualified. To provide sufficient numbers for estimates to be reliable, the sample included all those qualifying from the learning disability and child branches, two-thirds of those qualifying from the mental health branch and a third of those qualifying from the adult branch. The latter two branches were sampled to be nationally representative (Marsland and Murrells, 2000).

Results
Of those asked to take part, 88% agreed to do so and received questionnaires on qualification and at intervals thereafter. The findings reported here are drawn from the 'at qualification' questionnaire. Response rates were: learning disability 85%, (n = 225); mental health 82% (n = 554); child 89% (n = 634); and adult 87%, (n = 1,596).

This article adds to the studies described in relation to mental health, but also provides information on the learning disability branch. It differs from other studies in that it focuses only on diploma students and provides an indication of the scale of branch change at a national, rather than institutional, level.

Table 1 shows the branches on which respondents started and finished the nurse diploma programme. It reveals that learning disability and mental health were the branches into which people were most likely to transfer during the programme.

Those who transferred to the learning disability or mental health branch during the programme were asked how important placements were in their decision to change. For both branches, more than three-quarters considered their enjoyment of clinical placements to be 'very important' (Table 2). Indeed, 90% indicated that this was either 'very' or 'quite' important in their decision.

Further analysis revealed that respondents who transferred during the CFP were less likely to have had experience of the relevant client group before the programme than those who chose these branches at the outset. Of those who selected the learning disability branch before the CFP, 87% had previous experience of this area of nursing, compared with only 40% of those who selected the branch during the CFP. Similarly, 65% of those who chose the mental health branch before the CFP had relevant experience, compared with 35% of those who selected the branch later. (Figures for both branches reached statistical significance at the 0.001 level).

Furthermore, of those who changed branch, respondents who had not previously been exposed to learning disability or mental health nursing were more likely to indicate that CFP placements were very important in their decision to change than were those with prior experience (Table 3). (Figures for the learning disability branch reached statistical significance at the 0.05 level).

Discussion
This study confirms other findings that the experience of working with learning disability or mental health clients is an important factor in deciding to specialise in these areas. For many students, clinical placements during the CFP are their first experience of these client groups. If such placements are not available, these students may not have the opportunity to discover whether they might prefer either of these branches. This raises important issues for staffing the learning disability and mental health services.

The study reported here, together with the earlier work reviewed, suggests that a substantial proportion of those who qualify from the learning disability and mental health branches originally intended to work as adult or child nurses. It also shows that there is less likelihood of those who initially choose learning disability or mental health moving to either adult or child nursing.

Removing learning disability and mental health clinical placements from the CFP for students who have chosen the adult or child branches may not affect the overall numbers who complete the programme. However, it may mean that the adult and child nursing workforces benefit at the expense of the learning disability and mental health services.

- The authors would like to thank the Department of Health, which funded the research; members of the pilot cohort who helped to develop the questionnaires; members of the main cohort who completed the questionnaires; Louise Marsland, Trevor Murrells, Gary Hickey, Alison Tingle and Rosie Chick of the Nursing Research Unit who worked with us on the research on which this article is based.

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