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Exclusive: Nurses should learn more ‘informally on ward’

  • 13 Comments

Sending nurses off on training courses is not always the best way to improve care, according to a leading nursing expert who has called for more “social learning” on the wards.

Professor Jan Dewing, director of the Centre for Person-centred Practice Research at Queen Margaret University in Edinburgh, said she wanted the NHS to move away from routine investment in training to develop more informal, workplace learning.

“Some training is necessary but what seems to be happening is a proliferation of training for everything,” she told Nursing Times. “As a profession, we need to be technically competent but we have other learning needs.” 

“With social learning people can learn from each other and work through things together”

Jan Dewing

She said key professional skills and knowledge were at risk of getting lost amid training focused on implementing policy and this was reflected in complaints from patients and issues around poor care.

“The emphasis is generally on implementing the evidence and compliance, because it is all going to be measured,” she said.

“Yet the real stuff, the heart of nursing practice is how we provide individualised or person-centred care to people, especially when they don’t want the evidence delivered in the way an organisation wants it delivered,” she said.

“We need other types of learning that takes place close to practice where nurses and other healthcare practitioners meet to talk about issues that matter,” she told Nursing Times.

Social learning could involve weekly or monthly gatherings, coaching sessions and impromptu knowledge and learning huddles similar to patient safety huddles.

Queen Margaret University

Nurses should learn more ‘informally on ward’

Jan Dewing

She highlighted that, at one trust, a consultant nurse did teaching rounds for nursing staff.

“Nursing staff say what they want to talk about – we want talk about this man who has delirium and this particular problem,” said Professor Dewing. “They set the agenda and don’t have to come out of practice. It is happening in real time, with real issues, real people.”

Challenges include the fact many nurses do not have instant access to a computer at work and are banned from using mobile phones, which could enable real-time research and learning, said Professor Dewer.

Meanwhile, spaces on wards where nurses can meet and learn have been taken away.

“Part of the benefits of social learning is it brings people who work together to learn together,” said Professor Dewing.

“Often when you go off and do training you go on your own. Under current champion or trainer initiatives again it’s one person who goes off and is expected to come back and make all these changes,” she said.

“Whereas with social learning people can learn from each other and work through things together so it does much more than training when it comes to help develop effective cultures,” she noted.

Professor Dewing, who is Sue Pembrey chair of nursing at Queen Margaret University, said there was evidence from practice development work at her university and with partners, such as the Foundation of Nursing Studies, that social learning could change the culture with teams.

“Changing the culture is about making people notice more what is going on in practice, finding it easier to ask questions or challenge people in positive ways,” she said. “Those three things alone create a safer care environment and help everybody to be responsible for quality.”

“It should be about creating a dynamic learning environment”

Jan Dewing

She said learning and development teams, and nurses responsible for continuous professional development were ideally placed to introduce and encourage social learning, which can count towards revalidation.

However, Professor Dewing stressed that the approach needed facilitators at the outset because nurses were used to training where they turned up, signed in and knew exactly what the session would be about.

“There are lots of people in posts in NHS organisations supporting new nurses, return to practice nurses and nurses new to this country,” she said. “People in these positions can introduce different types of learning experiences and encourage learning to take place in the workplace.”

Ideally, the approach needed executive support and she said it was vital nursing leaders had the opportunity to develop skills to enable workplace learning, and saw it as “their responsibility to make it happen”.

“It isn’t just about organising training, it should be about creating a dynamic learning environment with lots of different things happening for different people,” she said. “Leaders need to play an active role in making that happen.”

Professor Dewing gave a public lecture entitled Workplace learning in nursing and healthcare: leading at the edge at Queen Margaret University on 16 June.

A recording of the lecture will subsequently be available from the public events archive on the university website.

  • 13 Comments

Readers' comments (13)

  • michael stone

    “The emphasis is generally on implementing the evidence and compliance, because it is all going to be measured,” she said.

    That is a serious problem - 'compliance with what is measurable': it often leads to significant divergence from 'what is sensible and needed'.

