Wirral and Cheshire Clinical Placement Expansion Programme
Wirral and Cheshire Clinical Placement Expansion Programme Innovations supporting high qual i ty learning environment in capacity expansion
Case studies
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Contents
Warrington and Halton Teaching Hospitals NHS FT Implementing a ‘ Continuity of Carer ’ learning experience
East Cheshire NHS Trust Virtual placement pathway for Nursing students
Wirral Community Health and Care NHS FT Autonomous practice framework
Wirral University Teaching Hospital NHS FT Expanding placement capacity whilst enhancing learning experiences in Midwifery
Mid Cheshire Hospitals NHS FT Multifaceted approach to increasing student capacity
NHS Halton CCG and NHS Warrington CCG Practice Development role in Primary Care
Countess of Chester Hospital NHS FT Implementation of a ward-based Practice Education Facilitator role
North West Boroughs Healthcare NHS FT Enhancing Practice Educator Facilitator functions
Bridgewater Community Healthcare NHS FT Developing fundamental skills for the future nurse standards
Cheshire and Wirral Partnership NHS FT Creating online learning community across the fields of practice
Foreword By Kimberley Salmon Jamieson, Chief Nurse, Deputy Chief Executive, Warrington and Halton Teaching Hospitals NHS Foundation Trust
The importance of strengthening and developing clinical placement capacity is a strategic focus for Wirral and Cheshire NHS organisations and has been identified as a priority area by the Cheshire & Merseyside Nursing and Midwifery Workforce Programme.
In May 2020, NHS England announced a support package for universities and pre registration healthcare students to ensure that barriers were not put in the way of increasing the future domestic supply of Nursing,Midwifery and Allied Health Professionals. The statement included the approval of 5000 additional training places allocated to Nursing, Midwifery and Allied Health Professional courses.
The announcement was made across a backdrop of the COVID-19 pandemic which resulted in significant changes to the delivery of healthcare provision and impacted on established healthcare placement capacity. In September 2020, we were delighted that a Wirral and Cheshire consortium bid to Health Education England, supported by NHS Improvement England was successful, and clinical placement expansion funding was awarded. The funding has supported members of the consortium to develop new initiatives to deliver sustainable growth in placement capacity and the NHS workforce, in line with the priorities of the long-term plan. I am pleased to confirm our ambition to
provide an additional 187 first year Nursing and Midwifery students withplacement opportunities in our partnership organisations was exceeded. I am delighted to present the associated case studies and a huge well done to all the teams involved.
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The Wirral and Cheshire consortium includes the following organisations :
Lead Provider:
Warrington and Halton Teaching Hospitals NHS FT
Service Provider Partners:
Bridgewater Community Healthcare NHS FT Cheshire and Wirral Partnership NHS FT Countess of Chester NHS FT East Cheshire NHS Trust NHS Halton and NHS Warrington CCGs Mid Cheshire Hospital NHS FT North West Boroughs Healthcare NHS FT Wirral Community Health and Care NHS FTWirral University Teaching Hospital NHS FT
Lead HEI :
University of Chester
Members of the consortium have developed a series of case studies showcasing the work that has been undertaken with the funding received which include:
• • • • •
The utilisation of technology enhanced learning opportunities The creation of new frameworks to support autonomous practice
Optimisation of 24-hour 7-day week rota capacity The implementation of new models of supervision Building practice supervisor and assessor capacity
• Increased practice education facilitator support to learners, their supervisors and assessors.
The success of this work has enabled the consortium to both exceed the target increaseand implement new initiatives which have improved the quality of our learning environments.
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Case Study
Implementing a ‘ Continuity of Carer ’ learning experience
Background
Rachel Crone Midwifery Practice Educator
In December 2020, we were both delighted and proud to have opened a new £1.2 million unit for expectant mums and their new arrivals from across the region called ‘ The N est’. This Midwifery-led unit is state-of-the-art and creates a relaxing and supportive home away from home experience for new parents having their baby. The Nest is available alongside our other maternity services, including those for pregnancies that are considered to be more complex, and home births supported by community midwives. We have also launched our ‘Continuity Of Carer’ model. NHS England recommended model aims to provide consistency in the midwife or clinical team providing care and achieve improved outcomes for the woman and baby throughout the three phases of her maternity journey: pregnancy, labour and the post-natal period. This case study outlines how we have increased the Practice Based Educator resource within maternity services to support an increase in placement capacity for first year student midwives, with a long term goal of preparing practitioners who at the point of registration have the knowledge, skills, confidence and competence to work in these new environments.
Key Aims
• To increase the number of 1st year Midwifery students placed in the Trust by 16, to meet our placement expansion target.
