I have been reflecting on the first season of ‘This is Going to Hurt’, based on the book of the same name by Adam Kay (https://www.bbc.co.uk/iplayer/episodes/p0b6k5gx/this-is-going-to-hurt). The story centres on Adam Kay's experience of a being a junior doctor, in training to become an obstetrician. It shows, from Adam Kay's perspective, the pressures the NHS is under to meet demand and the pressures junior doctors can be under to work in such a pressured and stretched environment, while learning the specialism itself and teaching those more junior than themselves.
While the programme is for entertainment not information, it did make me consider the parallels with nursing, and specifically, the ways in which nurses in primary care learn their specialism, teach others more junior than themselves and all the while delivering on their own job in the pressured environment of general practice.
In the show, Adam Kay's character, faced with another impossible clinical decision for his level of experience, uses the phrase ‘see one, do one, teach one’ – an approach in nursing we have been trying to eradicate for decades. But we also know that teaching student nurses and colleagues less experienced than ourselves can be time consuming and is often the first aspect of our work to be deferred when patients are waiting for care.
Retention of the workforce
Robust education, teaching, supervising and assessing learners are all essential elements to consider in relation to patient safety – but also to the retention of the nursing workforce. If a nurse is not confident in their knowledge and skills, they are more likely to leave the profession, as they will not feel safe to do their work. We know this through the feedback we receive from Queen's Nursing Institute (QNI) network members, but it is also logical that self-confidence, based on robustly taught and assessed clinical knowledge, skills and expertise, is essential for safe care.
Feedback to the QNI from our network members has however highlighted that there is an emerging challenge with the loss of the Practice Teacher role. This followed the Nursing and Midwifery Council regulated standards for teaching and learning being replaced with the practice supervisor and practice assessor standards in January 2019 (NMC, 2019).
‘Robust education, teaching, supervising and assessing learners are all essential elements to consider in relation to patient safety – but also to the retention of the nursing workforce.’
National standards for Practice Teacher Education and Practice
Responding to the feedback we have received from practice, the QNI is developing national standards for Practice Teacher Education and Practice which will be available for all universities and providers who wish to continue to develop their own programmes and support the role. Some university programmes have continued, based on demand from providers using CPD funding – and local agreements with universities – to guarantee the viability of the year-long part-time programme.
Nurses undertaking the Specialist Community Public Health Nursing (SCPHN) or the Specialist Community Practitioner (SPQ), which includes general practice nursing, had for many years benefited from the expertise of the Community Practice Teacher (CPT) in teaching, learning and assessing when developing skills at an advanced level of practice. Arguably, this would provide an excellent opportunity for learning for those who are responsible in practice for teaching nurses and other clinicians who are undertaking the advanced clinical practitioner programmes too.
The risk of the removal of the regulatory standards for the Practice Teacher programme is that it signals to the profession that there is no longer a need for a specific teaching role in practice, focused on the quality of the learning environment and the experience of all learners and delivered within a senior clinical role. The response from the profession to the QNI creating new Practice Teacher standards has been overwhelmingly positive and the engagement and support for this work in all the focus groups we have held with all levels of nurses, has been excellent.
The QNI standards for Practice Teacher Education and Practice will be published in the summer of 2022 and we look forward to creating more. We owe it to our patients to ensure these are then adopted in practice nationally.