As some of us break up for the festive holidays, I wanted to wish readers of this blog a happy time. I do appreciate that some of you will be working though. In our university we have a December graduation and it is always with pride and pleasure that I sit on the stage with my colleagues as we watch our students cross the same stage and be awarded their degree. The three or four years that the students have been on our courses seems to fly by for us - not sure if it is always the same for the students - and we can see the changes in them over that time. We have 'graduation stories' here, and it's interesting to hear about the challenges that some of the students deal with as they work their way through the course. I am amazed and humbled by their ability to juggle the challenges of the course with the personal circumstances that must take so much time in their lives. My PhD showed that some students manage these challenges and successfully complete (first year), while others find that they need to make the decision to leave. Amongst my conclusions was that (rather obviously) those who were highly motivated towards the profession were much more likely to stay than those who were ambivalent about nursing as a career. This issue is of real interest to me as I work with colleagues on a NES-funded project on selection processes for student nurses and midwives. Back to the graduation, and it is always a high point to end the year for those who have graduated and us as their lecturers.
Happy Christmas all!

An inspirational lecture by Professor Brendan McCormack of the University of Ulster ('Human flourishing through nursing research and development: seeing, appreciating, and making use of what is right in front of us) has set me thinking. The focus of his research is on the person at the centre of the care experience, and his lecture uses a number of examples of patient/carer voices that really bring home to the listener what it means to be on the receiving end of care. For me, it is this kind of research that makes a massive impact on the educational experience of student nurses. A couple of personal examples illustrate what I mean by this:

Gwen is a newly-qualified nurse who had a challenging educational pathway for a number of reasons. One of these reasons is that she developed breast cancer as a third year student. She is one of the most inspirational people I have met - genuinely. She quietly got on with her treatment, and then came back to our university and successfully completed her course. As well as this, she has developed a 'lecture' where she talks to our students about what it meant to her to be on the receiving end of care - what made it a 'good' experience and what made things harder for her. Gwen and I have written an article about her work with our students, and the ripple effect (as she calls it) of her shared reflective patient journey - the impact that her experience has had on the people that she has spoken to, the ones they have spoken to...... and so on. The article is in press and I will make sure I let readers of this blog know about it when it is published - Gwen is an eloquent writer.

A second example relates to my own experiences as a relative of someone who is on the receiving end of care on a fairly regular basis. My daughter has epilepsy and, although she has been fit-free for around 3 months now (touch wood!!), she has had a difficult few years. We have received amazing care from her specialist nurse and her consultant. And we had reasonable care when she was admitted this year in status. When she was taken into A&E with a smashed face following a fit in the High Street, care was ok. But what makes the difference is not the technical care (can't fault it), rather the artistry of care - the demonstration of care through the use of language, touch, a look. When that is missing, it makes one feel invisible and not important.

My aim is to help our students to understand how we can ensure that patients, relatives and their carers feel visible and important.

Always Events

The Picker Institute’s website provides a refreshing view of patient care. Discussing ‘Always Events’ they focus (rather obviously) on the things that one should always do when working with patients. The aim is to optimize patient care through events that are significant (i.e. fundamental to patient care), evidence-based, measurable and affordable (i.e. things that the organization can do without major resource implications). The focus on patient safety is absolutely crucial in the effort to improve patient care, but a renewed effort to meaningfully engage with patients and others to determine what should always be in place is energizing. Unsurprisingly, the key areas in which patients ask for Always Events include: respect; coordination and integration of care; information, communication and education; physical comfort. I am sure we would all say that we espouse these values and approaches to care, and in our relationships with students. For me, the Picker Institute’s work is a timely reminder as I work with my colleagues to develop the pre-registration nursing curriculum – with the person (patient, student) – at the centre of the experience.

