Section Three — Findings and Discussion for the Nurse Rotation Scheme Study (Continued)
3.7 Quantity and quality of support
3.7.1 Lack of awareness of the different types of supervision
The topic area addressed here was, on paper, ‘the quality of clinical supervision received’. This term tends to reflect an ideal model of supervision and most, perhaps all, of the participants who had something to say about this topic, chose to talk about and not differentiate between, clinical supervision, management supervision, mentoring and even preceptorship or informal discussion. This was in spite of my efforts to probe more deeply and the responses were so mixed and, in the context of an ‘ideal model’, confused that I am referring instead to the topic ‘support’. Indeed, I gained the impression that, to a large extent, any form of support was interpreted as supervision.
A further consequence is that dividing the quotes into different sets became unwieldy and, ultimately, meaningless so they are simply delivered in a way that demonstrates the situation as perceived by these rotation scheme nurses.
3.7.2 Expectations of supervision
The expectation of ward supervisors by the pilot scheme managers was that they should provide the basic standard of one hour of supervision per month. For most of the potential supervisors, some introductory sessions were provided in their locality on the project and its expectations, although not everyone would have attended. Furthermore, by the time this fourth cohort of rotation scheme nurses were appointed many of the initial supervisors would have moved on and new people taken their place. This suggests a need for an ongoing induction scheme for these important, potential stake holders in the scheme.
3.7.3 Supervision course for supervisors
The scheme also included the option for potential supervisors to undertake a three day external and accredited course on clinical supervision for the rotation scheme, thus indicating that the organisers were hoping to set some standards for supervision. Not many people took up the offer, possibly because of time related difficulties, but, that apart, the demands of hard to staff areas make it very difficult to provide formal supervision, a point appreciated by a number of participants in the research (see Lucock & Coyne September 2006).
3.7.4 Tensions
Many of the quotes below are somewhat negative but this is unsurprising given the context of their work and taking into account the fact that some of the supervisors they encountered may have been less well educated, less trained and possibly less experienced than themselves. This would be especially the case once the rotation scheme nurses had begun to experience the work based learning/rotation approach and its benefits.
3.7.5 Formal education as support in hard to staff areas
This problem, along with others possible ones, was appreciated from the start by the course’s organisers. There were four boroughs involved in the scheme, each with their own problems in resources and staffing and the external education and support group of others and the educators were to be a substitute for the level of support that might be found on wards or in services that are fully staffed. Unfortunately, as can be seen particularly from quotes under the theme of ‘communication’, whilst the educational support remained constant the support from course organisers gradually faded away as the piloting and the funding of the scheme came towards its end.
3.7.6 They do try to support me
Sarah felt that, in general, there was a lack of support where she worked. However, in reference to the ward to which she had presently rotated, she said,
“They do try here. I should give it to them; they do try! It’s only things like mentors and supervisors, you don’t get that kind of support. I’ve got a supervisor now but mentors, or people who can help you as you go along, it’s not very forthcoming.”
I asked Sarah if she was getting good supervision to which she replied,
“At the present moment it’s not the best but you have to work with what you’ve got. When you’ve read about supervision and you know about transference and all those things and you get allocated a list of supervisors and you choose a supervisor and they aren’t aware of these things then you have to dig it out of them.”
3.7.7 Mentoring others because of high turn over
Sarah then spoke about mentoring, saying,
“I’ve only been there for four months but at the present moment, because of the high turnover, I’ve got three people I’m supposed to mentor. At the same time I’ve got a team leader who is mentoring me at the moment but I don’t get any feedback. It’s all about getting feed back and more or less an appraisal. But I’m not getting that.”
3.7.8 Expected more support
Speaking of support from those running the nurse rotation scheme, Kim had said,
“Initially I thought, when it was advertised, it was a very good course. There seemed to be a large support network to support us through the course but when I came here the reality was very different.”
3.7.9 Someone with whom to discuss college work
Asked about supervision she replied,
“The clinical nurse manager for my previous placement is my supervisor now.”
