Published: 24/10/2002, Volume II2, No. 5828 Page 30 31
The transition from student to nurse is a difficult and prolonged period.But programmes are available to ease the burden, say Maggie Mallik and colleagues
How can trusts support the development of newly qualified nurses and encourage retention? Salisbury Health Care trust and Royal Free Hampstead trust have developed preceptorship programmes for newly qualified nurses, in conjunction with universities.
The programmes offer structured study periods, focusing on drugs administration, clinical skills updates and time for reflection and peer support. Candidates can complete portfolios of learning that can be submitted for consideration for academic credits.
Royal Free Hampstead trust All 29 newly qualified nurses at the trust, including the 16 programme participants, were given questionnaires. The results showed ward-based support was seen as desirable in facilitating the transition from student to staff nurse. It was evident that there was a significant dichotomy between the support the nurses wanted and what they received.
Participants were required to complete a portfolio of learning. But despite encouragement and offers of structured support by the academic teaching team, only two out of 16 participants submitted one and the rest dropped out of the programme.
The trust decided to incorporate the needs of newly qualified staff into a D-grade development programme that would include overseas nurses being adapted and return-to-practice nurses employed by the trust. The focus would be on the attainment of clinical competencies with no academic requirements.
Salisbury Health Care trust All newly qualified nurses at the trust were offered the programme, which included rotations in three areas over two years and study-time sponsorship to earn the remaining 60 credits needed for an honours degree. The trust piloted its preceptorship 'top-up' degree programme with two pilot groups in 1998.
At two years, only one person from the pilot cohorts had not completed the programme, and all were still employed in the trust. But as the numbers recruited increased, problems with the clinical placement rotations and completion of the academic requirements started to emerge. Table one gives a breakdown of outcomes of the programme. The trend for increasing numbers of the preceptees withdrawing from the programme and/or not completing the academic work required to obtain degree credits is clear. It is important to note the cost to the trust in purchasing academic credits (average of£250 per 10 credits) and in release time from practice for all preceptees.Overall, despite the completion trends, the retention rate at Salisbury Health Care trust remains high.
There were a number of problems in maintaining the rotation scheme. Preceptees frequently find a clinical area that becomes a preference. Taking up permanent D-grade posts and/or making numerous changes to the original rotation programme had a destabilising effect on workforce numbers in all clinical areas in the trust. After an internal review, Salisbury Health Care trust decided to offer one-year support to all preceptees and provide academic sponsorship for a limited number of places, and only during the first year. It also decided to discontinue the rotation scheme.
The evaluations found the programmes reduced the stress that nurses feel in making the transition from training to work and participants valued the structured learning sessions.
Participants also valued the support of preceptors in their clinical areas, though the quality of this was seen as variable. It is important to review what preparation, training and ongoing support preceptors are given to undertake their role.
The evaluations suggested newly qualified staff nurses were initially attracted to a preceptorship programme that offers rotations to one or more clinical areas and/or offer academic credits. They are encouraged by the university lecturers to complete top-up degrees as soon as possible.However, the majority of preceptees have difficulty in meeting the demands of completing a portfolio of learning.
Working students need a high level of motivation to continually analyse what they are learning.
This finding is significant in light of the trend towards awarding academic accreditation through work-based learning.
The prime concern for trusts and the newly qualified staff nurse should be in becoming a competent, safe healthcare professional. Evidence from both trusts would suggest that being 'fit for practice' (ie coping competently with the demands of the post) is a sufficient requirement at this time. The preoccupation of nurses with topping up a diploma/advanced diploma to a degree as soon as possible after qualification needs to be questioned.
In the UK, there has been a return to the emphasis on practice learning through students undertaking longer periods in practice. There is also a re-focus on improving the quality of the practice-learning environment through quality monitoring. The first cohorts of preceptees are due to complete in the autumn of 2003. It will be important to assess their perceived and actual levels of competence and the subsequent level of support needed.
Newly qualified nurses are entering practice at a time when nursing roles are changing and being redefined and tasks are being redistributed between healthcare workers.The experience of these two trusts suggests that all newly qualified nurses should be offered a structured support programme.
Consideration of the need for an all-graduate nursing profession should remain on the agenda for debate and within the framework of current developments in multiprofessional education.
Preceptorship programmes for newly qualified nurses can help ease the transition from training to work.
Experience at two acute trusts found that some participants had difficulty in completing learning portfolios.
Participants welcomed support on the wards and structured learning sessions.
Maggie Mallik is associate nurse executive clinical education, Salisbury Health Care trust. Clare Bennett is senior lecturer, Middlesex University. Annette Toulson is practice educator, Salisbury Health Care trust.