Section Three — Findings and Discussion for the Experienced Nurse Rotation Scheme Study

3.1 Introduction

As previously mentioned (1.1), the reasons for addressing many of the topics that were selected was to elicit data that could help in the search for common or individual factors that might influence the eventual level of success of the Experienced Nurse scheme in general or the success of a particular individual in that scheme. This will not be referred to again in the presentation of the findings but where there were other reasons they will be explained.

In this type of research, it is important that the voices of the participants are heard as well as the voice of the researcher (Lather 1991) so, here, practitioners’ comments will be used to illustrate and validate the findings. Some voices will be heard more than others. There are two reasons for this. First, some speakers sum up succinctly what others are taking longer to say. Second, some quotes could not be used because the speaker could be clearly recognised. However, where a useful quote is available but would be likely to identify the speaker the words are paraphrased to uphold confidentiality. Similarly, there are places where just one or two words would reveal the speakers identity so these are replaced with four dots. Three dots are use where, for the sake of brevity, words that do not contribute to the meaning of the quote have been omitted.

3.1.1 Background

Each practitioner was asked to talk about his or her background and present work. This was done mainly to create a context for the rest of the data but there were some interesting findings.

Although not specifically asked about their previous education, each practitioner referred to it and it transpired that three members of the group had started but not completed a degree course prior to coming into nursing; another had started but not completed a health related degree course after becoming a nurse and one had recently gained a BA in a health related subject. The other five, all of whom had trained prior to Project 2000, had completed a number of courses, as had the other members of the group. However, the courses were all at level 1 or level 2 (certificate or diploma level) which tended to devalue them in the practitioners’ eyes because although they required a substantial amount of work they led to only basic qualifications i.e. they did not accrue points towards higher qualifications (a demotivating factor in staff retention).

Given that this is a Work-Based Learning degree (‘bespoke’ and intended to change something in the ‘real world’) and thus quite different in nature to traditional degree courses (‘ready to wear’ and not specifically applied to change in the ‘real world’), it will be interesting to discover from later interviews with this cohort of practitioners the extent to which previous education played a part in individual success.

This background information demonstrated that all the practitioners shared a common enthusiasm for nursing; for learning; for enjoying a challenge; and for being eager to put into practice something they had learned. Indeed, all but two already knew exactly what they would like to do for their job rotation and project although they were not entirely confident that they would be given the opportunity and/or the funding to do so. We will return to this topic in 3.1.9

3.1.2 Why the practitioners decided to join the scheme

When the present scheme was first advertised there were a few teething problems in targeting potential practitioners (see 4.3). It was hoped that asking the practitioners about their reasons for joining the scheme would provide information that would help in the identification of future possible cohorts.

As was expected, all the practitioners had felt the need to gain a qualification at first degree or Masters level and they all referred to problems that the lack of such a qualification made to the development of their careers. However, there were different perceptions of why the need was there. Referring to job interviews, Richard said,

“But the interviewers will always say, ‘But you haven’t got an academic qualification’, and that’s absolutely right. And so, I need it for that reason. I don’t think I need it for my confidence because I’m very clear, I don’t apply for jobs that are beyond my ability.”

Judith’s argument was somewhat different. She commented that,

“There is that part of me that I feel that I need to have a piece of paper to prove that I’m actually worthy of what I’m doing. It’s a little bit like learning to drive. I didn’t believe that I could actually drive safely on the road until I’d actually passed my test.”

The views of the other practitioners reflected one or other of these arguments but some also reflected the view of Tania, who had not finished her first degree. Her comment was similar to Richard’s but she added,

“I made a decision that for me to get where I wanted to go I needed to get my degree. Because I didn’t complete it and so my ultimate aim was to get my degree so then I could do research at an academic level, you know, where I wanted.”

A further argument about the advantages of having a degree was mentioned by several of the practitioners. Chris put this rather well when he said that you have to have a degree, preferably a higher degree, so that other people will listen to you. No matter how extensive your experience and how good your ideas, particularly on policy, you are ignored, particularly by doctors.