But it is not clear that this was clinical supervision since Kim added,
“She is some one I can talk to and she is someone who is really good and who is really supportive and I can even discuss with her some college work, the learning material and all that kind of stuff. She has agreed to do sessions after every two weeks. The only disadvantage of having a clinical nurse manager as a supervisor is that they are really busy.”
I asked if the level of supervision was, perhaps, sufficient to make up for the lack of time and Kim answered,
“I think it is good. The one I have now is really good. I mean, you’d wonder how I would cope with what has been happening on the ward but with the supervision input I manage to smile at some of the things that happen. She even told me about my entitlements and said, ‘You’re entitled to carer’s leave’ and she phoned me to say, ‘You should ask for that’. These are all the sort of things that you don’t know when you are newly qualified. You need to be in the system for a long time for you to know all those things.”
3.7.10 Create a two year internship
Kim’s final comment highlights the need for mentorship and supervision and it also gives focus to the idea of internship for newly registered nurses with the expansion of the idea of preceptorship to a formalised two year programme.
3.7.11 No staff to allocate as supervisors
Ellie said,
“I’ve never had that. Honestly speaking, on my first day at preceptorship time I said, ‘Can I meet a supervisor because I’ve just qualified plus I’m part of the rotation’, and she said, ‘Well, there’s no one I can allocate to you at the moment but I’m having two E grade nurses starting in a few weeks so I’ll allocate one of them to you’. That was in May. And she said to me, ‘But in the meantime I’ll be your supervisor’, but she didn’t do anything for me. The staff came in June but she still didn’t allocate anyone to me. And I was just going along really and then, I don’t know when it was; I think it must have been November time, I just asked one of the nurses to be my supervisor, so I did it myself. She’s been really good. Whenever I work with her she talks to me and shows me how to do things; guiding me along. So that’s supervision in a way but then I only had about two supervision sessions.”
3.7.12 The intrinsic nature of hard to staff areas — turnover
This constant staff turnover illustrates another core element of ‘hard to staff’ areas. It seems probable that the rotation scheme with its work based learning might help retention.
It is interesting to reflect that whilst the hospital ward is a constant supervision environment consisting of observation, information exchange, direction, support and handovers, Ellie’s comment demonstrates a need for individualised packages of supervision.
From her further comments it would appear that Ellie had had some support from her line manager, at least before she got her E grade and that other staff were helpful when she worked with them.
3.7.13 Supervisors unaware of expectations
It is not possible to present part of what Ruth said without identifying her location but her argument was that a lack of liaison between those running the scheme and the hospital she was working in meant that those who should be providing support in the form of supervision were unaware of what was expected of them.
She went on to explain,
“I’ve got a supervisor and this is the second supervisor I’ve had and it’s ongoing and they seem to really, really not know what is expected of us. He said, ‘you’ll just have to tell me, I’ll have to just take it from you what it is you wanting’. And I told him, ‘Well, I have a fair idea what is expected of you’, but I think it would have been good if somebody had spoken to them just to get down some guidelines.”
Previously I suggested a possible need for an ongoing induction scheme to initiate supervisors newly involved with the scheme. Ruth’s comments suggest that policy and procedures for this need to be put into place at the start of any new rotation scheme and a good practice model for supervision devised.
3.7.14 Feeling cheated
Ruth went on to say,
“Basically, I have been getting bits. It’s ok because you actually learn from it but at the same time you feel a bit lost in space and cheated. You do feel cheated because you have to sort things out yourself.”
3.7.15 The organisation’s perceptions and attempts to help
‘Sorting things out for yourself’ is a reality of nursing in hard to staff areas and no doubt contributes to a high level of turnover in those areas. Those who planned the rotation scheme and brought it into being were well aware of this and thus the concepts of internship, work based learning job rotation and supervision were central to their aims and purposes.
Ruth said that she felt that the staff on her first placement had been, as she put it,
“…a bit more relaxed about things.”
Her next comment shows that by this she meant that they were just mechanically carrying out ward routines. She said,
“On this ward they tend to be a bit more up with current thinking and such things; very sensitive to care and they have the culture and are sensitive, gender sensitive. These are things that they talk about nowadays and I’m quite interested because it keeps you going, you know.”
