Development of codes and themes: Nurse educator focus group

Phases two to five (Braun & Clarke, 2006) identified a number of themes and sub- themes for this focus group (Figure 5.8). The figures in brackets refer to the number of references for each sub-theme.

Figure 5.8: Themes and sub-themes (nurse educator focus group)

The themes identified were unique to this focus group but there were clear links with some identified from the student focus group.

142 5.6.3 Further details of themes

Clinical Practice

This theme focused on the discussions on aspects of clinical practice. There was general consensus that the acuity of patients had increased and length of hospital stay had decreased. As a result, it was felt that students needed to, “hit the ground running,” (E3), whatever the care setting. Participants had also noticed a trend where a number of students on completing the course were securing their first RN posts in primary care,

E4: If it follows the same trend for end employment which [the September 2011 cohort] have just gone through a significant number of first time appointments were in primary care.

E2: Yeah, we’ve got quite a few this time.

E4: And you would imagine that, you know will continue. […]

E1: And that’s a change in mind set as well from the staff out there, because not going back, not too many years ago I probably wouldn’t have been here if I’d have been accepted for a community job but I wasn’t accepted coz all my experience had been in acute care. ‘Oh no, you can’t be coming out here…,’ to what was then an E grade, ‘…with not having worked in community.’

[…]

MODERATOR: Or even get a job as your initial job after registration. It was the standard then, wasn’t it, ‘Go get some ward experience.’

Some concerns were expressed regarding the issue of mentors grading students in clinical practice, an aspect that had been introduced at the start of the all graduate curriculum. For placements in year one and two, and the first placement in year three, the grading was formative, based on criteria devised by another local university. However, the grade given in the final placement in year three was summative and this was causing some anxiety. As E4 stated,

I target the mentors [on the Supporting Learnings in Practice course] that are coming through … about grading in practice, because they are going to get it. And we see the variances in gradings at the

143 moment from first years and second years and I just think I hope that

is going to iron itself out by the time we get to the final one.

[agreement from others].

Degree v diploma

There was clear consensus amongst these participants that the move to an all graduate entry was a positive one, and all highlighted equity with other AHPs as a key reason. All four participants had facilitated mentor updates in the time leading up to the introduction of the programme and all had received some objections from clinical colleagues.

E3: When we have been talking about we’re introducing an all graduate profession I would say there is some resistance in practice, and probably erm, the erm, the qualified nurses feel a bit threatened if they have not been qualified to degree level so I think there is definite … that isn’t just an isolated case. It’s happened on a number of occasions.

E1: I have experienced the same.

E4: I have experienced the same as well.

Significantly, E2 offered a different perspective, “I come at it from a community background and when I do community audits, they, I’ve found them quite embracing, quite welcoming, I think because they recognise that district nurses are leaving rapidly now.”

There was general agreement that a clear difference in the level of critical thinking had been noted from previous cohorts. This cannot be verified as part of this study as no tool was used to measure the critical thinking of either this or previous cohorts, but the perceptions of these participants were clear enough. The difference had started to be noticed during year two, and it was felt that this was due to the fact that the students had been introduced to the research process and been encouraged to ‘think critically’ as undergraduates from the start of the programme.

E4: I think they’ve been through specific research things as well, which I think has had an impact on them understanding evidence…

144 E1: Yes, yeah, I think the impression I had from previous cohorts …

with research was something you just got to grin and bear it. Just get over this module, write the assignment and it’s all done with, whereas they [September 2012 students] are much more immersed in the process now, right through year one and year two and it’s going to be year three.

Inter-professional learning and working

The theme of inter-professional learning/working was prominent. E1 stated that as a result of increased IPL,

Hopefully there will be greater understanding, greater multi- disciplinary team working, communication, all the rest of things that can enhance patient care … I think unless you are almost forced to work with other professions … then you don’t. You still stay in your little silo and stay with all the nurses, or with all the physios, or with all the OTs or whatever and never the twain shall meet, and as much as it’s been painful for some of them, and it is painful isn’t it? But then some people say learning is painful [laughs]. They have been ‘made’ to work together and all those research groups that they are in now like in year two and they are going to be in the same groups in year three every single one is inter-disciplinary in some form or another.

