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Placement of the Year Winner - Bolton

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The smiling faces of engaged students who were enjoying their placement at Bolton FT is the one thing that stuck in the minds of the judges overseeing the marking of the Placement of the Year category in the Student Nursing Times Awards 2011.

Bolton’s practice education facilitators didn’t just want those judges to take their word for it that students were finding their placement rewarding, so they made a DVD of students describing what it’s like to be on placement at the busy acute trust.

Student feedback is taken seriously at Bolton, with university evaluations showing 90% of students feeling that placement areas see teaching and learning as important. But the trust is striving to achieve 100% and has action plans in place to support placements to attain that high level.

The seven practice education facilitators shared a philosophy that all students deserve quality learning environments within all areas of the healthcare economy, from their very first day on clinical placement through to being newly registered health professionals.

“We really believe it’s important to create a student-friendly event,” says the practice educator facilitator Sam Bulpitt.

It would be all too easy to disregard students’ needs because of the hectic pace at Bolton FT, which serves a population of approximately 260,000 patients and accommodates 350 healthcare professional students a year, mostly within nursing, from Salford University, within 85 placement areas. There are about six students per placement area with a ratio of around two students to each mentor. Despite the scale of the placements, the practice education facilitators work hard to ensure that all placements are consistently providing the right outcomes and equitable learning environments and patient care.
Because students are working in busy clinical environments where traditional mentoring can be difficult, the team promotes a culture of innovative mentoring, ensuring students develop their knowledge, skills care and compassion in a variety of ways alongside traditional mentoring. This change in culture supports mentors with the assessment of students’ knowledge, skills and capability through the involvement of other professionals, production of personal development plans (PDPs) and evidence of their development. Students have given positive feedback, and say the approach is instrumental in helping them recognise what they need to improve.

The trust also uses blended learning to help student’s link theory to practice. It has a programme of work-based learning forums, directed learning workbooks and e learning resources, which are directly linked to the nursing curriculum. This culminates into a 10-week consolidation programme (pre-preceptorship), supporting final placement students to prepare for their role transition and post-qualifying period. Being curriculum led, it ensures the consolidation of university-based theory into clinical practice. The forums provide a platform to enable students to discuss, reflect and challenge current practice with the direct support of the team in a safe environment. The aim is not to replicate theory taught via university but strengthen it by clearly linking clinical practice, theory and assessment process.

Work-based learning booklets are available within clinical areas and intranet is used. All placement areas have welcome/induction packs available online.

The practice education facilitators have also developed a curriculum map to support mentors and students to tailor the students’ clinical learning and development to the appropriate point in their training. Hubs and spokes, devised in partnership with placement areas, help students to understand a patient journey; other healthcare professional roles and use reflective skills to critically analyse practice and identify further development.

Hubs and Spokes booklets encourage students to identify their own learning objectives, both for the Hub placement and any spokes identified and gives the students an opportunity to reflect on their experiences. PDP development is supported by mentors in practice and the team at forums where students identify gaps in any skills and knowledge. Opportunistic learning is encouraged within placement areas and promoted within the Trust NMC-accredited in-house mentorship programme such as working alongside a paramedic student who may be on placement; or junior medical colleagues; teaching another student a skill.
Far from being just about theory, theteam supports Trust initiatives for example Safety Express, 100 voices and NW Care Indicators, giving students an opportunity to understand and play an active part in national and local agendas. Students have been involved in Trust Engagement events – the Big Conversation - to create an environment where students can connect with the organisation, feel valued and understand the behaviours and attitude required to work within the trust.

The annual review of their educational audit action plans are in place along with action plans for the quarterly student evaluation received from the HEI and an e-survey to obtain student feedback.

Students are made to feel special throughout their time at Bolton. The trust has a recognised student of the year award within our Trust. As an organisation we have developed, and see students as part of our future workforce. It has employed 85-90% of our pre registration nurses in recent years and are beginning to work with Workforce planning to ensure employment for future cohorts. This in turn supports the need for the organisation to engage with the pre registration student population to ensure the workforce is fit for the future challenging healthcare needs.
Named PEFs in each placement area allows students and mentors to raise concerns timely and confidentially, which are then dealt with by individuals that understand the day to day challenges all face within clinical practice. We have visibility and an open door policy, and it’s clear that with their university link lecturers and mentors, we are there to support them. Since the team has been in place, there have been an increase in complaints and failures by mentors, which shows that people have the confidence to speak up or fail students.

Quarterly Student Focus Groups – using the appreciative enquiry approach – seek to engage students and renew, change and improve performance of placement areas. Student Rep drop-in sessions have been set up from feedback from the Big Conversation engagement event and provide an opportunity for students to raise issues about clinical placements, which the rep can then raise informally with the team or university link lecturer.

“Occasionally, we have students who complain that they are treated like HCAs,” says Ms Bulpitt. This was taken forward and discussed within the student rep group forum. This highlighted the issue of maintaining supernumerary status whilst at the same time educating the students about holistic care and team working, and that it is everybody’s responsibility to deliver care, from toileting, to giving out meals and feeding.”

By offering a variety of learning material/opportunities, the Bolton Practice Education facilitators hope to meet most students’ learning styles. Mentor guidance supports a practical, structured way of meeting skills development and action planning. For example, in medical devices workshops, core medical devices used by students in placement areas are covered and an overview of policy and their responsibility and accountability gives placement areas assurance of students’ baseline knowledge. Forums are delivered in a variety of ways through Powerpoint presentations; group work; scenarios; DVD and board games, examples linked to clinical practice are paramount and students are asked to reflect on their placement experiences is undertaken.

In fact, the judges acknowledged this trust’s “creative and different styles of teaching”. “We are trying to move away from death by Powerpoint,” said Ms Bulpitt.

The trust has authored a DVD on medicines management, a DVD about a complaint made at the hospital and how that affected the patients, and are in the process of producing another called coroner’s court about a death. The trust pulled on its strength of being multi-disciplinary to resource the production of these professional DVDs.

The Trust has in place its own NMC-accredited mentorship programme, which is linked to placement areas and the needs of the student, HEI and organisation. The programme is theory and work based and supports the trainee mentors to review their learning environment and develop the placement so that it supports each student individualised learning needs.

It is clear that clinching a finalist place at the inaugural Student Nursing Times Awards in the placement of the year category has not been regarded as the finale, but the start of a fantastic journey for Bolton FT.

In fact, after the awards, it built on the success of the complaints DVD, to produce a medicines administration DVD and another student experience DVD.

The practice education facilitator says its pledge is “to feel proud to work in a team that values and respects both patients and staff and promotes a culture of learning and development which supports staff / learners to deliver the best possible care to all our service users”.

Tips for providing a great placement

  • If you’re a large trust, think about combining resources to produce learning materials, such as DVDs that can be used by all the wider team
  • Produce DVDs, notes or documents that can show a new cohort what to expect from the student’s perspective
  • Be visible and available to both mentors and students so they can raise issues, challenge practice and make complaints
  • Create your own student of the year award to recognise those who do well in your organisation
  • Don’t just settle for 90% - put action plans in place to work on reaching 100%
  • Set up a student rep body – and don’t be afraid of hearing what they have to say
  • Engage all students in trust-wide initiatives/audits to promote a sense of pride and belonging
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