Assistant practitioner

Abstract: The United Kingdom is currently experiencing a recruitment and retention crisis in its nursing workforce. Mental health care is a particular problem area. Widening access to health and social care careers is a challenge for educational and health care organizations. This discussion paper examines the congruence between an educational programme aimed at developing Mental Health Assistant Practitioners’ and the organizational responses to the subsequent opportunities for practice innovation within mental health care services. Whilst the ‘learning while working’ philosophy of the educational programme has been enthusiastically embraced by many health care organizations, the change in management required for using these assistant practitioners in service innovation appears beset by organizational, cultural and professional concerns. Not least of which are the often ambiguous concepts of the role and purpose of being a mental health nurse. This paper argues that if current mental health nurses are unclear about their role it is oxymoronic to establish the mental health assistant practitioners.

Abstract: This article attempts to project the future of nursing education by learning the lessons of the past. Since 1989, a constant discourse has evolved: pre-registration nurses are emerging from nursing education programmes without essential clinical skills. It is argued that, if the profession is to heed the lessons from the past, a focus on this constant discourse is inevitable. This is because, in the UK, nursing practice-based learning has long been valued and considered to be of equal importance to institution-based learning. The article thus draws on lessons that can be learnt from the evolution of models of nursing education over the past two decades. Having identified and outlined three models of nursing education, the article predicts the demise of pre-registration nursing and the development of practice-based assistant practitioner programmes and practice-based postgraduate nursing programmes owned and managed by primary care trusts and NHS foundation trusts.

Abstract: Despite the proliferation of support worker roles in the UK, little is known about their actual numbers, employment conditions or levels of training. Intermediate care services appear to be an important employer of support workers, but the diversity of intermediate care services makes the task of understanding support worker roles even more complex. This paper presents data from 33 services which were involved in an NHS Modernisation Agency’s Changing Workforce Programme project, the Accelerated Development Programme for Support Workers in Intermediate Care in England. Within this project, the main employers of support workers were primary care trusts and/or social services. Participating intermediate care teams were involved in admission avoidance, assisted discharge and re-ablement, or combinations of these services, and the majority of care was provided in the patient’s own home. The 33 services employed 794 support workers and 368 professionally qualified staff. The mean ratio of professionally qualified staff to support workers was 0.95 (range = 0–4.9, SD = 1.05). Support worker roles included multidisciplinary working, meeting rehabilitation needs, providing personal care and enablement. Team leaders included nurses, social workers, physiotherapists, professional managers, home carers and support workers. The most commonly reported sources of support worker training were National Vocational Qualifications and in-house training. In 80% of the services, at least half of the support workers had a qualification. Three models of supervision emerged across the services: the allocation of a mentor; team supervision; and formal and informal line management. These findings illustrate the diversity of employment of support workers in intermediate care. The variations in training, supervision and skill mix have implications for clinical governance and support worker regulation. The employment of support worker staff jointly across health and social care raises cross-boundary issues around employment contracts and pay.

Abstract: In 2014, the NHS Five Year Forward View (FYFV) set out new models of care and care strategies. Amongst them was the introduction of the role of Assistant Practitioner (AP). The AP role was positioned at Band 4 (of 9) on the NHS Careers Framework, gained through the successful completion of a foundation degree (fd). Those already in employment accessed the fd through day release to university and work-place clinical skills development. A qualified AP would work under the supervision of a registered nurse. This thesis examines and centralises the experiences of ten Black British and Black Caribbean women’s experiences of the fd programme and its impact on their personal and professional identities. It (re)tells, (re)captures and (re)presents their accounts of getting in, moving on and getting through Higher Education. This study disrupts the silence of Black women in the NHS. Black Feminist Methodological Stance is put to work to centre and privilege Black women who transitioned through the research process unearthing, examining and unapologetically speaking their ‘truths’. The analysis is intentionally theoretically provocative, it uses performative autoethnograpy to present the voices of the women through characters in fictional settings. The characters use the works of predominantly Black philosophers to critically reflect on their experiences of education. Their exposures to philosophies and their sharing of life leads them to Black feminist epistemologies. This study demands engagement, it challenges all who access it, to come and reside in our spaces… to feel the discomforts… to rethink the stereotypes… to speak of the biases… then to co-align with us… it questions… challenges… and seeks honest approaches to fairness in nursing education and professions; two areas, where for seven decades Black women have been professionally subordinated and exploited. This thesis demonstrates the courage of the author to engage in research which breaks the silence of Black women in NHS and makes the theorised assertion of our ‘right to write’ as Black women about Black women. The presentation of the data as performance autoethnography, renders this work accessible to the contributors, as well as significant and important for academic scholarship. This study strives for engagement, it resists recommendations which, historically are ineffective liberatory tools of the master’s house, in that they fail to make a difference to the Black women’s assigned subordinated space. Finally, this work challenges Black women in the NHS to become active agents of their professional emancipation. New Knowledge Contribution: This thesis contributes the following new knowledge: The production of a literature review which resists the normative approach to the production of a thesis, it utilises oral accounts which work to both contradict as well as illuminate accounts presented in written text. It retells the stories of ten Black female Health Care Assistants (HCAs). Because of their low professional status, HCAs are generally invisible and voiceless in research studies. This study centralises their experiences, making them visible, therefore providing a partial illumination of their educational experiences. The literature provides Black nurses of the 21st Century with an example of how Black nurses in the past coalesced to redress the inequitable nursing education provision they experienced during colonial times. Black nurses of the Caribbean broke the nursing profession’s class ceiling securing positions previously solely reserved for Caucasians. The unearthing and presentation of Black Caribbean women’s nursing education history provides Black nurses with a positive self-liberatory learning example from Caribbean nurses of the past. This study demonstrates the courage of the author to present the data analysis as performance autoethnography, in so doing, it renders this work accessible to the contributors, the academic as well as ordinary members of the Black community. This thesis strives for engagement and discussion asking questions of institutions rather than being prescriptive and autocratic (making recommendations). It also challenges Black women in the NHS to become active conduits of their own professional emancipation rather than awaiting ‘redemption from those using the tick box tools of the ‘master’s house’.