Section Three — Findings and Discussion for the Supervisors of the Nurse Job Rotation Scheme Study (Continued)

3.3 Advantages and disadvantages of the job rotation scheme for colleagues at work

3.3.1 Benefited — recruitment and retention to hard to staff areas

The responses to this theme demonstrated that, in general, the supervisors felt that they and their colleagues benefited from the presence of the job rotation scheme nurses. Only one person was rather negative and the enthusiasm of two others was somewhat muted.

3.3.2 Patients/Clients benefits

In 3.4, what patients/clients can gain from the rotation scheme is considered. It provides fewer comments than does this section but it should be noted that most of the quotes here in 3.3 are, indirectly, relevant to the care of patients/clients as well as to colleagues on the ward. In fact, an examination of quotes made about the two topics suggests that discussing what they and other members of staff gain from sources such as the job rotation scheme allows supervisors to refer more naturally to patient/client care than does direct reference to that care.

3.3.3 Variable enthusiasm

I commented to Karen,

“The feeling I have from those I have interviewed is that there are those who are enthusiastic wherever they are and those who are enthusiastic in some places and not enthusiastic in others. There isn’t a group who aren’t enthusiastic ever.”

Karen responded with an interesting comment about staff motivation and satisfaction saying,

“I think that’s true. For someone like (name omitted) I think she’s maintained her enthusiasm right across the board and I think she’s always shown an interest in getting experiences in different areas. And I think she’s found it difficult to leave each area that she’s been to because of her attachment to the context. And I think, for those people, they tend to be more focused on their clients and they develop relationships with their clients so the motivation isn’t so much where they are as who they are working with.”

3.3.4 Useful assignments

At a later point I commented,

“I got the impression, from what you were saying, that the job rotation scheme nurses bring things back to you.”

Karen’s response provided some confirmation that the work based learning assignment and project, both of which are related to the National Service Framework, provide valuable foundations for a curriculum that can be relevant to all stakeholders. She replied,

“Yes, they do. When they’re in the final stage they need to produce assignments and I work with people on their assignments and because they are work based we try to make the projects relevant to what’s happening in the team at the moment. I think that’s a sensible thing to do so that the team can actually get something out of the work that they’re doing. I think, that in my own experience, that is, experiences I’ve had myself in the past, that when we do assignments and stuff that are university projects they don’t have that much relevance and it’s quite separate. It becomes academic and I think that what we try to do is make it more relevant to the specific group workplace. And I think that’s reflected in what they’ve been expected to do.”

Karen’s final point is encouraging in two ways. First, it demonstrates that she appreciates the work based nature of the degree from a learner’s point of view. Second, it demonstrates that introducing assignments that are directly related to the workplace can make things ‘simpler’ and is useful in terms of managing very complex situations, particularly in understaffed areas.

3.3.5 Good at simply staffing the wards

Susan’s comments were almost totally about gaining more trained and continuing staff. She claimed,

“I would say for this hard to staff area where it was difficult, not really to get staff because you always have the agency or bank staff, but to get permanent staff, the course was very beneficial in that respect of simply staffing the wards. How appropriate it was or how useful it was for the nurses who came to us, I found doubtful and I was mentally quite guarded about what it involved, working in that particular area. Really, it’s just been good, you know, that people take on those responsibilities of just total patient care and to know that they obviously had a sound knowledge base and that they’re workers; they’re not just practising for they’re education.”

Susan’s final sentence above suggests that, at least in her experience, job rotation scheme nurses are keen to develop their competence as well as their factual knowledge. That, and the following quote, shows that, whilst acknowledging the importance of recruitment and retention, Susan seems to be aware of the ‘added value’ associated with the scheme.

3.3.6 Improved skill mix and knowledge base

She continued,

“It was good to get the personnel into post. As I said, at that first initial meeting that Peter and I went to with (names omitted) and somebody else at Trust headquarters they were saying that this was being set up, obviously to provide degree education but also to get full time staff into these posts that are difficult to staff. The D grade posts were made for the rotation scheme. There wasn’t really a D grade position only D grade positions held by enrolled nurses. So there was provision made for the rotation staff to fit in. I think it was a bonus because you didn’t have the staff and not only have you got an extension of the skill mix, you’ve also got people who are coming in, newly qualified; they’re up to date and they had a lot of knowledge to share with the staff on the wards.”

This led me to ask,

“And did they share it?”

to which Susan replied,

“I think it’s like anything, isn’t it. If anybody comes onto the ward and they have information to share, sometimes you have to ask them for it; ask them to share.”

