An Undergraduate Programme Lead (Nursing) and Practice Placement Co-ordinator (both registered nurses) at the University of Lincoln worked with General Practice Nurses to develop General Practice (GP) placements for pre-registered nurses. This project enabled student nurses to experience General Practice Nursing (GPN) and aims to support succession planning for the future of general practice nursing.
Where to look
General Practice is facing an acute shortage of doctors and nurses, with rural locations in particular finding it difficult to recruit and retain staff (NHS England, 2017). The Five Year Forward View (NHS England, 2015) and the General Practice Forward View (NHS England, 2016) discuss the importance of training and development to move care closer to home and meet the needs of an aging population.
Health Education England (HEE) initiated a Training Hub model, to engage local GPs in delivering and supporting continuing education for both existing staff and students (nursing, medicine and other allied healthcare professions). In Lincolnshire, the initial objective of the Training Hub was to focus on undergraduate students, in particular nursing and medical students. The GPN ten point plan (NHS England, 2017) further supported this initiative with an aim to increase the number of pre-registration nurse placements. Previous work by the Programme Lead had seen a Community Education Provider Network (CEPN) in place that had facilitated practice learning enhancement.
What to change
Prior to the HEE training hub initiative, only 10 GPs out of 104 in Lincolnshire offered placement experiences for student nurses. Staff had not undertaken the relevant training for practices to offer a final management placement. The Programme Lead and Practice Placement Co-ordinator, in collaboration with three lead GPNs, identified the need to provide additional training for existing mentors to be in a position to sign off final placements for students. The GPNs and other practice staff fully advocated student exposure to general practice, to gain the skills necessary (as detailed in the Nursing and Midwifery Council pre-registration competencies), which would not only support recruitment but encourage retention and development of GPN careers.
How to change
The Programme Lead and Practice Placement Co-ordinator worked closely with training hubs in Lincolnshire and the lead GPNs in three different practice locations (military, rural and urban settings), to explore how their clinical areas could support a final placement for student nurses. The aim was to secure at least one primary care GP placement during the 3-year undergraduate programme and to equip students who are about to graduate with necessary skills to enable them to enter practice nursing once qualified. This could support graduates to consider practice nursing as an attractive career option. A mapping document was collaboratively prepared to support learning objectives through the demonstration of how the GPN environment could facilitate a student to meet the required NMC competencies. The final placements in these three practices were then advertised to all third-year student nurses; those who expressed their interest in this placement were shortlisted by the GPNs as if applying for a post.
Once the students were allocated to their GPN mentor, dates were set for the preliminary, intermediate and final interviews to be completed at the University. The Programme Lead was the nominated active sign off mentor who could support the additional training of the GPNs, which not only supported staff mentors new to the ‘sign off process’ but also provided additional support for students and flexibility in provision. For example, due to the nature of one of the settings, it was more difficult to expose students to areas such as long-term conditions. To accommodate this, competency sets exchange visits were arranged with other participating practices. In addition, there was support for the adoption of other learning strategies such as scenario work and educational workshops. Practice support visits were undertaken for all sites to add further support and evaluation opportunity.
A research project was established to evaluate the final placements. This consisted of a semi-structured focus group with the three students to explore how they had prepared for the placement, how they had achieved their competencies, what the positives were of this placement experience and what the challenges were. Ethical approval was granted by the University to interview the students. There were three main themes round from the analysis of the interview data, around myth busting, the teaching and learning environment, and competency attainment.
Better outcomes – The collaboration between the Programme Lead, Practice Placement Co-ordinator, GPNs and the students enabled the aims of the project to be effectively realised. Myth busting sought to address the preconceived ideas students had about the role of a GPN – these had changed following the placement and students were keen to tell other students of the under recognised role complexity within GP nursing. Previous experience in this placement setting had increased students’ understanding of the role and their wish to re-visit this speciality of nursing.
Better experience – Students experiencing placements in General Practice evaluate these favourably, reporting that they felt it allowed them to understand more about the role of a GPN and the work undertaken in General Practice. Competency attainment referred to the ability to develop both skills such as communication and empathy, as well as clinical skills, such as long-term condition management, wound management and venepuncture. Students positively reflected on their placement experience and discussed how this had prepared them when qualifying as a nurse. Informally, the GPN mentors reported how this experience had supported their own development as sign off mentors. The GPNs are continuing to work with the Programme Lead and Practice Placement Co-ordinator to offer final placement experiences for student nurses.
Better use of resources – Giving students placement experiences in general practice helps to promote a GPN career and supports future recruitment with the right skills for practice as well as retention. The experience had increased students’ desire to pursue a career in practice nursing, feeling that they could do so on registration. It also supports current GPNs with their own professional development and has equipped them with skills to support final placement students, as well as established a support system to make this sustainable. The GPNs continue to offer placements for student nurses and they assist with disseminating this experience to others. The GPNs facilitate career events at the university to encourage student nurses to consider GPN careers.
Challenges and lessons learnt for implementation
The availability of sign off mentors in general practices was a challenge and it is important to encourage more GPNs to undertake this important role to allow more students this opportunity.
Collaborative working of the three practices support the provision of an all-round learning experience which is highly recommended and adheres to competency guidance.
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