As might be expected, the above comments indicate a mixture of intrinsic and extrinsic motivation. It is generally accepted that individuals are more likely to succeed in any endeavour if they are intrinsically motivated but, with regards to the qualification, the situation here appears to be more complex. A small minority do appear to have entered the scheme mainly to obtain a master’s degree but the rest, whilst valuing the qualification, seemed to be intrinsically motivated by having the opportunity to bring about change by rotating their job and carrying out and researching a project of their choice to fit them for their new job and their career plan.

3.1.3 Things Other than a qualification that could be gained from the scheme

The practitioners were also asked to talk about what they hoped to gain from the scheme other than the actual qualification. It was clear from their answers that they had great hopes that a Work-Based Learning degree would develop and hone their skills far more than would a traditional degree. Tania put this well.

“I think its more relevant. You know, the advantage is relevance to an area of work. One would think it would make you a better practitioner because you’re doing specifically in you’re area of work instead of something that maybe is a bit more off the wall and academic. Its totally related to what you’re doing. That’s got to be an advantage for all, I think. You know, for the patients.”

The sentiments suggested in this quote are reflected in different ways in many other arguments made. Many were about self awareness, personal growth and the development of knowledge and of skills. For example, Kevin said,

“I hope to get out of it a sort of self-awareness. I want to understand exactly what I’m good at; what I need to improve on and what I can use these skills to do, other than what I’m doing just now. So, it’s a self-awareness thing.”

Chris said,

“For me, personal growth and it will give me, also, the academic underpinning to do my work more effectively.”

In relation to knowledge and skills Marion said,

“I hope I would be more able to help the client. It will give you some sort of knowledge reinforcing the skills and knowledge that I already have.”

The findings here would appear to indicate that this group find professional development and personal growth important both for themselves and for their clients. If they can go on and inspire others, within and across boundaries, to do the same, then they will contribute to the possibility that the government policies discussed in 1.3 will eventually succeed.

3.1.4 Job Rotation

As was explained in the introduction, the scheme requires that the practitioners make one job rotation (but see 4.5) and that their projects should be carried out when they are on rotation (but see 4.5) Although the scheme is flexible it was decided initially that the rotation should take place in May 2002. This would allow for the first two modules of the course to be completed whilst allowing time for the projects to be fairly well developed and well researched.

Once again the practitioners were somewhat divided in their views. Some, like Tania and Colin, were eager to start. Tania said,

“I want to see if I have got the skills to do it by actually doing it and then thinking, ‘Well yeah, I’m good at it or I’m bad at it but I know why I’m good or bad at it’. So, rather than just, sort of, thinking, ‘Well, there’s a place there I can probably do but I don’t know if I could so I won’t bother doing it’, I want to actually challenge myself a bit more. So, I’m going to challenge my ability and, hopefully find that I’m good at lots of things that haven’t actually tried before.”

Colin’s sentiments were similar. He said,

“It will give me the experience of working in another area and, hopefully, an area pretty much of my choosing which is quite liberating, that I can think about where I want to take my career and what job will help me on the next step towards that. So its an opportunity to experience something other than .... because they encourage you to do something completely different in your rotation.”

Ruth argued,

“I think that with rotation going on you’ll have people of high grades of experience looking into areas and bringing that experience with them. So that if I go into .... I can bring my experience of .... with me and that would have effects on ways groups are run. It depends on how much latitude I’m going to be allowed by the staff in .... .”

There were others who were concerned about the notion of leaving their present job and felt that they should be allowed to stay and develop a new project. Judith’s argument well represents the concerns of this group,

“I really feel uncomfortable about the idea of leaving a service that’s … to go off and do something completely different. I feel like I’m going to be letting a lot of people and things down.”

It became clear that although the practitioner’s were eager to bring about change by developing and running a project, a few were not all were happy about rotating into a different area because they felt committed to their present area of employment. Those concerned displayed a degree of anxiety about rotation and so, in keeping with an Action Research study, their concerns were fed back to the organisers of the scheme with the suggestion that the rotation could be more flexible (see 4.5).

