Evaluate the Impact and Experience of using Flying Start NHS

Transcription

1 Evaluate the Impact and Experience of using Flying Start NHS A Final Report to NHS Education for Scotland May 2016

2 Report completed / submitted by: Pamela Reid, Sarah Thompson, Jeremy Hanks, Shona McCluskey and Charlotte Ellis Proof check completed by: Shona McCluskey and Charlotte Ellis Date: 23 rd May 2016 Report reviewed by: Pamela Reid Date: 23 rd May 2016 ii

3 TABLE OF CONTENTS 1 Introduction 1 Introduction 1 Flying Start NHS 1 Evaluation Aims and Objectives 1 Methodology and Evaluation Framework 2 Structure of the Report 5 2 Flying Start NHS 7 Introduction 7 Aims and Objectives of Flying Start NHS 7 Programme Development 8 Structure 8 Flying Start NHS Operation and Quantitative Performance 10 Programme Monitoring and Management 10 3 Comparable Approaches to Early Career Development 12 Introduction 12 Scope of the Review 12 Key findings 13 Comparable Approaches in other Professions 18 Conclusions 20 4 The Strategic Contribution of Flying Start NHS 22 Introduction 22 Perceptions and Understanding of Flying Start NHS 22 The Factors Affecting Perceptions and Understanding 24 Strategic Contribution 25 The Future Development of Flying Start NHS 26 5 The Delivery of Flying Start NHS 27 Introduction 27 Engagement 27 The Learner Experience 30 Delivery Challenges 32 Completion 35 6 The Role of Mentors in Flying Start NHS Delivery 38 Introduction 38 The Importance of Mentors 38 The Role of Flying Start NHS Mentors 40 Mentor Challenges 43 The Future Development of Mentoring 44 7 The Content of Flying Start NHS 46 Introduction 46 The Appropriateness of Flying Start NHS Content 46 Selecting Learning Units and Activities 50 Completing the Learning Units 51 Applying Learning 52 iii

4 Flying Start NHS and Mandatory Training Provision 54 8 The Impacts of Flying Start NHS 56 Introduction 56 Engagement Impacts 57 Educational Impact 60 Performance Impact 64 Service Impact 65 Maximising the Impacts of Flying Start NHS 65 9 Conclusions 68 Introduction 68 A Continuing Rationale for Flying Start NHS 68 Impact 68 Strategic Fit 68 Delivery 69 Mentoring and Support Measures 70 Content 70 Flying Start NHS Completion 71 Extending the Reach of Flying Start NHS 71 Appendix A: Quantitative Survey Sample 72 Appendix B: Literature Review Introduction Pre-registration preparation for transition Experiences of transition: newly qualified nurses, midwives and allied health professionals perspectives Programmes to support transitions for newly qualified nurses, midwives and allied health professionals Support for newly qualified social workers Support for newly qualified teachers Conclusions 84 References 86 iv

5 1 Introduction Introduction 1.1 In October 2015, ekosgen, in partnership with London South Bank University and the University of Stirling, were appointed by NHS Education for Scotland (NES) to evaluate the impact and experience of using Flying Start NHS. The evaluation took place between October 2015 and March 2016 and gathered feedback from a wide range of individuals involved with Flying Start NHS, including Newly Qualified Practitioners (NQPs) who are currently enrolled or have completed the programme, mentors, line managers, programme and key strategic stakeholders and Flying Start NHS area leads. This report presents the findings of the evaluation. Flying Start NHS 1.2 Flying Start NHS is a web-based learning resource hosted by NES designed to be undertaken by newly qualified nurses, midwifes and allied health professionals (NMAHPs) in their first year of practice. The programme is designed to support the transition from pre-registered student to registered NQP and develop individuals into confident and capable practitioners. It is work based and learner directed and aims to promote reflection and a focus on continual professional development (CPD). 1.3 Flying Start NHS was introduced in 2006 and, although it has been developed and updated annually to reflect developments in practice, the programme has followed the same format since its introduction. Learners complete 10 work-based Learning Units during their first year in practice with a nominated mentor to help to facilitate this and support the process. Learners complete the programme by submitting a portfolio of evidence which shows how they have applied learning activities selected from each of the ten units. 1.4 Around 250,000 NQPs have been supported through the Flying Start NHS programme since 2006 and two prior evaluations have shown that the learner experience is greatest when the learner is supported by both a mentor and line manager. Evaluation Aims and Objectives 1.5 The overall aim of the evaluation is to: Explore the extent to which Flying Start NHS has achieved its intended outcomes for newly qualified NMAHPs i.e. o o o To make a successful transition to their new role in NHS Scotland (and organisations where Flying Start NHS is adopted e.g. care homes); To enhance their capabilities as accountable, registered practitioners; and, To provide a learner centred introduction to reflective practice and CPD on which to build a career-long approach to professional development. Explore the impact of Flying Start NHS on mentors, managers and service; Provide an options appraisal for the development of the programme or alternative approaches to support NQPs in their first year of practice; and, Develop an engagement and marketing strategy to support implementation of a revised/new approach. 1.6 The specific objectives of the evaluation are to: 1

6 Identify educational approaches used in other professions to support and develop newly qualified staff; Evaluate the design, content and delivery of Flying Start NHS as a method of supporting NQPs to make a successful transition into their new role and enhance their capabilities as practitioners; Explore which elements of the programme have been most effective, and identify good practice and lessons learned to inform the future design and delivery of the programme; Evaluate the learner experience through Flying Start NHS and understand the impacts generated through completion of Flying Start NHS ; and, Explore the impact of Flying Start NHS on mentors/managers/services, and the benefits and challenges associated with the programme. Methodology and Evaluation Framework Methodology and Sample 1.7 The evaluation team used several qualitative and quantitative methods to gain an in-depth understanding of the programme. The approach gave all those involved with the programme an opportunity to provide feedback and share their experiences. Evaluation activities are shown in figure 1.1 below. Figure 1.1: Evaluation method Stage 2 Desk-based research and documentary analysis Stage 6 Options Appraisal Stage 1 Inception, planning and design Stage 4 Primary Research Stage 3 Strategic Stakeholder Condultations Stage 7 Analysis and reporting Planning Primary research Analysis and reporting 1.8 A detailed description of the primary research stages is provided in Table 1.2 overleaf. 2

7 Table 1.2: Evaluation Methodology Stage Description Sample Desk Research - In-depth review of existing literature - Analysis of programme monitoring information Stakeholder - Semi-structured telephone and face-to-face interviews with Consultation key stakeholders - Semi-structured telephone interviews with Flying Start NHS area leads Focus - Focus group discussions with NQPs enrolled on Flying Groups/Listening Start NHS ; NQPs who have completed Flying Start Events NHS ; experienced practitioners with and without experience of Flying Start NHS ; NQPs about to register; and line managers - Follow up telephone interviews with pre-registration students and line managers. - Listening events with NQPs enrolled on Flying Start NHS ; NQPs who have completed Flying Start NHS ; mentors; line managers; experienced practitioners with and without experience of Flying Start NHS ; and NQPs about to register. Telephone and - Quantitative telephone and online surveys of NQPs Online Survey currently enrolled or who have completed the programme; and Flying Start NHS mentors. Liveminds - Two online discussion groups with NQP s who have Discussion Group completed or are currently enrolled on Flying Start NHS, and mentors. Monitoring information provided by 10 NHS areas 11 stakeholders and 18 Flying Start NHS Leads Total of 26 Focus groups and 5 listening events respondents (176 telephone and 337 online) 29 participants 1.9 In total, ekosgen received 513 online and telephone responses to the quantitative survey. Of these, 97 respondents were currently enrolled on Flying Start NHS ; 255 had completed Flying Start NHS ; and 161 were mentors Respondents predominantly worked in nursing or midwifery and collectively accounted for almost three quarters of the sample, with just over a quarter working in other Allied Health Professions 2 (AHP). The lower response rate from AHPs reflects the structure of the NHS Scotland workforce, where AHPs account for less than 15% of the total workforce Over two thirds of respondents worked in hospital-based settings, with a further quarter working in the community. Response rates amongst individuals working in care homes were low, reflecting the low number of Flying Start NHS participants within the care sector. 1 Approximately 700 responses were received, but not all were included in the analysis due to incomplete data entry or respondents not being eligible to participate. 2 Allied Health Professionals include art therapists, dieticians, drama therapists, music therapists, occupational therapists, orthoptists, paramedics, physiotherapists, podiatrists, prosthetist/orthoptist, radiographer (diagnostic), radiographer (therapeutic) and speech and language therapists. 3

8 1.12 Responses were gathered from 14 NHS Health Boards, with the highest number of responses from Tayside, Greater Glasgow and Clyde, Grampian and Ayrshire and Arran. Further details on the survey sample are included at Appendix A Focus groups and listening events were primarily located in five case study areas selected by NES 3. Events were attended by NQPs currently enrolled on Flying Start NHS, those who had completed the programme, Flying Start NHS mentors, line managers and experienced staff. The attendees included staff nurses, occupational therapists, district nurses, community nurses, AHP staff, care home staff, Practice Education Facilitators and Practice Education Leads. The Liveminds discussion received input from NMAHPs which included Radiographers and Occupational Therapists. The participants included those working in hospital and community settings such as care homes and GP practices. Logic Model and Theory of Change 1.14 The logic model overleaf illustrates the inputs and anticipated outcomes from Flying Start NHS and provides the framework for the evaluation analysis. 3 Selected case study areas were NHS Tayside, NHS Ayrshire and Arran, NHS Greater Glasgow and Clyde and NHS Dumfries and Galloway. NHS Grampian was also selected but it was not possible to arrange a focus group in this area. 4

9 Figure 1.3: Flying Start NHS Logic Model Inputs Activities Outputs Outcomes/ Impacts Lead management/ delivery support Mentors Learning Resources (e.g. Website) Financial investment Externally commissioned evaluation Appointment of mentors Marketing and awareness raising Design, management and delivery of Flying Start NHS learning resource Dashboard pilot (6 NHS Health Boards) NQP completion of Learning Units Assumptions No. of NQPs participating (by setting and profession) No. of NQPs completing No. of mentors Improved transitional process Development of clinical skills Development of people skills Increased confidence Enhanced identification of learning needs Commitment to reflective practice and CPD Increased staff retention Improved quality of care Development of a culture of reflective practice The programme progresses as intended with no significant revisions to programme inputs There is a pipeline of NQPs and demand for Flying Start NHS Processes and systems are in place to capture monitoring and management information Opportunities are available for NMAHPs to apply their learning in the workplace It is possible to demonstrate causality between Flying Start NHS and outcomes Other factors which may have supported or influence stated outcomes are acknowledged and understood 1.15 Flying Start NHS is based on the assumption that by completing a web-based programme of broad-based learning, NQPs will develop the skills and knowledge to make a successful transition to practice and become more confident and capable practitioners. It is assumed that this will occur more quickly than would otherwise be the case; and by developing more confident and capable practitioners, the quality of service and patient care will be enhanced It is assumed that completion of Flying Start NHS will instil a culture of reflective practice and CPD within NQPs which will support their future career progression and personal development, as well as support service level improvements. Structure of the Report 1.17 The report is structured as follows: Chapter Two: Flying Start NHS - provides an overview of programme aims and objectives; its development; structure; operation and targeting. It also outlines the quantitative performance of the programme from available data. 4 This evaluation has not included engagement with service users to assess impacts. 5

