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How to ensure a culture of training

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Despite financial pressures and time constraints some trusts are managing to make post-registration training a top priority for nurses, as Jennifer Taylor discovers

Over the past few months, NT has outlined the problems of time and funding that nurses face trying to fulfil their post-registration training needs. But while many trusts have cut back on CPD, some are still delivering on training despite financial pressures. So what do these trusts offer and how do they do it?

Education and training is an ‘absolute priority’ for West Sussex PCT, says Lucy Botting, associate director of provider modernisation and professional development at the PCT’s provider arm, and a nurse practitioner by background. ‘Like all other PCTs, as we move to an agenda of being fit for the future, one of the priority areas is looking at staffing skills and how we update them to work with the government’s agenda.’

The commitment comes right from the top, including the managing director of the provider arm, the chief executive and the board.

s Botting says financial stability is not a requirement for ensuring training is delivered. ‘It’s not a necessity that you have to be financially in the black. But training is one of the must-dos because if you don’t put investment behind education, all your plans, all your aspirations to get the workforce to become effective won’t happen.’

The PCT has developed competency frameworks for each band of staff, which detail the clinical skills, education and training needed at that level. Each nurse has a portfolio of evidence that is assessed at each appraisal.

Alongside the frameworks, the PCT has talked to universities to ensure there are enough commissioned places. There is also a lot of in-house provision.

‘Because this is a priority area, we make sure there is backfill for staff attending courses. We have a service to run but we have to make sure that staff have time to undertake these courses and also reflect on them.’

The PCT has had a difficult time recruiting senior staff in the past, so one of the aims is to create a home-grown culture, where staff are developed through the bandings.

Ms Botting admits being committed to training hasn’t been an easy process. ‘Trying to develop a culture of education and training is one thing but we’re also trying to change what we offer slightly.’

She explains: ‘If we’re looking at bringing care out of the hospitals, and care is becoming more complex, nurses need slightly different skills, and slightly higher level skills to be able to deal with that complexity. And because of that, we’ve had to change and tweak the education and training to focus it at a slightly higher level. Staff have found that quite difficult.’

Leicestershire County and Rutland PCT is also investing in its workforce by training up health visitors and school nurses, since many staff are due for retirement in the next five years. ‘I think it would be foolhardy for any organisation not to be responding in this way,’ says Mark Roberts, service development manager for children’s services at the PCT.

A new management team came into being in June last year, following the merger of four PCTs. This saw the creation of a children’s services team, separate from adult services. While a change of structure isn’t vital for setting up good training, Mr Roberts says it has enabled the PCT to change its approach.

He adds: ‘It doesn’t come down to us having lots of money because as an organisation, we’re under quite a lot of financial pressure. It’s really been about the culture that comes from our director of provider services all the way through the organisation, and about us being more proactive and supportive in the way we manage the service.’

A new clinical leadership team was also established as part of the recent restructure. Each of the five localities in the PCT area has a service manager. In addition, there are two senior nurse roles – one has responsibility for three localities and the other for the remaining two. ‘Their job is to have an overview of clinical practice and to really set a culture of learning and development and high standards,’ says Mr Roberts.
The two nurses are supported by two clinical educational leads, who happen to be health visitors but could just as easily have been school nurses. Their role is to complete the loop. Mr Roberts explains: ‘They take a lead on understanding how the training that we’re applying has an impact on the ground and if it isn’t having an impact, how we need to change.’ A training coordinator at band 7 keeps a record of who’s been trained and what training they’ve received.

Education and development of staff is fundamental to establishing communities of practice, says Mr Roberts. It’s a concept the PCT has adopted, which involves people working and problem solving together. To that end, part of the clinical educational leads’ time will be spent training staff from local authorities in social care or education.

Salford Royal NHS Foundation Trust also has a robust structure for training. Professional development teams are made up of four layers to encompass different bands of staff.

Assistant trainers at band 3 have roles around ensuring competency and looking at data about who is due for updates. They also do some mandatory training.

At band 6, practice trainers have responsibility for mandatory training, plus going out on to the wards and working one-to-one with people. They might help new starters, a staff member with performance issues or somebody who wants to learn something new. ‘They work in the clinical area [as] clinical experts and [are] seen as very credible in their role,’ says Gaynor Varden, practice development lead nurse for neurosciences and orthopaedics.

