Enhancing the learning of student nurses in a community "sign off" placement: implications for students, health services and higher education

This action research project explored the implications for student nurses, health services and Higher Education Institutions (HEIs) of placing students for their final “sign off” placement prior to registration with district nursing teams who nurse patients at home. The placing of students with District Nursing teams for the “sign off” period is unusual in the London area. The stated aim of the Department of Health is that students should have more experience outside of the hospital setting (DH 2006) and the Nursing and Midwifery Council has a specific standard that students acquire practice experience in the home setting (NMC 2010). The literature review highlighted a tension between those aims and a national trend of reduced district nursing numbers and fragility in the student nurse mentorship preparation system in the London area. Data was obtained over a two year period from interviews with ten students, their mentors in practice, NHS managers and educationalists and the researcher’s own learning log. Key findings from the data were that despite the initial concerns expressed in the HEI that students could be disadvantaged compared to their hospital based peers, the students placed with District Nursing teams successfully completed the placement gaining the requisite skills and management experience. The objective of designing a sustainable process at the author’s institution to support these placements was achieved and the resource implications explored. Although not explicitly stated as an objective of the research intervention, the students felt competent and confident to apply for staff nurse posts in District Nursing teams and most were successfully appointed. Arising from the reflexive analysis of action research, a recommendation is made that the NMC should reconsider a standard that all students should gain experience in the home setting (NMC 2010) and consider developing a more realistic standard which would allow some students to focus on the home setting and others to explore other settings outside of hospital. Recommendations for the local context are made to maintain and develop the processes which were put in place as a result of this action research intervention to support students and practitioners during the sign off period of the pre-registration nursing programme.