Section Three — Findings and Discussion (Continued)
3.5 How reflective practice has been used
Perhaps the most interesting aspect of the reflective practice aspect of the scheme is that it has continued to play a part in the lives and work of the members of the Experienced Nurse Scheme after the scheme ended and long after Jonathan and Kevin left the scheme early.
Kevin, speaking about his job change for the rotation said,
“Actually, I didn’t have client case load for the year. I was managing staff and having a small case load and I enjoyed going back to doing nothing again. So the stuff I got from the RAL around negotiating management helped me to become a better manager and so putting that all together led to doors opening for me.”
Kevin’s story is particularly interesting because of the insights he provided into his greater awareness of his capabilities and his awareness of how empowering reflective practice had proved to be. When discussing the nature of his present job, he said,
“I had the opportunity to use a lot of the skills that I identified through the RAL and I don’t think I’d have been able to say what I was good at, to be able to get that far but that gave me the confidence to say I’m good at this that and the other and that I’ve learned this that and the other and this is what I can do and this is what I need to work on. I don’t think I’d have been able to do that before. I might have said, ‘I’m quite good at this’, but I wouldn’t have felt confident about it. So, if anything, the RAL has certainly shown that I am skilled in certain things; I have learned a lot and this is how I can show other people how I can do it, put it into action.”
3.5.1 Long term benefits for the workplace of reflective practice
I asked Kevin to give me some examples of ways in which he is now using reflection? He replied,
“What am I doing now? Part of my work is planning services and what we do is to put in tenders to obtain funds to set up new businesses. Part of my work is to write up the tenders, to design new services and look at imaginative new ways of looking at how to put my concept of services into a tender which actually goes out and is discussed at a tender interview. So my work is actually thinking about what is different about this and how can I design a service which is going to be better than the rest of the other services for which people are putting in tenders. So, it’s actually taking something and thinking about it.”
I asked,
“Can you capture, in any way, why the RAL helped you to do that?”
Kevin’s explanation provides a unique ‘selling point’ for reflective practice. He said,
“Because I’m describing how I see a vision for something new. I know about this; I know how to do this; I can describe this in an imaginative way that other people can’t. So, therefore, I’m sort of selling myself when I’m selling the service because I’m putting myself into it. I feel that’s different from what other people can do. Nobody’s like me; nobody has got these skills and attributes that I’ve got so I’ve go to influence the document that I’m writing up to say, ‘This is why it’s so good; this is why I’m good at it and this is why you’re going to get a good service because I know what I’m talking about. I would never have been able to do that before because I would have thought, ‘Well, everybody else is the same and nothing is going to be any different to what I’m doing’. But I actually believe that what I’m doing is much better and much more experienced based than what anybody else is doing. If you believe that then you feel that you can do anything. That’s an example but basically, they say, ‘Kevin, how would you design it’, and I say, this, that and the other. I’m designing new things and I’m putting myself into them and I believe that it’s right and that I can justify that and I can carry it through. It’s about self confidence; believing that what you’re doing is the right way. And I do! I’m convinced that I’ve got it right but I’m prepared to listen if I’m not going in the right direction but I’ve developed my leadership skills.”
3.5.2 Patient/client benefits
I asked Kevin for something more tangible and his response is relevant to patient/client outcomes. He said,
“Well, what I did, I’m developing a pilot service in the .... area. Part of the work is to get service users on the planning committee and the project group and the steering group as well as working with a lot of the NHS Providers that we’ve already done some work with before but not for .... services. A big part of that is actually getting the partnership working and getting the partners going. They’ve been there for a while and are quite rigid in their thinking. So it’s actually building up new relationships with them and, by doing that, and getting the partnership working from the start, it can probably open the door for lots of other work for the organisation because we’ve built a lot of bridges with the statutory agencies and with service users and so if we ever want to put in a tender for other work in that area we would have no problem in getting it. So to know that we provide a good service and to know that we will do the right things from the start, we’ve got a good chance of getting more services in different areas. We’ve done the ground work for individual services and that’s good for the clients because they get good services and it’s good for us because we get the contracts to set up the services. Hopefully the department that we’re working with have got the confidence that we have new ways of thinking that will be led by us. I think that benefits everybody.”
