An Investigation into the Effects of Clinical Facilitator Nurses on Medical Wards: PhD Thesis 2010 Bill Whitehead presented at the launch of the Clinical.

An Investigation into the Effects of Clinical Facilitator Nurses on Medical

Wards: PhD Thesis 2010

Bill Whitehead presented at the launch of the Clinical Educator Network 21st October 2014 at University of Derby

Clinical Facilitators: a brief history

1919: Ward Sister

1957: Clinical Teacher

1986: Lecturer/practitioner

2000: Clinical Facilitator

What is a CF: Eight Traits Describing CFs

1.CFs are employed by care providers such as NHS trusts rather than educational institutions such as universities.

2.The supportive presence of CFs encourages recruitment and retention of staff which leads to improved nurse to patient ratios and better patient outcomes.

3.CFs suffer from problems with role definition due to their position between education and clinical patient care.

4.These roles are a logical outcome of the organisational changes engendered to produce more and better skilled nurses to provide better patient care.

5.CFs help staff to improve their clinical skills and thus to improve the quality of patient care.

6.CFs provide a link between theory and practice within an equal educational framework.7.CFs have varying status and power dependent on local factors often outside of their

control. Their position is better when part of an organisational framework designed to provide practice based education and support.

8.The CF is an ideally placed policy instrument for the implementation of strategic change management.

What do CFs Do?

• Triangulation from CF interviews; literature review; student questionnaire; and field observation.– Support learners in the clinical area– Change “sitting with Nellie” to real

teaching/learning/assessing– Prioritise education in the clinical area– Champion clinical skills in the broadest sense– Manage learning

Are CFs an expensive luxury?

• CFs are relatively inexpensive and are highly productive.– They provide real education in the clinical area– They encourage recruitment and retention– Both of the above lead to improved patient

outcomes– Consequently, CFs make a contribution to the

ward greater than if they were deployed in a purely clinical capacity.

Could we manage without CFs?

• Without CFs the job of management of the clinical area is much more onerous

• CFs can implement policy in the clinical area

• CFs support and ensure that essential training takes place

CF Ideal Type

• The ideal CF should be employed by care providers such as NHS trusts.

• The CF role should be defined clearly in their job description and include specific time to fulfil CF duties. These duties should include supporting all learners in the CF’s geographical area.

• The CF status should be the same as a nurse lecturer and as a senior clinical nurse with similar levels of experience and qualification.

• The CF should be part of a CF team with a supportive management preferably with an entirely clinical educative responsibility.

• The CF manager should monitor the effects of the CF team with regard to skills improvement; recruitment and retention; and quality of patient care.

Conclusion 1Recommendations for ActionThe move to compulsory preceptorship, which will be implemented in

2010 (DH 2009), made the use of CFs an even more attractive proposition to trusts. The results of this thesis are important for those managers in a position to commission these staff and to those, such as trade unionists, who would seek to influence those in positions of power. It appears likely from the analysis of the findings that CFs will be useful to trusts in bringing about the required changes and in supporting front line staff in the increased workload that this new level of responsibility will bring about. Therefore, the use of the models devised in this thesis for identifying and implementing a successful CF role into an organisation's structure is recommended. This can be done by mapping existing or proposed roles to the diagram presented in the thesis as Figure 37 and attempting to move the sliders towards the values on the right of the continuum.

Conclusion 2

Ideally, the Department of Health and the professional regulator should recommend or stipulate the use of CFs in every trust. If this took place there would be no fear of being redeployed back into the direct-care workforce during times of financial pressure. This would enable an even more secure position for these valuable staff and encourage other equally highly qualified staff to join their ranks. The design of the role should be based on the ideal type identified in this research as figure 36 in the PhD thesis.

Supporting And Developing The “Educator” In The Clinical

Nurse Educator

Liz Allibone

Head of Clinical Education and Training

Royal Brompton and Harefield NHS Foundation Trust

What is the role of Clinical Nurse Educator?

Organisationally?

Nationally?

Internationally?

