Section Three — Findings and Discussion for the Nurse Rotation Scheme Study (Continued)
3.5 Rotation experiences
The theme ‘rotation experience’, is briefly presented here in a much reduced form. The reasons for this were discussed above under the theme ‘placements’. After the initial analysis I considered completely omitting this theme but there did seem to be some interesting but quite disparate quotes that were worthy of inclusion. There are no groups of quotes and those that are here come from a limited number of participants.
3.5.1 Settling
Caroline said,
“I haven’t had any problems with my rotations although when you are settling in on the ward and then the time comes for you to move on. It’s like, ‘Oh, now that I’m trying to settle on this ward then I have to move on’. And you have it in the background that at the end of the month you are moving.”
She continued,
“I was two months late. Initially I was supposed to go to ICU at the end of the six months. By then I decided I would stay… I agreed it with the managers so I stayed eight months and had six months on the ICU.”
About her third placement she said,
“Coming here, I didn’t know because initially… (name omitted) gave us a choice for the second rotation but the third one we were told you go where you are placed so there was no choice. But I haven’t regretted coming here because I wanted the community experience.”
3.5.2 Well staffed community placements with support
Not all the areas in which rotations are offered are hard to staff, some are well staffed but with some posts that are hard to fill. One example is that of e-grade nurses in the community where there is a reduced salary. It was felt that such posts would be attractive as the type of short-term learning posts experienced on the rotation scheme. Furthermore it was felt that there would be much better support in the community for rotatees since the staff are in high grades and have considerable education and experience. Evidence suggests that these assumptions were justified.
3.5.3 Rotating rather than resigning
Holly had been discussing the pressures that exist in different placements and then said,
“I think people always think that the grass is greener somewhere else. They think, ‘Oh, this place, I’ve got to get out of here’. But for me anyway, I know I’m somewhere for eight months and I think, with the last one, I was getting kind of fed up, thinking, ‘Oh well, I’m going to have a change. It’s going to be a different environment’. And so I think that’s a good idea because maybe if I’d just got a job on an acute ward in the Trust I may have left after six months or a year anyway and gone somewhere else. But I’ve stayed with the Trust because I’m on this rotation scheme.”
3.5.4 Poor planning by organisers
David felt aggrieved about his first placement, saying,
“I don’t think it is really well planned. I don’t think it’s well planned at all because when I joined, when I went for an interview to begin with, I did say that I’d had about five years experience and I had had two years acute experience and I wouldn’t like to go acute. But, to my surprise I went straight to acute because they didn’t say to me that it was initially designed for newly qualified people and therefore you would expect that because people go to acute as the basic. But they also did understand that I was not newly qualified, I had experience, I was already an E Grade so therefore they agreed to cater for my needs. But I was sent straight to acute and when I said to the organiser who came to our class on the first study day, that I was really disappointed that I’d been sent to an acute ward when I’d been on an acute wards for two years, the answer I got was that there’s nothing we can do. So, I said to myself, ‘I’ve never worked in anything but acute’, but I was very disappointed from the very first time. And I got over that and worked for the eight months.”
3.5.5 Different perspectives
In fairness to the original organisers of the rotation scheme, it is surprising that David did not know what the options were. They were specified in the advertisements, in the application pack and at the interviews. The purpose of the scheme for the patients/clients and for the organisation was made explicit.
This would appear to be a matter of perspective. It is understandable that potential candidates for the scheme put their own needs before those of patients/clients and the organisation but this may affect their ability to listen, remember and understand.
3.5.6 Nursing capability to accommodate oneself to the needs of clients
However, David’s next comment demonstrates a capacity to accommodate to the situation in which he found himself. This is a capacity that was noticeable in all the participants as I interviewed them but one which is not directly captured by the quotes.
Asked if he had gained anything from that first placement, David responded,
“Well, I always make the most of what I do. I consoled myself that I’ve never been in an acute in London so I just decided ok I’ll just make the most of it then. Yes, it was a great experience.”