It is useful to see that Susan is aware that it is necessary to welcome and encourage colleagues to participate and share. I gained the impression that not everyone does this and some job rotation scheme nurses may not realise that that is alright to bring to the ward what they have learned.

I then asked Susan if there were benefits from the education that the rotation nurses were undertaking and her reply provided further insights into the value that accrued to colleagues from indirect educational input. She indicated that varying levels of competence/capability were appreciated by colleagues and seen as being a resource for the team. She also argued for the value of using the resources of the university to help the ward team and, through them, client care.

3.3.7 Sharing information

Susan replied,

“Education! I mean, it helps obviously because you’d have different tiers of the education. You have your student nurses and then you’d have your degree nurses. And, of course, the education for student nurses moved to diploma level so I think it helps having the three levels. With the job rotation scheme nurses, there was always a surplus of useful information coming on to the ward. You could ask any of them, so having them there was beneficial for anyone else doing even an ENB course because they could ask, ‘Have you got any information on this?’ and they’d say, ‘Well, I haven’t but I’m in college, I can look up something for you.”

3.3.8 Conflict

Susan then commented,

“I got the feeling before that you thought everything was harmonious between them… you said that in some areas that they were looked at and frowned upon… I’m sure that’s the same with anything… anybody coming into an area, you know, there’s always one or two staff, isn’t there, who are afraid to change? Their attitude is, ‘I’m happy with my post and you’re coming in and you’re threatening me with your education’. That always happens. But I wouldn’t say that their lives were ruined by that. I think that, as an experience, it was beneficial to go through this conflict.”

3.3.9 Staff in continuing care services

Finally, Susan said,

“Alright, I think we’ve touched on the usefulness for myself and my colleagues and the only other point I would really make about the scheme was that it got people into the areas, onto continuing care as part of the rotation but I’m not sure how much it encouraged people to think of a career in that field because, off the top of my head I can’t think of anybody who’s ever stayed within the directorate now.”

3.3.10 Long term retention

This last comment from Susan certainly provides food for thought. Susan’s area of continuing care is one that does not, at present, attract full time nurses. However, Susan aspires to attract such people to her speciality area, not just in the short term, but also for the longer term. She indicates that, whist the job rotation scheme nurses are better than agency and bank staff, they move on and do not return. There is, perhaps, a need to consider more direct ways to achieve this.

3.3.11 It’s been fantastic — six rotatees

Mary remarked,

“Oh, for me it’s been fantastic because I’ve had… it’s naughty really but we’re on to our sixth one now and, out of those six, three stayed put, didn’t go, didn’t move… well one, because she’d finished her placements so she stayed put here and the other two actually dropped out of the course to stay on the ward which I know is not good in one sense and I understand that, but it was very good for me because they were both fantastic nurses. One’s still here in fact. So, I’ve gained three very good nurses from the scheme. And then, the other three that I’ve had who moved on were also very, very good and were all an asset to the ward. And so, for me, it’s been absolutely wonderful.”

3.3.12 Temptation to persuade rotatees to stay

Although, as Mary says, it is ‘naughty’ to attract people away from rotating this is an excellent quote from the point of view of those who set up the scheme because it demonstrates how at least one manager regards the job rotation scheme nurses in a positive way.

I asked,

“So, you’ve got six people here who are a tremendous asset. Do you think that says something about the course or something about the nurses?”

Mary replied,

“I think it’s luck. I don’t think it says anything… I don’t think it’s necessarily the course. I think it’s the nurses and I think it’s the luck of the draw as to who I’ve ended up with.”

3.3.13 Type of nurse — committed

She added,

“But obviously it’s a certain type of commitment isn’t it, that entices someone to do a course like that? My experience is that it’s obviously attracted the right kind of people.”

This is one of those comments that should, ideally, have been followed up. It would have been interesting to know what qualities the ‘right kind of people’ have. Irrespective of that, what the comment does suggest is that, whilst the job rotation scheme was set up with the main aims of the recruitment and retention of newly qualified nurses, its design has been such as to attract ‘high calibre’ rather than ‘run of the mill’ nursing staff, whatever those two terms may mean.

3.3.14 I have never seen any disadvantages.

Ursula reflected on the advantages and disadvantages of the job rotation scheme from the point of view of the staff, saying,

“I think there is more advantage than disadvantage. I have never seen any disadvantage really. But the advantages; most of them specialise in different projects but a lot of them have CPA research. And they’ve actually come back and implemented some things on the ward. And despite the fact that some of them seem to be doing the same CPA they all interpret it differently and it’s nice you know.”