10 Chapter Three: Comparable Approaches to Early Career Development a summary of a review of literature which explores comparable approaches to early career development and highlights findings which could be of relevance to Flying Start NHS. Chapter Four: The Strategic Contribution of Flying Start NHS drawing on the findings from stakeholder consultation, chapter four outlines strategic perceptions and understanding of Flying Start NHS ; exploring its strategic contribution, and thoughts on future development. Chapter Five: The Delivery of Flying Start NHS drawing on primary research findings this chapter examines the learner experience of Flying Start NHS ; identifying good practice and delivery challenges. Chapter Six: The Role of Mentors in Flying Start NHS delivery considers the role of mentors and the effectiveness of the mentoring model; the added value that mentoring offers; and suggestions for future development. Chapter Seven: The Content of Flying Start NHS considers feedback on the appropriateness of the programme s content and how it aligns with mandatory training provision. Chapter seven also considers the extent to which Flying Start NHS meets the needs and expectations of those about to enrol on the programme. Chapter Eight: The Impacts of Flying Start NHS - examines the impacts generated by Flying Start NHS, including engagement impact; educational impacts; performance impacts; and service impacts. It also considers how impacts could be maximised. Chapter Nine: Conclusions summarises the key findings of the evaluation. 6

11 2 Flying Start NHS Introduction 2.1 This chapter provides an overview of Flying Start NHS including its aims and objectives and a summary of the development, structure and operation of the programme. It presents the monitoring information gathered from NHS Boards, providing quantitative information on the programme s performance to date and a description of the programme monitoring and management systems. Key Point Summary Flying Start NHS is a web-based programme to encourage reflective practice and support the learning and development needs of newly qualified NMAHPs working in all care settings across Scotland during their first year of practice. Mentors are available to NQPs to support them through the Flying Start NHS programme. Flying Start NHS is a self-directed learning programme incorporating ten Learning Units which include core skills such as communication, teamwork and reflective practice. Each Learning Unit contains learning activities, learning outcomes and concluding activities which can be selected by participants depending on their skills needs. Flying Start NHS delivery is not prescribed by NES and there are variations in approach between NHS Boards. The programme is only mandatory in 5 areas. There is not a consistent approach to Flying Start NHS data and information collection across Scotland with each NHS Board responsible for their own programme monitoring and data recording. The Flying Start NHS dashboard which records programme data at a centralised level has been piloted in five NHS Board areas. Aims and Objectives of Flying Start NHS 2.2 Flying Start NHS is a national web-based programme in Scotland. Introduced in 2006, it has the aim of supporting the learning and development of NMAHPs during their first year of practice. The programme is intended to meet the generic needs of NQPs in any setting within the NHS and social care sector e.g. in residential care homes. This includes practitioners based in hospitals, community settings and primary care organisations. 2.3 Flying Start NHS is the primary programme available to all staff to support their induction process, transition into practice, and the NHS Knowledge and Skills Framework (KSF) development review cycle. It is both a framework and a stepping stone for NQPs 5. The benefits of Flying Start NHS are intended to be realised by NQPs as well as employers, mentors, supervisors and NHS KSF reviewers. The Flying Start NHS website states that the programme aims to: 5 Flying Start NHS : Developing confident, capable health practitioners. Available at: 7

12 Provide newly qualified practitioners with benefits such as a learner-directed solution to source information and make sense of a complex environment, guidance during the transition from student to qualified practitioner and the provision of up to date material which can support newly qualified practitioners in their transition from student to qualified practitioner For mentors, supervisors and NHS KSF reviewers, the intended benefits listed on the website include the development of staff who are responsible and accountable for their own learning; a consistent framework for development against the NHS KSF; and the provision of a wider pool of resources for mentors to carry out their role. 2.5 The objectives of Flying Start NHS on a sector wide scale include the provision of a clear message to staff that newly qualified employees are valued; and that safe, effective, and multidisciplinary team working is achieved through a consistent learning support approach across NHS Scotland. Programme Development 2.6 Flying Start NHS has evolved since it was introduced in 2006 following annual reviews and two formal evaluations 7. The 2010 evaluation focused on the impact and effectiveness of Flying Start NHS in supporting the recruitment, confidence and skills development of NMAHPs within NHS Scotland. The second evaluation (2012) explored the key characteristics that support the successful completion of learning outcomes of the programme for newly qualified NMAHPs. As a result of these evaluations and the changes within the health and social care policy context, Flying Start NHS has been adapted and refined, particularly the website layout and content 8. Structure 2.7 The programme focuses on self-directed learning, providing material via the Flying Start NHS website (see Figure 2.1 overleaf) to encourage reflective practice. The online structure of the programme allows those registered to login to the website and upload evidence of their participation and completion of learning activities. 2.8 Ten Learning Units with accompanying learning material are provided, which contain learning activities, learning outcomes and concluding activities. The guidance available on the Flying Start NHS website states that not all learning activities within the Learning Units need to be completed but the learning outcomes and all ten concluding activities must be completed by participants. 2.9 Although this is an online programme, NQP s undertaking Flying Start NHS do not have to electronically register on the website to access the material and undertake the activities. Many NQPs enrol, print off the materials, and create a portfolio of work separately from the online domain. 6 Ibid 7 Evaluation of the impact of Flying Start NHS on both recruitment and retention of newly qualified staff within NHS Scotland: University of the West of Scotland ( ); Evaluation of the key characteristics which support completion of Flying Start NHS in NHS Scotland: University of Worcester ( ) 8 NHS Board Lead consultations 8

13 Figure 2.1: Flying Start NHS homepage Source: Flying Start NHS website, Flying Start NHS includes the following Learning Units: Communication Clinical Skills Teamwork Safe Practice Research for Practice Equality and Diversity Policy Reflective Practice CPD Careers 2.11 The programme structure enables each NQP to create a portfolio of work based on the ten Learning Units. As Flying Start NHS is a reflective programme intended to be tailored to individual learning needs, there is flexibility for individuals to complete the programme as best suits their needs. General information and guidance as to how an individual should create a portfolio of work is provided which sets out how Flying Start NHS portfolios can be used towards NHS KSF reviews. However, each portfolio is unique due to the reflective nature of Flying Start NHS and its intended use to identify and address individual learning and development needs The majority of NQPs are supported to complete Flying Start NHS by a mentor. Portfolios of evidence compiled by NQPs are typically presented to the NQP s line manager or mentor for review in order to qualify for completion. 9

14 Flying Start NHS Operation and Quantitative Performance 2.13 Flying Start NHS delivery differs between NHS Boards and is not prescribed by NES. The programme is mandatory within 5 NHS Boards (NHS Forth Valley, NHS Ayrshire and Arran, NHS Highland, NHS Dumfries and Galloway and NHS Borders 9 ). Within the other NHS Boards, NQPs are strongly encouraged to complete it The use of mentors and approach to protected time for Flying Start NHS activity differs across, and within, NHS Boards. Not all NQPs are assigned a mentor, and protected time is easier to take in some clinical areas than in others. Induction and completion practices also vary The evaluation gathered Flying Start NHS monitoring information from NHS Boards to understand the number of starts, completions, non-completion rates and number of mentors. Thirteen NHS Boards participated and eleven were able to provide data Within these 11 NHS Boards (Table 2.2), there were 3,363 starts between 2013 and 2015, of which 1,838 completed the programme and 219 who did not complete. The majority of those enrolled on Flying Start NHS completed the programme within 12 months, although for a minority it stretched up to 18 months Based on data provided, approximately 2,301 mentors support NQPs. This is likely, however, to include mentors who support NQPs not enrolled in Flying Start NHS. Table 2.2: Performance of Flying Start NHS ( ) No. Starts 3,363 Completions 1,838 Non-completion 219 Source: MI received from eleven Flying Start NHS Leads Programme Monitoring and Management 2.18 The responsibility for management and monitoring of Flying Start NHS is assigned to each NHS Board. This has resulted in different methods of managing and recording programme information being adopted which makes national-level data analysis difficult The Flying Start NHS Dashboard is being piloted in six NHS Boards with the aim of providing up to date monitoring and progress data and improving consistency in data collection. Local Programme Monitoring and Management (Non-Dashboard Areas) 2.20 Within NHS Boards, data is extracted from registrations on the Flying Start NHS website and through learner self-reporting to the relevant department, or by senior staff who oversee the programme. Flying Start NHS Leads recognise that strong internal communication systems are required to provide accurate monitoring data but this can be challenging given the other pressures on staff time. One person is usually responsible for programme administration in each NHS Board, relying on coordinators in different locations within the Board areas to pass on accurate information about their departments which the administrator adds to the local database. 9 NHS Board Lead consultations 10

15 2.21 There are inconsistencies in the way in which new recruits are recorded (this data is gathered from a combination of Human Resources communication and Senior Charge Nurses) which produces unreliable figures, particularly as many NQPs are in temporary positions and can frequently relocate. Data of Flying Start NHS completers between NHS Boards is also often unreliable as the data is usually sourced from completion forms and portfolio evidence. The practise and consistency in completing the forms and presenting evidence differs amongst NHS Boards and departments. Dashboard Pilot Areas 2.22 In 2012, the Dashboard was introduced as a pilot in six NHS Boards (NHS Ayrshire and Arran, NHS Borders, NHS Grampian, NHS Greater Glasgow and Clyde, NHS Lanarkshire and NHS Western Isles) 10. The Dashboard was created to record Flying Start NHS completion rates at national and local levels in order to provide information for stakeholders and NHS Boards. The Dashboard is a single, centralised collection point for Flying Start NHS monitoring information to track learners use of, and progress through, the programme The Dashboard produces statistical and custom reports, and displays performance against the objectives set for the programme. It is intended to reduce programme administration for NHS Boards 11. Dashboard data provides an overview of how the Flying Start NHS website is used through key usage metrics and headline statistics at a glance A recent evaluation of the Dashboard found that all participants in the pilot could see the benefits of the Dashboard if data reliability issues were addressed. ekosgen s evaluation of Flying Start NHS has identified that there is strong support for programme data to be centrally aggregated and stored. It makes sense for NHS Education for Scotland to be the single admin point. (Flying Start NHS Lead) 2.25 There is also support for the principal of monitoring individuals progress. However, there are concerns that Dashboard data is not accurate. For instance, NQPs do not need to register on Flying Start NHS online to participate and so they are not all captured in the Dashboard data (which requires electronic registration). Pressures on staff time can also limit how comprehensively NHS Boards monitor and use the data. A lack of confidence in Dashboard data means that NHS Boards often rely on their locally collected monitoring data rather than the Dashboard. However, one NHS Board reported that they actively use the Dashboard to monitor progress and encourage people enrolled to work through and complete the programme The evaluation findings suggest that more consistency in programme monitoring could enhance the quality of programme performance data and support programme management; and the Dashboard may be a step towards achieving this. Mandatory online registration and sign off could help to generate more consistent starting, completion and non-completion figures, and provide insight into engagement by clinical area, geography, and profession. 10 Evaluation of the Flying Start NHS Dashboard Resource. January Bell, F. pp.1 11 ibid, pp.2 12 Ibid, pp.2 11

