Is it time to rethink post-registration supervision, support and outduction in nursing?

By Jane Wray, @livinginhope, Senior Lecturer in Nursing, Director of Research, Faculty of Health Sciences, University of Hull, UK.

In 2020 the Nursing and Midwifery Council (NMC) in the UK published their Principles for Preceptorship1 which provided guidance for preceptors, preceptees, employers, students, educators and regulators on how best to support those new to the nursing profession. This represented a welcome and long overdue update to earlier NMC guidance published in 2006.  Central to these principles was a focus on the mental and physical health and wellbeing of the new nurse, midwife or nursing associate. The NMC reinforced the importance of establishing systems and processes that allowed new registrants to flourish, practice safely and become confident, accountable practitioners.  Preceptorship can positively impact competence; its impact on professional socialisation, retention or job satisfaction is less well evidenced2,3,4.

The evidence tends to favour transition to practice programmes; internships; residencies; and clinical coaching5  – all commonly used internationally. Overall however, the current evidence base is insufficient to justify widespread implementation of such programmes4,6.  Preceptorship also relies heavily on a 1-1 (preceptor-preceptee) model. This single point of failure makes it vulnerable in practice to the impact of staffing deficits and workload pressures. It also fails to recognise that nurses work within, and are part of, multi-disciplinary team structures. It is the ‘team’ that works with the new registrant on a daily basis. It is the team that creates an organisational culture that either facilitates or hinders their learning and development. The type or nature of programme appears to be less important than the fact that a supportive environment and framework is available6.

There is no dispute that supporting new registrants is important and there are preceptors and organisations leading the way delivering exemplary and innovative practice.  However, despite significant investment, turnover remains high3,5. Ensuring a more sustained and continuing connection between education and clinical practice beyond graduation may need consideration. In medicine, completion of education is followed by provisional registration and then a mandatory period of embedding knowledge and skills e.g. accredited intern training7 and Foundation year one,8 prior to general registration. An academic outreach or ‘outduction’9 approach may offer an alternative for nursing in which the new registrant continues to be access academic supervision and support beyond registration. This support could be connected to, but independent of, the workplace and build on and expand clinical-academic roles10, helping to advance career pathways in nursing research and education. It is time to re-think what best serves the interests of new registrants, employers, the profession and patients. We can look beyond our immediate borders – geographically and professionally – to alternative approaches, informed by evidence of clear benefit.

References

  1. The Nursing and Midwifery Council (2020) Principles for Preceptorship. Available at https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-principles-for-preceptorship-a5.pdf)
  2. Ke, Y.T., Kuo, C.C., Hung, C.H. (2017) The effects of nursing preceptorship on new nurses’ competence, professional socialization, job satisfaction and retention: A systematic review. J Adv Nurs 73 (10), 2296-2305.
  3. Pasila, K., Elo, S., Kääriäinen, M. (2017) Newly graduated nurses’ orientation experiences: a systematic review of qualitative studies. Int. J. Nurs. Stud., 71, 17-27
  4. Aldosari, N., Pryjmachuk, S., Cooke, H. (2021) Newly qualified nurses’ transition from learning to doing: A scoping review. Int. J. Nur. Stud., 13, 103792 https://doi.org/10.1016/j.ijnurstu.2020.103792.
  5. Brook, J., Aitken, L., Webb, R., MacLaren, J., Salmon, D. (2019). Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review. Int. J. Nur. Stud., 91 47–59.
  6. Wray, J., Watson, R., Gibson, H., Barrett, D. (2020) Approaches used to Enhance Transition and Retention of Newly Qualified Nurses (NQNs): A Rapid Evidence Assessment. Nurse Education Today. https://doi.org/10.1016/j.nedt.2020.104651.
  7. Medical Board Australia (2021) Australian and New Zealand medical graduates undertaking an accredited internship in Australia. Available at Medical Board of Australia – Interns
  8. General Medical Council (GMC) (2021) Outcomes for provisionally registered doctors. Available at Outcomes for provisionally registered doctors – GMC (gmc-uk.org)
  9. Hughes, P. (2010) Outduction – The Transition to Students’ Futures. Advance HE. Available at Outduction – The Transition to Students’ Futures | Advance HE (advance-he.ac.uk)
  10. Coffey, J.S., White, B.L. (2019) The Clinical Nurse Educator Role: A Snapshot in Time. J Contin Educ Nurs, 50(5):228-232.

Jane is Co-Lead of STaR The STaR Project – Supporting the Transition and Retention of Newly Qualified Nurses (wordpress.com) 

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