3.3.15 Supports real change

Ursula’s claim suggests that the job rotation scheme supported real change. This is precisely what it was hoped work based learning would achieve. If this was achieved more widely then we can see that the benefits of the partnership between the scheme and the wards or services were maximised.

3.3.16 Closed cultures

She continued with comments that demonstrate how closed cultures can be overcome, and how supporting and sharing can take place whilst modelling the learning

approach from University, She remarked,

“It also helps us because, as I say, it’s not just my point of view and then it’s no longer just a closed shop because they come along and they’re quite happy to discuss. And if there’s anything that crops up in the study day they’re quite happy to come back and tell me.”

3.3.17 Useful with doctors

She added,

“They’ve certainly been very, very useful. Also with the doctors… we have so many new doctors coming along but the rotation nurses were very good to them because they worked with them and they weren’t afraid to question or put ideas forward, in a nice way.”

3.3.18 Team teaching

The above comment suggests team work and team teaching, as well as equality, so I asked Ursula if she thought that that was because of the scheme and she replied,

“I think it has given them that little bit more confidence in that way.”

3.3.19 Makes a big difference on elderly ward

Mark worked on an elderly mental health assessment ward and what had been said to me on previous interviews led me to state,

“So, in theory, being elderly, it is more difficult to staff and should raise less enthusiasm, or you’d expect it to.”

Mark replied,

“But the staff who we have here… I mean, they have been quite good. They have shown some interest and when they have finished their rotational programme, some have said that they would come back to work with us. And having them with us was very, very useful. I must say, they were very good staff nurses. I upgraded three of them while they were here with me. I found that as D grades they functioned really well and quite confidently. It makes a big difference because they know that they had to move on from here and they still worked hard. The learning process is ongoing and that keeps them going I think. What I found was that they were not laid back; they’re very keen and enthusiastic and looking forward to their next placement or their upgrading.”

So, yet again we have a supervisor who refers to the motivation and commitment of job rotation scheme nurses to patients/client and to the team or service.

3.3.20 By comparison — more motivated

Mark went on to argue,

“I really don’t know the reason why, but I found them quite motivated. That’s unlike people who have been in one job for a long time and then are applying for another job and come in or work with the elderly sector for a while and then decide they want to remain in the sector because they applied to come to work with us. I find that people like that are a little bit difficult to motivate and they don’t really willingly apply their knowledge and their skills. They tend to take a back seat and see what is happening here and then try to fit in whereas with the rotation staff they seem quite keen and they would always ask questions saying, ‘Why are we doing this? Why is this happening? Can I do this, can I do that?’ They were very, very keen, the staff that we have had here. I was very impressed. I put it down to the different type of training that they’ve had. All the staff nurses who had been working as C grades or D grades for a while who came to join us new were not as on the ball and really keen to put what they have got into the new area whereas this staff are.”

3.3.21 Comparison with staff seeking long term posts

It is interesting that Mark’s comparison was with other staff who may be looking for long-term post as opposed to bank or agency staff. His remarks highlight the ‘value added’ nature of what the job rotation scheme had to offer.

Mark’s comment led me to say,

“Obviously you don’t know for sure, but do you feel that it’s to do with the sort of people who want to go onto the job rotation scheme or to do with what’s happening at the university with them, or both?”

Mark responded,

“Both probably, yes. To me I always thought they were keen, enthusiastic and well motivated.”

3.3.22 Bringing assessment tools to the service

I asked Mark what, if anything they brought to the ward about the education side of the scheme and he replied,

“Yes, you know, like with the assessment process, they would say,’ Oh, when we were on placement at such and such a place we used this or did that, why don’t you try that?’ We use the Camberwell assessment tool and I remember one of the staff nurses who was on the programme saying, ‘Instead of just having the plain Camberwell sheet why don’t we adopt the one with the scoring on it, then it’s easier for us to highlight the problem area. The higher they score it shows that there are related problems’. So, things like that they would come and point out to us.”

3.3.23 Benefits to patients/clients

As mentioned at the start of 3.3, this theme is concerned with the advantages of the scheme to those working with the job rotation scheme nurses but here Mark has given a very clear example of the benefit for patients/clients.