3.1.5 Recognition and Accreditation of Learning (RAL)

This was also explained in the introduction. Unlike the rotation this was very much the present for the practitioners since they were going through the RAL process when they were interviewed. The response to RAL was both positive and negative. There were two practitioners who were somewhat unenthusiastic about the process and saw it as something to just get through but most enjoyed the experience of reflection and their confidence was boosted by the realisation that they had learned so much during their careers. Colin put this well. He said,

“What I didn’t know, prior to starting on the course, is how much it would make me look at myself and what’s led me to this stage professionally and personally and how there’s been a, kind of, theme and pattern to my own development and I find it very, very self indulgent and enlightening to really think about myself rather than just thinking about clients and practitioners and others. Reading through the bumph about the course I had no idea it would be so introspective and reflective. I thought it would be about filling gaps in the services and that I would be providing something to the Trust, which is part of it, but I didn’t realise how beneficial I’d find the whole process.”

Colin expanded on this but the first part would intrude on confidentiality so suffice it to say that he had had other university training and worked in an even different area before coming to nursing. He then said,

“…and nursing and it has this flow to it, like, my life development, I didn’t really notice before. I think it is interesting tracking development and it also made me more accepting of what I might have viewed as mistakes in the past, for example, .... . I’ve actually transferred skills that I used then to the present day. It made me feel a lot better about myself as a person and about my life’s direction. That I’ve not made mistakes and probably struck it lucky. There’s been a progression, which felt very good.”

Judith’s experience was rather more painful. She explained,

“That was my biggest headache, to actually look at what areas of learning have I achieved and how do I know that I’m good at them and what skills have I got and where do these skills come from and how do know I’ve achieved them’? Its all come to me in the last few weeks; again its actually sitting down and writing it, but I have a better idea and an understanding and I’ve found my individual tutorial very, very useful and I also found Patrick very, very supportive and actually gives me the time of day to sit down and work it all out. But I think the use of a tape recorder would be very handy in future so I might be using that. It has been painful, it is being painful and it will be painful until I finish it. The pain has been trying to get the information out of my head.”

Given that the interviews for the research took place over a period of weeks (2.5.5) those interviewed later had gone through the reflective process and were trying to write their essays on the themes developed. They were mostly finding it extremely difficult.

Jonathan explained why he thought he was having difficulty in writing down the themes and explaining the processes of his experiential learning. He referred back to the difficulties he had writing a job application the previous year and compared it to the RAL process

“Because I had started that before, so other people had probably been doing it all along if they’d been applying already. I hadn’t actually had an interview for six years. I hadn’t gone through that and it did my head in because I didn’t know what I’d done… what was relevant; what was irrelevant; what was a learning process; what was an achievement and all this.”

However, from the later interviews it did appear that almost everyone seemed to be having the same problem (and see 4.9). Richard was the last to be interviewed and, after talking abut his own experience with RAL he went on to discuss what he thought was happening with the group as a whole. It should be remembered that these are his own views and that he may not have been, by this point, in contact with all members of the group.

“I’ve just watched other members in the group, their anxiety rising as time has gone on. And I think the book, you know, the green book that they have for RAL, is just totally, totally unhelpful. And its contradictory throughout and I can see some of the people in the group are really panicking because in one part of the book it says do this and the next part of the book it says do something else.”

He added,

“In some ways I think all they want is just for somebody to sit down and show them how to write it out. That’s all, one example of it rather than the three that are in the book that are just not applicable to mental health. And I think people find it very difficult to regurgitate that and come up with different information. And really, in some ways, they’re asking you very, very simply just to demonstrate your learning. That’s all, there’s nothing complicated in it at all and I think people are getting lost in that; really lost. Its an absolute thought block. I think it’s a thought block or people have got very, very anxious and can’t move beyond that.”

And later,

“I think that bit of the course needs a bit more direction and I I don’t think anyone has picked that up and I don’t think .... picked that up. But certainly in the small groups its very, very evident.”

