Covid 19 Guide – Pan London Practice Learning Group

The Pan London Practice Learning Group

Guidance regarding practice support for deployed nursing students during the COVID-19 emergency.

1.0 Introduction to the Pan London Practice Learning Group Guidance
regarding practice support for deployed nursing students during the COVID-19 emergency

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Nursing and Midwifery students have been invited to volunteer to undertake an extended placement.

This includes:

Year 2 nursing and midwifery students or those in the first six months of the third year of their degree programme or first year postgraduate students These students may spend no more that 80% of their hours in clinical placement and 20% of their hours in theoretical learning, hence equivalent to 30 hrs a week in clinical practice.

Year 3 nursing and midwifery students in the final six months of their pre-registration programmes. These students may do up to 100% in practice (some HEIs have agreed an 80/20% split) and complete their programmes in clinical placements, while ensuring all learning outcomes are met. (See section 1.3 re NHS Staff Council temporary job descriptions)

The NMC is also exploring a Covid-19 temporary register for nursing students who are in the last six months of their programme in the event that a ‘state of emergency’ is declared. This is currently not available. If this does occur students can volunteer to enter this temporary register as a Band 5 but transition to the Band 5 will involve discussion between the HEI and partner organisation regarding the students’ level of performance and capability. (See section 1.3 re NHS Staff Council temporary job descriptions)

1.1 What are the NMC saying about support and supervision in practice.
The Nursing and Midwifery Council outlined their guidance regarding student supervision and support in their ‘Emergency standards for nursing and midwifery education’ published on 25th March 2020.

Some key areas include:

To ensure students get the support and supervision they need to learn, protected learning time must be provided. The level of supervision a student needs is based on the professional judgement of their supervisors.
All students will receive support, supervision and assessment in line with the Standards for Student Supervision and Assessment (SSSA – NMC 2018) but exceptionally, the same person may fulfil the role of practice supervisor and practice assessor during this emergency period.
The assessment is to be conducted by a registered nurse, midwife or nursing associate (in line with the SSSA), with suitable equivalent qualifications for the programme the student is undertaking, and who is not on the temporary register

NMC (2020)
www.nmc.org.uk/standards-for-education-and-training/emergency-education-standards/

The NMC statement have also produced a statement on personal protective equipment during the Covid-19 pandemic (See link below)
www.nmc.org.uk/news/news-and-updates/nmc-statement-on-personal-protective-equipment-during-the-covid-19-pandemic/

1.2 Health Education England have also published guidance in March 2020 that states that these students will be employed in clinical practice working with appropriate support and supervision within an appropriate delegation framework. See link to HEE document ‘Student Support Guide’.

HEE (2020)
www.hee.nhs.uk/sites/default/files/documents/Student%20support%20guide%20master%20.pdf

1.3 On 07.04.20 the NHS Staff Council produced temporary job descriptions and guidance for deployed nursing students. These have been shared with all potential employers and include reference to two groups of students:

Year 2, beginning of Year 3 or Year 1 postgraduate nursing students (referred to as ‘mid programme students’)
Nursing students in the final 6 months of their programme (referred to as ‘aspirant nurses’)

NHS Employers (2020) NHS Staff Council advice on job descriptions and banding of nursing.
www.nhsemployers.org/-/media/Employers/Documents/COVID19/NHS-Staff-Council-advice-job-descriptions-and-banding-of-nursing-students.pdf?la=en&hash=12AD2E919FE425704985AB47BB75DC2C66BD5461

1. Key Links

These three documents are referred to in the guidance:—
NMC (2020) Emergency standards for nursing and midwifery education

HEE (2020) Student Support guidance during COVID-19 Outbreak

NHS Employers (2020) Staff Council advice on job descriptions and banding of nursing

2. CapitalNurse Resources

The CapitalNurse programme team have developed resources and identified relevant e-learning for healthcare modules to support returners to practice which are equally relevant to support student learning and assessment. These can be accessed via this link:
www.hee.nhs.uk/our-work/capitalnurse/back-clinical-practice-covid-19

3. Student Health and Well-being

Each HEI will have directed students to a range of support mechanisms and resources that can be accessed via their university virtual learning pages. Each practice organisation will also have access to a number of resources that students can access locally. HEE direct students to the NHS Employers free access to wellbeing apps for all NHS staff:
www.nhsemployers.org/news/2020/03/free-access-to-wellbeing-apps-for-all-nhs-staff

Further resources are being developed to enhance student and staff support across London and these will be included here once available.