• To provide learners and educators with more accessible and timely support provided by the maternity Practice-Based Educator.
• To explore and implement a new model of learning supervision.
• To design a student ‘ Continuity of Carer ’ learning experience in the following areas:
Birth Suite Community Continuity Team Antenatal Service The Nest Maternity Ward
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Working in collaboration with HEI’s to accelerate learning audits and placements – as above.
Student has opportunity to do specialist visits both virtually and physically, have e-learning opportunity to ex-pand knowledge and skills
Case histories to discuss with mentors and staff.
CCG collaboration and meetings. Opportunity for funding to enhance the learning environments and supportdevelopment of both student and mentors.
Challenges How it works
Rotational placement experiences across the continuum of services covering the antenatal, intrapartum and postpartum period are planned for learners.
A new model of practice supervisor/assessor support has been implemented using a 2:1 student to supervisor model, moving away from the previous 1:1 model of support.
A programme of in situ in practice and classroom-based skills training was designed and implemented.
Daily walk arounds are undertaken by the Practice-Based Educator monitoring levels of supervision,progress towards learning objectives and completion of the practice assessment document, addressing queries or concerns in a timely manner, capturing example of good practice sharing across Midwifery teams.
Summaries of findings and details of new innovations are shared at a senior midwife forum to promote high quality learning environments across the maternity services.
The practice-based educator represents the Trust at regional networks to share learning and opportunities for development. The role also works in close partnership with our local Higher Education Institutions and Practice Educator Facilitators.
Resources
• Business mobile phone to increase accessibility to the Practice-Based Educator for students, practice supervisors and practice assessors.
• Daily walk around contact sheets to capture issues or queries raised for action planning and escalation as required.
• Laptops are available to learners to support access to virtual and online learning opportunities.
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Case Study Midwifery
Warrington and Halton Teaching Hospitals NHS Foundation Trust
Key Outcomes
The target set for Midwifery placement expansion has been achieved and exceeded as detailed below.
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During the project period we have received 44 student midwife placement evaluations. The table below provides an overview of the top 5 scoring questions.
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Feedback from learners
“I have found the Continuity of Carer model to be invaluable to my training. Seeing the benefits of continuity inspires me to build relationships with our women and makes this job so rewarding”
Challenges
The most pivotal challenge faced has been the number of significant changes taking place over the past 12months, including the impact of the COVID-19 pandemic on service delivery, the implementation of the ‘ Continuity of Carer ’ model, the implementation of the new Nursing and Midwifery Council (NMC) ‘Standards for Education and Training’ and NMC changing models of supervision.
Key learning
By increasing the accessibility of the Practice-Based Educator we have been able to support staff to adop tnew models of supervision and a new curriculam requirement for the NMC ‘Standards for Education and Training’.
The Midwifery Practice Educator role has supported effective communication of the changes between universities, Practice Educator Facilitators and clinical teams.
Providing Midwifery learner forums has created an opportunity for learners to share experiences and reflect on practice, builds professional resilience and promotes autonomous practice.
When increasing idwifery placement capacity consideration needs to be given to the impacts on other learning environments/short visits as part of the planning process e.g. gynaecology and neonatal unit.
Quote “I have found the Continuity of Carer model to be invaluable my training. Seeing the benefits of continuity inspires me to build relationships with our women and makes this job so rewarding”
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Sustainability
Funding has been secured to sustain the full time practiced based educator position until 31st March 2022 to embed the new ways of working.
Next Steps
To work in partnership with the Practice Education Facilitator team to review Collaborative Learning in Practice model (CLiP) and consider how coaching methodology can be applied within Midwifery services.
For further information contact: whh.clinicaleducationteam@nhs.net
Quote “I feel privileged to have experienced such amazing continuity, being able to be a part of such positive outcomes and building such strong relationships with the women. Bernie is just incredible at what she does, so my experience has been second to none!”
Quote “As a student midwife I have loved working in a continuity model, seeing the impact my supervisor has had on women and families in his care has been amazing and made every day of learning that little bit more special as I had the opportunity to meet women multiple times throughout my placement antenatal through to postnatal”
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Case Study Virtual placement pathway for Nursing students
Background
East Cheshire NHS Trust in partnership with Cheshire and Wirral Partnership NHS Foundation Trust is developing a virtual clinical placement pathway that will form part of a clinical hub placement. There are seven areas of practice: Medicine, Surgery, Emergency Medicine, Critical Care, Community, Mental Health & Learning Disability. The Learning and Knowledge Hub is an intuitive platform that will host a range of practice-based learning activities that will be mapped against the learner’s current programme of study and count towards practice hours. The learner’s objectives and competencies will be be aligned to their stage of learning and mapped against the Practice Assessment Document (PAD) within each pathway. Our aim is to centre the learning opportunity based upon the “lived experience”. Each pathway will align to a family or our virtual care community, which will give the learner the opportunity to explore different elements of health and social care, care pathways and the patient journey and experience. Patient stories, video clips and live simulation will be embedded within the virtual experience. Assessors and supervisors will have administration rights to oversee their learner ’ s virtual placement experience. Each learner will achieve certification at the end of their virtual placement which will contribute towards their formative or summative assessment.