3.7.16 Good supervision keeps me going
Finally she said,
“And you have supervision of course. They haven’t had someone to talk to them about the support they should be giving, on this course but they’ve had supervisory training and that’s what we get. I mean, I can’t complain, it’s keeping me going. I actually want to stay on for the next rotation. I don’t want to deprive anybody of the experience but I would like to stay.”
Ruth’s final remarks underline my initial comments. What is not clear from this newly registered nurse is what actual support is missing; whether it is clinical supervision, professional supervision, line management supervision or even mentoring. Such a lack of awareness and clarity can reinforce insecurities, and lead to dissatisfaction.
3.7.17 A lot of ill-defined and poorly organised support
Robert’s views about supervision and mentoring also showed a lack of distinction. He said,
“When I was on the acute ward there were dates set aside by my mentor there to have clinical supervision and it’s really been done every three to four weeks. Currently, where I am, I find supervision quite good and quite motivating. I mean, this present rotation it’s been every two weeks and I find the ward manager to be very supportive.”
Following through, I commented,
“That’s clinical supervision, is it? You also mentioned mentoring”,
to which Robert responded,
“It’s partly to do with some form of mentoring. There is a support and then you have to do some teaching as well. Whoever asks is benefiting from your wealth of experience. It’s like my current ward manager is combining both, mentoring at the same time as clinical supervision. There is a little bit of difference between both but in a nutshell the two have to be going along the same line. Those that are registered know that each one is accountable for his or her own practice but at the same time, if you benefit from the experience of somebody who has experience in that line, experience in that ward, experience in that field you tend to benefit more in your day to day practice and at the same time you extend that practice.”
3.7.18 The effect of unled hard to staff areas
Holly said,
“Supervision has been a bit lax really. I’ve not had that much supervision. I had a little bit of supervision on (name omitted) ward. When we had the new manager and she gave me a few sessions of supervision and when I first started here I had a couple of sessions of supervision with the deputy manager. But the manager has also left here before Christmas. We’ve got a new one now.”
I commented that she was not doing very well for managers and Holly responded,
“I’m not! I’m thinking it must be me; everywhere I go managers disappear. So, it’s been a bit up and down here and nobody’s had supervision for the past few weeks.”
Asked if she felt the lack of it, Holly replied,
“I do, yes.”
And, asked for some examples of where it would have helped, she said,
“I think it just helps when you’re making decisions on your own because there’s not always managers around here, you know, obviously at weekends and things or night shifts. There’s a few of us around and I think just support in the way we work with the clients here and just some one to seek advice from. I mean, there’s been nothing in particular that’s come up that’s been bothering me but it would be nice to have that regular supervision and I believe it’s going to start again; I think after Easter.”
3.7.19 24/7 services — poor organisation of supervision
Holly’s comments about night shifts highlights the twenty four hour a day nature of the services provided, and the problems that this raises for the management of care/nursing over the twenty four hour period in relation to the mentorship or supervision of staff and to their education. Such problems are often not fully and explicitly taken into account.
I asked if she was referring to clinical supervision, to which she replied,
“Well, clinical supervision is supposed to be with someone who is not your manager I think, isn’t it? I haven’t really thought about who I’m going to have that with or who would be the most appropriate person.”
3.7.20 Feeling able to ask for supervision
It turned out that, although she had been in her present community placement for some time, Holly had had no specific clinical supervision. She had not been offered it and she had not asked for it. She commented that perhaps she ought to have requested it but added,
“I don’t know anyone that has clinical supervision here and I wouldn’t know who to ask to actually give me that supervision.”
She then commented,
“I suppose I’m not very good at asking for help and advice at times and on the rotation I’m the first one to come to this place.”
And pondering the matter, she exclaimed,
“I think it used to be half the staff with the support workers and social workers who got supervision from the manager and the nursing staff and the junior support workers got supervision from the deputy manager. But it’s been changed now so that nursing and social work staff take on the support workers and they supervise them. But then, I would call this managerial supervision anyway, not clinical supervision.”
