Foreword and introduction

This guidance provides a best practice framework for nursing preceptorship in the justice secure and detained estate and is designed for staff and organisations providing prison healthcare, leaders, managers, those working within human resources, practice development nurses, senior nursing leaders and health and justice commissioners.

While it is designed for adult prison healthcare settings, the core components of preceptorship can be applied by other healthcare services within secure adult custodial settings, such as healthcare within immigration removal centres.

It is also designed for newly qualified nurses, newly registered nursing associates and registered nurses new to prison healthcare. The nursing workforce is a key priority for me; I hope that this guidance will make a significant contribution to developing the future nursing workforce through supporting newly qualified nurses and nursing associates in their first year of clinical practice.

Providers of adult healthcare within the prison estate in England experience the same types of recruitment and retention workforce issues experienced by acute and community services.

However, vacancy rates are significantly higher for the prison healthcare workforce which can be due to perceived risk and stigma attached to prison environments. Unfilled vacancies increase the pressure on staff, leading to high levels of stress and absenteeism, and high staff turnover.

To help address workforce demands, nursing within the criminal justice system should be widely promoted as a career option and a service having comprehensive preceptorship programmes may help to encourage staff into the sector.

We must champion the experience of newly qualified nurses and newly registered nursing associates so they feel supported, valued, and facilitated via robust, evidenced-based, preceptorship programmes within adult prison healthcare.

An effective preceptorship programme will improve recruitment and retention of nurses within prison healthcare services and improve outcomes for patients, heath inequalities and the quality and safety of care delivered to people accessing healthcare in prison.

I want to thank the organisations and the individuals that provided their time and expertise to help co-produce this guidance, including a range of prison healthcare providers, working both within NHS foundation trusts and private provider organisations.

Kate Davies CBE, Director of Health and Justice, Armed Forces and Sexual Assault Referral Centres, NHS England.

1. What is nursing preceptorship?

Preceptorship is a period where all newly qualified practitioners are given guidance and support in their transition from student to autonomous practitioner. A good preceptorship programme will:

• effectively support newly qualified nurses and nursing associates to become competent and confident practitioners
• ensure nurses and nursing associates feel valued by the organisation and have a positive experience during their first 12 months
• enhance patient care and experience
• support the organisation to recruit and retain registered nursing staff.

Preceptorship should be available for all newly qualified nurses in the transition from student to autonomous competent and confident practitioner in the first 12 months of qualifying; and available to all newly registered nursing associates and registered nurses that are new to prison healthcare settings.

It helps professionals to translate their knowledge into everyday practice; to grow in confidence; and to understand how to apply the Nursing and Midwifery Council (NMC) Code in their day-to-day work.

The importance of preceptorship programmes is supported by a range of national guidance, principles, and general preceptorship frameworks. These include:

• The NMC Principles of Preceptorship (2020) that sets out generic principles for preceptorship and strongly recommends that all new registrants have a period of preceptorship when commencing employment.
• The Royal College of Nursing (RCN, 2021) Workforce Standards expectations are that individuals with no previous experience should have a preceptorship period which includes structured induction and close supervision until specialty competence and confidence are achieved.
• The Health Education England (HEE) and Capital Nurse Preceptorship Framework (2020) sets out a recommended ‘best practice’ approach to preceptorship to ensure that the right number of nurses, with the right skills, are in the right place at the right time, by:
  • decreasing variation in education and practices
  • reducing attrition
  • better retaining nursing staff.

2. Nursing preceptorship in prison healthcare

Preceptorship programmes delivered in prison healthcare settings should provide exposure to the wide range of healthcare delivered within a prison establishment. Nurses in prison settings require specific preceptorship programmes to develop the skills and competencies tailored to these areas.

How newly qualified nurses and nursing associates experience their first year of qualifying and registering with the NMC can be fundamentally shaped by effective preceptorship; this can impact their proceeding years and career progression significantly and encourage staff to remain working within prison healthcare.

Benefits for nurses and nursing associates

• Preceptorship offers the structured support needed to transition knowledge into everyday practice successfully.
• It provides a lifelong journey of reflection and the ability to self-identify continuing professional development needs.
• A positive preceptorship experience is reported to result in newly registered nurses, midwives and nursing associates having increased confidence and a sense of belonging and feeling valued by their employer.

Benefits for employers of prison healthcare

Effective preceptorship programme outcomes are linked to:

• improved recruitment and retention
  • attracting and retaining skilled nurses and nursing associates is important for delivering better, safe, and effective care
• reduced sickness absence
• improved staff morale and job satisfaction
• enhanced patient care and experience.

3. Effective preceptorship programmes in prison healthcare

3.1 Recommended length of preceptorship

The recommended length of an effective preceptorship programme is 12 months. This should be tailored to individual needs: for example, experienced registered nurses who are new to prison healthcare settings may need a shorter length of preceptorship than newly qualified nurses.

