All hands on deck? Clinical Educators supporting the front line during the COVID-19 pandemic

Vicky Williams is an Associate Director of Nursing for Education and Research at University Hospitals Coventry & Warwickshire NHS Trust. Her role has professional responsibility for education, research, professional and practice development, advanced clinical practice and non-medical prescribing. Her clinical experience is in care of the elderly, clinical education and advanced clinical practice roles. She has presented both nationally and internationally on developing advanced practice services.

 

If you forgive the nautical reference, we have all been through the most profound need for ‘all hands on deck’ in recent memory. Now, as  we move to restoration and that already overused phrase ‘new normal’ we are making time to reflect on our experiences, in preparation for (and in trepidation of) another surge. Like most ‘support functions’ those in nursing educational roles initial response was to stand down ‘non-essential’ activity and get onto the clinical areas.  Indeed, our immediate initial response in the Practice Development Department in my organisation was to review and stand down all non-essential training to enable as many staff as possible to be available for patient facing front line duty in order to support the impact of the emerging situation.

However, a number of things became very apparent quite quickly:

  • The need for professional and practical support for our existing learners in practice including apprentices, students, international nurses and newly qualified staff
  • Supporting those staff that would normally supervise and assess learners in practice in the middle of a crisis to ensure safe and effective learning and experience as well as care delivery was essential
  • An increased and pressing need for upskilling at pace to support the fluid deployment requirements of our changing patient population – both into critical care and the associated ‘backfill’ requirements left behind in other areas
  • A need to ensure that principles of robust governance and professional decision making were supported and evidenced

This meant that the work of the practice development team was as important, if not more so than ever. So just what did we do, who did we do it for and why?

Without going into Benners novice to expert or tales of ‘lifelong learning’ it is well known that we have a number of different learners in nursing at different stages in their career journey. Trying to continue learning, whist contributing to the care of an unknown cohort of patients, with an unknown end-point is a stressful situation for anyone to be in. I for one have been massively impressed and proud of the contribution of the nursing student workforce in response to the crisis, who were deployed at pace, in large numbers, generally not supernumerary for the first time in many years whilst still expected to meet their learning outcomes, and in an unfamiliar environment.

Those learners extended beyond students; apprentice student nursing associates, newly qualified just commencing in post, international nurses, those returning to temporary NMC registration as well as those registrants that haven’t practiced clinically for some time but offering support to practice areas meant that we had more ‘learners’ than ever.

For our international nurses we developed a governance framework in order that they could be deployed safely and practice effectively including a condensed preparation for practice programme and mock OSCE as well as a medicines administration assessment and policy addendum. We rapidly deployed over 150 students from across the country processing them through the recruitment process at pace, and kudos to the recruitment teams that supported this as this was no mean feat. We continued the apprenticeship programme of our nursing associates (against a backdrop of apprenticeships being postponed) in order that they remain on programme and qualify on time. Our newly qualified staff were each visited in practice by our Facilitators to support essential skills and knowledge, introducing our competency framework, and a newly revised frontloaded preceptorship programme was developed to support transition into practice.

Yet it doesn’t stop there ….. as many acute Trusts were preparing for a potential huge expansion in critical care beds, this planning went beyond the availability of ventilators and other equipment. Many of us up and down the land were watching the news (and probably said out loud) ‘how are we going to staff all those beds?’

Against the backdrop of a significant nursing shortfall, and the impact of C19 itself on the workforce, we were planning for a move from a nurse to patient ratio that was already a challenge to maintain, to a unknown increase in beds requiring a 1:1 ratio. I would mention here the fantastic support to the nursing workforce from our AHP colleagues and medical students, multidisciplinary working at a completely different but equally beneficial level.

This urgency and pace caused quandaries; how to support the rapid deployment of staff into an unfamiliar area, and how to support staff that may be required to fill the gaps they leave behind. We assessed our workforce against a skills matrix so that staff could be most safely and effectively deployed, we developed critical care workshops for staff to support the transition: from a support function to a refresher session for former ITU experienced nurses and we developed a series of updating and upskilling sessions for those that had been out of ward based practice for some time. All developed and ready to go in days.

I am exhausted thinking about it, and I haven’t even mentioned the support we provided to staff regarding PPE, donning and doffing and FIT testing! I am however, immensely proud of my team, my organisation, my profession and the NHS and as I round up my blog, my reflections bring me back to the nautical reference ‘all hands on deck’ and that I have learnt that in order for those on the deck to function and for the ship to sail through the storm, you need people to support, guide and train those hands as well as someone to steer the ship. Clinical Educators across the land, I salute you.

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