16 3 Comparable Approaches to Early Career Development Introduction 3.1 This chapter provides an in-depth review of the available literature on transitions from student to qualified practitioner in the health and social care sectors, as well as comparable approaches in education. The findings are drawn from recent research reports (including unpublished doctoral studies), and policy documents. The full version literature review is included in Appendix B. Key Point Summary The majority of NQPs find their first year challenging and this can impact on their performance, confidence, satisfaction, and subsequent retention in the workforce. There is a need for programmes to support transition and there is evidence that support programmes generate positive impacts for individuals and organisations. This includes increased retention. A supportive and nurturing environment which builds NQP confidence is vital to effective transition. Strong leadership and management is required to integrate NQPs into teams and promote professional socialisation. Programmes to support transitions are generally aimed at growing competence and confidence, and most programmes include both further education and an identified experienced practitioner for workplace support. Successful transition starts during pre-registration, and the delivery and content of preregistration programmes are recognised as key factors in supporting individuals from undergraduate to NQP status. Effective mentor/preceptor relationships are a key component of successful transition programmes. However mentors require support and training to perform this role effectively. A review of approaches to transition in other professions suggests that a regulated and statutory programme may increase consistency of implementation. Scope of the Review 3.2 Transition in the context of Flying Start NHS is the process or passage of developmental change and adaptation that a practitioner undergoes as they construct a new self-identity 13. A review examining the transition from student to newly qualified professional across social work, teaching, nursing and AHPs highlighted the lack of agreement about what newly qualified professionals should be able to do 14. It is therefore unsurprising that there is a lack of consensus about how they should best be supported in their first year of professional practice. There is however considerable evidence that NQPs find their first year especially challenging. It often sets the pattern for the rest of their career as 13 Kralik et al Moriarty et al

17 this is the point at which they develop their approach to work and working practices; and this can impact on their performance, confidence, satisfaction and their subsequent retention in the workforce. 3.3 There is a particularly large body of work relating to the experiences of Newly Qualified Nurses (NQNs), also referred to as New Graduate Nurses (NGNs). The three main theories about transition for NQNs are Kramer s (1974) reality shock theory, Duchscher s (2009) later development of this theory into transition shock and Benner s (1984) novice to expert theory. 3.4 Much of the literature on NQNs arises from Australia and the United States of America (USA), with less from the United Kingdom (UK). International comparisons in the UK context should be approached with caution as pre-registration nursing programmes differ. However, despite the varied healthcare systems, pre-registration preparation and support programmes for NQNs, transition experiences seem remarkably similar. The length of transition period varies across studies but most identified in this review considered newly qualified or the transition period to mean the first year postregistration. Key findings Pre-registration Preparation for Transition 3.5 The delivery and content of pre-registration programmes are recognised as key factors in successful transitions from undergraduates to newly qualified practitioners. In particular, important elements in pre-registration courses which are thought to aid transitions are: Theory and clinical activities; Integrated pathophysiology and critical thinking; Evidence-based practice; and, Care for specific client populations (Rush et al, 2013). 3.6 Phillips et al. (2015) recommended that transition to practice content should be a key identifiable component of undergraduate nursing programmes. 3.7 Final practice placements can also influence transition experiences, with preceptorship experiences found to assist NQN transition 15. There is evidence that placements help to support transition by developing independence, ensuring NQPs feel valued and supported to build confidence (Major, 2010), and by increasing the familiarity of the workplace, nursing team/routines and sources of support, thus reducing the fear of the unknown 16. Further, placements give NQPs the opportunity to practise their role without ultimate accountability Research identifies six areas in which NGNs lack competence: Communication; Leadership; Organisation; Critical thinking; 15 Batory, Halpin, Horsborough and Ross

18 Stress management; and, Situation-specific skills such as end-of-life Medicine administration skills have also been highlighted as a particular concern 19, with other learning needs of NQNs being: safety concerns, applying a holistic care approach, and using new technology and communication within hospital systems Academic preparation for transition into professional practice is debated in the literature, although nursing students in the UK (and other European countries) spend more time in clinical practices than students outside Europe, and this European Model is thought to better prepare them. Skirton et al. (2012) found that newly qualified midwives in the UK were well prepared to work effectively as autonomous practitioners and could cope with a range of challenging clinical situations safely, but they lacked confidence. Feltham (2014) identified that student midwives about to qualify in England felt unprepared for emergency situations. Both recommended that more simulation in midwifery preregistration education was required 21. Further, Jones et al. (2010) identified that physiotherapy students in England (and applicable in Scotland), who were about to qualify, felt unprepared for employment and were unable to identify the skills required to meet employer s expectations; and Jones noted that university curricula must ensure that graduates meet employers' expectations and are able to make a smooth transition into the workplace. Experiences of Transition 3.11 It is recognised that the first three years is a significant confidence-building time for NQNs 22, and being able to self-identify improvements enhances self-confidence 23. In a successful transition this is when NQNs became able to take responsibility, prioritise and convey confidence to patients 24. However it is also noted that some can lose confidence during this period due to unsupportive experiences 25, with previous work experience found to reduce stress The stressful nature of the transition experience is well documented for NQNs in the UK 27, and emotions experienced in the first year include frustration 28, disappointment 29, feeling like a hindrance to their team 30 and feeling overwhelmed Theisen and Sandau Myers et al. 2010; Rush et al. 2013; Halpin, Myers et al Skirton et al. 2012; Feltham Smith et al Halpin, Andersson and Edberg Fenwick, Seah et al Higgins et al. 2010; Horsborough and Ross 2013; Halpin, Thomas et al Tastan et al Halpin, Horsborough and Ross 2013; Thomas et al. 2012, Grove,

19 3.13 Many studies have examined factors that support successful transitions, mitigating stress and developing confidence. Of particular importance is a nurturing environment with a supportive culture and staff 32, enabling NQNs to ask questions 33 and checking that they are working safely Other important factors for successful transitions are leadership and management support 35 and constructive interpersonal relationships with mentors and other colleagues Conversely, NQNs have been the target of unprofessional workplace behaviour 37 and such behaviour is thought to adversely affect NQNs integration into the workforce 38. Positive feedback from senior colleagues is essential, 39 although this can be dependent on the willingness of individuals with whom NQNs work rather than being formalised 40. Comparable Approaches 3.16 Programmes to support transitions are generally aimed at growing competence and confidence whilst supporting professional socialisation and thus, retaining these newly qualified practitioners within the workforce The positive outcomes identified in recent evaluations of transition programmes include improvements in: Retention 41 ; Clinical skills 42 ; Leadership development 43 ; Confidence 44 ; and, Job satisfaction Programmes of support vary across countries, with differing terminology used to describe NQPs. Most programmes include both further education and an identified, experienced practitioner for workplace support. Any type of programme apparently has a positive effect, but there is no conclusive evidence about the optimal model due to the variation in types of programme, the different research methods and outcome measures used in evaluations and the generally weak research methodologies (ndersson and Edberg 2010; Henderson 2011; Rhéaume et al. 2011; Chandler 2012; Rush et al. 2013; Parker et al. 2014; Kumaran and Carney 2014; Phillips et al. 2014; Halpin Bisholt 2012b 34 Riegel Kowalski and Cross 2010; Mellor and Greenhill Malouf and West 2011; Feng et al. 2012; Fenwick et al. 2012; Mellor and Greenhill Smith et al. 2010; Bisholt 2012a; Chandler 2012; Suresh et al. 2013; Rush et al Walker et al Grove, Horsborough and Ross Bullock et al. 2011; Cubit and Ryan 2011; Dyess and Parker 2012; Thomas et al. 2012, Rush et al. 2013, Missen et al. 2014; Al-Dossary et al. 2014, Morton 2014; Figueroa et al. 2013; Dixon et al Dyess and Parker 2012, Marks-Maran et al. 2013; Al-Dossary et al. 2014; Rush et al Dyess and Parker 2012, Rush et al. 2013, AL-Dossary et al Steen et al. 2011; Missen et al. 2014, Darvill et al Rush et al. 2013; Missen et al. 2014; AL-Dossary et al Rush et al. 2013; Missen et al. 2014; Edwards et al

20 Further research into the outcomes of NGN transition programmes, with robust research designs, has been recommended Rush et al. s (2013) integrative review identified variable length, type of education and support in transition programmes, but common elements were having a designated resource person(s) for new graduates, mentorship and formal education. Rush et al. (2013) recommended that preceptors should receive formal training for the role; that the length of transition programmes should be at least 9 months; there should be a focus on practical skill development; and that clinical environments need to be more amenable to NGN transition Edwards et al. s (2015) revealed four different types of support strategies: 1. Nurse internship/residency programmes aimed to bridge the gap between academic preparation and the demands of clinical practice, typically lasting 6 months to a year, comprising taught days with additional clinical support for all NQNs. 2. Graduate nurse orientation programmes were similarly structured to the internships but generally of shorter duration such as 20 weeks. 3. Mentorship/preceptorship (terms which were often used interchangeably) programmes were defined as where an experienced, qualified nurse is assigned to an NQN to support their development within their own clinical environment. 4. Programmes which had investigated the use of simulated scenarios to support transition All strategies had successful outcomes, highlighting that the important factor is to provide support to ease transition rather than NQNs having to make the adjustment alone The transition programmes described in recently published studies ( ) were all evaluated positively and commonly included a combined approach of orientation, structured support including education and workplace support from an experienced individual, whether termed a mentor or preceptor 48. National Approaches to Transition Programmes 3.23 In Scotland, the Flying Start NHS programme for NMAHPS was introduced in 2006, with the aim of increasing confidence and competence during the first year of practice and support career development 49. Banks et al. (2011) conducted an evaluation of the programme and found that most NQPs had found the programme helped with clinical skills development, although time to complete the programme was highlighted as an issue for both NQPs and mentors, and this has emerged as a consistent finding throughout this most recent evaluation In New Zealand, there are national programmes of support established for NQNs and NQMs. These include: A nationally funded Nursing Entry to Practice (NETP) programme (a 12 month programme including at least two clinical placements, a clinical preceptor with whom they share a caseload for the first six weeks, 12 group learning days, two days for goal setting and assessment and peer/cultural support, and a certificate on successful completion). 47 Missen et al. 2014; Phillips et al Dyess and Parker 2012; Tastan et al. 2013; Hunsberger et al. 2013; Morton 2014; Thomas et al. 2012; Dixon et al. 2015; Rush et al Banks et al

