Foreword and introduction

As the Director for Health and Justice for NHS England, I am really pleased to present this guidance which provides a best practice framework for nursing preceptorship in the children and young people secure estate (CYPSE).

It is designed to support staff and organisations including CYPSE healthcare providers, leaders, managers, human resources staff, practice development nurses, senior nursing leaders and health and justice commissioners.

It is also for newly qualified nurses, newly registered nursing associates and registered nurses new to the CYPSE. Supporting the nursing workforce is a key priority for me, and this guidance will make a real difference to the first 12 months of newly qualified nurses and newly registered nursing associates and will play a key contribution to developing the nursing workforce for the future.

CYPSE settings present unique and diverse learning and development opportunities for nurses and nursing associates. Children and young people are seen by nurses at an extremely vulnerable and difficult time, where the receipt of the right care and support could significantly change the course of their lives.

This guidance is commissioned via NHS England’s Health and Justice Inclusive Workforce Programme. It describes the key components of an effective, evidence-based preceptorship programme, and is intended to build on and enhance existing processes for preceptorship – to enhance, not replace, effective existing preceptorship programmes.

It will support organisations to improve the recruitment and retention of nurses within children and young people’s secure services, and I am confident that this will positively influence outcomes for children and young people, heath inequalities and the quality and safety of care delivered.

It has been co-designed and developed in partnership with our organisations providing healthcare to our CYPSE. I want to thank the organisations and individuals that provided their expertise and helped to co-produce this guidance.

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

1. The children and young people secure estate

The following 4 types of secure settings are known collectively as the children and young people secure estate (CYPSE):

• young offender institutions
• secure training centres
• secure children’s homes
• secure schools – a new form of secure setting currently being developed.

Children (up to the age of 18) are placed in these settings either because:

• they have been sentenced or remanded to custody (for example, on youth justice grounds)
• they have been placed there for welfare reasons under the Children Act (2004), known as a welfare placement.

However, these two groups of children often have very similar needs. They can experience a range of health inequalities, higher rates of neurodiversity, neurodisability, mental health and trauma.

Children and young people from ethnic minority communities are over-represented in the CYPSE, particularly children from Black and Asian backgrounds. These groups experience more and sometimes different health inequalities.

Recently there has been added investment into the CYPSE, and the creation of the Framework for integrated care (secure stairs).

This provides a framework to support and train nurses to provide care that is child and young person-centred to ensure that all their needs are identified and met, through co-produced, comprehensive assessments and supporting a psychologically informed formulation (my story).

2. Nursing preceptorship in children and young people secure estate

2.1 What is nursing preceptorship?

Preceptorship is a period to guide and support all newly qualified practitioners in the 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 that 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 first 12 months of qualifying, and to all newly registered nursing associates and registered nurses who are new to prison healthcare settings.

It helps professionals 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) 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.
• Health Education England (HEE) and the Capital nurse preceptorship framework (2020) sets out recommended ‘best practice’ approach to preceptorship to ensure that the right number of nurses, with the rights skills, are in the right place, at the right time, by:
  • decreasing variation in education and practices
  • reducing attrition
  • better retaining nursing staff.

2.2 Children and young people secure estate settings

Preceptorship programmes delivered in children and young people secure estate (CYPSE) healthcare settings should provide exposure to the wide range of healthcare delivered within a CYPSE.

Children and young people in secure environments often present with complex needs that may span mental health, neurodisability, substance misuse and physical health. These needs can be hard to meet through conventional services. This group is sometimes described as ‘high risk, high harm, high vulnerability’.

Providing healthcare for people in these settings therefore requires a wide range of clinical knowledge, experience and skills and a thorough understanding of all healthcare delivered there. Nurses in CYPSE settings will require preceptorship programmes to deliver skills and competencies tailored to these areas.

Effective preceptorship in CYPSE healthcare settings is a fundamental aspect in how newly qualified nurses and nursing associates experience their first year of qualifying and registering with the NMC.