Telehealth and nursing education

The RCN has commented on the Audit Scotland report A Review of telehealth in Scotland. The RCN's comment relates to the benefits to patient care that telehealth can bring. It also highlights the need for education and training of staff. What about student nurses? It is a key imperative in a technologically-enhanced healthcare context and one which educators of nursing will need to address within their curricula. One example of the way in which telehealth impacts on care is the Scottish telestroke programme. It highlights the aspirations that the Scottish Government has in achieving effective and sustainable 24/7 acute telestroke services. These kinds of developments will impact on our students while they are undertaking their courses and as they progress as qualified nurses. Telehealth champions have been identified in practice and in HEIs in Scotland and working together to take the agenda forward.

Leadership in nursing education

There is a great deal written about nursing leadership - in the research literature, policy (think clinical leadership) and in the national media. Leadership certainly seems to be at the heart of quality nursing practice. But what about leadership in nursing education? Leadership at all levels is vital to the development of innovative, creative, quality education. Leaders take measured risks; they experiment with a view to developing practice; they support others to be creative and to do things that are out of the ordinary. What we also need to do is to make sure that as we work differently in these evolving education and healthcare contexts, is to ensure that we find ways to build the evidence-base. I recognise that this is a challenge - funding is not always forthcoming for research in education, but there are real opportunities to understand the impact of changing educational provision on patient care and health outcomes. 

As part of my Florence Nightingale Leadership scholarship, I am obviously looking at my own leadership development with the aim of improving myself both personally and professionally. But one of the fantastic aspects of the scholarship is the opportunity that I have had to 'shadow' others - senior nurses, senior academics, senior police officers and others. As I think of the challenges of leadership in nursing education, evidence building and creativity in practice, I am pleased to have had the chance to see others' leadership in action.

Quality assuring nursing education

As I sit in the midst of my institution’s NMC Annual Monitoring visit, I am reflecting on the ways in which organisations work to ensure that the quality of their courses is of the highest standard. While the Monitoring Visits, and the other organisational quality assurance processes, are of absolute importance, I would suggest that quality assurance is an embedded feature of our everyday working lives. As an educator - whether in the university, in practice or both – we will all work towards the enhancement of the delivery of an educational experience for students that aims to prepare them as effective practitioners. I’m currently delivering a Clinical Leadership Masters module – an online module – and have worked very hard to provide creative learning materials and activities that will inspire the students to engage actively in the learning experience. Quality assurance for this comes through peer review, technological support, and external validation. Most importantly for me, the students’ responses to the activities and their ongoing feedback keeps my feet firmly on the ground, and my mind firmly focused on quality assurance and enhancement.

My own view is that the monitoring of quality is a learning opportunity – as well as an opportunity to celebrate what others tell us we are doing well. I personally experience this in my work life every day.

Welcome to new bloggers! And thinking about pre-registration nursing education

I have had a number of queries from people about this blog – how to sign up. All you have to do is click on the ‘sign in’ on the top right of the blog page. If you don’t have a Google account, you will be asked to sign up but you can use your work or home email – no need to create a new email! I hope that works but email me outside of the blog if anyone is still having problems.

For those of you who are not used to the world of blogging I am pleased to be engaged in this new venture with you! If you’re familiar with blogging, I’ll look forward to sharing discussion and debate with you. If you are interested in having a ‘guest’ blog – just let me know. The greater the debate around the issues that affect nursing education, the better from my perspective.

As we embark on a new academic session, it is always pleasing to see the new students (keen and enthusiastic, finding their way), and the students who are entering into a new academic year. In my institution, we are currently developing the pre-registration programme for the implementation of the new NMC standards. We have been engaging with students, clinical staff, service users, and academic staff with the aim of having early conversations so that we can take on board views, evidence, feedback in a meaningful way. This aspect of the development work links directly to the focus for my Seattle visit (mentioned in an earlier blog) in which I aimed to come to a stronger understanding of how approaches to partnership, collaborative working relationships can blur the boundaries between the groups of people who are working towards a common goal (in this case the development of a curriculum that is fit for purpose and which ‘produces’ graduates who can take on the evolving demands of working in the future healthcare environment). What I learnt in Seattle was this (amongst other things): we need to find ways to celebrate the good that we do, the progress that we make, the leadership that we see across organisations, and the ideas that we have. Partnership working is such a complex area – one which is dependent on so many variables – that making them work is sometimes a challenge. I am pleased to be working in an environment where we can have open conversations with the relevant people, and where we are all working towards a common vision – of the development of practitioners who make a positive impact on practice.

