In the UK, preregistration nursing students (trainee nursing associates and student nurses) include those with a disability or impairment who may require reasonable adjustments to maximise their achievement of practice-based learning proficiencies. Examples include hearing loops on telephones and altered shift patterns (King, 2019). Under the Equality Act 2010, this support must be available to these nursing students to maintain their quality of working life and to ensure equitable access to effective learning opportunities.
Provision of this support is co-ordinated by the students, clinical practice staff and university-based staff. Facilitation of reasonable adjustments can vary, which can have a negative impact on a student's practice learning experience (Foster et al, 2015; Craig et al, 2023). Students report that effective support from university and clinical staff regarding organising reasonable adjustments while on clinical placement can enhance their learning and help them maintain their progression through their preregistration nursing programme (King, 2019).
In previous work, the author (King, 2018; 2019) found that many practitioners who work with nursing students requiring reasonable adjustments for practice-based learning can feel unprepared to support them. This is mainly because of a lack of clarity around their roles, limited national guidance and a weak knowledge of types of disability and impairments.
Literature reporting on the experiences of facilitating reasonable adjustments for these students on clinical placement, including research examining the views of all practitioners involved, is limited. This potentially hinders the provision of this support and warrants further exploration (King 2022; Craig et al, 2023).
This study explored the viewpoints of nursing practice tutors at The Open University (OU), whose roles are described in Box 1. Nurse academic roles at the OU differ from those at traditional UK universities. Practice tutors are unique to the OU and have the responsibilities of an academic assessor (Nursing and Midwifery Council, 2018); the position is similar to that of the link lecturer in many UK universities. The role involves liaising with both clinical and OU-based staff to monitor nursing students' progress through their course. This investigation was prompted by the challenges reported in the literature on link lecturers' experience when supporting nursing students who require reasonable adjustments for practice-based learning.
Box 1.Overview of the role of Open University nursing practice tutors
- Practice tutors are registered nurses (not necessarily nurse lecturers), who support Open University (OU) nursing students, nurse apprentices and trainee nursing associates in clinical practice
- They are based around the UK, supporting nursing students in their region
- Practice tutors liaise directly and regularly with students' practice assessors and practice supervisors
- They also liaise directly and regularly with students' employers (students are only recruited to OU preregistration nursing programmes through employers)
- Students are not taught theory by practice tutors unless they are also module tutors
- Practice tutors are responsible for ensuring a student's practice assessment document is completed, marking these documents and attending practice interviews where progress is discussed by the student and staff
- The progress of any action plans for students not reaching appropriate proficiency levels while on placement is overseen by practice tutors
- Practice tutors can instigate a disability assessment for a student to ascertain a need for any reasonable adjustments
Research aim
The main aim of this study was to elicit practice tutors' views on their readiness to support OU nursing students who require reasonable adjustments while on clinical placement. This research also intended to ascertain if resources available were sufficient for preparing practice tutors to support these students effectively. Additionally, it aimed to identify future training and development required for OU nursing practice tutors.
Research objectives
This study had three aims:
- To ascertain which resources assist practice tutors in supporting OU nursing students who require reasonable adjustments for clinical placement
- To explore whether practice tutors from the OU feel prepared to support these students
- To clarify what training and development could be provided by the OU for practice tutors to enhance their readiness to support these students.
Method
The methodological approach chosen for this study followed a qualitative, broad interpretivist paradigm using focus groups as the data collection tool. This allowed for a deeper analysis of participants' responses and reflected the explorative nature of this research. Ethical approval was sought as per OU processes, with potential risks identified and plans for mitigation made. Once ethical approval had been gained, participant recruitment started.
Purposive sampling was carried out by contacting all OU nursing practice tutors via email. A study participant information sheet was attached to the email, and practice tutors were able to contact the researcher with any questions. A consent form was also created for participants to complete.
