Peach, practice, placements and partnership: an initiative tosupport clinical placements in nursing curricula

PAUL TURNER BSC, MSC, CERT ED, RGN, DIPN, RCNT, RNT

Director, Clinical Placement Support Unit, Faculty of Health and Community Care, University of Central England,Edgbaston Campus, Westbourne Road, Birmingham, B15 3TN, UK

Correspondence

P. Turner

Clinical Placement Support Unit

Faculty of Health and

Community Care

University of Central England

Edgbaston Campus

Westbourne Road

Birmingham B15 3TN

UK

TURNER P. (2001) Journal of Nursing Management 9, 325±329

Peach, practice, placements and partnership: an initiative to support clinical

placements in nursing curricula

This article reports on the formation of an innovative new unit, termed the Clinical

Placement Support Unit (CPSU), within a Faculty of Health in a Midlands

university. The CPSU is concerned with managing the clinical experiences of the

Faculty's health care students and promoting a healthy dialogue between the staff in

the Faculty and their clinical colleagues. Several approaches by which a relatively

small group of people (the Faculty staff) keep informed a relatively large group of

people (the clinical staff within the local NHS Trusts) are detailed. One of the

approaches is an assessors newsletter and a second is a website for use by both

health care students and the clinical assessors of those students. The main part of

the website is an ambitious attempt to help better prepare students prior to their

clinical placements and this section of the website is called the Placement Directory.

The Placement Directory currently holds details on hundreds of placements where

the health care students may be placed. Each web page gives details about a speci®c

clinical placement and has a number of hyperlinks to relevant internet resources.

Accepted for publication: 5 February 2001

The shaping forces

The drive to move nurse education from schools and

colleges of nursing, predominantly located in clinical

settings, into higher education institutions (HEIs) began in

the mid-1980s. The resultant moves and mergers led to

major changes for both the staff involved and, as a

consequence, the services that these staff provided.

Leonard and Jowett (1990, p. 16) report on the, `great

deal of time and effort' staff had to invest in this process of

integration. This suggests that the investment of staff's

`time and effort' was no longer directed at their local

clinical institutions and a consequence of these changes

was that the close ties between service and education,

which were helped enormously by the geographical

closeness of the two, were, in many instances, eroded.

The support from educationalists for their students while

on placement and for their service colleagues was

consequently adversely affected.

The clinical environment, both now and during the past

decade, has seen an increase in the throughput of patients

exacerbated by a reduction in the number of beds.

Between 1987±88 and 1997±98 the average daily number of

available beds has fallen by an average of 4.2% per annum

The Clinical Placement Support Unit (CPSU) is a part of the

Faculty of Health and Community Care (FHCC), which in turn is a

part of the University of Central England (UCE) in Birmingham.

The CPSU came into being on 7 April 1999, but the disparate

forces which eventually led to its formation had been in existence

for some time before.

Journal of Nursing Management, 2001, 9, 325±329

f 2001 Blackwell Science Ltd 325

(DoH 2000). Thus, clinical staff operate in areas where

high turnover of patients is the norm, leading to them

feeling `pressurised, unappreciated and unsupported'

(UKCC 1999) and therefore with little time to devote to

the supervision of students.

Genesis

From the preceding it is evident that the clinical placement

component of nursing courses was in danger of being

starved of resources (most importantly, human resources)

from both the educational and clinical sides. While the

importance of practice to the education of nurses was

never in doubt, a clear evidence base was developing to

show that practice was beginning to be seen as the `poor

cousin' to academia (Cuthbertson 1996, UKCC 1999).

(The so-called `Peach Report' by the UKCC (1999) was

the result of a comprehensive review of preregistration

nursing and midwifery education and was to prove very

in¯uential in helping to determine the shape of the new

nursing curricula.) The teaching and supervision of

students by clinical staff was in danger of being perceived

as yet another onerous task to an already overburdened

workforce. This is in no way intended to belittle the

excellent work that had continued to be done by both

clinical and academic staff, just to acknowledge that

enough was enough and that there was potential to set

in motion plans to improve things. With this as a

background to the situation, the Faculty of Health and

Community Care (FHCC) at the University of Central

England (UCE) in Birmingham decided to devise a robust

strategy to address this. This strategy resulted in the

formation of what was eventually to be called the

Clinical Placement Support Unit (CPSU).

