Nurses at Northamptonshire Healthcare Foundation Trust (NHFT), in partnership with 3Sixty Care, a training hub and federation of primary healthcare practices, led the establishment of a new placement pathway for third year student nurses wanting to work in community settings. The aim of the project was to broaden student’s experiences of the range of community services in which nurse’s work so their enhanced knowledge informs their career choices and strengthen recruitment in community services.
Where to look
District and community nursing teams provide an invaluable service to the individuals, families and communities which they serve and are integral to the delivery of timely, quality, integrated health care.
The community nursing team in Northamptonshire identified unwarranted variation in the support and mentoring provided to community student nurses, recognising that traditional approaches to mentor updates, team meetings and discussion groups weren’t meeting today’s needs. The team recognised that the number of qualified district nurses has dropped and there has been a change in student demographic applying to enter pre-registration programmes
What to change
Trainers at NHFT and 3Sixty Care supported the nurses by recognising that a new approach was needed to enable newly-registered nurses with the right skills to deliver care in the patient’s home to move straight into community roles should they wish. The new approach would also raise awareness of the range community nursing of roles and the principles that underpin the development of nursing services (Royal College of Nursing 2010).
The leads identified a need for a more flexible model, exposing students to a wider range of experiences and learning. They also recognised that there was still more to do to help address challenges of recruitment and retention into community roles locally.
How to change
The leads gathered information from a wide range of areas referring to workforce strategies and holding listening events with student nurses, community teams and staff who had supported newly qualified nurses. A review of the small number of newly qualified nurses previously recruited directly into community posts identified some support factors for successful recruitment:
- An interest in community roles during pre-registration nursing
- More community practice opportunities in a supernumerary capacity
- Exposure to a breadth of healthcare settings which provided a sound knowledge base and clinical proficiency, prior to qualification
Following an engagement event nursing teams worked with training leads and the University of Northampton to develop a community pathway for third year Student Nurses who were committed to starting their careers within a community setting. They also worked with local acute providers to ensure that all students had both acute and community placements before year three, to meet pre-registration requirements and to help students make an informed choice about their future.
A feature of the new pathway is that third year students do not follow a traditional 12-week ‘static hub’ placement – unless it is their final/sign off placement. Instead, students are placed with a mentor for 2 days per week within a hub base. The rest of their time is spent in areas chosen by them to meet their training needs. This practice exposes the student nurses to a broad range of practice and settings, including general practice, in partnership with specialist practitioner teams and access to masterclasses.
Students can then go onto secure a conditional post of employment within the Trust in their chosen area with this becoming the setting for their final placement, and where they will begin their preceptorship and NHFT job following qualifying as a registered nurse. The team developed practice educator support roles utilising current NHFT nurses to help with transition from student to preceptee.
Better outcomes – 80% of students completing the new third year pathway have been successfully recruited into a community post. Of the 14 recruited in the pilot phase, 11 have remained with NHFT which is positive. Employers report that upon qualification, students who have taken this route into nursing are practice ready with a core set of clinical and decision-making skills
Better experience – Feedback from students using this route into practice have said they feel part of a supportive organisation and that this has led to continued successful recruitment and retention rates.
Better use of resources – Students are able to join the nurse ‘bank’ in their third year which allows them to have paid work in a healthcare setting as a Health Care Assistant role. It is from this role that they frequently gain valuable experience at the Trust before they qualify as a registered nurse. Students are recruited about six months before registration, creating more robust succession planning for NHFT. Successful recruitment from the programme has meant community teams have an increased number of community staff to provide safe, effective and caring services
Challenges and lessons learnt for implementation
- The project depends upon partnership and a multi-agency approach, where all stakeholders can buy into the vision and provide support
- The pathway development has been an opportunity for a wider understanding of working across organisational boundaries
- On commencing the pilot there were a number of changes to existing systems that needed to be made within NHFT – operational systems, equipment, electronic record keeping systems, governance, staff perception and readiness to change. Having student nurses in the pilot group in practice helped to remedy a number of these
- Pre-pathway seminars are held at the university end-of-year 2 students, with numbers of attendees increasing substantially
- Preceptees are supporting new pathway students as peer mentors, extending their learning experience
For more information contact
- Lisa Gammon, Practice Learning Facilitator, Lisa.firstname.lastname@example.org