Demographic questions and confirmation of consent.
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TA: What was the context of you using the e-Learning for health learning?

P2:  It was so that I could do COVID immunisation. I was working as a [clinical specialist] nurse, and I was a dual role because I was doing [clinical specialist] research nurse one day a week. The research nurse role actually was more than [clinical speclist]. I actually recruited to other studies.  And then, of course, when the pandemic kicked in, it was thought likely that we might, I might need to support with the COVID vaccination study that was going on, because in my trust they were supporting, and some of the other research nurses did support with the COVID vaccination research in [city name]. In the end, I didn't need to do that, but because I did the training, I decided to do COVID immunisation on the bank. I did extra shifts to vaccinate people against COVID because I didn't want to waste it and I felt like I wanted to do something useful.

TA: Okay, thank you. So what was your experience of using the oers, that could be around how you found them, how you accessed them, and what it was like to use them.

P2: Even though it’s only, I’m trying to remember, so I would have started it in 2020 and finished it early 2021. Because I started doing vaccination clinics in January, 2021.That's when I started them. Because of COVID I do feel slightly fuzzy about it, because I actually think I've mentally blocked out some of that time because I didn't enjoy it very much. However, because I knew I was doing this interview I did sort of reflect back and think about it, and I went back into to remind myself of the experience and what I did. My key feelings about it were that it was straightforward. It was easy to access. It was pretty user friendly and it was very convenient because I was able to do it around my life. Actually, it was quite a lot of work. I had to do a lot. I remember that it was a lot of time that it took me to do it and in reality if I hadn't been able to do it at times and places that were convenient to me, because I did it on my laptop and I remember even doing some in Costa to be honest. If I hadn't been able to do that  wouldn't have been able to do it. It wouldn't have been practical. It had to fit around my regular job and my family life. I’m a mother to three kids and everything that was going on at that time because it was COVID. If I hadn't been able to do it in that way it would not have been accessible to me, so the fact that I was able to do it remotely was really the main reason I was able to do it, and it was quite straightforward to do it. I’m not saying that it's perfect because I do think that overall the experience of doing that kind of learning is better when you do it face to face in terms of the actual enjoyment you get out of doing it, the interaction you have with other people, the option to ask questions of a facilitator. But as a experienced nurse who's gone through lots of different learning, and I’m able to self-direct and I’m autonomous. It worked absolutely fine for me.

TA: Okay, you said you accessed it in places like Costa. Can you tell me a little bit more about how you went about doing it? Because it sounds like you did it in your own time.

P2: I probably did do the majority of it in my own time. I may have been able to do some of it on a Thursday, which was my research day. But probably I wouldn't have done much of it on a Thursday because what I ended up doing, so Monday, Tuesday, Wednesday, I was [clinical specialist] nurse. Thursday was my research nurse day which was a secondment actually, so it was sort of funded separately to my other role and when the pandemic hit, because at that point we weren’t, we stopped recruiting for the regular studies because everything else had to take priority. I basically just said well, I might as well just do my clinical role on Thursdays and that's what I did. So I ended up supporting the [clinical specialist] centre because we were short staffed anyway and it made absolute sense. I’m already in the [clinical specialist] centre. We're not doing studies. I'll do the [clinical specialist] nursing because we've you know, we really needed it. Our patients needed us. So I think that most of the time when I did it, I probably did it on a Friday morning when I dropped my daughter off at school, walk up to the coffee shop and my main memory is of doing it there. I’m sure I must have done some of it at home, but that I didn't mind too much because it was fitting around actually having a coffee or whatever. Now, obviously there would have been times when I couldn't have done that because of lockdowns, so I would have done it when I could do it. I’m just trying to remember when I started it. It's so hard to remember it all because it was all a bit of a blur. So I would have done some of it in work time, in my research nurse time, and I definitely did some of it in my own time.

TA: Okay. When you were engaging with it, what was the experience of actually engaging with the learning that you had to do, would you say?

P2: It was fine, I mean it is a bit dry when you're doing e-learning because you are sitting there engaging with the modules and that is dry. It's not the same as when someone's interacting with you presenting something and talking it through with you. But my recollection is that the information was presented in a very user friendly way. I was able to, you know your own when you get to my stage in life, you know your own way of learning so you know that you'll read through something. You'll make notes. Well, I’ve still got my notes somewhere, you know, because obviously I was going to use it for a practical reason. So I wanted to be clear that I knew what I was doing when it came to giving people the vaccine. You want to be confident.  Yes, that all seemed quite straightforward. And I remember there being a range of different, I can't remember exactly but I have a feeling there were some videos. Things like that. It's not all delivered in one way, as far as I could recall.

TA: Okay, thank you. Did you find you experienced any issues in technology at all, during the time that you were accessing the learning? 

