Section Three — Findings and Discussion (Continued)

3.15 Difficulties that emerged regarding the educational aspects of the scheme

Although all but one of the experienced nurses expressed satisfaction with the scheme it became clear that they had experienced difficulties so I decided to follow this line of inquiry. The main concern appeared to be with the RAL module but there was also some reference to research. Tania was most unimpressed with the structure of the research module but whilst others made passing reference to having initial difficulties with research they felt they had managed to cope with it in their own way.

3.15.1 Teaching versus accommodation

A quote from Colin exemplifies this.

He said,

“We met up as a group and we went through exercises and we’d pick out some of the vocabulary that’s used in research applied to hypotheses, which was useful but a lot of it was self directed learning. I found it very confusing at the beginning.”

I said that I had thought it was going to be a taught module on research to which Colin replied,

“There was, in that we were taught the different phrases and different methodologies and, like I said, applied them to hypotheses. But it only really became clear when I was doing my own reading round the subject applying it in principle.”

3.15.2 Help from tutors

Pressing further I asked if he thought they were getting all the help they needed with the modules from the university. Colin responded,

“Yes, the tutors were available but there was only so much you could do as a group. What I got most out of meeting as a group was critiquing each others work and presenting it to the group which was an essential part of the assessment.”

3.15.3 RAL as a new concept

With reference to the RAL module, Kevin said,

“I did find the RAL really difficult. They were complete new concepts about how to think about what to do with and how… I really struggled with it.”

He did not mention any other difficulties although, of course, he didn’t complete the scheme.

3.15.4 Lack of professional portfolio evidence

Jonathan also referred to the RAL module although, in retrospect, he felt he had exaggerated things, saying,

“When they were talking about the NMC and everybody having a professional profile, I was thinking, ‘What do they want me to do’, and thinking, ‘What do they mean by a professional profile’. And, as usual with me, making a mountain out of a molehill, when really, it was just about collecting evidence for what you’d done and actually having a think about it. I suppose it was that I’d done quite a lot of things but I couldn’t pick out what it was that I had particularly done.”

3.15.5 Preparatory work for joining the scheme

However Jonathan also had another explanation which, whilst feasible and worth consideration, was not mentioned by any of the others. He said,

“A lot of us were struggling because we went on the course very quickly and we hadn’t said, ‘Oh, this course is coming up, I’ll apply for it for the September intake’. There wasn’t anything like six months of planning; of knowing you’re going to go on the course so you could psychologically build yourself up for it. The thing was starting and there were places available and the next thing you know, you were doing it. So, in that process there hadn’t been the psychological build up and that, I think, made it a bit more difficult and, ‘Oh, get our heads round this! What have we signed up for?’ ”

Without detracting from what Jonathan felt, it should be noted that the situation was not the same for all the participants in the Experienced Nurse Job Rotation Scheme. A small group were involved with the planning of the scheme for up to a year before it started.

I then said to Jonathan,

“I’m wondering in what way it impeded you because you started so quickly? Was it just that you weren’t psyched up for it or did it have other implications for your work and things like that?”

Jonathan replied,

“I think it was simply the fact that when people know they’re going to do a course there’s a lot of unconscious preparation they do. There was about four weeks between when I applied and when I got on it so there was an initial bit of excitement there but also I had not fully planned and thought through the consequences of doing some work. I think Richard was somebody who just needed an open door to take things through. He was somebody who was ready for it. I think that was evident in how he embraced it and took it forward. I think a number of us, such as Kevin, Jane and myself seemed to be much more of, ‘Cor blimey! Where the hell are we’? We probably weren’t at the stage that Richard was at. I think that, perhaps, we wouldn’t have been in the position we were in if we were a bit more academically motivated because we would have already gained a piece of paper. It may not have been something like the work based learning or as appropriate as that, but we may well have actually already gone and done a degree. So, what you were talking about were people who weren’t academically motivated and people like us need a kick up the but and then it starts to roll. I feel that I would have finished the course if I had stayed. I think Jane just felt that it was a lot to think about. She thought it was good but it was that initial bit of collating and thinking about the past. It’s quite a difficult thing to do. It sounds silly now I can look back and think about it, but to get your head around all this stuff and write about yourself. And there was a bit of pressure on as well because you knew that if you did it well you’d have fewer units to do. So it wasn’t like you thought you could just throw anything in because, for instance, Richard embraced it and was ready for it and, after a little bit of getting his head around it, he was able to produce something. What he did was exactly the thing that I was hoping I could have done; he only had one unit to do and his dissertation. Of course, I was hoping that I could be in that position as well. I think it made me feel a little bit mentally constipated because I felt pressured. I suppose the problem is that subconsciously you think in terms of scores even though this wasn’t going to be scored that way. I think subconsciously I was feeling that I needed to do the RAL module at first degree level to be able to get this one unit and a dissertation.”