21 The midwifery first year of practice programme (a year-long programme to meet the essential elements that support transition, with a requirement to undertake a quality assessment and reflection process at the end of the first year) In the UK, the Nursing and Midwifery Council (2008) set out an expectation that NQNs and NQMs will have professional preceptorship defined as: the process through which existing nurses and midwives provide support to newly qualified nurses and midwives A review of preceptorship identified both positive and negative features 51. NQNs themselves wanted preceptorship, which was seen to support transition by assisting with their skills development; and preceptors found the role satisfying and it assisted their own development. However, there was inconsistency in preceptorship implementation, often little preparation for the role, insufficient time for preceptors to work with the preceptees, and an over-emphasis on competency assessment In 2010, the Department of Health (DH) published a preceptorship framework for newly registered nurses, midwives and AHPs, with an expectation for a structured transition supported by a preceptor, with a formal responsibility to support the newly registered practitioner. While the DH has published a framework for preceptorship (for use in NHS England), it appears that each NHS Trust develops their approach to transition at local level resulting in variation and inconsistency. The Importance of the Preceptorship/Mentorship Role 3.28 Most transition programmes include a preceptor or mentor, and their role appears pivotal in supporting NQPs. Preceptorship can have a positive effect when well implemented 52. The quality of the relationship between the preceptor and the NGN is an important factor, influencing satisfaction and retention 53 and the development of critical thinking There are some examples of mentors being selected by the NQP 55, but no indication as to whether this is preferable to allocation Formal training for the role of preceptor/mentor is recommended 56 and obligatory in some programmes. However educational preparation for preceptors is not routine 57 and lacks standardisation In the UK, preceptors identified the following factors as inhibiting the successful delivery of their role: Lack of preparation for their role; Lack of clarity about expectations of preceptors; and 50 Nursing and Midwifery Council Standards to support learning and assessment in practice NMC standards for mentors, practice teachers and teachers, P Robinson and Griffiths Higgins et al. 2010; Henderson 2011; Moore and Cagle 2012; Kumaran and Carney 2014; Batory Copenhaver Kaddoura Dyess and Parker 2012; Dixon et al Banks et al. 2011; Rush et al. 2013; Kowalski and Cross 2010; Ford et al. 2013; Maringer and Jensen 2014; Panzavecchia and Pearce Myers 2010; Thomas Zoroya

22 Limitations and difficulties associated with being a preceptor The preceptorship role is additional to the preceptor s patient care responsibilities 60, and UK studies have identified that finding time for preceptorship or mentorship, in particular, time to meet with newly qualified practitioners, is problematic 61. Others have suggested that, in addition to training, preceptors need ongoing support There is considerable variation in the length of training programmes for preceptors in nursing (from three hours to three days) and in their delivery of training, but content commonly included adult learning principles, learning styles, conflict resolution, and Benner s (1984) novice to expert framework (Rush et al. 2013) The potential benefits of effective preceptorship training have been found to include: Safer patient care 63 ; Improved satisfaction with the preceptor role; and, Increased competency and retention of their NGNs 64. Comparable Approaches in other Professions Social Work 3.35 In England, newly qualified social workers go through the Assessed and Supported Year in Employment (ASYE). This was introduced in 2012 in response to suggestions that newly qualified social workers were not job-ready. The ASYE is not a compulsory period for newly qualified social workers but employers are expected to provide an ASYE programme for all recently qualified social workers. Adults 65 ; and child and family 66 ; have separate ASYE programmes focussed on understanding employer expectations and the specific requirements of their areas of specialism Newly qualified social workers can expect to be supported by having a protected caseload; regular supervision; and in house training within the first year. They are assessed by means of a portfolio of evidence. However, a pilot in child and family is exploring replacing the portfolio assessment with a more structured model, which will include endorsement by the employer; an online set of questions; a simulation; and a written essay. An evaluation of the programme emphasised the importance of newly qualified social workers taking some responsibility for their professional development, with a more structured model of assessment and completion intended to support this In Scotland, there is currently no nationally recognised scheme for newly qualified social workers 67. However, a recent report commissioned by the Scottish Social Services Council (SSSC) 59 Panzavecchia and Pearce Myers Banks et al. 2011; Muir et al. 2013; Marks-Maran et al. 2013; Lewis and McGowan Richards et al. 2012; Thomas 2014; Zoroya Batory Covelli 2012; Leftwich The ASYE for Adults: Available at: 66 The ASYE for child and family: Available at: 67 Gillies 2014; Grant et al

23 recommended the establishment of a formal probationary period for newly qualified social workers (Gillies 2015), which should include: Mandatory formal process of supervision, support and assessment mapped against professional requirements; Satisfactory completion of the probationary year for full registration; Requirements for probationary year to be mapped against any changes to qualifying social work education; and, Role of supervisor to be formalised and linked to career progression. Social Care 3.38 The Care Certificate is an induction programme recently piloted in England which is primarily aimed at Healthcare Assistants, Assistant Practitioners, Care Support Workers and those giving support to clinical roles in the NHS where there is direct contact with patients or people who receive care and support. The Care Certificate comprises 15 standards, within each of which is a series of outcomes and assessment criteria. Support Workers, supported by a mentor/supervisor, must satisfy all of the assessment criteria in order to be awarded the Care Certificate The Care Certificate is intended to be the start of a career journey for Support Workers, and each Support Worker starting in a new role that is within the scope of the Care Certificate is expected to have completed the training, education and assessment relating to the Certificate within the first 12 weeks of their employment The pilot of the Care Certificate was evaluated by ekosgen in The evaluation found that the majority of sites were delivering training and assessment in-house, and welcomed the concept of a standardised approach to induction. There were some concerns over the potentially variable interpretation and assessment of the Certificate across different sites; achieving an appropriate balance between theory, practical knowledge and workplace application; and the practicalities of supervisor observation and assessment requirements, particularly for remote and mobile care workers. However, the recognition and quality of induction that it gives to the Support Worker workforce were all praised Key learning points from the evaluation include: The Certificate has allowed the introduction of a more structured and consistent approach to induction which increases portability and uniformity across a diverse sector. Completion of the Certificate is intended to build a portfolio of evidence demonstrating Support Workers key competencies. This portfolio can be used towards formal, accredited qualifications and was more effective where it was linked to individual performance management and career progression. Completion of the Care Certificate involved classroom based learning as well as individual study time, but was closely integrated with daily work with supervisors required to observe the application of learning in practice and sign off individual competencies. The introduction of the Certificate was focused on developing ownership of skills development and CPD amongst new staff by building their portfolio of evidence which had to be signed off to complete induction. 19

24 Teaching 3.42 Newly qualified teachers in Scotland have a statutory induction period, during which they have a reduced class commitment time to that of a full-time teacher, with additional time for their professional development and access to a mentor who is an experienced teacher 68. Teachers who successfully complete the induction programme can apply for full registration with the General Teaching Council for Scotland Similarly, in England, all newly qualified teachers (NQTs) who are employed in a relevant school (not independent schools) must, by law, complete a statutory induction period which lasts a school year. The NQT must show that they have consolidated their initial teacher training and sustained the standards satisfactorily. The induction period is described as a bridge between initial teacher training and a career in teaching with the expectation of an individualised programme of development and support with monitoring and an assessment of performance against the relevant standards 69. Schools offering induction programmes must meet specific standards and the National College for Teaching and Leadership is informed of any NQTs starting induction. The induction programme requirements and the experience that must be provided are set out in detail, and their induction tutor regularly observes their teaching and gives feedback. They also meet with them to review their progress against the standards and conduct a formal review each term Smethema and Adeya (2005) found evidence that the structured induction has increased reflection; improved relationships with colleagues; and increased teacher autonomy, self growth, and personal efficacy. Conclusions 3.45 Drawing on this review, there are several useful points to consider in relation to the evaluation of Flying Start NHS. These include: The transition from student to professional is recognised across professions as being a difficult process, but one which can be facilitated by a programme of support. Confidence building underlies positive transitions, and this is most successfully developed within a supportive environment which provides regular feedback, builds constructive relationships with mentors and facilitates peer support transition. It is important that NQPs are not overwhelmed but feel that they have control over their personal development and training. Strong leadership and management support is vital in achieving this and supporting the development of constructive interpersonal relationships with mentors and other staff members. Programmes should support professional socialisation and integration of NQPs into the workplace. The mentor/preceptor relationship is very influential, although value attached to the mentor role is often lacking because of poor implementation and a lack of mentor training/induction. Pre-registration programmes and final placements can impact significantly on transitions and there is evidence that inclusion of theory-practice links, transition to practice content and simulation opportunities have a positive influence on this. 68 Scottish Government Department for Education

25 There is evidence that transition programmes generate positive impacts for individuals, organisations and service delivery including increased retention, clinical skills, job satisfaction and confidence. There is also evidence of more efficient service delivery and better quality service delivery. Considering approaches to transition in other professions suggests that a regulated and statutory programme may increase consistency of implementation. 21

26 4 The Strategic Contribution of Flying Start NHS Introduction 4.1 Chapter four sets out strategic stakeholders views of Flying Start NHS including its continued relevance and strategic function and thoughts for future development. Consultees included AHP Directors and Associate Directors from several NHS Boards; stakeholders working with pre-registration students; Nursing and Midwifery Heads; Care Home Managers; as well as nursing staff. Key Point Summary There is strong strategic support for a programme to support NQPs in their first year of practice, and Flying Start NHS is viewed as being broadly fit for purpose. Flying Start NHS is felt to have lost some of its momentum and focus over recent years, and NES s review of the programme has been welcomed. Strategically Flying Start NHS is widely understood and valued, but it is accepted that this view is not shared consistently at an operational level because of workload pressures experienced by NQPs and their mentors, and poor understanding of the programme s purpose. There is a desire to see Flying Start NHS evolve to ensure it remains relevant and continues to play an effective role in workforce development. Attention needs to be given to increasing the reach of the programme into the Social Care sector. The programme contributes to the delivery of wider policy agendas and is consistent with the four Pillars of Practice 70. There are some suggestions that the programme could be more closely integrated with Effective Practitioner, and NQPs need a better understanding of linkages between Flying Start NHS and other training and CPD programmes. Protected time and effective mentoring were amongst the factors viewed as being important to successful delivery. Whilst Flying Start NHS makes an important strategic contribution there is a sense that it has more to offer and the impacts could be enhanced. Perceptions and Understanding of Flying Start NHS 4.2 There is strong strategic support for Flying Start NHS. It is widely understood and valued by senior staff across the sector. The rationale for the programme, i.e. professional development to support NQPs in their first year of practice, is deemed to be as relevant today as when Flying Start NHS was first introduced; with some stakeholders commenting that it may be even more important given the continued emphasis being placed on raising service standards and CPD. The need to develop confident, competent staff with the skills to integrate into established teams remains an important objective for the sector and Flying Start NHS has a key contribution to make. 70 Clinical Practice; Facilitation of Learning; Leadership; and Evidence, Research and Development. 22

