Background to learning

During the pandemic experienced staff, particularly those with previous experience of critical care, have been redeployed to Intensive care units to care for extremely unwell individuals including COVID-19 patients. Although redeployment has been vital to ensure safe and effective care across expanded ITU capacity, at times it has led to smaller proportions of experienced staff outside of critical care including more junior colleagues.  This case study looks at how organisations have worked to support newly qualified nurses and midwives and new members of the teams joining during the pandemic and the valuable role experienced colleagues have taken in this leadership effort.

Learning and advice to be shared

It is recognised that this has been a challenging time and for new colleagues joining teams.  Within the CNO National Shared Professional Decision-Making council, members recognised the important roles nursing and midwifery colleagues have held in continuing to deliver safe and effective care. Council members highlighted how teams have deployed new ways of working to support all members of the team including ‘buddy’ systems, the use of badges to identify newly qualified staff to colleagues and the introduction of team huddles on each shift. The rapid development of new networks among newly qualified staff and their experienced counterparts has been crucial to success.

The council highlighted how their teams have supported new colleagues and how they have sought to maintain the important focus on the ‘early weeks’ and settling in periods including approaches such as:

• Continuing supernumerary status in the early weeks of practice.
• Night shifts not being allocated to new colleagues during their first month with teams.
• Mentor and ‘buddy’ support such as frequently touching base and more formal one-to-ones.
• Peer support approaches to complement buddies/Mentors to assist support and listen or chat through any concerns or issues.
• Daily team huddles are also used for feedback/discussion and support.
• Careful allocation that places staff in the most appropriate areas for their skillset, so as not to overwhelm new colleagues.
• Development of networks and providing support to new colleagues such as to health and wellbeing offers and resources available to them more widely in their organisation.

Council members underlined the importance of organisational level support for new team members as a way of relieving demands on more experienced members including maintaining structured development programmes for newly qualified staff which ensure they can continue to develop their skills and competencies.  Council members noted some of the regular development activities for new starters have been impacted by the pandemic. They further noted challenges to completion of on-line learning and fulfilment of study days due to competing pressures, as teams have needed to balance learning with providing care on shifts.

The council recognised that changes in this area with more learning in practice offers a temporary solution, although itself can provide additional challenges for the existing ward staff and services.  Here however, organisations have been highlighted to work collaboratively to support the new and existing colleagues by ensuring that the early weeks support is backed by one-to-ones, with practice educators and facilitators to manage progress and competence milestones.

Would it be beneficial to retain these changes?

Ensuring a positive experience for new members of the team continues to be a priority and is not only beneficial for newly qualified staff but it can also benefit the wider team, patients and the organisation itself in terms of retention, recruitment and staff engagement.  When this works well nurses have been seen to rapidly develop their confidence and extended skills as independent practitioners.

Team working is key and these approaches could also support teams to in relation to the onboarding of final year nursing and midwifery students following the re-introduction of emergency standards which enable final year nursing students to undertake a paid clinical placement.

Applying a supportive approach to new starters is also suggested to be beneficial as part of welcoming internationally recruited colleagues, supporting temporary staff or those redeployed from other organisations during the pandemic into the nursing team.

For further information about this case study, email england.1professionalvoice@nhs.net