Succession Planning for Advanced Nursing Practice: Evaluating the Scottish Experience

1. Succession Planning for Advanced Nursing Practice: Evaluating the Scottish Experience Dr Kay Currie Dr Maggie Grundy Janette Palmer Dr John Biggam David Cochrane

2. Aims of this presentation: • Introduce the NHS Scotland national pilot project: ‘Advanced Practice Succession Planning Development Pathway’ • Present selected findings evaluating the impact of the range of educational activities involved • Discuss recommendations for the ‘way forward’

4. The Year Long ‘Pathway’ Components • Generic, flexible & sustainable approach, embedded in the needs of clinical practice • Service manager commitment & nomination • Developmental Needs Assessment Tool (DNAT) • £2,000 funding from NES to seek appropriate learning opportunities • ‘Central supporting mechanisms’: on-line Action Learning Set; Critical Companion

5. 4. Educational Solutions (Methods of Delivery) Includes: Work-based Learning and/ or Academic Education • 1. Central Supporting Mechanisms (Infrastructure) • Includes: • Organisational support • Development Needs Analysis Tool (DNAT) • On-line Action Learning Sets • Critical Companionship • 3. Underpinning Principles • (Development) • Autonomous Practice • Critical Thinking • High levels of Decision Making& Problem Solving • Values Based Care • Improving Practice Advanced Practice Pilot Succession Planning Development Pathway • 2. Four Overarching Themes • (Areas of Learning) • Advanced Clinical Practice • Leadership • Facilitating Learning • Research

6. 15 participants in 2 cohorts, six months apart

7. Data Collection • Participants, service managers and critical companions (7 case study sites) • Documentary review and analysis • Semi-structured interviews • Structured questionnaires

8. Selected findings • Perceived effectiveness, strengths and limitations of • the Development Needs Assessment Tool (DNAT) as a means of identifying learning needs and areas for further development. • the central supportive mechanisms incorporated into the pathway (i.e. action learning sets, critical companionship) on the development of advanced practice attributes. • Determine the overall usefulness of the pathway in the development of advanced practice attributes.

9. Developmental Needs Assessment Tool Frequency scores for perceived helpfulness of DNAT in identifying learning needs “

10. DNAT • Initially daunting and difficult • Raised awareness of what advanced practice encompassed. • Encouraged thinking about education in wider sense – not just formal accredited modules. • Increased self-awareness. • Could be used to demonstrate what achieved – but self assessment

11. Comments on the DNAT “Using the DNAT helped me to think more laterally and realise that it wasn’t only about the clinical aspects of this job, but how I am going to make myself a nurse practitioner rather than something like a physician’s assistant or even a nurse specialist in acute care. Looking at all aspects of it, using the DNAT stopped me from spending all the money on clinical courses and made me think of how I could develop my leadership skills, and research skills.” (NP5; 98)

12. Limitations of the DNAT ‘It felt very challenging and I found it quite difficult to do’ (NP7; 66) “I don’t think that it was the way it [DNAT] was presented, I think it was more my limited knowledge of the advanced practice toolkit and the themes of advanced practice and the underpinning principles. I genuinely don’t think I understood just exactly what it was talking about. It wasn’t until I was about halfway through my Masters that I thought ‘Oh yes, I get it now’ but at the time – well, values based care, I had no concept of what that was.” (NP 5; 139)

13. On-line Action Learning Sets Frequency of ratings related to the effectiveness of Action Learning Sets

14. Benefits of action learning sets • Encouraged sharing of experiences, which increased confidence levels • Provided a link to the pathway and the other participants • Provided structure

15. on-line ALS “It definitely improved my experience during the year of Advanced Practice and I felt that as the students were so far flung, it allowed me to remain in touch with them and the process. It encouraged me to stay involved when it would have been easy to withdraw because work-based learning is difficult and I felt isolated at times. The ALS enabled me to continue in the pathway”.

16. On-line ALS: Key findings Mixed views : • Only 5 of 12 respondents participated in all 6 ALS & motivation to stay engaged with the ALS waned over time • 7 reported preference for face-to-face ALS • <1/3 of respondents reported ALS ‘very effective’ in helping to address developmental needs.

17. Limitations of on-line ALS “we really didn’t get a good rapport set up with the other participants at the first day … it really held us back as a group, certainly in the ALS. I didn’t feel that we really ‘gelled’ as a cohort. …” (NP4; 12) Challenge of getting to know others in the group resulting in a lack of cohesion

18. Other barriers to ALS • lack of experience with online discussion technology • pressures of work and time • prior experience of face to face ALS generating particular expectations of this on-line ALS • lack of contribution by other participants

19. Overall effectiveness of critical companion Frequency of ratings related to the effectiveness of Critical Companion support

20. Critical companion Most useful aspects: • ability to challenge supportively in a non threatening way • encouraging critical reflection on practice as well as focusing attention on learning that had occurred • planning goals for further development

21. To illustrate: “I think a big part of the critical companion role was to enable you to reflect on aspects that came up within the pathway, which was very helpful to us… the reflection probably was the greatest part of it you know, with an independent, objective perspective rather than somebody just trying to give you what you wanted to hear” (NP3; 320)

22. Some problems though … “I have met a few times with my critical companion but I would have to say that didn’t work as well for me, as although my organisation agreed to it, they didn’t then provide any protected time … I think the organisation is very good at agreeing that you can go and do things but then they don’t allow any time or wherewithal to be able to achieve that.” (NP4; 132) It wasn’t that I didn’t get support, I think it was that we had quite different ideas about what developing clinically means” (NP7;115)

23. Overall usefulness of pathway • Changes in self-reported confidence levels related to DNAT areas for learning • Relative usefulness of learning activities • Overall strengths & limitations of the pathway

24. Improvement in confidence levels

25. However … Not possible to identify the relative impactof each type of activity; more likely, engaging in different forms of learning concurrently had a synergistic effect, with the combined impact being greater than the sum of their individual effects. DNAT CriticalCompanion MSc ALS

26. Evident impact “I think in terms of her confidence in clinical decision making, and her ability to translate the theoretical stuff that she has learned both in this [pathway] and at the same time she was doing a clinical skills course. I think that the combination of this course at the same time as that one meant that she gained a lot more confidence. So as a person I think she is more confident, she is much more likely to make robust clinical decisions as a result of that.” (Clinical Manager interview 11; 17-22)

27. Most and Least Helpful Factors

28. Final words … “For myself, I think it [the pathway] was pivotal, absolutely. I think if I had been allowed to develop organically, I would have got there eventually but I think I would have been a very different practitioner. I think I would have been very clinically focussed and possibly now not in a position where I could manage, or lead, a team. (NP5; 343)

29. Key Messages Pathway valuable by participants although usefulness of various elements varied. Flexibility is key! No ‘one-size-fits-all’ solution for ANP Integrating theory IN practice is crucial Organisational support for planned development essential

30. Moving Forward Current and Future Activities: • Regional advanced practice education coordinators to assist NHS Boards with succession planning, support & evaluation of ANP roles • Support for service needs analysis • Advice and guidance – ‘Toolkit’ • Organisational infrastructure - support and supervision • .

31. Further information • Advanced Practice Toolkit – www.advancedpractice.scot.nhs.uk • Full Evaluation Report and Executive Summary http://www.nes.scot.nhs.uk/disciplines/nursing-and-midwifery/role-development/advanced-practice K.Currie@gcu.ac.uk Maggie.grundy@nes.scot.nhs.uk