In our last article, we wrote about the ongoing cycle of roundtable conversations on social care nursing and the image problem from which it suffers. We bemoaned how these events could often turn into a talking shop, resulting in the same comments and calls to action being made, but little tangible activity.
In an attempt to break away from this cycle, we summarised five key areas where action could be taken to improve the profile of adult social care nursing. Our aim was to suggest practical steps that could bring about sustainable change.
The first area we looked at was expanding the number of student nurse placements in social care settings. We highlighted the importance of undergraduate experiences early in nurses’ careers. Here, we delve deeper into what’s involved in the provision of placements in social care and look at some of the resources and research that explore what makes a successful placement.
Why are placements important?
There are growing calls for student nurses to have a broader experience of clinical placements that moves them away from hospitals to include greater focus on primary care settings, including care homes. As healthcare faces a growing population of older people with increasingly complex long-term conditions, the requirement for nurses with the expertise to meet these needs is well understood. The provision of placements in the care sector is vital in supporting student nurses in starting to develop this expertise.
Integration of health and care services and commissioning is becoming commonplace across the UK. Interprofessional learning is therefore next on the agenda, so increasing visibility in a community or care home context will support mutual understanding between nursing and social work, occupational therapy, wellbeing support, physiotherapy and more and enhance future joint working.
Right place, right time?
Care homes have historically been perceived as offering little value to students as their skills and experience develop. As such, care homes are often the first placement student nurses undertake, to learn the ‘basics’ of care. Rarely are care homes utilised to provide placements in the second or third years as students become more advanced in their practice. At this point, the hospital beckons and primary and community care take a back seat in the minds of students and tutors.
There are of course exceptions to this, especially if the university has a strong research focus on social care or the ageing population. Kingston University has long been a beacon and leader in its field, focusing learning on wellness and then gradually on illness. Placements have been creative for some years and they combine their nursing faculty with social work.
Sadly, this approach is not widespread, as is evident in the recent experience of one of the authors, who supported care home staff through their training to become Registered Nurses (RNs), only for those staff to be actively discouraged by the university from working in a care home when they complete their programme. The rationale given was that they would become de-skilled. Such attitudes seem out of step with the increased awareness of the demand for nurses with aged care expertise, and show a lack of understanding about the role of the nurse in a care home setting.
Instead of perpetuating aged tropes, universities should strive to be change agents, encouraging students to learn in the social care context precisely because the competence and range of skills is different from that of hospital settings and provides a valid alternative to hospital-based careers. Derby University is one of those that is getting there but, there, social care sits with occupational therapy and allied health, so it may well be that student nurses don’t get to experience interprofessional learning and development.
Research on the experiences of student nurses on care home placements reinforces this issue: students on placement spend much of their time with care staff and not RNs. Because the placement comes in the first year of their programme, the objectives around learning the skills and practice of helping residents get washed, dressed and ready for the day ahead do not reflect the role of the RN in the modern social care environment, which is much more focused on co-ordinating care and supervising the care team, as well as co-ordinating some of the more complex care interventions. As a result, students cannot fully appreciate the nature of the RN role in the care sector. The more the sector can support students later in their programme, the more complete their understanding of social care nursing will be.
This mismatch in the requirement of the early placement versus the role of the RN in the care sector suggests that universities perceive care homes as marginal learning environments, with little ability to support student learning in later stages of their programme. Anecdotally, we have heard that if the majority of teaching staff in the faculty have a background in hospital nursing, they are less likely to champion social care as a viable learning and development opportunity.
None of this is new, but the question remains: how do we challenge and change this perception? Skills for Care has made a great start, producing a guide showing how placements in different care settings support students to meet the Nursing and Midwifery Council Nurse Standards of Proficiency. This guide is aimed at students, providers and universities and presents several case studies describing providers’ experiences of supporting placements. Crucially, it illustrates how social care placements support students in achieving objectives throughout their programme, highlighting how care sector placements have value beyond the traditional first year, first placement (get it out of the way) arrangement.
