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• To find out about a masterclass designed to support band 5 children’s nurses with their career development
Background Continuing professional development (CPD) is an important factor in being able to recruit and retain staff. However, it is recognised that budget constraints make offering CPD difficult, and it often falls to local NHS organisations and higher education providers to develop CPD initiatives that are fit for purpose.
Aim To evaluate the impact of a CPD masterclass on band 5 children’s nurses.
Method Fourteen band 5 children’s nurses attended a CPD masterclass delivered as a series of workshops over one day. Participants completed questionnaires before, at the end of, and three months after the masterclass. The pre-masterclass and three-month follow-up questionnaires included the short version of the Occupational Self-Efficacy Scale.
Findings After the masterclass, all participants had a plan (or a partial plan) for their career development, compared with 79% before it. Participants felt more confident at handling challenging situations at work after the masterclass. Participants appreciated the opportunity to focus on their CPD needs and discuss them with colleagues.
Conclusion Time for CPD, career development opportunities, workplace culture, learning and development, and confidence are all important factors to consider when developing CPD opportunities for band 5 children’s nurses.
Nursing Children and Young People. doi: 10.7748/ncyp.2021.e1352Peer review
This article has been subject to open peer review and checked for plagiarism using automated software
Rosengarten L, Callum J (2021) Continuing professional development: evaluating a masterclass for band 5 children’s nurses. Nursing Children and Young People. doi: 10.7748/ncyp.2021.e1352
Published online: 04 May 2021
Continuing professional development (CPD) for NHS staff is a priority for employers and staff alike. The NHS Long Term Plan (NHS England 2019) identified CPD as an element of its workforce plan and CPD will be given additional funding and investment from the Health Education England training budget. The plan states that a lack of career development and CPD is one of the main reasons why staff leave the NHS (NHS England 2019). The NHS Staff Survey for 2019 found that 55.7% of staff felt their manager supported them to address training needs identified during their appraisal (NHS England 2020a).
In 2019, NHS Employers published a national staff retention programme focusing on practical resources to aid NHS organisations in retaining their staff, including advice for career planning and development (NHS Employers 2019). However, it has been acknowledged that it is challenging for NHS organisations to offer CPD opportunities due to budget constraints (Davis 2019). It often falls to local NHS organisations and higher education providers to develop CPD initiatives that are fit for purpose, based on service and patient need, flexible in their delivery, and designed to improve and expand the skills of individuals (Gibbs 2011).
Workforce development strategies in the NHS that incorporate the use of CPD have traditionally been focused on areas of nursing where there are retention and/or recruitment issues, such as learning disability and primary care nursing (Buchan et al 2019). There are published studies that consider the career development of children’s nurses, but their findings are often not transferable, either because the studies have been conducted in countries other than the UK ,where nurses are not trained to practise in specific disciplinary fields (Bong 2019) or because they were focused on staff who had already undergone career progression and were working at advanced levels (Gibson and Bamford 2001).
This article describes a CPD masterclass developed for band 5 children’s nurses working in the NHS in England and presents the findings of a study conducted in 2019 to evaluate the impact of that masterclass on 14 band 5 children’s nurses.
The CPD masterclass was developed for band 5 children’s nurses with more than one year’s experience of working in the NHS, after a need for support had been identified in that group by band 5 staff and managers. The masterclass was designed in conjunction with local NHS trusts to provide participants with an opportunity to consider the important issues they may be experiencing in their career, such as career progression, developing as a leader and handling challenging situations.
The masterclass was designed as a series workshops, each incorporating critical reflection (Kemp and Baker 2013) and opportunities for discussion and engagement. The use of critical reflection as a learning tool is well established (Rolfe et al 2001, Williams 2001) and the development of critical reflection can be supported by focusing classroom learning on practice experiences (Williams 2001). Figure 1 shows the masterclass content.
It was crucial that the educators delivering the masterclass provided context, motivation and knowledge to encourage active learning (Jones-Schenk 2017). The ‘context’ element was embedded in the masterclass through scenario-based activities and the inclusion of critical reflection on participants’ own practice (Rolfe et al 2001, Williams 2001, Kemp and Baker 2013). The ‘knowledge’ element was provided by the input of experienced children’s nursing lecturers and of participants themselves. The ‘motivation’ element was largely intrinsic – that is, originating from participants themselves – and was also provided by offering content that participants would perceive as useful for their practice (Brekelmans et al 2016).
