Overview Programme Structure: Nursing
The introduction of the NMC (2010) ‘graduate standards’ gave the programme team an
unprecedented opportunity to review how the structure of the programme and practice learning
activities impact upon the students’ learning. The review was informed by:



Consultation events with key stakeholders.
Feedback from present and past students
Literature relating to nurse education.
The consultation and student feedback suggested that value was placed on:
1. A clearly structured programme where theoretical, assessment periods and study leave are
planned to support and complement longer periods of practice learning.
2. Inter professional learning. This is a major component of the Making it Real curriculum.
Focused IPL sessions are valued and IPL modules are to be retained in the new curriculum.
3. In line with the work of Levett-Jones et al (2008), students and mentors requested longer
periods of practice learning. This supports the students’ feeling of belonging within the
clinical arena and enables them to progress from orientation to active participation in care
delivery.
In examining our portfolio of practice opportunities we became aware of the challenge caused by
the transformational change which clinical services in the North East have experienced. This has
been brought about by the modernisation agenda, Transforming Community Services and major
rebuilding programmes. It was acknowledged that our current coding of placements no longer
reflects the new and emerging services and the diverse and challenging areas where nursing care is
delivered in the 21st century. The programme team consulted on recoding practice learning
opportunities based on a framework which would both incorporate the diversity of nursing as well
as ensuring that the service user is placed at the centre of the student experience. This would enable
the student to understand the patient journey or pathway in accessing care. Looking at these
factors, the Chief Nursing Officer’s framework for ‘Modernising Nursing Careers’ was considered to
be the best fit for the programme. This is based on five pathways:
First Contact
Acute and Critical care
Family and Public Health
Mental Health and Psychosocial care
Supporting long term care.
The clear representation of the framework in the ‘MNC wheel’ (Diagram 1) has ensured that it is
known and accessible to the majority of practitioners, this supported the teams decision to adopt
the MNC framework for recoding practice.
Recoding practice learning opportunities is one step in refreshing and refocusing to provide relevant
practice learning opportunities but the team realised that, to fully meet the brief set, they would
need to move from a ‘fixed’ placement plan to a more flexible plan based on longer ‘hub and spoke’
experiences. The ‘hub and spoke’ approach is a key element of year 1 and 3 of the programme
where the students experience in University is based on two semesters and they undertake year
long placements.
Diagram 1: Modernising Nursing Careers
The hub is where the student’s main mentor (or sign off mentor in year 3) is based and where the
student will spend the majority of their time and, in line with NMC requirements, the last 4 weeks
(year 1) and final 12 weeks in year 3. The spoke experiences are short, normally 2 week, periods of
practice learning which either supports the students understanding of patient pathways linked to
the hub experience or ensures that the practice learning opportunities in the adult field of nursing
are in line with the European Dirctive2005/36/EC. For all nursing students their practice learning
opportunities will provide either an authentic or simulated introduction to all fields of nursing and
midwifery.
Year two follows a trimester model with three shorter (7 / 8 week) periods of practice learning, this
is an acknowledgement of the nursing skills acquired in year one and a wish to expose students to a
series of different care settings where they can apply, adapt and build upon their previous learning.
By the end of year two, the student will have experienced all pathways within the MNC framework
and will be supported by their guidance tutor to choose an area of nursing practice for their ‘guided
option’ hub in year three. Tables 1- 5 give an overview of the student practice learning experience
across the four fields of nursing.
TABLE 1: Adult Nursing - Placement Plan
14
1
2
1
2
2
7
2
8
2
7
3
6
3
6
3
12
Fundamental
nursing skills
1
NOTES
Developing skills:
Decision making
& autonomy
WEEKS
Spokes, flexible (i.e. not at fixed
points in the placement), but will be
allocated as part of the planned
practice experience.
CLIENT GROUP
Patients in need of 24hr Inpatient care / Day Unit care where fundamental nursing skills
may be practised.
MENTAL HEALTH AND PSYCHOSOCIAL CARE PATHWAY– Mental Health
FAMILY AND PUBLIC HEALTH PATHWAY – Healthy Living centres, Stopping smoking
teams, GUM, Drug and Alcohol teams, Practice nurses, etc.
FIRST CONTACT PATHWAY
Streamed
SUPPORTING LONG TERM CARE PATHWAY - District Nurse
ACUTE AND CRITICAL PATHWAY
GUIDED OPTION BASE HUB
Leadership &
Management
YEAR
Spokes based on guided option (i.e. Community – Ward – Hospice, ITU – Theatre – A & E, Ward – Community - Outpatients
and/or individual student requirement (i.e. is student seen to be lacking in critical care or ward experience)
GUIDED OPTION BASE HUB
TABLE 2 :Children’s Nursing - Placement Plan
2
2
7
2
8
2
7
3
6
3
6
3
12
Streamed
Psychosocial care
1
Spokes, flexible (i.e. not at fixed points in the
placement), but will be allocated as part of
the planned practice experience.
CLIENT GROUP
Mental Health &
2
autonomy
1
Fundamental
nursing skills
14
Decision making &
1
NOTES
Developing skills:
WEEKS
Patients in need of 24hr Inpatient care
FIRST CONTACT PATHWAY - Out patients, walk in centres, practice nurses
ACUTE AND CRITICAL PATHWAY - Theatres
FAMILY AND PUBLIC HEALTH PATHWAY - e.g: Health Visitor / School
Nurse
SUPPORTING LONG TERM CARE PATHWAY - e.g: CCN teams, Hospice,
CAMHS, neonatal /SCBU.