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  • Social learning is now the buzz word is it!...Nurses on the wards barely get time to greet their fellow members of staff let alone find time to go on ward rounds...oh please...we are going backwards and forwards. I take the point about one nurse going on a training course who is then expected to come back and pass on the information gleaned, however, in real terms it is nearly impossible to find time to send off one person on a course in general. My daughter who is a NQ Nurse is spending most of her days off doing further research and reading based on the previous shifts experience. It would be nice for her to have a chance to discuss this new reading with fellow nurses however it is a pipe dream. In previous posts Mentors are advising that they have not got time to go on the mentoring courses to enable further learning of students. We all realise the more you learn the better it is for us patients but those of us with insider knowledge know that it is far from being as simple as that. Those of you out there working your backsides off are appreciated, you really are.Keep going all of you.

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  • I like the idea of social learning just wonder how the content can be measured and assessed to ensure that all staff are accessing similar levels of knowledge and to ensure that standards remain constant across the board. What evidence of learning will staff have going forward.

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  • I get it, we are spending money on courses that the NHS would rather we didn't. However although 'learning on the job' is a wonderful concept, with the workload on the wards now, it is sometimes difficult to find time to stop and think about anything other than getting the job done well and not making any mistakes. Attending study days and short courses allows one the time to exchange ideas with staff from other areas. It allows experts to impart new ideas and up to date research based information. I am afraid the days of " weekly or monthly gatherings, coaching sessions and impromptu knowledge and learning huddles", are a thing of the past for most, (although I remember them well), they went out with the demise of the 'overlap' of staff between shifts. That was the time when research papers were critiqued and expertise was shared. Sadly the clock is now always against us.

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  • Ha ha ha....I really don't know whether to laugh or cry with despair at this re invention of the wheel...it now has a new name it seems 'social learning'...are we not already doing that..in the form of experiential learning, the process of learning through experience, and is more specifically defined as "learning through reflection on doing". Hands-on learning is a form of experiential learning but does not necessarily involve students reflecting on their product. I will resist the urge to quote reflection models...the problem is there are not enough nurses...

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  • I tend to agree with Anonymous 4:09 PM - while the expertise of nurses around you can be a wonderful thing to mine and exploit, as well as fostering a great environment for the growth of high nursing standards of practice this does not reflect the experiences of nurses working in high volume high pressured environments often in circumstances which are less than ideal. If we rely on social learning without making work environments places where this can happen naturally we are doing staff and nursing in general a great disservice. I also think Jo's comment about variability of standards is realistic - there needs to be a benchmarking process led by local nurse leaders

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  • In common with others this was how most of my training was delivered pre and post registration. Universities then said they could deliver better education but now it seems they want the student to pay the university for their colleagues to teach them, great business model!

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  • This is a badly informed view from a nursing professor which would never be heard from our medical colleagues because it can too easily be used to legitimate cutting post-registration education and training budgets for Registered Nurses (RNs). This sort of short-termism has be seen against current moves to cheapen the British RN workforce through introducing yet another ancillary grade - the 'associate nurse' (a poor recreation of the old SEN role) - and the drastic cuts proposed to student nurse busaries which will also potentially damage not just recruitment to undergradute nursing programmes leading to registration, but will have the added potential to further decimate recruitment to health visiting, district nursing and school nursing programmes which are highly valued yet in very short supply. The British nursing professoriate need to ask itself some very important questions in the current socio-economic climate about where it actually stands regarding the current political moves to destroy the hard earned position of the profession within higher education.

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  • michael stone

    I do see Kevin Corbett's 'it can too easily be used to legitimate cutting post-registration education and training budgets for Registered Nurses (RNs)' as a potential danger.

    But I don't see 'learning from each other' as being a sensible REPLACEMENT for structured learning - I see it as a useful ADDITION TO structured learning.

    And if it is seen in that context - as something very much to be promoted, encouraged and facilitated - you would never be 'assessing the learning from each other': you would still be assessing 'what does the nurse understand' about the topic at hand.

    However, it seems clear from several posters, that in the reality of current working enviroments, nurses are so 'time poor' that there is not really much possibility of this 'on-the-job nurse-to-nurse' type learning happening.

    And I might have paid less attention than I should have done, to precisely what the article was suggesting (I'm in favour of 'reflective practice' and 'peer-to-peer on-the-job knowledge/understanding sharing' - but perhaps the article was promoting something different).

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  • Finally, the majority are united. Michael Stone has it in one!
    Not replacement but in addition to...sharing knowledge is wonderful but who ever is doing the sharing has to be sufficiently trained/educated/experienced to ensure that the information being passed on is current/correct and the most validated. Time poor is the key and there is no point anyone suggesting making their OWN time available as by the time you all get a break you are too worn out to want to think about work. We need more of you and soon.!

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