3.5.7 Leadership and the main aims of recruitment and retention
Caroline had not rotated. She explained,
“It was the constant changes, you know, change is not for me, it’s probably not for me. I just get so comfortable; I was just comfortable here so I decided to stay on.”
It should be noted that it gradually became clear to the organisers that whilst they needed to encourage the rotation, the overall aim of attracting staff into hard to staff areas was the primary aim. Consequently the possibility of remaining in a placement was accepted. In particular, those who were promoted were allowed to continue since this was a change of role. The change was seen as freeing up the system and the person in order to implement change.
However, Caroline did approve of rotation, saying,
“Well, what I do actually, I encourage people. I say, ‘It’s good. You need to grow and if you do it will help you’. So, I encourage them to join actually. You know, I tell them, ‘It’s no use if you start off and you just stay in one place. Get a feel of different areas’. You have to be objective. Even I can be objective even though I stayed and didn’t go on the last placement. I think someone young… because most of them are younger than I am, some of these are twenty something; twenty one. They’ve just finished. It’s good that they go and consolidate their training because, remember, when you are in college doing the diploma you go to some places for six weeks or three months. When you are starting to understand the meaning of your studies you have to go somewhere else, whereas on rotation the placements are of eight months. So, by eight months you’ve gained confidence; you’ve gained knowledge.”
3.5.8 A challenging scheme
Caroline, who had also left the degree part of the rotation scheme, went on to discuss what others had felt about rotating. She commented,
“Some people say that it’s a lot of work. It’s hard to combine being on the job and the study, the academic part. And I think I fell into that category because I’m not naturally academic and into books all the time. So, I never really disciplined myself properly. That was my reason; that bit of it. The placements and all these things yes, that’s ok for me. You know, I function well on the wards but in terms of the academic bit, no.”
3.6 Educational experiences
The response to the topic concerning the educational aspect of the rotation scheme was almost totally complementary but very varied. As with most other topics quotes will be provided from all the participants but, on this occasion, without the use of groupings apart from the final two topics concerning the comparison of the rotation scheme and initial training and the conclusion.
Again, it should be remembered that this particular research approach was adopted partly because of the expectation that there would be a variety of perspectives amongst the individual participants. And, of course, it was assumed that the considerations of the perspectives of these particular key stakeholders was important to help with an understanding of the success, or otherwise of the rotation scheme.
3.6.1 Management of the scheme was helpful
Sarah commented,
“I like the way it’s run because it gives me a lot of freedom to go and do my own work and I like working that way. I don’t like being pushed so I like the way it’s structured. I get given guidelines and I go and do my own research and use my own motivation. Plus now there’s evidence! You can say ‘What makes you say that? Have you found any research on it?’ ”
She added,
“I’m a lot more confident in that aspect and if I wasn’t going to college I wouldn’t be as confident and it wouldn’t be as challenging.”
3.6.2 Work based learning
When I asked if that confidence came from it being work based learning, Sarah replied,
“I think it comes from work based learning because you’re getting some input and you’re filtering it through. So, if you weren’t working, you’ve got nowhere to filter it through.”
On a more negative note she added,
“I could filter it through here if only people were interested and they would listen.”
However, Sarah implied that she can at least change her own work when she said,
“And now, having done the second module, I am feeling the benefits of doing it and my awareness and my skills, I think, have improved.”
And finally, she said
“I like that side of it; I enjoy that side of it because if you look at it, you gain more through reflective practice and the things that you learn are things that you can actually change.”
3.6.3 The curriculum fits work requirements
The original rotation scheme leaders and planners can take comfort from Sarah’s comment above since it supports their belief that the curriculum, CPA for example, needed to directly support the work of the Trust and that it should seem to be directly relevant to the nurses on the rotation scheme.
Kim’s comment was,
“The course is designed in such a way that it can help you whatever client group you are working with because it is work based.”
This implies that, for Kim at least, the CPA, clinical and risk assessment, shift management/governance modules of this National Service Framework related project is generalisable across speciality areas.
