Student exposure to the complex challenges involved in the care of older people can help develop vital skills and generate interest in working in this area ABSTRACT Bournemouth University

worked in collaboration with a large independent nursing home organisation, Colten Care, to implement an innovative placement experience for a final-year adult nursing student. During a

six-week placement, the student was able to work alongside the home manager, to develop their leadership and management skills. Examples of learning opportunities included being part of the

interview process for new staff and leading team meetings. The findings from the project highlight that there are significant opportunities for final-year student nurses when placed in this

nurse; all at Bournemouth University. Dee Lovewell is home manager at Colten Care. * This article has been double-blind peer reviewed * Scroll down to read the article or download a

print-friendly PDF here (if the PDF fails to fully download please try again using a different browser) INTRODUCTION Practice placements for student nurses in the nursing home setting are

essential. Dalsmo et al (2022) recognised how they equip the novice student in developing and enhancing their fundamental skills and professional identity. In addition, due to the increasing

average life expectancy, complexity and acuity of residents, Laugaland et al (2021) also emphasised that the nursing home experience is a vital component of the students’ overall practice

placement journey. In this setting, the more experienced students also have opportunities to explore multifaceted complex care needs, which draw upon leadership and management skills.

Kingdom-Mills (2023) introduced an initiative to work with local care homes to develop their environment and the team to support student nurses as a placement provider. This project

highlighted the value of placements in the care home setting and identified a range of learning opportunities, including initial assessments, long-term care provision and end-of-life care.

The Nursing and Midwifery Council’s (2018) _Future Nurse: Standards of Proficiency for Registered Nurses_ acknowledged that due to the changing landscape of healthcare and more complex

patients being managed in the community, opportunities to experience the value of the extended nursing role are essential for student nurses. Health Education England (HEE) and Skills for

Care also recognised a plethora of opportunities that can be experienced in the nursing home environment and have developed some useful guides, including _How to make the most of student

nurse placements in social care settings_ (HEE and Skills for Care, 2021). More emphasis needs to be placed on the fact that the nursing home setting is a valuable resource where an

experienced student can gain an understanding of the autonomy and skill set required for a future practitioner. However, there is limited evidence available, in the UK, of the more

experienced students being placed in this setting to develop vital skills, including caring for complex patients and their leadership and management abilities. Ryan et al’s (2018) Australian

study scoped the understanding of final-year student and qualified nurses in the care of the older person and recognised that there are some reservations associated with this type of care.

This appraisal highlighted that the students and nurses believed they would not be exposed to the same challenges and clinical skills development available in the acute setting. Following

this research, Ryan et al (2018) recommended that a change in mindset for students and registrants is essential and should start from the beginning of the student journey. During the

academic year 2021-22, Bournemouth University worked in collaboration with a large independent nursing home organisation, Colten Care, to implement an innovative placement experience for a

final-year adult nursing student. The allocated student would have the opportunity to spend time in one of the nursing homes, where they would work alongside the home manager and clinical

lead. Placing students in the nursing home setting and, in particular, working in partnership with Colten Care, is a process that has taken place at the university over several years.

However, widening the opportunities for students and recognising the value of placing final-year students in this setting was an innovation. PREPARATION The planning for this placement

experience started approximately six months before the start date and included meetings with the student lead for the organisation, the nursing home manager, and university practice learning

advisers (UPLAs) from Bournemouth University who have a remit for supporting practice areas that provide placements for healthcare students. A six-week placement within the year plan for

final-year students was identified. During the planning meetings, learning opportunities for the student that would support them in meeting their proficiencies were recognised. These

opportunities included pre-assessments, recruitment including new staff interviews, supporting new starters inductions, and leading the clinical team meetings. The initial interview would be

used as an opportunity to plan the placement for the student. The allocated student, who was identified through the placement allocation process completed by the placements team, was also

contacted as part of the planning process to explain this placement in more detail, highlighting the opportunities they would have in this setting. The student was advised that during the

placement they would take more of a leadership role and, therefore, work closely with the home manager and clinical lead. The student did have previous experience of being on placement in a

nursing home setting and we explored how this placement would differ, but also recognised that there were opportunities to develop their clinical skills as and when required. The placement

was reviewed approximately halfway through the allocation and a formal student evaluation was also completed at the end of the practice experience. IMPLEMENTATION At the beginning of the