It can also encourage staff to remain working within these settings, helping to continue to grow and develop this workforce.

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 sense of belonging, feeling valued by their employer.

Benefits for employers of children and young people secure estate 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 children and young people secure estate 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 the children and young people secure estate (CYPSE) may need a shorter length of preceptorship than newly qualified nurses.

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

We would encourage your organisation to include a one-month supernumerary period to enable the nurse and nurse associate to complete an effective induction programme, which will:

• incorporate the preceptee’s individuals needs
• support them to attend continuing professional development and complete mandatory training
• assist them in understanding the competence, individual objectives, and their responsibility requirements for their first 12 months in post.

3.2 The role of an effective preceptor

A preceptor is 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 1 preceptor to 2 newly registered nurses or nursing associates.

3.3 Preceptorship lead for each organisation

We recommended that your organisation has a preceptorship lead to oversee the programme, which may include:

• ensuring that 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 the 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 children and young people
• meet regularly with their preceptor
• engage with guided reflective practice in line with the Framework for integrated care (secure stairs) to promote the best possible care for children within the secure estate
• 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, evaluate and measure 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 CYPSE 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 children and young people secure estate healthcare services

We recommend that the following 6 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 children and young people secure estate (CYPSE) healthcare environment, the healthcare teams and types of healthcare delivered.

4.1 Effective clinical and professional practice

Nursing in a CYPSE offers a unique, challenging and rewarding environment to provide effective and professional nursing practice for children and young people.

Your preceptorship programme should have effective systems, processes and competencies in place relevant to delivering care within a CYPSE. This will help the preceptee to deliver safe, person-centred care and demonstrate the values and behaviours of the Nursing and Midwifery Council (NMC) Code.

This may include:

• assessing the risk and the impact of the secure setting programme on health and education and being able to mitigate risk to children and young people
• assessing and understanding making improvements to health inequalities and disparities
• clinical competencies bespoke to the needs of children in CYPSE, including training and implementation of the principles of the Framework for integrated care (secure stairs) and the perspectives in care of vulnerable children including ethics and protected characteristics
• access to regular clinical supervision and guided reflective practice in line with the Framework for integrated care (secure stairs) to promote the best possible care for children within the secure estate
• gaining experience, skills, and competence across all aspects of CYPSE healthcare care relevant to the secure setting. For example, primary care, long-term conditions, speech language and communication need, mental health and neurodisabilities, substance misuse and sexual heath.

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 children and young people accessing and receiving healthcare services in the secure estate.

4.2 Supportive learning environments

Part of your organisation’s responsibility in developing a preceptorship programme is ensuring the required nursing workforce and environment are 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 care of the child and collaboration
• 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 child’s 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 CYPSE teams’ roles and responsibilities and how good working relationship with colleagues can support good quality care and healthcare pathways for children and young people in a secure setting; in line with the Framework for integrated care (secure stairs).

4.3 Collaborative working in integrated care in children and young people secure estate settings

It is essential that newly qualified nurses and nursing associates are supported to experience the integrated working relationships with the wider CYPSE healthcare team and others working within the CYPSE settings, and to understanding their roles and responsibilities in keeping the children and young people safe.

Ensuring that the children and young people’s experience and facilitation of their voice is central to any nursing preceptorship programme.

Where multiprofessional teams work together, patient/person satisfaction is higher, healthcare delivery is more effective, there are higher levels of innovative practice, lower levels of stress, absenteeism and turnover.

As part of your preceptorship programme, you should put in place mechanisms allowing the preceptee to gain experience of the CYPSE and spend time with residential colleagues.

For healthcare to work at its best, integrated working is key and supports good working relationships between all staff working in the secure setting. As part of the preceptorship this may include time spent shadowing and working with:

• specialist children’s nurses including school nurses, looked after children and safeguarding
• professional nurse advocates
• doctors, dentists, and opticians
• pharmacists
• speech and language therapists
• occupational therapists
• healthcare professionals supporting mental health, neurodisability and substance misuse
• residential care staff and education teams.