Given that Jonathan had left the scheme so early on I was keen to find out if his experience had been similar to Kevin’s. I asked,
“You started to reflect. Is that something that’s continued? Was it, ‘I was doing this reflection and then I left’, or ‘I was starting this process and it’s a process that’s gone on’?”
Jonathan replied,
“Yes, it has gone on. It was something that started me to recognise things but what has happened is that one of the things I had to do down here was to give myself a pat on the back because I wasn’t doing that either. I was doing other things as well down here and although I was able to start reflecting on my past experience and saying, ‘Yes, I’ve done all these things’, when I came down here I still wasn’t at the position of actually being able to reflect on the things I was actually doing at that point in time and to be saying, ‘Oh yes, you’re doing a good job’. And one of the things I had to learn then, through this process of reflection, was to recognise that I actually was doing something quite well. And what’s happening now, for example, is that I’m doing something that appears to be quite pioneering or so I’m finding out. I’m working alongside a service user, both of us in an equal partnership, doing a .... course for people. It’s a twelve week thing and it really seems to have taken off. All the service users are really keen on it; it’s got a lot of plaudits. So although it’s taken me a long time to do it, I’ve actually been able to give myself permission to say, ‘Yes it is going alright’. Really, I’ve given myself permission to say, ‘Well done Jonathan’, where I wouldn’t have done that when I first came here and I wouldn’t have done that when I first started the course. The whole period of things starting off where you start to reflect back on what you’ve done, and ultimately, if you carry it all the way through, it enables you to start to reflect on things that you are doing now.”
I gained the impression that Tania did not find the reflective process useful but the others who completed the course were also continuing to use it in their lives and work. Richard and Chris provided good examples.
3.5.3 Personal Benefits
After summing up what Richard had said about the university course and the research, I asked him,
“Where are you now?”
Richard’s response was,
“I think that’s interesting! Where am I? Possibly one of the things I’m looking at is teaching. And that’s something I wouldn’t have considered before. And that’s good; that is good. And I suppose the other thing is that I think I’m much more open to learning. Also, I’m probably less cynical.”
Richard’s comment about cynicism was peculiar to him but interesting since cynicism can be one of many pathways to burnout which in turn can lead to the making of decisions that are not in the best interest of clients and colleagues. From the descriptions they gave of how they felt prior to commencing the scheme all the experienced nurses on the scheme may well have been on pathways to burnout but the possibility has not been followed further in this study. Suffice it to say that following their experiences on the scheme negative attitudes were not on display.
I then asked,
“So, are you saying that what the scheme has done for you as a person is that it has allowed you to approach your work slightly differently?”
Richard replied,
“I think so, yes. I think it’s about me. I think the one thing it’s about is the much more objective part of who I am, standing back and seeing things from a different perspective. And some of that is going out into the big, bad world and seeing how other people live, networking and reading.”
I commented,
“So, apart from what it has done for you personally, it has given you a skill you didn’t have before; that’s the skill of always working in a positive rather than a negative way.”
Richard replied,
“Yes! It’s given me that skill or the insight to realise that I have to reframe things and knowing that I’ve got the confidence to reframe them.”
