(2007) Structured learning for newly qualified nurses. …
VOL: 103, ISSUE: 37, PAGE NO: 28-29
Sue Hickie, MPH, PGDip Educational Research, DipHE Nursing, RN, RM, RHV; C. Paul Lyttle, MPhil, PGCE, BA, RGN, RSCN, RMN, SCPHN FWT; Linda E. Harris, BScOT
Sue Hickie is freelance education consultant and project leader, Flying Start NHS Primary Care, Edinburgh; C. Paul Lyttle is lecturer, Bell College, School of Health Studies, Dumfries Campus and project leader, Flying Start NHS (nursing and midwifery); Linda E. Harris is AHP programme leader, NHS Education for Scotland, Edinburgh
Newly qualified health professionals often feel unprepared and unsupported in making the challenging role transition from student practitioner to becoming confident practitioners. A positive learning environment can influence long-term recruitment and retention. In 2005, the Scottish Executive Health Department addressed this issue by commissioning a national programme, with links to the NHS Knowledge and Skills Framework and the e-library, to support all newly qualified nurses, midwives and allied health professionals (AHPs) during the crucial first year. The first cohort is now completing the programme, which includes online materials, an online community of peer support and support from workplace mentors. This article presents a review of the development process and describes the challenges of introducing Flying Start NHS throughout NHS Scotland.
This article describes how Flying Start NHS supports all newly qualified nurses, midwives and allied health professionals (AHPs) employed by NHS Scotland. The programme has been designed to support new practitioners, using a web-based learning programme with support from workplace mentors. Making a successful transition from student to confident practitioner is a complex process both for individuals and NHS employers. There is evidence of the links between development of staff and the organisation’s success in recruiting and retaining staff (Gerrish, 1990).
The article demonstrates the integration of policy and practice that guided the consultation and development activities led by NHS Education for Scotland (NES). The Flying Start NHS website was launched in January 2006 jointly by Paul Martin, chief nursing officer for Scotland, and Jacqui Lunday, chief allied health professions officer for Scotland. There are now 3,335 newly qualified practitioners registered and using the development programme. A mentor supports each practitioner throughout the year and guides her or him towards completion of a portfolio of evidence designed to meet the needs of the NHS Knowledge and Skills Framework (DH, 2003) development review. Alongside the development of the online programme, a parallel project (Flying Start NHS Primary Care) explored the direct employment of newly qualified nurses into a range of primary care posts.
Evidence has been steadily growing that newly qualified healthcare professionals find their first post stressful. Structured support during the early months can make a difference to confidence levels and also to ongoing recruitment and retention (Field, 2004; Gerrish, 2000). Flying Start NHS was designed to have a positive impact on recruitment issues and assist new practitioners to make a positive and proactive start to building a career in NHS Scotland.
A document entitled Facing the Future (Scottish Executive Health Department, 2001) first highlighted the key themes that need to be addressed to improve the recruitment and retention of nurses and midwives in Scotland, namely: careers, leadership, flexibility, education and training, research and evaluation, employment packages and new roles. The Facing the Future group was charged with overseeing the achievement of goals set in the Facing the Future Action Plan. The impetus for the Flying Start NHS and Flying Start NHS Primary Care initiative, designed to address recruitment and retention issues in the nursing workforce, came from this group.
Nurses and midwives comprise the largest part (43%) of the NHS Scotland workforce (Scottish Health Statistics, 2005) and several policy documents are guiding the changes required in the nursing workforce. The document Caring for Scotland: TheStrategy for Nursing and Midwifery in Scotland (SEHD, 2001) outlined how the capabilities of nurses and midwives needed to be enhanced to provide the flexible, needs-driven service required by the public. More recently the Framework for Developing Nursing Roles (SE, 2005) presented a generic framework that can be used to guide the development of new roles and also a rationale for structured role development in nursing. The policy document Delivering Care, Enabling Health (SE, 2006) provides a framework for the nursing and midwifery contribution to healthcare in Scotland.
One newly introduced legislative document that impacts on primary care practitioners, including the newly qualified, is the Scottish Executive (2006) document Visible, Accessible and Integrated Care - Report of the Review of Nursing in the Community in Scotland.The review will lead to a modern, redesigned community nursing service.
