Cath Gordon from Radiotherapy (Lecturer/Admissions tutor and Year 1 tutor) Cathy Fletcher from Nursing (Lecturer/Practice Placement coordinator)

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2 Great Expectations: A study to compare and contrast the expectations of radiotherapy students with those of nursing students at the University of Liverpool. Cath Gordon from Radiotherapy (Lecturer/Admissions tutor and Year 1 tutor) Cathy Fletcher from Nursing (Lecturer/Practice Placement coordinator)

3 INTRODUCTION BSc(Hons) Radiotherapy 3 year pre-registration vocational programme Blocks of clinical placement in between academic study Entry criteria BBB at A level Leads to registration with the Health and Care Professions Council (HCPC) Clinical role of Band 5 therapeutic radiographer Bachelor of Nursing (Hons) 3 year pre-registration vocational programme 50% theory 50% clinical placement Entry criteria: BBB at A level Leads to registration with the Nursing and Midwifery Council (NMC) Clinical role of band 5 registered nurse. 3

4 BACKGROUND Attrition rates for radiotherapy programmes have been historically higher than other healthcare programmes. > For 2010/2011 it was 36.5% (Jewell, 2012). Nursing programmes historically have had attrition rates as low as 1.6% (Clover, 2011). > However, in 2014 the attrition rate across the UK was close to 20% (Merrifield, 2015). Attrition rates for healthcare programmes coming under the microscope (Bowden, 2008; College of Radiographers, 2012; Beardmore, 2013). Attrition can impact upon both workforce planning and ultimately patient care (Hamshire et al., 2012). 4

5 LITERATURE REVIEW The literature identified that individual expectations, can have a profound impact upon students perceptions of their learning experiences and ultimate decision to continue or leave. White, et al. (1999); Glossop, (2001); Glossop (2002); Deary, et al.(2003); Last and Fulbrook, (2003); Stott, (2006); Zysberg and Zisberg, (2008); Orton,(2011); Hamshire, et al., 2013; Hamshire et al., and McKendry et al., (2014) 5

6 METHOD: STAGE 1 Ethical approval by IPHS Research Ethics Committee prior to study commencing. Design of 1 st prospective questionnaire. Included three key areas: Academic expectations Clinical expectations Practical expectations Timing- week one, semester one of year 1.

7 METHOD: STAGE 2 Same cohort of students Design of 2nd retrospective questionnaire: Same three key areas: Academic expectations Clinical expectations Practical expectations Timing- week one, semester one of year 2. 7

8 THEMATIC ANALYSIS Miles and Huberman (1994) analysis tool used > This approach consists of three procedures which are data reduction, data display and conclusion drawing. Initial data reviewed independently. Independent findings compared. Key emergent themes identified. Emergent comparable and contrasting themes highlighted. 8

9 STAGE 1 COMPARABLE EMERGENT THEMES Support Approachability of staff Importance of the role of mentor/educator Preparation for practice Academic support Communication Interacting with patients Understandable feedback from staff and mentors/educators Terminology-use of jargon Confidence Clinical skills Use of equipment Hands on care Time management/shift work 9

10 STAGE 1: EXAMPLES OF COMMENTS Support Support from my mentor including emotional support as well All the help and support they can give as I will be scared and nervous. Communication Be able to communicate with service users To be able to ask them[clinical staff] any questions I have about placement. Ask them for advice. Confidence I want to be more confident in my clinical skills More confidence to do the activities without feeling worried if I do it wrong. 10

11 STAGE 1: CONTRASTING EXPECTATIONS Radiotherapy: Many felt their role was largely to observe. Gaining insight before taking a more active role. To have a largely observing role with increasing amount of involvement as the year progresses. Nursing: Caring for a person who is dying or has died emerged as a concern. Caring for patients needing end of life care. Dealing with patients who are dying or have died. 11

12 STAGE 2 Second questionnaire retrospective Timing- week one of semester 1, year 2. Same cohort Compare the data from both questionnaires. o As Crombie et al., (2013) noted experiences in clinical practice have the greatest influence on students desire to stay on a programme. 12

13 STAGE 2: COMPARABLE EMERGENT THEMES Support Supportive staff Mentor/educator generally very supportive They felt prepared for practice Academic support vital Communication Increased confidence in interacting with patients Feedback from staff and mentors/educators constructive Confidence Greater confidence in clinical skills Use of equipment Hands on care Time management/shift work Greater awareness of career pathway 13

14 STAGE 2: EXAMPLES OF COMMENTS Support Communication Confidence Very good emotional support Great support. Some new radiographers I met were very helpful and treated you like part of the team. Stood back and let students learn. I feel I can communicate better with service users [Most enjoyable aspect of placement] Talking to patients and building a rapport. Being comfortable within the ward setting To develop further to carry out more roles and gaining confidence along the way. 14

