Placement expansion is a national strategic priority. Meeting the Government's intention of delivering 50 000 extra nurses for the NHS and achieving the growth in placement capacity required for this (Department of Health and Social Care, 2020), against a backdrop of disruption to clinical and education services, and buoyant recruitment to healthcare programmes, can feel a challenge. But it is one that has coincided with a time of significant opportunity.
First, the Nursing and Midwifery Council (NMC) (2018) Future Nurse standards set the ambition of what needs to be achieved at the point of registration, paving the way for diversifying practice learning opportunities beyond existing ways of working. Additionally, the UK's exit from the EU brings opportunities to distance itself from EU directives that are no longer fit for purpose (Leigh, 2021).
Work completed in the Health Education England (HEE) South East Region has demonstrated that averaging demand for placements across the calendar year would mean that there is better utilisation of existing capacity for pre-registration students, with these practices already in place across Greater Manchester. Although this makes logistical sense, there is a need for balance against the constraints faced by education providers, student expectations, and wider considerations such as the recommendations of the Reducing Pre-registration Attrition and Improving Retention (RePAIR) project (HEE, 2018).
Another important aspect is that practice learning environments are not exclusively accessed by pre-registration, direct-entry students. There is a huge range of learners, including existing employees, who require supervision and support. This is something that needs to be managed at organisational level by utilising the full range of working hours, with all staff, at all levels, contributing to the development of learners. Creating this culture and mindset for practice learning may help to address the perceived status of placement capacity. For example, many senior managers believe there to be sufficient capacity for pre-registration learners, while clinical teams are reporting a different reality. A variety of factors sit behind and contribute to both viewpoints which, although complex, can be explored with a shared understanding of terminology.
‘Capacity’ can be interpreted in many ways. A standard dictionary can offer several different meanings so it is easy to appreciate why there can be a loss in translation. In its simplest form, capacity tells us how much of something we have available to use at any one time and, in principle, the potential for practice learning capacity exists whenever and wherever health and care services are being delivered. However, capacity is often determined subjectively, based on historical trends, established ways of working and leadership preference.
For practice learning capacity to be realised, three interdependent conditions are needed:
- Function—this relates to the identification of practice learning opportunities that support the learner in meeting their programme's intended learning outcomes, leading to professional registration
- Size of service—this comprises factors including service hours, workforce and estates. A service that operates full time has greater potential capacity compared to a part-time service. Whole-time-equivalent staff are a useful indicator of size of service, but caution should be taken if used in isolation as there can be distortion with high acuity or highly specialised areas
- Ability—this is the final and, arguably, the most significant element, focusing on the need for sufficient supervision and assessment from suitably prepared staff with dedicated time to undertake the roles. Whatever its function and size of service, without ability, the potential capacity will remain unused. Ability is what can be safely achieved while maintaining quality, person-centred care and professional judgement. When a practice learning environment reports limited capacity, perhaps what is meant is that there is limited ability. For example, when a service employs larger volumes of new registrants and has a higher turnover of staff, is it its ability that is impacted, rather than its function and/or the size of the service?
The NMC Code (2018) (https://tinyurl.com/gozgmtm) expects that every registrant supports students' and colleagues' learning and helps them develop their professional competence and confidence. Increasing ability is therefore a critical piece of the jigsaw when diversifying and innovating practice learning environments and for maximising capacity.
Within the context of creating innovative practice learning models, the authors suggest that function, size of service and ability should be considered when exploring placement capacity. Offered for debate is the principle that potential capacity exists wherever and whenever health and care services are being delivered and that at least one learner is supported during daily working hours.
The convergence of the NMC Education Standards (https://tinyurl.com/3as22nzu) with new ways of working, technology-enabled health and care services and digital learning solutions, together with the review of EU directives, should be capitalised on to think differently, building a new landscape of practice learning opportunities that will future proof the role of the nurse and promote effective workforce development, and, at the same time, increase the number of nurses.