3.6.4 Assignments were useful for clients
Kim had earlier commented about having learned on the first rotation because it fitted in with the assessment. I raised this and she answered,
“Yes, Even the second one, this one, other than the problems I’m having with staff and the clinical work I’m supposed to do, I think I’m doing better because of the rotation programme. They teach us how to do the care plans and how to implement them and how it fits in with the National Service Framework and how it fits in with the care programme approach. So now, because I do the course, when I attend clinical team meetings I know what they are talking about. A few times I have challenged them on whether they needed to do an assessment of a patient, because I had the impression that there were some side effects from the medication. I asked them to administer a tool that I’d learned about, the Liverpool University tool (LUNSARS), to see if there were some kind of side effects and they agreed.”
3.6.5 Rapidly developing capability
The rotation scheme nurses, who are mainly recently qualified, might quite quickly become the senior nurse in a hard to staff area so it was another ambition of the project organisers that such nurses would become competent to participate in multi-disciplinary meetings. Kim has provided some confirmation that their plan is succeeding.
3.6.6 Policy to practice transfer time
A further advantage that can result from this ambition is that major political policy developments, investment and change management in the organisation, can be quickly linked with the direct care workers. As a result, the developments and changes ‘make sense’ to them and can increase the speed of change and improvement.
3.6.7 The power of connecting organisation, workers and clients
Kim’s final comment above provides an excellent example of the power of the connection between education, organisation, worker and clients. The side effects of medication, the needs for which have been either poorly assessed or not assessed at all, are major causes of relapse. This leads to unnecessary utilisation of scarce health resources, and unnecessary illness among clients. Thus the education provided was useful and the approach has probably led to benefit for clients.
3.6.8 Useful degree
Caroline commented,
“The educational aspect is good. It’s broadened my knowledge. Our lecturer is good. He’s always available. If only you have time he’s there to help you. He is very supportive.”
When I asked what she thought about it being a work based degree she said,
“That’s been good because one way or the other you write on what you actually do and compare that with the policies. And then you critically analyse it; this is the policy and this is what we do. This is policy and this is not; this is what we do and this is not in the policy.”
I asked Caroline if they had to analyse why policies are not followed and she responded,
“That’s so as well. It can’t all be implemented but at least it’s there. At times you don’t even get to see the policies. The policies come on the ward; you see them briefly and then they file them away. If you are keen to know your policies you’ll go for them but there are times, because of the nature of the work and shortage of staff, you don’t go and look at policy unless you really want something from it.”
However, she added,
“I think most of the policies are in an induction pack so a lot of people have them at home. I think they read more at home because on the ward you have ward rounds, you have to see your clients and you have meetings to attend.”
3.6.9 A really good experience
Ellie argued,
“The educational side has been good. I didn’t really know what to expect but my experience of the education has been really good.”
I asked why it was good and Ellie responded,
“Because we learn about stuff that is actually happening on the wards; stuff that we’re actually doing. And we get to discuss different ways that people work and also we learn about what is expected of us and we tally that with what we are actually doing. For example, this last module on CPA, Alan (the lecturer) has been talking about what the government expects and what the government set up. He’ll be telling us the ideal and then people sort of put in what is actually happening on their ward and what they are actually doing and what other nurses are actually doing which is a good way of learning because learning is not only about learning the idea, it’s also about getting to know what’s really happening in the real world. Most of the time it’s mostly negative stuff that comes up… it’s negative in the sense that it’s not really what the government has asked the Trusts to do. It’s what the Trusts really won’t stop and are just doing independently.”
3.6.10 It helps me to change things
She added that the lecturer provided guidance as to how that could change,
“…to see how your practice should actually be.”
In her response, Ellie demonstrated that, helped by the course tutor, she had developed insights into how difficult it is to create change and behavioural changes in organisations. The project organisers intended that work based learning and rotation should, together with the focus provided by the written assignments, equip the nurses on the scheme with insights and skills in organisational change and improvement. The important part played in this by the course tutor is highlighted by Ellie’s comments and those made by other participants.