3.3.24 Changed the format of the care plan — more specific

He continued,

“We have to be welcoming to new ideas because I haven’t had the diploma level training so I’m more than willing to accept any new ideas, whatever they bring in, anything at all. I look into them, even changing the care plan and that. What we were doing before was not very specific but they suggested the change and we got together and we changed the format of the care plan and things like that.”

I asked,

“So, you’re actually learning from them?”

Mark replied,

“I am, that’s right, yes, and the other staff.”

3.3.25 Filling gaps with very good nurses

At another point in the interview, Mark commented,

“And on many occasions, it has been beneficial for us because we had staffing shortages and they were able to fill that gap. And they were also very, very good nurses. They’re coming straight from their training; straight after finishing their training and they seemed very, very enthusiastic. And the other thing is that they start nursing at D grade and then they want to move on and work their way up and that gives them some incentive to do well and be more motivated. I found them very, very good, I must say.”

3.3.26 It’s good to have someone who is questioning energetically

Jane said,

“I’m just thinking about the rotation nurses that I’ve come across and I think, for their colleagues, it’s always good to have somebody who’s questioning everything; looking at new tools; looking… if you don’t know anything they’ll go and find out. You know, you need to share information. So, from that point of view I always thought it was very good to have, well certainly the rotation nurses that I’ve come across, because they were also attending the university, you know, looking at different areas within wards and because of their assignments and things, it kept us up with all the tools and things.”

3.3.27 Four rotatees would have been wonderful

Jane then went on to say,

“They work in the ‘hard to staff areas’ so… the first one, the first rotation nurse that I had, that was a hard to staff area. And I suppose if we could have had four like him it would be wonderful but we had one and he was excellent. You know, he would fit in immediately. He was certainly an asset at the time.”

3.3.28 Team workers: much more than bank/agency

A later comment made by Jane indirectly highlights the difference between the usefulness of job rotation scheme nurses when compared with bank or agency staff. She spoke of working in a hard to staff area which was very demanding and a very difficult place to work. She had referred to a job rotation scheme nurse whom she considered to be very able and I asked if having just another pair of hands could actually be a problem. She responded,

“Yes! I think if it was just a pair of hands on that particular ward, who was the opposite to the guy we had, I think it would quite probably have been problematic because it needed strong team work in there and if you weren’t part of that, if you weren’t prepared to do all of the jobs, I think there might have been some animosity between the staff who were there… I think it would have been a problem for me, certainly.”

I then asked,

“How much does that depend on that person coming in and on the team that’s already there?”

3.3.29 Team working — attitudes and capabilities

Jane’s response did not quite answer my question but it did draw attention to the way in which the job rotation scheme can, during each rotation placement, develop capabilities in team working. She replied,

“It’s always difficult joining a team, you know and it is all about personalities and how you approach things. I’m just trying to think of another person who, I think, is just going along with the course. He seems to take more than he would give, you know, and I’m just trying to think of him in that particular area and he probably wouldn’t get as much experience. I don’t think he would be as involved. The observation of patients, he probably would opt for that; it would be an easy option to go and sit whereas there’s a whole range of things that you could be doing. I might have been unfair to this guy because I haven’t worked with him in that area but that’s how I would see him.”

3.3.30 They’re experienced and know the system

Harry’s comment, although brief, highlights the benefits of knowing the organisation and provides yet a further indication as to the extent to which the job rotation scheme nurses are valued. He remarked,

“I think we are getting something because we are able to fill the gap with the staffing issue and we are getting people who are already experienced in intensive care. We’re getting people who are experienced already and somebody who’s already in the system. We do have people who are coming from outside and they are good. It’s not because they are coming from outside. It’s just sometimes we are getting people who already have some sort of experience within the Trust and they’ve got some of the educational input as well so we do gain from that part of it.”

3.3.31 Budgetary fears in notoriously hard to staff service

Martin was somewhat equivocal and he did not look beyond the staffing problem. He observed,

“The usefulness for us is in the staffing. It’s notoriously hard to staff units and so we were guaranteed staff. But sometimes it becomes difficult in terms of the establishment and working out, you know, whether we were going over our establishment or not because, you know, I might go up to having one D grade vacancy but actually, you know, (name omitted) or somebody might turn round to me and say, ‘Well, I’ve got two nurses for you’. How am I supposed to pay for two nurses? There’s the whole logistics of working out… and the coordination between the person in charge of the scheme and also HR and also the managers. But whatever, it helped us fill our vacancies; very much so.”