Finally Richard said,

“They’re looking forward to the outcome. They’re very positive about the outcome and they’re going to come out with the degree or a Masters. They’re all really positive and they know they’re going to get there. Its doing it is a problem and they’re getting really, really anxious. And I think everybody gets anxious about it. There isn’t any direction in how to write it and if you look at everybody on the course, they haven’t got an academic background because they’ve diverted it for whatever reason. And that’s the bit they’re frightened about it is actually putting pen to paper. And also putting pen to paper about what they’ve done because the majority of people don’t talk about what they’ve done. They never ever talk about what they’ve done and they’re all really, really very clever people in what they’ve done but they don’t talk about it. I can honestly say I haven’t had a conversation with any of them about what they’ve done.”

One or two people pondered on what they hoped to gain from doing RAL. Colin suggested that,

“From a selfish point of view, I feel I can go forwards now into any job and either take my portfolio or what I’ve learned from it and really, sort of, sell myself. And its made me feel much more confident about how I’m going to come across at interviews.”

As the interviews progressed the interviewer became very aware of the problems being experienced and the levels of anxiety that had arisen. Once again those who were organising the scheme were informed. It seems clear that if the scheme is to be repeated this is one area that will need to be looked at in advance. The next interviews with the present cohort should help to identify what needs to be done.

However, a word of caution is also needed. RAL is a tremendously complicated and difficult process that, for some people may be massively enlightening and helpful but for others may be telling them what they already know and/or may not make any difference to their ability to influence the system. It may not be very useful for the latter group and it may need to happen differently for different people since reflection probably means different things to different people.

3.1.6 What the scheme will consist of

There are three sets of stakeholders involved in this scheme, the practitioners, the university and the Trusts. It seemed important that they should all have similar expectations of the scheme if it was to be a success. Consequently, we asked the members of the group, the lecturers designing the scheme and the Senior Nurse Advisor for research in the Trust to talk about what the scheme was going to be like in order to see if their expectations were in line with each other.

Quite clearly there was agreement about the first three modules namely the RAL, Programme Planning and Research modules. Beyond that the practitioners tended to be less certain about what might happen. They were aware that the rest of the scheme would relate, at an individual level, to the projects they would design, run and research. However, they were less clear as to how this would come about (see 4.6).

Comment made by Chris and Tania illuminate this. Chris said,

“I’m rather disappointed but I’m not clear. I thought it was a workshop learning area. I thought we were going to have workshops as practitioners meeting together and sharing experiences. I would have liked that because you learn from workshop situations and seminars as well because you’ve not only brought your experience, people bring other experiences. So I think it’s an individual learning process but I don’t know what the process is yet.”

Tania was equally puzzled by the process arguing,

“I think we will do the agreement and our learning will be doing a piece of work or two pieces of work, however many pieces of work is identified. And probably doing a lot of that on your own with something like e-mail support from Alan and that. Proof reading and stuff. With us as a group meeting. But I can’t see how it will work, us meeting for academic support, meeting, you know, personal support, social support, whatever.”

Kevin was beginning to feel that he did know what was going to happen and it wasn’t how he felt he had been led to believe it would be. However, he did display a ray of hope. He said,

“What I’m wanting it to be is a collection of Experienced Nurses who are, maybe, in a bit of a rut, who have got lots of experience but are not channelling it properly — its not being channelled - who can argue with each other and debate and have a discourse about nursing as it stands. An action learning set and problem solving; championing one another; doing presentations and, like, being critiqued by each other. Therefore, becoming peers but senior peers and so, I guess, we start off like the baby, deskilled and having to write essays and write sentences again and look at syntax, ‘What’s that? You know, do things like that to start off again. But I see it as a collective experience where, hopefully, in two years time we come out at the end of the tunnel and have become stronger as a group and as individuals.

“There’s been meetings planned out for the group. For the group to come together to do this exercise. They want the group to… there’s a lot of television schemes about survival and all that where they say, ‘OK, this group has got to discuss politics and nursing and discuss it for an hour and there’s no right or wrong answers but everyone has a debate about it, a discussion. But they have time to do it, whereas here, I don’t have that sense about it. I have the sense of it being traditional; that you’ve got to jump through the hoops and do the same as we have done on traditional courses. Its not what I thought would happen. I thought it would be more us directing the course. Although, we probably will direct it as we get on with what we are doing. At this stage I don’t understand what it is about.”