The Clinical Placement Support Unit

This Unit brought together, under one management

structure, the various elements that dealt with matters

concerning the students' experience in clinical areas. Thus

the Allocations Department which arranged and managed

many thousands of placements for many hundreds of

students was brought together with the Audit Department.

The Audit Department co-ordinated the extensive annual

round of audits of clinical areas, as well as the continuous

feedback about clinical areas provided by nursing students

of the Faculty who are required to complete a `Student

Clinical Placement Evaluation Questionnaire' at the com-

pletion of each clinical placement. To these two well-

established departments was added a third, the Education

Support Department, which was staffed by an experienced

part-time academic. A new post of director of the Unit was

created and an experienced academic also ®lled this post.

In addition to requiring a certain amount of experience in

the ®elds of nursing and working in a university setting,

the director also needed to have a technological bent, as

exploitation of the opportunities afforded by the `internet

revolution' were to be seriously explored.

The Unit's broad aim was to further promote a healthy

dialogue between the staff in the Faculty and their many

colleagues in the clinical areas, as well as supporting the

students' experience before, during and after placement.

An initial list of objectives was drawn up and included the

following:

. Create a computer database to form the live register of

assessors.

. Produce a quarterly newsletter to be distributed to all

assessors.

. Grant free access to the UCE nursing libraries for all

registered assessors.

. Conduct a review of clinical nursing skills to ensure

that the most frequently practised are given priority in

the nursing curricula.

. Create a Unit website, which would include a Directory

of Clinical Placements for students to access. This

would provide students with information about areas

they are being allocated to so that they could better

prepare before commencing each placement.

Progress to date

Assessors

In common with many HEIs that are providers of nurse

education to substantial numbers of nursing students, the

need to maintain a live register of assessors (ENB 1997a) is

dif®cult. There are a number of reasons for this. The sheer

scale of the enterprise creates a good deal of logistical

dif®culties, trying to keep tabs on what has traditionally

been quite a mobile workforce is hard, as well as the dif-

®culties posed by the number of assessors involved. There

is also a degree of inertia to overcome in the individual

assessors. If the individual assessors' details change, the

need to inform the local nurse education provider is one

among many other parties who also need to be informed.

HEIs have to comply with statutory obligations; unfortu-

nately many assessors do not appreciate this or the role

that they as individuals can play in assisting with this.

In an attempt to address this issue some thought went

into how we could best foster good relationships with the

many assessors. A newsletter containing articles pertinent

to their work as assessors and which would help in keep-

ing them informed and up-to-date in their role as assessors

was seen as a viable means of achieving this. Also the

P. Turner

326 f 2001 Blackwell Science Ltd, Journal of Nursing Management, 9, 325±329

Faculty management took the decision to allow anyone

acting in the capacity of assessor to nursing students to

have access and lending rights to the UCE nursing libraries

± in effect giving something back in recognition of their

efforts in helping to produce the next generations of

nurses.

Towards this end a form was produced which consisted

of a two sections: a top half, which the assessor needed to

complete and have countersigned by a member of the

CPSU staff to get access to the nursing libraries; and a

bottom half, which requested the assessors details, which

were then entered onto a computerized database. Obtain-

ing the assessors details for entry into the database was

a prerequisite for access to the nursing libraries. The

assessors' addresses held in the database were then used to

do a print run of address labels which were used to send

individual assessors copies of the quarterly newsletters.

The dispatch of newsletters to individuals was thought to

personalize the process and encourage the idea that they

were known to the Faculty as individuals and that they

and the work they did as assessors had value. To ensure

adherence to the Data Protection Act the following

statement was included at the bottom of the form:

`Please note that this information is for the use of the

Clinical Placement Support Unit only and will not be

released to any third party nor used for any purposes

without your prior permission.'

Quarterly newsletter

As mentioned previously, a regular newsletter was to be

produced, written for the assessors. After carefully con-

sidering the resources and time available, it was decided

that an achievable goal of a quarterly newsletter was

possible. Three thousand copies of each edition are pro-

duced and distributed to the clinical areas in two ways.

The ®rst way has been described previously, in that when

the details of each individual assessor are held on the

assessor's database, a copy of each newsletter will be

posted to them. This is obviously the preferred route and

much work has gone into encouraging assessors to return

their details to the Unit. The second way is via a second

database, this one being termed the `clinical areas data-

base', which contains the addresses of approximately 600

placements. In exactly the same fashion as the assessors'

database is used, a print run of labels is produced for each

newsletter so that those approximately 600 placements

each receive two copies of the newsletter.