For further information contact: Sonia.meadows@nhs.net
Key Aims
• To increase student Nursing capacity using technology enhanced learning opportunities
• Enhance the quality of learning for all healthcare learner’s health professional students
Resources
This is an interactive learning tool that enables the learner to engage with a Lived Experience Connector, their peers, assessors/ supervisors, using chat and break out rooms, it supports live teaching sessions and simulation, has conferencing facilities, and video streaming.
Behind each pathway will be uploaded resources, including reading materials, videos links/clips and workbooks, that will be used to facilitate learning in line with the learner’s programme of study.
The funding for this project has been used to purchase Flipping book, animator and whiteboard to support the development of the workbook material. A Band 6 Practice Education Facilitator (PEF) will be appointed to facilitate and operationalise the virtual learning platform.
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How it Works
Each virtual placement pathway has been designed around a fictional care community, hosting families that have specific health needs based on demographic and ethnographic research. Each activity is aligned to the clinical hub speciality and each family member is aligned to a lived experience. There are three workbooks that align to each cohort year, each set against the PAD learning outcomes. Activities include case studies, research critique, quizzes, presentations, watching video clips delivered by a service users, multi-professional speakers or subject matter experts who are involved in care provision and live streamed simulation. The learner will be allocated a practice placement by the University of Chester and the virtual placement aligned to their hub; medical, surgical, community, critical care, emergency medicine, mental health or learning disabilities. The virtual week will be allocated within their block placement and instructions sent in advance of the start date with a link to enrol onto their allocated pathway. The band 6 PEF will facilitate and monitor student progress throughout the week. A live simulation event is scheduled to run at the end of the virtual learning week which covers all the learning objectives set within the workbooks. Each activity is mapped against the PAD domains and learning outcomes. Progress is awarded certification at the end of the virtual placement to demonstrate completion and access remains open to the learner for the duration of the hub placement, which can be shared with their assessor and supervisors. The placement pathways can be used to support the hub placement for up to 3 years as each cohort stage is reflected in each workbook.
Key Outcomes
• Increased learner capacity within the system
• Flexibility within the hub & spoke placement model
• The opportunity to use virtual practice learning to make up hours, self-isolate, unblock capacity
• The potential for Inter-professional learning
• Provide live stream simulation
• Provision of live stream simulation
• Peer support and virtual co-working
• It is expected that learners gain a deeper understanding of clinical conditions including the assessment and subsequent managementof the patient’s needs , they also gain an insight into the views, experiences and expectations of service users
• Endorse and highlight evidence-based practice
• Promotes team and partnership working
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Activity Examples
Challenge s
• Coordinating and aligning hub placement blocks with the learner cohort and placement dates • Coordination and the allocation of supervisors/ assessors in advance of the virtual learning week
• IT access for some students
• The amount of time and resource to set and create the learning material behind each pathway • GDPR risk assessment pertaining to the Lived Experience Connector/patient experience video clips
Sustainability
There is potential to upscale this model with partner organisations and across professional groups. The project has not included AHP or Midwifery professions, this has been included in phase two of our project plan and would be dependent on further funding to develop the resources required.
Next Steps
The pilot phase is set for June 2021. Data from student evaluations will be collated and used to inform further development based upon feedback received from learners, supervisors and assessors.
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Key Learning
Stakeholder engagement has played a key part in building this intuitive virtual placement model. A learner survey was sent out at the beginning of the project to gain a deeper understanding of what our learners required and what their expectations were of a virtual learning placement model. Project management principles have been essential to keep momentum and to set deadlines to reach the pilot phase. The pandemic whilst disruptive, has allowed us to think more creatively, work more collaboratively, and provided the opportunity to use technology enhanced learning. Blended and virtual learning methods can increase placement capacity and provide learners with the clinical knowledge and skills required to meet their learning outcomes. This is a new way of delivering a clinical placement and it will require continued monitoring and evaluation to ensure the quality of the learning experience is not compromised.
