The key to delivering safe, high quality care is a knowledgeable, competent and confident workforce, yet the Francis Report shows that the NHS is struggling to ensure that staff develop and maintain the necessary skills. Val Dimmock, simulation and clinical skills facilitator at Homerton University Hospital NHS Foundation Trust, says clinical skills leads must adopt a new approach to training, supported by innovative online learning tools. The goal, she says, is to create an environment in which staff see learning as something that happens in the workplace, continuously, rather than something delivered in the classroom.
Clinical skills leads must rethink their role - and how their trusts provide clinical training - if the NHS is to successfully implement the recommendations of the Francis Report and respond to the calls by the Nursing and Midwifery Council to move from renewal to revalidation.
Many acute hospitals have appointed senior nurses with a wealth of practical and theoretical experience to drive forward training and development. Typically, the role of these clinical skills leads covers providing colleagues with classroom-based training opportunities and working hands-on to train them on the ward. Yet the findings of the Francis Report indicate the NHS is still struggling to ensure staff develop and maintain the necessary skills.
This is not from lack of effort on the part of clinical skills leads. In large part, it's because economic, regulatory and operational constraints mean most trusts find it difficult to release staff from clinical areas for training sessions. Classroom-based training does not make best use of learners' or teacher's time. In addition, clinical skills leads bound to the classroom delivering courses cannot spend time on the ward, either helping individual staff brush up on skills or fostering a culture of learning simply by being visible.
Continuous, workplace-based learning
To address these challenges, I believe we need a sea change in the way we, as clinical skills leads, approach our role. We need to start from the position of encouraging staff to see learning as something that happens every day in the workplace, not something that takes them away from their job. More than that, we need to provide an environment in which that is possible: one where clinical staff can quickly and easily access training to meet particular needs – such as refreshing their knowledge in specific procedures so they can care for a patient with a condition they see only rarely – as well as one where they can regularly add new skills and maintain existing ones without taking too much time away from the ward.
In order to achieve that change, we must create a learning environment that allows staff to access self-study materials on the ward or at home, so they can learn the theory and achieve certification before they reach the classroom. Classroom sessions can then focus almost entirely on the practical element – bringing the double benefit of reducing time away from the clinical environment while increasing time spent on hands-on practice.
To make that work, we also need to encourage our hospitals to rota in specific learning time for each nurse every week, in the same way that medical staff are allocated protected teaching time. Nurses could use that time to work towards certification in advance of a classroom course, undertake training specified by their ward manager, or maintain existing skills.
Innovative online tools
The final piece of the puzzle will be to provide an online learning environment that blends the best in evidence-based course material with the ability to customise or extend that standard content with local policies and protocols. Ward/department managers should also be able to use the same tool to track what training their staff have received, set personal development plans, carry out performance reviews and evaluate the skill mix in their team for workforce planning.
Such a tool could, in addition, help the many trusts who are behind on their mandatory training to deliver that training, driving up training rates and allowing them to demonstrate compliance, with a solution that supports the move to a "paperless NHS". Finally, it could provide a speedy way to deliver a hospital-wide education programme following a serious untoward incident. Of course, all that needs to be underpinned by working with the IT team in your hospital to ensure the infrastructure is in place to allow online courses with video and audio content to be accessed from any of the trust's computer.
At Homerton, a teaching hospital with over 3000 staff and more than 120 student nurses and midwives, we have adopted an e-learning solution called Elsevier Clinical Skills which I believe will support me in making these changes in my trust. During a trial earlier in the year, clinical staff reported that the content was easy to access outside the classroom, high quality and well explained, while the self-assessment options helped them test their own knowledge and prepare well for practical clinical assessments. Over the longer term, we expect the solution to improve staff productivity and allow us to get more from our training budget, while supporting trust-wide objectives around the quality of care and staff development. For patients, of course, the benefit is simply safer, higher quality care from competent, confident nurses.