Chris said,
“I’m more conscious and aware of this. I’m using it more consciously. In all my teaching I do with .... I use reflective practice. My subjects, the .... are well resourced and well informed so there’s no point in going into a didactic way of teaching. They all prefer a discussion and reflection to learn what has worked and what has not worked and where we take this and if there is any gap where we need to find more resources. I’m talking abut literature, research or whatever. And then I bring it in. But normally I take a case scenario and we discuss it and we reflect on the treatment model it is and on the plan and then we see where we have gone wrong or where we have done well. And this is more like becoming evidence based practice, eventually, in absence of research literature or RCTs. We say, ‘Let’s see, in the absence of all this, what we are learning and weigh the evidence. I am wearing my research cap every time I do the training now. So I am getting in that mode whereas before I was a bit disorganised, now it’s more concrete and systematic. So that has given me confidence in myself. Before I might have been short of words or didn’t present well but now I am always using reflective practice. When I go to do a training session or even an informal recruitment chat, selling my project, before I would spend five or ten minutes introducing the scheme. Now I’m spending an hour which is a transformation in itself. I reflect on what happened in other .... and what the benefits have been. Some .... are very difficult to convert so I reflect on what strategy has worked for me with other .... and use that strategy with the new recruitment. I will say, ‘This .... is willing to do it’, and I give the reasons why, and say, ‘You have much the same profile so you may want to have a chat with him but I can tell you what is going right there’. There is also the philosophical argument asking, ‘What is your agenda’. I have my agenda and so we try to find a common goal. Before this didn’t happen so if I hadn’t done this degree using reflective practice I wouldn’t be thinking this way. So it has worked in practical terms.”
3.6 Work based learning and Action Learning
It is no accident that reference to Work based Learning and Action Learning (McGill, & Beaty, 1995) are referred to immediately after discussion of reflection. Both topics are being introduced even though they were mentioned by only one of the respondents.
Reference to Action Learning is included in order to draw attention to the potential for this sort of scheme to facilitate such learning. Reference to Work based Learning is included because although only Jonathan spoke about it in any detail it was implied, favourably, in the comments of the rest of the group.
As indicated in the previous paragraphs, Jonathan was the only person on the Experienced Nurse Job Rotation Scheme who mentioned these two topics in any detail although an examination of the transcripts shows that all the participants referred briefly to the topics of work based learning at various times. For that reason and to draw attention to the value of the scheme being work based what Jonathan had to say has been included.
3.6.1 Attraction of work based learning courses to staff
Speaking of his situation prior to joining the experienced nurse scheme, Jonathan said,
“I wouldn’t go off to do a course that wasn’t related to what I was doing clinically. When the work based learning came about, that was the thing that attracted me more than anything because it was allowing me to do things that were academically related to the people I was working with and actually doing something with them. That’s where I thought its appropriateness came in. I suppose, for me, just the short experience I had doing it… it wasn’t long enough an experience to change things radically and make me a different person but it was part and parcel of a number of things that happened to me at the time.”
Jonathan’s brief reference to action learning has been included because it draws attention to a previously unmentioned but possibly important aspect of the form of study that could be used to facilitate this form of job rotation scheme. It is referred to in passing but because it was not specific to the educational aspect of this scheme it will not be enlarged upon.
Jonathan remarked,
“I suppose it’s a term I wouldn’t have used until we started rejigging the course. I recognise that it was something that we were starting to do and in our own little way, if you think about it, there was Richard and Kevin and myself and maybe Jane as well, who were starting that process. If we’d all stayed there a bit longer maybe that would have been a little action learning group that we would have had.”
3.7 Value of the educators to the organisation and the rotatees and the clients
A parallel study (Nurse Rotation Scheme — Perceptions of a Sample of Cohort Four Rotation Nurses, Lucock & Coyne August 2006) of D/E grade nurses indicated that the tutor played an important part in the success of the educational aspect of that scheme. The tutor in that study was the main tutor in the present study. It was therefore thought to be important to see if the tutors played an equally important part in this study.
Not all of the experienced nurses emphasised this aspect of the scheme. Tania had not found the tutors particularly helpful and Chris explained,
“To be quite honest with you, it was self directed study so I did most of the job myself. Most of the work was done and Alan just guided me through the protocol. But I did all the work myself and he told me, “It’s your project. You have to invest your time and you have to do it’. He just guided me through the written protocols or guidelines. He would guide me to which area of the programme I needed to take forward; when the deadlines were; how I meet them and he provided me with some sort of supervision prior to my submission of the project.”
Colin did not make plain if the tutors were generally helpful because he concentrated on one aspect saying,
“What I found most useful was when my tutor came to see me here and I had about an hour of undiluted time which was really very, very useful because one of the anxiety making things about this course is that it is so self directed that you actually wonder if you’re on the right path. You need that reassurance. So, face to face individual contact, I’d say.”