3.6.11 Keeps you motivated
Ruth said,
“I think it’s quite good. I’m actually enjoying it a lot, just as much as training. I think it’s quite informative; very, very evidence based and I quite like that because it motivates me as well, you know, to see examples of the work and what they do and stuff like that. I quite like seeing that and it just keeps you motivated. So I find my whole experience of the scheme is quite positive. There isn’t much I could say against the scheme.”
3.6.12 Studying at work
She added that the educational aspects had fed back into work, saying,
“I can apply stuff that I learn at university to work. That’s quite good because often you find, you know, you do things at college and it’s not very practical once you get onto the wards. But I’m finding the course quite practical. There’s no sense having the knowledge and then you can’t really do anything with it.”
3.6.13 Common perspectives among partners
Robert said that he was enjoying the modules. After listing the modules he had completed to date he said,
“I didn’t have any problem with them. I really enjoyed it. It really fits with the work. It’s really in tune with the work based… how it’s actually designed.”
The fact that someone actually directly involved in the scheme appreciated and understood the complex link between the key elements of the scheme and the benefits for clients should provide comfort for the project team.
3.6.14 It was worth it
David had been reflecting on the stresses he had experienced on the ward and this led me to ask him if it had been worth it. He replied,
“That’s a very good question. I think so yes because, at the end of the day, I am going to get something.”
Asked what he was going to get, he responded,
“Apart from the degree, which is the greatest, the experience, and the knowledge. I don’t think I would have got that anywhere else. You’re all so dedicated and reading policies and keeping yourself up to date. I don’t think I would have had all that knowledge because when you have to study, when you have to do something… it’s not like, ‘Now let me take that policy and browse through and read’. If you have to do an assignment, a project, you have to dedicate yourself to doing that.”
Here, David provides direct praise for the scheme with its potential benefits for individuals and their professional practice and the competitive advantage it can provide for ‘hard to staff’ areas. Furthermore, he, at least, shows no awareness of any similarly attractive scheme being offered elsewhere, thus implying that a newly registered nurse joining this scheme is at an advantage.
3.6.15 The university was great
David added,
“University has been absolutely great, especially Alan. He has been so supportive apart from being a good lecturer. He’s a fantastic lecturer but he is also very supportive. You talk to him about everything basically and he is very supportive. And I think it’s fantastic it being a work based degree because when you sit down to do your essay it’s not about references, about what so and so was writing and the theories and whatever. It’s about what you do and the quality of care. What you think, what do you do and what do you actually think about how you do things. It is more reflective. You look back at your work and you think, ‘How do we do this? Do we do it right and if we don’t do it right, where are we lacking?’ I think it’s absolutely great.”
3.6.16 Falling behind
John, who had fallen behind in his assignments, argued,
“The lecturer is good and the university course is a good programme. I haven’t finished all my essays as yet but I’ve still got the chance to do the degree if I want to.”
John’s comment shows up a dilemma facing adult learning. It is important to allow adult learners to take responsibility for their own learning and for the outcomes of that learning. However there do need to be limits and the question is, ‘Should they be based on research, based on educational and/or organisational theory, or should they depend on arbitrary bureaucratic boundaries’?
3.6.17 Lifelong learning
Commenting on the rotation course giving him the opportunity to study for a degree, Michael’s response highlighted the conflict between the concept of life long learning and the ‘job for life’ approach. He argued,
“It’s very important because it’s giving me leeway to carry on with studies really and not staying just with work because I’ve always had the sort of people who have said, ‘Get a job and it’s for life. Get a job and stop there. You don’t want to move on’. But life is not only for that.”
The process of work based learning would appear to be a boost to the concept of life long learning.
3.6.18 Making sense of my experiences
Tony had said that he decided to join the scheme because of the opportunity to rotate. This led me to ask him if the qualification and the fact that it was a work based degree held any importance for him. He replied,
“One of the other reasons why I liked the idea of the rotation scheme was that element of being supported through developing your own style and having the opportunity to be able to talk about things. I like the university element being work based because my training, was very theoretical without getting a lot of experience. So whatever you were writing was being supported by all these references whereas now, it’s a complete turn around. Having more experience to draw on, you’re actually being asked to talk about your experiences at work and obviously do reading and make some references but it’s making sense of what you’re actually doing and that whole reflection thing.”