Blogging confidence

After a short break from the blog having been away in Seattle, I plan to increase the blog membership through wider dissemination to colleagues locally, nationally and internationally. As a relative newbie to the form, blogging takes some commitment, a focus, and confidence! If I'm hoping to engage in wide debate, I had better get the blog 'out there', or I will be writing to myself:-)

So, if you are reading this, and you feel there is scope for more of us to get talking here, do feel free to pass the blog address on. Let's see if we can create some notable debate!

Seattle - but not sleepless

I'm in Seattle at the moment as part of my FNF leadership scholarship. I have had three fantastic days with faculty from Seattle University, University Washington Bothell and Renton Technical College. I had the privilege of being invited to the Puget Sound Consortiuum which is working to achieve a streamlined approach to clinical placements (as well as finding ways to increase capacity and deal with quality issues). They were fascinated to hear about the UK system but, despite the very different contexts we operate in, we are facing many of the same issues. I'm hopeful that we can sustain ongoing connections so that we can learn from each other. One of my areas of interest is retention and selection of student nurses - we had some valuable discussions about the contexts of nursing education, the impact on retention, and the factors that affect students in the States. Again, a different context but broadly similar issues.

I had an amazing day at RTC where I was invited into a reading programme for new student nurses which aims to connect students with academic reading and concepts. I'll be looking into this when I come home as there is much to learn from the approach. My favourite part of the day was when I was taken into a completion ceremony for (the equivalent of) the nursing auxiliary course. The people that I met have overcome major domestic, financial and learning barriers and it was an emotional ceremony that saw them receiving their certificates and looking to a future that they could only have dreamed of before coming into the college and being taught by their inspiring teachers.

I feel that I have caught something of the American positivity in the few days that I have been here. The welcome I have been given has been immense and I hope to continue the conversations that we started when I get back to the UK.

Globalisation

I'm off to Seattle next week to meet with academics from two universities. It's a real opportunity to compare their healthcare issues and nursing education with what's going on in Scotland and the UK. Having read the document that is proposing the way forward for nursing in the States, it is clear that (while there are some contextual differences) the key issues are the same. The drive for safe, efficient and person-centred care seems to lie at the heart of the debate, as it does here. The shift towards degree education (with an aim of 80% degree output for the States) mirrors the policy shift in the UK. I will be interested to talk to Seattle colleagues about curriculum, selection of students, and the future of healthcare. Interesting times, and a real opportunity to learn something more about international healthcare.

Reflection on curriculum development

With the new NMC standards, we are all embarking on (or have completed) curriculum developments which aim to enhance the education that we offer. We have many drivers - the NMC requirements, service requirements, policy drivers, student experience and feedback...... How we manage all these is a matter of developing approaches to communication that enables all of the stakeholders to meaningfully engage in the discussion and critical debate that enables the development of curricula that will impact positively on practice. My own experience is one where we aim to diminish the boundaries between practice and university learning through the development of great working relationships with our stakeholders. After all, we are all aiming to do the same thing - provide students with an excellent education that will enhance the service delivery both in the short term and in the longer term. The ever-evolving nature of healthcare requires that we produce graduates who can take forward practice innovatively and who can contribute to the evidence-base that will ensure that nursing practice continues to evolve positively.

Getting older.....

Having just had another birthday I started thinking about getting older and where the healthcare system will be when I am in need of it. As an educator I feel that I am in a position to influence the healthcare of the future, but we will have to work together towards a coherent vision for the future. Blogs and other social media are one way to generate ideas and vision - I plan to engage with others in similar educational roles and pursue a national conversation on nursing education and the key issues that excite us.