3.7.21 Line management supervision
I asked if, by managerial supervision, she meant making sure that you’re doing what you should and Holly replied,
“Yes, and advice and support, I suppose, on the way you’re working.”
Holly’s responses to my questions about supervision raise a number of questions for future consideration. For example, her comment about not being very good at asking for help and advice at times draws attention to a professional capability that is developed over time and which might be nurtured by internship.
There is also the question as to what type of supervision is needed and how much it is ‘reasonable’ to expect. In relation to this, a further question arises as to how the rotation scheme nurses, as novices, are to know if the supervision they are receiving is sufficient or, indeed, what is missing.
3.7.22 Good practice model — supervision system for professional staff
This again raises the need for a ‘good practice’ model for supervision with working definitions of the various type of supervision that are realistic for hard to staff areas compared with a fully staffed environment.
David also brought attention to the work problems that can interfere with supervision, saying
“I think I had supervision once in those eight months and basically, when you said things, it would just end up right there.”
Asked how supervision had been on his previous rotation on ICU, David responded,
“Unfortunately, I had it once and my supervisor was off sick, but I had it once.”
He then went on to say,
“I think it’s very difficult on the ward. It’s very difficult to keep up. I mean, as much as the policy stresses that it has to be very frequent it’s difficult. It’s just something that does not happen that frequently.”
3.7.23 Quantity and quality of supervision
John commented,
“The first place was mostly not very good and in ICU we did get enough of it but the quality of it wasn’t very good. But supervision here has been very good.”
3.7.24 How do you know what to expect?
John’s comparison of his two placements introduced one possible solution to the question as to how the rotation scheme nurses, as novices, were to know if the supervision they were receiving was sufficient and what might be missing. In any one cohort, a proportion of the rotatees were likely to encounter differences in the quality of supervision they received, and with the benefit of the work based learning element of the scheme they had the opportunity to discuss these differences and understand why and how things might have been changed and improved where necessary.
3.7.25 Time to meet supervisors when working shifts
Michael commented,
“My assessor is a team leader; they choose team leaders to be your assessors on the ward. They’re team leaders so they are responsible for the whole team here. You’re working only two shifts that they’re in charge of the ward … they’re in charge of everything. There’s hardly a minute for you to sit down and speak to each other. I suggested that assessors should be someone you are working with on the same shift pattern because, I said, ‘you can catch up with what’s happened’. Your assessors see you and if you’ve done something they could say to you, ‘I saw you did some thing nice’, or, ‘You’ve done something wrong. I saw you.’ But the answer was ‘No, that’s not the way we do it’.
3.7.26 Experiencing prejudice — what to do about it
He continued,
“And then I had to call the manager once… Well, first, when I went on that ward I found it really hard. I’m still kind of struggling with the staff really. I feel that the other big thing is the racism there. And being from an ethnic minority you feel it worse. And then you see the racism on the patient’s side and they’d say, ‘No, there isn’t really’. They try to deny it.”
To clarify, I asked if the staff were racist towards the patients and Michael replied,
“You could see that and then you would say if they were doing those things to you as well. They deny that they’re doing it to the patients but when you’re feeling it, you’re experiencing it you say, ‘How come’. Once I had a word with my assessor and he said to me, ‘Well anywhere you work you’ll experience racism’. And my answer to him, ‘I don’t call it racism. I call it ‘people ignorant’. I said, ‘That’s ignorance because in this world we now live in, everybody is a human being; everybody’s important.”
3.7.27 Absence of preceptorship
Finally, Michael returned to the induction routine he had referred to above saying,
“And the preceptorship part is not there at all. Preceptorship should be telling us the clinical side; your competencies. We’re told nothing about that.”
