AERA Conference, Montreal, 2005 Early career learning at work The LiNEA Project Nurses Taking Action

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AERA Conference, Montreal, 2005 Early career
learning at workThe LiNEA Project Nurses
Taking Action

• C.Caballero, C.Blackman
• Professor C.Miller

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Phase I

• 40 Newly Qualified Nurses
• Interviewed and observed in practice
• Interviewed mentors and managers

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Interim Report Findings

• Transition from student to staff nurse
• Induction processes support varied
• Structured mentorship
• Feedback on performance
• Learning to delegate and prioritise
• Crisis of confidence

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Action Research

• Phase 1 findings fed back to Trust
• Use these findings to enhance provision for Newly
  Qualified Nurses
• The Trust took up the interim report
  enthusiastically
• Introduced several new initiatives to support
  Newly Qualified Nurses

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5 New Initiatives

• Trust Day for Student Nurses
• Nurturing the Novice
• Induction Day for Newly Qualified Nurses
• Competencies
• Action Learning Sets

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Aim of Action Research

• Evaluate the impact of any changes made on a new
  group of employees and Newly Qualified Nurses

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Action Research

• Contacted Newly Qualified Nurses who had recently
  attended the new induction programme.
• 11 Newly Qualified Nurses have been interviewed
  to date
• 4 Mentors have been interviewed to date

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3 Main Themes

• Mentoring
• Support
• Feedback

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Mentoring Positive Outcomes

• Following the Nurturing the Novice Day
• Mentors recognised the importance of discussing
  Newly Qualified Nurses progress
• Examples of good practice were
• Protected ½ hour a month
• Reshaped working practices to facilitate this
• Facilitated competency acquisition

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Positive Outcomes Cont

• Structured supernumerary status
• They took me under their wings but at the same
  time they made me independent as well. I mean
  they didnt shelter me and not let medo
  anything. They let the leash go and one time, my
  first craniotomy, she mentor was scrubbed up
  with me and all of a sudden I turned around, and
  she was sitting down, and she said well youve
  taken over anyway, youre fine, you know. But
  she was there

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Positive Outcomes Cont

• Mentors able to identify Crisis of Confidence.
• about a month ago 4months in I felt for a
  good few weeks I felt absolutely awful. I was
  like, no I should be getting this by now and I
  had to go for supervision and I was asked if I
  was alright and I was close to tears and she
  mentor turned round and she said Ive been to
  this nurturing the novice day about the LiNEA
  Project and they told us about this, that you
  might have a wobble at this time, you are
  supporting the statistics

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Mentoring Negative Outcomes

• Newly Qualified Nurses were not always allocated
  Mentors.
• I think I would have liked more time with my
  mentor because I knew she was a really good nurse
  but nine times out of ten if we did work together
  she was always in charge of the ward so it was
  quite difficult because she was just here there
  and everywhere and the ward being so short
  staffed anyway there wasnt very much time to sit
  down and chat

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Negative Outcomes Cont

• ½ of the mentors interviewed to date felt they
  were not real mentors as they had not undergone
  any formal training.
• Responsibility lay with more senior colleagues
• Their self perception of whether they are a
  real mentor or not influences how seriously
  they take the Nurturing the Novice Day

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Negative Outcomes Cont

• Disparity of Mentorship Provision
• Supernumerary status varied from one day to six
  months
• Lack of induction programme provision for Newly
  Qualified Nurses who had been students on the
  ward.

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Negative Outcomes Cont

• Because I had been a student here I think they
  just expected me to get on with it straight away
  and its actually a very difficult transition
  from going, you know, from a student to a staff
  nurse and I dont think the ward recognised that
  at all. They just expected me to be a staff
  nurse from day one.

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Support

• Trust Day for student nurses was found to be of
  value
• Senior nurses discussed their career progression
• Advised to get as much general experience as they
  could
• Trust representatives discuss job vacancies

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Support Cont

• The Newly Qualified Nurses Induction Day was also
  found to be of value
• A chance to hear about agencies such as the
  Chaplaincy and the Patient Support Services
• Chief Executive and Deputy Director of Nursing
  came and welcomed them to the Trust

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Support Cont

• Because you think that people like The Deputy
  Director of Nursing as being sort of up there
  but you realise that shes very down to earthand
  theyre actually taking on board what youre
  saying

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Support Cont

• Competencies were also found to be of value
• Help develop confidence in decision making
• They were achieving something
• Worked best along side Work based learning
  programme where competencies were seen as
  integral to the Newly Qualified Nurses
  development.

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Feedback

• Important to their development
• One of the Newly Qualified Nurses had never
  received feedback
• Ive never been told up until today that I was
  even a good member of staff, so I did not know, I
  thought I was terrible

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Feedback Cont

• Following attendance at the Nurturing the Novice
  Day some mentors did report that they now
  recognised the importance of Feedback
• I used to think it was important but we never
  had the time. Now I know how important it is and
  we make the time.

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Feedback Cont

• Structured Feedback is very important
• Boosts confidence
• Boosts morale
• Increases chance of staying in post

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Feedback Cont

• and when I did something they were quick to
  say, thats fine, you did really well, they
  were quick to praise. And I asked if I , you
  know, if I was doing things right and they were
  quick to answer me. And that wasnt just one
  person, that was all of them. So it was good.

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Feedback Cont Action Learning Sets

• A forum to discuss issues in practice.
• Reassured that they were not alone.
• Senior management were listening to them
• Just being able to sit in a small group and
  have somebody there thatwas sympathetic that you
  know wasn't going to go away and say oh God
  those newly qualified nurses they dont know what
  its all about

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Feedback Cont

• Action Learning Sets
• Lucky to be in a supportive environment
• Lack of follow up
• Facilitator Training
• Clarify purpose and function of Action Learning
  Sets and the responsibility of those involved.

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Conclusion

• Comments about not being real mentors suggest
• Mentors are given little support by managers
• Little sense of a learning community on their
  wards
• Ward managers create the learning culture of the
  ward
• Learning Friendly managers would be aware of
  their mentors behaviour
• None of the initiatives set up by the Trust were
  aimed specifically at ward managers

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Conclusion Cont

• The LiNEA Project has
• Enabled an NHS Trust to focus on the needs of
  Newly Qualified Nurses
• Recognised the importance of managing career
  pathways
• Enabled a Trust to think ahead and plan for the
  future development of all qualified nurses
• Enable them to grow their own nurses into more
  senior positions
• Improve recruitment and retention

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Nurses Taking Action(The LiNEA Project)

• C.Caballero, C.Blackman
• Professor C.Miller