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Case Study Autonomous practice framework
Background
Wirral Community Health and Care have devised and developed the ‘Autonomous Practice’ framework guidance for placement educators and locally developed coaching cards to support delivery of framework. The framework work enables final placement student nurses to work indirectly supervised freeing up Placement Educators to directly supervise junior students. This increases the quality of the placement experience and enables an increase in placement capacity. Extensive resource was committed through Practice Educator Facilitator and administration hours and support from the Learning & Organisation Development team to devise a block training programme provided by Trust specialists to ensure students were equipped with the knowledge, skills and confidence to successfully undertake their placements using the autonomous practice framework.
Learner and educator evaluation of the innovation has been overwhelmingly positive.
Key Aims
To increase student nurse capacity and autonomy, with additional Trust training and educator support to maintain a quality learning experience.
Resources
• Increased Practice Education Facilitator hours and administrative support • Block Training Programme for 3rd year students, with co-ordination support from Learning and Development colleagues, delivered by clinical specialists • Autonomous Practice Framework: Guidance for placement educators • Increased training for placement educators and provision of locally designed coaching cards
How it works
Utilising a coaching approach, and with the provision of block trust training, 3rd year final placement students are enabled to work autonomously under indirect supervision in the community environment, freeing up placement educators to directly supervise more junior students. This approach develops confidence and competence, enables a quality learning environment, supports the transition to newly qualified nurse and aids in the management of an increase in placement capacity.
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Challenges
• Cultural shift supporting supervisors and assessors to understand and embrace the new framework capacity to increase knowledge and understanding of the framework.
• Additional resource for skill-based training required to enable students to practice autonomously through the framework.
• Additional resources needed to provide clinical laptop loans to students for duration of placement.
Key Outcomes
Improvement in quality of placement.
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• Improved experience for students as evidence through evaluation.
• Development of autonomous practitioners confident and competent at the point of registration.
• Notably improved quality of newly qualified nurses applying for community Nursing vacancies.
• Increase in capacity of student placements through indirect supervision.
• Unanimous positive feedback from placement educators of the framework.
Key Learning
Investment in skills development upfront enables the framework to be applied more successfully. Peripatetic support from the Trust ’s support from the Trust’s Practice Educator Facilitator was needed in building practice assessor/ supervisor confidence and competence with the framework and underpinning coaching principles, reducing resistance to change.
Sustainability
• Introduced the community nurse development programme that is delivered quarterly that 3rd year student nurses are enrolled on to.
• Continued printing of locally designed coaching cards.
• Increased PEF and administrative hours to manage increase in capacity.
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Case Study
Wirral Community Health and Care NHS FT
100% of students agreed that this model of learning and supervision should be implemented by the Trust for all student nurse placements. Here are some of their additional comments that were captured via the Trust placement evaluation
“all staff were very supportive and understanding of any concerns/anxieties”
“such an amazing placement, staff so welcoming”
“my mentor was so, so, helpful and on the ball with my pare”
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“really thought the first two -week block training was beneficial”
“the two-week training was amazing and very informative; I wish I had this training earlier in my course”
“clinical training was very informative and contained lots of new info I didn’t know”
“I feel the training I have had is outstanding”
Learner feedback
96.16% of students reported the support from practice educators what excellent or very good.
100% of Students evaluated the block training as good to excellent
“being able to make decisions on my own with confidence”
“Working alongside many amazing professionals and being a part of the team – I am proud of everything we have achieved”
“gaining confidence and believing in myself as part of a team”
“being autonomous and of value to the team ”
Next Steps: •
Continued evaluation
• Continued practice assessor / supervisor workshops • Collaboration with key projects such as Enabling Effective Learning Environments (EELE) • End of placement celebration event (virtual)
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Case Study Expanding placement capacity whilst enhancing learning experiences in Midwifery
Background
September 2020 saw an increase in student numbers which required a new model of placement allocation to enable quality learning environments to be delivered. The Practice Educational Facilitator (PEF) team and Maternity Practice Educator worked together to review and map the placement programme planners from three local universities and identify potential areas of gaps in placements and possible areas of expansion. This mapping exercise enabled an increase of three extra placements. Feedback from one of our placement student champions has identified that the work with mapping the placement and formalising spokes has had a positive impact on learning.
This work has identified that the increase has not impacted negatively on the student experience.
Key Aims
• To increase placement capacity for pre-registration midwifery learners whilst maintaining a high quality learning environment and ensuring the quality of care for our service users is maintained in line with COVID restrictions.
• To scope wider placement experiences to enhance the learner journey and to support the placement expansion.
• To embed the ‘ continuity of carer ’ model into the pre- registration learner experience.
How it works
Midwifery placements are structured with allocated spokes mapped to the learning outcomes. This enabled an increase to be identified within the hub areas ensuring COVID-19 restrictions are being adhered to and supporting placements previously used for short visits to be utilised to their full potential.
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Key Outcomes
• Sustain the new model of placement allocation.
