Practice teachers are essential in supporting specialist community public health nurses (SCPHNs) during their OH degree courses. They are also key to meeting Nursing and Midwifery Council (NMC) standards for nurse registration and achieving government aims for an ageing working population. Catherine Kelsey makes the case for developing more practice teachers.
Following the changes made to the NMC’s “Standards to support learning and assessment in practice” in 2008, nursing and nurse education has continued to develop across the UK. The emphasis is now on “fitness to practise”, and the overall aim is to ensure protection of the public through professional standards (NMC, 2008).
These standards define the expected outcomes for mentors and practice teachers. They utilise a single development framework that identifies the knowledge and skills required to support nurses and midwives undertaking a NMC-approved programme leading to a registrable or a recordable qualification on the nursing register.
Practice teacher accountabilities
In accordance with the NMC (2008), practice teachers supporting SCPHNs are responsible and accountable for:
- coordinating learning activities, fundamentally in practice environments for those undertaking a programme of study that will enable, once successfully completed, registration as a SCPHN on the third part of the nursing register;
- providing support and guidance to SCPHN students when learning and applying new and existing knowledge into a new professional context, while ensuring public protection;
- supervising students and providing constructive feedback on professional achievements, while identifying any concerns related to performance and agree action plans as appropriate;
- setting and monitoring achievement of realistic learning objectives in professional practice;
- observing and assessing professional performance including skills, attributes and behaviours that ensure NMC-defined outcomes are achieved;
- providing evidence as required by programme providers of the student’s achievement or lack of progression;
- liaising with other professionals to ensure an overall assessment of professional practice; including mentors, supervisors, managers, personal tutors and course leaders; and
- signing off achievement of proficiency at the end of the final period of practice learning or a period of supervised practice.
Recent political initiatives from the Department of Health (DOH) and the Department for Work and Pensions (DWP) have indicated the Government’s commitment to improving the delivery of community care through ensuring the provision of experienced specialist practitioners and leaders, able to effectively manage today’s healthcare challenges and future expectations. This signals a major shift towards primary care and public health.
In 2004, the Nursing and Midwifery Council (NMC, 2004) took the view that nurses working within public health had a responsibility that was distinct from that of the general nurse. They were ultimately responsible for decisions made on behalf of a population, without essentially having direct contact with everyone in that community
This decision required a sound theoretical knowledge base, one which was able to inform community public health practice. To facilitate this, specialist mentors were required in the shape of practice teachers able to provide a rich learning environment that effectively challenged “blinkered thought”, encouraged “critical thinking” and validated future professional practice.
There is, however, a current shortage of practice teachers working in OH as it is not a particularly well-established role in this field of nursing (Shaw, 2009). It is clear that this has the potential to undermine the current educational frameworks and to limit the expansion of the specialist role.
This article seeks to raise awareness of the essential role that practice teachers play in developing future SCPHNs. It also aims to help understand the educational requirements of the practice teacher and ultimately the opportunities that are available for continuing professional development within the context of lifelong learning.
In 2011, the coalition Government recognised the increasing need to expand and strengthen health visiting services (DH, 2011). With the challenge to develop 4,200 new health visitors by the end of 2015, it was evident that there would also be a need to increase the number of practice teachers available to provide support within professional practice. Ultimately, the need to expand the numbers of health visitors led to an increase in the number of practice teachers able to support their development..
Political and professional drivers
The DWP is focused on ensuring that older workers are supported when they remain in work (DWP 2014, Altman 2015). Enabling employees to stay at work for longer, through, for example, the use of rehabilitation strategies, is just one way in which OH services can support the working population. OH advisers can support managers to make effective decisions and they can be at the forefront of government initiatives.
Furthermore, the Government has also recognised the importance of ensuring the provision of OH advice by establishing the new Fit for Work service. This will provide advice and guidance to those organisations whose employees do not have access to OH services, as well as provide additional support to GPs. The Government hopes that this approach will help share the burden of long-term sickness absence.
With such a strong message that older workers must be supported to stay in the workplace, SCPHNs working in OH are well positioned to support organisations in enabling workers to remain in work longer. As the demand for support increases, it is likely that the need for SCPHNs will grow, and with it the need for additional practice teachers and quality placement opportunities.
Role of the practice teacher
Many skills are required of a practice teacher (NMC, 2008) to enable specialist nurses to drive forward innovation within practice. The Standards to Support Learning and Assessment in Practice (NMC, 2008) state clearly that practice teachers should:
- be on the same part or sub-part of the register as that which the student is intending to enter;
- have developed their own knowledge, skills and competency beyond that of registration through CPD appropriate to their support role;
- hold professional qualifications at an appropriate level to support and assess the students that they mentor/teach; and
- have been prepared for their role to support and assess learning and meet NMC-defined outcomes.
It is clear, therefore, that qualified SCPHNs can and should develop the skills required to be practice teachers to enable the continued development of OH specialist nurses and ensure that a rich source of professional knowledge and skills continues to exist (Gopee, 2010).
Practice teachers therefore have a significant educational role that can stretch to providing input into student education programmes, as well as course curriculum planning and delivery (Gopee, 2010). Being a practice teacher also offers opportunities to maintain CPD by accessing conferences and completing triennial reviews to maintain and develop core skills.
Practice teacher module
The practice teacher course at Leeds Beckett University is a postgraduate, Master’slevel, 40-credit module. Many SCPHNs considering becoming a practice teacher may find this a significant challenge, however support is provided through the university’s Skills4Learning website. The course offers an opportunity to develop new knowledge and skills, while providing evidence to meet the needs of revalidation (NMC, 2015).