Public involvement in nursing education

A key challenge in any nursing education provision is meaningful public involvement - in the development of the education, its delivery and in the wider aspects of assessment in practice, selection of students etc. While there does not appear, so far, to be a strong evidence-base for public involvement, it is intuitive to me that service users, carers, and others should be involved in the work that we as educators do to develop practitioners who are fit for purpose and practise. There are many ways in which we can work with the public - through the use of volunteer patients, through forums within the community, through links and networks that feed into the work of education providers..... If we are to educate practitioners who can provide person-centred care, we absolutely must engage with the public as an integral part of the development of our programmes.

Partnerships

I'm back to one of my current key areas of interest  - the partnerships that are forged between service providers and universities. I have re-read an interesting article in Nurse Education Today (Casey, M., 2011. Interorganisational partnership arrangements: A new model for nursing and midwifery education. NET, 31, 304-308) in which the obvious (but very pertinent) assertion is made that the development of nursing education requires support from both clinical and academic partners. Casey points out that the implementation of frameworks for partnership working will facilitate a responsive approach to the development of education for contemporary nursing practice. Her model incorporates context (the purpose of the partnership), environment (internal and external factors and relationships), input (an implementation strategy), processes (e.g. decision-making, conflict management), skills (in the facilitation of collaboration), outcomes (the resulting interactions), and the role of co-ordinator (for the building of strategic alliances) as the core concepts of a framework for partnership. None of these come as any surprise, but what is useful is to see them together within a framework as a basis for taking partnership working forward. I am sure that we all do well in some of the areas - but do we take a strategic and planned approach within a framework of engagement for our partnership working?

Interprofessional education

I am writing a book chapter with a social work colleague on interprofessional working. As I wade through some of the literature (with which I am relatively familiar), I have been interested to see that the arguments and discussion points remain broadly similar to those presented 10 years ago (working in 'silos' is not good for the service user experience, the barriers to IPW are many and varied, the terminology is challenging, etc etc.). In reflecting on this literature, I can't help but think about the interprofessional education that many of us 'provide' within our curricula. At my university, we aim to help students from a wide range of professions consider the processes and structures which enhance interprofessional working, and to consider the potential for positive impact on care. At a national level a Score (Scottish Common Core Curriculum) project completed but never really seemed to get off the ground. At a policy level we are absolutely striving for a unified approach to care. I wonder how best to work with our students across the professions as we move towards achieving this aspiration?

"Being ill is an education.....'

Yesterday's Guardian had an interesting opinion piece by Mike Marqusee (the fuller version of which will be published in the August issue of Red Pepper at http://www.mikemarqusee.com). He was talking about what he has learned through his experience of living with multiple myeloma for the past 5 years. With a focus on independence/dependence, he highlights the delicate balance of attaining independence in a situation where he is (was) dependent on so many things (the advancement of science, the network of people who supported his experience, the social developments that determine the focus of care....). Key within this article for me was the quote, "I'm being kept alive by the contribution of so many currents of labour, thought, struggle, desire, imagination. By the whole Enlightenment tradition, but not only that: by older traditions of care, solidarity, mutuality, of respect for human life and compassion for human suffering." How pleasing that this person's experience reflected these human attributes that are core to caring. Whilst struggling to be autonomous, Marqusee acknowledges the need to be dependent on others in order to achieve independence through support, advocacy and allies. These are attributes for nursing and helping students to achieve their potential in these areas is vital for the continuing development of compassionate care within a highly educated workforce.

Education - Practice partnerships

One of my areas of particular interest is the partnerships that we all strive to achieve when working together to support and develop student learning. For me at the moment, my primary area of work relates to pre-registration nursing education. With the implementation of the NMC's new standards we are developing curricula that will impact on both the type of student, and the type of practitioner, that will be in practice. To achieve a joined-up approach to the development of these curricula we absolutely must work together in real partnerships to achieve meaningful integration of theory with practice. In an edition of RCN's Edlines earlier this year, I highlighted the ongoing 'divide' that students still sometimes see between what they learn in university and what they learn in practice. How can we all work together to achieve the best fit between education and practice so as to ensure that the practitioners that we educate are the ones that will work with current practitioners to take forward service developments for the enhancement of patient care?