27 4.3 The title of the programme, Flying Start effectively conveys the programme s purpose, although some stakeholders consider that incorporating NHS in the title is unhelpful in engaging the social care sector. 4.4 Despite strategic support for Flying Start NHS and a continued need for intervention to support NQPs, the programme may have lost some of its strategic focus and primacy amongst senior staff over recent years. The evaluation is a timely opportunity to refocus attention on the programme and review what the sector needs now and in the future. As one stakeholder commented, I ve not heard it discussed as much recently. 4.5 Concerns were raised as to whether the sector as a whole is geared up to fully embrace and reinvest time and resource in refreshing Flying Start NHS. Staff time and financial resource is stretched across the health and social care sector, creating practical barriers and less appetite for staff development programmes. Beyond the most senior staff, the findings also indicate inconsistent levels of awareness, understanding and perceived value across sectors, organisations and individuals. 4.6 At an operational level, stakeholders accept that negative perceptions about the value of Flying Start NHS are common and difficult to change; and there is awareness that some NMAHPs view the programme as a chore and a tick box exercise. I do not think Flying Start [NHS ] should be mandatory as it is very repetitive and I just find it as unnecessary work along with the work load of the ward (Survey respondent) I don't feel that it is clinically supporting my development and career as it is too broad a programme. It consumes a lot of my time as I feel it is duplicate information that I am recording for some of the units. (Survey respondent) 4.7 Amongst management staff there are examples of Flying Start NHS being viewed negatively because it is perceived to offer little value to NQPs, and be too long and complicated (Flying Start NHS Lead 71 ). Whilst managerial staff may be aware of Flying Start NHS and understand its content, it has been suggested that many may not fully grasp its purpose and the overarching ambition of the programme; viewing it as just a skills development programme. 4.8 Mentor knowledge and understanding was identified as being variable, particularly if mentors had not completed the programme themselves. Furthermore, within the social care sector general awareness levels are low, and there are some misconceptions about whether staff in the sector can take part in Flying Start NHS and how relevant it is to a care setting. 4.9 Whilst some strategic consultees acknowledge that their perceptions may have been skewed as they are a focus for negative rather than positive feedback from staff, greater clarity needs to be given to the programme to improve general perceptions and develop a more consistent approach to delivery. Examples include: Clarifying how much time should be allocated to Flying Start NHS and the balance which should be sought between workplace-based learning/study and personal study. Developing a more consistent model for delivery across different professions. 71 This is a Flying Start NHS Leads view of how management staff perceive the programme. 23

28 Variations in whether the programme is mandatory or voluntary were felt to create further confusion. There are significant variations in how the programme is marketed and the extent to which it is integrated with other training. For instance, o o o Senior members of staff in midwifery actively encourage completion of Flying Start NHS as it is required for progression to Band Six. As one consultee commented, It gives it teeth and makes it a priority. NHS Lothian run an eight day NQ programme for staff who have been working for a year or more. The course is well attended and includes a one day introduction to Flying Start NHS which helps to ensure consistent levels of understanding and awareness amongst all staff. In NHS Fife, NQPs have information about Flying Start NHS sent out in starter packs and it is discussed in induction practice. Sessions are held to support staff completing the programme. Although support is offered and NQPs are encouraged to complete as it is not mandatory, the volume of work required can be overwhelming which results in variable engagement with the programme. Developing a more consistent approach to the integration of Flying Start NHS into induction practices and other training processes. Flying Start NHS is not positively perceived across all NMAHPs as their focus tends to be on learning the job, and the programme is viewed as a distraction from this. As staff have to complete Flying Start NHS alongside other mandatory training, it is also seen as extra work. Conversely however the programme is well received amongst speech and language therapists in one case study area as Flying Start NHS has been mapped to the Royal College of Speech and Language Therapy and their professional body. Closer integration of Flying Start NHS with training and on the job experience therefore appears to improve perceptions of the programme. The Factors Affecting Perceptions and Understanding 4.10 How Flying Start NHS has been used and promoted by different professions, and the delivery model adopted, has a bearing on levels of awareness, understanding and in some instances perceptions of value. A number of stakeholders suggested that general levels of awareness seemed to be higher amongst midwifery and nursing staff compared to AHPs, although as the case study example at 4.9 above highlights, this is not universally the case Positive marketing and integration of Flying Start NHS into induction and personal development practices can raise the profile and status of the programme amongst staff. Where professions have actively promoted Flying Start NHS there are good levels of awareness and positive perceptions of the programme. 24

29 It s a great start for band fives We promote it at staff meetings to raise awareness and the leadership team also raise awareness about it (Senior Stakeholder) The programme is perceived as being NHS-focused, which has resulted in low awareness of the relevance of Flying Start NHS amongst care home staff. In some instances, care home managers and staff have been unaware that the programme is available to non-nhs workers or organisations Word of mouth and senior support can influence perceptions of the programme. Understanding was argued to be better amongst staff that have a mentor or line manager who understands and promotes the value of the programme, rather than it being promoted as, something they have to do. For many consultees there also remains a need to consider how Flying Start NHS can be better integrated into practice and mainstreamed within wider induction processes. Strategic Contribution 4.14 Flying Start NHS is seen to make a valuable strategic contribution to the sector by helping to promote a culture of continual professional development and reflective practice. It supports the wider portfolio of training undertaken by NQPs and contributes towards the overarching objective of delivering person-centred care. It promotes the message that we invest in our staff (Flying Start NHS Lead) 4.15 The extent to which it effectively achieves this, however, is influenced by the variables outlined above. The theory behind it is important and it is good to get NQs in the habit of reflective practice and to understand that it is important.it is a sensible idea but from NQs perspective they have too much to do it absorbs a person. (Flying Start NHS Lead) 4.16 The programme contributes to the delivery of wider policy agendas. The integration of health and social care provides a strong rationale for a workforce development programme which engages NQPs across different settings and focuses on developing core skills and competencies which cut across workplaces and professions. In this context Flying Start NHS is seen to be a tool to help achieve integration across health and social care The increasing pressures on staff time, particularly within clinical areas that have seen a significant increase in caseload, was identified as a key driver for the programme. Flying Start NHS is a tool to help NQPs become effective quickly where they are joining fast-paced and pressured environments. This is also a challenge for the programme as teams that are under pressure cannot always release NQPs and mentors for CPD activity. Therefore the value of doing so needs to be clearly understood and articulated across teams if the programme is to be prioritised Overall, stakeholders see Flying Start NHS as consistent with national policy. The National Delivery Plan for AHPs for instance, has a leadership focus which complements Flying Start NHS content, and the emphasis of 2020 Vision was also identified as being consistent with the programme Flying Start NHS is consistent with the four Pillars of Practice which comprise the NES Career Development Framework for NMAHPs. Effective Practitioner is identified as a tool to demonstrate learning and skills against the Career Development Framework and Flying Start NHS is a tool for evidencing learning. There is however a need to more closely integrate Flying Start NHS with the four Pillars and Effective Practitioner to demonstrate to practitioners at all levels how Flying Start NHS feeds into wider CPD activity and Revalidation. 25

30 The Four Pillars of Practice The post registration Career Development Framework aims to support the continuing and changing development needs of NMAHPs across the Career Framework for Health. The framework contains four Pillars of Practice which include aspects of practice. These are as follows: Clinical Practice Safe, effective and person centred care Professional Judgement and Decision Making Facilitation of Learning Learning, teaching and assessment Creation of the learning environment Leadership Team work and development Professional and organisational leadership Evidence, Research and Development Evidence into practice The Future Development of Flying Start NHS 4.20 There remains strategic support for Flying Start NHS but a strong sense that the programme could be more effective. Formalising completion and establishing Flying Start NHS as a programme of excellence was identified as a future opportunity. Ensuring the benefits and potential use/application is widely understood was also felt to be important, particularly at the pre-registration stage and within early induction processes Overall the content is viewed as being fit for purpose and should be continually refreshed rather than expanded; but the programme needs to be made more relevant to the care sector with consideration given to the introduction of management as a core Learning Unit. Awareness and understanding of the programme (and therefore accessibility) needs to increase across care settings. It was suggested that the care sector is frequently viewed as the poor relative of the health sector and negative perceptions of the sector as a career option form during pre-registration. Attracting and retaining skilled workers within the care sector is widely acknowledged as a significant challenge. It was suggested that Flying Start NHS could be a tool through which negative perceptions of the care sector are challenged and equal weight is given to care and health sector needs There were also suggestions that there could be scope to streamline content, with fewer activities across fewer Learning Units. The volume of work to be completed was frequently identified as a barrier to participation and completion Mentoring is a critical element of the programme and it needs to be made more effective and consistent. NQPs working through Flying Start NHS in isolation is not considered effective delivery as it is the relationship between NQPs and mentors and Practice Education Facilitators which adds the most value. 26

31 5 The Delivery of Flying Start NHS Introduction 5.1 This chapter explores the delivery of Flying Start NHS, from the NQPs initial engagement with the programme through to completion. It considers the learner experience, including the mode of learning, the types of support received and delivery challenges. Key Point Summary Most students are introduced to the programme at pre-registration training or during their job induction. Enrolment is mandatory in 5 NHS Boards. Where it is voluntary, learners participate to continue their learning and development or are encouraged by line managers. NQPs are frequently over-whelmed by the volume of content and have concerns about the time commitment and pressure of work. Learners use a variety of different devices to complete the programme, making it widely accessible. The vast majority however complete it at home, with few receiving allocated time during work. AHPs and those in a community setting receive more allocated work time. NQPs value highly support from mentors and peers, but have concerns regarding the time requirement of the programme and the usability and navigability of the web-based resource. A learner-centred approach has been achieved to some extent, with evidence of NQPs managing their own time and drawing from learning in practice. There is not a standard approach to completion of the programme, with Learning Units signed-off in a variety of different ways and uncertainty about how programme completion will be acknowledged. Formal acknowledgement of completion is very important to NQPs. Engagement Early Marketing 5.2 Pre-registration training is a key point at which students are first introduced to Flying Start NHS and presents an important opportunity to shape views and perceptions of the programme. Three quarters (75%) of survey respondents indicated they first heard about Flying Start NHS during prequalification education and this was reflected by the findings from the focus groups. 5.3 Pre-registration students do not always gather a positive view of the programme at this first introduction. There is anecdotal evidence of it being introduced largely as a tick box exercise that has to be done rather than an important learning opportunity that will benefit NQPs, service, patients and the wider team. 27

