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Innovation

Supporting student nurses with an online induction

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One trust developed a web-based induction resource to welcome and inform students who are about to undertake clinical placements

Abstract

With funding from Education Commissioning for Quality, we created the Student Hub, an online induction package to welcome students to trusts where they are on clinical placement. This article explains how the hub has helped tackle challenges facing a large community trust committed to providing high-quality placements for students and supporting mentors. It also outlines required improvements, highlighted through evaluation of the hub.

Citation: Reynolds S, Kaur R (2016) Supporting student nurses with an online induction. Nursing Times; 112: 45/46, 13-15.

Authors: Stephanie Reynolds is senior teaching fellow at Birmingham City University; Raman Kaur is a student co-ordinator for speech and language therapy at Birmingham Community Healthcare NHS Foundation Trust.

Introduction

Students attending clinical placements should have a corporate induction to their placement trust. This is good practice and mandatory within Education Commissioning for Quality (ECQ) (NHS West Midlands, 2010). The corporate induction – an addition to a local placement induction of their immediate environment – would include:

  • Introduction to the healthcare setting;
  • Introduction to policies and procedures;
  • Familiarity with the organisational values and senior management.

These points are important if students are on a placement in a community setting where they may have to work in multiple locations, some of which may be remote.

A comprehensive induction should support students and introduce them to the working environment and wider trust in which they will be spending a considerable amount of time, building up their clinical skills and competence. Providing each student with a face-to-face corporate induction is ideal in theory, but the logistical practicalities of implementing this are challenging for healthcare organisations. The challenges include:  

  • Students take their placements at different times;
  • Placements vary in duration and taking place over a relatively short period, such as two weeks;
  • Some students have a placement in an organisation covering a large, urban or rural area, and may have to commute a considerable distance from the allocated base;
  • Community mentors from all professions have reported managing ever-increasing clinical demands and commitments on a daily basis. The Queen’s Nursing Institute (QNI, 2016) highlighted this for district nurses.

To support mentors with the formal corporate induction process, Birmingham Community Healthcare Trust designed an online induction that students from all healthcare professions can complete, either before starting their placement or when it begins. As well as mandatory requirements, such as access to training and policies, the scope of the resource was extended to provide a learning platform, through which students could access learning materials and clinical resources to support them on their placements.

Student Hub

The Student Hub is an external-facing resource that welcomes students to the trust via a series of digital recordings from senior management and the chief executive (Box 1). Students are addressed directly, trust values and expectations of students are set out. Mentors, initially from nursing and speech and language therapy, also feature in these recordings and were asked:

  • What would you expect from students on placement?
  • What would make you go the extra mile for students?

Box 1. Student Hub features

  • Refresher training and quiz – blended learning opportunity
  • Video recordings from chief executive, director of nursing, library, mentors, former students and service users
  • Interprofessional learning resources
  • Profession-specific and branch-specific resources and web links
  • Interactive polls
  • Library portal
  • Link to main trust website and information about the trust

Former students also give accounts of their personal experiences of placements and share their ‘top tips’ for future students. Service users were identified and invited to give their experiences of the care they received and what they consider a good-quality care experience to be, in relation to the 6Cs (Department of Health, 2012). They also gave guidance to students about how to best interact with service users on placement and what would be important to a service user for best practice to be achieved.

The Student Hub features profession-specific areas for relevant resources and links to other useful websites. Policies and procedure links are related to students’ experience and mandatory requirements, such as information governance, escalating concerns, record keeping, infection control and fire safety updates.

There is also a quiz to consolidate learning to specific placement areas. This directs students to elements of refresher training, which builds upon mandatory training undertaken at the university.

To link e-learning theory with practice, mentors need to be involved in reviewing students’ quiz answers. This encourages learning that is relevant to students’ placement areas and gives mentors an opportunity to talk with students about wider issues of policies and procedures that are not necessarily addressed solely by e-learning. This approach is supported by theories of blended learning where e-learning is combined with face-to-face learning so the optimum quality of learning takes place (Sharpe et al, 2006).

Evaluating the Student Hub

Initial evaluation took the form of an online voluntary questionnaire to which 11 student nurses responded, and interviews with four SLT students and their mentors. The impact of the Student Hub and students’ and mentors’ views about it were the first things evaluated; this was done to ascertain the initial responses on value and effect for students and mentors. The questionnaire asked respondents how they felt about the Student Hub, with a range of predefined answers. Views were explored further through interviews with students.

On the whole, and including the comments made by students at interview, the hub can be seen to have had a positive impact. Fig 1 (attached) shows that out of 11 respondents from the questionnaire, only one felt annoyed and two did not think the hub made a difference. Four students interviewed about the hub were positive, calling it “useful”, “unique” and “tailored to needs”. The fact that the resource was dedicated to students and mentors was welcomed.