I asked if he had been expecting it to be like that and he answered,
“No, not so much. I mean, I knew it was work based so I had a little bit of an idea but not really, no. And I think, as it’s developed, it’s actually drawn me in much more and I do feel that I don’t need to be concerned as much about my, academic skills as, say, I did at college. It’s more about what you’re being asked to do rather than, sort of, trying to get it right.”
3.6.19 Leadership: a brilliant tutor
Discussing what he felt about the degree course, Tony referred to it by commenting on the course tutor. He explained,
“I think that Alan is brilliant. I mean he really is very enthusiastic and motivated and because of the way he is, then that is enthusing and motivating within itself. But also he just makes things so simple so that his style, there’s the content of it but also, his presentation. It’s just a perfect package really. Most definitely! And he’s very approachable and so I think that’s one of the other things as well. Very approachable, very understanding and very willing to go just beyond the, sort of, the academic side of what you’re doing to just be able to talk about other things that might be happening on the ward or whatever. And I think that’s very good as well. I do like that because sometimes one of the things that can be missing, particularly from the ward environment, is that there are things that happen that you don’t get the opportunity to talk about. As a group, sometimes we do that and he just lets that go and contributes to it. So, all round, you know, I think he’s very good.”
3.6.20 Seamlessness
What Tony has highlighted here is that the course tutor manages to blur the boundaries between education and work and makes them appear seamless. He also demonstrates how the rotation scheme nurses both use their own experience and learn from the experience of others.
3.6.21 Reducing the gap between theory and practice
Speaking about the degree course, Clive said,
“It is work based so it is really quite helpful. The different modules that we have done, we have implemented what we have learned. For example, the one we’ve just been doing about CPA, from the discussions in the lessons we have had, I was able to implement that. What I learned at university has helped me to work confidently.”
Clive has shown how the degree course reduces the gap between theory and practice. In other words it helps to facilitate both ‘knowing that’ and ‘knowing how’ rather than just one or the other.
3.6.22 Quite tough
Holly was the only rotation nurse to be rather negative about the degree course. However, the final paragraph from what Holly said serves to remind us that research can only provide a snapshot in time.
As she reflected on her initial expectations and actual experience to date of the educational aspects of the scheme, Holly remarked,
“I don’t know really; I suppose it is about what I expected. I suppose the assignments seem to come round quicker than you expect. I must say I do find it quite tough to get it done in time because what with working as well and… I have found though, with this assignment I have found it very hard to get myself motivated and I really have to keep on pushing myself and say, ‘Come on, get on with it now’. I have found it really hard because I’m tired when I go home and the last thing I want to look at is my pile of papers.”
3.6.23 Settling down to learning as a full time worker
Holly raises a key issue for newly registered nurses, namely that settling down to learn, whilst undertaking an full-time job is difficult; particularly so when the learning involved relates to advanced practice.
She also highlights the problems that arise at the interface between personal motivation, practical circumstances, and the ability of an educational institution and/or an organisation, to inspire and motivate busy professionals to participate in learning when they work in very demanding environments.
3.6.24 The first assignment
Holly added,
“I enjoyed doing the first assignment. I must say, I’m struggling a bit with the one I’m doing at the moment and I’m thinking, ‘Oh no, is it worth it all’? So it’s a bit tough at the moment. I managed to get to grips with the first one and get that done and I did quite well with it but this one, I’ve been struggling a bit. As I said, I enjoyed the first one and maybe that was… I mean it was still work based but I found I was drawing on more different information.”
