Nurchat: Fortnightly Twitter Chats for Nurses and Healthcare Professionals

Making the leap from student nurse to registered nurse is undoubtedly challenging. Self-confidence is essential to becoming an effective practitioner, and the experience of the first few months in a nursing career is pivotal. Good support and guidance in those initial stages can be facilitated by a well-structured preceptorship, which can lay the foundations for a solid and rewarding career in nursing.

Student nurses have several priorities in their crucial final year, including a management placement and final sign-off. Identifying a career route post-graduation that includes a preceptorship can be difficult, especially as they may not be widely available.

There are also several other aspects of the transition period to consider, such as compiling a detailed portfolio, creating a CV and applying for jobs. As several participants in the recent NurChat discussion highlighted, there are a range of options for portfolio material that add unique touches and impress an employer. Reflective practice can be applied in different ways to demonstrate learning following real life experiences, and understanding of how theory can be applied in a practical way.

@ruthiepm my portfolio as student is full of examples of volunteering and extracts from my blog/reflections #nurchat

@cantgetinvolved The best portfolios contain real interactions, reflections on practice…not all about study days and certificates #NurChat

Preparing for a job interview itself is as important as creating a strong portfolio. Researching the role, the employer and the challenges of the job are all key to a good level of preparation. Some universities offer assistance in this area, as Rachel Payne (@RachieRuu) pointed out, there are sessions available to help students prepare for their first nursing job. An interesting portfolio can often be part of this and could be used to support interview responses, especially in the competency section as pointed out below.

@colintwangel Real-life reflections from professional portfolios are a great help with competence-based job interview questions. #NurChat

The first nursing job following graduation brings with it a newly acquired level of accountability, along with the title of Registered Nurse. As Jo Thomas (@Jo_Thomas67 ) pointed out during the NurChat discussion, the ‘reality shock’ effect identified by Kramer in his 1974 piece¹ still applies today.

A preceptorship is designed as an induction period for a newly qualified nurse to grow in confidence with the support of a designated preceptor. While the NMC ‘recommends strongly that all new-registrants should have a formal period of preceptorship of about four months’², not every NHS trust or private sector organization offers such a programme. It is not currently a mandatory requirement in England, and concerns have been expressed for some time now that not all newly qualified nurses are receiving the support they need³.

@RebeccaLouiseUK Is the preceptorship mandatory? As I had the option to do it- glad I did otherwise I would have been a rabbit in headlights! #NurChat

@RebeccaLouiseUK There aren’t enough preceptorship facilitators in hospital. My trust has 1 nurse for about 25 newly qualifieds they employ! Crazy #NurChat

@abrianpratt: preceptorship was useful and welcome 4 me. v supportive team and leaders #NurChat

@allheathensnow on my first day off preceptorship there was a suicide by hanging on the ward. Without team support, I’d have capsized #NurChat

The discussion also focused on the structure and content of a preceptorship programme, the general consensus being that the content should be tailored to the individual while maintaining an agreed structure of learning. The NMC recognises that there should be protected time and regular meetings between the newly qualified nurse and their preceptor, however the method of delivering a preceptorship has not yet been defined.

Several participants in the discussion felt that a ‘one size fits all’ approach simply is not appropriate because everyone learns in different ways. However, it was felt that a structure with defined learning outcomes, scheduled protected time, competency assessments and final sign-off should be implemented.

@ruthiepm Find it hard getting protected time with mentor on placement as student…I like sound of structured programme post-reg #nurchat

@cantgetinvolved I like the structured plan to identify transitional role / outcomes for newly qualified staff #NurChat

@cantgetinvolved We seem to have more shadowing and unstructured mentorship rather than structured preceptorship #NurChat

@Jo_Thomas67 #NurChat each RN had structured outcomes to demonstrate & action plan

@RebeccaLouiseUK I remember for the first couple of weeks I had 4 patients and then slowly built up to more. Helped loads! #nurchat

There was also some debate over the appropriate length of a preceptorship programme:

@sydeveau Minimum 6 months preceptorship. A year would be better #nurchat

@allheathensnow I’ve heard of people taking 18months! Ridiculous! At least 3 months, max 6 months #NurChat

@IanMcKnight4 #nurchat NQ nurse should only need preceptorship for 6 months- if it’s leadership then go get training as PDP

@sphams at least 12 months, but in reality we never stop learning and we always need #highsupport and #highchallenge #NurChat

Lifelong learning is at the very core of nursing, and the value of a preceptorship programme is not in doubt. While there remains some debate on the most effective duration and delivery of an effective preceptorship, there is a strong demand from newly qualified nurses for places on such programmes.

@sydeveau I picked the trust I currently work for over others because they have a mandatory preceptorship. #nurchat

@allheathensnow good preceptorship is vital to building confidence and sets the tone for your subsequent qualified years #NurChat

Training and development is clearly essential, but with recruitment freezes and budget reductions still in place in the public sector, and to some extent the private sector as well, the likelihood is that mentors and preceptors will be juggling an ever growing number of newly qualified nurses. That will inevitably put pressure on protected time and the availability of support, which could reduce the quality of any preceptorship programme on offer.

@DGFoord Investment in preceptorship training pays back in coaching, assessment & feedback skills developed across all MDT #nurchat

References:

1. ‘Reality Shock: Why nurses leave nursing’, M Kramer, 1974
2. Nursing and Midwifery Council Preceptorship Guidelines, 3 October 2006
3. Newly qualified nurses must have proper support says Government advisor, Nursing Times, 17 January 2012