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How nurses are filling the training gaps

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A lack of available funds for post-registration training has encouraged some nurses to come up with their own cost-effective training solutions, reveals Jennifer Taylor

Since the beginning of this year, NT has outlined how cash-strapped trusts have been failing to meet nurses’ post-registration training needs – in some places, even mandatory training has been put on hold. But it is possible to access training cost-effectively despite such pressures.

So when you have an idea, you need to take it to the top and show managers how it will help the organisation. That was the experience of Rachael Hodson, nurse practitioner at Hull and East Yorkshire Hospitals NHS Trust. She was part of a team that helped set up the national nurse endoscopy project (NNEP), which was formed because nurse endoscopists up and down the country were not attending courses through the national endoscopy training programme. Ms Hodson says
they were not being supported by their trusts – in terms of backfill, travel and accommodation – to have time away.

The Cancer Action Team, which is part of the Department of Health and works to improve cancer outcomes, donated funds to set up the NNEP, which has so far met the training needs of more than 200 nurse endoscopists across the country. Training has been targeted on a bespoke basis for each nurse via the 10 national training units for endoscopy around the country. Trusts pay travel, accommodation and study leave but the courses are free.

Ms Hodson says trusts have responded better to the NNEP than they did to the national endoscopy training programme because it has been targeted through each layer of nursing. ‘We flooded everybody, and had regional facilitators ringing up nurses, letting them know what was going on, so they were aware of it. But also we targeted nursing directors and chief executives through the national briefings from the DH, and had personal statements from nurses ranging from chief executives to frontline staff saying “this is good for your trust, you’ve got the 18 weeks’ target coming up, you’ve got cancer targets to meet and your nurses in endoscopy are key people who can help you to achieve that”.

‘So we tied it more into trusts’ agendas, rather than saying it’s a good idea just for your nurses. I think those combined approaches have made the difference to people saying “this could make a difference to our organisation”.’

Growing your own trainers is another cost-effective solution, and one that’s being used in endoscopy. From this summer,
the national endoscopy training programme will fund places for a senior nurse, band 6 or above, from every unit to undertake a ‘training nurses to train’ course, specifically around endoscopy.

Cascading knowledge is an approach that has been used at Sue Ryder Care to make the most of allocated money for training.

The healthcare charity, which provides compassionate support for people with serious illnesses and conditions, received money from the DH for training in the Mental Capacity Act 2005, and used it to train its education leads. ‘They’ve cascaded that training to all staff in each of our 14 centres,’ says Jane Appleton, quality and learning manager at Sue Ryder Care.

She also finds that using a range of methods for training – for example e-learning packages and in-house presentations – makes it more cost-effective because it increases the number of chances for people to access it.

Doing a block of training all in one hit can also be cost-effective, says Dickon Weir-Hughes, director of nursing at Barking, Havering and Redbridge NHS Trust in Essex and professor of nursing at London South Bank University. He brought a system of mandatory training to the trust, which he developed at The Royal Marsden, which requires every registered nurse, every year, to spend three days in a classroom.

Barking, Havering and Redbridge NHS Trust is one of the biggest trusts in the NHS, so the course is run twice a week, every week apart from at Christmas, in order to reach through all of the trust’s registered nurses.

The three-day period covers all mandatory training, including requirements from the NMC and other external bodies. As part of the training, the trust also deals with topical matters, such as issues that have resulted in complaints.

Professor Weir-Hughes says the three-day block is a more efficient way of delivering mandatory training than ‘doing an hour here and an hour there’.

‘It is also cost-effective because it means that all of these staff have got training in all of the safety issues that they’re supposed to have training in,’ he says.

Professor Weir-Hughes also uses in-house specialists to offer training, which costs nothing apart from the specialists’ time. One of the matrons has developed a series of two-hour lectures that are given by clinical nurse specialists and which any nurse from any ward can go to. These take place every week on topics such as pain management, wound care and breaking bad news.

‘We generally have around 30 or 40 people turning up to these sessions. They’re completely free, and it gives the specialists some experience of teaching as well, which is great.’

Education and training isn’t just about being in a classroom. Nurses can learn through networking and sharing their ideas and stories. NHS Live (, a free national learning network run by the Institute for Innovation and Improvement, provides a free way of doing that.

Jo Godman, lead associate for NHS Live, says it has around 3,500 members including nurses. She adds that cash-strapped organisations often can’t afford website technology, which can be used to share information, and are therefore well advised to make use of the network.

When it comes to getting someone to run with your idea, whether it be around cost-effective training or otherwise, Ms Godman advises being clear about the benefits. She says: ‘What will be the difference by doing it, who will receive those benefits and what does it look like in your local context in terms of priority. I think you need to be able to say that for any change.’

‘Because I’d put all the work in, I was determined that my training tool was going to be used’

Menna Jones, senior nurse in tissue viability at North West Wales NHS Trust, produced e-based learning tools on pressure ulcer grading and on how to choose a mattress after she noticed nurses having difficulties. Staff can do the training in their own time, using the workbooks she developed as evidence that they’ve done it.

Training courses had been poorly attended by acute staff, who had problems being released off the ward, and by community nurses, for whom centralised training wasn’t practical because of the distances involved in travelling.

One of the trust’s IT trainers made a template for Ms Jones in PowerPoint, and she developed the tools, which took a few months each. The only expense was her time.

Ms Jones approached the nurse executive and the head of nursing at the trust after she had a working model and gave them a demonstration.

And the response? ‘They liked it straight away,’ she says. ‘They said yes and they wanted all the nurses to do it.’

‘I think the biggest thing that I’ve learnt is that nothing is as straightforward as you think it is. We came up against hiccups – for example, we couldn’t email it because it was too big and the district nurses didn’t have access to the trust’s intranet. We were coming across a hurdle and then finding a way round it.’

But what kept her going? ‘Because I’d put all the work in, I was determined that it was going to be used,’ she says.

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