Background

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.

Masterclass format and content

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.

Figure 1.

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.

Aim

To evaluate the impact of a CPD masterclass on band 5 children’s nurses.

Method

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).

Findings

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).

Quantitative findings

Career development

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.

Benefit of the masterclass

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).

Handling challenging situations

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.

Figure 2.

How confident would you feel about handling challenging situations or conflict with the following groups?

Leadership

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).

Occupational Self-Efficacy Scale

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).

Discussion

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.

Conclusion

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.