It was, perhaps, this uncertainty that led a few practitioners to express a desire for more structure to the scheme. Judith, for example said.

“I think if there was a timetable… I think there needs to be some slight bit of structure. I’m not saying we need lots of structure. I think it needs to have some sort of boundary that we can all push away at when we’ve had enough. I get from the feeling of the group, we’re all very strong people and we’ve got our own views on life and how we work and operate. But, for a course, there does need to be some sort of structure, guidelines, there. A beginning and an end.”

This was another area of concern that was fed back to the organisers of the scheme. It is important that any future cohorts should be very clear about how the scheme is to run if some of the disappointment that is apparent here is to be avoided. Essentially, this is a distance learning programme with a number of seminars and tutorials built in. It is not the responsibility of the university to go further than that. Ideally, those practitioners who would like to work together should organise this themselves and 3.1.10 below show that efforts have been made in this direction. This will be discussed further in 3.1.10.

3.1.7 What the Trusts can gain from the scheme

The main inspiration for this scheme is the retention of experienced staff but it seems probable that there will be other advantages. It is possible that in the future these could play an important role in deciding if the scheme should continue. The practitioners were, therefore, asked to consider what the Trust might gain from the course being run on this and future occasions. It should be borne in mind that these are only the possibilities muted by some of those interviewed. Later interviews, and perhaps further research, will be needed to demonstrate whether or not such advantages have materialised and if not, why not.

Naturally enough some spoke about retention. Colin’s view was typical of these. He said,

“I’m more likely to remain with this Trust rather to move to another one because, you know, it reaffirms my belief in it valuing nurse education and professional development. I think that by helping more experienced nurses to have the luxury of mapping their career development out more and looking at what resources are needed in order to do that, it just encourages people to, I think, advance as well within the Trust, take on more responsibility and really feel more confident in themselves. By rotating as well, I will have experienced another part of the Trust. And so rather than looking for jobs elsewhere I’d, hopefully, have a positive experience from the rotation and, you know, I think it helps with staff retention.”

Tania suggested a very practical and potentially important advantage. She said,

“If you’ve got ten people on the course, there are ten people doing specific academic work around the work area and they’re going to gain a lot of evidence based, in depth work in one particular area. But there’ll be ten particular areas because we’ve got ten quite experienced people.”

Ruth, after talking about more and less dynamic units suggested that,

“And one of the… one of the results of the scheme would be that staff would mingle… would mix so that the ones from the dynamic unit could go into the other unit and wake it up a bit and staff from that unit could come to the dynamic unit and get themselves woken up a bit. Because it is terrible to have a job in which you’re just marking time. Just dying on your feet.”

Jane argued that,

“And there also could be going to a different Trust. They come over here so its Trust cross-fertilisation, sharing of knowledge, sharing of experience, sharing of resources. So, then there won’t be all these upsets and hating other Trusts.”

Jane also suggested that,

“The Trust will have a collective of knowledge; shared knowledge; knowledge base increases; research in locality — local issues, local communities rather than just, you know, a huge organisation that doesn’t see what’s happening. Because each area is quite different from the other whereas if you’ve got people doing research projects in those areas they’ll inform the regular picture. And that’s how the Trust will benefit because the senior management level needs to look globally and politically at resources.”

The responses here were all very positive. This is another area in which the hopes and beliefs of the practitioners are in line with government policy and, hopefully in line with the policy of the Trusts within which they work.

In relation to what Jane argued above, it should be noted that a main reason why funding was gained in this instance was because it was for a joint Trust project which provided the potential for cross-organisational rotation.

3.1.8 What colleagues and patients can gain from the scheme

Just as gains by the Trust may arise from the scheme so might gains for colleagues and patients. The practitioners were asked for their views on the possibilities here.

Jonathan suggested that.