At band 7 there are practice development nurses who do less mandatory training but instead look at the development needs of different groups of staff. That includes monitoring the preceptorship programme for newly qualified staff, and facilitating a band 6 development programme. Ms Varden says: ‘What we try to do with that group of staff is to look at their development needs but also look at what we need in the trust. So, for example, the last one we ran was around standardising the approach to recording clinical observations.’

The top layer comprises Ms Varden and her colleagues, who are the lead nurses, and who coordinate training from a more strategic viewpoint. They adopt a supportive attitude instead of a carrot and stick approach. ‘Rather than “we’ve come to check that you’ve done this training”, it’s all about working in partnership with all staff and especially with the ward managers.’

Ms Varden says there is support for training from all sides of management at the trust. She believes that it is that commitment, along with believing in the service they deliver, that are the key elements to training – rather than sound finances.

Being able to release staff comes down to being organised and planning well ahead.

She says: ‘We plan our training calendar 12 months in advance. Obviously things change, people have to swap around, holidays might interfere with that but at least if we know that people are booked in, then we can do that swapping and changing as and when it’s required. To rely on booking things at the last minute doesn’t work.’

Being flexible is essential, says Ms Varden. ‘We’ve all been nurses so we do appreciate that wards are extremely busy and there are occasions when they can’t release people. We run training however and whenever we can.’ That includes Ms Varden going in at ‘odd hours’ to make all training available to night staff.

Another key to success has been changing the culture around training, since in the past nurses were tempted at the end of a shift to wrap up their paperwork and head home, rather than attend a course. Ms Varden says the practice development team now encourages people to attend. ‘I feel strongly that over the last six months especially, we’ve turned that around and sessions are very well attended because people want to be there.’

Part of that culture is personal motivation, where staff fill in for each other to help ensure they can all get to training. ‘They’re not just going because they [have to], they actually get a lot from it,’ she says.

‘We have 22 specialist nurses across neurosciences, which is a lot of expertise and knowledge that they can pass on to other nurses [as part of our in-house training].’

Having a wealth of specialist experience on tap is a key ingredient to training for nurses at Evelina Children’s Hospital, which is part of Guy’s and St Thomas’ NHS Foundation Trust in London.

All newly qualified staff in children’s services undertake a rotational programme that is organised by the department’s practice development team. Rotations include general paediatrics plus specialties like cardiac and renal care, and ICU.

‘We have a lot to offer here,’ says Caroline Spencer, assistant head of nursing for children’s services. ‘The newly qualified staff appreciate the support that they get.’

She adds: ‘Because there are excellent development opportunities, that does help support recruitment and retention
of staff.’

Time Out For Training - NT's campaign aims

  • To persuade trusts to guarantee sufficient training time is set aside for both career progression and patient safety

  • To compel the government to bring back ringfencing of training budgets

  • To persuade SHAs to guarantee that education funds are spent only on training

  • To raise awareness of the importance of post-registration training for nurses for the profession, those in the NHS and the wider public

  • To secure guarantees for sufficient backfill to cover the training requirements of nurses

  • To support nurses in lobbying trusts and government on their training needs

The trust that provides training modules through headphones

New, modern, intriguing and novel – not words normally associated with mandatory training. But it’s how Karen Vella (pictured), head of organisational development at Mid Yorkshire Hospitals NHS Trust, describes the situation at her trust, which introduced a media player to provide flexible mandatory training that is very specific to the organisation.

The films for the media players were produced by MezzoFilms and enable staff to listen to training modules through headphones or watch them on a computer.

She says: ‘Because it was new and modern, people were intrigued to find out what it was all about. And because it was all filmed locally – they used a combination of library images but also local filming using our staff – people wanted to see the training programme. It was partly the novelty factor but also the fact that it was very real.’

The key driver behind the initiative was a commitment from the board to ensure that all staff were receiving all of their mandatory training. The commitment filtered right through the organisation, including heads of nursing, who made arrangements for filming in clinical areas, to portering staff who took part in the filming by showing the correct way to move laundry trolleys and pick up boxes.

‘As an organisation we spent a lot of time clarifying the mandatory training requirements of individuals in the organisation,’ adds Ms Vella. ‘Senior people were involved in that, including directors and clinical directors. I think because we did that we got engagement.’

From the nursing side, the main issues were around ensuring the content was right, so that training materials were applicable to the local context, and flexibility, since nursing staff said it wasn’t always easy to get released from the workplace to attend classroom-based training. Staff now have options. And it’s cost-effective – the trust bought 600 media players for less than £2 each.

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