'preceptorships matter more than ever' | nursing times

As part of Unison's Only Enough is Enough campaign for safe staffing levels, I visited a number of hospitals to get first-hand experiences from nursing teams. The feedback was

surprisingly consistent. Staffing levels have always been a challenge, but greater still currently are the difficulties facing nurses and managers in maintaining a good skill-mix and

supporting their new starters. On every ward, nurse rep colleagues and I met new recruits from India or the Philippines, along with graduates fresh from university. They were settling in and

learning their roles in complex and demanding clinical environments, to a soundtrack of ever-present patient alarms and bleeping equipment. > "We’re determined to secure the best 

preceptorships for all newly > registered nurses" In staff rooms, managers and clinical leaders described their fears for patient care and their guilt at burdening new starters with

such responsibility. Many wards on which complex clinical care was delivered were often led overnight by newly registered nurses, juggling teams of healthcare assistants and international

recruits. The hospital at night teams – staffed by advanced practice nurses with years of experience – were spending much of their shifts dashing from ward to ward to supervise and assist

more junior colleagues. The number on the Nursing and Midwifery Council register reached a new high last week, exceeding 800,000 professionals for the first time. And the government has been

trumpeting the achievement of meeting the target of 50,000 extra nurses in England. But as ever, the figures tell only a part of the story. Nursing and healthcare are more complex and

demanding than ever. Hard-won clinical experience is an increasingly valuable asset. Many of these new registrants, whether they studied in the UK or internationally, are working in teams

with much less clinical experience around them than would traditionally have been the case. That’s led to some concern that the stress and challenges of their early years on the job could

lead quickly to burnout for many. What I heard strongly reinforced many of the responses to Unison's preceptorship survey, jointly with Nursing Times and the Florence Nightingale

Foundation (FNF), two years ago. "We’re thrown into the deep end and expected to swim … My physical and mental health have suffered tremendously,” one newly registered nurse had said.

Another described the level of responsibility being given to NRNs as “beyond dangerous”. Comments like these show that building confidence and skills, and giving the support needed to

maintain their wellbeing, are more important than ever for these nurses. We can’t afford to squander the progress made in recruitment, at a pivotal time for the long term future of the NHS.

The previous survey, the most comprehensive to date, revealed a widespread consensus in nursing. Almost all who took part agreed the transition to registered practice had become much more

challenging. Only a minority said they’d had a good preceptorship and been given the time to make the most of it. Unsurprisingly, workplace pressures and staffing shortages were the main

factors undermining access. Importantly it illuminated the elements those entering nursing considered to be most crucial in high-quality preceptorships: guaranteed supernumerary time,

dedicated training sessions and clinical supervision for all. Since then, we’ve taken the findings to policy and decision makers. We’ve used them to help shape campaigns to influence

investment and frameworks. A demand for better support for new health professionals, still being negotiated, was part of the union demands to settle the NHS pay dispute this year. In

England, with input from Unison and the FNF, the new national framework for preceptorship has been launched. Its first-year review has identified significant improvements, though much

remains to be done. In the devolved nations, new strategies are being implemented and a focus on preceptorships taken forward by chief nursing officers. But these are organisations marking

their own homework. The only true measure of progress will be the experiences of those in practice. That’s why as many nurses as possible should complete the new survey. Clinical practice

remains hugely difficult, with constantly evolving challenges. We’re determined to secure the best preceptorships for all newly registered nurses. They deserve to be given the support

that’ll help secure the long term future of the NHS. Your feedback is critical to making this a reality. _Stuart Tuckwood is national nursing officer, Unison_