3.15.6 Working through confusion

Judith’s problems had also been to do with the RAL module but she put it down to the way the tutorials were organised. Initially she said,

“At that time there seemed to be confusion as to what was expected of us. Looking back now, I look at it like it was a novel or a film; one of those that you don’t actually know what it’s about until you’ve actually finished it. And you really need to be committed to see it through; to actually follow the process. Because what was happening was that we were being given information but it wasn’t connecting, particularly around the RAL. I remember the exercise when we went into groups and we had to talk about a skill we had; what skills we had and how we learnt those skills and what experience we had with them. It was to try to get us into the focus of thinking how did we get to where we are today. And I struggled trying to think of a skill I had outside what work I was doing. That was how tight and closed my head was, screwed into thinking about work. I couldn’t think of any practical skill that I had outside work which was quite scary because we had to explain. We couldn’t just say we had the skill like, ‘I can drive’. We had to say how we know we are good drivers and give an example of being a good driver. And I thought, “What do I do outside of work; what skills have I got”? And I actually realised that all my life I’d spent so much time focused on my work that I hadn’t really spent much time thinking about my external life and what skills I’d developed and I actually think that I’d become deskilled outside of my work life. And this was good. I used to get these pop up flags, ‘Ah, I understand this’. At that time I think the tutorials for the RAL part wasn’t very clear. When it came on to the research module it was very different. It was much clearer.”

3.15.7 Tutorials

Then Judith went on to discuss the nature of the learning situation explaining,

“I think that in the one to one tutorials I had with Alan I learned a lot more or I had a better understanding, rather than in the group. And I also think that is very much to do with the fact that what we had to do was to look at our own selves. To come together in a group and to talk together about, ‘Well this is what you’re going to do and this is how you do it’, doesn’t help because it’s a group exercise or a group activity but it’s different because everybody has individual needs and I wonder perhaps if the first part could have been on an individual basis and that the group could have met on the first day just to know who was on the course and for networking but then instead of having group tutorials, which were quite spaced out, we could have had individual tutorials.”

3.15.8 Clarity of course booklets

She added,

“And there were these course booklets given that we couldn’t make head nor tail of. They were the problem, these wonderful green books and there were examples that really weren’t relevant. It would have been easier to have had the structure of what needed to be put in. But then again that’s being fed and we weren’t supposed to be fed; we were supposed to be adult enough to know what is to come from us. And I think it is was a very thin line of leaving it wide open with no… especially when you’re looking at a group of people who haven’t had the academic experience. You know they’ve been through the work but I think it’s about how to write. It’s about how to actually present information and for some… I do struggle when it comes to doing assignments because although I’m getting better, it comes with experience. What information is it that the examiner is looking for? What style do they want? It’s like interviews. Until you know how an interview should be presented it’s going to be a guess. So again, if we could have been given a structure… it’s like how the folder should be put together. It’s practice and I suppose, for me, and I’m only talking for myself, I would benefit more looking at how a folder is put together; the type of information people present; that it’s how it should be. And I know that it might seem like somebody else’s work and that’s their information but some of those examples…”

3.15.9 Structure and process

I interrupted here and asked,

“Is it about the structure?”

Judith responded,

“It’s about having structure because I could put anything down and I wondered, half the time, ‘Am I just rambling on; does it make any sense and is this what is really being looked for? Am I explaining myself; am I expressing myself?’ I was writing pages to try and get as much information as I could and then I was thinking, is this really what I should be doing? It’s about what really is it that’s needed to enable me to get the RAL. The RAL, if I could ever get over that point, I would be so happy because I would like my work to be evaluated just to see what I’m capable of. I mean, I’ve put all my certificates together; I’ve set my folder up; I’ve done pages… and I do think that individual tutorials would be better and those green booklets just needed to be revisited. They gave the information but that’s my personal feeling and I don’t want to say I’m right.”

