Band 5 staff nurses often need targeted training to make the transition to specialist practitioners. A trust set up a course to prepare candidates for degree study
Lorraine Elliott, PGCert, BSc, RN, is clinical practice lead, NHS Blackburn with Darwen.
Elliott L(2010) Supporting staff nurses to train as community specialist district nurse practitioners. Nursing Times; 106: 15, early online publication.
The removal of district nurses from the Nursing and Midwifery Council’s recognised specialist practitioner list has resulted in many employers not commissioning district nurse courses and a lack of clarity about the skills required to be a team leader.
This article discusses a practice development initiative to support learning through a practice based competency programme, to develop skills of local staff members.
Keywords District nursing, Community specialist practitioners, Training
- This article has been double-blind peer reviewed
- As this development programme received positive feedback and constructive evaluation, this approach to role development and competency based practice learning could be trialled in other trusts and clinical areas. This would enable a smooth transition from the staff nurse to specialist role, with opportunity to “practise” the role under guided supervision and clinical/professional support.
- The programme supports the values of The Queen’s Nursing Institute (2009) by using district nurses’ leadership and strategic skills through continuous professional development and service improvement projects.
Many primary care trusts face major challenges in enabling nurses to continue their professional development while maintaining staffing levels to ensure high quality care.
The volume of district nursing work makes it a significant part of the health service. It is also crucial that district nurses can respond to patients’ needs in a proactive way.
Nursing in the home is fundamentally different to nursing in other settings and district nurses are experts in their field. Its key elements are expert assessment and care and the need to work with the whole family and carers as a unit. Historically, these services have been diluted, with reduced leadership opportunities and a lack of recognition of the value of the specialist qualification (The Queen’s Nursing Institute, 2009).
Longley et al (2007) argued there is a lack of definition of career pathways in advanced and specialist nursing roles and educational preparation programmes. However, the Knowledge and Skills Framework (Department of Health, 2004) is attempting to address work based learning and development and the setting of standards in the healthcare workforce. This development programme aims to redress the balance of work based learning, career development and competency development, in addition to raising the profile of the district nurse specialist practitioner role.
The remit of “growing your own staff” is attractive due to their knowledge of local communities and practice populations. However, some staff have had difficulties in meeting the requirements of community specialist practice interviews, which do not enable them to demonstrate their strengths and understanding of the district nursing role. The aim of the competency framework in this programme is to give staff a clear understanding of the district nurse role, with the advantage of being guided and supported through a learning process, ideally in the year before undertaking the specialist practitioner degree.
Students benefit from being exposed to mentors, practice teachers and teachers who have developed themselves to a higher standard, in both academic and clinical settings (Nursing and Midwifery Council, 2006). The mentors on this programme have completed further academic study and are excellent role models.
The initiative was prompted by a decline in the numbers applying for district nursing sister posts. Following a discussion with the clinical practice lead and head of service, band 7 team leaders were consulted and a competency framework was designed.
The removal of district nurses from the recognised specialist practitioner NMC list has impacted significantly on district nursing, resulting in many employers not commissioning district nurse specialist practitioner courses, with course provision now potentially reduced. This could contribute to a lack of clarity on the skills required to be a district nurse team leader/caseload holder, resulting in role dilution. Since competency based practice learning can enable standardisation, the competencies were devised and adapted in line with best practice from the NMC specialist standards for health visitors/school nurses. They were developed with a view to staff completing them under supervision from the district nurse specialist practitioner.
The programme was designed to run over 10 months and included key elements of the district nurse role including:
- Health needs assessment;
- Complex assessments;
- Change management;
- Risk management;
- Teaching and learning.
Criteria for selection were at least two years’ community experience, previous level 3 study and a requirement to go forward to complete the specialist practitioner degree in the following year. Six staff members expressed interest in the posts out of a total of around 50 and four were recruited following interviews.
Learners were supported by a district nurse mentor, who worked alongside them for at least 20% of the week until the competencies were completed.
The staff being developed met monthly with the clinical practice lead to undertake supervised practice visits, alongside monthly action learning sets and facilitated teaching sessions. The clinical practice lead had overall responsibility for the programme’s design, coordination, delivery and evaluation.
