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A lecturer-practitioner's contribution to the Health Visitor Implementation Plan in East London.

Introduction

The role of lecturer-practitioner arose in the 1980s in an attempt to bridge the perceived theory-practice gap (Hancock et al, 2007). Initially established in the clinical acute setting, the role continued to develop into the community arena. The role can be described as being suitable for a senior nurse who demonstrates specialist knowledge in the areas of practice, education, management and, ideally, research.

My nursing background, predominately in health visiting, captured the role prerequisites for a lecturer-practitioner, offering credibility to the dual aspects of teaching and being a practitioner. A dual role that straddles both education and health necessitates a joint and clear focus of how the role should work so there is no confusion or ambiguity in the expectations of the role. The demands of a dual role (academic vs practice) and being able to combine both cultures is a challenge (Fairbrother and Mather, 2004).

I was fortunate that there was a strategic desire to blend the contribution between academia and practice, and an intrinsic foundation of support in working within the boundaries of the Implementation Plan, both at university and in practice. At University London, I taught on the specialist community public health nurse (SCPHN) programme, and I got to know my Hackney SCPHN students very well, being visible and accessible to them both at university and in practice. This was an advantage as I possessed knowledge of their progress academically via the classroom and being their link tutor, and I understood their practice environment and the challenges that this presented to them.

I worked closely with the director of the SCPHN programme and the trust's health visiting head of service (HOS), meeting quarterly to review my progress as a lecturer-practitioner, setting new objectives as necessary. It was here that my idea of 'learning in practice' (LiP) was put forward. My primary designated objective was to contribute to the Implementation Plan's aspect of 'growing the workforce'. For the academic year 2011/12 the organisation was committed to significantly increasing the number of SCPHN students that could be accommodated from two to nine, requiring a corresponding increase in practice teachers (PTs). Working in collaboration with the trust's education lead and three existing experienced PTs we were able to support a further six student PTs who were recruited internally from a pool of experienced health visitors.

Figure 1 shows how each experienced PT would oversee the two student PTs, each having a student, including the experienced PT, enabling the proposed nine SCPHN students to be supported in practice by three experienced PTs.

Undoubtedly, the increase in PTs' workload impacted upon the health visiting teams, and increased the pressures in being able to deliver the service--a new way of working--to our clients. Nursing and Midwifery Council (NMC) guidance (NMC, 2008) requires PTs to maintain their competencies as a teacher in practice, meet the requirements for their triennial review and to attend regular study days at university, as well as being able to facilitate the learning of their assigned student and manage an active workload. This, in part, was achieved by raising the profile of PTs and their essential role in facilitating students in the context of their team. Discussions with PTs and their colleagues assisted in adapting to different ways of being a team with a SCPHN student.

For a number of years, before it became an Early Implementer Site (EIS) in 2011, a low number of SCPHN students were being placed in Hackney so the expectations of the nature of learning and the benefits of having students needed to be restated. They would, after all, be our future colleagues. The PTs were balancing the demands of complex workloads in one of the most deprived boroughs in the country, adapting to new ways of working and I was asking them to participate in developing a LiP environment in addition to their own teaching in practice.

Learning in Practice workshops

To develop a learning culture is to recognise the challenges to be overcome and, importantly, the potential to increase staff motivation and commitment. Working closely with the PTs, the responsibility lies with the lecturer-practitioner to constructively align theoretical input with experience in practice placements to ensure students have a smooth transition to a new way of working. A major consideration for PTs was that they were not having to provide all the experience and learning. They could share their own knowledge and skills in a supportive environment, coming together on a regular basis, which benefited the SCPHN students. Having previous experience as a PT, I possessed a real understanding of and insight into the responsibilities and accountabilities in facilitating a student's learning. At the same time I was able to maintain a degree of objectivity in what was needed to be achieved en route to qualification.