3.6.25 National policies transferred to practice
Holly went on to say,
“The assignment I’m doing at the moment is based around policies and things which is very work based but my mind, I must say, switches off a bit when I’m reading all these policies and things. And a lot of the course is around the national policies, you know, the new service frameworks and things for the NHS and a lot of that, I don’t know, sometimes I think, ‘Mm, really how much difference is it going to make or how much has it affected these things’. But I suppose that’s the idea of doing these assignments, to question the changes that are being made. So, it is relevant but…”
3.6.26 Clinical case studies
However, Holly also commented,
“If you had spoken to me a few months ago I would have said, ‘Oh, yes, I love it’, because I really enjoyed doing my last assignment.” It was to do with assessment. I really enjoyed that because half of that assignment was a case study and I enjoy doing case studies. I just find it more interesting when you talking about people’s backgrounds and things and all sorts rather than talking about policy.”
3.6.27 Awareness of organisational and client priorities
It is important to note that, without the course Holly and the other rotation scheme nurses may not have become sufficiently aware of and not have reflected on the implications of the new service framework such as waiting times or care co-ordination. However, what she has to say highlights an extremely important issue for health service modernisation namely how to motivate people when they are doubtful about results. Holly was the only respondent who claimed to be ‘switched off’ by the subject matter of a module but nevertheless, only a demonstration of the relevance of that subject matter to self, clients and organisation is likely to increase the chance of successful learning, improve clinical practice and improve outcomes for clients.
All of this underlines the connections between policy and practice and education by illustrating that the first stage of implementing change is awareness.
3.6.28 Differences between pre and post registration learning
Asked how it compared with when she was training, Holly answered,
“I suppose that it’s just one step above what I was doing. I actually did my training at Middlesex University so I find some of the ways of working, obviously, the same. I suppose we haven’t got as much support as when you are at college because then we used to have study time in blocks, you know, weeks. And maybe it might be useful to have a few study days grouped together because sometimes there are big gaps between study days and it might be useful to have groups of days together so you’ve got a bit of continuous learning. Because it’s one day a fortnight there’s a long gap. I mean, obviously we can get hold of Alan if there’s any problems, which I have done. But sometimes it’s just nice, if you’re learning a big module, to have a few days to really get into it rather than a day here and a day there and then you’re back at work again.”
3.6.29 Personal versus Trust perspective — costs
Whilst Holly’s arguments demonstrate what some, or even many, might find desirable, they do show an ignorance of the costs of education for the Trust. She appears not to have considered the difference between the supernumery status of the student-learner and position of the worker-learner.
3.6.30 Personal reasons for leaving
Anne is discussed at the end because she was the only interviewee who had dropped out of the course although, before the interview, I did not know this was the case. She said,
“Since the last couple of weeks I’ve actually decided to come off the course; the degree part of it as well, due to my own personal situation. I’ve some things to sort out and it wasn’t the right time for me to be doing a degree.”
I asked if it was something to do with the degree course but Anne assured me that it wasn’t. She said, quite vehemently,
“No, no, no! There’s nothing wrong with the course at all. Actually, I think it’s quite a good course; it’s quite informative; the lecturer is very informative and it’s work based. So the knowledge you actually gain, is good. It’s really good! You know, you get all the different handouts; all up to date information about what’s going on in mental health. It’s actually a good course if you succeed, if you keep with it, which I didn’t. Unfortunately, for me it’s not the right time. For those who are on it and continue it will benefit them.”
I asked her if she could think of anything that could have happened that would have helped her to stay on the course. Her reply was,
“Myself! Disciplining myself; nobody else.”
3.6.31 Benefits of a good tutor
She added,
“Alan he’s an excellent lecturer. And he actually got all the information for us and just gave us all the relevant websites. He is a good facilitator. He makes it interesting. He knows; he understands.”
3.6.32 Comparison of the rotation scheme and initial training
Comparing the present degree course with their initial nurse training courses was not part of the agenda but with some of the rotation nurses the topic arose and was followed through.
3.6.32.1 The theory to practice divide
For example, Sarah commented,
“In college you learned about nursing models and that kind of thing but the application was totally different.”
