VOL: 97, ISSUE: 50, PAGE NO: 42
Kath Evans, MSc, BSc, RN, RSCN, is nurse rotational programme leader at Central and East London Educational Consortium (CELEC)Many nurses say that on completion of their preregistration training, they feel ill-equipped to deal with the demands of clinical practice. They often remark that they feel as if they have been 'thrown in at the deep end'. Consequently, the first six months following qualification are known to be particularly stressful.
Many nurses say that on completion of their preregistration training, they feel ill-equipped to deal with the demands of clinical practice. They often remark that they feel as if they have been 'thrown in at the deep end'. Consequently, the first six months following qualification are known to be particularly stressful.
In recognition of this problem, preregistration programmes will soon be redesigned to give greater emphasis to the development of clinical skills. In the meantime, ongoing professional development, preceptorship and clinical supervision, as well as innovative processes such as rotational programmes, can ease the professional demands on newly qualified nurses.
Research into rotational programmes has indicated that staff welcome the fact that they offer job security combined with the opportunity to take study leave and gain a wide variety of clinical experience (Charnley, 1999).
The programmes may also increase the likelihood of supportive mechanisms being in place in the clinical areas. This is particularly important, as there is evidence that newly qualified nurses often lack the support they need (Kelly, 1996).
Rotational programmes are well established in medicine, and are gaining popularity in nursing. Many major trusts in the UK now offer some form of rotation, ranging from six months to two years. This indicates either an increased commitment to professional development, or difficulty in recruitment and retention.
The rotational idea incorporates a number of themes: programme development, support mechanisms, professional development, continuing education, rewards and incentives.
The nursing profession is aware of the need to support newly qualified staff in the clinical environment, even though the appropriate support is often not provided.
While rotational programmes are often regarded as a means of retaining and supporting staff, their organisation can be a daunting prospect. Difficulties can arise when programme participants become established in placements and then do not want to move on. A lack of central coordination is another problem, as are service requirements, which can lead to initial promises of preceptorship, clinical supervision and study leave not being fulfilled.
Developing a rotational programme
With these issues in mind, a London education consortium decided to offer a rotational programme to newly qualified children's nurses. The programme was developed in partnership with five local trusts and universities and aimed to implement a framework of clinical and academic facilitation for the nurses.
A steering group was set up, which included a consortium representative, senior/lead nurses from each trust, and human resources and educational representatives. The group monitors the project, which is managed by the programme leader and the practice facilitator.
The programme leader was responsible for developing and implementing a framework and liaising with all participants at both strategic and grassroots levels. The leader remains responsible for ongoing management of and recruitment to the programme, and its evaluation.
The practice facilitator nurse has four areas of responsibility:
- Ensuring participants' educational needs are met;
- Organising their supervision;
- Acting as a direct link and resource to all parties involved in the programme;
- Liaising with participating trusts.
This has three main goals:
- To help to improve the recruitment and retention of newly qualified children's nurses;
- To ensure newly qualified nurses broaden their knowledge and skills through experience as a qualified team member within a range of acute health care settings;
- To provide newly qualified nurses with an 18-month structured programme of support and continued learning.
To achieve these aims, the nurses are offered three six-month placements in any of the participating trusts. The combination allows them to work in both specialist and general areas, and is supported by a detailed framework of professional development.
Students frequently identify a deficit in the breadth of clinical experience they gained during preregistration education. Rotational programmes offer the opportunity to redress this while giving newly qualified nurses a degree of control over their placements.
The programme consists of the following:
- A handbook, outlining how the programme is organised;
- Three-day orientation timetable;
- Evaluation sessions on completion of each placement;
- Negotiable study sessions;
- Peer support from the other programme members;
- Clinical supervision sessions/structured reflective practice;
- Clinical support from the practice facilitator;
- A formal preceptorship package and a guaranteed preceptor in each clinical placement;
- A practice portfolio;
- Two level-three academic modules.
The consortium purchases academic input from local universities and study leave is negotiated with individual clinical areas. The nurses undertake the modules best suited to their own practice.
A block purchase of ENB 998 Teaching and Assessing in Clinical Practice has been made from one of the universities, because it is the most commonly requested module.
Recruitment and retention
The pilot programme focused on children's nurses, and has recruited three intakes at six-monthly intervals. Being recruited to the programme is financially advantageous to nurses because they are directly recruited from universities and are employed as soon as they qualify.
Apart from posters and information leaflets circulated to the universities, no advertising costs are incurred. We consequently have 35 nurses rotating within the trusts. The number of applications to the programme has increased with every intake, indicating its popularity.
A collaborative human resource policy has been implemented. This means that each trust recruits its own nurses and acts as a 'host trust', at which the nurses start the programme. After completing their first six months on the programme, the nurses rotate to 'receiving' trusts, which give them 'honorary contracts'. The host trust remains ultimately responsible for them, and they return there on completion of the programme.
Advantages of the programme
The benefits for clinical areas include increased numbers of D-grade staff nurses. Certain clinical areas that have found it difficult to recruit for a variety of reasons have benefited.
The programme provides an innovative method of meeting newly qualified nurses' postregistration needs, while retaining them at a crucial time in their careers.
The clinical areas also receive fresh personalities and ideas every six months and, at the end of the programme, they should have competent D-grade staff nurses with excellent experience in both specialist and general areas of child health.
The programme aims to enhance the care given by the trusts to children and their families by increasing the experience gained by their newly qualified nurses.
The nurses' views
The programme participants have been given evaluation forms to complete every six months. Comments on these forms show that they are generally extremely enthusiastic about the programme (see Box 1).
However, concern has been expressed. For example: 'Why do you have to develop a special programme so that people are entitled to clinical supervision and preceptorship?'
The peer support offered led to comments such as: 'It's quite good that we have each other as well'; 'Sometimes you want to talk to a friend who perhaps is not older than you but has had similar experiences, so that you can ring each other or meet up in groups to discuss any concerns or fears'; 'Knowing there is a group of us all going through similar feelings and emotions is reassuring'.
Because of an increased demand for programme places, it has been necessary to turn down some newly qualified nurses. Increasing the number of places available would resolve this, but the support received in clinical practice would need to be explored.
The success of the programme is clear: it provides an ideal opportunity for newly qualified nurses to improve their clinical skills, develop academically and network with staff across local trusts. It also provides trusts with an effective recruitment and retention model. While no formal figures are available to demonstrate the programme's overall effect on recruitment and retention, anecdotal evidence from ward sisters involved suggests it has helped. Debi Lee, a ward manager at Newham Health Services NHS Trust, where recruitment of D grades has been a major problem, says: 'the programme has resulted in an increase in our establishment of D-grade nurses'.
While many major trusts in the UK offer some form of rotational programme, we believe this one is unique as it involves all trusts within the consortium and is truly collaborative.
We now hope to extend this model to mental health and community settings, and would be keen to share our experiences with anyone thinking of setting up such a programme in their area.n