The design of the masterclass enabled participants to focus on their own CPD needs and aspirations, and encouraged them to discuss these with colleagues in similar situations. The goal of encouraging participants to work together was to develop a community of practice that they could continue to access afterwards (Wenger 1998, Andrew et al 2008). Participants were encouraged to have pride in their skills and abilities, and to take ownership of their career development by seeking future opportunities.
Many studies evaluating CPD programmes have been published (Draper and Clark 2007, Lee 2011, Steven et al 2018) and it is recognised that a robust evaluation of CPD needs to distinguish between CPD that is fit for purpose and CPD that is not (Draper and Clark 2007). This needs to be balanced with a pragmatic approach to evaluation, especially when resources to conduct the evaluation may be restricted due to budget constraints (Draper and Clark 2007). This article describes a pragmatic and robust evaluation of the CPD masterclass, offering measurable outcomes and considering the stakeholders involved (participants and senior management) (Draper and Clark 2007).
The masterclass was delivered by experienced children’s nursing lecturers as a one-off day-long session at the authors’ higher education institution. It was composed of a series of workshops led by different facilitators and overseen by the authors.
In total, 14 band 5 children’s nurses from three local NHS trusts attended the masterclass. The masterclass was advertised in the workplace and nurses either volunteered to attend it or the masterclass was recommended to them by their manager.
Data were collected via three questionnaires combining open and closed questions, with opportunities for participants to expand on their answers. The questionnaires were completed at three points in time: before the start of the masterclass (to collect baseline information on participants’ views and experiences); at the end of the masterclass (to assess the immediate impact of the masterclass and identify any unmet need); and three months after the masterclass (to assess the impact and value of the masterclass in the longer term). The questions were presented in a similar format but differed in wording in each questionnaire according to the aim of data collection.
The first and third questionnaires incorporated a validated self-efficacy tool, the short version of the Occupational Self-Efficacy Scale (Rigotti et al 2008), which consists of six short statements relating to respondents’ ability to: remain calm when facing difficulties; find solutions to problems; handle problems; feel prepared for their professional future; meet personal goals; and meet the demands of their job.
Participants were asked to rate their own confidence in handling difficult situations using a 5-point Likert scale with options ranging from ‘very confident’ to ‘very unconfident’.
Quantitative data were analysed using SPSS to identify any changes in participants’ responses. These quantitative data were visually inspected by the authors and a descriptive analysis was conducted to determine trends. Qualitative data were subjected to thematic analysis, which involved developing initial codes and identifying interrelating themes to understand the views of participants (Braun and Clarke 2006).
The study had gained ethical approval through the Northumbria University Ethical Approval System (reference: 13987) on 21 June 2019. Participation in the study was voluntary and all interested nurses were given a participant information sheet, as well as the opportunity to ask questions, to ensure they would be able to give informed consent. Written consent was gained from participants before each questionnaire. Participants chose a unique identifier number to ensure that all data were anonymous.
All 14 participants returned the first and second questionnaires. A 50% return rate (n=7) was obtained for the third questionnaire, with no reasons given by participants who did not return it. Participants had one to 22 years’ experience working as children’s nurses in the NHS (mean=7.1 years).
After the masterclass, 85% (n=12) of 14 participants said they had a plan and 15% (n=2) said they had a partial plan for their career development over the next five years, compared with 79% (n=11) who had a plan and 21% (n=3) who did not have a plan before the masterclass.
When asked at the three-month follow up whether they were making progress with their career development plan, 43% (n=3) of seven participants reported that they were making progress, 29% (n=2) that they were making some progress, and 29% (n=2) that they were not making progress. Those who said they were not making progress added comments identifying barriers to their career development which are discussed in the section on qualitative findings.
At the three-month follow-up, 57% (n=4) of seven participants said that the masterclass had been beneficial and 43% (n=3) said that it had been somewhat beneficial to their CPD.
There was no correlation between finding the masterclass beneficial and the length of time participants had been qualified (r (6) P=0.46), participants having a plan for their career development (r (6) P=0.84) or participants having a high self-efficacy score (r (6) P=0.16). However, there was a statistically significant negative correlation between finding the masterclass beneficial and participants describing themselves as leaders in the first questionnaire (r (6) P=-0.04). This suggests that participants who were the least likely to describe themselves as leaders were the most likely to find the masterclass beneficial.
The length of time participants had been qualified was not significantly correlated with self-efficacy score (r (13) P=0.15), participants describing themselves as leaders (r (13) P=0.32), or participants having a career development plan (r (12) P=0.92).