3.7.28 Poor retention because of poor support
Tony spoke of how little supervision he had had but did not blame the senior staff on the ward. He commented,
“My personal feeling at the moment is that there are quite a lot of newly qualified nurses that come into this unit that aren’t given support. At the moment it’s quite difficult because, you have Ds and Es, and the F grades are all doing bed management and the G grades, the ward managers, are all off on meetings. So the actual day to day running is, by the nature of the grading system, by the less experienced people. And even when F grades are there, certainly in my experience, almost from the word go, I was the nurse in charge and I’d not long qualified. Within a week or ten days of being here, I had to deal with seclusion situations and with many things. A big freak out is to have grades, people with more experience that are there to be able to work things through with people and they don’t. Certainly in the time that I’ve been here there have been people that have left that started at the same time as me because they don’t feel supported.”
Tony’s comment about people leaving because of not feeling supported, again highlights a characteristic of hard to staff areas and also highlights the potential benefits of a work based learning rotation scheme and of internship.
3.7.29 F grades’ supervising thirteen people each
He continued,
“I think it’s around support and I think because of the pace of it all the things that should be in place such as supervision are not there. And when things occur; any particular kind of incident about things like property briefings, like all that kind of structure, although there is a policy to say that this should be happening, the reality is that what is actually expected of the G grades and the F grades actually does not happen. You know, if you’ve got F grades that are supposed to be doing supervision for thirteen people, realistically speaking how can that possibly be carried out between, Es and D’s and A grades? It’s so stupid! I mean, they’re also expected to have their own patients and to do bed management. You know, I think that’s unrealistic and if you’re expecting people who are supposed to be supporting the team to do that much, then everybody, kind of, flounders. And I view it in regards to conditions and support and actually realistic expectations of what people should be doing rather than… to me, quite a lot of it is just a token gesture.”
3.7.30 Repelling rather than retaining forces
I asked Tony if he meant this to refer to management off of the ward or management on the ward and he responded,
“Off the ward. My experience, certainly on the ward that I worked on before, was that management on the ward were very supportive but, obviously they have expectations that are made of them and they are asked to implement things and there just seemed to be no real understanding of how much time there is. I don’t know! I mean, that’s just my feeling and my experience. But then I don’t know how much people are saying here, what realistic pictures of what’s happening on the ward is being given to management. I don’t know about that but my feelings in regards to whether I would want to stay here, and whether I feel supported; those feelings are the reasons that I am beginning to feel that I want to go.”
Tony’s responses to my questions about ‘which management’ provide some evidence in support of arguments for greater resources and better management which could, in turn, lead to a good internship programme for novice nurses. His comments also highlight time pressures in hard to staff areas and imply an element of fear and/or ignorance.
3.7.31 Needs and expectations of supervision
I followed through by specifically asking Tony about the expectations he had had about clinical supervision. He replied,
“Well. My expectations of supervision would be that I would have the opportunity to be able to talk through incidents that had occurred that I had struggled with or found difficult from a clinical and emotional point of view. To be able to work through those things so that the next time a similar situation arose I would be able to deal with it in a different way. And to explore what was positive and negative about it. And then there were development areas that I felt that I was struggling with. I think also, that as time went on that sort of transference, counter-transference, all that, kind of… because you become very emotionally involved with people on the ward and as much as you know that there should be a distance, you see people day in and day out and it’s very difficult not to develop a fondness or whatever, for people. So, it’s important to be able to have the opportunity to acknowledge that and to talk about that and to talk about people that you find intimidating. You have to mange these things and the reality was that that in the year that I was there I had supervision on three occasions and they all focused on the filing of my notes which, quite honestly, I found to be utterly useless.”
3.7.32 Desperate measures — Informal supervision
Tony continued,
“In regards to this, sort of, informal supervision structure that goes on, you know, if you go down the pub or something like people are available to talk amongst yourselves, so you do have the opportunity to be able to do that but in regards to a formal structure I think it’s been pretty poor.”
3.7.33 Emotional labour
As with others, Tony acknowledged the source of the problem saying,
“But then again it is down to pressure.”