15 STAGE 2: CONTRASTING EXPECTATIONS Radiotherapy: Nursing: [Practical skills still required] To apply the technical knowledge learnt at the university. Adapting to differences between satellite centres and main site. The time it took to travel there and back to placement was more than I expected Having more time off during placement 15

16 LIMITATIONS Hawthorne effect- students may have felt unable to give frank answers. Researcher bias during data analysis. (To address this we would used others to analyse data in the future.) Question interpretation. (Several students did misunderstand questions.) Pilot of questionnaire to address this. 16

17 WHAT HAVE WE LEARNT? Therapeutic Radiography Career expectations - some unrealistic? Increase in student support expected both clinically and academically. Nursing: Increased Academic Advisor support meetings both in university and clinically Increase in content on death and dying in year 1. 17

18 CONCLUSION Expectations were high but generally realised. Academic support invaluable need to maintain the high level of support. Clinical support essential to support student development and continuing engagement with the programme. 18

19 LINK TO STUDENT RETENTION? Radiotherapy 2016/17: cohort of 30 attrition rate 0%. Compared to 2014/15 cohort of 28, 3 have left (11%). Nursing retention 2016/17: cohort of 60 students 4 have left (6.7%). Compared to 2014/15 cohort which had an attrition rate of 33%.

20 Any questions? 20

21 References Bowden, J. (2008) Why do nursing students who consider leaving stay on their courses? Nurse Researcher. 15: (3), Beardmore, C. (2013) Improving retention of the radiotherapy workforce-the role of practice placements in student attrition from pre-registration programmes in England. (Accessed 12/5/15) Clover, B. (2011) Huge fall in nurses dropping out of nursing courses. Nursing Times. 27 th September. Crombie, A., Brindley, J., Harris, D., Marks-Maran, D., Morris Thompson, T. (2013) Factors that enhance rates of completion: What makes students stay? Nurse Education Today, 33(11), Deary, I. J., Watson, R. and Hogston, R.(2003) A longitudinal cohort study of burnout and attrition in nursing students. Journal of Advanced Nursing. 43, 1, Glossop, C. (2001). Student nurse attrition from pre-registration courses: investigating methodological issues. Nurse Education Today, 21(3), Glossop, C. (2002). Student nurse attrition: use of an exit-interview procedure to determine students' leaving reasons. Nurse Education Today, 22(5), Hamshire, C; Willgoss, TG: Wibberley, C. (2011) The placement was probably the tipping point. The narratives of recently discontinued students. Nurse Education in Practice, 12, Hamshire, C., Willgoss, T.G., Wibberley, C. (2012) Should I stay or should I go? A study exploring why healthcare students consider leaving their programme. Nurse Education Today, 33(8) pp

22 References.. Hamshire, C; Willgoss, TG; Wibberley, C. (2013) What are reasonable expectations? Healthcare student perceptions of their programmes in the North West of England. Nurse Education Today, 33, pp Health and Care Professions Council. Standards of Education and Training. London: Health and Care Professions Council, (accessed 10/04/15) Jewell S. Therapeutic Radiography Attrition Update paper. Society and College of Radiographers Last, L., and Fulbrook, P. (2003). Why do student nurses leave? Suggestions from a Delphi study. Nurse Education Today, 23(6), McKendry, S., Wright, M., Stevenson, K. (2014) Why here and why stay? Students' voices on the retention strategies of a widening participation university. Nurse Education Today, 34(5), Merrifield, N. (2015) Review identifies vital need to find out why student nurses drop out. Nursing Times. March 12 th. Nursing and Midwifery Council (2010) Standards for pre-registration nursing education. (Accessed 4/3/15) Orton, S. (2011) Re-thinking attrition in student nurses 22

23 References Polyani, M. (2009) The tacit dimension. Chicago: University of Chicago Press. Schwind, J. K., Zanchetta, M., Aksenchuk, K. and Gorospe, F. (2013) Nursing students international placement experience: an arts-informed Narrative Inquiry. Reflective Practice. 14, 6, Schyns, B., Tymon, A., Kiefer, T. and Kerschreiter, R. (2012). New ways to leadership development: A picture paints a thousand words. Management Learning. 0, 0, The College of Radiographers. Analysis of students and recent graduates survey London: The College of Radiographers, (Accessed 10/4/15) White, J., Williams, R. W. and Green, B. F. (1999) Discontinuation, leaving reasons and course evaluation comments of students on the common foundation programme. Nurse Education Today, 19, 2, Whitehead, B; Owen, P; Holmes, D; Beddingham, E; Simmons, M; Henshaw, L; Barton, M; Walker, C. (2013). Supporting newly qualified nurses in the UK: A systematic literature review. Nurse Education Today, 33: pp Zysberg, L. & Zisberg, A. (2008). Nursing students' expectations of college experience. Journal of Nursing Education, 47:9,