Learning from experience

A student nurse work placement scheme at Kent NHS trust could provide one solution to the shortage of occupational health practitioners and the difficulty of recruiting nurses in the field.

The problems encountered in implementing the scheme were more than matched by the benefits for the morale of the OH team, with a chance for nurses to develop their mentorship, evaluation and supervisory skills.

My role within the OH department of West Kent NHS Mental Health and Social Care Trust concentrates on clinical development. As well as setting up regular clinic supervision sessions with the existing nurses, I also wanted to investigate the possibility of OH hosting a student nurse from the local university on a regular basis.

In several meetings with the university practice placement facilitator, the OH team identified a set of reasons why they believed student placements would be beneficial to both OH and the university. Such placements would:



  • Re-introduce mentorship skills to the OH nurses, many of whom had not worked with students for years
  • Raise awareness of OH among student nurses (many who took part confessed that they had a very limited understanding of the role)
  • Enable the OH team to use the feedback and comments of the student nurses to re-evaluate its own perceptions and understanding of its role and function
  • Enable OH nurses to develop interests or strengths to offer the student a more varied experience (for instance, one nurse had just completed a counselling diploma and was able to discuss mental health in the workplace, while another had been studying the place of complimentary therapies in combating work-related stress).

The OH team then identified a number of concerns about implementing the scheme, such as:



  • Getting to grips with the language used in the student nurse training programme
  • Completing formal assessments and evaluations
  • What should be done if a student was deemed to be failing to meet the placement criteria
  • Meeting student expectations.

Training

The first stage was to arrange for the OH nurses to have updated mentorship training, and the practice development facilitator was more than happy to deliver a bespoke session for the department. Getting all the nurses together at once did have an impact on the service for the day, but provided a forum to discuss specific requirements.

The OH nurses all benefited from a review of the main principles and practices of good mentorship and had an opportunity to look through the latest student feedback forms and placement criteria relevant to the OH placement.(1,2,3)

Following a further team meeting, the team agreed the main goals. Taken from the university’s ‘Students Skills Acquisition Matrix’, the team decided to focus on the following areas to help the student to develop:



  • Demonstrating non-judgemental behaviour
  • Developing knowledge and skills to meet client needs
  • Maintaining a professional appearance to and relationship with other healthcare workers
  • Applying good manual handling and infection control principles
  • Preparing a client for a nursing intervention (such as an injection)
  • Maintaining accurate records
  • Good communication skills
  • Participating in a health needs assessment
  • Identifying a health promotion model and demonstrating an awareness of health promotion strategies
  • Using interpersonal skills to enhance a client’s sense of wellbeing
  • Identifying actual and potential health risks to healthcare workers.

The department agreed to take on three student nurses for two-week trial placements.

The placements – which formed part of their ‘community experience’ – were offered on the basis that they had some interest in OH. They were asked to phone the department where an initial introduction was made and information was given about the location of the department and housekeeping arrangements. An occupational health nurse (OHN) then took responsibility for planning the placement details with the student nurse on their first day.

Feedback

Following these placements, feedback from both the students and the OH nurses has included positive and negative elements.

On the positive side, the students found the placements enjoyable and interesting. One said: “I feel I have achieved all of my learning outcomes during my time with occupational health. I feel I know the role of the OHN and what the job involves on a daily basis – and now I understand it is very different to that of an occupational therapist, which I had first confused the role with.

“Before I came to OH, I knew I didn’t like ward work, but now I have discovered that I like working in clinics. I’ve realised there is still a close team network, so you are not working on your own, you are part of something.”

The OHN’s feedback included the following points: “Positive learning experience; encourages reflective practice and keeping up to date with current clinical practice. Also, it is useful to know the details of current student nurse training”. Another nurse said: “It gives us a chance to see what students are doing and update our knowledge.”

But there were some difficulties. One OHN said: “If a clinic is particularly busy, it is not always easy to spend time between each appointment going through each case and explaining the rationale for the advice given.” Another added: “Some clients are not happy for a student to sit in on their appointment – which has to be respected – but it leaves the student feeling awkward if they have to sit outside.”

Difficulties

The main problems encountered were students not arriving for their placements or contacting the department. It also had to accommodate a wide range of learning needs, which could not be predicted before the student arrived due to the different stages of the course they were on and vast differences in ability and aptitude.

Following this review, the department was approached by the placement co-ordinator, who wanted them to extend the placements to five weeks.

The OH team agreed to rise to the challenge. It decided the best way to show the full remit of the OH department was to incorporate an experience of OH in various settings into the placement.

I contacted the local police station’s health and safety manager. They agreed that the students could attend the police OH department for a week-long placement. In return, I arranged for the police practice nurses to attend the NHS trust’s updated mentorship training, which they were able to use to meet part of their PREP requirements.

The feedback from both students has been favourable, particularly from the student who was able to become involved in a mock operation, carrying a ‘substance’ through a shopping centre as part of a police dog training exercise.

Kent NHS trust arranged a second placement at an acute hospital trust, which was also commended by the participating students. They concluded: “Occupational health is a vital support service, which has the capacity to enhance the working lives of both the employer and the employee.”

As well as providing the student with a wider understanding of OH’s role, the placements have encouraged collaborative relationships between NHS and non-NHS OH departments.

Outcome

Introducing student nurse placements to Kent NHS Trust’s busy OH department has been challenging, interesting and, ultimately, rewarding. Using a flexible approach and utilising other local OH facilities to expand the students’ experience and understanding of the OHN’s role has proved beneficial both for the students and the OH team.

Initial anxiety regarding mentorship, evaluation and supervision skills proved unfounded, and the main hurdle was actually that of becoming familiar with the course language and set-up. However, the mentors soon discovered that basic nursing skills had not changed drastically over the years, and they were able to offer a meaningful and valuable learning experience, which in turn benefited the team.

The challenge now for the OH department is to continue working with student nurses to raise awareness of the role and function of the OH nurse among training and newly qualified nurses. As one student nurse said: “I have been pleasantly surprised by my placement in occupational health.”

Such positive feedback reminded the OHNs that they have much to offer in terms of teaching and learning, and that the role is a viable career option for the next generation of nurses.

Emma Palmer is senior occupational health nurse at West Kent NHS Mental Health and Social Care Trust

References



  1. Baseline Standards for Practice Placement Areas (2002), Kent Workforce Development Confederation Practice Placement Co-ordinators
  2. DoH (2001) Placements in focus: Guidance for education in practice for health care professions
  3. DoH (2001) Preparation of mentors and teachers: a new framework of guidance

Bibliography



  • Duffy K (2004) NMC News, July Issue: Nursing and Midwifery Council
  • Hinchliff SM, (2004) The Practitioner as Teacher, Churchill Livingstone
  • RCN (2005) Guidance for Mentors of Student Nurses and Midwives: an RCN toolkit
  • Price B (2004) Becoming a Good Mentor, Nursing Standard 19(13)

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