However, he added,
“But I think it’s bad because you do end up, carrying things that, in the right sort of environment, you could quite easily be letting go of. But it’s because you’re not having that opportunity to talk through things more… not knowing sometimes. I mean, I don’t mind talking so I will actually approach people and say, ‘Look, this happened and this is how I dealt with it’. Not, ‘Was that right or wrong?’ but, ‘I need some feed back so that I know what works and what doesn’t’. Or, ‘I have a suspicion’. Sometimes I feel I know what worked or didn’t work but I just need to be able to have somebody to be able to tease that out a little bit or just give it a little shake up and make me think a bit in a different way. I need that and I will actually approach people to do that. But that’s not always ideal because you know you’re catching on people’s time and stuff. People have always been quite willing to do that but it would have been better if there had been a space structured to do that, definitely. So my experience has not been… when I was on the ward, not good.”
3.7.34 Further external supervision
This painted a very depressing picture but thankfully, Tony added,
“But then in the time that I’ve been here in (place omitted) I’ve had supervision with my manager and we have an external supervisor that comes in that actually quite… that is very different and that is something that I’m quite positive and feel that I do want to take advantage of, very much so.”
3.7.35 Feeling the stress of the post
Asked about mentoring Tony replied,
“Again in the same kind of style of it being quite informal. And I think that when people are being very supportive they are being very supportive and when they’re not it just feels like there’s a great big hole. And I suppose as things become more stressful you might feel that you’re not being supported because of the nature of how you are feeling.”
3.7.36 Unclear about forms of support and what to ask for
Clive also demonstrated the lack of a clear understanding of the different forms of support. He commented,
“As far as supervision is concerned, anything that I have wanted to discuss, that has been good. I have been able to express any views or speak about any problems.”
I asked if he had had one supervisor, someone who was allocated to him and his reply was,
“In acute I had a mentor who was a friend for me.”
Probing further I asked,
“And did you get clinical supervision there”? to which Clive replied, “Yes.”
Trying again, I questioned,
“But you haven’t had that here?”
Clive answered,
“Yes, as far as having someone as a mentor is concerned. It is just general, I get it from everyone.”
I asked if that had been as good as he would have liked it to be and he replied,
“If I feel that there is anything that I want to discuss I am free to go and discuss it.”
Finally, in answer to the question,
“Is that as good as or better than having an actual mentor”?, he said, “I would prefer to have a mentor”.
3.7.37 Lovely to get supervision in a hard to staff service
Caroline said,
“Supervision, Yes it’s ok you know. I’m on a busy ward but it’s alright, it’s alright.” However, she added, “I think in reality, on your placement because you’re a staff nurse you are expected to do the job of a staff nurse. Now as a student… I mean, I know you are a student because you come on a placement but this is a grade of a staff nurse so you’re expected to carry out the duties of a staff nurse anyway. If you want some supervision… I don’t have a mentor or anything, you know, but if you feel you need to talk about something; if you think, ‘This is too much’, you know, you can talk to someone.”
In Caroline’s comments there is a sense that whatever you get, if you get something at all, you are lucky. She does speak about support but it is clearly ad hoc in nature. The types of support that is, or should be, available to the rotation scheme nurses need to be clarified and the sources identified for everyone.
3.7.38 Reflection and supervised practice
A final comment that applies to all the quotes related to this topic, is that there does not seem to be much awareness of the connection between supervision and the reflective practice facilitated by the nature of the work based degree course they are undertaking.
3.8 Things gained from the scheme other than a qualification
One of the themes offered to the participants was ‘things gained from the scheme other than a qualification’. Only seven people responded to the theme but what they had to say provided some of the most insightful and illuminating quotes from the study. The comments are given below.
3.8.1 ‘Lots of things’
Sarah said,
“What I’ve gained? I’ve gained considerable experience, particularly working with the variety of patients that we have. I think I’ve gained from that in the sense that I know how to communicate better with people with personality disorders. I know how to say no in different ways without actually saying, ‘no’, and I’ve learned to look at various traits more but then, that’s experience too.”
Sarah’s comments are an indication of the way in which the work based learning approach used in the educational component of the scheme encourages reflection and how the experience gained from rotating consolidates that reflection.
3.8.2 Rich CV and marketable — employability
Robert remarked,
“In the sense that what really motivates me… this opportunity of going through three different settings of mental health and after you’ve finished on this rotation and you want to apply for any job, you really want to go for any other job elsewhere, at least you have a rich CV and you are marketable. At least this educational background is there, likewise the experience that cuts across practice.”