3.16 Aspects of the scheme that would need to be changed

This sub section is a continuation of the previous one in that I followed that topic with the above question. Once again Tania’s arguments were not representative and Chris’s response reflected his own individual situation. The other comments are more representative and once again there seems to be a general theme running throughout the responses.

Tania said,

“Organisation, structure, discipline, university! I mean, it was a great concept but its delivery let it down.”

3.16.1 Education

Regarding the fact that the scheme had involved work based learning as opposed to just studying for a degree, Tania argued,

“I think the good idea is that your assignments are work related but I also think now that there is space for some taught things within that. My idea would be that you have a taught component and then the work that you do is in relation to your specific work place”. Asked what the taught component would consist of she replied, “Ethics, organisational change and research. With research it depends on what degree you’re aiming for but there are components that you can do that can give you an academic baseline and then you take the bits of that that relate to your work or you adapt the bits of that that relate to your work so that you are getting something out of that taught component. Instead of just doing a pure academic response to the module you do it in relation to your work.”

Changing tack I asked,

“Would you say, ‘Yes, repeat the course?” and Tania responded, “I’d say do it as long as it was organised. If I was going to run such a course I would certainly say, ‘Well, I’m going to ensure that the organisation takes a role in assisting with the organisation of the scheme and that the university does its component a bit more didactically; not mainly but a bit more structured than nothing. I’ve done a quite intense course taking research from a novice to an expert with a primary care focus and that was far more insightful. I knew terms like triangulation and all that but other people didn’t and I’m not convinced that, at the end of it, they knew anything different because it was more of a discussion. And they would have to go away and read it. I think they would have to have read everything; every part of it. So, I would recommend the approach if it was done differently, yes. We are all self motivating and strong characters and if you weren’t then I wonder what the end result would be.”

3.16.2 Organisation

I pointed out that the assumption from the start had been that people who had been in their jobs as long as those on the experienced nurse scheme had, would know their way through the system and should be able to undertake the scheme pretty much on their own. I added,

“That was part of the course. And clearly, you all did but I get the feeling from what you’re saying, is that what was lacking was enabling.”

Tania responded with,

“Yes, the people on the course should have skills and should be able to do it but you can only do so much within your position in the organisation and then you need someone else to help you. We were given the impression that, ‘We’ll support you. If there’s a job vacant then you’ll be able to go into it as long as you fit the criteria or you have transferable skills’. But that wasn’t the case because individual managers said, ‘Oh, bog off. Anyone can apply’. It was meant to be an experiment, to go and have a look in a different area, a completely different area to see who had an interest and to discover if skills were transferable but that support wasn’t there.”

3.16.3 Middle managers

I summed up Tania’s comments by saying,

“So, the top management were saying, in effect, ‘Yes, go on and do it’, but not, ‘We’ll help you’, and middle management were saying, ‘No way’ ?”

Tania answered,

“Yes!”

Chris suggested,

“One needs to achieve some rewards afterwards. If you have a rotation programme with a built in reflective process then at the end of the programme they should say, ‘Ok! If you can’t get job internally then we’ll put you on a secondment place’. There needs to be somewhere to go to use your expertise and to move on.”

3.16.4 Accepting culture

When Colin was commenting on how his colleagues had facilitated his studies, I began to say,

“Had they not been so amenable here, then it might have been…”

Colin immediately said,

“It might have been very different, absolutely. I noticed on the ward, as well, when you’re in the numbers you feel guilty and staff do feel resentful that you’re taking time out because it leaves the ward feeling unsafe. When you’re doing it you’re not supernumerary. I think if there’s some agreement that, for example, the day that you’re doing interviews for your research project, they would employ an extra member of staff it would be a lot easier.”

Reflecting further on what might need to be changed, Colin commented,

“Probably, if anything, we needed more individual tutorials because everybody had very different areas that they were exploring and when we all came together it did feel a bit competitive. Everybody wanted their own space to ask about their particular projects and that sometimes got to be a bit confusing because everybody was doing things in a very different way. Some people were on masters and some people were on degrees.”

