A new approach to mentoring that has allowed an NHS trust in Great Yarmouth to double its number of student nurse placements is to be extended across all departments in the organisation, marking further support for the model in the region.
James Paget University Hospitals NHS Foundation Trust will no longer use its traditional model in which mentors work one-to-one with students, and instead will use the ‘collaborative learning in practice’ (CLiP) approach that sees coaches and fellow students support those on placement to deliver care themselves.
It follows a similar move by the Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, which is also now using the CLiP model after it and several trusts in the region ran pilots with the University of East Anglia in 2014.
The model was later highlighted in a major assessment of nurse education commissioned by Health Education England in 2014, called the Shape of Caring review.
Nurses leading the new approach at the James Paget Hospital said it was needed to improve the quality of learning for students so they were more confident upon qualifying, and to deal with the trust’s limited capacity to provide placements in the face of increasing numbers of trainee nurses.
“This [the CLiP mentoring model] has created a massive change in the culture on the ward, to a learning culture”
They also said they hoped it would lead to fewer students in the region dropping out of training or choosing to work elsewhere. The East of England currently loses 28% of student nurses during their university programmes.
Under the new model, a registered nurse – who does not need to be a qualified mentor – works as a coach with a group of students who are at different stages in their training.
The students deliver hands-on care to patients themselves, but are prompted and questioned by the coach who guides their practice. Senior trainees are expected to help provide teaching to junior students as well.
Students must still have access to a qualified mentor – who will eventually sign them off – for 40% of the time they are on placement in order to comply with Nursing and Midwife Council standards.
Those leading the new approach at the James Paget Hospital outlined the CLiP model to a group of nurses from around the country this week during a conference at the trust.
“All of the staff are involved. Every single member of my staff now coaches students and enjoy having them with them”
The trust has been using the model across a range of wards including those in midwifery, paediatrics, acute medicine, orthopaedics, stroke and the emergency assessment unit.
On average, the number of students has doubled to 12 during a placement period in each ward, with support provided by a group of six coaches.
They said the delivery of care by students meant trainees were more confident in their abilities, that it was easier to identify those who were struggling, and that there was also an indication patient outcomes had improved as a result – shown by reduced numbers of falls and pressure ulcers and shortened lengths of stay.
Sister Lisa Ruthven, who first introduced the new mentoring model on her ward at the trust, said it had benefits for staff as well, because it had created a “learning culture” in which nurses reflected on their practice, and meant mentors had more support from coaches.
A clinical educator post supports both roles and delivers training to coaches. The trust was originally provided with additional funding from Health Education England to set up the model and training. It now receives no extra funding and uses money through its ongoing placement tariff from HEE to pay for the clinical educator post.
“This has created a massive change in the culture on the ward, to a learning culture. When you have that many students coming through on a regular basis – the thing they do is question. When you are being questioned every single day and shift, it makes you question your practice,” said Ms Ruthven.
“All of the staff are involved. Every single member of my staff now coaches students and enjoy having them with them and several have gone on to do their mentorship training because it’s now not quite as onerous as it used to be,” she added.
“Without the CLiP model…we wouldn’t have had the ability to provide enough placements or in the right areas”
However, she also acknowledged there were some challenges, including concerns about accountability for sign-off mentors who now receive feedback from coaches, and also anxieties among healthcare assistants and registered nurses who needed reassuring about students delivering care.
Sharon Crowle, a nurse and head of education and practice development at the trust, later told Nursing Times the CLiP model was helping to improve both the quality and number of placements, as well as to reduce burnout among mentors.
“Without the CLiP model we would have had difficulties meeting the capacity, because looking ahead to the three year cycle of commissioned training places we wouldn’t have had the ability to provide enough placements or in the right areas,” she said.
“We also know there is a huge number of nurses retiring nationally, so we need to look at new ways to support learners, and mentors too,” said Ms Crowle.
“It’s busy in the NHS, we need to nurture and look after our staff. Coaching is a fantastic ethos for everybody which also hopefully makes us a place where people want to work and stay,” she added.