Problems were encountered with the use and marketing of the Student Hub, and technological problems caused anxiety for students. Some practical issues also needed to be addressed, such as navigational issues and links that failed to work, while the expected use of the website had to be determined. A key change was to make the link to the quiz clearer.

Studies by Cheng (2013) and Winnard and Elliot (2012) show there is a need for learning websites to have a user-friendly interface that is well arranged with a clearly identified screen layout, making navigation feel more effective, and the resource easier and more enjoyable to use.

Induction methods

Interviewees were asked whether online learning induction could replace face-to-face induction. The consensus of the interviewed students was that students preferred face-to-face training, but that having mandatory training online complemented face-to-face training with the additional benefit that they could access it if they needed it while on placement.

The problem of not being able to deliver face-to-face induction in the community can be resolved when an online induction is built on what has already been learned from longer face-to-face sessions delivered at university. This suggests the content of the Student Hub is appropriate for the needs of students on a community placement because of the practical issues of not being able to deliver face-to-face training to large numbers of students at different times. At an interview one student said:

“The nice thing about [the induction] being online is that it is summed up… you could look at things that interested you, whereas if we had had a whole day or a half day of someone just talking about general stuff it would get really boring.”

Another student added:

“You could always refer back to it when you needed it, whereas if you had it on one day you would forget about it – if I needed it in the middle of placement, I could access it and use it then.”

This approach is in line with DH (2011) guidance – which shows the benefits of any technology-enhanced learning are the accessibility and convenience for the learner – and Greenhalgh (2001) who calls “just in time learning” an idiosyncrasy where students make no attempt to use a learning feature until they need it.

Mentor engagement

One difficulty encountered was the engagement of mentors. Although the Student Hub had been advertised, with posters and emails circulated to appropriate teams, mentors did not always encourage students to complete the quiz or use it as a discussion tool. The interviews with mentors indicated that they saw the hub as primarily for students and did not recognise their role or the importance of the blended learning element of the quiz. It was decided that there needed to be some active investment into greater promotion of the Student Hub at mentor updates and placement visits.

During interviews, mentors were asked whether the hub allowed them time away from students to focus on documentation and enabling students to have some placement relevant independent activity. Their responses considered how the Hub could be adapted further to support mentors and students on placement. One mentor said it would be good for targeting learning outcomes with a formal framework, and others discussed activities that could be built on, such as specific case studies and reflective pieces.

Other informal feedback from nursing mentors gathered from working in the student clinical support role suggested busy workloads meant they prioritised clinical commitments, without meaning to disengage with innovative advances in their mentoring role. One mentor was unhappy that students had to rely so much on online learning.

Mentor engagement with the website may be attributed to motivation, confidence and competence with IT. In exploring the attitudes and confidence of nurses using web-based learning, Liang et al (2011) drew parallels between self-efficacy and attitude in that the higher the confidence in the nurse’s own experience of web learning, the more positive their attitude in embracing the benefits.

Marketing of the Student Hub

It could be argued that it is easier to market the Student Hub to mentors as they are permanent members of staff and can reinforce its intended purpose and use, whereas students are temporary and would need constant targeting. Suggestions about how to improve this included renaming and re-marketing the Student Hub as a Learning Hub – this could incorporate mentor learning, for example, by attaching a mentor e-portfolio. The portfolio (which meets Nursing and Midwifery Council requirements for mentorship) could encourage mentors to engage with the hub and use the website in the blended learning approach.

Overall, mentor engagement could be improved by setting up working groups to encourage, support and use the hub to enhance mentors’ and students’ learning experiences. The Higher Education Funding Council for England (2009) supports the need for investment in technology, including the championing of senior managers to increase staff knowledge in the use of technology and its benefits.

Cost efficiency

The Student Hub does not necessarily balance cost effectiveness with the quality of student learning. Resources from technical support are required, along with staff input and engagement to populate the website with useful and current information. In essence, the website requires more than one initial investment – ongoing maintenance and evaluation is necessary to ensure it continues to serve students’ and mentors’ needs.

Conclusion

Nurses and other health professionals value technology that is efficient and strives to improve the quality of learning and patient care. However, as shown, although online induction support packages can go some way to do this, ongoing investment is needed to ensure the resource remains useful.

The novelty of the Student Hub has created interest in the potential value of enhancing the learning gained through student community placements. Despite the highlighted difficulties, the hub successfully meets ECQ requirements and fulfils the aim of the original concept and design. One student said:

“It showed that the trust had gone out of their way to accommodate students, which made me feel a bit more at ease before I came here. The idea is brilliant!”

The Student Hub has been developed further since its launch with enhanced IT support and the involvement of other professionals, such as physiotherapists.

Key points

  • Student nurses attending a clinical placement need a corporate induction to their placement trust
  • Although the preferred option, face-to-face inductions can be difficult to organise
  • Mentor engagement is vital for a blended learning induction
  • Online resources need to be user friendly to promote engagement
  • Online information needs ongoing maintenance to encourage engagement and ensure it serves the needs of users
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