2.0 Preparation for Practice

Each HEI has been keeping students fully informed of the guidance and standards that have been distributed in the preparation for undertaking extended placements and their deployment to work in various practice settings. This has included the Public Health England, NHS and World Health Organisation guidance regarding COVID-19.

Programmes have continued to be delivered online with many students accessing simulated skills sessions virtually.

In addition to specific preparation and guidance given by the individual HEIs discussion with the CapitalNurse programme team has resulted in the identification of some resources they have developed to support returners to practice but which are equally relevant to support student learning and assessment. Some examples are provided below though e-learning for healthcare modules can also be accessed via this link:

www.hee.nhs.uk/our-work/capitalnurse/back-clinical-practice-covid-19

The following learning resources on this page may be particularly helpful in supporting student learning:

Infection Control level 2: a brief training programme that has been updated to include COVID-19 national infection control guidance.
Medicines Management – a PowerPoint presentation to refresh one’s knowledge and skills
Undertaking an accurate and comprehensive assessment of the acutely ill adult: a CPD article to support knowledge and skill development / refresh
Using the ABCDE approach to assess the deteriorating patient: a CPD article to support knowledge and skill development / refresh.
End of Life Care: a video and or e-learning for healthcare modules

3.0 Student Support from the HEI

All HEIs have clearly structured frameworks of support that students will be made aware of and know how to access.

Each HEI will take responsibility for supporting their own students – wherever they are on placement.
This is essentially a three-pronged approach as outlined below

All students are being invited to engage in regular virtual communication / reflective sessions / debriefs with a named academic within their organisation. This may be their personal tutor or academic assessor in the main. Academic staff will undertake their own risk assessment to determine if actions are needed regarding student safety and support and will escalate appropriately to senior HEI colleagues who will address with the local practice organisation as relevant.
Placement organisations will be given the name of an individual or central point of contact should they have any queries or require support on any student related issue. Where necessary the individual queries will be filtered and escalated to the most appropriate individual to respond. The identified process will be shared with organisations and students. Students who take up an extended placement outside their usual placement patch will be instructed to share this information with their temporary employers.
All HEIs will continue to liaise closely with their identified partner organisations and be fully responsive to any requests for information, support or guidance.

3.1 Student Health and Well-being

Initial support from the HEI related to the student placement are highlighted above and each HEI will have directed students to a range of support mechanisms and resources that can be accessed via their university virtual learning pages. Each practice organisation will also have access to a number of resources that students can access locally. As other links are developed they will appear on the PLPLG website (See www.plplg.uk)

If a practice supervisor identifies that a student requires additional guidance or support they should contact the identified university representative.

4.0 Induction/Orientation to Practice

We appreciate that all organisations are planning some form of induction for deployed students. Students who are being deployed to an organisation that they have never previously worked in will require a more comprehensive induction to familiarise themselves with that organisation. Students will be required to wear their university student uniform during this period as well as their university identification badge.

The orientation checklist in the practice assessment document outlines the following areas to be included in the area orientation:

A general orientation to the health and social care placement setting needs to be undertaken including where to access fire and resuscitation equipment and related policies.
An overview of the area systems and routines: shift times, meal times, reporting sick policies, uniform and dress policies (students will wear their own student uniform where relevant).
Discussion re mandatory training relevant to their role such as infection control, safeguarding, resuscitation. Please note that mental health and learning disability students only receive Breakaway Training within their programmes and do not usually undertake Prevention and Management of Violence and Aggression (PMVA).
Information and access to relevant policies and procedures to support evidence-based practice including access to IT systems.
Processes for escalating concerns – both related to patient care/safety as well as their individual concerns related to their learning experience, support and personal safety (See below section).
Access to Personal Protective Equipment and appropriate training in its use.
Information and guidance regarding their scope of practice during this emergency period and how their supervision, support, protected learning and assessment will be managed.

