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Innovation

An alternative model for practice learning based on coaching

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Northampton General Hospital Trust uses a placement model that encourages students to support each other and shares the responsibility of practice learning among the whole team

Abstract

Practice Learning at Northampton (known as PL@N) is an innovative method of managing student nurses’ practice placements and learning experience. Designed and implemented at Northampton General Hospital Trust, it uses a coaching model rather than the traditional mentoring model. After being piloted in 2016-17, the model was rolled out and there are currently 21 PL@N wards or areas across the trust. This article describes how the model works and its outcomes so far.

Citation: Ashworth G (2018) An alternative model for practice learning based on coaching. Nursing Times [online]; 114: 12, 30-32.

Author: Gillian Ashworth is clinical placement facilitator, Northampton General Hospital Trust.

  • This article has been double-blind peer reviewed
  • Scroll down to read the article or download a print-friendly PDF here (if the PDF fails to fully download please try again using a different browser)

Introduction

Practice Learning at Northampton – locally known as PL@N – is a new model of learning for all ward-based student nurses on placement at Northampton General Hospital. It uses a coaching model, rather than the traditional mentoring model, and involves all students in adult nursing including trainee nursing associates, return-to-practice students and adaptation students.

PL@N was introduced because the trust wanted students to:

  • Feel better prepared for professional registration (in the past students often told us they did not feel sufficiently prepared;
  • Have more opportunities to develop their skills in managing a ward shift.

Furthermore, the trust also wanted to reduce mentor fatigue and encourage the whole nursing team to actively participate in student learning.

How PL@N evolved

In recent years there has been growing concern regarding clinical placement and mentoring capacity. The national shortage of mentors is being addressed by the Nursing and Midwifery Council in its revised nursing education standards: in the Standards for Student Supervision and Assessment (NMC, 2018) from 28 January 2019 the roles of ‘assessor’ and ‘supervisor’ will replace mentors and sign-off mentors, and all registered nurses will be required to supervise or assess students in practice.

PL@N is delivered by registered nurses who have completed coaching training provided by the trust. It uses the whole ward as a learning environment and aims to enhance the quality of the learning experience by enabling:

  • Third-year students to lead the bay to which they are allocated;
  • Second-year students to initiate care and support;
  • First-year students to participate in care delivery with support from second- and third-year students.

Practice-based learning models have proven successful in countries such as the US, the Netherlands and Australia (Royal College of Nursing, 2015). In the UK, several trusts have adopted similar models, such as the Collaborative Learning in Practice (CLiP) model (Lobo et al, 2014). James Paget Hospital in Norfolk is one such organisation and its team helped us set up our pilot. The coaching model we use is OSCAR (Gilbert and Whittleworth, 2009) (Box 1), as it best lends itself to practice.

Box 1. OSCAR coaching model

O: Outcome – what would you like to achieve today?
S: Situation – what is happening currently?
C: Choices and consequences – what can you do and what could happen?
A: Actions – how will you do it? Who will support you?
R: Review – when will we evaluate your progress?

According to Starr (2011), coaching builds students’ confidence in their clinical skills and develops their self-awareness by encouraging reflection and enhancing relationships. Through our evaluation, coaching has also been shown to reduce pressure on mentors. It allows students to ‘step forward and out’ to deliver care, thereby allowing coaches to ‘take a step back’ and observe.

Table 1 outlines the differences between mentoring and coaching.

table 1 differences between the roles of a mentor and a coach

How does PL@N work?

The PL@N model encourages students to support each other and shares the responsibility of student practice learning. It can be adapted to suit most specialty learning environments and is based on the following principles:

  • Two bays (or a group of up to 16 beds) within a ward are used for practice learning; once assigned to this purpose, these areas remain ‘PL@N bays’;
  • Three students – ideally one first-, one second- and one third-year student – work together in one bay (or are allocated a certain number of beds);
  • The three students are supported by a named coach for the duration of the shift;
  • One coach can supervise up to three students at any one time;
  • The shift coach is chosen by the ward manager or coordinator;
  • One month before PL@N is implemented on a ward, staff members receive group training sessions on coaching;
  • Any registered nurse who has received coaching training can be a coach (a mentor qualification is not required) but the ward manager or coordinator should not take on the role of coach.

Students

Students are allocated patients and tasks that require skills that are in line with their required level of learning. The need to provide holistic patient care is kept in mind:

  • The first-year student will care for two less-dependent patients who do not have complex needs with support from a healthcare assistant (HCA);
  • The second-year student will care for four patients, with support from the first-year student and taking directions from the third-year student;
  • The third-year student will manage the first- and second-year students, and care for two patients who have more complex needs, with support from both the shift coach and the multidisciplinary team.

Students follow a static off-duty rota of long shifts, whereby they are in practice Mondays, Tuesdays and Fridays; the NMC requirements for nights and weekends are factored into the rota. This enables forward planning for all.

Mentors

For the duration of their placement, students are supported by one identified mentor (allocated by the ward manager), who is expected to work as the shift coach at the beginning, in the middle and at the end of the placement. All students in one bay have the same mentor. Mentors liaise with the shift coaches, ensuring that all learning outcomes are met and they gain a fair and objective view of the students’ needs and progression.

Educators

The PL@N educator role was created in the practice development team to:

  • Implement and maintain the PL@N model;
  • Provide coaching training to new or returning members of staff;
  • Resolve potential problems.

The PL@N educator visits students, mentors and coaches once during each shift to address any issues or queries as early as possible.