Funding and staying within budget is important but Martin seems to have viewed this narrowly. As discussed in Section 1, there is also the need to consider the added costs of bank and agency staff which can be up to 35% (approximately £8,000 per year per whole time equivalent post) on top of the cost of permanent staff.

3.3.32 No, we are not benefiting

But when I asked Martin,

“Were you and your colleagues on the ward benefiting from the rotation nurses in other ways, he responded, “No, I don’t think we were actually, to be honest.”

Given the enthusiasm of previous participants it would be easy to assume that Martin is not very reflective. It would be wrong to judge people on the basis of one interview but, when we compare his remarks with those of others, questions are raised, and should be considered in the development stage of any future rotation courses, about recommendations for the leadership and management of the projects.

3.3.33 To contribute or to bide time

Stuart said,

“In my area, two people who have come said that they didn’t like elderly but, having said that, they made the best that they could of the placement. They used their knowledge thoroughly. I trusted them. I could let them loose. In fact they were the first two I had and they were followed by one who obviously had no rapport with the patients. She was just biding her time basically. But there are two types, the people who want to learn and develop and they will adapt; they go through a transition. And people who say, ‘I only want to be a community nurse’, ‘I only want to work in acute’, ‘I’m here because I have to do it’.”

3.3.34 Was useful

Robert, who had supervised on two wards in the same hospital, showed only limited enthusiasm. He said,

“The usefulness of the course for us? When it first started, the first student I had was very enthusiastic and made the most of his actual placement. This was on the ICU. He had no experience of working with difficult patients and so he had a lot to learn. And he actually was the one person who rotated on and did very well. What we are finding now is that it is probably not quite so useful because people don’t want to rotate.”

3.3.35 Reluctance of rotatees to join a service

I pressed further on this and Robert answered,

“Some of them don’t, no. Or, they don’t want to come to particular wards. I think the acute wards are the hardest areas, people don’t always want to come here. They will come if they’re told to come but a lot of them wouldn’t actually elect it as a particular place.”

3.3.36 He was brilliant

Robert’s next remark confirmed that there can be tangible benefits from the job rotation scheme in the form of real returns for the team and team members. His discussion returned to the student mentioned above, saying,

“Certainly the first one I supervised was excellent. He’d show us what he was doing in university. He’d bring back all the information; he’d bring us all the handouts and let us have copies and there’s no doubt that he was extremely good. But the moment he finished the scheme he moved off out of the post. And he’s turned out to be an excellent practitioner and somebody that everybody respects. He was fine. He was very good with the patients and did a lot of individual work, and that was somebody, that when he came here, was really anxious and nervous about even coming out of the office. And he was brilliant towards the end.”

3.3.37 Refusal to rotate — crisis

Robert’s next comment clarified the difficulties created by students not wanting to rotate. In doing so, it demonstrated a potential downside to the rotation scheme, namely having rotation nurses on the ward and then suddenly finding that gaps leave staff in their original position and dissatisfied. It is interesting but not helpful to note that raising the level of capability in the team, followed by is diminution can lead to dissatisfaction.

3.3.38 Supervisors who want nurses to stay

Robert said,

“I’ve got two students, two here now both of which are staying here and not rotating on. And then the last group we had, I had four of which one person stayed. Three rotated on but I didn’t get anybody in return. So, for me it’s not been that beneficial.”

3.3.39 Quick promotion

Robert then went on to say,

“I think they possibly see it as a quick way to get on to an F Grade, particularly if they move into the community, which is where the majority of them want to work. They, in some respects work day-to-day like everybody else but they don’t always bring what they’ve learned in school, back to the ward. They don’t do teaching sessions here.”

I asked,

“Is that because they’re not allowed to?”

Robert replied,

“No, no. They can do them but a lot of them don’t use their initiative to actually go and do that.

3.3.40 I’ve lost rotatees — I’ve done quite badly

I then asked,

“Do you invite them to?”

He responded,

“I’ve often said about having teaching sessions on the ward and that we need to get some started but nobody seems particularly keen. Here, we are particularly short of staff at the moment and I’ve got one person who had to leave the course and I’ve got one more. I lost three people so they weren’t replaced. So in terms of these two wards I think I’ve done quite badly actually.”

At this point it was difficult to untangle Robert’s remarks and gain some understanding concerning his perceptions of the value of the rotation scheme. His comments began to imply that he was the one lacking in initiative but this could be explained by the ward being particularly short staffed. My field notes indicate that I was about to give up on this question but I persisted a little longer and the result is an example of how follow up questions can be of value.