P2:  No, not that I can remember. When I've used other systems at work to do statutory and mandatory training, sometimes you have issues like you do the whole thing and then it doesn't log that you've done it. You’ll be getting in touch with learning and development because of IT glitches because it's not coming up that you've completed it. I didn't have anything like that.  No, I don't remember having any technical issues. There could have been, but not I recall

TA: Okay. So, moving on a bit, what did you learn?  Can you tell me what you learned from using the oers or e-learning?

P2: So, I, yes and no. The quick answer is I can't because I’ve blanked it all out because I’m not doing COVID vaccinations anymore and I've got no intention to do any more. So, I try to know things on the need to know basis and I’ve now moved on and I’m doing my [academic programme] and now that is where I've got to put all my focus and attention. But basically, what I learned at that time was how to safely administer COVID vaccinations to members of the public, so I was working in the public clinic. I did both brands of vaccinations so covered things like anaphylaxis. I suppose some of it might have been a bit of a, it's not a waste of time but there was definitely, I had to do all the other vaccines. I think I had to learn about all the other immunisations, which I didn't mind at the time because I knew that I didn't want to carry on in my exact job role that I was in at that point, and I've been a practice nurse before. So as a practice nurse I've had to deliver childhood immunisations way back. And I kind of liked knowing that I might then have that as an boption to go back to if I wanted to, so I didn't mind. I can imagine that some people might have got a bit frustrated about that. I remember at the time thinking why am I having to do this because I’m not going to be delivering these vaccines, but I could see the relevance and I knew that it was another string to my bow, but I can imagine that. Well, I had another colleague who didn't do the training because when she saw how much it was she just said oh, I’m not doing that. So she didn't do the vaccination. It was a lot of effort considering I didn't do that many clinics. I did about 5 clinics. So if you think I did all that training!  But it was just such a weird time anyway and none of us knew what was going to happen, and you didn't know. I didn't know whether I'd be doing more in the future. I must have lapsed because it's 2 years and I think you have to do it. I would probably have to do it, I’d have to revise it but I’m not planning to do it again so it's not the end of the world.

TA: You mentioned relevance a couple of times. I just wondered if you could tell me any more about that, because you've talked about some of the learning you did and you’ve made several references to the fact there was a lot of it.

P2: Well, at the end of the day if you're delivering COVID vaccinations it is sensible to have an understanding of vaccination generally, because you don't know whether you might then transfer that knowledge and skill to a different role. Probably most of the vaccinators didn't and were just using it purely for working in COVID vaccination clinics. Obviously for me, I was trying to think more broadly and bear in mind that I might want to use it for some other role, like if I did decide to go back to practice nursing for example. And because you don't know what questions patients are going to ask you, and they might have concerns. If you understand the whole principles of immunisation generally, in the context of different health conditions, then that does seem sensible, but in reality it would have made more sense in terms of time, in terms of getting people to take part, to really just focus on COVID, the COVID vaccinations, the principles of immunisation of course in the in the wider context, and some understanding of different vaccinations. Obviously you need to understand about anaphylaxis.  But in truth, did I really need to do all the other vaccinations which I don't even remember. 

TA:  Can you remember any of the other learning you did as well, because it wasn't just about the vaccinations, was it? There was other stuff that was compulsory?

P2:  I can’t remember.

TA: What about safeguarding and things?

P2: No, I didn't. I don’t think I did safeguarding through that because I do safeguarding through [organisation name] because I’m employed by them now, but I would have done safeguarding. I don't think they would made me do that because I've done that through my Trust. I do that online. Is it the same e-Learning for Health? I was in practice. My statutory mandatory training was up to date. I left my job to do my studies. Because I knew that I would need to supplement my income and just to keep my clinical skills up to date, I joined [organisation name] and they did transfer over some of my statutory and mandatory training. Some of it was due for renewal anyway. They gave me so much it was unreal. It was nuts.  That was bonkers, some of the stuff I had to do, and some of that definitely didn't feel particularly relevant, because it wasn't relevant to my role as a [clinical specialist] nurse. 

TA: Was that e-learning? 

P2:  Yes, it was all e-learning. I did that in September. There were loads of modules. Again, it is off-putting for people. So, if I think about my colleague she took ages to get around to it because we, you have to do it in your own time. One of them I got, let me just remember which one it was, I think there was one about equality, so there was one that I had to do quite recently. It was about equality and diversity and it said something like you need half a day for this. Well, I will be straight with you because I know this is confidential. I didn't spend half a day on it. I’m afraid to say what I did was not what I did with the COVID vaccination thing. I went to the assessment, answered the questions and then, because I knew I'd be able to answer the questions, because I've done enough equality and diversity in my life. Then, because you can't complete it until you've gone through all the modules, went to the start and click, click, click, click, click, click, click, click, click, click. And what was very frustrating about that was when I looked at the content as I was clicking through it, it was good. The content was very good. I could see it was a really good programme, but that was one module out of numerous modules that I had to do in my own time, when I knew I could pass the assessment. Well, why would I do that? I’m not going to do that am I, but that's not good. That's not good use of a resource. Someone's created that resource. I should be doing that because that's relevant to my role. Just because I can pass the assessment doesn't mean that I wouldn't learn something from it. Of course I would learn something from it. Every time you do those sorts of training courses you learn something from them. They're important. I do recognise that but I can't spend the amount of time in my own time on a statutory and mandatory training and I think that's it totally wrong that they would expect you to do that. So, I do a shift once a week or once every 2 weeks and I think that you should be paid to do your statutory and mandatory training, so that you can deliver the care the best way you can. That's my opinion.