Data were collected via three focus groups conducted through Microsoft Teams. A total of 10 participants attended the focus groups; they worked in various parts of the UK and had different lengths of service. A semi-structured question schedule was used for the focus groups to allow freedom of conversation. Predominately, questions on the three project research objectives were asked, with the researcher leading the focus group prompting participants to expand on their answers. Reflexivity was acknowledged throughout the project, enhanced by the fact that the researcher was not a practice tutor. Guidance for focus groups provided by Marková et al (2007) was followed to ensure robust data collection.
Recorded audio material from the focus groups was transcribed using a function on Microsoft Teams. All recordings and transcription data were kept on an OU password-protected computer throughout the study and all personal participant data were anonymised. The audio transcriptions were checked for accuracy, then thematically analysed using a complete coding technique following the guidelines of Braun and Clarke (2013). Themes and subthemes were then identified for the writing-up stage of the study.
Findings
Three main themes were identified: it's complex; impact of engagement; and a cohesive approach. All main themes and associated sub-themes are discussed below.
It's complex
‘What's my line?’
Study participants reported that, in general, the practice tutor role is multifaceted, so there can be a lack of clarity about it on the part of employers and practice tutors themselves. This can leave practice tutors unsure of the procedures on how to facilitate support for nursing students who require reasonable adjustments for practice-based learning:
‘I've been flummoxed … you know the complexity really of the practice tutor role [in facilitating reasonable adjustments] and, like, there wasn't much guidance … I didn't know if I was expected to just sort of be able to pick it up and run with it.’
Practice tutor E
‘Students as a movable feast’
Challenges in this process can be compounded by factors related to students. These include students being unwilling to disclose needing reasonable adjustments, or a having a diagnosis of a disability or impairment made after they started the preregistration nursing programme.
Requirements for reasonable adjustments can be changeable, and practice tutors may have to access advice from occupational health teams as to whether a student is well enough to be on clinical placement.
These factors increase the complexity of supporting these nursing students:
‘And there are very changeable conditions such as mental health, where you have students with anxiety, for example, or depression, who can be really unwell at times and other times be… really well.’
Practice tutor J
Impact of engagement
‘Empowered students’
All participants agreed that effective engagement with clinical and OU staff assisted in their ability to support these students on clinical placement.
‘Empowered’ students, who understood their condition and took responsibility for their reasonable adjustments, were viewed as an invaluable source of support:
‘If the student can access the right support, the different services available, it's up to them to a certain extent with the right support because ultimately [the responsibility] does lie [with them]; it's their learning.’
Practice tutor D
‘It's a team effort’
Practice tutors can find accessing advice from their OU colleagues regarding procedures for the facilitation of reasonable adjustments useful. These include their line managers and the OU student disability support services, which provide general advice regarding reasonable adjustments and funding for them:
‘My first port of call would be to go to my [OU line manager] … a lot of them have been in the university quite a long time, so their knowledge is amazing.’
Practice tutor D
Employers as a resource
Finally, staff employed in the nursing students' usual place of work were said to be a useful resource for providing advice and background information. Examples include line managers of nurse apprentices and local occupational health teams. However, these resources are helpful only if the student has given permission for their condition to be shared with the practice tutors:
‘Because the role I'm in in practice education is still current, I would definitely go straight to practice [staff].’
Practice tutor G
A cohesive approach
‘One-stop shop’
Despite reporting positive experiences of supporting students and being able to access advice, all participants agreed that OU procedures and guidance for supporting these learners needed to be reviewed to ensure consistency.
OU resources were described as satisfactory, but the development of a new web page specifically for practice tutors that included all the relevant information about their role in one place would be highly beneficial:
‘There are plans to have a practice tutor [web page] and there would be a one-stop shop where we could find out information about lots of things … this would be an ideal area to find out information for reasonable adjustments.’
Practice tutor H
‘Streamlined training’
Streamlined practice tutor training was suggested as potentially being helpful and addressing regional differences between the OU teams. The participants suggested that this education should include how to support nursing students requiring reasonable adjustments on clinical placement. They especially wanted instructions on how to have conversations about this learning support with students and their employers:
‘A rolling programme throughout the year [would] be very helpful … so I'd like to see something more formal.’