More than 8,000 AHPs are employed throughout Scotland. They frequently work in multidisciplinary teams and their education and ongoing professional development increasingly reflects this. The report Building on Success: Future Directions for the Allied Health Professions in Scotland (SEHD, 2003) set out a vision for the evolving contribution of AHPs to care for the people of Scotland. This was followed in 2005 by Framework for Role Development in the Allied Health Professions (SE, 2005) which develops the theme of role development in the context of service redesign. The document Delivering Care, Enabling Health (SE, 2006)seeks to enable continuing improvements in the experiences and outcomes of care for patients, the public, families and carers by nurses, midwives and AHPs, and provides a clear direction of care being delivered in multi-professional teams that are patient-focused.
The policy context described above challenges all employers to think differently about the recruitment and retention of their staff. Flying Start NHS supports the employment of newly qualified nurses, midwives and AHPs directly into a wide range of healthcare organisations and aims to ensure an evolving workforce whose contribution is essential to the changing agenda of healthcare in Scotland.
Flying Start NHS
The Flying Start NHS and Flying Start NHS Primary Care projects were undertaken concurrently. Project leaders from the initiatives worked closely together, bringing together a skill set which included expertise in project management and educational practice, and the NHS Knowledge and Skills Framework.
Throughout 2005, the NES project team collaborated with web designers and writers to develop the website design and the content of the online learning programme.The team made best use of existing good practice and drew on the skills and knowledge of staff who had developed local programmes across NHS Scotland. Their generous sharing of experience with the project team proved invaluable in developing Flying Start NHS.
The learning outcomes of Flying Start NHS were developed taking into account the evidence which newly qualified practitioners could present at their NHS KSF development reviews. Critical readers from the fields of nursing, midwifery and the allied health professions reviewed draft text for the learning units, offering helpful comments and suggestions for further topics, learning activities and reference materials.
The learning programme is made up of 10 learning units which were distilled from a scoping exercise combined with the triangulation of the views of NHS employers, higher education institutions and newly qualified staff in NHS Scotland.
The 10 learning units begin with clearly defined learning outcomes, assisting each practitioner to create an individual pathway through that unit. Sub-sections within each unit encourage the completion of more topic-specific learning activities. Individual practitioners set achievable goals with support from work-based mentors, recording their progress in a reflective portfolio. The programme concludes with a reflective summary and an agreed personal development plan for the forthcoming year, providing a unique foundation and a natural progression towards the NHS KSF foundation gateway.
Approximately 150 hours of varied learning activities make up the overall learning programme and it is envisaged that newly qualified practitioners will choose to select approximately two-thirds of the content which best relates to their role and learning needs. Early indications are that using a ‘light touch’ mentoring approach of 2-4 hours per month can significantly improve the experience of working through the development programme.
The online programme links with the NHS Scotland e-library, allowing users easy access to a wide range of current information and reference materials and encouraging ongoing use of this valuable resource from early in their career. Registering allows newly qualified staff to engage with the online community functions of the site; these include discussion forums, a members’ area and access to discussion with expert clinicians. The move from Diploma in Higher Education (Scottish Credit and Qualifications Framework Level 8) to Ordinary Degree (SCQF Level 9) would be evidenced in a Flying Start NHS portfolio. A completed portfolio can be submitted for recognition of prior learning for staff seeking Scotcat accreditation.
From the outset, NHS mentors were viewed as crucial to the success of Flying Start NHS. The Flying Start NHS website provides specific information for mentors suggesting a ‘light touch’approach be used. The relationship has similarities to coaching and acknowledges the different approach required when mentoring a qualified member of staff compared with students.
A mentor area within the website offers guidance on preparing for the role of being a mentor to a newly qualified practitioner. It describes the qualities of an effective mentor and directs mentors to useful websites for further information.
Within NHS Scotland, an educational infrastructure was established in 2003 by introducing the new role of practice education facilitators in each health board. In 2006 this network was strengthened by appointing regional practice education coordinators for nurses, midwives and AHPs. This network contributes significantly by supporting the work-based mentors of Flying Start NHS.
Flying Start NHS Primary Care
Flying Start NHS Primary Care is a parallel project to Flying Start NHS. The introduction of community health partnerships, the implementation of the general medical services (GMS) contract and changing demographics all make an impact on the workforce profile in primary care. To address these issues, the Scottish Executive commissioned NES to concurrently manage a project exploring how, despite traditional resistance, newly qualified nurses could be employed directly into primary care nursing posts and supported over the challenging first year of employment.