The length of the preceptorship programme will depend on the prison setting, organisational needs, and individual competency assessments with reviews at key points.

We encourage you to include a one month supernumerary period in your preceptorship programme to enable the nurse and nurse associate to complete an effective induction programme which:

• incorporates their individual needs
• supports them to attend continuing professional development and complete mandatory training
• assists in understanding the competence, individual objectives and responsibility requirements for their first 12 months in post.

3.2 The role of an effective preceptor

A preceptor is a registered nurse with at least 12 months of post-registration experience, who provides support and supervision for the preceptee. They must have attended relevant organisational training and have support and regular supervision from senior nurses Band 6 and above.

There should be no more than one preceptor to two newly registered nurses or nursing associates.

3.3 Preceptorship lead for each organisation

It is recommended that each organisation has a preceptorship lead to oversee the programme, which may include:

• ensuring a programme of support is in place: for example, peer-to-peer support, clinical supervision, coaching and action learning sets
• leading the evaluation of the preceptorship programme to track, evaluate and measure the effectiveness of the programme, including completion rates for all preceptees and impact on retention rates
• quality assuring the preceptorship programme to ensure the preceptor/preceptee relationship is working adequately and development and training needs have been identified.

3.4 What is a preceptee’s responsibility?

The preceptee must:

• attend and complete the organisations induction programme
• complete statutory and mandatory training
• maintain a reflective log and gain feedback from patients/residents
• meet regularly with their preceptor
• engage with clinical supervision
• raise any patient safety and safeguarding concerns immediately.

3.5 Organisational responsibility to ensure an effective preceptorship programme

Your organisation should implement a process to track, measure and evaluate the effectiveness of your preceptorship programme; this will allow you to demonstrate the programme’s value and make improvements where necessary.

Your organisation’s commitment to developing and supporting a bespoke prison healthcare preceptorship programme will be crucial to its effectiveness; as will the support given to those staff delivering the programme and supervising newly qualified staff and nursing associates.

4. Key components to preceptorship within adult prison healthcare services

We recommend that the following six key components should be included as part of your preceptorship programme or used to enhance existing preceptorship programmes. These should be adapted to accommodate the requirements of the individual adult prison healthcare environment, the healthcare teams and types of healthcare delivered.

4.1 Effective clinical and professional practice

Nursing in an adult prison offers a unique, challenging and rewarding environment to provide effective and professional nursing practice for patients.

Organisations should ensure their preceptorship programme is supported by having effective systems and processes in place relevant to delivering care within an adult prison setting. This will help to ensure the preceptee is supported and able to deliver safe, person-centred care and demonstrate the values and behaviours of the NMC Code.

This may include:

• assessing the risk and impact of the prison regime on healthcare and being able to mitigate risk to patients
• assessing and making improvements to health inequalities
• clinical competencies bespoke to the individual prison setting
• access to regular clinical supervision
• gaining experience, skills, and competence across all aspects of prison healthcare care relevant to the individual prison. For example, substance misuse, primary care, mental health, long-term conditions, end of life, older people, sexual heath, and management of people with disabilities.

This will support the preceptee to understand their role, responsibility and remit, and the practices within the limits of their competence, to help ensure safe and high-quality care to adult residents accessing prison healthcare services.

4.2 Supportive learning environments

Part of the preceptorship programme is ensuring the necessary nursing workforce and environment is in place to support newly qualified nurses and nurse associates. Facilities for regular professional reflection and clinical supervision should also be in place to support ongoing learning and best practice development.

 This may include:

• learning with and from others, teaching others to improve patient care and collaboration through shared learning and experience
• setting a clear set of objectives for the first 12 months of practice, developed and agreed with the preceptee and preceptor to ensure individualised learning needs are considered, and to support any protected characteristics of the preceptee
• understanding each other’s professional roles and their contribution to the patient journey
• actively reflecting on positive and difficult situations and learning from these to improve practice
• providing preceptees with the opportunity to reflect on their practice, individually and with peer support
• understanding the wider prison teams’ roles and responsibilities and how good working relationship with colleagues can support good quality care and healthcare pathways for people in prison.

4.3 Working collaboratively with the wider prison teams

The healthcare team comprises a broad range of healthcare professionals; working alongside these are the prison psychology team, chaplaincy services, education teams, peer workers, healthcare champions and voluntary organisations; and to ensure the safety and security of the prison are the prison governors, prison officers, security and safer custody teams.

Healthcare in prisons can be directly affected by the prison regime, which presents unique challenges for nurses working in this environment. Security is a main priority in any prison setting and the movement of people in prison may sometimes be restricted. This, coupled with the reliance on prison staff to safely escort people to the healthcare centre for appointments, can impact on healthcare delivery.

It is essential that newly qualified nurses and nursing associates are supported to experience collaborative working relationships with the wider prison healthcare teams and others working within the prison, and to understanding their roles and responsibilities in keeping people safe and collaborative work.