“In the long run I’ll be hoping is that they’d be getting an opportunity to go on this thing themselves and maybe that some people might see me as a sort of a role model, or maybe not. It may be that, ‘Oh, .... has gone and done that’, or maybe, ‘That sounds like a good thing to do’.”

He also made two other points. The first was that,

“If, at the end of it I’ve learned things and I’ve got some skills that are from the experience of doing that it might make it easier for me to do something else. So, there’s a thing about my finding it a bit easier to take on another project and lead that.”

The second was,

“The other thing would be, be setting up a service that other people can feed into with their patients. So that what you actually do is have a direct impact on patient care, which will actually have an impact then on workers because they’ll, hopefully, get to see things a bit better. Also, the other thing is going to be that’s, I hope, going to be built into this is the opportunity for people to learn because one of the things we’ll be doing is .... .”

Kevin’s and Tania’s arguments are two good examples of what all the group had to say. Kevin said,

“Well, they’d get a happier me. If I feel happy in my job; I feel there’s a direction in my job and I feel there’s a challenge then I’ll will feel supportive towards my other colleagues. If I’m not particularly happy and start thinking… it starts going internal and I start coming inward and I start thinking, ‘Well, if I’m unhappy then why should I bother if you’re unhappy? Because I’m not going to go out of my way to get you whatever you want if I’m not getting what I want’. So, that’s a very selfish, sort of, kind of way of thinking but, you know, ultimately I think it will happen to other Trust employees on this. I think what we will get is, hopefully, a skilled practitioner; a good manger who actually can be quite self-aware and knows how to direct others. You know, manage other people because of the skill you’ve learned from being aware of yourself. And if you don’t really know what direction your career’s going, how can you hope to influence others and support them. So, I think as well as having an employee that’s good at his job you’ve got an employee who’s aware of his skills and has been able to analyse them and, hopefully, give opportunity to other people that he’s working with and other people he’s trying to support.”

While Tania said,

“They’re going to get a more motivated colleague. I think they’ll get second hand knowledge. I mean, like, you bounce things off your colleagues. If you’re doing a piece of work in the area, you ask for their opinions. You know, even just informally, you say, ’Well, what about this’. So, I think they’ll get just the knock on effect because someone’s doing some work and, you know things are changing or someone’s doing this and I think they’ll get as equally excited.”

The sentiment displayed here should also give encouragement to the Trusts and to the government.

3.1.9 Factors that could undermine the scheme

Once the scheme has been completed by this cohort of practitioners, it will be important to examine their experiences and discover if the were any factors that undermined or threatened to undermine the overall success of the scheme. It was, therefore, felt to be important to ask the practitioners if, at this point, there were factors which could possibly work against the success of the scheme.

The possibilities for rotation were of great concern for all the practitioners at this point in the scheme. They were eager to do their projects but fearful that there would be problems.

Support was mentioned by most of the group. Tania argued for help in gaining funding. She said,

“I think we’re being asked to manage it ourselves and I think I’m doing a lot of work to do that. But I will need support from the Trust. The claim will have to go through the Trust just for financial reasons because I can’t afford to just put the claim in for myself. I still want to be paid by the Trust, you know. I feel quite positive that they would be supportive as much as they could. I think the biggest thing to undermine would just the general way the NHS is run. You know, just things that are out of their control finally. You know, the fact that everything is bidded for and funded and, you know, I don’t expect them to make the job out of nothing. So, I think its those things that are going to fight it, more than them.”

Kevin, on the other hand argued for support in negotiating the placement. He said,

“Not having somewhere to go to. That’s a worry. That I don’t find anywhere that’s suitable. If I can’t find somewhere what do you do then? If you don’t get a placement, what do you do? I think a lot of the work should involve preparing yourself to put a proposal as to why you should move. I hope that that will unravel itself. I think its probably down to me, you know, the individual, to find out and to sort it out for themselves. But its really important that you get high level support and a high level of supervision. You know, to sell it to somebody because it may be the best project in the world but if you can’t sell it to anybody who’s going to take that problem for you?”

