Florence
Nightingale
Foundation

Funder: Health Education England South East

Summary: The Student Councils programme, funded by Health Education England (HEE) South East, was a two-year initiative aimed at incorporating student perspectives into the development of education and learning structures across the region. The funding was used to develop six multiprofessional student councils, comprised of student nurses, trainee nursing associates, midwives, and AHPs across the six Integrated Care Systems (ICSs) in the region.

FNF undertook a realist evaluation of the programme to assess its implementation and outcomes. The evaluation demonstrates that well developed and adequately supported multiprofessional student councils can bridge the gap between practice providers, universities, and the student population – galvanising positive change and preparing students to transition into practice.

The programme was found to benefit students personally by boosting their core confidence, expanding their support networks, and helping them develop new skills in leadership, quality improvement, and stakeholder engagement.

The student councils benefited the educational structure of ICSs in numerous ways, including by providing a platform for students to voice concerns and identify issues in practice education. This inclusive approach has highlighted supervisory and assessment challenges across universities and practice settings.

Successful councils achieved tangible outcomes, such as establishing hardship funds and wellbeing support initiatives. These initiatives may contribute to reducing attrition rates amongst the student and newly qualified nurse, midwife, nursing associate and AHP populations.

Key factors for an effective student council programme include reimbursement schemes, an induction programme, leadership opportunities, social media use, system-level representation, alignment with training competencies, collaboration with RePAIR fellows, regional meetings, engagement with higher education institutions, and dedicated facilitative and administrative support.

Some councils faced challenges, including navigating an evolving system, reconciling local variations, managing engagement levels, setting realistic objectives, ensuring continuity of membership, addressing personality clashes, and a lack of administrative support.

Implementing positive action measures during recruitment, like reserving seats for global majority members and providing reasonable adjustments for those that required them, is critical for creating a diverse and inclusive council, despite logistical challenges that need mapping and action.

Learnings from this Student Councils programme evaluation can provide a blueprint for other regions and ICSs to follow to develop their own Student Council programme. The final evaluation includes specific recommendations for any regional Student Councils programme.

Outcomes: An evaluation report was published in January 2024. Download the report here.

Read more on the Student Councils Programme here.

Funder: NMC

Summary: The Nursing and Midwifery Council (NMC) commissioned FNF to undertake a programme of research to inform its future decision-making regarding additional regulation for advanced practice and its possible impact on internationally educated nurses and midwives (IENMs) on the NMC register. In particular, the NMC is interested in understanding what is known about advanced practice in the countries where the UK primarily recruits from and the extent to which IENMs on the NMC register use their experience of advanced practice gained outside of the UK.

The findings in the paper are primarily intended to inform planned primary data collection exercises with IENMs on the NMC register. The findings presented here and via the subsequent primary data collection activity will then be combined to form a single report to inform the wider NMC advanced practice review.

Key findings

• Advanced practice roles are spreading globally, including in countries where the UK now primarily recruits nurses and midwives from. It is likely this trend will accelerate.
• The regulatory and legislative landscape with regards to advanced practice in some of the countries where the UK primarily recruits from (India, the Philippines) is in considerable flux and change is likely in the near to medium term.
• Existing evidence shows that the competencies, scope of practice, regulatory mechanisms and educational requirements that underpin advanced practice roles in some of the countries the UK now primarily recruits from partially align with international standards. Alignment is most seen in educational requirements to practise at an advanced level, and least seen in extent of adherence to scope of practice characteristics.
• Advanced practice of IENMs in the UK is not captured in the scholarly literature, highlighting an evidence gap that primary research will need to fill.
• Failure to recognise the prior skills and experience of IENMs can lead to deskilling and demotivation regarding long-term career aspirations, e.g. developing into the advanced practitioner role.
• IENMs employed in the UK perceive the prospective regulation of advanced practice as an enabler for career progression. However, they may face distinct barriers to accessing this opportunity, which additional research will need to explore.

Conclusion: There is much that remains unknown about how the potential new regulatory options of advanced practice under consideration would impact on IENMs currently on the NMC register. We can, however, conclude that there are likely to be a growing number of professionals either on the register or who will be joining the register in the near future who hold an advanced practice level qualification gained outside of the UK – regardless of what it is called or the exact competencies underpinning it. Any regulatory decision will need to fully understand these complexities in order take this into account and plan accordingly.

Read more in the final report here.

