Transcript An Investigation into the Effects of Clinical Facilitator

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
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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 1
Recommendations for Action
The 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
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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 Plan
Framework
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
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Band 6 and band 7 roles
Clinical Care / Clinical Education
Management and Leadership
Service improvement
Framework for
Recruitment and retention
aspiration,
Quality and patient safety
development &
Research and Audit
success
Staff development
Teaching
Networking
Person specification
We need a recognised
Framework & Career Pathway
for the role of
Clinical Nurse Educator
…..Organisationally ✔
Nationally…?
Internationally?
References
Anderson, J. K. (2009) 'The Work-Role Transition of Expert Clinician to
Novice Academic Educator' Journal of Nursing Education. 48 (4) pp. 203208
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