There was a positive correlation between a high self-efficacy score and overall confidence with handling challenging situations (r (13) P<0.01) and overall level of comfort with discussing career ambitions (r (12) P=0.08).
Figure 2 demonstrates that, three months after the masterclass, participants felt more confident in handling challenging situations with different groups of people at work than before the masterclass, as determined by asking them to rate their level of confidence on a five-point Likert scale.
Before the masterclass, 36% (n=5) of 14 participants said they would describe themselves as leaders, 36% (n=5) said they were unsure, and 29% (n=4) said they would not describe themselves as leaders. After the masterclass, 85% (n=12) of 14 participants said that they would be more likely to describe themselves as leaders, 8% (n=1) said they were not sure, and 8% (n=1) said they still would not describe themselves as leaders.
A positive correlation was identified between participants who would describe themselves as leaders and overall confidence in handling challenging situations (r (12) P=0.03). However, there was no statistically significant difference between participants who would describe themselves as leaders and overall self-efficacy score (r (13) P=0.52).
Before the masterclass, the item on the short version of the Occupational Self-Efficacy Scale with the lowest mean score was ‘whatever comes my way in my job I can usually handle it’, with a mean score of 4 and a range of 3-6 (n=14). No participant scored any item on the scale less than 3.
After the masterclass, the mean score had increased for four of the six items on the scale; one item had remained the same; and the mean score for one item had slightly decreased. The largest change in score was seen in the last item on the scale, ‘I feel prepared for most of the demands in my job’, which had increased from 4.6 before the masterclass (range 3-6, n=14) to 5.6 three months after (range 4-6, n=7).
Following thematic analysis of the qualitative data, four themes emerged: time and opportunities, workplace culture, learning and development, and confidence.
Participants repeatedly indicated that time was a significant barrier to CPD:
‘Getting time away from work to attend courses (have to do in own time) along with full-time work. Having a family, this is difficult.’ (Participant 11)
‘Difficult during winter pressures to put anything into place.’ (Participant 5)
‘Not having the staff on the department to allow time for extra training and study days, which would allow me to develop and progress.’ (Participant 1)
Time was also identified by participants as a barrier to discussing their career plans, with one participant saying that they felt ‘senior management would not have time to discuss this’. Furthermore, participants reported that, for their careers to develop, they needed career development opportunities to arise. The questionnaires before and three months after the masterclass featured comments suggesting that such opportunities were limited:
‘I feel [I] have not been given many opportunities to lead.’ (Participant 2)
‘I feel I have identified the path I need to take to further develop, however the job opportunities rarely come up.’ (Participant 2)
Workplace culture appeared to be both a barrier and an enabler to participants discussing their career plans:
‘I feel that we have an environment in the department where we can talk about job prospects or aspirations freely.’ (Participant 5)
‘I think it is hard sometimes to discuss career aspirations for worry of being judged.’ (Participant 3)
There was also, among participants, a desire for a different culture:
‘Talking about career progression to other colleagues is sometimes a taboo but it should not be and people wanting to achieve more should be celebrated.’ (Participant 14)
In the pre-masterclass questionnaire, participants identified that workplace culture was an important factor in deciding where they would seek support:
‘I know I would be supported and listened to by senior work colleagues.’ (Participant 5)
‘Some of the higher ups (band 7s) aren’t very helpful.’ (Participant 4)
Workplace culture was often linked to senior colleagues, with one participant reporting that their line manager is ‘very supportive and will try to address problems within the team’.
When discussing challenges in their career development, participants identified a need for high levels of knowledge and experience:
‘I feel since qualifying the role of the band 5 nurse has expanded. I feel that the nurse takes on more of a medical role, but not always with the correct training/teaching.’ (Participant 9)
Participants also identified that nurses are ‘expected to have a lot of in-depth knowledge on conditions’ and are ‘looked at as a senior nurse’ and that it was challenging ‘being the person to make decisions’.
Before the masterclass, participants repeatedly referred to leadership as being associated with ‘taking charge’ of a unit or team:
‘I have started to take charge on shifts, for example night shifts on the ward, but I would not use the term “leader” to describe myself’. (Participant 14)
Despite discussions during the masterclass that leadership is not just about being in charge, responses to the three-month follow-up questionnaires still demonstrated that participants felt that ‘taking charge’ was a crucial aspect of leadership:
‘I often take charge on the ward on shift, therefore allocate patients, delegate tasks, lead the team and manage the ward in the absence of a band 6 or 7’. (Participant 2)
This may indicate that further learning and development is needed in this area. Additionally, participants identified that they would like more training on leadership and how to develop leadership skills.