I inquired,
“With them coming to you or you going to them or both?”
Colin responded,
“I think both or either.”
3.7.1 The value of individual tutors
I asked,
“Why did your supervisor come here?”
Colin responded,
“I requested it. It was just a mutual agreement. That was right towards the end of my course when I was doing the research project and I wanted to talk about what the planned project was. I felt it really helped me to define my aims.”
I asked,
“Did it make a difference, it being here?”
Colin answered,
“I think so. It felt like a more positive experience. It was really, really helpful.”
Richard’s evaluation was that his tutor had been interested in him as a person. He said,
“I’ve also had a tutor, Barbara, who has been wonderful. There were the pressures of having children and the continual pressures of work and she was actually lovely and understanding when things were difficult and she was very, very encouraging.”
I asked him if he could have managed the work without his tutor and when he responded, “No! Absolutely not”! I asked, “What was it that she gave to you?”
Richard replied,
“I’ve only contacted Barbara when I needed something and I’ve never ever contacted her about something positive; it’s always, ‘Oh, my god, I’m in trouble, help me’. And I can rest assured that Barbara would have e-mailed me back within two hours and to me that’s just what it’s all about. And she was never patronising; it was never, ‘What a bloody mess this is’. Nothing like that, even though the first drafts were always a mess. It was very much, ‘Come and let’s see what we can retrieve from this’. And I also think it was somebody who when you said to her, ‘I don’t feel confident; I don’t feel able to do this’, was very much, ‘Let’s forget about the work and let’s talk about what the problems are; what is difficult in your life and why is it you can’t do it’. And it was seeing me as a person and not as this person who she wanted to get through to get results so that the university looked good. It was, ‘No, there is something about your level of maturity that I can work with’, and I felt that. I felt that it clicked together and it was terrific. I didn’t use the library so I only went to the university to see Barbara and it was such a wonderful feeling. I’ve actually written in one of my reflective essays, ‘When you come out after seeing Barbara your thought processes are much better organised. It’s not that she said anything but you unburdened yourself and when you came out your head was much clearer and to me that was what it was all about’. It was getting rid of all the rubbish that was in your head and then being able to go away, write it up that night and I was happy then.”
Jonathan’s and Kevin’s comments very similar to each others. Jonathan said,
“I’ve always felt fondly of Alan in all of this. Part of my guilt thing I went through was I felt like I let him down a bit by not completing the course. But the thing is, there was the peer support that showed you you’re not the only person like this and that gave you some confidence to realise you could move forward; there was the reflection bit, but also there was the facilitative aspect coming from Alan.”
Jonathan spoke of a work colleague who had motivated him and added,
“Alan was somebody for whom I had respect for but in a different way. He didn’t have to be there as a great motivator and leading in clinical skills but he had to be somebody there who was more motivating in a gentle way. He was motivating but also he made you feel ok about yourself.”
Kevin said,
“Alan helped me to think straight. He helped to motivate me and he helped me to put my thoughts into action. And he helped me academically. I don’t think I would have been able to do it without the challenge he gave me. I was a bit lost and I think a lot of people in the group were, and Alan helps you to think straight. He was certainly the driving force behind a lot of it. But also, there was the support network of the group at the time which was very helpful. We were all supporting each other and that was useful”. He added, “There were a few things at the time that were really important. Alan was really important and I felt that certainly the RAL was not really that difficult if you knew what you were doing. You needed the support from Alan for that.”
The above quotes indicate that the tutors were not as generally important to the experienced nurses as they were to the nurses on the D/E Rotation Scheme (Lucock & Coyne, August 2006). This is not really surprising given the difference in experience between the two groups. However, it is clear that the tutors were important in relation to the RAL module and reflection, particularly Alan who tutored most of the experienced nurses. These findings seem to highlight the fact that, at least in relation to reflection, the scheme could fail if it did not have tutors who were particularly empathetic and oriented towards work based learning.
