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Shake-up of current model of nurse training specialisms needed, says Willis


Community nursing should be explored as a specialist branch of undergraduate courses, according to a major review of nurse education, which also suggests all students should spend two years receiving general training on both physical and mental health before specialising.

The Shape of Caring Review has recommended the Nursing and Midwifery Council investigate whether the current model for training nurses – which sees students specialise in either adult, paediatrics, mental health or learning disability nursing – is fit for the future.

“If we are going to treat more patients with acute needs in the community you do need to look at whether we are producing a nursing workforce that can go straight into that”

Phil Willis

Lord Willis of Knaresborough, who chaired the review, said that despite the healthcare sector calling for better integration between physical and mental health, the nursing workforce was still being educated in “silos”.

He said: “So people focussing on physical health – either with adults, children or people with learning disabilities – do a minimal amount of mental health work and yet mental health goes through everything.

“We’ve also found that mental health nurses – who are brilliant at doing their job – when asked to address some of the physical health issues find that they are not competent to do so,” he told Nursing Times.

Lord Willis said he was not suggesting the NMC “throw out” the specialisms, but that it should look into introducing a “concentrated, detailed and in-depth” first two years of degree training that provided a “deeper” grounding in both mental and physical health.

Specialist training should then begin in the third year of undergraduate training before leading into a year-long, structured programme of preceptorship with an employer in the students’ chosen field, he said.

He has also recommended that the NMC explore whether to introduce additional fields of specialisms, such as community nursing, highlighting the renewed aims in the NHS England five-year plan – the Five Year Forward View – which was published in October.

“The Five Year Forward View has seen a major shift from acute to community. If we are going to treat more patients with acute needs in the community you do need to look at whether we are producing a nursing workforce that can go straight into that,” said Lord Willis.

He added: “What we’ve found is that general practices, which are going to be at the hub of modern health services, are desperate to recruit registered nurses. 

“Yet we’ve found departments in universities and hospitals telling students you can’t do that until you’ve had at least two or three years on the ward,” he said.

Meanwhile, the review also called for the professional regulator to review its current model of mentorship for students.

“Being a graduate and a professional means you share your expertise with others and nurses should constantly be doing that”

Phil Willis

Lord Willis said it was a widely held belief within the nursing profession that, during placements, students should receive one-to-one support from a mentor that signs off their competencies.

However, he said that during the review he had witnessed groups of students being trained by qualified nurses – who acted as coaches – and then report back to mentors who sign them off.

This meant more students could be attached to high quality placements, he said, and therefore the traditional model of one-to-one support should be investigated.

He re-reiterated his point from previous research work that not all nurses should be mentors who sign off students, but said he believed all nurses should be coaches.

“In the professional world, being a graduate and a professional means you share your expertise with others and nurses should constantly be doing that,” he said.

What did the Shape of Caring Review recommend?

  • NMC should gather evidence, explore and consult on the proposed 2+1+1 year model, alongside other alternatives, to examine whether the existing ‘four fields’ model is fit for the future.
  • NMC should explore and consult on the introduction of additional fields of practice such as community nursing.
  • NMC should review its current mentorship model and standards and amend them relating to the requirement for one-to-one mentor support.

Readers' comments (2)

  • Some years ago I began training as an LD nurse. I completed 2 years and in those 2 years the only clinical things I did was take a couple of temperatures, assist with some dressings and a bit of PEG feeding.
    Most of my cohort left with less skills than an HCA.
    When I queried why we had not been given any hospital placements I was told that the hospitals didn't have capacity as they were struggling to take in all the Adult nurses.
    It is not surprising that there are such inequalities in health for adults with learning difficulties when many of them only have contact with LD nurses.
    I think Lord Willis' plan to implement standard training before specialising is an excellent idea and it will certainly improve the skills of LD nurses.

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  • I actually think this is one of the better ideas proposed by Lord Willis. As a student mh nurse often find myself infuriated at the ignorance and prejudice of some adult nurses towards some
    clients with mh issues I've seen this on both sides as someone who uses services and now as a student nurse. Not all universities follow same standards e.g my university has a big emphasis on mh students having physical health knowledge so follow anatomy and physiology /pathology modules in first and second year same as adult students which I think is important and also getting training on wound care. we also have to do a 2 week placement in a nursery in second year and ld and adult in 1st year.
    I don't however feel fully confident 100% to care for people with learning disabilities as my ld placement was not brilliant (private care home very nice and good care but not allowed to do anything for insurance reasons) so I know basics from reading (no ld lectures) and the rest is just learning individual needs of service user with lds and using compassion and 6 c's and adjusting to make them feel safe comfortable and give them best care experience possible but really would like more training on it though

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