The module recognises the importance of a blended approach to learning, while providing five days of face-to-face teaching. Practice teacher students have access to the university’s library facilities with a bank of resources to support learning. In addition, a sign-off practice teacher (someone with the authority to sign off proficiency) will support students and academic guidance will be provided.
Students also have access to a lifelong learning support network, which includes the delivery of bi annual practice teachers’ conferences as well as support to complete triennial reviews that help to maintain professional competence.
A requisite of the practice teacher’s module is for students to identify personal learning needs through a self-assessment process, based on the NMC’s eight domains (NMC, 2008). This can often be one of the most challenging and yet most rewarding parts of the module, as nurses in particular can find it immensely challenging to define the skills of normal everyday practice that they take for granted. Practice teacher students can take time off to develop necessary skills, learning contracts and, in time, begin to define their own learning needs that ultimately empower their own professional journey towards becoming a qualified practice teacher.
Portfolios and revalidation
Many processes exist to support learning and assessment in practice (Gopee, 2010). These include: simulation (Jefferies, 2007); multiple-choice testing (Marsh et al, 2007); problem-based learning (Williams and Beattie, 2008); and formative assessment (Hinton et al, 2008). In particular, portfolios are used to support nurses in demonstrating professional learning through critical reflection (Timmins and Duffy, 2011). And, although only provisional at this stage, portfolios appear likely to be a crucial component of revalidation (NMC, 2015).
Practice placements
Practice placements are fundamental in shaping the experience of the student in order to meet the increasing demands of healthcare and the rigours of professional registration (Hughes, 2003). Students arrive at their placement with pre-determined prescribed curriculum expectations and clinical outcomes. The practice teacher’s role is to support students in interpreting those standards, while providing appropriate opportunities for learning (NMC 2008).
Leadership and practice teachers
A further dimension of the practice teacher role is leadership (NMC, 2008; Gopee, 2010). This is supported by Kelsey and Hayes (2012) who, in their Educational Quality Framework, extol the importance of the practice teacher as an effective leader, one who has developed a degree of self-awareness and is able to recognise their personal leadership style and how it impacts on decision making. Essential skills of the practice teacher are having the ability to manage successful change and respond quickly to challenging situations, as well as being able to drive forward new and innovative ways of working, while ultimately ensuring that the SCPHN student is able to effectively participate in the learning process.
Future education
As newly qualified nurses have degrees it could be argued that the future of nurse education depends on higher education institutes developing postgraduate courses that meet the career aspirations of the future healthcare workforce. Nurses who have completed a pre-registration nursing course now have the opportunity to move directly onto a SCPHN course.
The profession will therefore require practice teachers able to deliver Master’s-level support when their highest-level qualification may be that of a degree. Therefore it is vital that all SCPHNs in OH consider becoming practice teachers as, without a viable number of them supporting professional courses, they may no longer remain viable.
It is easy for the OH adviser to challenge the level at which SCPHNs are working and their level of skills, but it is not so easy to recognise that it is the profession’s responsibility to enable the development of these skills and help maintain OH on part three of the NMC register. Without such skills, there could be insufficient numbers of SCPHNs able to develop services that meet the needs of working population, and this could lead to the de-skilling of the OH profession.
This is unacceptable in an age where there continues to be a significant drive to ensure high-quality service provision that seeks to improve and make available OH services to the whole working population.
References
Altman R (2015). “A new vision for older workers: retain, retrain, recruit”. London, DWP.
Department of Health (2011). “Health visitor implementation plan: 2011-2015. A call to action”. London: DOH.
Department of Health (2013). “Care in local communities. A new vision for district nurses”. London: DOH.
Department of Health (2014). Maximising the school-aged children nursing team contribution to the public health of school”. London: DOH.
Department for Work and Pensions (2014). “Fuller working lives. A framework for action”. London: DWP.
Gopee N (2010). “Practice teaching in healthcare”. London: Sage.
Hinton C, Miyamoto K, Della-Chiesa B (2008). “Brain research, learning and emotions: implications for education research, policy and practice”. European Journal of Education; 43(1), pp.87-103.
Hughes SJ (2003) “Student nurse theatre placements: the new curriculum”. British Journal of Perioperative Nursing; 13(9), pp.366-373.
Jeffries PR (2007). “Simulation in nursing education from conceptualization to evaluation”. New York, National League for Nursing.
Kelsey C, Hayes S (2012). “An educational leadership framework”. Primary Health Care Journal; 22(8), pp.16-18.
Marsh EJ, Roediger HL, Bjorkm RA, Bjork E (2007). “The memorial consequences of multiple-choice testing”. Psychonomic Bulletin and Review; 14(2), pp.194-199.
Nursing and Midwifery Council (2004). “Standards of proficiency for specialist community public health nurses”. London: NMC.
NMC (2008). “Standards to support learning and assessment in practice. NMC standards for mentors, practice teachers and teachers”. London: NMC.
NMC (2015). Revalidation, available at: www.nmc.org.uk/ standards/revalidation
Shaw R (2009). “Occupational health nursing”. In A Smith, H McAskill, K Jack (eds) Developing Advanced Skills in Practice Teaching, pp.187-189. Basingstoke: Palgrave Macmillan.
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Timmins F, Duffy A (2011). “Writing your nursing portfolio, a step-by-step guide”. Berkshire, Open University Press
Williams SM, Beattie HJ (2008). “Problem-based learning in the clinical setting: A systematic review”. Nurse Education Today; 28(2), pp.146-154.