A standard format for the newsletter was agreed and

it was entitled the Clinical Placement Support Unit

News: The Newsletter for Assessors. Each newsletter

contains CPSU staff contact details, including telephone

and facsimile numbers as well as staff e-mail addresses.

Articles for inclusion in the newsletters are chosen on

the grounds of their usefulness and appropriateness to

assessors. It is intended that most editions will contain a

section headed `Pro®le on good practice'. These articles

feature a clinical area (or an individual) that has developed

an aspect of good educational practice which bene®ts

nursing students. To date, ten newsletters have been pro-

duced and areas of good practice highlighted have been

in paediatrics, theatres, mental health and learning dis-

abilities. The back page of every newsletter is a form

which the assessors complete and then send in to the CPSU.

The assessors' details are then entered into the assessors'

database, then for subsequent editions of the newsletter

the assessors will have a copy posted to them.

Nursing skills

The importance of nursing skills has gained in prominence

in the new nursing curriculum (DoH 1999, UKCC 1999).

This is encapsulated in the UKCC Year One Learning

Outcome, `Demonstrate a range of essential nursing skills

to meet individuals' needs_' For the UKCC competencies

for entry to the register this relates to: `Based on best

available evidence, apply knowledge and an appropriate

repertoire of skills indicative of safe nursing practice.'

With some degree of prescience, Louise Hunt, a member

of the CPSU, conducted a survey of all clinical placements

in use for student nurses to ®nd out which psychomotor

skills are the most commonly practised. A 78% return rate

was achieved, a remarkable ®gure that demonstrates the

interest of the clinical staff in this area. The high level of

response gave an accurate picture of the clinical skills

currently being practised. The skill identi®ed as being the

most practised is hand washing, which frequently occurs

in 83% of all clinical placements. The top 10 psychomotor

skills are:

. hand washing 83%;

. disposal of sharps 78%;

. administration of oral tablets and capsules 65%;

. administration of intramuscular injection 61%;

. administration of oral syrups and elixirs 59%;

. radial pulse measurement 51%;

. disposal of linen 51%;

. blood glucose monitoring 49%;

. wound dressing 48%;

. urinalysis 47%;

and the top 5 organizational skills are:

. prioritizing care 78%;

. allocating nursing duties 69%;

Peach, Practice, Placements and Partnership

f 2001 Blackwell Science Ltd, Journal of Nursing Management, 9, 325±329 327

. organizing community care 68%;

. providing discharge information 57%;

. arranging medication and treatments to take out 55%.

The teaching teams at the UCE have examined the

results of the survey and the ®ndings have been used to

in¯uence the present and new nursing courses in the

following ways:

. The most frequently practised skills are included in the

Foundation Programme curriculum.

. Each of the four branches of nursing will be able to

identify any skills which are particular to their area of

practice and include these in their branch programme.

. The skills booklets which are currently used as an

additional practical aid to assessing students will also

be updated in the light of the ®ndings of the survey

so that they are a true re¯ection of the branch of

nursing they refer to.

The questionnaire generated a list of over 100 other

nursing skills not listed that are being practised frequently

in one or more branches of nursing. This means that the

psychomotor skills in the nursing questionnaire can now

be revised to include these skills so that the next time it is

used it will accurately re¯ects skills practised across all

four branches of nursing. The comments received have

also encouraged the CPSU to carry out a further survey to

examine emotional, intellectual and psychological skills

being practised by nurses across Birmingham and Solihull.

Creation of a website

The CPSU website is intended as a resource for both

students and assessors. It is divided into a number of

sections (Table 1).

The site is in an easy-to-use menu-driven format and

has deliberately avoided becoming overly dependent on

graphics.

Placement directory

As stated previously, this is the largest and most ambitious

section of the website. Its aim is to overcome the perennial

problem of helping to better prepare students for speci®c,

individual placements. University staff always have done

and continue to do preplacement preparation sessions.

In these, useful information can be given about working

in particular ®elds of nursing; for example the lecturer

can talk in general about what to expect from a medical

ward experience. However, it is an impossibility for that

lecturer to talk about what the students can expect on all

of the medical wards that will be used for that allocation.

The Placement Directory, however, can and does provide

this information.