32 5.4 Where NHS Practice Education Facilitators provide this introduction, it usually involves a brief overview of the programme and the ten Learning Units, and a positive view of the programme is generally articulated. This positive view is not always reinforced by lecturers and NHS staff that preregistration students talk to during placements, and this can undermine their motivation to engage with Flying Start NHS when they qualify. The introduction at uni was awful. It didn t sell the benefits.it didn t explain what it would give to us, personally in terms of development [I was put off by] word of mouth from the nurses going through it. They said it was time consuming (Focus group with staff who had completed Flying Start NHS ) 5.5 A number of consultees currently involved in the programme felt insufficiently informed before they started the programme (e.g. was it mandatory? How many Learning Units would they have to complete?). This created confusion which in some instances resulted in greater anxiety about the transition process and employer expectations. As one completer commented, you know it s coming but you don t know what it is and what to expect. 5.6 When NQPs start their job, they usually undergo an induction programme during which Flying Start NHS is discussed. This is an opportunity for the benefits of the programme to be articulated and guidance provided on how to complete it; including working with a mentor. Thirty eight percent of NQPs first heard about the programme during their job induction post-qualification. As with pre-registration introduction to Flying Start NHS, this introduction varies in terms of depth and detail. Even within NHS Boards, the messages that NQPs sometimes pick up is that it is something which has to be completed if they wish to progress, rather than a tool to support their development. 5.7 NQPs tend to review the Flying Start NHS guidance documentation prior to beginning the programme and find it helpful. Two thirds (66%) of NQPs stated they had reviewed programme guidance, and half (51%) found this very/fairly helpful. Promoting Flying Start NHS at Induction In one example, Flying Start NHS was discussed for two hours during an induction day for NQPs. This included an explanation as to what was expected as well as an opportunity to collectively look at the website on-screen and ask questions, which was found to be an effective promotional method. It was suggested that the opportunity to talk to completers of Flying Start NHS and hear more about the benefits of the programme during pre-registration and at induction, would provide students with a more positive view of the programme and demonstrate how it will help them. Reasons for Participating 5.8 Participation in Flying Start NHS is mandatory in 5 NHS Boards, and was so for 69% of NMAHPs participating in the survey. This was higher for the Nurses and Midwives surveyed (72%) than AHPs (60%). This was reinforced in the qualitative research, where we identified that whilst it has been mandatory in some NHS Boards for Nurses and Midwives, it is less likely to have been mandatory for AHPs; although the incidence of this is increasing. 28

33 5.9 Other than it being mandatory the main reason that NMAHPs engage with the programme is because they want to continue their learning and development. Another key motivator is that their line manager recommended that they should do it. Figure 5.1 illustrates the reasons for taking part. It shows that NMAHPs in the study see Flying Start NHS as a useful tool to develop their skills and continue to learning. Figure 5.1 What made you want to take part in Flying Start NHS? I wanted to continue my L & D My line manager said I should do it Help me put my learning into practice I heard it was valuable from colleagues I wanted to develop my skills My university lecturer reccommended it Other Everyone else I qualified with doing it The course sounded interesting Source: ekosgen survey. 0% 20% 40% 60% % of respondents Initial Impressions 5.10 When NQPs first look at the Flying Start NHS website, whether pre or post-registration, they frequently report feeling overwhelmed by the volume of information and work. Each Learning Unit is dense. It s overwhelming It s daunting learning a new job, learning the practical skills and doing Flying Start [NHS ] within a year Nothing about Flying Start [NHS ] makes you want to do it, until you ve finished it and then it makes sense (Focus groups with staff currently enrolled and completers) 5.11 Over half of all NMAHPs surveyed indicated that the time commitment involved in Flying Start NHS and the added pressures of work were key concerns at the time they enrolled, as illustrated in Figure 5.2. The perceived volume of work means that many NQPs see the programme as an added pressure and an extra chore to do. Having insufficient information at this stage about what is expected from NQPs completing Flying Start NHS further compounds feelings of being overwhelmed. 29

34 The Learner Experience Use of IT Figure 5.2 Did you have any initial concerns about Flying Start NHS at the time you enrolled? Time commitment Pressure of work I had to do it in my own time Content looked difficult I didn t see that it was relevant Programme seemed difficult to use I wanted a break from education Other people put me off Lack of confidence Other people put me off I don t like learning online I don t have access to a laptop/computer Source: ekosgen survey NMAHPs use a variety of devices to complete Flying Start NHS, including work PCs, paper copies, laptops and personal PCs. Around one third (31%) of NMAHPs stated they always use work PCs to complete the programme, but it can be difficult for some to access work PCs and if NMAHPs are working on Flying Start NHS in their own time, they are more likely to use personal devices. Mobile phones and tablets were not commonly used as it is deemed too difficult to use the programme on these devices in its current format. It was also commented that if NQPs are seen to be using mobile devices in the workplace; staff, patients and visitors may believe they are using them for personal reasons e.g. social media and texting Perhaps surprisingly, a significant number of NMAHPs print off copies of the programme to complete and keep in a folder. In the study, we found one NHS Board that provides every NQP with a hard copy of the entire Flying Start NHS programme in a folder. When NQPs Work on Flying Start 0% 50% 100% % of respondents 5.14 Overwhelmingly NMAHP s work on Flying Start NHS exclusively or regularly in their own time rather than during protected time at work. As Figure 5.3 shows, just over two thirds (68%) complete the programme mostly from home, and a further quarter (26%) occasionally work on it at home. Smaller proportions mostly complete Flying Start NHS during protected time at work (28%) or during the working day (18%). This reflects the pressure on time at work and the fact that they are encouraged by line managers and more experienced staff to prioritise patient care Home-working was much more prevalent for Nurses and Midwives (73% worked on the programme mostly from home) than AHPs (49%). Similarly, hospital-based NMAHPs tended to complete more of Flying Start NHS at home (72%) than those NMAHPs working in a community setting (59%). Both AHPs and community-based NMAHPs were more likely to receive protected time at work to complete the programme. 30

35 Figure Staff in some clinical settings and roles, however, find it easier to take protected time and access work PCs. For example, staff working in substance misuse; staff who regularly work night shifts; and staff working in theatre where there may be gaps in activities, discussed being able to work on the programme during working hours. Delivery Support 5.17 NMAHPs place particular value on support from mentors and peers, as shown in Figure 5.4. Guidance and support from Flying Start NHS mentors is valuable in guiding NQPs through the programme and checking progress. More detail on the role and impact of mentors is set out in Chapter Where more than one NQP is enrolled on Flying Start NHS in a particular ward or workplace, there is evidence that they sometimes come together in informal study groups either in person or online. NQPs find this very useful, particularly around the practicalities of navigating the website, uploading materials and selecting learning activities, as illustrated by the following comments. I work with other people enrolled on Flying Start [NHS ] on my ward. This is very helpful as we discuss which units to do, how to do them, and help each other We had a Facebook page (Focus groups with staff currently enrolled on Flying Start NHS ) 5.19 Consultees felt that there could be more opportunities to learn from other NQPs going through the process. Although not necessarily mentor-provided support, this is an area that mentors could support by encouraging the formation of learning/discussion groups. A meeting with fellow flying starters (sic) to brain storm/discuss anything to do with flying start [NHS ]. Regular s from flying start [NHS ] to prompt you. A newsletter with tips of the day It would have been helpful to have discussed with colleagues that had already completed the flying start (sic). I think it would have been helpful to get their advice on what they found useful or helpful tips on completing the programme 31

36 Online groups / forums [would have been useful] (Online/telephone survey with those currently enrolled and completed Flying Start NHS ) Figure Support from line managers was viewed as slightly less helpful, and this was largely due to a belief that senior staff lack a full understanding of the programme and what it entails, meaning they are less likely to effectively support NQPs or mentors through the process. Delivery Challenges Time Requirements 5.21 A prevalent issue with NMAHPs throughout the evaluation was support with the time demand of the programme and protecting time within work to complete Flying Start NHS. Often when NMAHPs were given allocated time for Flying Start NHS, this was too little or was frequently disrupted. As it is a very demanding course - there should be time allocated within your working hours to complete Flying Start [NHS ] - this does not happen Protected time to complete some of the work [would be useful]. In the end I was offered a study day. Engaging management in taking it on so that time can be made during the work day to complete it... seeking opportunities through the day is impractical as 5 or 10 minutes here and there does not allow you to get into the module let alone start the required tasks. (Online/telephone surveys with staff currently enrolled and completed Flying Start NHS ) 5.22 The workload and time requirement of the programme were challenging for NQPs, more so than the difficulty of the content. Nearly three quarters (72%) of survey respondents felt that Flying Start NHS contained more work than they had originally expected, and a similar proportion (64%) found that they were completing more in their own time than expected Linked to the time commitment needed to complete the programme, there were suggestions within focus groups with currently enrolled NQPs, completers and mentors that having a grace period between NQPs beginning their new job after qualifying and beginning Flying Start NHS would be 32

37 beneficial. This was cited as a time that can be over-whelming as NQPs get used to their new surroundings and begin other mandatory training. Allowing some time to have elapsed before starting the programme would also give NQPs an opportunity to build up experiences to reflect upon within the Learning Units. Mentors also felt this would be of benefit as it would not coincide with other training and induction tasks occurring at this time When asked how long the grace period should be, most respondents felt that up to six months was sufficient. Mentors commented: Definitely must have guaranteed time to do this. Wait 6 months before starting the programme Trainees need [a] settling in period, do not start this until 4-6 months in post Let trainees have bedding in time before starting e.g. 3 months Newly qualified have enough to learn delay it a year A grace period would be a good idea to allow NQPs to get to grips with being qualified (Online/telephone surveys with Flying Start NHS mentors) 5.25 Some NQPs were delayed in their start of the programme for various reasons and they felt that this delay actually benefitted them and made it easier to complete the Learning Units. Benefits to a Delayed Programme Start In one example, the NQP was delayed in her start to Flying Start NHS for six months because her mentor was on maternity leave. She felt that this six month gap helped as she could reflect more and had more experience to draw from. When her mentor returned from maternity leave, the mentor was very engaged and saw the value in the programme, which transferred to the learner. Website User Experience 5.26 Websites and online materials are becoming increasingly sophisticated and technology is developing rapidly. More people than ever are using web-based resources in their personal and working lives and a positive user experience is vital There is general consensus that at first sight the website is attractive. It looks appealing and interesting with a good use of colour. However, when NMAHPs start to use the website, many of them do not find it as easy to use as they had expected. Less than four in 10 (38%) survey respondents found the delivery platform to be very/fairly user-friendly, while over one quarter (26%) reported it to be not at all/not very user-friendly. Some of the hyperlinks are broken and it is not always clear how to upload content to the system Although many consultees liked the visual appearance of the Flying Start NHS website, it was suggested that activities could incorporate different ways of learning and information could be conveyed in different ways to retain user interest. The use of video or audio material for instance was suggested, as was a better system to share and upload files. 33