• To maintain quality learning environments whilst increasing placement capacity.
• Placement readiness in line with the new Future Midwife Standards.
Challenges
• Clinical rotas to ensure learners are allocated appropriate placements at the correct time.
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COVID-19 restrictions.
• Managing the placement rotations to ensure placement outcomes can be fully achieved e.g. meetingthe required number of deliveries.
• Introduction of new assessment documentation.
Key Learning and Sustainability
• Resources required to ensure sustainability.
• Learner engagement is important in any change.
• Multidisciplinary collaborative working is required throughout
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Resources
• Collaborative working between the Practice Educational Facilitator Team and Midwifery Department
Programme mapping
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Senior management support
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Next Steps
• Monitor learner /service user feedback
Monitor assessment progress
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Review resources
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• Scope further expansion opportunities
• Ongoing review of placement opportunities in relation to COVID-19 restrictions
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10 NHS organisations collaboratively working on Clinical Placement Expansion Programme
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Case Study Multifaceted approach to increasing student capacity
Background
As part of the Clinical Placement Expansion Project at Mid Cheshire Hospitals NHS Foundation Trust (MCHFT) and Cheshire Central Integrated Care Partnership (CCICP), several initiatives have been proposed to support student placement expansion. They are at different stages of implementation and evaluation.
Key Aims
• • •
Enhance the quality of placements and experience of students Adopt new learning opportunities to support capacity Utilise virtual learning to support the student experience
• Enhanced clinical leadership development for student nurses with the development of a coaching model in practice
Project Initiatives
Virtual Learning Week Virtual ward was designed and facilitated by the Practice Educator Facilitator (PEF) to support placement capacity. Mapping of the 4 main university placement requirements highlighted peaks in capacity demands that could not be met within the current circuit. The programme is delivered over one week and aimed at the first year Nursing students to support their learning and understanding of the care needs of patients. The focus is on developing confidence in the fundamentals of clinical practice, to support application to their practice. The sessions include: • Human Factors • Communication workshops • Reflective practice • Nutrition and Hydration • Aseptic Non- touch Techniques (ANTT) applied to practice • Pressure ulcer prevention • Vital signs monitoring and escalation Virtual Ward In collaboration with the Trust Simulation Team, the Practice Educator Facilitator Team have designed and delivered a virtual ward experience. Our first day ran early July and took an innovative approach to simulation as it delivered over a 6-hour period without any breaks. This provided a fully immersed simulation and included the care of simulated patients and relatives. The day was divided into three separate shifts that includes clinical handover, structured debrief and a live cardiac arrest to systems test for a non-clinical area. Our first day included nine student nurses, two student physiotherapists and two security officers, plus a faculty that included a doctor, nurses, allied health professionals and volunteer patients. A second day is planned following this format late July.
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Coaching model for clinical practice Pre COVID-19 the Practice Educator Facilitator team had commenced the introduction of a coaching model to support clinical supervision and assessment. COVID-19 stalled the embedding of this approach, it was recognised that this was an area to revisit. Therefore, to support this a Practice Educator Facilitator was seconded for 0.4 whole time equivalent. The role will support the education and development of a coaching model in defined placement areas. The role will help to engage with key stakeholders, support the implementation of the coaching model (CLiP) and its evaluation to support capacity expansion, student leadership and decision-making skills. Access to IT in the community services To support the expansion and experience of students whilst on community placements with our district Nursing teams, following the introduction of agile working and reduced office space. A small number of laptops have been purchased for the care communities to facilitate the students to engage with the full assessment process of patients in their care.
Challenges
• Potential lack of personal connection when delivering virtual training, it requires careful facilitation.
• Requires the use of a full time Practice Educator Facilitator plus addition trainers for week of virtual training to manage and facilitate the delivery and monitoring of attendance. • Specialist equipment and facilitation required to deliver the virtual ward, additional support requiredfrom specialist multi-disciplinary staff that includes medical teams, AHP, resus team and security.
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Policy to be developed for student laptops.
• Recruitment of the right candidate to drive forward a coaching model with key stakeholders.
Key Outcomes
The virtual learning week provides an opportunity to support placement capacity and delivers a week of learning to meet the needs of students in clinical practice.
The use of additional laptops in the community will provide additional capacity and the opportunity for students to meet their learning outcomes.
The virtual ward has offered the opportunity for a multi professional and fully immersive approach to learning from simulation. This has offered high fidelity learning that can be applied to clinical practice moving forward. The Practice Educator Facilitator role to implement coaching has been delayed due to recruitment.