What is Known

» Isolating and overwhelming (Kelly et al 2002, Manning & Neville 2009)

» No clarity (Coates & Fraser 2014)» Insufficient support (Cangelosi et al 2009 )» Lack of preparation (Anderson 2009, Manning &

Neville 2009)

What is Known

» No consistent definition or job title (Conway and Elwin 2007, Pollard et al 2007)

» No national framework» No national career pathway» Valuable role but under researched

Local Role Variations

» Job description» Clinical background » Orientation » Clinical v formal teaching» Profile /networking» Supporting the manager » Supporting pre-reg students» Academic achievement

Focus Group Key Codes /Themes

» Role Definition“I found that I would be asked to do things and I would be

thinking that’s the manager’s role”‘it took me a long while to even figure out what my role really

was, because everyone was doing it completely differently.”

» Clarity“it wasn't clear what anyone wanted from me at all”“it’s just difficult to quantify sometimes what you do all day”

Focus Group Key Codes/ Themes» Clinical Facilitation

“it’s a bit like you're in the trenches together”

» Networking“I think we could gain a lot from each other if we weren’t scared

to talk to each other a bit more”

» Drawn“as soon as there is a problem everybody immediately runs to the educator”

Discussion

» No role clarity » Loss of identity» No career pathway» No clear agreement » Unsupported to meet Trust targets» Role tension » Visibility “prescribed” by manager

Respondents identified the “educator” remit as low priority,

conflicting with daily administrative, clinical and non-role related

demands

Conclusion

» The Practice Educator has the potential to be a powerful entity as a clinical expert and role model delivering national and local clinical nursing practice priorities

» The role should be supported to meet organisational targets

» A clear definition of work related role specifications is needed

Action PlanFramework Maintenance of clinical

credibility

Standardised orientation Standardised job description

Access to a mentor Formalised peer support

Opportunities to network Clinical link with HEI partners

Peer review of teaching Local and core strategic objectives

Framework

» Band 6 and band 7 roles» Clinical Care / Clinical Education » Management and Leadership» Service improvement» Recruitment and retention» Quality and patient safety» Research and Audit» Staff development» Teaching» Networking» Person specification

Framework for aspiration, development & success

We need a recognised Framework & Career Pathway for

the role of Clinical Nurse Educator

…..Organisationally ✔

Nationally…?Internationally?

ReferencesAnderson, J. K. (2009) 'The Work-Role Transition of Expert Clinician to Novice Academic Educator' Journal of Nursing Education. 48 (4) pp. 203-208

Cangelosi, P.R., Crocker, S. & Sorrell, J.M. (2009) 'Expert to Novice: Clinicians Learning New Roles as Clinical Nurse Educators' Nursing Education Perspectives. 30 (6) pp. 367-371

Coates, K., Fraser K (2014) ‘A Case for Collaborative Networks for Clinical Nurse Educators’ Nurse Education Today 34 6–10

Conway, J. & Elwin, C. (2007) 'Mistaken, Misshapen and Mythical Images of Nurse Education: Creating a Shared Identity for Clinical Nurse Educator Practice' Nurse Education in Practice. 7 (3) pp. 187-194

References

Creswell, J.W. & Plano Clark. V.L. (2011) Designing and Conducting Mixed Methods Research. 2nd ed. London: Sage.

Kelly, D., Simpson, S. & Brown, P. (2002) 'An Action Research Project to Evaluate the Clinical Practice Facilitator Role for Junior Nurses in an Acute Hospital Setting' Journal of Clinical Nursing. 11 (1) pp. 90-98.

Manning, L. & Neville, S. (2009) 'Work-Role Transition: From Staff Nurse to Clinical Nurse Educator' Nursing Praxis in New Zealand. 25 (2) pp. 41-53.

Morgan, D.L. (1998) ‘Practical Strategies for Combining Qualitative and Quantitative Methods ; Applications to Health Research’ Qualitative Health Research. 20 (5) pp. 718 -22

Pollard, C, Ellis, L., Stringer, E. & Cockayne, D. (2007) 'Clinical Education: A Review of the Literature' Nurse Education in Practice. 7 (5) pp. 315-322