ACUTE AND CRITICAL PATHWAY – e.g: PICU, Oncolgy Services
GUIDED OPTION BASE HUB
Leadership &
Management
YEAR
Spokes based on guided option and/or individual student requirement (i.e. is student seen to be lacking in critical care or ward
experience). It is anticipated that one spoke will include a 2 week PLO in an adult care area to facilitate the students
understanding of ‘transition’ services.
GUIDED OPTION BASE HUB
TABLE 3: Learning Disability Nursing – Programme Plans
1
2+2
1
2
1
8
2
7
2
8
2
7
3
6
3
6
3
12
CLIENT GROUP
COMMUNITY INCLUDING FIRST CONTACT
CLDT /CTLD
Streamed
Same as first placement
PROGRESSION POINT
Streamed
PROGRESSION POINT
Spokes based on guided
option
PROGRESSION POINT
Mental Health and
Psychosocial care
4
Fundamental nursing skills
1
NOTES
Developing
skills: Decision
making &
autonomy
WEEKS
Leadership &
Management
YEAR
ACUTE AND CRITICAL PATHWAY – (Physical Care)
Children’s Nursing Inpatient / Elderly MH
FAMILY AND PUBLIC HEALTH PATHWAY
School Experience
CLDT/CTLD
CHILD AND ADOLESCENT e.g.: Inpatient units and / or community teams
SUPPORTING LONG TERM CARE PATHWAY e.g.: Challenging behaviour
ACUTE AND CRITICAL PATHWAY (LD) e.g.: Challenging behaviour, Forensic, Autism
services
GUIDED OPTION BASE HUB
Medium security
i.e. Forensic low secure – Rehabilitation – forensic community team
GUIDED OPTION BASE HUB
TABLE 4: Mental Health Nursing – Placement Plans
1
4
1
2+2
1
10
2
7
2
7
2
8
3
6
3
6
3
12
CLIENT GROUP
Planned care (inpatient / Day Services)
Older Person/Rehabilitation Recovery/ Day Services
Streamed
Same as first placement
PROGRESSION POINT
Streamed
PROGRESSION POINT
Mental Health and
Psychosocial care
4
Fundamental nursing skills
1
NOTES
Developing
skills: Decision
making &
autonomy
WEEKS
Leadership &
Management
YEAR
ACUTE AND CRITICAL PATHWAY – (Physical Care)
A & E / Medicine / Poss. HV or DN
Planned care (inpatient / day Services
COMMUNITY INCLUDING FIRST CONTACT
SUPPORTING LONG TERM CARE PATHWAY
Specialist Services
ACUTE AND CRITICAL PATHWAY (Mental Health)
Urgent Care – Inpatient Services
GUIDED OPTION BASE HUB
Spokes based on guided
option
i.e Forensic – low secure – Forensic community - Rehabilitation
PROGRESSION POINT
GUIDED OPTION BASE HUB
TABLE 5: Integrated Masters – Programme Plan
WEEKS
NOTES
1
14
APL / APEL to include achievement of progression criteria for year one of the programme
1
2
1
2
2
7
2
8
2
7
3
6
3
4
14
CLIENT GROUP
24 hr inpatient care / Day Unit
No streaming of placements
Mental health & psychosocial
care
Developing skills:
Decision making &
autonomy
Leadership & Management
3
Fundamental
nursing skills
YEAR
14 week Hub placement with 4 week
spoke practice learning opportunities
Placement includes spoke to FIRST CONTACT
PATHWAY
SUPPORTING LONG TERM CARE PATHWAY - District Nurse
ACUTE AND CRITICAL PATHWAY
FAMILY AND PUBLIC HEALTH PATHWAY : Hub - Healthy Living centres, Stopping smoking
teams, GUM, Drug and Alcohol teams, Practice nurses, etc.
2 week spoke to HV / Family Health Nurse Partnership team
GUIDED OPTION BASE HUB
Spokes based on guided option (i.e. Community – Ward – Hospice, ITU – Theatre – A & E,
Ward – Community - Outpatients and/or individual student requirement (i.e. is student
seen to be lacking in critical care or ward experience)
The programme is structured to support the student, theoretically and in practice, to develop their
nursing skills in line with the NMC progression points and competencies. The key focus of each year
is:
Year One – Fundamental nursing skills
Year Two – Developing skills: decision making and autonomy
Year Three – Leadership and management
Students work 37.5 hours in practice and their overall experience has been planned to meet NMC
(2010) requirements:
Practice
Weeks
Hours
Year 1
Year 2
Year 3
Total
18
22
24
64 wks
675
825
900
2400 hrs
Theory
Student
Workload
27
1200 hrs
23
1200 hrs
21
1200 hrs
71wks
3600 hrs
Weeks
Annual Leave
Weeks
Total
Weeks
7
7
7
21 wks
52
52
52
156wks
International Opportunities
During the XXX year of the programme students may apply for the opportunity to take part in
international exchanges. The School has a well established EU Erasmus exchange programme with
Finland, Spain, Greece and Portugal. Students may undertake shorter experiences in Kenya or
negotiated areas of choice. All Erasmus areas have link lecturers attached to them who undertake
the audit, quality assurance and preparation of mentors prior to the students arriving in the country.
Queries
Is the section on simulation and IPL in L & T strategies?
Where is the section on student support?
Mentor Handbook / Student Handbook – we will need more re the principles of hub and spoke
placements. Or do you want it added here?
References
Levett-Jones, T., Lathlean, J., Higgins, I., McMillan, M., (2008) The duration of clinical placements: a
key influence on nursing students’ experience of belongingness.Australian Journal of Advanced
Nursing, 26(2) 8 – 16.