The workforce transformational agenda and the changes to services are dynamic and on-going and continue to affect proactive planning of workforce development and education. The traditional models of clinical placement are unable to provide for the increasing numbers of students required to meet the growing demand for qualified staff, and there is also a need for staff with the skills to work in a range of settings. Greater use of Private Voluntary Independent (PVI) placement opportunities are needed to meet the modern models of care and to develop high quality educational capacity.
There are increasing challenges in providing placements in sufficient number and of appropriate quality within Derbyshire healthcare provider organisations. McClimens, Keynon and Cheung (2013:8) also suggest that ”student nurses and allied health professionals need to gain a broad range of experience to prepare them for the complex and rapidly changing environments they will be entering as qualified professionals…” The Derbyshire Clinical Placement Provision strategy for pre-registration programme (2012-2015) requires proactive planning of placements to address and meet current challenges and build sustainable capacity for the future.
Learners spend 50% of their education and training in practice, hence the importance of ensuring that the practice learning environment meets the students learning outcomes and follows the patients / service users’ pathways in order to have a fit for purpose workforce to deliver high quality patient care. This context requires a cultural shift to more lone working, working in multi professional teams and in partnerships across organisations.
The HEE Mandate 2014/15 states that “ HEE will work with LETB’s and healthcare providers to deliver high quality clinical and public health placements that provide the trainees and students with sufficient time working with patients to gain experience in relevant and varied clinical and public health settings. Clinical placements should be supported through the engagement of employers and high quality supervision of students and trainees”
Why is this important to the HEEM?Through an event hosted by University of Derby in November 2012, ‘Busting the myths of Private Voluntary and Independent (PVI) sector placements’, the Health Education East Midlands (HEEM) Workforce Team (Derbyshire) identified opportunities to enhance the variety, quality and capacity of placement through partnerships with the sector which were considerably underutilised.
HEEM and its predecessor organisation had agreed, in February 2013 to provide non-recurrent funding to improve the quality of learning in practice and to smooth the implementation of the non-medical tariff from 1st April 2013. NHS organisations were requested to confirm that on acceptance of this funding they will deliver some requirements and one of them was to pump prime any specific projects at trust or local health community level.
Through engagement with NHS provider organisations, the Derbyshire team secured a commitment from the health community that £46,000 from the non-recurrent allocation would be ring fenced specifically to support the enhancement and development of PVI placements.
Proposed education interventionThe changing healthcare landscape with plans to shift care out of acute settings into more community settings, requires that HEIs develop an accurate assessment/evaluation of PVI sector capacity and to ensure the optimal use of these placements as part of the whole placement capacity.
The project was then commissioned by the HEEM Workforce Team (Derbyshire) and involved two local Universities (University of Nottingham (UoN) and University of Derby (UoD)) working independently on the Project.
The aim of the project was to increase placement capacity for student nurses within the PVI sector, whilst also ensuring quality of the learning experience for students within these areas. Prior to the project minimal numbers of PVI placements were used for clinical placements and these were sourced on an informal basis through professional contacts and were used on an intermittent rather than a proactively planned basis when need arose.
The project also aimed to meet the Health Education East Midlands Workforce Strategy 2013-2018 (please find a link above) which states that “our workforce must be able to deliver care whenever patients need them and that by 2018 the workforce will be delivering services in range of settings: primary care and community settings 20% more than today, in residents settings by 10% more and in hospitals by 40% less. Furthermore student and practice placements in community, primary care and residential settings will have increased by at least 30% from today.”
A Senior Lecturer in Nursing from each university was identified to lead the project for 12 months commencing April 2013 and protected time to facilitate the role was funded. The protected time enabled the leads to contact potential placements, visit them, conduct placement audits, prepare and update mentors and carry out placement support visits when student on placement within these areas. Time was also used for administration activities, which included maintaining the mentor database, collating student evaluations of practice.
Benefits to patients and serviceBefore the project only nine PVI placements had taken place, sourced on an informal basis through professional contacts and used on an intermittent rather than a proactively planned basis. In 2013/14, 71 adult nursing students experienced PVI placements within a variety of areas. Prospective planning for 2014/15 indicates 128 nursing students will experience PVI placements. This improves the quality and variety of training to develop a highly skilled workforce to the benefit of patients.
Productivity and impactThe key outcomes of the project have been:
• Provision of alternative and varied experience for learners thereby enhancing learners placement experience
• Increase in placement capacity within Derbyshire.
• Consistent improvement in the quality of the learning environment by ensuring that the placement provider meets the quality standards of the regulator and the commissioner as well as the educational requirements
• Through the use of Nursing Homes as Hub placements, preconceived views of these areas have been challenged early in career development, with all students providing positive evaluations of their practice placements within Nursing Homes.
• A further area to be highlighted is the use of PVI placements for third year nursing students; this has resulted in many students gaining employment as newly Registered Nurses within the PVI sector.
• Student feedback through their placement evaluations has consistently been very positive, the main focus has been on the quality of the learning opportunities and the support received from the teams within these placements.
Next steps will focus on embedding the inclusive ethos into local working practices. Further funding has been awarded to The University of Derby to continue the project with the emphasis being the development of placements within the PVI sector for Allied Health Professionals. This will include commissioned students of occupational therapy and radiography as well as opportunities for placement experiences for social work/social and creative expressive therapy students.
Top Tips for Implementation
• Preparation time and project leadership to develop high quality new PVI placements is considerable, to prepare the environment, the mentor and the development of partnerships between HEI and PVI staff.
• The Practice Learning Team link tutor for each PVI placement is key to keeping placement teams informed of changes/issues relating to their clinical placement.
• A robust process is required to ensure mentors in the PVI sector have similar access to the rolling programme of mentor updates as their NHS counterparts, to enhance inter-professional learning, sharing experiences across the field and developing networks.
• Co-operation, collaboration and effective and transparent communication between education providers and PVI providers of practice learning placements are essential to success.
• Inclusion of PVI partners in the infrastructure groups overseeing the practice learning strategy and delivery enables the necessary collaborative working.
Khonzie Ndlovu-Gachengo, Workforce Development Manager Learning Environment – Project Commissioner HEEM Workforce Team (Derbyshire): firstname.lastname@example.org 01332 258180