3.3.41 Other wards do quite well out of it

I asked if there were other wards in the hospital that had job rotation scheme nurses working with them, and Robert said,

“Yes, all the ICUs and two other acute wards, they all have them. ICU usually do quite well out of it because people want to go back to the ICU.”

I asked,

“What does ‘doing quite well out of it mean?”

Robert replied,

“It’s that most people, once they’ve done their placement on the ICU they don’t want to come back here because it’s a very busy environment; you have to think on your feet; you’re key worker to five patients, which is a lot. And I think a lot find it too stressful to be here.”

This response led me to ask,

“So, when you’re saying it hasn’t worked well, you’re saying it hasn’t worked well on this ward rather than on the scheme itself?”

Robert answered,

“Yes probably. I’ve only known it here and on the ICU. And on the ICU it worked really well in terms of retaining staff, people wanted to stay. Although, interestingly, the two who don’t want to rotate do want to stay here and there is one person who’s on the ICU at the moment who is thinking about wanting to come back. But there are very few because most people want to go to the community and likely stay there.”

3.3.42 It’s a big disappointment when good rotatees rotate

He added,

“I’m sure it has got some advantages but it feels unfortunate that I can have, say, four really good staff here and then they move on and then I loose four really good ones because then I don’t get four good ones in replacement.”

3.3.43 We did get staff

Robert’s answers to my follow up questions raise one comment and two methodological points. The comment is that he did get staff because of the job rotation scheme. This was in spite of it being a hard to staff area which was unattractive, created a lot of work with little time to reflect and, therefore, ‘too’ stressful,

3.3.44 Methodological Issues

The first methodological point is that the quotes from Robert highlight the fact that an interview, even when it is in depth and participant led, is a snapshot in time. Had I interviewed Robert when he was on the ICU, I would probably have had a much more enthusiastic response to this theme.

The second methodological point is that interviews help the participants to think, and to formulate considered opinions as opposed to simply having a jumble of thoughts about the topics being addressed. It should be noted that this fits with the emancipatory approach of Action Research.

3.3.45 A job rotatee who becomes a supervisor

Finally, we come to James who had been a job rotation scheme nurse in the first cohort. His interview tended to veer between that and his present role but his comments are being included here and under other themes because he provides a perspective from both sides.

In this instance he began by talking about how he had perceived the benefit to his colleagues on the ward when he was studying. He had been speaking about the knowledge he had gained from the academic side of the scheme and I asked,

“Did you find you were able to pass that knowledge on?”

3.3.46 Passing on knowledge from my community placement

James responded,

“Yes, because at that time I had just come from the community and I came to (name omitted) so there was quite a lot of stuff that people didn’t know that we did know. I was there with another nurse.”

3.3.47 Work based learning syllabus — CPA useful

I then asked,

“And they were happy for you to pass it on to them?”

He replied,

“Yes, because we had to attend CPAs and stuff. When it was first implemented, there were meetings to tell us about how it was going to happen but by the time we went there we knew all about it, so it was quite useful.”

3.3.48 Syllabus and major organisational priorities

CPA was the first module because, at the time, it was a high priority for the organisation. When considering any future job rotation scheme of a similar nature it must be remembered that curricula are not set in stone. They should attend to the major priorities of the day rather than slavishly following earlier versions because they ‘worked’. Equally, of course, they should not be changed for the sake of change.

3.3.49 Explain

I then turned to the advantages he now saw as a supervisor and colleague but he continued to look at things from a job rotation scheme nurse’s perspective saying,

“I think it’s quite an advantage because then they can ask you about various things and you can give some information about things going on with the course; you can explain to them.”

3.3.50 Got better

The next part of this comment should be of comfort to the organisers of the scheme. James continued,

“But it seems like the course has got better; it’s got better along the way because, for us, we had nobody to talk to. We were the first ones so we only had, the tutor to talk to, who was very helpful. He was very good.”

3.3.51 Competent, not struggling

I changed my approach, saying,

“You know what you brought to the wards. Do you notice it now in the job rotation scheme people who are coming here?”

James said,

“Yes I do, because they come here and they’re competent. They carry on with their work; they’re not struggling.”

3.3.52 Methodology

It is interesting that James sees other nurses as ‘struggling’ This is another comment where further questioning would have been useful in order to find out what he meant by the term.

3.4 — What patients/clients can gain from the scheme