A warm welcome
Nerys Kirtley describes the ‘Prep for practice’ project implemented to support the transition of student midwives to NQMs and enhance the preceptorship programme.
Without the support and security of mentors, many NQMs struggle when they start employment (Hughes and Fraser, 2011). NQMs find gaining resilience difficult, which can impact on the retention of staff (Department of Health, 2010).
Within the Cardiff and Vale University Health Board (CVUHB), NQMs had expressed on the Caring for You forum that they lacked sufficient support to fulfil the requirements of their roles. They voiced concerns around poor communication with senior members of staff, a lack of support in the clinical area and minimal guidance. Attrition and failure rates among NQMs were high and morale was low. It was important to enable our preceptees to feel more supported and be confident to give the standard of care expected of them.
As mentorship lead for midwives across CVUHB, I was keenly aware of how essential it was to bridge the gap between life as a student midwife and NQM and support the transition into employment. As part of the project-leading element of the RCM and Welsh Government’s leadership and development course that I had just won a place on, I chose to lead and implement a preceptorship project.
The ‘Prep for practice’ programme
Identified early was the need for a proactive team to develop the project to achieve the best results. Thirteen midwives volunteered, all sharing the same enthusiasm and passion for supporting the NQMs as myself. The team also included the practice facilitator, who had many years’ experience leading preceptorship within CVUHB, and a clinical supervisor for midwives, who could offer support within clinical practice. Members were designated ‘link’ midwives, to allow the preceptees access to senior midwives within the clinical areas.
The initial phase of the project aimed to bridge the gap between student and registered midwife and prepare NQMs for practice. Working collaboratively with the university leads, we arranged final placements to match NQMs’ first clinical rotations. These ‘continuity placements’ were intended to give NQMs more confidence through their familiarity with their first areas of work and allowed them to build upon skills gained as a third-year student to allow them to develop.
Students were allocated mentors, who would then become their ‘continuity preceptors’ as NQMs. This would allow them to build a relationship with a midwife prior to qualifying and see a friendly face in the clinical area as an NQM, thus extending support networks. We also organised placements for third-year student midwives to shadow our Band 7 coordinators on the labour ward, developing team-working, caseloading and prioritising skills, as well as strengthening relationships within that group.
Current NQMs were asked what they would have benefited from within the curriculum: the consensus included extending knowledge regarding record-keeping, use of high dependency charts and documentation, including complex care of a woman. From this, we facilitated a session on record-keeping that allowed student midwives to have a greater awareness and an increased knowledge of the documentation used within the health board. These additions to the university curriculum have been evaluated positively, and therefore collaborative working will continue between the university leads and myself as part of the midwifery programme for the foreseeable future.
The ‘Prep for practice’ team discussed many ideas on how to support preceptees. Feedback received from the previous year’s group was considered and utilised to develop ideas around what they wanted during their preceptorship year. We also considered the needs of the new midwives from beyond the local area who hadn’t graduated from the local university.
New ways of supporting
NQMs We redeveloped the preceptorship programme, offering support and guidance through, among other ideas, WhatsApp groups, badges and meet-and-greet orientation days. We offered preceptees protected supernumerary status for two weeks followed by two weeks working the same shifts as their preceptors. In addition, we developed a manual containing induction packs, useful contact details and expected competencies. The preceptorship programme was now a structured package, allowing our new midwives to feel part of the team and develop their confidence.
A meet-and-greet and orientation day was organised, at which the link midwives met the NQMs and provided them with an orientation to their clinical areas. A full induction was completed, including the management of a ward and responsibilities they would hold within that area. We provided scheduled monthly forums to allow discussion and regular evaluation but also to address any learning needs they might have. Forums were tailored to what the preceptorship midwives wished to discuss, and usually involved a nice cup of tea and a biscuit.
A WhatsApp group was established with all the team as members to allow us to offer support and communication 24 hours a day, although rules were set at the beginning regarding the use of this group. The WhatsApp group has been a massive success and a fantastic addition to the programme.
We received funding provided from the RCM Cardiff branch, which enabled us to provide preceptees with pink stork-themed badges to allow them to be identified. This was intended to encourage the entire multidisciplinary team to acknowledge that more support may be needed, but have also made NQMs feel welcome and part of the team. We received a single negative comment from a mother-to-be who was anxious about having a new midwife looking after her, but once the senior midwife and preceptorship midwife discussed with her that along with the care from the NQM came a great deal of support from senior midwives, she was reassured that she was in safe hands.
Comments from preceptees wearing the badges, which have been a great success, included:
‘It shows people I need a bit more help... or just to be a bit more compassionate if I’m not very fast at getting tasks done!’; ...and ‘The badge gives me a bit of a security blanket, so that people can see I’m not as experienced as other members of the team’.
The success of the project was measured through qualitative research gathered anonymously by questionnaire. A total of 21 questionnaires were returned, and the responses compared with the previous group of preceptorship midwives.
An example of the change that had occurred was evidenced when the two groups were asked: ‘Were you supported during the preceptorship programme?’ The results this year showed that 100% either strongly agreed or agreed they had been supported, compared with 45% of the previous year’s cohort. Overall, morale among preceptorship midwives is very positive, including those who came from outside CVUHB.
As the project has developed, some minor adjustments are clearly needed, including further development of the manual. The team acknowledged the timing of the meet-and-greet day was not appropriate and should be arranged at the start of the NQMs’ induction, but this can be rectified for next year, along with other minor tailoring to the needs of the preceptorship midwives.
The feedback we have received from all midwives within maternity has been excellent, morale is high and, apart from one NQM, all have remained with us – a massive improvement on last year! The knowledge that preceptorship midwives require greater support has grown since the beginning of this project, and therefore most midwives are more supportive than last year. Some preceptorship midwives are clearly coping differently with the challenges faced by clinical midwives, but with the support and guidance of a committed team, they are developing their confidence and competencies well. If a preceptee is struggling, this is identified early and practical support implemented immediately.
Looking to the future
What does the future hold? The future is brighter for our preceptorship midwives within CVUHB. We consider what we have achieved to be an innovative programme that will have a positive impact on the retention of NQMs and their overall health and wellbeing. Through working together, we have developed relationships, strengthened partnerships and offered greater support. Improving the transition for preceptorship midwives impacts on patient care, enhancing their abilities to provide safe, effective and holistic care for women and babies. We have also completed our objective of facilitating NQMs’ learning, and creating a supportive environment in a very difficult transitional period at the start of their careers. We will continue to work alongside Cardiff University and believe the development of our ‘continuity placements’ and ‘continuity preceptors’ can be shared and implemented in other universities and health boards in the future.
Nerys Kirtley is a midwifery mentorship facilitator for Cardiff and Vale University Health Board. Illustration: Lauren Rebbeck.
NHS England and NHS Improvement. (2018) Refreshing NHS Plans for 2018/19 See: ntw.nhs.uk/content/uploads/2018/02/Item-9i-Planning-Guidance-18-19b.pdf (accessed April 5 2018)
RCM. (2017) Brief scoping of the continuity of care evidence base. See: rcm.org.uk/sites/default/files/Brief%20scoping%20of%20the%20continuity%20of%20care%20evidence%20base.pdf (accessed April 5 2018)