E4 recognised the benefit of understanding what each AHP’s role actually was and stated that,

I think the more you know about something, the more you know about somebody, the more you understand why they do certain things and I think that’s going to come through.

E4 further suggested that this process would help improve how nursing was viewed by other AHPs,

Maybe hopefully that, because they are doing inter-professional learning, those other inter-professionals will then look upon us [nurses] in a more professional light because they are actually seeing what we’re doing and how we’re working. We’re working with them,

145 whereas before as [E1] said, maybe there was a case of education in

silos.

Students

This theme focused on the educator’s perceptions on how these degree level students were ‘different’ from students in previous cohorts. There was general consensus that their critical thinking skills were more developed. The students appeared to be more assertive, but there were concerns that students had, on occasions, allowed assertion to become confrontation and had acted unprofessionally with academic staff when raising concerns they had with particular modules. Participants also commented on the increased emphasis on primary care in the 2012 curriculum and how this had improved the range of ‘transferable skills’ the students acquired linked with recognising the scope of practice within primary care.

The course

A link between the theme of ‘students’ and this theme was the issue of academic support and pastoral care. E4 stated that,

I think they, the pastoral things that have come to me have all been the same … They all suffer the same anxieties and stresses and worries and problems at home and illnesses. It all repeats and I don’t think that’s changed. I think we still do what we do in supporting them as human beings who have problems, don’t they?

E2 disagreed suggesting that,

I think pastoral support has grown, which it should do as well. We get a lot of young people coming in, and they need lots of support, but we do do a lot of pastoral work. And we send them to the right people now because we’ve got more of an awareness of where people should be going.

E1 expressed some sympathy for the September 2012 cohort, identifying that in many respects they had been, “guinea pigs.” This is perhaps inevitable with the introduction of any new programme. The participants acknowledged that changes had been made prior to the September 2013 students commencing the programme.

146

5.7 Qualitative data: Student questionnaire (Question 30)

Question 30 asked the participants to ‘Please write about why you wanted to become a nurse’. Of the 150 participants across the four fields of nursing (Adult [A] =77, Child [C] =19, Learning Disabilities [LD] =17 and Mental Health [MH] =37) who completed the questionnaire (88% response rate), nine participants (6%: C =1, LD =4, MH =4) did not give a response to this question, with one other participant stating that they would, “prefer to talk via 1:1 interview. Difficult to articulate on paper.” (S54[LD]). Here ‘S’ identifies the participant as a student. The number, between 01 and 150 was randomly allocated to all participants, and the letters in square brackets refer to the field of nursing that the participant was studying.

5.7.1 Phase one analysis

Of the remaining 140, 86% (n=121) included reference to their desire to ‘make a difference’, ‘help people’ or ‘care for people’. Twenty respondents acknowledged that working in healthcare, particularly nursing was something they had always wanted to do. For others, the inspiration came either from their own experiences of healthcare, from participating in the care of others, often close family members, or through witnessing the nursing care given to others. For some the inspiration was actually seeing poor nursing practice/care and wanting to improve on this.

The financial rewards of nursing and job security were also mentioned by a handful of respondents, but often after the factors discussed above. A number highlighted the desire to gain a professional qualification and learn new skills/knowledge as an additional motivation for undertaking the course.

This was not just a ‘rose tinted spectacles’ view of nursing. A number of respondents had previous healthcare experience and all had had at least three different placements since the programme began. They knew the realities of healthcare in the twenty-first century. What shone through many of the responses was a passion for people and a passion for nursing.

147 5.7.2 Development of codes and themes: Student questionnaire, Q30

Phase two of the data analysis process identified the codes shown in Figure 5.9.

Figure 5.9: Phase two codes (student questionnaire, Q30)

Progression through phases three to five identified the themes and sub-themes shown in Figure 5.10. The figures in brackets refer to the number of references for each sub- theme.

5.7.3 Further details of themes