Flying Start Is Valued

The general consensus about Flying Start NHS was that it is a positive development. Not only did senior qualified nurses and midwives value Flying Start NHS, but also they believed that the robust and satisfactory way in which it was implemented made it a valued resource for newly qualified staff:

Have appointed newly qualified and they are doing Flying Start. Makes a difference to their competence and confidence. They are mentored by a Charge nurse. Programme seems to fill in gaps for example skills acquired, phlebotomy. Great idea. Flying Start is compulsory. No formal time off just depends on workload and if C/N can give them time.

I think Flying Start is good for that because obviously we are a tiny hospital so we don’t have we’ve got all our I think 18 newly qualified practitioners across the board and maybe there’s about 13 of those that are nurses so we don’t have a big in house community of newly qualified OT’s that can all sit and have an OT discussion and things so they tend to have a wee bit more.

Once again the role of PEFs features and is linked to the continued success of the course. A nurse manager commented that:

Oh yes very much so, I think it is a very good system and I think it is very useful for newly qualified in the community and would like more of it but if it is just me it depends on the resources and staff turnover for that to happen and the PEFs has got the role there as well in supporting the mentor and the Flying Start as well.

Although the majority of responses were positive there were a small number of negative perceptions. These invariably related to what were perceived as high intensity clinical areas such as ITU according to a senior charge nurse:

We don’t tend to take a lot of brand new starts especially as Flying Start has raised its head. Flying Start is mandatory by the Trust and I have problems with that due to

steep learning curve entering ITU with this added pressure of academic work. Priority should be to make the nurse safe to practice in this new environment

9.5 Discussion

The variation of responses within KSF core dimensions suggests that they may be poorly understood or do indeed reflect very different objectives across what are relatively simplistic range of outcomes. This needs to be explored in more depth. Variations may also suggest that core dimensions may be viewed as having different levels of complexity or achievability for newly qualified nurses and midwives. Whilst several students appeared to get good career advice, over half rated advice given on the poorer half of the scale. It is unclear who has the responsibility for career advice and career development support for newly qualified nurses and midwives. Given the emphasis placed on career development and especially development in the early stages of the career trajectory this may give rise to some concerns.

As expected, a large proportion of participants intended to remain in the NHS for at least one year after completion of Flying Start NHS. Whilst only around 1 in 10 would not give that commitment and these may not convert into leavers, it remains a concern and potential loss of staff and loss of what amount to three years pre-registration and one year post- registration investment in education.

Participants reported high levels of self-report competency. These were higher than those reported by students in an earlier chapter. This was interesting given the ceiling effects of the SNCQ and may suggest an increase in skills (or greater exposure to learning experiences) of a greater scale than evident in this data. There were no significant differences in self-report competency and self-efficacy between those who exited their pre- registration programme with a diploma or a degree.

Self-report competency was predicted by self-efficacy and skill discretion. The relationship between self-report competency and self-efficacy was also found in the survey of pre- registration students and provides support for social cognitive theory in relation to self- report competency. Skill discretion items have many similarities to notions of good ward

learning climate described by Fretwell (1983). Surprisingly, given the long believed importance of the ward sister in creating good learning climates (Orton 1981) supervisor support was not a significant predictor. Nevertheless, the importance of the workplace as a learning environment-community allied to fostering a sense of efficacy in the newly qualified nurse and midwife, are the core elements in promoting learning in the post-qualifying period.

Flying Start NHS was seen as a valued initiative and this is further support for the conclusion that emerged in earlier chapters, that nursing and midwifery have become mature professions. The idea of continued education and career development through education appears firmly embedded.

PEFs emerged as the potential key to the implementation and future development of Flying Start NHS. This role is increasingly becoming pivotal to education for nurses in the NHS. Managers and senior charge nurses had a relatively sophisticated understanding of education for professional practice. They managed to effect a de facto integration of formal courses such as Flying Start NHS and in-house provisions at the level of the individual practitioner. They managed education in the sense of the effective use of resources to support education and also at the level of promoting educational activity in seeking to achieve a balance of core and specific skills and knowledge for their particular specialty.

Support for Flying Start NHS and the ways in which this is seen as part and parcel of the career trajectory for a modern profession, is further evidence in support of the proposal that nursing and midwifery are now mature professions

9.6 Conclusions

Nursing and midwifery managers and senior charge nurses play an active role in managing resources to support Flying Start NHS. How this resource balancing act impacts in the longer terms needs to be monitored. The majority of participants want to stay in the NHS although a small, but potentially significant number did not indicate they would remain in

the NHS one year after completing the course and to this extent one of the aims of Flying Start NHS to address retention is justified.

Participants see themselves progressing up the career bands. Participants were evenly split in terms of satisfaction with career advice. There may be merit in the provision of more formal career advice at appointment and again at the end of the Flying Start NHS course. There were wide variations in levels in the core dimensions of the KSF participants aspired to achieve.

Self-rated competence shows increases post-qualification. There was no significant difference between diplomates and graduates in self-report competency. Skill discretion (ward learning climate) remains important in competency development post-registration. An important and emerging role was evident for PEFs in Flying Start NHS. Arguably, the key finding in this element of the evaluation was the value NHS staff placed on Flying Start NHS. This also lends support to the view that nursing and midwifery have matured as professions over the last 15 years.