Whilst the quotes from Tania and Kevin reflect the concerns of most of the group over the need for support those of Chris and Richard reflect a general concern that implementing change could be undermined by the actions of others.

Chris argued,

“I’m just saying, like, the NHS is a bureaucracy. If you want to implement the change from one level you have to go to a different level to get ratifying approval. So you don’t have autonomy to make a change. Say if I’m managing a clinic and I want to implement some changes in the clinic for the benefit of the patient, my managers may not agree with my change. So, where do we go from there? In a bureaucratic sort of organisation its very difficult to affect changes.”

Richard’s concerns were somewhat different. He argued that people might not allowed to do the things they want to do because if they are in any way confrontational the Trust may feel threatened by them.

Ruth mentioned a number of possibilities not voiced by the others. She said,

“Managers might not want their experienced staff disappearing for a whole year, some units might not be able to accept practitioners on rotation or simply blankly refuse them. Some units will prefer to have full time staff rather than secondments.”

Jane had been talking about the need for support from management in terms of study days. She had said that she believed that, in principle, management value the scheme and see it as a good idea but, like others in the group, she clearly felt that that was not enough. She went on to say,

“That should be built into the scheme or permission given to spend half a day, or even a week, at work just to process some of the facts for your course and for that to be permissible, just given.”

Jane then went on to make a thought provoking point. She said,

“I think its difficult for management because they’ve got these senior managers who need support. So, if you take me out of the equation, you know, say I had more time to study and who’s looking after this place? So, it’s a chicken and egg situation. If I was a newly qualified nurse, a D Grade nurse, doing this course I’d find it easier because all I’d have to do is mind some case load and people wouldn’t look to me for answers and to problem solve and to trouble shoot and to be a strong manager etc., whereas they do. So there’s no let up when I come to work.”

Colin was also concerned about finding enough time to set up his project and study but he was also concerned with how other people were already reacting to changes he had made. He said,

“Well, time is one thing. At the moment I am the senior member of the team. Its about making more time for what I’ve got to do. At the moment I’m having to get people used to not giving me patients all the time. I will key work a couple but not .... because I then don’t have time to do my management duties. But we’re very short staffed. Its very busy and its sometimes difficult to say no. But I notice that is creating some difficulties in the other staff, that, you know, ‘We’ve got .... patients’. So, it’s separating that out. You know, being more clear about my role.”

This comment led the interviewer to ask if Colin’s colleagues didn’t understand about the scheme. In answer, Colin said,

“I think not. Unless I sit down and talk to people about it. It is… like you said, it’s a pilot… pilot scheme and people would have been made aware of it by this advertisement, as it were, in the post. But, yeah, I mean, it could crop up more in news letters, it could be made more available to others.”

If the first two concerns, about getting help with funding and the negotiation of the rotation, are found to have been a problem, the organisers of the scheme will need to think carefully about their role. In 1.4.1, where Work-Based Learning was discussed it was pointed out that one of the characteristics of Work-Based Learning is:

Students undertake learning projects in the workplace. Drawing on advice and support from within their educational institution and their workplace, each student identifies a challenge in his or her workplace that reflects the future needs of both the student and the organisation.

The practitioners in this segment of the Action Research study were selected for the scheme largely because of their experience (see 4.4). Consequently, it can be argued that they could be expected to carry out their own negotiations but the characteristic described above does suggest that there should be help from the workplace. A balance may need to be drawn between the two arguments.

It is to be hoped that the valid concerns Chris has about the bureaucratic structures of the NHS can be shown to be overcome in this project where the concern is with decentralisation and modernisation Ironically, at the same time that the practitioners in the study may sometimes feel that they’re infantilised by their part of the organisation saying, ‘You can do this and you can’t do that’, this project is offering the opportunity to bring their influence to bear and this is supported by their managers (but see 5.2).

In relation to Ruth’s concerns about what managers might want, it should be noted that all the managers concerned had signed up to the scheme early on (but see 5.2)

Colin says colleagues didn’t understand scheme. Unfortunately, since this pilot is to develop a model for the scheme colleagues could not fully understand it. It is constantly evolving as is demonstrated in Section 4.