In 2005, 45 newly qualified nurses were recruited across NHS Scotland. The employing health boards received a development grant of £6,000 for each new member of staff employed on the terms and conditions of the project. Consultations indicated that learning needs are very similar for all new practitioners. Therefore, all new recruits in Scotland access the same programme, which aids staff transferring between NHS boards. Those working in primary care settings are directed to the learning activities with an emphasis on primary care.
A scoping exercise was completed before the start of the project to map existing employment practices and will be repeated at the end of the project to ascertain any changes. Various models of rotational programmes have been developed to suit differing geographical locations and local deployment needs. For example, in the West of Scotland, newly qualified nurses have worked in remote island communities, in community hospitals, district nursing teams and local hospices. In other areas, the newly qualified nurses have worked in public health nurse teams, in practice nurse teams, out-of-hours services as well as district nursing teams.
There were special concerns raised around mentoring in rural areas within small nursing teams but these were not considered to be insurmountable. Early feedback provided encouraging examples of how these challenges could be addressed. In some areas, for example, mentors have together designed programmes where new recruits meet with peers for learning set activities, so reducing the teaching input required of individual mentors. In NHS Western Isles, part of the primary care funding was used for mentors to undertake an open university programme (K350) Assessing Practice in Nursing and Midwifery, and this has been reported very positively.
Some early challenges were the lack of clarity on the role boundaries for the newly qualified nurse, and some continuing resistance to their employment in primary care. Some established staff still believe that newly qualified nurses benefit from two years of consolidation of skills in a hospital setting before employment in primary care settings. However, participation in the Flying Start NHS Primary Care scheme is challenging these views. Building on the lessons learned in the first year, a second group of newly qualified nurses has been recruited.
This article has briefly described the policy drivers for Flying Start NHS and has also outlined the challenges involved in developing and delivering the programme. The initial benefits of Flying Start NHS have been identified from the perspective of newly qualified staff, employers and the wider NHS Scotland community.
NHS Scotland and the way in which healthcare is delivered is continually evolving and needs confident, competent practitioners from all disciplines. It is vital that newly qualified practitioners get off to a ‘flying start’ in their chosen careers. The full evaluation of Flying Start NHS is planned and the results will be eagerly anticipated and of interest to managers, educators, mentors and newly qualified practitioners alike. Further publications are planned based on the outcomes of the evaluation.
Department of Health (2003) The NHS Knowledge and Skills Framework and Development Review. London: DH.www.dh.gov.uk
Field, D.E. (2004) Moving from Novice to Expert - the value of learning in clinical practice: a literature review. Nurse Education Today; 24: 7, 560-565.
Gerrish, K. (1990) Fumbling along. Nursing Times; 86: 35-37.
Gerrish, K. (2000) Still fumbling along? A comparative study of the newly qualified nurse’s perception of the transition from student to qualified nurse. Journal of Advanced Nursing; 32: 2, 473-480.
Scottish Executive Health Department (2001) Caring for Scotland: The Strategy for Nursing and Midwifery in Scotland. Edinburgh: SEHD.
Scottish Executive Health Department (2001) Facing the Future. Edinburgh: SEHD.
Scottish Executive Health Department (2003) Building on Success: Future Directions for the Allied Health Professions in Scotland. Edinburgh: SE.
Scottish Executive (2006) Visible, Accessible and Integrated Care - Report of the Review of Nursing in the Community in Scotland. Edinburgh: SE.
Scottish Executive (2005) Framework for Developing Nursing Roles. Edinburgh: SE.
Scottish Executive (2005) Framework for Role Development in the Allied Health Professions. Edinburgh: SE.
Scottish Executive (2006) Delivering Care, Enabling Health (Consultation Paper) Edinburgh: SE.
Scottish Health Statistics (2005) NHS Scotland Workforce Statistics: www.isdscotland.org
Further reading/useful websites
Scottish Executive (2005) National Workforce Planning Framework. Edinburgh: SE.
Scottish Executive (2005) Building A Health Service Fit for the Future: a National Framework for Service Change in the NHS in Scotland (Kerr Report). Edinburgh: SE.
Scottish Executive (2005) Delivering for Health. Edinburgh: SE.
Flying Start NHS
Scottish Credit and Qualifications Framework: www.scqf.org.uk/table.htm