placement, the initial interview provided a time for both the home manager and the student to discuss a plan for this placement, identifying and incorporating the range of learning

opportunities that had been identified. It was recognised that the student would be able to develop their leadership and management abilities through a range of learning experiences, while

also being able to demonstrate all fundamental skills of nursing including communication, assessment and critical thinking. This was endorsed by the home manager: “_The student could

identify problems and be part of the team and come up with solutions. The student could close the circle of the nursing process in terms of pre-assessments and ongoing assessments and

evaluation of care._” As the placement progressed, the student was also then supported to lead in many situations that would normally be the role of the home manager. This included the

recruitment processes, understanding the responsibility of safeguarding, and leading the clinical team meetings. There was also opportunity for clinical development during this placement.

The student nurse was supported to develop an understanding of some specialist and innovative medical equipment, including inner ear examination and wireless blood sugar monitoring, which

the home was now using. Ongoing monitoring of opportunities throughout the placement took place and through regular dialogue between the student and practice assessor, the placement could be

adapted to meet the student’s needs. FINDINGS Overall, the feedback from both the home manager and final-year student was positive. Both parties recognised the value of this placement

experience and how all these opportunities had allowed the student to develop their knowledge and skills in four key areas. These were preparation for registration, communication, leadership

and management, and the future workforce in nursing. PREPARATION FOR REGISTRATION The nursing home sector is a crucial element in the pre-registration training of students as it enables

them to experience the multifaceted arena of caring for the older person (Humphries and Smith, 2019). Ryan et al’s (2018) study also highlights that traditionally these settings are used for

students in their first year, but the students may not yet be equipped with the underpinning knowledge to make sense of the complexities of caring for the older person. This was

corroborated by the student nurse: “_Some students view nursing home placements as less challenging. Although long-term care facilities have routine tasks on a daily basis, one will

encounter challenging tasks every day. It will challenge someone’s critical thinking, clinical assessment and decision-making skills around the service users’ treatment and plan of care._”

Kingdom-Mills (2023) identified that final-year students will have opportunities to learn skills and observe situations in this setting that will be extremely beneficial in their role as a

newly qualified practitioner. Watson et al (2020) conducted focus groups exploring the perceptions of the role of the registered nurse in the care home setting. Following discussion and

viewing of a video, the students acknowledged that their perceptions had changed, and they began to appreciate that the registered nurse in this setting works in isolation, resulting in

nurses being highly skilled and adept in autonomous practice. COMMUNICATION The importance of communication in nursing cannot be underestimated and, while a first-year student is able to

gain the fundamentals, the final-year student is more likely to appreciate the many different facets to this skill. Douglas (2019) has suggested that, as student nurses progress, they can

hone their communication skills by, for example, learning how to assess while communicating. The student on this placement also identified the many facets of communication and stated that

their experience allowed them the opportunity to appreciate the importance of effective communication in a healthcare setting. They realised this for example when they were involved in

completing an audit, which helped to identify problems such as a resident’s poor nutritional status: “_It was identified that the root of the problem was communication among the staff

members ie kitchen staff, healthcare assistants and the trained nurses._” LEADERSHIP AND MANAGEMENT Willetts et al (2017) acknowledged that the leadership and management content in the

nursing programme is vital. Opportunities to develop these skills as a student are a significant component to the programme and relates to the practice setting. Willetts et al (2017)

expanded further by highlighting that nurses who are supporting the older population need to be able to initiate change for patients and advocate for them, making the leadership element of

their training course even more important. Within this placement, the student had a suite of experiences that they were able to draw upon, which enabled them to comprehend the complexity and

challenges of managing and leading in the nursing home sector. This was endorsed by the student: “_I never actually realised how it all fits together and how everything we do is done for

more than one reason. An example was when pre-assessing residents to move into the care home_.” It also became evident that the practice assessor’s role is crucial in supporting the student

to gain confidence and develop their knowledge in the many facets required of a leader (Nursing and Midwifery Council, 2018). The home manager, who was also the practice assessor,

highlighted this: “_Having a student understand the bigger picture has meant they are able to practice in a way that is holistic and complete, it’s more than a tick-box exercise. Building

confidence has meant the student was provided with opportunities to reflect on decisions and outcomes and evaluate how they may have done something differently or reviewing their work so

they could consider all the options and scenarios. A simple task of allocation meant that the student had to look at residents’ needs and the team’s skills and other factors, such as

equality and team morale._” FUTURE WORKFORCE The future workforce in nursing for the older person is a concern. The Department of Health and Social Care’s (2022) policy paper recognised this

and stated that they wish for all health undergraduates to experience adult social care and for there to be an increase in the number of trainee nurses who undertake a placement in this

area. Therefore, exposing students to this part of the workforce during their training could have significant benefit in enhancing the workforce in this sector for the future. Willetts et al