There are also things that providers can do themselves to start to change such negative and frankly outdated perceptions. Understanding what makes for a good placement experience is vital in providing a positive experience.
What makes a good placement?
Care home residents tend to be clinically stable (acutely) and present a wide range of longer-term health and wellbeing issues. This, combined with a good staffing model, can provide a rich environment where student nurses have the time and space to develop knowledge and practise skills in assessing, planning, implementing and evaluating interventions and care. This can include developing their knowledge and confidence around quality, innovation and evidence-informed practice, both from a practice perspective and with levels 6 and 7 of their academic studies. Despite this, students frequently approach care sector placements with the preconceived idea that their experience will be far from positive, and of less value than a hospital-based placement.
These concerns are borne out by multiple studies showing that student nurses, especially those in their first year, feel unprepared for what is frequently their initial clinical placement, and that the care home is often unprepared for them. Students find care home placements emotionally demanding, find working with older people, especially those with dementia, intimidating and occasionally find themselves alone in situations they feel ill-equipped to deal with.
Care homes can combat this in several ways. Initial contact with students before their arrival with information about the type of home, what to expect on their first few days, and details about their mentor/supervisor is vital in helping students feel wanted and welcome. The student’s mentor should be available on their first day to welcome and orientate the student – something which will require some supernumerary time to be truly effective. There are lots of examples where general practice nurses have developed a welcome pack, have a welcome board with photos of staff and build a sense of excitement amongst the team. These tips are easy to do and mean so much.
Capacity to mentor and support student learning is a frequently cited barrier to a positive placement experience. Care homes offering placements should ensure that the mentor has the time to work with their student to allow them to practise skills, reflect on their practice and work more independently as the placement progresses. Research exploring student nurses’ experiences in care homes suggests that the relationship between student and mentor is of the utmost importance when evaluating the learning and placement experience. Having a named person, contact number and regular touch points will ensure the very best outcome for student and care home.
Mentors need to be clear on the learning outcomes expected of the placement and how these can be achieved. When discussing student placements with the team, one of the authors found that RNs were concerned about their own lack of familiarity with the learning requirements and competence to act as a mentor. This suggests that when approaching universities about providing placements, there needs to be some discussion with the university about the support that it can offer to combat these concerns. In this case, the university has indicated its preparedness to provide training and development focused on the role of the mentor (or practice supervisor).
Meeting the workforce challenge
Placements for student nurses in social care are vital to ensure we continue to attract nurses into care homes, as shortages in staff and expertise become more pressing. Care homes offer a rich and varied experience for students throughout their undergraduate programme. Increasing engagement between care homes and universities helps to develop universities’ understanding of the RN in social care and improves the care home’s ability to support students in their placements.
Providing student placements is not easy, but it does come with its rewards. In our experience, care homes providing placements benefit from a greater sense of esteem and renewed purpose. We have also found that the ability to provide a positive placement experience carries over into the ability to provide a positive experience for newly registered nurses. And let’s not forget the five standards from the Care Quality Commission which support the case for hosting students – Safety, Effectiveness, Caring, Responsive, Well Led. All these can and should be evidenced by the end of a placement and it will support understanding of regulation to boot!
To join our conversation and offer hints and tips to other care sector providers on hosting students, post on Twitter using the hashtag #CMMStudent. We will see you there.
Joanne Bosanquet MBE is Chief Executive of Foundation of Nursing Studies (FoNS). Email: [email protected] Twitter: @MrsBosanquet.
Richard Adams is Chief Executive of Sears Healthcare. Email: [email protected] Twitter: @SearsHealthcare
How do you find student nurse placements? Do you feel more needs to be done by universities? Share your thoughts and feedback on this article in the comments section below.
[1] https://www.derby.ac.uk/departments/health-social-care/