3.8 Value of the scheme for the participants
Although this is a pilot scheme it may be used to inform the design of future job rotation schemes and their evaluation and so it was important to find out what the participants valued about the scheme. Quotes from five participants are provided here because they reflect the different points of view voiced.
Tania was not at all happy with it. She said,
“I think it was badly organised. We were left to our own devises quite a lot, which on another side was quite good but it shouldn’t have been like that, I suppose. It was chaos most of the time.”
I asked,
“When you say ‘it’, are you referring to the whole thing?”
Tania replied,
“On the educational side we got next to zilch support and it was all self taught, self motivated. There were occasional meetings but they weren’t very productive. I had done other courses on research but I’m not too sure for the last two modules (related to research) how people who had never done a literature search or had never done any research knew what to do because they weren’t really given much guidance on any of it. They didn’t really teach things. They just gave you a book, a work based book, which again was very confusing. So, on the educational side it was just that you needed the university to get the reward. That was about it really.”
Tania added,
“The rotation side of things, maybe the expectations weren’t laid out correctly in the first place or something but people were left to their own devices to find rotations and I’m not so sure that that was clear about the things you had to do to do that.”
When I pointed out that they knew in advance that they would have to negotiate rotations Tania argued,
“But it’s about there being no back up. It’s only something you learned as you went along as you deal with the process…”
I asked Tania if she had gained anything from having to achieve things by herself and she answered,
“I don’t know because to me, it just reinforces other struggles I’ve had within the Trust to do things that I wanted to achieve. So it’s just a continuation of things. You know, you expect people to motivate themselves and to organise themselves but still, when push comes to shove, you need to offer support for people to back them up. You need some structure with it as much as anything and I think that there’s no structure.”
She added,
“I got a degree and the opportunity to do some research in the workplace but I probably would have done that anyway and I think I would still have got the same support and the same backing from my line manager whether I was doing the course or not but I don’t really know. I suppose I gained the degree and I’m not too sure what more I got out of it. I’ve gained frustration with management but I’m not too sure about anything new.”
Colin said.
“I thought overall it was very good. I benefited a lot and I think my practice benefited as well. So, personally and professionally.”
I asked,
“In what way did you benefit personally?”
Colin replied,
“I felt it gave me educational opportunities that I haven’t explored for a while.”
I asked him to explain what that meant and he replied,
“I suppose, ongoing learning and reflective practice that was different to what I was doing on a day to day basis. I was doing courses related to client interventions but this was more about personal development; looking at the skills and knowledge you’ve gained previously; how it came you were applying them presently.”
I commented,
“That was on your first module”
and Colin replied,
“Yes, absolutely and that continued over the three years. I was able to chart my development.”
I recalled that he had valued that module in the first interview and Colin said,
“Yes I did, particularly, and everything evolved from there. I suppose it was quite difficult to keep up the same level of motivation over the three years. Probably the hardest module was towards the end where the enthusiasm had waned.”
On another occasion I asked Colin if his professional development was only through the knowledge he had gained through being on the scheme or if it was wider than that? He replied,
“It’s experientially based as well. I don’t know if I’d have left the ward when I did if I hadn’t gone on this degree pathway. An integral part was that you rotated to another post so it gave you permission, more than anything. I was rather over involved in the ward and I needed a ‘get out clause’ as it were. I had an excuse to look for another job and that’s been extremely beneficial as was experiencing community work rather than ward based work.”
I suggested,
“So, you’ve gained a lot from this?”
and Colin responded,
“Oh, absolutely!”
Judith, who had not completed the scheme said,
“It’s difficult! I’ve got a new position and one of the pieces of discussion that we had in tutorial groups was, ‘Where are we looking in our career development and how could this enable us to move on to other positions?” I’ve actually got a senior position. I don’t know if this course would have provided me that opportunity. I would think not, necessarily, because the post was available to apply for and I was actually working in that environment. I’ve done so little of the work and that was really looking at consolidating all my learning and where was I currently. But what it did do was give me some focus when I was actually applying for posts, for completing application forms. Also, when it came to answering interview questions it enabled me to be more focused on how I came to this view.”