Where multi-professional teams work together, patient satisfaction is higher, healthcare delivery is more effective, there are higher levels of innovative practice, lower levels of stress, absenteeism and turnover, and more consistent communication with patients.

You should put in place mechanisms for the preceptee to gain experience of the wider prison system and spend time with non-healthcare colleagues. For healthcare to work well, the service is dependent on good working relationships with the rest of the prison establishment team. As part of the preceptorship this may include time spent shadowing and working with:

• prison officers
• security teams
• safer custody teams
• drug and alcohol teams.

4.4 Patient safety and safeguarding

Operating within a prison setting can present unique challenges for nurses around patient safety and safeguarding.

Organisations should ensure their preceptorship programme allows the preceptee to understand their role and responsibility in relation to patient safety and safeguarding within this environment. This may include:

• how to reduce the risk of harm to those residents receiving care in prison to ensure the best possible outcomes
• how to assess risk and the impact of the prison regime on healthcare and be able to mitigate risk to people receiving healthcare
• understanding how the wider prison system can impact on healthcare provided
• building relationships with prison staff to ensure collaborative working to ensure the best outcomes for people receiving healthcare
• how to raise patient safety and safeguarding concerns
• spending time with the corporate nursing/governance team to gain understanding of patient safety and safeguarding policies and procedures and how this relates to practice; this could be undertaken while the preceptees are waiting for security clearance
• how incidents are reported, and lessons learned are used to reduce the risk of incidents occurring.

4.5 Self-care and wellbeing

The health and wellbeing of nurses are essential to the quality of care they can provide for people and communities, affecting their compassion, professionalism, and effectiveness.

An effective preceptorship can be a powerful platform to help ensure the self-care and wellbeing of newly qualified nursing staff and nursing associates. It can positively impact the delivery of care and job satisfaction. Working in a prison environment can bring challenges that new staff need to be prepared for and support through.

Prison healthcare organisations must support newly qualified nurses and nursing associates to prioritise their physical and mental health wellbeing. You should ensure that as part of the preceptorship programme, there are mechanisms and policies in places for the preceptee to be able to look after their own health and wellbeing.

This may include, but is not limited to:

• regular clinical/safeguarding supervision
• understanding of organisation’s polices and how to access support for physical, mental, and emotional health and wellbeing
• coaching
• reflective practice
• support from senior members of the team
• a supportive learning environment
• peer-to-peer support/action learning sets
• protected time to meet with preceptor and to undertake professional development

The health and wellbeing of nurses is fundamental to the quality of care they can provide. Supporting the prison nursing workforce to practice self-care will help improve with overall job satisfaction and thereby recruitment to the profession and retention of the current workforce.

Inherent within the NMC Code is the need for individual practitioners to look after their own health and wellbeing to be able to care effectively for others, and employers must ensure they are able to do this.

4.6 Professional feedback and patient experience

Gaining feedback and listening to patients about their experience of healthcare, and making improvements to care is an essential component of ensuring high quality of care in the prison environment.

Nurses and nursing associates are required to re-validate every three years with the NMC. A requirement of this process is the submission of five pieces of practice-related feedback from patients and/or colleagues.

Organisations should ensure that as part of the preceptorship programme there are mechanisms and policies in places for the preceptee to gain feedback from colleagues and patients and that this is also used to inform improvements in healthcare and quality of care, where appropriate.

This may include:

• ensuring safe and effective mechanisms are in place for preceptees to gain feedback from patients and colleagues in the first year of practice
• encouraging and supporting newly qualified nurses and nursing associates to gain feedback
• clinical supervision to support the preceptee to discuss and reflect on professional feedback
• learning from feedback, how this can improve patient experience, the patient journey and quality of care delivered in prison.

5. Conclusion

Setting out best practice guidance for preceptorship in prison ensures that organisations are supported to deliver a consistent approach to supporting newly qualified nurses and nursing associates in their first year of registered practice.

Effective preceptorship programmes will support recruitment and retention of registered nurses in prisons.

Preceptorship programmes underpin a foundation of lifelong career of learning and reflection for registered nurses and nursing associates who have the competence and confidence to be autonomous practitioners and remain up to date through continuing professional development and practice in line with the NMC code.

Putting these recommended components in place as part of new or existing preceptorship programmes within prison healthcare should therefore bring a range of benefits to the workforce and service in general.

This is particularly important within prison healthcare, where staff are expected to deliver care to support often vulnerable people with a wide range of health issues and health inequalities in a host environment setting that brings its own challenges. Ultimately, an effective preceptorship programme will lead to the improvements in the quality, experience, and safety of people in prisons accessing healthcare.

Appendix 1: useful documents and resources

• HEE, Reducing pre-registration attrition and improving retention, 2020, 
• NHS England, Competence Framework, health and Justice sector, 2017
• NHS Employers, NHS health and wellbeing framework 
• NMC, Standards of student supervision and assessment, 2019

Publication reference: PR1649