The LiP programme was developed in agreement with the director of the SCPHN programme at the university and the trust education lead. The HOS provided an overview of what was being developed under the guise of the Implementation Plan. The overall aim was to blend the growing newly acquired knowledge, skills and expertise of the student without duplicating the input of the university or their PT through a series of LiP workshops. Each workshop was planned with a theme, with the choice of topics arising from feedback provided by the previous year's SCPHN students and as identified by the current cohort. This included perceived gaps in theoretical input, primarily around child development and referral systems.

A series of 10 2.5-hour informal workshops were developed, running every five to six weeks, aiming to be inclusive of both the health visitor (HV) and school health SCPHN students.

Although school nurses are not part of the Implementation Plan, it was felt that they were an integral part of the community nursing family. They worked closely with their HV colleagues and this promoted an exchange of ideas and perspectives. The workshop sessions were themed, with their duration and frequency agreed with the university. This ensured that the sessions did not negatively intrude into practice time, met the requirements of practice and provided sufficient time to be meaningful and worthwhile to attend.

The sessions were held in a variety of accessible venues across the trust, including HV bases and an assessment centre for children with special needs. The workshops were also aimed at those new to being a PT, offering the opportunity to develop teaching and presentation skills. As Hackney lecturer-practitioner I co-ordinated the workshops and oversaw the running of each session, booking in-house speakers and venues. This was intentional as I felt that although I was competent to teach or present, the focus should be upon the PTs or other specialist practitioners, sharing their knowledge and skills rather than academic input per se.

Where possible the timing ie, the date for each session, was aligned with the modules at university and what the students were doing in practice. The sessions were usually led by a PT or speakers with a specialist interest who were offered a remit to fulfil. The first session was felt to be particularly important as it set the scene for the coming academic year, and provided the opportunity for the SCPHN students to be introduced to each other (outside of the university) and other key staff members of the health visiting service. See Table 1 for a list of the workshops held.

Evaluation by students

The students were asked to evaluate at the end of each session using a standard trust evaluation sheet. Towards the end of the workshops the students were also asked to evaluate their overall experience of the LiP sessions, to gauge whether the students' needs were met and what could be improved for future cohorts of students. Students were asked to complete an anonymous questionnaire regarding their views about:

* What they liked about the sessions

* How the sessions could be improved

* What could be undertaken differently

* The frequency and duration of the sessions

* Any other points.

The workshops were well evaluated by the students and it was clear from their comments that they viewed the sessions as being complimentary to their academic work and to be able to relate their experiences to practice.

'The sessions were really relevant to my practice placement experience and the theory to practice.

The initial 'meet and greet' as an afternoon tea, timed for the second week in practice, proved useful in welcoming the students to Hackney, away from the university. This was attended by the HOS, education lead, other team leaders and myself.

'It was good to have the meet and greet as it made me feel welcome.'

An unexpected positive outcome was the value placed on meeting the managers within the health visiting and school health services. The students were interested in the role of managers as leaders and were already contemplating the possibility of future opportunities, whether:

'This was somewhere I could work when I completed the course.

The trust also recognised the value in the sessions as potential for retaining new members of staff by demonstrating a keen commitment to learning.

The sessions led by the head of service provided the opportunity to understand how the wider public health role was being developed in the context of the

Implementation Plan, which the students were beginning to feel an integral part of:

'Good to see how current practice is implemented.'

The planning of the sessions considered the appropriate time, duration and frequency of the sessions that required a blending of theory and practice without being intrusive into the NMC requirements regarding teaching and practice hours (NMC, 2008). Interestingly, the students would have liked the sessions to have been held more frequently:

'The sessions were insightful.'

'Once a fortnight would be better as we could have more sessions including reflective practice.'

Other comments included:

'It has been good to meet up with other students in practice as they are my future colleagues, and therefore good for working relationships.'

'It is good to hear other people's experiences.'

'Very good programme to be continued with other students.'