38 Website format very poor, make it easier to upload, current links, needs to flow better A lot of the links were broken, and there were too many resources with little guidance about resource content The programme was difficult to navigate and I gave up with it. Some of the content didn't make sense (Online survey with currently enrolled Flying Start NHS learners) Programme Navigation 5.29 There were some challenges navigating the website, and consultees felt more guidance would be beneficial to help them understand what was expected of them. This particularly included greater guidance regarding the number of Learning Units, and the number of tasks within each Unit, required for completion. Mentors were not always able to clarify this. I would really appreciate more specific guidance on how many Units are required to complete in order to sufficiently work through the programme. It would be helpful if the programme had a 'tick list' The numbers of completed Units do not help as it doesn't necessarily state how much is still left of the programme to complete My mentor is unfamiliar with the programme I was unclear about what you had to do and in what order (Online survey with currently enrolled Flying Start NHS learners) 5.30 There was agreement during focus groups that a progress bar would not be possible for Flying Start NHS because there is no specific number of tasks to be completed, although NQPs felt that the website still needs an at-a-glance indicator to help them track progress. Having Learning Units turn green when they ve been completed was suggested, for example Clear guidance is required to ensure staff understand what they need to complete, and the level of detail required. Whilst guidance already exists, it has been described as bulky and unwieldy, while Unit specific guidance has also been suggested Similarly, there were issues navigating around the programme content. Consultees felt that more support with finding their way around the website, or indeed a different format for presenting all the information, would be useful. Other format rather than overwhelming amount of information online (Telephone survey with currently enrolled Flying Start NHS learners) 5.33 Evidence from focus groups suggested that the tag cloud tool, shown below, was confusing and too complicated to use as a navigation tool; and mentors were often unaware or too inexperienced to give advice on navigating the website. 34

39 Learner-Centred Approach 5.34 The evidence suggests that a learner-centred approach has been achieved to an extent for the Flying Start NHS programme. NQPs have flexibility to manage their own learning by using the programme as they want i.e. choosing the tasks within each Learning Unit that they feel are most relevant to their role and training needs; working through the programme at their own pace, in their own time, and by their own mode (e.g. online or paper copies). Not all NMAHPs however are aware of this flexibility and therefore view the programme as being prescriptive There is evidence suggesting that more can be done to promote a learner-centred approach. Increasing awareness of programme flexibility and enhancing guidance regarding programme structure would help NQPs feel more in control of their learning experience. Interestingly, some elements of existing programme guidance have been confusing to NQPs, and made them feel less in control of their learning. It has been suggested for instance that the use of recommended completion times for learning activities doesn t support those who work at different paces and may need longer to complete a task, but feel as though they are over-doing it by taking more time Protected time is also required to allow NQPs to make the most of the programme. Completion 5.37 Completion of the programme has been closely examined in this study as it is an area that has generated a lot of ambiguity in the past The evidence suggests that ambiguity and confusion surrounding completion still exists. One quarter (24%) of survey respondents state that they do not officially sign-off each Learning Unit, while a further fifth (20%) stated that they were unsure how completion of the Units was demonstrated. Indeed, 16% of Flying Start NHS mentors were also unsure how participants confirmed completion of a Learning Unit. 35

40 5.39 Where known, the completion of Learning Units is demonstrated in a number of different ways. Most commonly, NQPs will have their mentors sign-off each Unit (32%), although others seek sign-off from their line manager (18%) or discuss completion at performance reviews (11%). As one consultee noted, I handed my portfolio to my mentor who signed it and sent it away. I received a certificate a couple months later. Completion of Flying Start NHS In one example an NQP, who was very interested in her own CPD and engaged with Flying Start NHS, dedicated a lot of time and effort to compiling her portfolio folder. Once completed, she gave it to her line manager who signed it without opening it and handed it back to her, saying I trust you. The NQP found this experience demotivating and was left unsure if what she had included in her portfolio was correct, or indeed if there were elements of her work which she needed to improve. The extent to which her experience of Flying Start NHS impacted on her performance was minimised by the lack of constructive feedback There is further ambiguity around the awareness of how successful completion of the programme will be acknowledged. As shown in Figure 5.5, two thirds of NMAHPs were either unaware or unsure of how completion of the programme would be acknowledged. Indeed, one Flying Start NHS stakeholder said: there is no distinct completion, it is very blurred. Figure Despite the lack of awareness and understanding, programme completion is important to NQPs and mentors. As shown by Figure 5.6, three quarters (75%) of survey respondents felt that formally acknowledging completion is important, with fewer than one in 10 (8%) stating that it is not at all important. This acknowledgement does not need to be significant or resource-intensive however, as those currently enrolled much preferred the idea of receiving a completion certificate (72%) or discussing and acknowledging completion at performance reviews (61%) rather than through an event or ceremony for Flying Start NHS completers (13%). A Flying Start NHS badge/pin was also suggested. 36

41 I received a certificate; I m not too fussed about an event. CPD is good for moving job A certificate is appropriate as you can keep it in your portfolio. You don t need an event or ceremony (Focus group with staff who are currently enrolled on Flying Start NHS ) Figure Consultees were generally unclear as to what further learning and training could be pursued following Flying Start NHS. The majority felt that there is little by way of a natural progression from the programme. Whilst some cited Effective Practitioner as the ideal follow-on training programme from Flying Start NHS, others, including a number of mentors, felt that more practical learning and training was needed after completion. As one mentor commented, Learning on the job follows on from Flying Start [NHS ], more practical learning. 37

42 6 The Role of Mentors in Flying Start NHS Delivery Introduction 6.1 This chapter explores the role of Flying Start NHS mentors from the perspectives of the mentor and mentee. It considers the usefulness of the mentor role; the type of mentoring support given; and the weaknesses in current mentoring. It also considers the added value of mentoring support; the challenges faced by mentors; and suggestions for improving the model going forward. Key Point Summary The overwhelming majority of people enrolled in Flying Start NHS have a mentor, although a small number do not due to lack of awareness that they can have one, or lack of mentor availability. The role of the mentor is critical in supporting a smooth transition and the success, or otherwise, of the mentoring arrangement is pivotal in determining the experience of NQPs undertaking Flying Start NHS. When working effectively, the mentor s role is to provide guidance to their mentees on working through the programme. They support and encourage progress; help put learning into practice; and review and provide feedback on learning activities completed. Few give advice on what order to complete Learning Units in, or how to manage time. Flying Start NHS Mentors feel prepared for their role, and, where received, mentor training was valued. Not all mentors receive training prior to starting their role. Mentors face similar challenges to those completing Flying Start NHS, including the amount of work required, the time pressures and the lack of buy-in and support from senior management. Where available, mentoring is a useful resource which is valued by NQPs. Mentorship is a much needed support tool for NQPs in their first year of practice. Mentor self-development is evident, with impacts on mentor skills and job satisfaction. More mentor training/guidance, mentor-to-mentor learning and an increased buy-in from senior staff can improve the mentoring model going forward, although ultimately, an effective model is also reliant upon NQPs motivation and self-drive. The Importance of Mentors 6.2 Evidence from NMAHPs suggests that the mentor role offers significant added value. NQPs felt that staff support from mentors is critical (currently enrolled focus group). NQPs need guidance and contact with a team member so that they do not feel alone and have someone to meet with if needed. 38

43 6.3 As outlined in chapter three, feeling supported is a key aspect of achieving successful transition. The evaluation confirms that mentorship in general is deemed as the most important support and training need of NQPs to help them make a successful transition in their first year. Mentorship in general is very important and needed in the first year after qualifying, as well as support from nursing assistants and management Getting time with a senior member of staff and knowing there s someone there to ask silly questions to [will help make a successful transition in the first year] It is a shock to leave Uni with all the support you get and to then go into work (Focus groups with those currently enrolled on Flying Start NHS ) 6.4 The support which NQPs require to make a smooth transition into practice includes the allocation of a consistent mentor who they can approach for advice, who is experienced, and who will show them what to do. This was particularly noted by pre-registration students, who are concerned about the increase in responsibility when moving from student to practitioner, where they can no longer only observe other staff in practice but must quickly learn and apply new skills to perform their role effectively. You need a mentor, someone to go to for support and to answer questions You need a named person that you can go to, probably a Band 5 or Band 6. Basically they should be experienced in the ward and know what they are doing. You need a supportive work team as I have been in placements where I have witnessed new nurses flounder without this support (Pre-registration student qualitative research) 6.5 Where mentors have good knowledge and understanding of Flying Start NHS and are engaged in the role, the findings indicated that they provide very valuable assistance and the mentoring model adds considerable value. I had excellent guidance and support from all staff and mentors My mentor was great she helped with any questions and issues I had I have found my mentor helpful when I felt I need it, but have been very self-directed (Online/telephone survey with those currently enrolled and completed Flying Start NHS ) 6.6 However, there is scope for the mentoring role to add more value to the programme as a whole by ensuring good practice is more consistently applied. This includes giving more regular feedback; providing a sounding board for NQPs to share their learning objectives; offering advice on how to make best use of the programme; and having a better knowledge of Flying Start NHS. 39

44 Facilitating Completion Some NQPs took longer than the allocated one year to complete the programme, and there were instances of NQPs taking two or three years to complete. It was felt that if mentors had more time to encourage and guide mentees through the process, then the time taken to complete the programme would decrease. As one completer noted, the mentor role is important, but they don t have a good understanding of Flying Start [NHS ]. We were not pushed to complete Flying Start [NHS ] I completed it in three years The Role of Flying Start NHS Mentors Reasons for Participating 6.7 Flying Start NHS has successfully engaged mentors to support programme delivery. Forty percent of mentors surveyed engaged because they thought it would be a valuable experience, whilst 34% wanted to support NQPs. Encouragement from senior staff was also an important driver of mentor engagement with 28% of mentors indicating that they had become mentors because their line manager had asked them to. Mentor Preparedness 6.8 Overall, mentors felt well prepared for their role. Mentorship training is available 72 and the Flying Start NHS website contains guidance for mentors, although not all mentors were aware of this or had used it. Seventy eight percent of mentors surveyed had reviewed Flying Start NHS guidance documents prior to starting as a mentor, and three quarters (74%) of those found it very/fairly helpful. 6.9 Over half (54%) of mentors surveyed had received support in advance of starting their role, and around half of those reported it to be very helpful/helpful. Most of this support was centred around training on what the role of a Flying Start NHS mentor should be (66%), and specific training on the programme itself (49%). Very few mentors had received guidance or support on how to build effective relationships, provide constructive feedback, or constructively question their mentees. These were considered to be useful elements that could have been covered by the guidance and training. Access to Mentors 6.10 As an integral part of the programme every NQP enrolled on Flying Start NHS should have a mentor. The research indicates however that this is not being adhered to consistently, with 26% of all of survey respondents stating they did not have a mentor on Flying Start NHS and 5% were unsure Lack of awareness and lack of availability of a suitable mentor were the principal reasons for not having a mentor. Of the 26% who said they did not have a mentor, two thirds of these (64%) were not offered one, 29% said they were not aware that they were entitled to one (29%) and 25% were not offered one. Furthermore, the vast majority of Flying Start NHS completers without a mentor felt that looking back, a mentor s support would have been helpful to them. 72 This is not specifically aimed at Flying Start NHS mentors but is available to all NHS mentors. 40

