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”
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.
Nurses should learn more ‘informally on ward’
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”
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.