4.4 Safeguarding children and young people

Operating within a CYPSE setting can present unique challenges for nurses especially the safeguarding of children and young people they are looking after.

Safeguarding is everyone’s responsibility. Everyone who works with children has a responsibility for keeping them safe. All those working with children should be alert to risk factors and signs and symptoms of child abuse and follow local safeguarding procedures where there is cause for concern.

Your preceptorship programme should allow each preceptee to understand their role and responsibility in relation to children and young people’s safeguarding and safety within this environment. This may include:

• how to reduce the risk of harm to children and young people receiving care in a secure estate to ensure the best possible outcomes
• how to assess risk and the impact of the secure estate programme on healthcare and be able to mitigate risk to children and young people receiving healthcare
• understand how the wider CYPSE can impact on healthcare provided
• building relationships with other CYPSE staff to ensure integrated working to ensure the best outcomes for children and young people receiving healthcare
• how to raise patient safety and safeguarding concerns
• access to safeguarding supervision and guided reflective practice
• spending time with the corporate nursing/governance team, looked after children’s nurses and safeguarding lead to gain understanding of patient safety and safeguarding policies and procedures and how this relates to practice (this could be undertaken while preceptees are waiting for security clearance)
• how incidents are reported and lessons learned are used to reduce the risk of incidents occurring
• how incidents of self-harm or attempts to self-harm are recorded and referred to the named safeguarding lead.

4.5 Self-care and wellbeing

The health and wellbeing of nurses is 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 CYPSE environment can bring challenges that new staff need to be prepared for and be supported through.

Prioritising the self-care and wellbeing of nursing staff is key to sustaining an emotionally resilient nursing team that can work compassionately and effectively with children and young people within this challenging environment.

It is important that the nursing workforce is emotionally resilient, trauma-informed and child-centred when facing challenging behaviour and ethical challenges of vulnerable children and young people.

CYPSE healthcare organisations must support newly qualified nurses and nursing associates to prioritise their physical and mental health wellbeing. Your preceptorship programme should include mechanisms and policies allowing preceptees to look after their own health and wellbeing.

This may include, but is not limited to:

• regular clinical/safeguarding supervision and guided reflective practice
• understanding of organisation’s policies and how to access support for physical, mental, and emotional health and wellbeing
• coaching and mentoring
• guided reflective practice
• support from senior members of the team, including the professional nurse advocate
• 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 CYPSE 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; employers must ensure this is possible.

4.6 Professional feedback and patient experience

Gaining feedback and listening to children and young people about their experience of healthcare, and making improvements to care is an essential component of ensuring high quality of care in the CYPSE 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 children and young people and/or colleagues.

Your preceptorship programme should include mechanisms and policies for the preceptee to gain feedback from colleagues and children and young people 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 children, young people, 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 the child’s experience, the child’s journey and quality of care delivered in the CYPSE.

5. Conclusion

Setting out best practice guidance for preceptorship in the children and young people secure estate (CYPSE) 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 and nursing associates in the CYPSE.

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 CYPSE healthcare should therefore bring a range of benefits to the workforce and service in general.

This is particularly important within CYPSE healthcare, where staff are expected to deliver care to support some of the most vulnerable children and young people in our society with a wide range of health issues and health inequalities in environment settings that brings their own challenges.

Ultimately, an effective preceptorship programme will lead to the improvements in the quality, experience, and safety of children and young people receiving healthcare in a secure setting.

Appendix 1: Useful documents and resources

• Health Education England, Reducing pre-registration attrition and improving retention, 2020.
• NHS England, Competence framework, health and justice sector, 2017.
• NHS Employers, NHS health and wellbeing framework.

Nursing and Midwifery Council, Standards of student supervision and assessment, 2019.

Publication reference: PR1669