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Evaluations
Feedback from virtual learning week:
I’d just like to say thank you again, truthfully, I wasn’t looking forward to this as I’m much better hands on, if I’m sat at home in front of a computer, I do struggle, and honestly, ive very much enjoyed it. I feel I have got a lot out of it, the live sessions were brilliant, very much enjoyed the interactive side and I feel I’ve really learnt.
May I please take this opportunity to thank you all, and please pass on my thanks to the speakers this week. I feel this has been the best week so far since starting in September. I have learnt so much and having been urged to complete reflective accounts, using the NMC paperwork, I now understand how to write and refer to the code.
Thank you again for a brilliant week and I feel very empowered and positive
Next Steps
Delivery of the virtual ward and undertake student evaluation to review that the learning outcomeshave been met.
Use of PDSA cycle to support the implementation of a coaching model.
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Case Study Practice Development role in Primary Care
Background
NHS Warrington and NHS Halton Clinical Commissioning Group Primary Care areas in 2020-21 had capacity for 11 pre-registration students (years 1, 2 and 3).
The Primary Care Enhanced Training Practice Development role was vacant for six months of financial year 2020 - 2021. Practice Development Lead has come into post January 2021 and supports both NHS Halton and NHS Warrington Clinical Commissioning Group localities.
65% of the Primary Care Networks across the 2 Clinical Commissioning Groups have student placements.
Key Aims
To increase pre-registration student capacity by 20% across the remaining 29 practices within the 2 Clinical Commissioning Groups areas.
To identify and place students within a variety of clinical settings to reflect the breadth of primary care experience and optimise a quality learning experience.
To establish a future workforce who understand the complexity of Primary Care and are aware of positions following qualification as Registered Practitioners.
To increase the strategic understanding of how Primary Care work in collaboration with other Providers.
Ensuring representation in each of the 7 Primary Care Networks as direction towards Integrated Care Services continues and develops.
Resources
• Weekly review of student placements with training hub – Enhance Training Practice.
• Utilisation of funding to ‘golden welcome’ for practices taking students. This will be a non-recurring funding as COVID-19 restrictions reduce as well as offering new training opportunities to practices that have not previously participated.
Mentorship update opportunity offered via Teams meeting.
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A virtual primary care induction tool is utilised to simulate the experience of primary care setting.
The virtual tool can be used for students that have not had the opportunity to access a PrimaryCare placement – developed as part of Cheshire and Mersey academy.
Use of virtual meetings to communicate with interested practices and audit new sites in preparation for student learners. Learning environment audit completed in partnership with universities.
Working in collaboration with Higher Education Institutes to accelerate learning audits and placements – as above.
Student has opportunity to do specialist visits both virtually and physically, have e-learning opportunity to expand knowledge and skills
Case histories to discuss with mentors and staff.
Clinical Commissioning Groups collaboration and meetings. Opportunity for funding to enhancethe learning environments and support development of both student and mentors.
Challenges
A new way of working in primary care, virtual and telephone consultations. This has reduced the availability for students to have direct physical placements and engage with a wider experience of patient care.
COVID-19 restrictions and national guidance.
Changes in NMC standards for clinical assessment of learning environments and requirements of assessing and supervision of students.
Increased demand for learning placements from other clinical specialities e.g. Trainee Nursing Associates, Additional Roles Reimbursement Scheme roles and Advanced Clinical Practitioners. There are two practices that have in house Trainee Nursing Associates so have closed to the wider acceptance of pre-registration students.
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Key Outcomes
• The appointment of Practice Development Lead to support in learning environments.
• 3 new placements have been opened since appointment of Practice Development Lead
• Development of extension of virtual learning opportunities in view of limited patient opportunities due to COVID 19 guidance recommendations and guidance.
• Continued liaison between Clinical Commissioning Group Quality leads and Practice Development Lead.
• Liaison with wider University links to deliver mentorship training.
• Fostering of robust relationship with University staff.
• Fostering and sharing of best practice / peer to peer support in the development of opportunities for bothstudents and mentors.
Key Learning
• Close liaison with Higher Education Institutes and training hub to facilitate placements.
• New ways of working, using a variety of learning mediums such as skill suite, e-learning
• Shorter spoke placements to optimise exposure to primary care for a greater number of students
• Wider collaboration with other community providers and multi- disciplinary teams to enable an enriched experience in relation to the patient journey.
Sustainability
Continuity planning for Practice Development Lead role to maintain support – consider appointment of one for each Clinical Commissioning Group as currently working across two Clinical Commissioning Groups localities.
To scope and develop supervisor and assessor training to support new clinical placements undergoing theinduction process as well as the continued support of established placements.
Mentorship drop in opportunity – for clinical support and continued education.
Review of capacity with regards to current hours allocated to consolidate and continue developmentof the students and mentors.
Engagement with the Infection Prevention Control as evolving and developing.
