Readiness for Work of Newly Qualified Nurses

1. Readiness for Work of Newly Qualified Nurses Dr Jane Sayer, Acting Director of Nursing and Education South London & Maudsley NHS Foundation Trust

2. RfW Steering Group • Linda Burke (Chair), University of Greenwich • Jane Sayer (Chair), SLaM • Mary Crawford, KCL • Alison Crombie, Barking, Havering and Redbridge, LSBU • Veronica Corben, Chelsea and Westminster • Stephanie Fade. NHS London • Debbie Harris. LSBU • Fiona Ross, Kingston University • Kathy Wilson, Middlesex University

3. The RfW Programme • Originated in 2008 following work done by Trusts / HEIs • Focus on improving employment outcomes for newly-qualified nurses trained in London • Small steering group comprises Trust and HEI representatives • Seven research projects funded by NHSL, all co-led by service and education • Non-profit making, outcomes shared across London • Research carried out across London – Trusts recruited through London Deans’ group and London DoN group

4. Seven research projects - 2010-2012 Competency of newly-qualifying nurses Factors that impact on employment of newly-qualifying nurses Attrition of student nurses – factors contributing to good outcomes Mentorship capacity Exploring Assessment Processes in Selection / Recruitment of NQNs Exploring experiences of newly-qualified mental health nurses who are seeking employment at the point of qualification Exploring the role of the mentor in reducing student nurse attrition: Ascertaining factors which are associated with expert mentorship

5. 1. Competency of newly-qualifying nurses • How is competence interpreted in the context of selection and recruitment of NQNs across London Region? • What are the different expectations and experiences of NQNs from the perspective of employing Trusts across the London Region? • 64 Trusts surveyed - 45 respondents: 70% response rate • 57% have centralised recruitment process, 68% found the KSF Band 5 outline useful • The most useful assessments • interviews (88%) • drug calculations (43%) • role play (15%) • Reasons for non-appointment • failed numeracy and drug assessments • poor clinical skills • poor communication • poor performance • lack of motivation/poor appearance

6. 2. Employment opportunities for NQNs • Characteristics of NQNs at Sept and Feb from universities in London • First post gained within 3 months of qualification • Explore employment patterns including differences between ethnic group, age, gender, branch of nursing, level of achievement • All students in London:1649 students qualified, 1047 students present, 804 completed questionnaire response rate 77% (49% of all students in cohorts), 142 completed questionnaire 2 - response rate 18% (9% of all students) • Offer - 54% of all participants: 85% of those who had applied and been interviewed • Factors: Ethnic group, Branch, University • Levels of confidence and preparedness reasonably high

7. 3. Capacity for student nurse mentorship: roles, resources, structures and debates • To investigate capacity: providing placements; sufficient numbers of mentors; preparation for mentoring; ensuring effective delivery in practice • Methods: interviews with 37 personnel in 2 London HEIs and a sample of trusts • Achievements - achieving remits for mentorship through: partnership working and good use of resources • Good outcomes of mentorship: preparing students for practice and making sound judgements about competence • Challenges: Changing environments; responsibilities; practice education posts; education; capacity; meeting QA standards; assessment measures in practice • 4. Factors that influence the attrition of year 2 adult nursing students • HEI not a factor & positive placement experience is more important than the specialism of the area when seeking first posts • HEI & Trusts want attrition - perceive support strategies are to ‘sift them out’ • Pivotal point comes at end of the year 2 - emphasis on clinical feedback over HEI • Mentors are a vital element to student experience as is peer group • Perceived ‘Ideal types of students’ including ethnicity, age, dependent free, accepting of the status quo

8. 5 - The Experiences of Newly-Qualified Mental Health Nurses who are Seeking Employment Aim - explore the experiences of newly-qualified mental health nurses seeking employment Investigate the participants’ career aspirations and expectations; Explore the participants’ day-to-day approaches to securing employment and the factors they perceive as promoting and inhibiting success; Gauge participants’ perceptions of where their strengths and weaknesses lie in relation to preparedness for seeking employment; Explore, from the newly qualified nurses’ perspective, what factors impact their capacity and ability to secure employment. Methods A 3-stage longitudinal, qualitative study using semi-structured interviews: 20 newly qualified mental health nurses who had not secured employment at the point of qualification from 3 universities with a spring graduating cohort; Each participant interviewed at qualification, 6 weeks & 12 weeks Participants securing employment by the 6 week (n=9), 0R 12 week (n=6) period given ‘exit’ interviews on their experiences of securing employment; Participants not securing employment after 12 week period (n=5) invited to attend training on skills for seeking employment in nursing.

