Leading change

The Practice Education & Preceptorship Lead at North Staffordshire Combined Healthcare NHS Trust led on the development and implementation of a new preceptorship programme which has improved outcomes, experiences and use of resources locally.

Where to look

North Staffordshire Combined Healthcare NHS Trust is a provider of mental health, social care and learning disability services in the West Midlands. The Practice Education Team supports the preceptorship of newly qualified clinicians and the provision of advice and guidance regarding post registration professional development. The team facilitate, develop and support clinical placements for non-medical students within the Trust, working across the organisation and with other Trusts and universities to support the development of the future workforce for the local health economy and to promote the sharing of best practice.

The Nursing and Midwifery Council (2006) highlight that students on NMC approved pre-registration nursing education programmes must be supported and assessed by mentors. The Health and Care Professions Council (2017) support this by highlighting that practice-based learning must take place in an environment that is safe and supportive for learners and service users.

Further, the preceptorship framework (Department of Health, 2012) identifies that preceptorship should be a structured period of transition for the newly qualified nurse, midwife or allied health professional when they start employment in the NHS. During this time, he or she should be supported by an experienced practitioner (a preceptor), to develop their confidence as an independent professional and to refine their skills, values and behaviours. Having expert support and learning from best practice in dedicated time gives a foundation for lifelong learning and allows nurses to provide effective patient-centred care confidently.

Following feedback from previous preceptees, there was an identified need to change the current preceptorship programme, to align with the current needs of post registration clinicians and to support the ongoing need to recruit and retain registered clinicians.

What to change

The preceptorship leads reviewed current research and evidence which outlines the need for the Trust to:

• Have a preceptorship policy;
• An organisational wide lead for preceptorship;
• Be an organisation that facilitates protected time for preceptorship activities;
• Have a clearly defined purpose of preceptorship that is mutually understood by preceptors and preceptees;
• To ensure preceptors have undertaken training and education that is distinct from mentorship preparation and a central register of preceptors; and,
• Have systems in place to monitor and track newly registered practitioners from their appointment through completion of the preceptorship period.

Before the change, the Trust delivered a two-week preceptorship programme, with a preceptorship pack for the individual and a rolling preceptorship programme for people to attend. However, this had resulted in poor attendance rates and feedback.

The feedback from staff was that a two-week preceptorship programme was too long and did not always contain relevant training using traditional teaching methods leading to unwarranted variation in practice. The leads identified a need to:

• Run a preceptorship programme that is monitored and evaluated using action learning, group reflection or discussion that are included in the preceptorship process; and,
• Ensure preceptees contribute to the development of preceptorship programmes.

Building on this, the improved package focused on:

• Increasing support for preceptors;
• Increasing the visibility of the preceptor team in clinical areas;
• Ensuring the team were the central point of contact for mentors & students
• Improving communications;
• Identifying areas for improvement and make appropriate changes;
• Developing the team’s strengths and celebrate them; and,
• Increasing the number of AHP students the Trust was receiving.

How to change

A programme of work was identified and agreed with key stakeholders and senior managers. The Trust’s preceptorship policy was revised to support the changes in preceptorship and this was sent for consultation to many nursing and AHP forums.

A review or training within the team was undertaken and was reviewed for comprehensiveness, adapted so that it could be delivered and accessed in several different ways in order to make the programme more inclusive and interactive. A new Preceptorship Handbook was developed using feedback from staff and preceptees and the creation of a guide for Preceptorship to support preceptees in their roles. A preceptor register has been developed with a preceptor group email which allows the team to communicate with them directly and allows for peer support. A preceptor newsletter has also supported with this. Preceptorship workshops have been arranged to address different clinician milestones, for example ‘Are you ready to take charge?’ & ‘Lead on Preceptorship’. Action learning sets are also hosted for the preceptees to attend, which received excellent feedback on which is evaluated.

Development of ‘Preceptor of the Year’ award has created an environment to celebrate successes at the annual nursing conference with all preceptors receiving recognition and certificates for their good work.

In addition, the team also:

1. Delivered in house mentor updates to:
   • Offer peer support;
   • Tackle development areas specific to our Trust;
   • Celebrate our strengths; and,
   • Focus on our specialism of being a mental health and learning disabilities Trust.
2. Moved to a digital electronic version of our Resource folder to improve ease of access and for keeping information up to date;
3. Created a student mentoring recording form on the Trust intranet to provide easy evidence for mentors at Triennial Review;
4. Rolled out a programme of letters of recognition to mentors and teams following our student evaluations;
5. Identified a Mentor/Practice Educator Link for each area;
6. Delivered regular student interest groups;
7. Delivering training sessions at the university – with excellent student feedback; and,
8. Updated the Placement Charter and launched this in the Trust.

Feedback from preceptorship courses has continued to be requested and the programme changed and evaluated following the feedback.

Adding value

An evaluation of the programme and associated workshops has collated qualitative and quantitative information to inform improvements to the programme.

Better outcomes – The newly devised preceptorship programme has delivered a variety of benefits for the preceptee and employer such as:

• • Enhanced patient care and experience;
  • Reduced sickness absence;
  • More confident practitioners; and,
  • Increased staff satisfaction and morale.

Better experience – The new approach has been welcomed by staff within the Trust. Examples include:

“My preceptor ensured that she enabled me to be part of new and different opportunities and situations to enable me to gain valuable experience. She was supportive of me acting as nurse in charge to ensure that when I was signed off my preceptorship I felt comfortable taking on this role. She was supportive of my decisions made when acting as nurse in charge and if these needed to be reviewed she did this in a supportive way that showed me how I could learn from this in the future. I now feel confident and competent as a newly qualified nurse and feel that she has helped me to enhance my skills, particularly in terms of leadership and management.”

“My preceptor worked as my mentor whilst I was a student on placement at the intensive support team (IST), and also on beginning my employment as a staff nurse within IST she took on the role of preceptor. She spent time working with me throughout the programme. She was available when I needed support. She ensured that I was supported with weekly meetings.”

“An excellent role model sharing her knowledge and skills with myself and the team. She is easily approachable and always professional and has ensured that I have been welcomed into the team; she has supported me to develop into a confident and competent Nurse.”

“Overall my preceptor is a fantastic nurse, who always demonstrates care and compassion to her patients, she works at an excellent standard and is always available to support and guide the team”

Better use of resources – It is anticipated that through supporting recruitment and retention, as well as staff wellbeing at the Trust, there will be a positive impact on resources going forwards. Further evaluation will inform this assumption.

Challenges and lessons learnt for implementation

A successful preceptorship programme supports the transition from student to registered clinician.

Delivering an effective preceptorship course involves Trust engagement and involvement. Staff feel proud to work for an organisation that supports the education of its staff and want to be a part of that education. As this is embedded it will contribute to recruitment and retention.

The programme is currently being aligned to the new Education Standards from the NMC.

For more information contact

Rachel Bloor
Practice Education & Preceptorship Lead, Practice Education Team,
North Staffordshire Combined Healthcare NHS Trust
rachel.bloor@combined.nhs.uk

Julie Anne Murray
Deputy Director of Nursing, AHP and Quality,
North Staffordshire Combined Healthcare NHS Trust
JulieAnne.Murray@combined.nhs.uk