Funders: Unfunded

Collaborators: Unison, Nursing Times

Summary: This campaign intends to inform employers of what works most effectively during preceptorship and share evidence with policymakers and regulators to enable them to utilise their collective influence to:

1. Require time to be protected for preceptorship and supervision, for both preceptors and preceptees.
2. Set a standard for consistent access to preceptorship programmes.
3. Emphasise the need for preceptorship programmes to incorporate reflective practice and focus on professional support and development during the transition to qualified practice.

Outcomes: The campaign has commenced with a survey which is being managed by Nursing Times. The results will provide a current evidence base that all collaborators will commit to sharing with employers, regulators and policymakers.

Funders: NHS England

Collaborators: Kings Fund, NHS Confederation, Prof. Lisette Schoonhoven (University Medical Centre Utrecht)

Summary: NHS England  (NHSE) convened the Acute Deterioration Board and a “Worry and Concern” Task and Finish Group the latter a subgroup of the former. The issue of clinician, patient and family worry and concern was identified as a key priority for the Acute Deterioration Board, to understand and therefore improve the recognition and response to acute deterioration in patients in a range of settings, including learning disability, mental health, care homes and acute care settings. It aims to understand the barriers and enablers to escalate concerns that can affect outcomes for the patient.

FNF undertook a study to explore the influence of leadership, culture, and hierarchy on raising concerns relating to patient deterioration.

Outcomes: The study was published in July 2023.

The findings highlight elements of the healthcare environment that influence the quality of the care delivered to the patient. Leadership that role models multi-disciplinary team working, values the expertise of all stakeholders, and champions person-centred practice can create a psychologically safe working culture. This culture creates an environment in which clinical staff, patients, carers, and family members feel confident and less hesitant in raising worries and concerns.

In healthcare environments where these characteristics are not present, staff training and development alongside access to, and the availability of feedback avenues can provide the right conditions for all to escalate concerns and improve patient safety.

Read our news story for a summary and recommendations.

Read the full report here.

Next steps

NHSE is now funding seven pilot sites – one in each region – to participate in a national Worry and Concern Improvement Collaborative. The collaborative aims to catalyse two changes:

1. The systematic incorporation of patient worry and concern into early warning and diagnostic tools; and
2. Contribution to a shift in culture and practice that empowers patients/families/carers to speak up about deterioration and clinicians to listen to and communicate more effectively about these matters.

FNF presented our research findings to these pilot sites to inform their implementation processes and we continue to be involved with the programme.

We will also be continuing to strengthen and grow our leadership development work, to support nurses and midwives to have the confidence and skills to speak out and share concerns.

Funder: Health Education England

Summary: This project involved undertaking focus groups with Learning Disability Nurses recruited from the FNF alumni community. The nurses worked across a variety of sectors and were supported to explore the impact of Covid 19 on their practice. The research highlights how Learning Disability Nurses turned to collaboration and creativity in a monumental effort to maintain services for people with a learning disability. The nurses were driven by a desire to maintain a sense of normality and stability for those in their care and pulled together to keep people with learning disabilities connected and safe during an intense period of social isolation.

Outcomes: An article reporting on the project has been published in “Learning Disability Practice” and can be accessed here. It is also available in an Easy Read format. The results were presented to the HEE/NHS E/I “All England Plan for Learning Disability Nursing” steering group and informed the operational strategy for this workforce agenda.

Funder: NHS England/Improvement

Summary: The National SDM Council convened in May 2020. They are the first of their kind internationally and have had a focus on ensuring point of care nurses and midwives have influence on the direction of policy and subsequent change. This is particularly significant as the council was established during wave 1 of the Covid 19 pandemic and have continued to function despite the significant clinical demands. This has enabled the CNO and National policy team to have continuous and rapid insight into the experience of point of care staff and translate this into policy where appropriate. The council comprises 17 point of care staff who work within one of the 14 Pathway to Excellence pilot cites. They are representing their own views and perspectives and not acting as a representative for their organisation. As the National SDM Council reached the end of its inaugural year there is an imperative to evaluate both the experience and impact of its members. The FNF Policy Unit has undertaken this evaluation with the following objectives:

• Explore the personal impact of membership on the individuals’ perception of their leadership capability and capacity.
• Discuss the perceived personal impact of membership on the individual's ability to influence national policy which leads to positive change.
• Identify how this experience has translated into opportunities and approaches to influencing within their own organisation.
• Reflect upon the factors which have enhanced or inhibited this impact on the individual and their local and national influence.
• Gather examples of the member's perceived successes
• Describe their recommendations for the future implementation of National SDM Councils taking into consideration challenges they have encountered which offer opportunities to amend the National SDM Council model in the future