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'Nurse involvement in commissioning can bring experience to pathways of care'

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It is well known that the number of nurses is falling, with experienced nurse leaders leaving the profession.

lynnette glass

The opportunity to shape the future of nursing leadership, to engage adult student nurses in quality assurance, safety, experience, effectiveness and quality improvement, was identified as an exciting opportunity here at NHS Swindon Clinical Commissioning Group (SCCG).

In 2016, it was agreed to start student nurse (adult) leadership/management placements within the clinical commissioning group (CCG). 

Nurse involvement in commissioning can bring a breadth of experience to pathways of care, resulting in patient safety assurance and peer-to-peer conversations at all levels between the CCG and providers that are not just based on statistics but include frontline experience.

Such conversations would allow for more scrutiny and accountability to improve patient care.

I identified opportunities outside of the traditional clinical placement model, to meet the competency framework captured in an induction pack for students; to give them context as to what a CCG is, and to highlight all the opportunities available.

This gave me assurance that we could meet the non-clinical competencies, using the ‘hub and spoke’ model of placement with the CCG as the hub with planned visits to providers, primary care and also Public Health Swindon.

I met each student and aligned to their competencies and career aspirations map with bespoke visits, meetings or information.

The first third-year master’s student (now working as a safer staffing nurse practitioner) started in October 2016 after settling in quickly with one-to-one support from me as her mentor.

We intensively reviewed what quality and leadership are, with continued reflections on areas such as serious incident management, system-wide learning from national reports, and influencing and leading. Her feedback was fantastic.

‘“I feel that I have learnt a lot on this placement and there is still a lot to learn. I believe this placement will impact on my future clinical practice. I’ve seen first-hand how social policy can have an impact on my patients. I’ve gained a holistic insight into the challenges and barriers patients face in accessing health and social care; and how these influence how they manage their illnesses. I think that more student nurses should be exposed to commissioning as this will enhance their practice.

“Commissioning should also be presented as a career option during training. I also think root cause analysis and quality improvement should be introduced in the nursing curriculum as it empowers nurses to do something about the challenges and difficulties they face in practice. This was a valuable placement and I would recommend it to any student nurse.”

The second master’s student started in May 2017 as part of her second year. She spent some time with specialist nurses as a particular interest. Her feedback was equally impressive.

“Student nurse training is governed by NMC standards, which state that half of all training must take place in clinical settings. The NMC also state that learning environments must equip students with the necessary knowledge and skills for safe and effective practice at the point of entry onto the register.

“As a non-clinical placement, it is likely that students may experience some anxiety about their ability to meet NMC competencies with the CCG. Having just completed seven weeks’ placement with SCCG, I would like to briefly show how the placement can not only meet core competencies in all domains, but also extend and enrich the student’s knowledge about the provision of healthcare on a deeper level than that required by the NMC for entry to the register.

”Whereas clinical placements can highlight poor communication between service providers and multidisciplinary teams, students at the CCG will hear how such issues are addressed, begin to understand the wider consequences and the complexity of organisational communication and the commitment behind the scenes to break down communication barriers for the benefit of patients.”

“This placement, more than any other, has stretched and developed my communication skills, offering immersion in the language of business management, risk, quality, assurance, service improvement, finance, targets, action plans and national strategies.”

The third master’s student’s aim was to become a health visitor – I do not have written feedback from her.

The fourth student was in his third and final placement and had met all his clinical competencies prior to starting in July 2017. He is now working part-time as a practice nurse and part-time within an eye hospital to gain experience in both areas.

He grew rapidly in terms of confidence in his leadership and management as we reflected on styles, behaviours and cultures within providers and the CCG.

“I felt confident of my clinical skills and competencies but I felt I needed to be focused during this stage of my training in leadership and management, which will contribute significantly to my future performance as a registered nurse.

”I consider my role, responsibility and accountability as student have been demonstrated from the beginning of my training and, my final placement need to consolidate and integrate all learning outcomes during my second and third year (as first year was credited by my previous foundation degree in health and social care).

“A mentor is a registrar who facilitates learning, assess and supervises students in a practice setting. I considered myself lucky this placement [was] offered to me; 100% interaction with my mentor on every shift and I was the only student allocated to her. I can resume my time at the CCG as an excellent opening for any student to a new perspective of care, where all services in different care sectors can be explored, examined and analysed.

”There are a lot of resources and different departments where to find how NHS England is working incessantly to improve care and wellbeing of different population including all age groups and needs. I really enjoyed my time here and I consider my mentor was the key of my development as encouraging me to be a thinker rather than a passive learner.”

The fifth student has just started with the CCG – as he in his second year, he is still considering his post-registration aims.

This is a unique opportunity that also supports future workforce preparation and in the ethos of revalidation – jointly reflecting and learning with students. I really enjoy having student nurses at SCCG and I would recommend other CCGs to start placements too.

The next innovative step is for students to have placements within the CCGs continuing healthcare team.

Lynnette Glass is quality lead for projects, Swindon Clinical Commissioning Group.

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