Care homes are being viewed “as a last resort” for nursing students when no other placements can be found, according to managers, who say the setting should be valued more highly by educators.
They argue that universities should do more to recognise and promote the sector as a stimulating and rewarding place to work.
“Care home nursing is a much misunderstood part of the nursing family”
This is one finding from a year-long project designed to make the most of the “untapped expertise” of nurses working in care homes and boost the image of care home nursing.
The Teaching Care Home pilot was funded by the Department for Health and led by Care England, which represents independent care services.
It involved five care homes embarking on a range of nurse-led projects aimed at improving the learning environment for staff, as well as nursing students and others on practice placements.
Key staff from each home received bespoke training from the Foundation of Nursing Studies, which also consulted staff, service providers, residents, universities, commissioners and others in order to draw up a draft vision for a “teaching care home”.
Meanwhile, the year-long project has also seen Manchester Metropolitan University devise a new Education and Development Framework for Care Home Nurses.
Findings from the pilot have been compiled in a series of reports put together by the International Longevity Centre UK and published today.#
- Report One: An introduction to the ‘Teaching Care Home’ pilot
- Report Two: Full scoping review from Manchester Metropolitan University
- Report Three: The voices of those who participated in the pilot
- Report Four: Additional outputs from the pilot: tweet chats, vision statement and education and development framework.
- Report Five: Summary impact of ‘Teaching Care Home’ pilot
As part of the project, university researchers interviewed managers, registered nurses and care workers at each site.
“The registered nurses who were interviewed often spoke positively about the person-centredness of their work,” said one report on the themes that emerged from the interviews.
“This was contrasted with nursing in the NHS,” it said. “In a care home setting, some of these nurses felt they had the opportunity in their job to form meaningful bonds with both residents and their families.”
However, nurses also highlighted the need for more continuous professional development to help them develop their own skills and achieve career goals, such as becoming prescribers or managers.
“Both nurses and carers have a vital part to play in the professional nursing agenda”
Many “spoke passionately about the existing talent in care homes” and the need to ensure all staff had training and career paths to help them realise their potential, it said.
“The importance of leadership and good management was also highlighted in retaining talented nurses in the sector,” stated the report.
Care home managers added that lack of financial resources was the main thing getting in the way of providing training opportunities for staff.
They also said negative views of care home nursing held by universities and others were a barrier to attracting new nurses to the sector.
All managers interviewed said they were interested in hosting student nurses on placements and three of the care homes already did so.
However, managers also expressed their frustration “at the type of student nurse they were sent”.
One said they were often sent mental health nurses rather than general nurses.
“One manager was frustrated that students were sent to the home as a last resort because they can’t find a placement elsewhere,” said the report.
Care homes should be viewed as positive placements for students
“This made the manager feel the home is seen as second class and they wondered if the students felt this too. The manager also felt the staff at the university did not appreciate the reality of care home nursing,” it said.
One suggested those responsible for assigning student nurses did not fully appreciate the complexity of care home nursing and that it could give nursing students “important experience in skills such as leadership, budget management complex clinical care, decision making and responsibility”.
Managers said care home nursing was a specialism requiring skills that often made it “more challenging than hospital nursing”.
“If you want to learn about staff leadership, I’ve got 150 staff that need leading,” said one. “If you want to learn about managing a budget and appropriately staffing units according to a budget, I’ve got £3.2m coming in and out. If you want to learn about decisions you make and how they would directly affect an individual’s care, I’ve got individuals here with very challenging nursing needs.”
In order to secure more student placements in care homes, they were keen for university placement teams to visit homes and “see what working in a busy, good care home is like as a nurse”.
As well as identifying overarching themes, the project involved specific pieces of work.
Care homes should be viewed as positive placements for students
Nurses and other staff who took part reported improved teamwork, communication and confidence and said they had been inspired to look for new ways to improve care.
One of the pilot sites – Berwick Grange in Harrogate – developed a career route for care workers from overseas who were nurses in their home countries to become registered nurses in the UK.
This included a tailored course to improve spoken and written English. Seven care workers are about the start the programme.
The home, which is run by care provider MHA, also strengthened links with Harrogate College and took three health and social care students on placement.
According to the evaluation, “staff reported a change in atmosphere and staff morale” at the home and one care worker is now applying to do a nursing degree as a result of the project.
Other projects explored particular aspects of care. Staff at Chester Court in Bedlington looked at ways to improve nutrition and develop an approach that was more responsive to the needs and wishes of residents.
It included introducing more flexible mealtimes and a cold menu available at any time of day.
Meanwhile, staff with expertise in dementia provided training for others on the challenges of ensuring residents with the condition were properly nourished. Staff reported improved weight gain in residents.
The home, which is run by Barchester Healthcare, also saw improved staff morale after introducing a points scheme to reward those “who go the extra mile”.
Professor Martin Green, chief executive of Care England, said the pilot showed care homes had a key role to play in training and developing an integrated workforce.
“These pilots demonstrate that the care sector is a crucial part of the health and social care landscape, and both nurses and carers have a vital part to play in the professional nursing agenda,” he said.
“This initiative has fostered strong partnerships and goes some way to developing a sustainable workforce that takes pride in high quality, joined-up care,” said Professor Green.
One of the goals of the project was to “improve the image and visibility” of care home nursing.
Evaluators said it is “too early to judge” whether this objective had been a success and ongoing work would be “crucial” to spreading the word among undergraduate nurses.
Professor Deborah Sturdy, director of health and wellbeing at Royal Hospital Chelsea and nursing advisor to Care England, said it was important to challenge misconceptions about care home nursing.
“Care home nursing is a much misunderstood part of the nursing family that requires a plethora of skills not often recognised by NHS colleagues,” she said.
“Without expert nurses in care homes many older people, or those with learning disabilities, do not receive the care that they need and deserve,” she added.
The pilot sites are as follows:
- Millbrook Lodge, Orders of St John Care Trust in Gloucestershire
- Rose Court, HC-One in Bury
- Berwick Grange, MHA in Harrogate
- Lady Sarah Cohen House, Jewish Care, in Barnet
- Chester Court, Barchester in Bedlington