OverviewProgramme Structure: Nursing
The introduction of the NMC (2010) ‘graduate standards’ gave the programme team an unprecedented opportunity to review how the structure of the programme and practice learning activities impact upon the students’ learning. The review was informed by:
- Consultation events with key stakeholders.
- Feedback from present and past students
- Literature relating to nurse education.
The consultation and student feedback suggested that value was placed on:
- A clearly structured programme where theoretical, assessment periods and study leave are planned to support and complement longer periods of practice learning.
- Inter professional learning. This is a major component of the Making it Real curriculum. Focused IPL sessions are valuedand IPL modules areto be retained in the new curriculum.
- In line with the work of Levett-Jones et al (2008), students and mentors requested longer periods of practice learning. This supports the students’ feeling of belonging within the clinical arena and enables them to progress from orientation to active participation in care delivery.
In examining our portfolio of practice opportunities we became aware of the challenge caused by thetransformational change which clinical services in the North East have experienced. This has been brought about by the modernisation agenda, Transforming Community Services and major rebuilding programmes. It was acknowledged that our current coding of placements no longer reflects the new and emerging services and the diverse and challenging areas where nursing care is delivered in the 21st century. The programme team consulted on recoding practice learning opportunities based on a framework which would both incorporate the diversity of nursing as well as ensuring that the service user is placed at the centre of the student experience. This would enable the student to understand the patient journey or pathway in accessing care. Looking at these factors, the Chief Nursing Officer’s framework for ‘Modernising Nursing Careers’ was considered to be the best fit for the programme. This is based on five pathways:
First Contact
Acute and Critical care
Family and Public Health
Mental Health and Psychosocial care
Supporting long term care.
The clear representation of the framework in the ‘MNC wheel’ (Diagram 1) has ensured that it is known and accessible to the majority of practitioners, this supported the teams decision to adopt the MNC framework for recoding practice.
Recoding practice learning opportunities is one step in refreshing and refocusing to provide relevant practice learning opportunities but the team realised that, to fully meet the brief set, they wouldneed to move from a ‘fixed’ placement plan to a more flexible plan based on longer ‘hub and spoke’ experiences. The ‘hub and spoke’ approach is a key element of year 1 and 3 of the programme where the students experience in University is based on two semesters and they undertake year long placements.
Diagram 1: Modernising Nursing Careers
The hub is where the student’s main mentor (or sign off mentor in year 3) is based and where the student will spend the majority of their time and, in line with NMC requirements, the last 4 weeks (year 1) and final 12 weeks in year 3. The spoke experiences are short, normally 2 week, periods of practice learning which either supports the students understanding of patient pathways linked to the hub experience or ensures that the practice learning opportunities in the adult field of nursing are in line with the European Dirctive2005/36/EC. For all nursing students their practice learning opportunities will provide either an authentic or simulated introduction to all fields of nursing and midwifery.
Year two follows a trimester model with three shorter (7 / 8 week) periods of practice learning, this is an acknowledgement of the nursing skills acquired in year one and a wish to expose students to a series of different care settings where they can apply, adapt and build upon their previous learning. By the end of year two, the student will have experienced all pathways within the MNC framework and will be supported by their guidance tutor to choose an area of nursing practice for their ‘guided option’ hub in year three. Tables 1- 5 give an overview of the student practice learning experience across the four fields of nursing.
YEAR / WEEKS / NOTES / CLIENT GROUP1 / 14 / Fundamental nursing skills / Patients in need of 24hr Inpatient care / Day Unit care where fundamental nursing skills may be practised.
1 / 2 / Spokes, flexible(i.e. not at fixed points in the placement), but will be allocated as part of the planned practice experience. / MENTAL HEALTH AND PSYCHOSOCIAL CARE PATHWAY– Mental Health
1 / 2 / FAMILY AND PUBLIC HEALTH PATHWAY – Healthy Living centres, Stopping smoking teams, GUM, Drug and Alcohol teams, Practice nurses, etc.
2 / 7 / Developing skills: Decisionmaking & autonomy / Streamed / FIRST CONTACT PATHWAY
2 / 8 / SUPPORTING LONG TERM CARE PATHWAY - District Nurse
2 / 7 / ACUTE AND CRITICAL PATHWAY
3 / 6 / Leadership & Management / GUIDED OPTION BASE HUB
3 / 6 / Spokes based on guided option (i.e. Community – Ward – Hospice, ITU – Theatre – A & E, Ward – Community - Outpatients and/or individual student requirement (i.e. is student seen to be lacking in critical care or ward experience)
3 / 12 / GUIDED OPTION BASE HUB
TABLE 1: Adult Nursing - Placement Plan
TABLE 2 :Children’s Nursing - Placement Plan
YEAR / WEEKS / NOTES / CLIENT GROUP1 / 14 / Fundamental nursing skills / Mental Health & Psychosocial care / Patients in need of 24hr Inpatient care
1 / 2 / Spokes, flexible(i.e. not at fixed points in the placement), but will be allocated as part of the planned practice experience. / FIRST CONTACT PATHWAY - Out patients, walk in centres, practice nurses
1 / 2 / ACUTE AND CRITICAL PATHWAY - Theatres
2 / 7 / Developing skills: Decision making & autonomy / Streamed / FAMILY AND PUBLIC HEALTH PATHWAY - e.g: Health Visitor / School Nurse
2 / 8 / SUPPORTING LONG TERM CARE PATHWAY - e.g: CCN teams, Hospice, CAMHS, neonatal /SCBU.
2 / 7 / ACUTE AND CRITICAL PATHWAY – e.g: PICU, Oncolgy Services
3 / 6 / Leadership & Management / GUIDED OPTION BASE HUB
3 / 6 / Spokes based on guided optionand/or individual student requirement (i.e. is student seen to be lacking in critical care or ward experience). It is anticipated that one spoke will include a 2 week PLO in an adult care area to facilitate the students understanding of ‘transition’ services.