At the end of the initial phase of the programme, mentors and development staff were asked to complete an evaluation form. The results were interpreted using a Likert scale ranging from strongly satisfied (5) to strongly dissatisfied (1).
The results were plotted in a graph to show how the feedback between mentors and participants compared. Fig 1 shows the satisfaction levels between the two groups.
The formal evaluation was undertaken in July 2009 through consultation with development staff, mentors and the operational manager. An evaluation tool was designed to critically appraise the programme’s strengths and limitations for future planning. Verbal feedback from both staff and team leaders has been extremely positive, indicating that staff are practising at a more advanced level than in their previous roles and have significantly developed skills in critical thinking and clinical decision making. They have also been exposed to and participated in leadership and change management strategies and developed the necessary skills to manage large neighbourhood teams. From observation in practice and feedback from mentors, this project has demonstrated the challenge required to create a positive learning environment for both teachers and students. Establishing a shared vision, with opportunities to meet learning outcomes in a limited time frame, is crucial when dealing with workload constraints. All involved have recognised the programme’s benefit and value to direct patient care, service delivery and improvement.
Three out of four staff have completed the competency programme; due to illness the fourth is due to complete later. Two out of four have since gained a place on the community specialist practitioner (CSP) degree course which started in September 2009.
One of the problems encountered during the programme is that as it ran from November 2008 until August 2009, the CSP interviews took place in May before its completion. For the two candidates who were unsuccessful at these interviews, it left them feeling disappointed and considering going back to their previous staff nurse role without completing the remaining competencies. To encourage them to complete these they have been given the option of completing them in a reduced timeframe or remaining on the programme until the end date. On reflection it would have been more beneficial to run the programme alongside an academic year.
This programme has enabled four selected staff to complete practice role based competencies with the support and supervision of district nurse specialist practitioner mentors and a clinical practice lead/ practice teacher. While we recognise that this is a small scale practice development, it is a step in the right direction in providing staff with opportunities to develop their skills while gaining an insight into the role of the specialist practitioner.
The use of a competency framework that focuses on role based learning can be replicated or adapted in other areas such as school nursing and health visiting. However, learners and facilitators will require time and professional support in order for them to complete the competencies within the expected timeframe. Within the district nursing service, continuous quality assurance and commitment has been maintained through the support of four district nurse mentors, a coordinator/practice teacher, clinical development adviser, operational manager and head of service. Staff development and improvement has been clearly demonstrated in practice.
The band 5 development role is an exciting initiative for district nursing practice with a clear career development pathway for those who aspire to be a district nurse. It also provides opportunities for district nurses to lead on practice improvement and service development and makes use of their leadership and strategic skills. The development role also raises the profile of district nurses’ role by demonstrating the skills and competence required to practise as a district nurse.
Locally the development role has resulted in an increase in staff wanting to go on to undertake the community specialist practitioner degree and as a result of this the programme will be repeated with four more staff in the second year. The band 5 development role is an excellent example of service improvement as it provides staff with the skills and knowledge they need to prepare them for the CSP degree.
- The programme originated with a “grow your own” philosophy, as it was recognised that it is often too big a leap for many to go from staff nurse to community specialist practitioner (CSP) student.
- The competency based framework was devised to give staff a structured understanding of the district nurse role and to prepare them with the skills and knowledge they need in the year before undertaking the CSP degree.
We would like to thank operational manager Rachel Sagar, acting operational manager Fiona Bentham, head of service Jane Pemberton and all staff in the community nursing service – provider service unit.
Department of Health (2004) NHS Knowledge and Skills Framework and the Developmnt Review Process. London: DH.
Longley M et al (2007) Nursing: Towards 2015: Alternative Scenarios for Healthcare, Nursing and Nurse Education in the UK in 2015. Summary. Pontypridd: University of Glamorgan.
Nursing and Midwifery Council (2006) Standards to Support Learning and Assessment in Practice. London: NMC.
The Queen’s Nursing Institute (2009) 2020 Vision: Focusing on the Future of District Nursing. London: QNI.