9. Emerging findings Those securing work in the 12 week period: Had concrete and detailed plans of nursing pathway they wished to take (also evidenced in their reports for motives for becoming a nurse) Portrayed recruitment as a process of filling extant roles with skills and personal qualities (could evaluate role and match to their personal qualities) Reported barriers with to employment as having an external locus, e.g. fewer jobs Those NOT securing work in12 week period: Tendency to emphasise a desire to want to ‘care for people’ (as a motive for being a nurse) Commonly saw selection and recruitment as a process of luck/fate rather than suitability) Reported barriers as having both an internal and external locus; frequently received interview feedback about communication skills

10. 6: Selection and Recruitment in Newly Qualified Nurses in London – A Mapping Exercise • Aim - provide an overview of current issues and developments in the assessment processes used in selecting and recruiting newly qualified nurses • 1) Review current literature on assessment processes employed to select and recruit newly qualified candidates in public sector organisations • 2) Review current literature on assessment processes used to select and recruit newly qualified nurses (NQNs) • 3) Map existing assessment practices in selection and recruitment in nursing recruitment in London, and explore the utility of current assessment practices in meeting the requirements that leaders in selection and recruitment have when selecting and recruiting newly qualified nurses • Methods • Objectives 1 & 2 comprised 2 literature reviews comparing nursing selection and recruitment processes with practices in other public sector organisations • Objective 3 has two phases: • Phase 1 – A factual mapping exercise of NQN selection and recruitment processes across all London Trusts (completed) • Spoke to 31 participants in Trusts across London (11 foundation; 15 acute; 5 mental health) • In 15 trusts responsibility was at nursing directorate level, 9 trusts with nursing education leads & in 7 trusts responsibility fell to appointed person/s in human resources (particularly acute trusts) • Phase 2 – An in-depth qualitative study interviewing 10-15 participants who have delegated • responsibility for selection and recruitment for NQNs in NHS organisations

11. Findings - Objective 3: Selection and Recruitment Tools Open day event Method A Method B Advert Method C Application Fill Vacancy Assessment Fill Vacancy Feedback Interview Personal statement Feedback Fill Vacancy as arises Interview Fill Vacancy as arises Shortlist Invitation issued • Selection and Recruitment Processes

12. Conclusions • Public sector • Dearth of literature assessing efficacy of tools in predicting ‘fit’ to role; lack of prospective longitudinal study NEED EVIDENCE OF EFFECTIVENESS of tools • Apprenticeship, Professional and Hybrid (?) models • Some evidence tools should be behaviour-based • Nursing • Some evidence of patient focus influencing NQN employment decisions; • Some evidence for Assessment Centre model (predictive capacity) & Development Centres; • Best practice suggests need to smooth transition between education and employment for NQN, need to diversify candidates and need for training in assessment processes; • Selection and Recruitment as a potential area for student consultation ? • Need for longitudinal/prospective studies to develop evidence • Mapping • Variation and inconsistency in selection and recruitment tools in Trusts • Tools employed infrequently supported by an evidence base • Weighting processes vary between trusts • Repetition of assessment processes across Trusts • Potential area for patient involvement?

13. 7: An appreciative inquiry of expert mentorship: Best practice guidance for the development of an effective mentorship culture Aim To appreciate what constitutes expert mentorship & identify best practice guidance Method Appreciative inquiry Interviews and a modified delphi

14. Initial themes in findings • Expert mentorship is: • Ensuring joint working between the Link Lecturers and mentors to improve the student experience • Mentors having the ability to inspire learners • Equipping mentors with the sills to give different types of feedback; developmental, positive and that which challenges students • Having robust ways of evaluating mentors to identify good mentoring practice • Articulating the mentor role and responsibilities in job descriptions • Wanting to mentor students not just wanting to progress • Having a Trust wide pre-registration mentorship strategy • Identifying expectations for mentors and students • Valuing mentors and mentorship • Taking ownership of the students and making them feel part of the Trust • Having mentors who are committed, knowledgeable, competent and motivated to mentor • Having strong links and good relationships with Link Lecturers • Link Lecturers having a good presence in the Trust • Recognising the importance of the Link Lecturer role in supporting students and mentors and raising standards • Providing mentors with on-going development relating to their mentoring practice • Promoting a culture that supports teaching and learning in practice • Having robust systems for feedback and demonstrating changes made as a result

15. Overarching themes in findings • Large variation in the number and types of selection assessments across London and little evidence of validity • Inequality of employment opportunity for different ethnic groups – for small numbers but significant • Perceptions that there is an “ideal type” of student – from students and staff • The importance of the quality of clinical placement experience and mentorship in student nurses choosing to remain on their nursing programme • Importance of support for mentors and the critical nature of the role • There are lots of expert mentors who have the ability to inspire learners • 85% of those student nurses who had applied and been interviewed were given jobs - having gone through rigorous selection processes • Levels of confidence and preparedness high for students • Evidence of successful collaboration between commissioners, HEIs and service providers in: • Undertaking empirical research into aspects of pre-registration education • Improving pre-registration nursing outcomes

16. Core issues for LETBs • Actions • Strategy for raising the profile of nursing as a career to all groups • Strategy supporting students from all demographic groups to prepare for selection process • Improve training of interviewers and have moderation process for recruitment to support consistency • Develop Strategic Framework for selecting mentors to ensure they have capacity, capability and passion for education and development - develop role as practice education leaders • Further Research • Exploration of behaviours of qualified staff in relation to employer expectations at recruitment • Exploration of literacy and numeracy skills in HEI staff / qualified nurses supporting learners • How are numeracy, literacy and professional behaviours are taught and assessed • Assessment of the return on investment in mentor development • Methods for developing rigorous processes for assessing, developing and sustaining personal attributes and behaviours e.g. compassion • Identifying the small number of new qualifiers who fail to get a job - assessing why and what happens to them in their careers • Explore factors that support resilience in student nurses – broken down by branch and demographic factors