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Next Steps
Greater cross working within a Primary Care Networks to encompass small practices who cannot support a full week of student learning.
Representation of placements within each Primary Care Networks and wider multi-disciplinary teams.
Representation within Clinical Commissioning Groups to develop strategic working skills.
Authors
Stacy A Evans Alison Robson
Head of Quality and Safety, NHS Halton CCG and NHS Warrington CCG.
Nurse Clinician, Eric Moore Partnership
Case Study Implementation of a ward based PracticeEducation Facilitator role
Background
In February 2021, with the increase in student nurse placement capacity across the Trust, we experienced a significant rise in the number of enquiries received by the Practice Education Facilitator team from students, clinical placement staff and university staff requesting support and guidance. Additionally, with the increased numbers of learners we identified a noticeable decline in practice assessment documentation being completedin a timely and accurate manner. It was becoming increasingly challenging to continue to work in a proactive manner as opposed to responding reactively. In conjunction with increasing placement capacity comes the need for training additional staff for the role of practice assessor and practice supervisor, as well as providing continuous development support and educationto those staff already undertaking these roles. Our case study provides an overview of how we have implemented a ward-based Practice Education Facilitator (PEF) role to address these challenges, supporting learners and educators in practice. It is hoped that the visibility of the role will lead to queries and concerns being identified and managed at an early stage.
Key Outcomes
• Increased accessibility to face to face PEF support for Practice Assessors and Practice Supervisors.
• A quantifiable improvement in the compliance rate for the timely and accurate completion of student assessment documents.
• Timely PEF support being provided to learners where developmental needs relating to proficiencies or pastoral needs have been identified.
• New methods implemented, and resources developed to sustain the delivery of the Practice Assessor and Supervisor updates / Preparation for the role of Assessor during the COVID pandemic.
• A quantifiable increase in the numbers of Practice Assessors and Supervisors within the Trust.
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Key Aims
• To release the time of band 7 PEFs to focus their time on: • Increasing the number of practice assessors to support capacity expansion, using creative solutions for training delivery
• A project to commence learners being added onto E-roster
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How it works
We have recruited to a band 6 Practice Education Facilitator. This role is currently a 10-month secondment. The post holder works flexibly, visiting wards and departments to meet with assessors, supervisors and learners. While undertaking these visits the PEF can:
· monitor completion of the online Practice Assessment Document (PAD)
· review progress of students against their proficiencies
· support identification of learning opportunities and development of action plans
· provide advice and support for learners who have reasonable adjustment plans
· communicate and remind leaners of upcoming workshops and skills sessions
· work 1:1 alongside a student in the clinical environment when additional support is required, or a particular assessment is to be undertaken
Sustainability
We plan to utilise an increase in placement tariff funding to continue to fund the role beyond the initial project period.
Next steps
We will be rolling out of the additional resources/materials and undertaking a review of their effectiveness. We will be encouraging learners to complete evaluations to facilitate further analysis of impact.
We will be engaging assessors, ward managers and senior managers in an evaluation of the new ward-based PEF role to inform how the role is developed further.
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Communicate changes timely and clearly
Preparing students for placements
Following the introduction of the NMC Future Nurses Standards of Proficiency and a new Practice Assessment Document there have been many changes to the guidance and instructions provided as our academic partners embed newly commenced pre-registration programmes. The more visible ward-based PEF role supports the timely communication of changes in person, providing an opportunity for staff to raise queries and questions.
Due to the impact of COVID, we have seen an increased demand for planner alterations resulting in late placement notifications which has adversely impacted on how well- prepared students feel for their placements. As part of our next steps, our new ward- based PEF will be developing resources and materials to enable students to feel better supported and prepared when undertaking their placements
Use existing technology effectively
Embracing new technology
It has previously been a challenge to identify when learners are on duty, to monitor, shift patterns, ensure they are appropriately supervised and maximise rota capacity. To address this, we have now moved the student nurses onto E-roster. We are now able to see at a glance when they are on duty to provide episodes of support.
Due to COVID restrictions, classroom-based training was minimised across the Trust. We were able to continue delivery of Practice Assessor and Supervisor updates / Preparation for the Role of Assessor using ‘Virtual Team Meeting’ sessions and the creation of aworkbook for Assessor preparation.
We will be engaging assessors, ward managers and senior managers in an evaluation ofthe new ward-based PEF role to inform how the role is developed further.
For further information please email: coch.practiceeducationfacilitator@nhs.net
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Case Study Enhancing Practice Educator Facilitator functions
Summary
Employment of a developmental Practice Educator Facilitator seconded on a full-time basis for a fixed term 12 month contract to enable greater time and space for substantive Practice Educator Facilitators to further explore and enhance clinical expansion across mental health and learning disability.
