What’s it really like to return to nursing practice after a break? Sarah Wilde explains the anxieties, frustrations and joy in coming back to the profession
I initially trained as a project 2000 student nurse in the early 1990s. After 10 years in the Royal Navy, I left to bring up my family with the intention of returning to nursing when the time was right.
I stayed true to my word. Last year my family and I arrived back in England after travelling overseas and I spent my 40th birthday sat in a classroom learning about the Francis report and the 6Cs.
The number of nurses returning to the profession after a break is on the rise and this can only be a good thing.
The need for an increase in the nursing workforce is well recognised and two years ago the Francis report added weight to the argument that the government urgently needs to address staffing levels.
Proposals to increase the number of student nurse training places however, won’t affect clinical areas until at least 2017.
As trusts seek short term solutions to the staffing crises, the pool of nurses whose registration has lapsed could prove a valuable resource.
“The pool of nurses whose registration has lapsed could prove a valuable resource”
As part of a raft of short term measures, Health Education England (HEE) commissioned a report on Return to Practice (RTP) courses to evaluate the current provision and underpin future training strategies.
This was followed by the ‘Come Back’ campaign in 2014 to encourage lapsed registrants to return to nursing.
In addition to increasing the workforce in a timely manner, the RTP courses are more cost effective than a three year training course.
But understanding the needs of these nurses is paramount to provide them with the support needed to become effective members of the clinical team and to give patients the best care.
What does a Return to Practice course entail?
Return to Practice courses are run locally by schools of nursing and follow NMC guidelines. The variations in training and the need for a consistent approach across all regions was a key finding of the HEE report.
In addition to study sessions to familiarise learners with new legislation and the drivers behind change, learners undertake a period of supervised practice in a clinical area and a final essay.
The course is currently available at both diploma and degree level but has a strong focus on practice development based on a similar competency framework to student nurse training.
Although for practical purposes the Return to Practice nurse is equivalent to a final placement student, they will have very different support needs.
According to HEE, the average age of returnees is 40-50. Some will have remained in care looking after family members or have taken on other caring jobs, while others may have taken on an entirely different role.
Returners may have a broad range of life experiences beyond nursing which can provide a number of highly transferable skills. I have found many times since being back in practice that my experiences in child care, voluntary roles in the community and life in general have enhanced the care and support I have been able to give in many situations.
Returning to clinical areas after a break of any length is a process which can be fraught with anxiety. A lack of confidence can be an issue for returnees who may have a heightened awareness of the potential to cause harm.
“The returner may have more self confidence and be more willing to challenge others or express themselves”
Conversely the returner may have more self confidence and be more willing to challenge others or express themselves. Understanding the returnee’s individual concerns and needs and supporting them in their development are very important in overcoming these stumbling blocks.
On a busy ward the feeling of putting additional burden on to others by being unable to undertake certain roles until vital competencies are completed can be an issue. This means the difference between being capable and being able to do something.
On the other hand, once training is completed and the returnee’s PIN revalidated, competencies can be achieved relatively quickly as the foundation knowledge is already there.
“As the returning nurse is unregistered they must be supervised at all times”
As the returning nurse is unregistered they must be supervised at all times and written documentation/all signatures must be countersigned. This is essential even if the returnee is competent and confident in the tasks undertaken until the PIN is reactivated.
Frustration can be an issue for learners.
A returning nurse may discover that simple procedures are complicated by a change in protocol or in the equipment available.
I would find myself confidently dealing with a complex issue with a patient one moment followed by having to ask for help with a seemingly simple procedure the next.
“Building the confidence of a returnee is an integral part of them becoming safe and competent practitioners”
Patience and support from colleagues makes the difference between learning and becoming autonomous or becoming disheartened. Building the confidence of a returnee, as with all learners, is an integral part of them becoming safe and competent practitioners.
For those returning it is not a decision to be taken lightly.
There is likely to be a high level of commitment to providing nursing care. Learners are likely to be either self funding or attending the placement unpaid.
Many on our course were juggling jobs, family and other commitments in addition to placements and coursework. Making the decision to return to practice, securing a place on the course and undertaking the studying is a serious undertaking.
The experiences of returning nurses will vary widely depending on the length or time away from nursing and the level reached prior to leaving. The experiences since lapsing will also have an impact on both confidence and competence.
For some, the transition may be overwhelming but within a very short time most returners will find themselves returning easily to the role and will become a committed member of the team.
Sarah Wilde completed her Return to Practice course at Plymouth University after 12 years away from clinical practice
Nursing Return to Practice: Review of the current landscape; Health Education England. April 2014