Creating connections – using the RCN Education Forum to start debate

As a new member of the RCN Education Forum committee, I wanted to find a way to engage with the membership in Scotland where I am based. My purpose was to determine whether there was an appetite for discussion and debate around educational issues within such a forum, and if so what these might be. Additionally, I wanted to try out ways of connecting to see what might work best for professionals working in disparate working environments and with geographical remoteness. The networks that I currently have led me to think that there could be some value in creating connections with those of you who are in the Education Forum and who work in Scotland. Colleagues elsewhere are looking with interest to see how this small experiment goes.

Those of you who are Scotland-based may remember receiving an email from me (through RCN communications) asking:

·       What area of practice are you in, and what is your role as an educator?

·       What are the key issues that you think would be useful to discuss and debate at a national level through this forum as Scotland based members?

·       Do you see any further benefits (on top of an opportunity for discussion and debate) to coming together (probably virtually) as Scotland based members? If so, what do you see as these benefits?

I have been delighted with the response to the email and provide here an overview of the issues that people have raised and on which they would value further discussion. Those who responded came from a wide variety of backgrounds: Telemedicine, Practice Nursing, Practice Educator and Clinical Nurse Educator roles, Research, Academic roles, NHS24, Theatre, Addiction Services, Community, Learning and Development. Many of us have strategic links with bodies such as the Scottish Government Health Directorates, NHS Education for Scotland, and NHS Scotland.

A number of particular challenges were identified associated with specific specialities (for example the challenges associated with accessing relevant dietetic input and the problems surrounding obesity in Scotland, and challenges relating to student nurses gaining access to full placement experiences with practice nurses). In addition, more general challenges were highlighted and these will probably be familiar to all of us – the impact of the economic environment on staff development and quality, and something around the challenges associated with sharing practice and thereby enabling others to access tools, approaches, and education rather than ‘reinventing the wheel’.

There appears to be a great deal of interest in having a ‘Scottish’ voice within a UK context – personally I see this as a Scotland-based voice which may facilitate wider discussion across the UK where we face similar challenges and opportunities albeit within political contexts that vary. As one person suggested, our connection could be a means to influence local, Scotland-wide and UK educational and professional networks. Of particular interest to those who responded to my email were some of the following issues:

• Telehealth and education for undergraduate nurses, and qualified nurses.
• Advanced Practice and Health Care Support Worker – roles and regulation.
• Assessment competence within NHS24.
• Support of the NHSScotland Quality Strategy.
• Harmonisation of skills education to avoid duplication.
• Nationally recognized generic awareness of addiction practices.
• Newly-qualified roles and support in practice.
• Use of guidelines.
• Partnerships between education practice, and how we can blur those boundaries (something that I have written on in Edlines before).
• The implementation of the new NMC Standards for Pre-registration Nursing Education.
• Dissemination of processes and knowledge gained through the development of education and training.
• Opportunity for networking.

What this tells me is that we are looking to connect - we are confirming that we want to debate important issues, and we are recognizing that networking virtually with colleagues across the country could add value to our working practices.

Taking this forward this professional blog aims to provide a forum where we can get agitated and creative and celebratory about what we need to change, how we can change it, and what we are achieving in our daily working lives.

I look forward to further engagement with my colleagues, and hope that the connections we create will also create something new in our thinking in Scotland.

Welcome

Welcome to my new blog. As you will see, the aim is to create some debate and discussion around the issues that are important to nursing education. I plan to post once a week so that we can connect with each other regularly. As a committee member of the RCN Education Forum, I will be inviting my colleagues from the forum to engage with the discussion in the first instance. 

See you soon. Going live this week.