Key Aims
• Student capacity management to enable clinical placement expansion
• Quality assurance of the student experience
• Responsiveness to new ways of working
Resources
Full access to all practice education shared resources, placement management systems and communication formats provided to seconded Practice Educator Facilitator.
Agile working devices sourced and supplied to seconded Practice Educator Facilitator Including laptop, iPad, mobile telephone.
Dedicated and protected time with substantive Practice Educator Facilitators and wider Team colleagues to ensure ongoing advice, support and guidance for the seconded Practice Educator Facilitator.
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How It works
The mental health and learning disability placement circuit is a diverse and multi-faceted structure providing community and in-patient services requirements across a multi-site, wide geographical footprint which was a key consideration in planning how the enhanced team would work.
Proactive contact with students and practice staff was provided by the seconded Practice Educator Facilitator at key placement points to ensure ongoing advice, support, guidance and risk management.
Time was therefore protected by substantive Practice Educator Facilitator to explore and further develop ideas for clinical placement expansion from a strategic viewpoint.
Key Outcomes
Challenges
Greater responsiveness of practice staff and operational management on a day to day basis to student requirements and to the overall clinical placement expansion agenda Positive feedback from students in practice to the increased engagement of Practice Educator Facilitators at a time of greater need
• Impact of pandemic on all practice education functions
• Responding to requirements for more than one Higher Education Institutes partner • Implementation of new Nursing & Midwifery Council standards & new Practice Assessment Document
Strengthening of strategic planning for creative resource development
Greater, more effective use of technology to enhance the student experience, whilst also generating capacity expansion opportunities
Key Learning
Both operational and strategic PEF functions require time, space and wider acknowledgement Capacity management and clinical expansion requires a whole organisation approach with support and ownership of the future Nursing workforce requirements by all concerned
Sustainability
Momentum can be progressed given further commitment to a substantive, rather than fixed term Practice Educator Facilitator Further development of dedicated IT kit provision will enable the student population to engage with agile working arrangements whilst also contributing to clinical expansion
Next steps
We will be rolling out of the additional resources/materials and undertaking a review of their effectiveness. We will be encouraging learners to complete evaluations to facilitate further analysis of impact. We will be engaging assessors, ward managers and senior managers in an evaluation of the new ward-based PEF role to inform how the role is developed further.
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Case Study Developing fundamental skills for the future nurse standards
Background
The time of submitting the Cheshire and Wirral Partnership bid, we were coming out of the first national lockdown and commencing our recovery plan. However, the initial and following waves of COVID-19 since have had a significant impact on how community-based services are delivered including: • The need for social distancing within office environments and the rotation of staff between office-based working and working from home. • Restrictions in place on visits within clinic settings, patient’s homes , schools including school closures and care homes.
• Guidelines implemented in relation to car sharing required learners to have their own transport (additional costs for mileage and business insurance).
• Re-deployment of staff impacted impacting on assessor availability for learner support.
In discussion with and to support the work of the partnership, the short-term goal was reassessed to ensure as a minimum we maintain placement capacity with a longer-term goal of increasing.
This case study provides an overview of how we have utilised digital resources to provide a structured blended approach to practice learning and created a new specialist teams rotational placement for learners.
Key Outcomes
• Learners were able to participate in remote working opportunities using trust laptops • Learners were able to access a wider portfolio of learning opportunities linked to the patient journey e.g. through project work, workbooks and case studies. • To support the implementation of the Nursing and Midwifery Council Future Nurse Standards, a fundamental skills booklet has been developed or 1st year learners.
• Staff engagement in the development of Practice Assessor roles. • Creation of a new hub or spoke placement in specialist teams.
Resources Required
• •
Laptops
Access to Microsoft Teams
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Key Aims
To develop a blended approach to practice learning to maintain placement capacity in the short term and leading to an increased placement capacity in the long term across services in adult, child and Midwifery services within Bridgewater Community Healthcare NHS Foundation Trust.
To optimise the use of digital technology to support placement learning.
How It Works
Generic learner’s handbook currently being developed by the Practice Educator Facilitators and Practice Education Lecturers to be introduced electronically in August 2021. As the need to support learners continues services are adapting and working differently. The handbook aims to inform learners and staff of the learning opportunities across the trust and Multi professional working. Feedback will be gathered via evaluations from teams and the handbook will be reviewed.
Developed a student ‘fund a mental skills’ handbook available electronically and shared via local Induction with all learners to provide learners with education resources available for all learners e.g.clinical skills .net
We have small number of laptops which are managed by the Practice Educator Facilitators. Services are required to complete a loan request form for their students. The laptops are configured to requirement of the service and can be access at work and home.
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