3.8.1 Achieving personal and professional goals
Chris explained,
“It was part of my personal development plan. My goal was to educate myself and improve my academic skill and I managed to achieve my goal. I also wanted to get this degree to empower myself to be more confident in my job situation. Primarily, my job is .... coordinator. I manage and coordinate the scheme with .... in .... which entails providing them with training. So, it has given me the confidence to do the training. So I feel more empowered.”
I asked.
“What was it that gave you that confidence?”
and Chris replied,
“The programme used reflective practice. It was work based learning so I used my expertise… I’m a good clinical nurse in my speciality so I used my expertise and also put it into an academic framework. There was a lack of academic understanding in my job. Critical thinking! I began thinking behind my job, which had been lacking.”
When discussing this topic with Richard, I mentioned a course that he had told me about in a previous interview. He had started the course but eventually gave up. I asked if this course was very different. Richard’s response was,
“Totally different! This was more rigorous! This was more rigorous because in the other course that I was doing, they handed you everything; they gave you hand outs. I was bored. It was very much, ‘Here are the references; go and get the books. This was very much, ‘You do it yourself’ and I needed that. And the more you read the more you want to read. And the more you read, the more you realise that there is somebody out there who has similar thoughts about what you’re thinking about. And you think, ‘Ah, it isn’t just me. Somebody else has thought that but has taken it that step forward and developed it’, and you think, ‘Well, why haven’t I done that’? So that has been good and it has also been good to see other people in the library. You meet someone and you happen to say to someone sat at a computer, ‘Well what are you doing’? and you think, ‘This is what it’s all about; this is what nurses are about. I must admit that I see nursing in a different light. I very much see nursing as task oriented and at a higher level than I’d thought.”
Here, I asked,
“As in problem solving?”
and Richard answered,
“Yes! Even though I probably knew that in my head, but sometime you get the aha experience and you can match it up with something in reality.”
I commented,
“In the initial report about the Experienced Nurse Job Rotation Scheme I wrote that, to me, the difference coming out of this was that this was like a bespoke suit as opposed to an off the peg one. To what extent do you think that that’s the direction that you’ll be going, rather than just pure academia?”
Richard replied,
“For me it is and I know there are other people like me because when I’ve spoken to other people about what I’m doing I think part of them feels that it’s terrific to be recognised for what you do, what you do in life and your work. And for that to be recognised and to be accredited is not an easy process. And it’s a process of having to be very sure that you’re confident of who you really are and once you realise who you are you have to get to like that person again, to move on. And in some way the RAL and, indeed, doing this course is about getting to know yourself again and be comfortable with yourself and then moving on into academia. In some ways RAL is about being at the end of that crossroads and realising, ‘I have to make a decision. I’m either going to go on and I’m going to further my career in terms of academia or I’m going to go on and I’m going to take a sideways move in my career’. And that’s what it’s about. And it’s about taking stock and sometimes that’s painful and sometimes that’s difficult and one of the main reasons that I didn’t want to continue a year ago and to finish off my course was that I felt, ‘This isn’t right! I need to consolidate what I’ve learned already’. And I did! I went back to the library and sat there until I was sure what I was doing. And I feel good about that because one of the things was that I couldn’t finish my project. I was looking at .... and I could have finished that really, really quickly but what I learned much more about was about theories of research and it was so good that I did that. I think that’s what it’s about; it’s about matching the theory to the practice.”
3.9 Value of the scheme for the colleagues of the experienced nurses taking part in the scheme
Whilst it is important to be aware what the experienced nurses gained from the scheme it is even more important to know if the scheme benefited their colleagues, their clients and the Trust/health service although not necessarily in that order. The next three sub sections consider the evidence for this.
3.9.1 Colleagues
The main evidence for the value for colleagues comes from Tania and Colin both of whom regarded their research findings as most important, from Judith who felt she had helped her colleagues to reflect and from Chris who felt that he was now more receptive to others than previously. The rest of the experienced nurses did comment on this aspect of the scheme positively but in less detail.