4.1 After the initial orientation during the induction period the following needs to be considered.

A discussion planned, within the first week with the staff member who will be supervising the student, to explore the students experience, knowledge and skills, relevant to their stage of learning and opportunities available.
Students must be supported to immediately speak up if they are delegated a task that is not appropriate to their level of knowledge or skill, and not leave this until a review at some point in the future.
Dates for regular reviews need to be set to explore whether students continue to feel supported and have periods of reflective learning in line with requirements for protected learning (see section 5.0).
Signposting students to appropriate colleagues who can provide clinical supervision/support and advice when they need it (e.g. nurses, specialty doctors, peers, allied health professionals)
Reminders regarding processes / policies of who to notify (and how) within the ward area/ department/organisation if they have concerns – escalating concerns below.

5.0 Student Support in Practice

As per HEE and NMC guidance students must receive the support and supervision required to support their learning and in accordance with NMC guidance protected learning time must be provided. The NMC also state the following:

The level of supervision a student needs is based on the professional judgement of their supervisors.
Students must receive support, supervision and assessment in line with the Standards for Student Supervision and Assessment (SSSA – NMC 2018) but exceptionally, the same person may fulfil the role of practice supervisor and practice assessor during this emergency period.
Student assessment must be conducted by a registered nurse, midwife or nursing associate (in line with the SSSA) with suitable equivalent qualifications for the programme the student is undertaking, and who is not on the temporary register. This does rule out those staff who have returned to the register during this period.

To meet the requirements for protected learning time we are proposing that students are:

facilitated to meet their learning outcomes within their PADs
given time to reflect on their practice either through scheduled reflective / drop in sessions that may be planned within the organisation and / or given time and encouraged to discuss their learning and experiences with peers/supervisors
supported to undertake some of the learning activities we are proposing from the CapitalNurse programme
given the opportunity to negotiate time to join an online call /virtual meeting that may be arranged by the identified university representative responsible for their support.

5.1 Completing the Practice Assessment Document (PAD)

Each PAD is referred to as a Part and there are three Parts to be completed during the programme. There are four key components in the Nursing PAD:

Professional Values
Essential Skills Clusters/ Proficiencies
Episode of care
Medicines management

Many year 2 and year 3 students will still be required to meet certain components of their PAD in order to meet the NMC requirements for registration.

For a number of students many of their essential skills will already have been met in previous placements and so it is important to identify which areas still need to be met to complete the Part.

Students completing Part 2 PADs (typically year 2 students) may be supported to progress and given the opportunity to meet some outstanding skills in the next academic year if they are not completed on their extended placement.

Staff are being reminded that the learning activities based on the CapitalNurse proposals for returning nurses and eLearning for health provide the theoretical underpinning for many of the essential skills that students need to complete.

For example:

there is a cluster related to inflection control and one related to medicines management – both of which link with activities they are being encouraged to complete.
the organisational aspect of the care cluster links closely with team working, developing leadership skills and in caring for patients with complex care needs, most of which is also reflected in the Episode of care.

Staff are reminded of the need to alert the university representative if any issues regarding student conduct and performance are identified so that a joint approach to student support can be initiated and an action plan developed if needed. The HEI process for raising concerns regarding student performance is outlined in the PAD.

Students are being advised to:

prepare in advance and be very clear regarding areas they still need to achieve during this extended placement
be proactive and take a lead in ensuring their documents are completed.
be sensitive to the workload and pressures on staff and therefore be flexible if interviews cannot occur at the required time and for example if a midpoint interview is due students are encouraged in this instance to complete their own self-assessment and rearrange a time for the identified registered nurse to complete this.
that the same person registered nurse who may fulfil the role of practice supervisor and practice assessor during this period.
maintain a regular record of their learning and skills in the additional record of activities / communication paged in the PAD and where possible have this countersigned by the appropriate staff members
focus on the completion of the episode of care early in the experience if not done so already
raise concerns early so that support can be given and seek advice from their university representative if completion becomes challenging so that alternative solutions can be sought.

5.2 Escalating concerns process for students.

Student concerns may be related to patient safety, related to their learning experience or related to their own safety at this challenging time. All organisations have clear policies for escalating concerns as do the HEIs. The following steps should be followed:

NMC Guidance on Raising Concerns

Contents

1.0 Introduction to the Pan London Practice Learning Group Guidance regarding practice support for deployed nursing students during the COVID-19 emergency