Before the masterclass, participants identified that confidence was an important factor in deciding where they would seek support. Confidence also appeared to be important in relation to whether participants would discuss their career plans or not.
‘I find it difficult to discuss aspirations with higher ups as I’m afraid they’ll tell me I can’t or I’m not good enough.’ (Participant 4)
When discussing leadership, it was identified that confidence can be both beneficial (if confident) and obstructive (if not confident):
‘Although I’m not the most qualified, I would feel confident to lead procedures that I have experience doing.’ (Participant 7)
‘Still newly qualified and I work with nurses who have all been qualified seven years or more. I have a lot to learn and improve on.’ (Participant 13)
Final comments at the end of the masterclass showed that participants valued that type of learning. Participants’ comments demonstrated that the masterclass had enhanced their confidence.
‘(The session) provides the push needed to become more aware and forthcoming in my leadership abilities.’ (Participant 14)
‘Really enjoyed it, given me more confidence in having and going for aspirations.’ (Participant 4)
When asked which workshop in the masterclass they had enjoyed most, participants offered different responses, but overall ‘planning future CPD’ was the workshop participants had most enjoyed.
The three-month follow-up questionnaire asked participants whether they had any suggestions to assist children’s nurses with their CPD. Only one response was offered:
‘Keep doing the study days. We’re understaffed and we have no idea where we want to go to. […] Knowing you have a plan can help.’ (Participant 4)
The findings from this study support the delivery of CPD masterclasses to band 5 children’s nurses and show that time for CPD, career development opportunities, workplace culture, learning and development, and confidence are important factors to consider when developing CPD opportunities for band 5 children’s nurses.
Before the masterclass, 79% of participants had a plan for their career development and 22% had no plan. After the masterclass, 85% of participants had a plan for their career development and the remaining 15% had a partial plan. These figures echo findings from Wilkinson and Hayward (2017), who found that all band 5 nurses in their study had aspirations for their career. Ernst et al’s (2004) study of paediatric nurses found that nurses’ experience and length of time on the paediatric unit were associated with confidence. However, in the study discussed here, there was no correlation between nurses’ level of experience and their self-rated occupational efficacy.
It has been previously reported that many nurses do not have time to complete CPD activities. Jones-Berry (2016) reported that 38% of nurses claimed their employers did not give them any time to complete CPD activities, with 81% expressing a clear need for protected time. This may be due to budgetary constraints. It is hoped that the announcement, in 2019, of a £1,000 personal budget over three years for nurses’ career development (Royal College of Nursing (RCN) 2019) helps address this issue.
This study has identified the influence of workplace culture, and of senior nurses, on encouraging or hindering CPD and career development for children’s nurses. Similar findings have been reported in other studies (Gould et al 2007, Govranos and Newton 2014, Coventry et al 2015). Methods for improving workplace culture, and consequently access to CPD, have been proposed (RCN 2018).
The NHS People Plan, published in 2020, commits to making the culture of the NHS ‘universally understanding, kind and inclusive’ (NHS England 2020b). There is evidence to suggest that an increase in open communication, a commitment to lifelong learning and a positive attitude to change can contribute to improve workplace culture (Manley et al 2011), and each of these elements were addressed in the CPD masterclass. Although the evaluation of the masterclass was not designed to measure whether an improvement in workplace culture had occurred, there was evidence that some of these elements were present after the masterclass.
The findings from the responses to the short version of the Occupational Self-Efficacy Scale demonstrated that the CPD masterclass may have influenced the reported self-efficacy of participants. Only small changes were noted in the six items on the scale, which may have been due to the small sample size. Rigotti et al (2008) found that self-efficacy is strongly related to perceived performance, which would align with the finding that participants with high self-efficacy scores reported higher levels of confidence in handling challenging situations and higher levels of comfort when discussing career ambitions.
This study has identified that there is value in offering a CPD masterclass to band 5 children’s nurses working in the NHS. Participants appreciated the support and guidance for their career development. More initiatives such as this masterclass could be of benefit for children’s nurses. Time for CPD, career development opportunities, workplace culture, learning and development, and confidence are all important factors to consider when developing CPD opportunities and seeking to encourage band 5 children’s nurses to develop their careers.
• Masterclasses for band 5 children’s nurses on continuous professional development (CPD) can be beneficial and further research in this area would be useful
• Protected time to complete CPD activities, career development opportunities and a supportive workplace culture are important to promote career development for children’s nurses
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