SUSTAIN: Supporting and retaining newly qualified nurses in NHS Lothian. Realist evaluation

Realist evaluation of a pilot of the SUSTAIN project which involves three interventions to support the transition from student to newly qualified nurse and their support and retention in clinical practice for the first 12 months following registration. The interventions were: 1) placement in clinical areas for management placements where they would take up posts as newly qualified nurses 2) allocation of a preceptor and co-production of preceptorship 3) employment of Clinical Educators with a specific remit of supporting preceptorship.

This project evaluated the use of three interventions which made up the SUSTAIN project aimed at supporting the transition of students to newly qualified nurses and their support and retention in the first year after qualifying. The SUSTAIN project entailed the following 3 interventions: 1. students placed in clinical areas for their
management placements where they would transition to newly qualified nurses 2. named preceptors identified to support the newly qualified nurses and to explore their support and educational needs 3. Clinical Educator employed to support newly qualified nurses, preceptors and charge nurses

Conclusions

 Despite the huge pressures experienced by the NQNs and all those working in the clinical areas, the retention rate is high (85-89%). It seems that the support that NQNs received from their colleagues, preceptors, charge nurses and Clinical Educators, particularly when they were struggling, has enabled them to remain in their posts.

 Undertaking the final management placement in the clinical area where the student then transitions to NQN might improve the experience of that transition as well as provide some form of stability in the clinical area, meeting staffing needs and creating the possibilities for increased retention.

 Whilst there was evidence of preceptorship activity, the lack of structure and support for preceptorship leaves it to those who are operationalising it to determine both what it should look like and how to manage it, creating stress and anxiety. The provision of training and clear information about the role would provide support for preceptors and those around them.

 There is a clear need to protect time for NQNs to find their feet in the role, supporting them to learn and to feel like a valued member of the workforce.


Recommendations

1. Development of preceptor training and information providing clarity about preceptorship, expectations and roles for preceptors, Charge Nurses and NQNs.

2. Development of a culture of preceptorship through senior management support including attention to rostering and protected time for preceptors to meet with their preceptees.

3. The retention of NQNs is partially linked to having access to development opportunities. Thus, there should visible investment in NQNs through access to training and support e.g. study days, clinical education to support development of clinical competence. Whilst cognisant of the extreme pressures faced by the NHS during this period, we suggest that there are some safeguards put in place to ensure that development opportunities are retained where at all possible.

4. Consider the impact of moving NQNs to other areas in the hospital to cover staff shortages on their confidence and gaining competence in their work. We acknowledge the difficult decisions made because of the circumstance, but we suggest that within the first 3-6 months of qualification NQNs should not be moved.

5. The Clinical Educator position should be retained and expanded beyond the pilot sites. Our analysis demonstrated that the Clinical Educator role offered NQNs external emotional support and assisted them in conceptualising their career development. Given the immense clinical pressures that face the NHS, having this form of support may be needed in order to help retain nurses and make them feel valued.

6. We recommend that the HEIs and NHS partners organising the management placement to NQN intervention in SUSTAIN revise, clarify and streamline the processes. Clearer clarification of the roles of the NHS and the HEI is important in order to avoid miscommunication. Clearer communication about details of the programme should be provided to prospective students.

7. In terms of the allocation of post to students on the pilot, we believe that the job should be conditional on completing the placement and an interview with the charge nurses at the end of the placement. Through having to pass an interview, we believe that students will be more motivated and will perform better. It will also act as a formal marker of transition from being a student to an NQN in their clinical area. Charge nurse involvement is essential for making sure that the NQNs are a good fit for the ward.