(2017) noted that many Australian-based student nurses did not identify the care of the older person as the area of specialty that they would like to progress into so initiatives of this

kind could help to promote interest. Many organisations are now offering supportive packages for qualified nurses, which includes internal and external training, support with working in this

environment and career progression. Box 1 lists our recommendations for anyone undertaking a similar project. BOX 1. RECOMMENDATIONS * Ask students to complete a leadership questionnaire

before starting placement * Identify specific learning opportunities in relation to leadership and management before the placement starts * Make sure the higher education institution takes

the lead in informing the student about the expectations of this placement * Collaborative working is needed between the placement provider and higher education institution before and during

the placement * For all student nurses to be allocated this type of placement experience During this placement, the student nurse experienced supporting the future workforce by being

invited to participate in interviews of new staff. The home manager stated that they ensured the student’s opinion was considered, and they were included in the discussions following the

interviews. Willetts et al (2017) identified that it is vital to develop a resilient and sustainable workforce in this sector. Out on this placement, the student gained excellent insight

into how support, investment and effective working relationships are important components of a manager’s role in order to build an effective workforce. CONCLUSION This placement experience

has highlighted significant opportunities for a final-year student nurse when placed in the nursing home setting. Four key areas have been identified, where the student nurse was able to

develop their knowledge and skills. This included preparation for registration, communication, leadership and management, and future workforce. Comments from both the student nurse and home

manager show that the experience of a final-year student in the nursing home setting is valuable and has a positive impact in highlighting the opportunities that are available in this arena.

KEY POINTS * It is important that student nurses can try a range of placement experiences throughout their course * Final-year students need opportunities to develop their leadership and

management skills * The nursing home sector provides an excellent environment to help students learn about caring for complex patients * Allowing students the opportunity to work alongside a

range of staff improves their understanding of various roles * Innovative placements for students are important in a rapidly changing health and social care sector REFERENCES DALSMO IE ET

AL (2022) Learning in nursing home placements: a phenomenological study of student nurses’ lived experience. _Journal of Clinical Nursing_; 32: 3-4, 452-464. DEPARTMENT OF HEALTH AND SOCIAL

CARE (2022) Health and social care integration: joining up care for people, places and populations. _gov.uk_, 11 February (accessed 1 August 2023). DOUGLAS J (2019) Care homes as learning

environments for student nurses. _qnis.org.uk_, 6 September (accessed 1 August 2023). HEALTH EDUCATION ENGLAND AND SKILLS FOR CARE (2021) How to make the most of student nurse placements in

social care settings – for the person who needs care and support, employer, student and education provider. _skillsforcare.org.uk_ (accessed 1 August 2023). HUMPHRIES B, SMITH S (2019)

Boosting students’ learning experiences in care homes. _rcni.com_, 17 April (accessed 26 June 2023). KINGDOM-MILLS S (2023) Home advantage: the benefits of care home placements._

rcn.org.uk_, 19 June (accessed 26 June 2023). LAUGALAND K ET AL (2021) Nursing students’ experience with clinical placement in nursing homes: a focus group study. _BMC Nursing_; 20: 159.

NURSING AND MIDWIFERY COUNCIL (2018) _Future Nurse: Standards of Proficiency for Registered Nurses_. NMC. RYAN C ET AL (2018) Australian final year nursing students’ and registered nurse

supervisors’ perceptions of a gerontology clinical learning experience: a preliminary appraisal. _Nurse Education in Practice_; 31: 182-187. WATSON J ET AL (2020) Care home nursing:

co-creating curricular content with student nurses. _Nurse Education Today_; 84: 104233. WILLETTS G ET AL (2017) The dynamic role of the graduate nurse in aged care: an Australian experience

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