Leading change

A Quality, Health and Innovation Lead in the Nurse Development Team at Bradford District Care NHS Foundation Trust (BDCFT) has developed a new placement model for  first year nursing students, to address variation in the experience and opportunities available to them.

Where to look

Supporting students within a practice-based placement presents a wide number of challenges for mentors in terms of creating a welcoming and interesting learning environment, which facilitates the achievement of the student placement outcomes. The Nursing and Midwifery Council (NMC) Standards for Pre-Registration Education for Nursing (2010) identify that for registration, in addition to the outcomes that the student requires to demonstrate in their chosen field of practice, the nurse must also demonstrate the achievement of a range of knowledge and skills on: people with mental health needs, people with physical health needs, people with a learning disability (LD), children and young people, maternal health and people with a long term condition.

This has been a continued challenge for the nursing team supporting both the local university and their students due to limited opportunities for all students to have placement experiences within all these areas. In comparison to opportunities available to students in other parts of the country, the nursing team at BDCFT identified the unwarranted variation in the types of placement and experiences students were receiving as part of their community placements locally. Health Education England in 2015 had also identified the need to address disparity between mental and physical health education across fields and exposure to LD and community services knowledge, which supported the need for change.

With this in mind BDCFT has looked to develop an alternative approach in working together as a “virtual community placement”. This both meets education standards and reduces unwarranted variation by affording a wealth of additional opportunities to build early partnerships with nursing students and afford them early exposure to critical learning. The nursing leadership team set out to develop and implement a new model of community placements with support of other key stakeholders.

What to change

First year nursing students (Adult, Child and Mental Health) had previously been allocated a base area for their community placement on a Mental Health in-patient ward or Community Mental Health team, within a District Nursing Team or with a School Nurse or Health Visitor for 8-10 weeks. They could arrange to spend time with other teams to complement the learning but due to the capacity of BDCFT teams and the number of students coming into the organisation, opportunities could vary across the student population.

This new model endeavours to ensure that all first year student nurses from the University of Bradford would come out of their BDCFT base placement for 1 day each week for a workshop across a number of topic areas and so all students would gain an equitable access to training.

How to change

BDCFT nursing leads with the support of other stakeholders developed and piloted a “Virtual Community Placement” (VCP) from November 2016 to February 2017. This model brings together 12 teams to provide a set of workshop-based learning experiences for first year nursing students, across all fields of nursing who had placements within BDCFT.

To enhance learning, the team also included in the workshop a number of service users and patient stories. This has now grown to 14 workshops including: Compassion in Practice/Care Makers/LCAV, Resilience, Palliative Care, Research and Development, Health Visiting and School Nursing and Patient experience and Carer Involvement (including service user stories) amongst others.

The workshop model sought to provide assurance to the placement providing organisation, HEI and students that the programme requirements can be achieved early in students’ studies. The workshops also afforded an education programme by BDCFT that is a quality driven and a sound foundation on which to build the remainder of their course and future nursing career.

Adding value

• Better outcomes – BDCFT community services feel they have benefited from this early engagement with student learners and their workshops have raised the profile of how community services link and work together to address unwarranted variation in practice and provide high quality and responsive services. The inclusion of patient experience stories and service users attending to talk about their experiences has been both thought provoking and inspiring for the students. These stories have proved critical in translating theory to practice. The service users have also found this opportunity personally valuable and have committed their time to supporting this model moving forward.
• Better experience – Feedback has highlighted the benefits of early engagement with all fields of community nursing. For example:
  • “Out of all of these workshops we have had so far this is by far the superior. The osteoporosis talk – I learnt a lot! The falls prevention talk was fabulous …”
  • “I have learnt about the importance of service user involvement. The significance of inclusive care”
  • “It takes everyone within the MDT to work together to safeguard and protect individuals of all ages. Each professional can help/prevent in their own way and should share information where it is appropriate to do so to help build a bigger picture of what is going on”

• Better use of resources – The Virtual Community Placement is now embedded as part of the placement offer to all first year student nurses across BDCFT. Key areas where added value is demonstrable include:
  • Early organisational engagement – delivered to over 450 first year nursing students since November 2016;
  • Utilisation of skills and knowledge within the Trust to increase the quality of practice learning;
  • Transferability of multi-professional learning identified and valued across different fields of nursing;
  • Combining service user and service provider engagement in a collaborative model for maximum impact on learning;
  • Opportunity to challenge and share pre-conceptions, attitudes and beliefs in a safe environment which supports learning but also supports continued improvements to the programme;
  • Measurable impact on Alternative Field Experience exposure, achieving NMC programme requirements & addressing recommendations from Shape of Caring (Health Education England);
  • Evaluations reflect quality of content, pastoral support and transferability of learning via this “virtual placement”.

Challenges and lessons learnt for implementation

The presence of the Trust’s Practice Education Lead at all workshops acted as a mentor to students and afforded them weekly access for pastoral support, guidance and timely liaison with the Higher Education Institute, if needed.

The initial challenge was to secure and coordinate the range of teams needed to provide this overarching virtual placement model, to meet both programme requirements and also to proactively address the variation in placement provision previously encountered.

Capacity to deliver the placement 2-3 times a year was initially a concern. However the nurse leadership team now have a core of dedicated and passionate staff, service users and carers which has resulted in the virtual placement being embedded as part of the Trust’s substantive placement offer.

The virtual community placement has addressed the inconsistency and provided a fair and equitable approach to students understanding the wealth of services provided for their communities.

Find out more

For more information contact:

• Debbie Cromack, Quality, Health and Innovation Lead, Bradford District Care NHS Foundation Trust, Nurse Development Team, debbie.cromack@bdct.nhs.uk