45 6.12 Some mentors have a single mentee at a time whilst others have more than one. Where mentors have more than one, there are examples of them bringing mentees together for group working and peer to peer support which NQPs reported to be helpful Where mentorship was available to NQPs, it was considered a helpful and valuable resource. Just over half (51%) of survey respondents rated their mentor as either helpful or very helpful in assisting them to work through Flying Start NHS ; while fewer than one in 10 (7%) felt their mentor was not at all helpful (as displayed in Figure 6.1). Figure 6.1 Support from Mentors 6.14 Mentors should be able to provide advice, guidance and encouragement to their mentees as well as reviewing their work, providing feedback and signing off Learning Units. However, it should be noted that due to the reflective and learner-centred nature of Flying Start NHS, the mentoring model works best when mentees are encouraged to take responsibility for their learning and are motivated to complete the programme, rather than mentors proactively guiding them along the journey. A balance therefore has to be struck The research shows that there are significant variations in the support that mentors provide and also the format of how they work with mentees. There are very good examples of mentors having a thorough understanding of the programme; taking an organised approach to providing mentorship and achieving a good balance between the provision of mentor support and NQP-led learning The most effective approach identified involved an in-depth first meeting at a very early stage to talk through Flying Start NHS, explore the website together, agree a way of working and plan the next steps. This would then be followed up with regular meetings to track progress, review work to date and set objectives for the next period. Where this approach is adhered to, the experience of Flying Start NHS tends to be much more positive. However, there are many instances where mentoring support falls short and this can be for a number of reasons including pressure on time, lack of buy-in from mentors, and insufficient knowledge and experience of Flying Start NHS. 41

46 In one example, the NQP would ask their mentor for deadlines to meet, which ensured their timely progress through the programme. The two would also talk through Flying Start NHS during performance reviews Figure 6.2 shows the most common support received by NQPs from their mentor was encouragement to progress through the programme and checking their learning records/providing feedback. Sixty percent said that their mentor explained parts of the programme that they found difficult. This is encouraging as it shows that many mentors are providing the sort of support required by NQPs, although there is scope for this to be more consistent for all enrolled NQPs We know that NQPs often have difficulty finding opportunities to put their Flying Start NHS learning in to practice (see chapter seven), but more than half of survey respondents did not receive help to do this from their mentor. Figure The support received by Nurses and Midwives and AHPs varies little, although AHPs tend to receive slightly more support from mentors, particularly around identifying opportunities to apply learning in practice and explanations of anything they find difficult As shown by Figure 6.3, the majority of mentors state that the support they give includes explaining anything mentees find difficult, encouraging them to progress through Flying Start NHS, monitoring progress and providing feedback on learning records. 42

47 Figure There is little discrepancy between the support that mentors say they give (Figure 6.3) and the support that mentees say they receive (Figure 6.2), although a considerably higher proportion of mentors report to explaining anything found difficult and helping mentees plan and manage their time It is important to note that in practice the scope and scale of support provided by mentors varies, and this is to be expected. It is key however that variations are driven by NQP needs and requirements, rather than other factors which can influence the mentoring relationship or failure to apply good practice. Mentor Challenges Challenges Faced by Mentees 6.23 An important issue raised in the evaluation is that not all mentors have an adequate understanding and knowledge of Flying Start NHS which means they are less able to provide the advice, guidance and feedback that mentees require. My mentor had no experience with Flying Start [NHS ] so it was difficult for both of us to understand what exactly had to be completed. My mentor was new to Flying Start [NHS ] so she knew very little. Maybe more knowledge from the mentors part would have helped. (Telephone surveys of staff who have completed Flying Start NHS ) 6.24 Mentors who had completed Flying Start NHS are generally recognised as having a better understanding of the programme than those who had not. As one NQP commented, I felt that my mentor and line managers had very little knowledge of the Flying Start [NHS ] programme although they were extremely supportive in providing an encouraging learning environment. However, this does not mean that mentors who have not completed Flying Start NHS are not or cannot be effective mentors Whilst there was some support for mentors to be drawn from staff who had completed Flying Start NHS, this may be unrealistic due to insufficient completers in each site. 43

48 Challenges Faced by Mentors 6.26 Flying Start NHS mentors face a number of challenges in fulfilling their role, many of which are similar to those experienced by mentees. Nearly four in 10 (38%) mentors stated that being a Flying Start NHS mentor involved more work than they had anticipated and 24% said that they have to complete more work in their own time than expected. One hospital-based nursing mentor stated that it was time consuming, there is no available time along with other demands of the job, while another commented that: it is too time-consuming, but someone has to do it Many mentors perceive that senior management have a limited understanding and awareness of the programme which makes it difficult for mentors to commit the time required as they are under pressure from their managers. As one mentor commented: I do not believe the role and work put in by the mentor and mentee is valued within our organisation at a line management level, it is treated as a paper exercise. It is supported very well by the PEFs however without the support and encouragement from Senior Charge Nurses at ward level or consequences for non-completion then it is not taken seriously 6.28 A Flying Start NHS mentor who had also completed the programme stated that to encourage more staff to become mentors, there is a need to, raise awareness to managers, so that they can support the mentors. Mentors, in turn, will then better support mentees Some mentors, particularly those with multiple mentees, find it difficult to monitor progress and find time to spend with mentees, which hinders effective communication. This was particularly true in NHS Boards where the Flying Start NHS dashboard (see Chapter 2) is not being trialled. The general feeling is that the dashboard would help and could only be positive (Flying Start NHS mentors). It would allow mentors to more easily track the progress of learners and target support where and when it is most needed. They reported that it could potentially increase the completion rates within the one year allocated. The Future Development of Mentoring 6.30 More training, guidance and clarification on the role of a Flying Start NHS mentor is something that Flying Start NHS mentors have an appetite for. Mentors also require protected time to provide effective support and an adequate level of engagement with their mentee There is an appetite for more mentor-to-mentor learning. Learning Action sets have been helpful to NQPs as a useful way of exchanging experiences and learning from one another, and mentors too believe that working together will promote resource-sharing and the sharing of good practice. More sharing between other mentors more examples of completed programmes accessible More support for mentors in the form of line management support (Focus groups with Flying Start NHS mentors) 6.32 However, there is still a strong feeling amongst the mentor community that their role is to guide mentees through the self-directed programme rather than hand-hold and direct them along the journey. One mentor stated that the purpose of a mentor is to have a support role also, to give them encouragement and reassurance while a line manager said a mentor is an enabler and a facilitator for an individual. Achieving balance in the relationship between mentor and mentee and encouraging NQPs to take ownership of their personal development are important aspects of the mentoring model. 44

49 The mentee must take responsibility for this training, it should not be up to the mentor to ensure it is completed. As a newly qualified staff nurse, taking responsibility in their development is a vital part of progression [Flying Start NHS can be improved by] the commitment of student to complete (Focus groups with Flying Start NHS mentors) 45

50 7 The Content of Flying Start NHS Introduction 7.1 Chapter seven considers the extent to which the content of Flying Start NHS is fit for purpose. It examines the findings on its usefulness, relevance and scope; and considers the ease of applying Flying Start NHS learning in the workplace, the relevance of content in meeting NQP s needs and explores alignment and overlap with mandatory training. Key Point Summary The content of Flying Start NHS is on the whole fit for purpose and incorporates core skills and subject areas relevant to the different NMAHP settings and subject areas. NMAHPs found the Learning Units with an emphasis on practical skills development and core skills development such as communication and team working to have the most value as they are used on a day to day basis. The theoretical Learning Units were not received as well by NMAHPs although were identified by NHS strategic consultees to have value. The majority of survey respondents found the Learning Units useful. Weaknesses focused on the content being too generic; some Units (such as Careers) being less relevant; and the content duplicating post-registration training. The majority of survey respondents and consultees believe there are no gaps in Flying Start NHS content, although it was suggested that the content should be streamlined to make it less overwhelming. Overall, pre-registration students thought Flying Start NHS content appeared broadly fit for purpose and an opportunity to reinforce theoretical learning from University in a practical context. In general it was agreed that the Learning Units are very easy/easy to complete, particularly those which were most relevant for practice. Where NMAHPs found Learning Units difficult to complete it was due to the perception of insufficient guidance about how to complete the Units and how much evidence should be provided. Putting the Learning Units into practice was sometimes hindered by a lack of opportunities in the workplace and some Units being more difficult to interpret and apply in a practical setting. There is little evidence of a significant unnecessary overlap between Flying Start NHS and mandatory training provision although some of the NMAHPs did note that there was repetition and overlap between Flying Start and their University degrees and a lack of clarity as to how Flying Start NHS links with other mandatory training such as LearnPro NHS and the NHS Knowledge and Skills Framework. The Appropriateness of Flying Start NHS Content 7.2 The content of Flying Start NHS is largely appropriate and fit for purpose. The programme covers a wide spectrum of core skills and subject areas which are applicable across different settings 46

51 and professions within the NHS and in other settings. The scope of the content provides all NMAHPs with a flexible development tool to support their transition. Usefulness of Content 7.3 On the whole, all of the Learning Units were rated as being useful to various extents, although some Units were reported as being more useful than others. Reflective Practice, Communication, Teamwork and Clinical Skills were identified as the most useful Learning Units by respondents to the survey although in the qualitative research there was strong support for Reflective Practice to be a cross cutting theme rather than a separate Learning Unit. As a learning disability nurse, many of the units were extremely useful, communication, for example, is really important Teamwork and communication with community nursing is pivotal to providing patient care in a safe manner (Focus group participants enrolled and completers) 7.4 The most useful Learning Units were those that NMAHPs perceived as being most closely related to their practice and responsibilities on the job. As one consultee commented, Communication was useful. A lot of the activities made you think about how you communicate with patients and families in practice. As a result these Learning Units were also identified as having the most impact. It helped me develop my people and patient skills through communication skills. I work with dementia patients so communication is really important It helped me communicate with relations in stressful situations It has helped me to manage stress in stressful situations, ensuring I get my point across clearly without an argument (Focus group participants - completers) 47

52 Figure The more theoretical Learning Units, such as Policy, were less well received by respondents in the survey and this was supported by the qualitative research. Whilst some recognised that these helped to contextualise their work and explain the reasons behind what they do in practice. Others felt that the content was boring, irrelevant to practice, and repetitive of pre-registration learning. 7.6 Qualitative consultations suggested that these perceptions were often driven by lack of understanding as to how to use and apply these Learning Units, rather than because the content was not useful. For instance, where NMAPHs had used the Policy Unit to look at specific policies relating to their work, they tended to find it more rewarding. Policy can sometimes be difficult to understand. I do not feel I know an awful lot about this [I] did not understand safe policy, it was very dry and very repetitive. (Survey respondents enrolled and completers) 7.7 Overall, pre-registration students thought Flying Start NHS content appeared broadly fit for purpose, with clinical skills identified as their main support need. In contrast to NQP views, preregistration students were less likely to consider content covered at university as repetition but as an opportunity to reinforce theoretical learning in a practical context, and welcomed the broad scope of the programme. It can never be covered too much (pre-registration student). 7.8 At a strategic level consultees were more likely to see value in theoretical Units such as Policy and Research for Practice, as they provide a balance to practical experience and present a good opportunity for NQPs to research wider policies, explore relevant research, make links to the NHS Knowledge and Skills Framework; and build a foundation of knowledge (Flying Start NHS Lead). 7.9 Overall the findings suggest that participants in Flying Start NHS find it much easier to see the value in practical skills development units and core skills such as communication and team working which are used on a day to day basis. NQPs require support however to better understand how more 48