Conclusion

The balance between developing a new idea in practice, adhering to NMC requirements for SCPHN students and working collaboratively with all stakeholders were met. Developing the LiP sessions was not without its challenges however. Managing demanding workloads and meeting the needs of their student, coupled with staff shortages would prove difficult for the PTs. They found it a challenge to maintain a sense of continuity in attending the sessions when they were not leading on a session, while actively encouraging their student to attend.

This was a particularly successful year in terms of recruiting and retaining staff, with all but one of the students upon qualifying securing posts within the trust. This student accepted a post nearer to where they lived, thus reducing their travelling time. For the following academic year, three students PTs achieved their award, resulting in the service having six PTs with sign-off mentor status and accountable for stating that a SCPHN student is fit to practise. This allayed fears around the PTs being able to manage their workloads and their teaching responsibilities. Anecdotal feedback from the teams around the students reported that, overall, they welcomed a SCPHN student within the team, not least as they offered new insights and perspectives around the Healthy Child Programme (2009).

In reflecting upon the planning for future cohorts of students and in meeting their needs to embed 'best practice', the LiP model allows for a degree of flexibility to meet identified learning needs. This can enhance the experience for the SCPHN students examining local and national issues. The increase of PTs offers the opportunity to further strengthen the learning environment for students, and to progress the LIP model, demonstrating leadership skills. There is scope also to embed real joint learning between health visitors and school health students.

Key points

* Health Visitor Implementation Plan: Growing the Workforce

* Lecturer-practitioner role in supporting practice teachers and an increase in SCPHN students within practice placement areas

* Supporting a SCPHN student network in practice

* Learning in Practice

Community Practitioner, 2013; 86(8): 29-31.

No conflict of interest declared.

Acknowledgements

I cannot conclude without acknowledging the support and understanding of the HOS and team managers, as without their support the LiP would not have been as successfully completed. I also would like to acknowledge the support of the director of the SCPHN programme who understood and approved the LiP and was excited by this development in practice.

References

Department of Health (DH). (2011) The Health Visitor Implementation Plan: A Call to Action 2011-2015. London: DH.

DH. (2009) Healthy Child Programme: pregnancy and the first five years of life. London: DH.

Fairbrother P, Mathers N (2003) Lecturer-practitioners in six professions: combining cultures. J Clin Nurs 13: 539-46

Hancock H, Lloyd H, Campbell S, Turnock C, Craig S. (2007) Exploring the challenges and successes of the lecturer-practitioner role using a stakeholder evaluation approach. J Eval Clin Pract 13(5): 758-64.

Nursing and Midwifery Council (NMC). (2008) Standards to support learning and assessment in practice. London: NMC.

Ann Russell SRN SCM Dip PgDip Lead Professional Health Visiting Kent Community Health Trust

Correspondence: ann.russell@kentcht.nhs.uk

Table 1. Learning in Practice workshops

Session 1    Meet and greet          Opportunity for students
                                       to meet with each other
                                       in practice, PTs, education
                                       lead, head of service,
                                       other managers and the
                                       lecturer-practitioner
Session 2    First contact visit     How to undertake the first
                                       visit to a client in the
                                       home or school setting.
                                       Led by a PT
Session 3    Speech and language     Led by a speech and language
               development and         therapist and a PT
               referral systems
Session 4    Implementation Plan     Led by head of service
               update
Session 5    Working with children   Led by specialist nurse
               with special needs
               and their families
Session 6    Preparation for         Led by PT
               consolidated
               practice
Session 7    Child protection: Q&A   Led by named nurse for
               session                 safeguarding
Session 8    Immunisation            Led by specialist nurse
Session 9    Personal health and     Led by specialist nurse
               social education
Session 10   Bringing it all         Education lead
               Together
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Title Annotation:PROFESSIONAL AND RESEARCH: PEER REVIEWED
Author:Russell, Ann
Publication:Community Practitioner
Geographic Code:4EUUK
Date:Aug 1, 2013
Words:2339
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