3.8.3 ‘Learned a lot’
Holly said,
“Well, I think it’s good to be going to different areas and I’ve actually been lucky in that I’ve been to places I wanted to go. I started off on an acute ward and that was where I wanted to start off with really because they’re very, busy and fast places and you need to use a lot of different skills and have a lot of information about the mental health act and those kind of issues. So, that’s where I wanted to start off to get that experience.”
3.8.4 Growing up with the course
John made a number of illuminating comments providing evidence for the many benefits the scheme can provide. He said,
“You’re getting the experience of different areas that you’re benefiting from. Also, it’s nice to move around because you can get fed up in an area but you know it’s only x amount of months before you have to go on to the next one. It makes you feel more settled within yourself that you’re going somewhere else. And each placement has got better because of the nature of the work and the type of people that I’m working with; the staff as well as the clients. I have really enjoyed it. And another thing is you grow up. You know, because of the changing experiences. There are people who don’t like change but for me, I love change because it’s good to know what other people are facing in their working life, in their area because, you can’t, from one side, judge other people, as such.”
3.8.5 Going for my master’s
John continued,
“I’ve gained a broader experience really and you don’t stay stagnant on just one side of your training as well. You could move, you could have a choice where you want to go, which side. You could go into research with these things. I’ve decided now I could go for my masters. I could go for my masters. In the first place when I was finishing my training I didn’t have all these ideas.”
This last remark led me to ask John what his initial expectations of the scheme had been, if any. He replied,
“I didn’t have any really. Well, the thing is, for me, I’m open-minded. I’ve always kept an open mind and I said, ‘I’ll see how much it gets me. And I can see it’s giving me a lot really for what I’m doing because I’m working on a normal salary and I’m studying at the same time and the course is paid for which is another nice thing that’s happened for me because I didn’t have to think of putting money aside. Not only the question of money; it would be the time as well for me to manage between work and study. Now I can just work. I don’t have to think about overtime to pay for that extra course. If I had been doing it on my own I would have been doing overtime so my time for studies would be very limited. I can balance my studies and my working time as well.”
3.8.6 I would recommend it
John added,
“It’s attractive. I would recommend it to people. It’s very interesting, really. If you think of it, you’ve done those three years training where it is almost kind of the same but you’re getting a bursary there and this one, where you’re working for the Trust and you’re doing the scheme, which is lovely.”
3.8.7 Paid course
Michael had commented that if he had been paying for himself and just doing agency work he would not have been able to undertake a work based learning degree such as the one for the rotation scheme nurses because it has to be focused on where you are working. I asked him to compare a work-based learning degree and ordinary studying in that respect. He replied,
“Well, ordinary study would be like… you’re not attached to a place are you. You wouldn’t care. It would be like, ‘Oh, if I’m going to this place tonight I don’t care what will happen there really. I’m just going for my money’. Here you’re not just doing it for your money. Though you’re working, you’re earning your living at the same time you are being responsible to your work. You are following your guidance as well. What you’re learning you’re putting into practice as well and so I have gained that extra experience.”
3.8.8 Useful to clients
Clive provided excellent evidence of the usefulness of the scheme for patients/clients. He argued,
“I’ve gained some skills such as using assessment tools and especially listening skills in different kinds of settings. For example, in acute I found it quite challenging. You might meet some aggressive behaviour in that setting so there are some skills that you need to utilise or develop. As you move around, you don’t expect that aggressive behaviour. There will probably be different skills needed with the elderly who are presenting different symptoms. So, you develop different skills.”
3.8.9 Learning from peers in other placements
Tony said,
3.9 — What the Trust can gain from the scheme“I think that having the opportunity to go away and discuss and find out what’s happening in other places of work and learn about other people’s experiences; that and ideas and from being focused into particular areas; having a greater knowledge, say, of assessment, or CPA means you can, hopefully, function as a team member and as a primary nurse, as a nurse on the ward, in a more effective and confident way and in a way that what you’re doing is supported.”