Practice tutor A
‘Consistent peer support’
Peer support from other practice tutors, involving sharing experiences and knowledge of supporting these students, was viewed as invaluable. Again, the study respondents suggested that this should be made more consistent, with perhaps allocated mentors and the creation of a formal related community of practice for OU nursing practice tutors:
‘It would be far better if people who are experienced practice tutors were actually doing [the training] because then [they] could use anecdotes – you could discuss things in a much more realistic way.’
Practice tutor C
Discussion
Practice tutors are clearly motivated to support any nursing student who requires reasonable adjustments for clinical placement, but the lack of clarity around their role can cause confusion and hinder the success of the facilitation of this support. This echoes previous research where stakeholders have reported not knowing exactly what they can or should be doing, who to contact or how to access relevant resources (King, 2018; 2019). This aspect is potentially compounded by student-related issues such as non-disclosure, which further complicate the provision of reasonable adjustments. Echoing the earlier findings of the author (King, 2022), the study participants suggested that the OU needs to produce clearer guidance on the practice tutor role in general to OU staff, students and employers and, specifically, on the facilitation of reasonable adjustments.
To assist in overcoming this lack of clarity, practice tutors have identified resources that can be accessed to acquire information and knowledge; these are predominately nursing students, OU colleagues and practice-based staff. However, experiences of their effectiveness can vary. For example, if a nursing student has not disclosed to their employer that they require reasonable adjustments, then practice tutors cannot approach colleagues for advice (a disability or impairment is a private diagnosis and can be shared only with a student's permission). Therefore it is suggested that, on induction to the preregistration nursing programme, students should be encouraged to disclose any diagnosis to their practice tutor and to be made aware of the benefits of this for receiving all the support they require for their learning.
A clear recommendation from practice tutors is for the OU to standardise and streamline training on how to support nursing students who require reasonable adjustments for clinical placement. Current variations in or absence of such education is causing gaps in practice tutors' knowledge and little confidence regarding instigating conversations with students and their employers. The proposed web page, exclusively for practice tutors and with a section on this topic, was viewed as a step in the right direction.
Additionally, consistent peer support is reported as essential because of the uniqueness and complexity of the practice tutor role. Recommendations include mentorship and regular practice tutor forums to provide space to share nursing student scenarios. All these recommendations would also aid practice tutors' professional development.
Limitations
This study has been insightful and will assist in planning local professional development for OU nursing practice tutors. Additionally, it will add to the existing international body of evidence regarding the topic of supporting nursing students in clinical placement who require reasonable adjustments. However, it has to be acknowledged that this is a small study and has nuances that potentially relate to the OU only. Both of these could affect the generalisability of the findings.
Conclusion
Although the practice tutor role is unique to the OU, comparisons can be drawn from existing literature in terms of stakeholders needing clarity on the processes involved with facilitating reasonable adjustments for nursing students for practice-based learning in clinical placement (King, 2018; 2019; 2022).
Consistency in training, regular peer discussions and easier access to OU resources could help widen practice tutors' knowledge and also boost their ability to provide this support to the nursing students and their employers.
Despite the obvious interest in helping their students, practice tutors are hindered by barriers that require the development of effective resources for this essential group of student-facing practitioners.
KEY POINTS
- The nursing practice tutor role is multifaceted and clarification is needed on how these practitioners should support nursing students who require reasonable adjustments in clinical placement
- Despite their obvious interest in helping nursing students who require reasonable adjustments for clinical placement, practice tutors can be hindered by a variety of issues
- Practice tutor professional development requires standardisation to ensure consistency in training for the facilitation of reasonable adjustments for practice-based learning
CPD reflective questions
- What are the advantages of nurses understanding the roles of university-based staff when supporting a nursing student who requires reasonable adjustments?
- As a practice assessor or practice supervisor, how can you help facilitate reasonable adjustments for nursing students' practice learning?
- Visit the Reasonable Adjustments In Nursing Education website, www.raine.org.uk, and identify three useful resources and think about how you will use these in your future practice