‘Factors which could undermine the scheme’, was a specific topic but the concerns that the actions of others could undermine the success of the scheme permeated most other topic areas. The practitioners were hopeful but wary. Aware that the NHS is still an hierarchical organisation and aware that there are those who resist change and prefer the status quo they were understandably concerned that they might have difficulty putting their plans into action. This particular group do seem to have embraced many parts of the government’s plans but those plans were ‘top down’ and there are others in the NHS who might resist them. Perhaps Colin’s suggestion that others in the Trust should be more informed about the scheme would help here or perhaps more individuals need to be helped to identify themselves as stakeholders in the Action Research programme as a whole (see 5.2).

Finally, the concern about time should be considered. There are a fixed number of study days that are allowed to any members of staff but it may be that those taking Work-Based Learning degrees are in a somewhat different position to those doing traditional courses since they are doing projects for NHS. Although its Work-Based Learning the time should be spent improving work and the outcomes for the client. The actual amount of time required for studying is, in some respects, relatively small since a lot of the product is the change made in the workplace or the consideration about the workplace but for any kind of academic study there is a need to consult the literature, to spend time pondering what that literature means, and still find time to write things up. The conundrum for the Work-Based Learning scheme is where to find this time and how to validate and legitimise it.

3.1.10 Working as a group

Several members of the group talked at some length about working with others in the scheme. Everyone mentioned the rest of the group in one way or another but in some cases this seemed to be just in passing. Reading the transcripts it does appear that only a few saw the group as important. It is not possible to be certain because, since the scheme is, essentially, distance learning, it was not introduced as a topic but raised by group members themselves. It is interesting to note that the people who spoke at length on this topic tended to be those who were more critical of what they felt the scheme was going to be like.

Looking back to the planning of the scheme, Kevin argued,

“We felt peer support would be as important as any other aspect of the scheme. And it actually is; we’re finding a lot of common goals. Just things like not being sure where you’re at; maybe not having good supervision. Having a group to talk to and run things by and being able to express your opinions but not in an oppressive, sort of, kind of environment. Being able to understand that there’s shared likes. And so, having that is important. Its one of the things about it.”

Judith appeared to reluctantly accept that whilst there might be a few group members who would come together to support each other this would not apply to the whole group. She said,

“Well, to be honest, two I actually had a good relationship with because we’d actually met up in .... so we built up better relationships, got to know each other and were supportive at that time. Unfortunately, with everyone’s work patterns we’ve all not kept in contact. But that relationship is there which, if we needed to, we’ve got contact numbers. But we haven’t, sort of, jelled, come together as a group, no.”

In response to question of whether group support is important Judith replied,

“If it is our scheme, which I get the feeling that’s what it should be, it should be ours and we should be making it something of our own, we should own it. We are mature, all of us, and we’ve all come from, I think, the school of training where we have been guided, we’ve come from the classroom setting where its talk and chalk and that’s not a role… I don’t think its wrong because I think we’re all adult enough to know that we facilitate ourselves in our own learning and we’re all able to do that. But this is new.”

Discussing support from the group, Tania argued,

“I think there’s a few people on the edge that have got their own various strict agenda and are achieving that but part of that isn’t being within the group. The group’s just a tool for them to get their agenda. But I think there’s another group within the group who are there, I mean, more for the philosophy around the group, you know, who do attend the meetings and support each other and learn from it and talk to each other.”

In 3.1.6 where the topic was ‘What the scheme will consist of’ it was argued that ideally, those practitioners who would like to work together should organise this themselves and some of the comments made here indicate that efforts have been made in this direction. However, there is a tension between the notion of the group who meet formally at the university and naturally occurring ‘self help’ groups which are clearly valued by some. What Judith has to say about difficulties created by different work patterns might be considered by other stakeholders in the Action Research programme to see if help can be given in facilitating such informal groups.

Section 4 will, hopefully, supply some of the answers to questions raised in this section since it considers the development of the Action Research Study in general and, in particular, the way in which that development has influenced the shape and form of the Experienced Nurse Rotation Scheme.