27 / 04 / 2011
At the point of the review, South Tees Hospitals NHS Foundation Trust consisted of two hospitals - The James Cook University Hospital in Middlesbrough and the Friarage Hospital in Northallerton. Part of the North East strategic health authority, they are one of the largest employers in the area, with approximately 7,000 staff.
What we did and why
Five years ago, the trust introduced nine assistant practitioners (APs) in the division of surgery. These were drawn from the existing support workforce and successful candidates undertook a two year Foundation Degree.
In 2009, the organisation created an assistant practitioner development programme and information pack with an aim to standardise the role across the trust, changing the AP education requirement to a one year certificate in higher education.
The trust arranged a meeting to review feedback and issues from the 2009 cohort of APs and plan for next steps. The meeting attendees consisted of APs, AP students from other divisions, higher education institutes and the assistant director of nursing, ward managers and senior nurses. This feedback is being used to improve the experience of future AP students and adding value to AP role in the workforce.
Feedback from the certificate programme was very positive. The course was rated highly and tutor support scored well. A mentor workshop and workbook had been created to support assistant practitioners and this was well received.
However, some staff attending the university course struggled with the level of study. Some of these staff had never completed higher education previously and encountered a steep learning curve, not appreciating the workload. In the past, summer schools have been arranged as an induction to the course but due to timing issues this was not available for this cohort.
There were also concerns about study time not being consistent across the trust. The division of surgery gave guaranteed study time but this was not always replicated elsewhere.
Student APs were allocated mentors but often there is little contact time with the mentor to review competencies and they are not always allocated to work the same shifts.
One of the largest areas of feedback was around clarity of understanding of the role of assistant practitioner across both the organisation and division. Staff and patients were not always clear on the role, understanding the tasks and responsibilities. Due to ward restructures and merges, one ward had five APs whist other wards only had one or two. The ward with five APs usually had an AP on every shift and this contributed to the role becoming embedded with a greater level of understanding compared to the other ward.
There was also discussion around the need to accept that whilst studying, the role is a learning and development position and should staff not be counted in the numbers, in a similar way to how student nurses are viewed. This is not financially viable at present.
The newly created HR pack (developed for the 2009 October cohort and updated annually) will go some way to standardising the role across the organisation but there is recognition that more work needs to be carried out to promote the role across multi-disciplinary teams and service users. As well as increasing understanding of the position, promotion of the particular skills of APs will also be raised, to further facilitate integration of the role. This work will need continue to be carried out as an ongoing basis to ensure new starters to the organisations gain clarity of the role and vision of the position.
The division arranged for unique epaulettes to be created for APs which has led to questions from staff, patients and relatives, that further raises the profile of the position.
An assistant practitioner forum is due to be created by the trust in order to increase prominence of the role and share information across divisions.
- Ensure staff are aware of the role and purpose of the assistant practitioner role - tasks, responsibilities and elements that are suitable to be delegated from the registered practitioner.
- Find a way to visually identify assistant practitioners as a distinct staff group.
- Examine the previous level of study of applicants to determine their suitability to pursue further education. Look to see if you can provide basic study skills training or even basic computer/IT skills if necessary. Obtain an early reading list to allow those considering attending the course to get a flavour of the course content.
- Set review meetings to track progress of role implementation, inviting a range of relevant parties to ensure representative views.
- Ensure a clear vision of the role of AP that is standardised across the organisation, with clear job description/scope of practice.
Further information and contact information
Joanne Angus, practice development sister - division of surgery