3 / 12 / GUIDED OPTION BASE HUB
TABLE 3: Learning Disability Nursing – Programme Plans
YEAR / WEEKS / NOTES / CLIENT GROUP1 / 4 / Fundamental nursing skills / Mental Health and Psychosocial care / COMMUNITY INCLUDING FIRST CONTACT
CLDT /CTLD
1 / 2 + 2 / Streamed / ACUTE AND CRITICAL PATHWAY – (Physical Care)
Children’s Nursing Inpatient / Elderly MH
1 / 2 / FAMILY AND PUBLIC HEALTH PATHWAY
School Experience
1 / 8 / Same as first placement PROGRESSION POINT / CLDT/CTLD
2 / 7 / Developing skills: Decision making & autonomy / Streamed
PROGRESSION POINT / CHILD AND ADOLESCENT e.g.: Inpatient units and / or community teams
2 / 8 / SUPPORTING LONG TERM CARE PATHWAY e.g.: Challenging behaviour
2 / 7 / ACUTE AND CRITICAL PATHWAY (LD) e.g.: Challenging behaviour, Forensic, Autism services
3 / 6 / Leadership & Management / GUIDED OPTION BASE HUB
Medium security
3 / 6 / Spokesbased on guided option / i.e. Forensic low secure – Rehabilitation – forensic community team
3 / 12 / PROGRESSION POINT / GUIDED OPTION BASE HUB
TABLE 4: Mental Health Nursing – Placement Plans
YEAR / WEEKS / NOTES / CLIENT GROUP1 / 4 / Fundamental nursing skills / Mental Health and Psychosocial care / Planned care (inpatient / Day Services)
Older Person/Rehabilitation Recovery/ Day Services
1 / 4
2 + 2 / Streamed / ACUTE AND CRITICAL PATHWAY – (Physical Care)
A & E / Medicine / Poss. HV or DN
1
1 / 10 / Same as first placement PROGRESSION POINT / Planned care (inpatient / day Services
2 / 7 / Developing skills: Decision making & autonomy / Streamed
PROGRESSION POINT / COMMUNITY INCLUDING FIRST CONTACT
2 / 7 / SUPPORTING LONG TERM CARE PATHWAY
Specialist Services
2 / 8 / ACUTE AND CRITICAL PATHWAY (Mental Health)
Urgent Care – Inpatient Services
3 / 6 / Leadership & Management / GUIDED OPTION BASE HUB
3 / 6 / Spokesbased on guided option / i.e Forensic – low secure – Forensic community - Rehabilitation
3 / 12 / PROGRESSION POINT / GUIDED OPTION BASE HUB
TABLE 5: Integrated Masters – Programme Plan
YEAR / WEEKS / NOTES / CLIENT GROUP1 / 14 / Fundamental nursing skills / APL / APEL to include achievement of progression criteria for year one of the programme
1 / 2
1 / 2
2 / 7 / Developing skills: Decisionmaking & autonomy / No streaming of placements / Mental health & psychosocial care / 24 hr inpatient care / Day Unit / Placement includes spoke to FIRST CONTACT PATHWAY
2 / 8 / SUPPORTING LONG TERM CARE PATHWAY - District Nurse
2 / 7 / ACUTE AND CRITICAL PATHWAY
3 / 6 / Leadership & Management / FAMILY AND PUBLIC HEALTH PATHWAY : Hub - Healthy Living centres, Stopping smoking teams, GUM, Drug and Alcohol teams, Practice nurses, etc.
2 week spoke to HV / Family Health Nurse Partnership team
3 / 4 / 14 week Hub placement with 4 week spoke practice learning opportunities / GUIDED OPTION BASE HUB
Spokes based on guided option (i.e. Community – Ward – Hospice, ITU – Theatre – A & E, Ward – Community - Outpatients and/or individual student requirement (i.e. is student seen to be lacking in critical care or ward experience)
3 / 14
The programme is structured to support the student, theoretically and in practice, to develop their nursing skills in line with the NMC progression points and competencies. The key focus of each year is:
Year One – Fundamental nursing skills
Year Two – Developing skills: decision making and autonomy
Year Three – Leadership and management
Students work 37.5 hours in practice and their overall experience has been planned to meet NMC (2010) requirements:
Practice / Theory / Annual LeaveWeeks / Total
Weeks
Weeks / Hours / Weeks / Student Workload
Year 1 / 18 / 675 / 27 / 1200 hrs / 7 / 52
Year 2 / 22 / 825 / 23 / 1200 hrs / 7 / 52
Year 3 / 24 / 900 / 21 / 1200 hrs / 7 / 52
Total / 64 wks / 2400 hrs / 71wks / 3600 hrs / 21 wks / 156wks
International Opportunities
During the XXX year of the programme students may apply for the opportunity to take part in international exchanges. The School has a well established EU Erasmus exchange programme with Finland, Spain, Greece and Portugal. Students may undertake shorter experiences in Kenya or negotiated areas of choice. All Erasmus areas have link lecturers attached to them who undertake the audit, quality assurance and preparation of mentors prior to the students arriving in the country.
Queries
Is the section on simulation and IPL in L & T strategies?
Where is the section on student support?
Mentor Handbook / Student Handbook – we will need more re the principles of hub and spoke placements. Or do you want it added here?
References
Levett-Jones, T., Lathlean, J., Higgins, I., McMillan, M., (2008) The duration of clinical placements: a key influence on nursing students’ experience of belongingness.Australian Journal of Advanced Nursing, 26(2) 8 – 16.