I asked if that problem had existed right from the beginning when they were doing the RAL or if it had arisen later and Colin interrupted to reply,

“Half way through I would say. When we were doing our different research proposals and projects, it did get a little bit confusing but, on the other hand, it was quite useful to see what other people were doing. We were all so different and we’d present our proposals to the group and get feedback from each other which was very useful.”

3.16.5 Interviews

Judith said,

“What didn’t seem to happen, well I don’t remember it happening, is that there wasn’t an interview or there wasn’t, that I remember, an application to apply for the course. And perhaps that is something, to have an initial, perhaps informal, interview to see why someone wanted to do the course; what would they hope to get out of it and what would they be bringing back to the service with a commitment.”

I asked,

“What is your reason for saying that”? and Judith replied, “I think it would make them look at who was actually applying and why were they applying and perhaps they would be able to work through who would be able to benefit more from it.”

She went on to say,

“What is also in my mind is what would the Trust provide in return during the programme? Although it’s very much a work based course, there wasn’t necessarily the understanding of senior managers as to what it was about. So, it’s about time commitment and about being able to recognise that people do need time to actually do this course or to actually have time to think. Not to be given additional workloads because what happens, or what happened with me was that, although I had this course, I had a number of investigations in the past year. When I became the operational manager, I walked into three investigations which I had to be part of. Instead of actually sitting down and looking at the service and having an orientation time to see what I was going to do and plan my year and set some targets for myself, I was actually thrown in to resolving three different and quite serious situations and that took up a lot of time. If you have staff nurses who have less responsibility overall; they come in and they do their days work; they have a case load….”

3.16.6 Time allocation for study

I interrupted with,

“Like with the D and E course”? Judith responded, “Yes! They don’t have as many day to day commitments work wise and the higher the grade you are the more work commitment youcve got on top of.”

Judith’s comments here introduced the issue of ‘ownership’ of negotiation and this led me to say,

“I have the feeling that the course leader felt that because of your positions, your experience and the type of post you held you should all be able to negotiate that for yourselves. Was that unrealistic?”

3.16.7 Line manager

Judith replied,

“We are strong characters in the group and, looking back at who was on the programme, we all had years of experience behind us; we were all in positions where we were dealing with complex situations and a range of activities happening around us on a daily basis. Yet, we were also, all of us, there to support the service. For us to actually stand up and say, ‘Well, we need this for ourselves’, and to actually get that message across… well, I’m talking for myself. My line manager at that time was brilliant. He supported me through the service change, particularly with this difficult situation of the closure of .... and the rebuilding and restructuring of the service. He was very, very supportive and he enabled me to actually get on and do what I had to do, all I had to do was feed back to him and say, ‘This is where we’re at; this is what I need, I might need your support in this; I might need you to sign something to give me the authority to do it’. He was very, very supportive. I met with him on a monthly basis for supervision. However, when it came to doing this course, although I spoke about it and said to him, ‘This is where I’m at and this is what I’m doing’, for me it was the conflict of which comes first, the service or my course work. And when I came to supervision, talking about this programme, I had this, this and this to address first and then it came to my personal development and what I needed to do. If I needed time out he would support me to take the time out. That wasn’t the problem. But there were a number of other work issues that I knew if I didn’t address them, who would I have to deal with that for me? It would still be there. So, it comes back to me as a person and I think, from the conversations I had with others on the course, the situation was the same for them. And I do agree to a point with the course leader but….”

Again I interrupted and asked,

“Are you saying that somebody else has to give you permission to give time to the scheme or are you saying it’s not on anyway? I mean, what are you saying?”

Judith’s response was,

“What am I saying? I think the course leader is right that we should be able to negotiate but it’s always easier said than done in the current climate and there’s always more to do than any of us, including my line manager and head of service can do and there are a lot of staff who we wonder what they are doing because we are doing everybody else’s jobs. So we need to look at how we operate our organisation. Perhaps what is called for is more than on paper saying, ‘We support this and we’re signed up to it; aren’t we a wonderful organisation’? Perhaps there should be a contract agreement where it’s been signed up to. Maybe I’m getting very regimental in my old age, that I like things on paper so I can say,’ You agreed when we discussed this and you supported me to go on this, you agreed that I wouldn’t be doing this and I need to show you to remind you about this’. It’s not that any manager is going to renege on this but there is so much pressure.”