Asked in what way it was different Sarah argued,
“You can use nursing models theoretically but practical wise, like, you know, we talk about assessments now and what assessment tools you are using and you’re given a practical tool and you use it and you say, ‘yes, it works in this way’. We can identify a patient’s needs or goals and nursing models come in place in that way, you know, in the way you use them. But they are used as a means of instruction on which you can reflect or analyse how they work.”
3.6.32.2 Changing perspectives with changing roles
From interest, rather than it being relevant to the educational aspects of the rotation scheme, I asked if the work based learning complemented the diploma. She replied,
“I think the diploma could have been more like it because they way the diploma is, it’s quite practical as well. I mean, students do have placements and quite long periods of placements and if I had had the awareness that I’m gaining now maybe some of these changes could have happened earlier on. As a student you challenge things. You’re not afraid to go and say what you want because you’re only there for two or three months. Like now, I’m mentoring students. If I bring them to a ward review or a clinical team meeting, they are going to challenge the obvious… what we presume is obvious… but they challenge that and you have to explain it. And if you can’t justify or have a rationale for doing things then it can change the way we behave. It’s only small but it’s significant. I feel that if nursing students came in and learned some of the things I’m learning now, once they start questioning what is being done it’s shown to be wholly impractical. Most students, they don’t care, they’ll just tell you.”
Asked how, being a work based degree, it compared with other forms of studying, John responded,
“Because it’s work based learning you can deduce your learning from the ward. What you know from the wards you put into your written pieces of work rather than what you would do, for example, in your nurse training where more information would be from books rather that experience.”
3.6.32.3 Tough but motivating
Asked if that was better or just different, John said,
“Well, it’s not better in a way because you have to provide more information to actually put into your pieces of work from yourself rather than from the books, although you use some bits to reference your material and back up a statement. I don’t know if that’s a good thing or a bad thing. Maybe it’s good because it’s real stuff but then it’s a little bit harder to put things down.”
John’s comment illustrates that, in some respects, work based learning is not as easy as traditional education.
3.6.32.4 A higher level
In further discussion, Michael compared his present degree course with his initial training. He said,
“When I did my diploma it was all the same thing really because it was set. You spent that much time in university and you spent that much time in clinical practice. And with this one you’re spending more time in your clinical practice and you’re spending less time on your study side. But when you’re working at your clinical practice you’re also learning. There are things that you’re learning from what you’ve learned from this side. I feel it’s a continuation from what you learn on your diploma, really. Because you’ve learned about the CPA (care programme approach), you’ve learned about government rules and everything but coming up in this scheme now with this university your getting a continuation, a higher level of those things. And now it puts things into perspective as well; where you’re working with those things and how comfortable you are about those things with your patients, your users and yourself. Really, it’s about why you should be doing those things. So it makes it more understandable.”
3.6.33 Conclusion of educational experiences
Examining the findings in this topic area in more depth and comparing them with what the rotation scheme nurses had to say about other topics led to the identification of three salient factors.
3.6.33.1 Most enthusiastic about education
Respondents were more forthcoming and more enthusiastic about the educational aspect of the scheme than about anything else. This draws attention to the importance of the quality of the education provided and the ability of those providing it. The participants uniformly praised their tutor and his qualities and eight of them commented on the value of work based learning whilst another three implied it. A different type of educational programme and/or a less capable tutor could have adversely affected those enthusiastic comments.
3.6.33.2 They accepted the extra work associated with work based learning
There was very little comment about the university work being drudgery. This is somewhat surprising given that these nurses are concurrently studying and working full time. It is likely that they all see their studies as drudgery at some point, particularly in the run up to handing in an assignment, but it would appear that the obvious enthusiasm the participants have for their studies led them to ignore that side of things during their interviews.
3.6.34.3 ‘Knowing that’ and ‘knowing how’
By implication, they mostly provide evidence that a work based learning degree facilitates both ‘knowing that’ and ‘knowing how’, something that will, hopefully, reduce the theory/practice gap for this group of people and, through them, for others.
3.7 — Quantity and quality of support