As students are funding their own education, we felt that quality needed to be at the heart of their experience so that, upon registration, they would feel equipped to be confident and competent practitioners. The role of the educator is proving pivotal to this.

‘Hour of power’

The ‘hour of power’ is one hour per day shift that is reserved for studying; on night shifts, it is at the discretion of the coach. It is negotiated with the shift coach in advance on a daily basis. The hour of power can be used to explore any relevant subject, whether in medicines management, disease pathology, patient management or other topics. Ideally, the students take this hour alone, but there may be situations conducive to shared learning – for example, if an event such as a peri-arrest occurs on the ward.

The hour of power cannot be taken as an extended break or to start or finish a shift early. Students must remain on the premises and can access the library and/or the placement area laptop.

After completing their hour of power students are required to feed back their findings to the shift coach. Any evidence gathered needs to be uploaded to their electronic portfolio and recorded in their folder held on the ward. Students are also expected to present their most remarkable hour of power to the university and placement team.

When mentors act as the shift coach, they also take an hour of power during the shift; they are expected to use it to complete students’ practice portfolios.

Pilot, evaluation and roll out

PL@N was piloted from May 2016 on two wards for a year, after which we conducted an evaluation using anonymous questionnaires exploring students’ and mentors’ experiences. Twenty-six out of 92 students (28%) and 23 mentors out of 68 (34%) completed the questionnaires.

The outcomes were overwhelmingly positive: 95% of mentors and 96% of students who responded had had a positive experience. Students felt supported and armed with greater confidence. Less-positive feedback from students related to the fixed off-duty rota, not working alongside their allocated mentor as much as they would have liked, and not fully understanding the role of the shift coach. Boxes 2 and 3 show further responses from students and mentors.

We addressed the issues raised and, after the success of the pilot, it was decided to roll out PL@N to additional wards or areas. Currently, there are 23 PL@N wards or areas across the trust and the roll-out is continuing.

Box 2. Feedback from students (n = 26)

100% found the hour of power useful
100% believed that contact with the educator was sufficient for their needs
96% had a positive learning experience
92% thought that the static work rota and allocated mentor were adequate to meet their learning objectives
88% stated that worries and concerns were addressed during the placement
84% felt more confident with practice as a result of the model
76% used the support of other students in the bay to develop their skills and knowledge

Box 3. Feedback from mentors (n = 23)

100% of mentors surveyed found that students complied with the static work rota
100% of shifts had coaches allocated at the start
100% of mentors surveyed said students were involved in handovers
100% of coaches supported students to deliver care to the patients
82% of surveyed mentors received student feedback about the hour of power
82% of the mentors surveyed felt that issues and concerns were being addressed
82% of surveyed mentors thought students were more confident than those who had not been through PL@N placements
65% of mentors used the ‘hour of power’ to complete practice portfolios

Lessons learned

Designing and implementing PL@N was a learning experience for all. Some of the lessons learned are described below.

  • Preparation – plan well, especially the staff coaching sessions, and use the best available methods to deliver coaching to clinical areas; only convert those areas that want to be converted;
  • Communication – good engagement with all stakeholders, including the senior nursing team, practice development staff and universities, is key; you also need to engage with HCAs, who may feel under threat, and make it clear how valuable they are in the learning process;
  • Education – both staff and students will have questions and concerns; you need to keep explaining the principles of PL@N at every opportunity;
  • Adaptation – the perfect mix of students from different years is not always possible, so you need to use PL@N flexibly and adapt it as needed;
  • Data – gather baseline data before you start so you can make meaningful comparisons when you evaluate the model. For example, we noticed a reduction in falls and pressure ulcers during implementation but we could not separate this from several other initiatives that could have had an impact on that reduction;
  • Recognition – a certificate of attendance for coaching will make staff feel appreciated; make sure you include all staff from the ward or area.

Conclusion

PL@N is clearly easing mentor fatigue, as the whole team is involved in mentoring and coaching. It also allows students to guide their own learning and develop their confidence. The PL@N model has increased student placement capacity within the trust by creating 42 extra placements without burdening registered staff with additional work. It has also enhanced the quality of students’ experiences, making them feel more valued and part of the ward team. As one third-year student explained: “PL@N has given me great confidence and progressed me in a professional way more than in any other placement.”

Key points

  • Practice learning for students is often hampered by a lack of placements and mentors
  • Mentor fatigue can be avoided by using the whole team to support student learning
  • Getting students to work together on placements increases their confidence
  • Using coaches allows students to step forward and learn from delivering care
  • The Practice Learning at Northampton (PL@N) model enhances students’ learning experience
  • For a discussion of the Nursing and Midwifery Council’s new standards for student supervision go to: New standards on the supervision and assessment of students in practice
  • Acknowledgements: The author would like to thank Anabel Dobson (Northampton General Hospital Trust) and Karen Thom (James Paget Hospital Trust) for their help in implementing the pilot; staff at the University of Northampton for their support throughout the process; Maggie Coe, associate director of nursing and midwifery, professional and practice development (Northampton General Hospital), for her belief in the project from day one; and Heather Gallagher, associate director for midwifery (Northampton General Hospital), for her support with editing this article.
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Readers' comments (2)

  • Our trust have also been doing it for nearly 4 years now, there are some positives and negatives though.

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  • Sounds great, as a mentor I have allocated whole bay to third year students max of 6 for several years. My experience showed that these nurses were not in a position to actually qualify with confidence. Each student I had give me positive feed back. One saying where have you been during my training. Constant support and training given throughout their placement.

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