The information concerning the individual wards,

clinics, etc., is provided by the clinical nursing staff

themselves who work in those areas, so it is relevant and

up-to-date. Because this is a web-based resource there is

then the opportunity to transform the basic text document

that is provided by the clinical nursing staff into a linked

Table 1

CPSU website

Section Content

Welcome Introduction to the Unit

Newsletters Copies of each newsletter

Stop press! Details of latest news of interest to assessors

Audit Brief explanation of the work of the Audit Department

Allocations Brief explanation of the work of the Allocations Department

Education support Brief explanation of the work of the Education Support Department

Clinical liaison teams These teams are the Faculty's implementation of Standard 9 (ENB 1997b)±lecturer's involvement in practice. This

section of the website holds details of who the lecturers are and what clinical areas they liaise with

Placement directory This is the largest and most ambitious section of the website. Contained here are details of the

clinical placement areas that student nurses are sent to for practical experience. This will be

expanded upon later in the article

Course details Copy of curricula documents for Diploma, Degree, Conversion and Post Graduate Diploma in nursing courses

Assessment documents Complete set of the assessment documents used in the existing diploma course and a copy of the

student Portfolio to be used in the new degree and diploma courses

On-line evaluation form An on-line version of a Student Clinical Placement Evaluation Questionnaire, which the nursing

students within the Faculty are required to complete at the conclusion of each placement

On-line assessor registration An on-line version of the form on the back of each newsletter. The intention of having an electronic

version of this form was to provide the assessors with as many ways as possible to get their details

to the CPSU so that they could have future copies of the newsletter posted directly to them

Student travel Information relevant to when students travel to the various clinical placements

P. Turner

328 f 2001 Blackwell Science Ltd, Journal of Nursing Management, 9, 325±329

hypertext web page. The various sections which clinical

nursing staff are asked to supply details on are as follows:

NHS Trust, placement name, placement address, tele-

phone number, contact name, type of placement, details of

type of clients being dealt with, the type of experience

which may be gained from this placement, special knowl-

edge and information which would be useful to you, and

recommended reading. The postcode on each placement

address is made into a hyperlink to one of the many

internet companies which supply on-line maps. So if the

student clicks on the postcode of a placement address they

are presented with a street map of the area, extremely

useful for students who are unfamiliar with Birmingham

and its environs.

Other hyperlinks are established on many of the

Placement Directory pages to take the students to useful

internet sites and give them access to a plethora of infor-

mation which is relevant and related to the placement

experience. For example, a number of the community-

based placements returned their information and were

expressing the wish that students have some awareness of

matters relating to primary care groups (PCGs). As the

government documents relating to the formation of PCGs

are available on the Department of Health website, it

seemed a logical course of action to make the hyperlink

to them. Thus the student has access to the source

documents. The website now contains many hundreds of

hyperlinks to a whole variety of internet resources related

to the clinical placements that the students will be

allocated to.

It is eventually hoped to have available for students

within the Faculty web-based information about any

clinical placement that the student may be allocated to. As

we are a large faculty and use many hundreds of clinical

placements, this is a considerable task. However, the

Placement Directory already consists of over 400 web

pages. This number is rising on a monthly basis as more

clinical areas return their information to the Unit and

this information is turned into a web-based resource for

our students.

The CPSU website is located at URL:

www.hcc.uce.ac.uk/cpsu/.

References

Cuthbertson P. (1996) Attitudes to Project 2000: a survey of quali®ed

nurses. Nursing Standard, 11 (11), 38±41.

DoH (1999) Making a Difference. DoH, London.

DoH (2000) www.doh.gov.uk/HPSSS/TBL_B16.HTM.

ENB (1997a) Standards for Approval of Higher Education

Institutions and Programmes. Standard 14, Criteria b, p. 27.

ENB, London.

ENB (1997b) Standards for Approval of Higher Education

Institutions and Programmes. Standard 9, p. 23. ENB, London.

Leonard A. & Jowett J. (1990) Project 2000 ± I, Charting the Course

± A Study of the Six ENB Pilot Schemes in Pre-Registration Nurse

Education. National Foundation for Educational Research in

England and Wales, Slough, Berkshire.

UKCC (1999) Fitness for Practice. p. 40, 4.42. The UKCC

Commission for Nursing and Midwifery Education, London.

Peach, Practice, Placements and Partnership

f 2001 Blackwell Science Ltd, Journal of Nursing Management, 9, 325±329 329