Tania said,
“Maybe from my doing the literature reviews, because I’ve done a number of literature reviews specifically to do with prevalence but we would have had to get a base line prevalence anyway because it’s a new service.”
I asked if she had set up the service and she replied,
“It’s going through review at the moment and I’m setting it up in a new way, yes.”
When Tania explained about the literature reviews she had undertaken because she was setting up a new service I asked,
“So, would you have done that anyway?”
Tania replied,
“Yes! I honestly can’t pinpoint it. What it did was focus you on wanting to move somewhere and that’s it. It focused you on looking at a different area of work and what you do to develop that area of work.”
Tania also claimed,
“Colleagues have gained because the purpose of the job is to enable them to work for this client group.”
Colin remarked,
“I’d say possibly it’s more in the area of research subjects that they gained. I’d say my colleagues who were doing the educating for relatives gained more because I was more experienced and I used similar research tools. Clients of colleagues had relatives so my colleagues would refer the relatives to this group that I was coordinating. Through doing this research project for the course, I became more knowledgeable about research and educating carers and I was able to pass that on and that had a knock on effect for the relatives, children or loved ones, which then benefited my colleagues.”
3.9.2 Respect
Chris said,
“As far as my immediate colleagues in the team are concerned, I think they respect me for what I have done and also my attitude towards them has changed. I am more receptive in a discussion. I don’t dismiss, I listen to people more. I don’t think I used to dismiss them but I’m more receptive and listen more. And also they benefit from my learning in a way.”
I asked,
“Is this because of your experience with the reflective process?”
Chris replied,
“Yes, because if people have disciplinary action against them they may come and talk to me and I will reflect and say, ‘Look, I have known some cases and how they have gone’. It’s a counselling set up, more or less. I will advise them that in the past this is the way things have gone. I will also bring some research evidence. So I am also wearing a research hat as well to give them information. Now when I talk, I talk more about reviews. I back things up with statistics. I always wanted to be able to back up my arguments with facts and figures. Now when I speak with .... it comes naturally. I might say, ‘This is the percentage of .... that have been involved’. Or, ‘From a diagnostic point of view, RCTs have been done and they confirm that this medication works or this medication doesn’t work’. Before, I was unable to do that but now I do it automatically. When I look at something I just need to find facts and figures before I speak.”
3.9.3 Cascading through the organisation
When Judith was talking about what the organisation had gained from the Experienced Nurse Job Rotation Scheme she commented,
3.10 — Value of the scheme for clients“How do I put my reflection into practice! I can encourage others to reflect and I have encouraged all the staff to actually start building up their own portfolios already. I know that as nurses we should have our own portfolios. But it was never encouraged. It was said in e-mail or a memo, ‘you must keep your portfolio going’. But what I’ve actually done with the staff is that when they’ve gone on learning or training courses I’ve had them sit down and actually put together what they’ve learned… write it down; dates and what was the course; what they learned; what scores they got for it; what have they taken away; what would they like to learn more about and how will this help them in their day to day working. And I remember the staff really had an issue with it because I wanted them to back track. I wanted them to think about what courses they had done over the previous two years and to put down the dates, the name of the course and where they did it and three things they learned from it and how they could use that and what else would they need to learn? And they struggled and they hated it and they thought I was a right pain. But they did it and I gave them their folders and a joint description and everything inside and some of them have come back to me since and said how appreciative they had been for that because it had helped them when they have come to fill in application forms because they’ve got the information there. It comes back to interviews and applying their information and expressing themselves and they’ve been able to take the time to look back and say, ‘Oh yes, I’ve don’t that course, that’s what I learned from it’, and to be able to enter into conversation with other colleagues and to support new staff coming through. And they feel quite proud of their folders now whereas, initially they would say, ‘Why are we doing this?’ and I would say, ‘You will be so grateful. One day you’ll thank me for doing this because I’m giving you that opportunity to sit down and do it’. And they have been doing it and they have come to me and said, ‘Thank you, because I’ve been able to use it for filling up my application forms of what courses I’ve done. I’ve been able to have a discussion with my line manager now as to, ‘I’ve done this course and this is what I got from it’.”