Preparation and equipment

When preparing to write an action plan, you need to ensure you are aware of the reasons why it is needed. For example, if this is for a student who finds it challenging to meet their objectives or for a qualified nurse whose practice is of concern, a clear understanding of the context, as well as sensitivity to it, will be crucial to achieving positive outcomes.

Ahead of the action plan meeting, it is advisable to reflect on how you want to complete the action plan with the student or nurse. You will need to ensure that everyone involved – the nurse or student, the practice assessor or practice supervisor, the university link lecturer or tutor, and so on – has read the paperwork beforehand and that you are using the appropriate template, if there is one. If you are supporting a preregistration student, most universities will have an action plan template within the practice assessment documentation. In the case of a post-registration student, most universities will have appropriate documentation. If you are supporting a qualified nurse whose practice is of concern, the nurse’s employer may have an action plan template – possibly available on the organisation’s intranet. Performance management policies will be involved and compliance with employment law will be required. If needed, you can seek guidance from the organisation’s senior management and/or human resources department.

Writing a draft action plan before the meeting can be useful to steer the discussion. However, it is important to think of the action plan as something that is developed with the student or nurse, not imposed on them. For an action plan to be effective the objectives, and what everyone involved needs to do towards achieving them, should be discussed and agreed jointly. An action plan needs to be tailored to the individual as learning styles differ.

You will need to set a date for the meeting, book a meeting room and invite all relevant parties – for example, the university link lecturer or tutor in the case of a preregistration or post-registration student, or other members of the team in the case of a nurse. The number of attendees should be kept as small as possible, as attending a meeting with a large number of people can be intimidating for the student or nurse. The meeting must take place somewhere private where you will not be interrupted – it may need to take place away from the placement setting (for students) or role setting (for nurses).

Procedure

Table 1 shows an example of an action plan setting objectives for a preregistration nursing student undertaking a placement on a cardiology ward – the layout and the terms used will vary.

Table 1.

Example of an action plan for a preregistration nursing student undertaking a placement on a cardiology ward

Evidence base

The demonstration of competence in clinical practice has long been considered essential in preregistration and post-registration nursing programmes (Duffy 2003, Nursing and Midwifery Council (NMC) 2018b, 2018c). Action plans are commonly used in nursing practice and nurse education to support nurses and students to meet specific objectives, particularly if they face challenges in their role or course.

Historically, in the UK, the person supporting and assessing preregistration nursing students in clinical practice was called a mentor and that role was undertaken by an NMC-registered professional. In 2018, the NMC updated that approach and created two separate roles of practice supervisor and practice assessor (NMC 2018b). Practice supervisors can be drawn from across the multidisciplinary team to reflect the fact that healthcare delivery is a multidisciplinary undertaking. Practice assessors are NMC-registered professionals – or for prescribing programmes qualified prescribers – who assess and confirm students’ achievement of practice learning for a placement or series of placements (NMC 2018b). In other parts of the world, the term ‘mentor’ may still be used.

Preregistration nursing students’ learning on clinical placements is assessed against objectives set by the university as part of an accredited programme that meets the standards of the regulatory body – for example, the NMC in the UK. The NMC recommends using an action plan if a practice assessor becomes aware of concerns regarding a student’s performance during a placement (NMC 2018b, 2018c). In addition, the student and their practice supervisor can agree on objectives relating to opportunities available on the placement and/or arising from the student’s self-assessment of their progress. An action plan can be used to assist in achieving all of these objectives.

The key to an effective action plan is well-formulated SMART objectives (Brown et al 2016). SMART objectives were first used in management but are also appropriate in healthcare (Revello and Fields 2015). There appears to be a lack of robust evidence to back up the use of the SMART acronym, which is mainly based on a practical approach. Ogbeiwi (2017) argued that a basic requirement of effective goal setting is that objectives are formulated using a clear and logical structure or framework. Each step in the action plan links to the next and it is important to consider the overall plan and ensure it flows logically (Canadian Nurses Association 2022).

Writing an action plan is always part of a wider process of support, which will involve meeting the nurse or student at agreed time points to review their progress towards achieving their objectives. An action plan may need to be adapted to changing circumstances (Canadian Nurses Association 2022). For example, the nurse or student may encounter challenges in accessing some of the suggested resources and may require more time. However, there will be a point at which their progress will need to be evaluated and the action plan signed off.

Writing an action plan is one way of giving constructive feedback to a nurse or student. Feedback has been shown to be among the strongest factors influencing learner achievement (Askew 2000, Hattie 2009). Writing an action plan is also one way of making a nurse or student aware that there may be concerns about their progress or performance. For preregistration students, universities will have a procedure and designated tutor(s) to support the action plan process. As soon as concerns arise about a student’s level of knowledge or professional conduct, it is imperative that feedback is provided to them to enable them to reflect on the concerns raised and discuss them with their tutor at university. Some universities may ask that an action plan is developed at the midpoint of a student’s placement. Others may request that an action plan is developed at the summative end point of the placement and the student will implement the action plan in their next placement as required.

Elliott (2016) argued that there is a need for early identification and support of students who are struggling and that cultivating an open and honest professional relationship with them is crucial for their progress. In the case of preregistration students, the NMC regards the role of university tutors, practice supervisors and practice assessors as one of empowering students to be proactive and take responsibility for their learning and professional development (NMC 2018b).

Nurses and students may see an action plan as a sign of failure. It is therefore crucial that there is a two-way conversation and that the action plan is written with the person, is tailored to their needs and is presented as a means of supporting them. Writing an action plan can be a valuable tool to develop a student’s confidence and resilience, as long as practice supervisors cultivate a positive and professional relationship with the student during their placement. Power and Albaradura (2018) recommended a tripartite approach to supporting a student who is struggling or failing – for example, the student, a practice supervisor and an appropriate representative from the university, such as the student’s link lecturer or tutor.

It has been known since the influential work of Duffy (2003) that practice assessors – at the time referred to by Duffy as ‘mentors’ – may not always ‘fail a failing student’. According to Duffy (2003), some mentors may feel that the fact that one of their students does not pass reflects badly on them and is seen as a failure on their part, and they may therefore ensure that the student passes. Findings in a literature review by Elliott (2016) suggested this may still be the case. Duffy (2003) and Elliott (2017) argued that instead of focusing on students who are failing there is a need to identify potential difficulties earlier and to put in place effective management strategies to improve performance. Writing an action plan is one of these strategies.

Writing an action plan may not always be the best way to support students who find it challenging to meet their objectives. Action plans should only be used if the student’s deficiency can be measured against a specific learning outcome or behaviour – for example, attaining a specific level of knowledge, performing a specific nursing intervention or exhibiting a specific professional behaviour. Action plans should not be used to remedy an aspect of a student’s personality, such as excessive shyness or that they never smile. Ongoing constructive verbal and written feedback provided to a student throughout a placement, or to a nurse regarding their practice, may sometimes avoid the need for an action plan.