Against the backdrop of over 40 000 registered nursing vacancies nationally, and a fall in applications to study nursing by a third since the final year of the bursary in 2016, the Royal College of Nursing (2019) has detailed a number of areas in the Long-Term Plan (LTP) for NHS England that aim to address the current position:
The LTP (NHS England and NHS Improvement, 2019) includes an extra 5000 clinical placements funded from 2019/20—this represents an increase of 25%. NHS leaders are shaping a separate workforce implementation plan to detail how this will be delivered.
Concerns about placement capacity have been discussed for a number of years. Merrifield (2016) reported the concerns being raised at that time by both pre-registration students and the Council of Deans that the clinical placement situation was ‘fragile’. In 2016 Health Education England (HEE) appointed Karen Sheehy as an academic fellow, in response to the challenge of the increasing number of adult commissions for placement providers in terms of placement capacity and the added pressure that this would put on nurse mentors. During her time in post she highlighted the growing importance of mentoring in nursing (HEE, 2016), referring to a number of reviews such as the Shape of Caring, led by Lord Willis, where it was identified that many services in England were exploring innovative ways of supporting learners in practice to address the issues of increasing capacity issues (HEE, 2015).
A rapid review of mentoring models undertaken for the RCN in 2015 (Bazian, 2016) showed that the most promising system-level options are more peer/team-based mentoring, supported by one-to-many clinical facilitators, within a supportive organisation, as illustrated by the following models:
All three of these models differed from the UK 1:1 mentoring practice in having increased ratio of students to mentor, and offering tiers of mentorship, for example, using associate mentors or peer mentors. Several studies reported that both the organisational context and the quality of individual relationships had more impact on positive outcomes than the type of mentorship model used.
Reviews such as this have informed our professional bodies, provoking a change to Nursing and Midwifery Council (NMC) (2018) standards for student supervision and assessment. The NMC argued that these changes from January 2019 will increase the pool of professionals available to support and improve the quality of student learning, and will also allow greater independence of assessment, greater innovation by placement providers, and development of placements in more settings.
In its new standards, the NMC describes two specific assessor roles:
The NMC no longer stipulates training requirements for supervisory and assessment roles, but it is in the process of developing guidelines on how to prepare for those roles. The guidelines for practice supervisors have already been published, while those for practice assessors and academic assessors are still in development
The challenge to us as nurse leaders is to re-think the totality of clinical placement availability, as the growth in demand is not solely from student nurses. In addition to the planned increase of both pre-registration placements, and nursing associates this year, there will also be a drive to support industry placements for T-level learners and a desire to support an increase in the volunteer workforce. This does offer us the opportunity to prepare for a readiness in our practice environments that I would suggest we have not required at this scale before. We must scope the opportunities to prepare a wider pool of staff and infrastructure to support learners in practice than we have previously, and consider the wider context of the learner environment and support provided to our permanent teams, particularly our ward and departmental leaders. This is crucial to sustain a practice environment that enables learners to thrive while the delivery of care to our patients continues.