TA: Yeah. That's interesting to relate to those recent ones, because obviously those are more, they’re not more realistic. You can recall those more easily.

P2:  Yeah, but I know I didn't do that with the other ones. Maybe because I felt, I don't know, that was like it was different. I was doing it for the COVID vaccination. It was all, I just know it was a bit different. And I’m trying to do my [academic course]. I’m trying to look after my kids.  I’m trying to work. I’m trying to do this. I’m trying to do that, when you're telling me that I've got to spend half day of my own time unpaid when there was actually loads of them. I had absolutely loads of modules, and some of them, like the one about equality and diversity, well, that's definitely appropriate to anything that I’m doing as a nurse. But there were some more clinical ones that weren’t, I’m trying to remember some examples, but because they weren't particularly applicable to my role, I can't really think of them now. I’ve blocked them out. As an example, one of my colleagues, because our role as a [clinical specialist] nurse doesn't actually exist on [organisation name], they try to code you according to something else and it doesn't quite work. So then you start getting given modules that aren't relevant to your role because they don't have a code for [clinical specialist] nurse, so they might try and tag you to like community nurse as if you were a district nurse, which is a very different role. So they might be trying to tell you stuff about catheters, well we don't deal with catheters. I don't, I haven’t touched a catheter for years. But my colleague got one because they coded her where they were asking her to do blood transfusion and she said no, I’m not doing that. I don't do blood transfusion. It's completely irrelevant to my role and I wouldn't be safe to do that, I’m not going to. I don't need to do a module about blood transfusion.  So, I think one of the challenges might be making sure that the training that you're given lines up with the role that you have. That's very important, because sometimes there’s a discrepancy there.  

TA:  Yeah. So I’m just interested, when she said she wasn’t going to do that blood transfusion, just from talking with her. Is there a system to then justify that? 

P2:  Then, what she then had to do was, she was having to try and work out whether they had to change her code, [organisation name]. So, she was trying to work out which code she should be under so that she didn't then get given training that was irrelevant to the role. But the thing is we're not the same band, so I was down as something like team manager which actually isn't my role. I don't go into the [clinical specialist] Centre as a team manager. I go in as a specialist nurse, but on my card it says Team Manager so she couldn't use the same code as me because she's a band 6 and I’m a band 7. I don't know how she got round it. In the end she must have worked out. There were a few little things like that. But that's not so much about the existence of the e-learning, because that could happen if it was face to face training. That's just about how complex things are now, and that there's all these different types of nursing roles, and then there’s this training, and then it's trying to work out which training is appropriate to each role, because some of them won't be. Yeah, does that makes sense?

TA:  Yeah, it does.  So you made reference to talking to somebody else about the e-learning in the context of what you've both been doing, but can you tell me about any more about whether you spoke about the learning with anybody else, or how you thought about what you'd learnt?

P2:  Probably the main topic of conversation is the expectation that you will do it in your own time. Another senior nurse, the same level as me, who works four shifts a week as a specialist nurse, she said I’m, I’m not happy with this expectation that I’m going to do all this statutory and mandatory training in my own time, and the expectation was tough, suck it up or you don't work for us. I didn't know that they could really do that but I think, I suppose you know. Sorry to digress slightly but I'd better say it before I forget, I do think one of the disadvantages of e-learning is, e-learning is great because it's accessible and it's easy to use and I've given you examples of how I was able to use it and fit it around my time, and I found it really simple. I think one disadvantage is that it just increases the expectation that you will fit it in with everything else and that you won't necessarily have protected time to do it. When you had to go somewhere for face to face learning for the day, it would be more unusual that it would be expected that you would do that in your own time or that you would be trying to fit that in around your day to day job, because everyone knew you were going to training. Because that's still face to face everyone knows you're there. You can't answer emails. You can't see patients. That's what you're doing. If you say I need the morning to do my statutory and mandatory, my fire safety, my manual handling, you would get a look of well, you've got to. We've got patients. We've got phone calls. We've got emails to respond to. So, our modern life is, this translates to modern life generally, the more we have this sort of technology the more expectation there is that you then have to fit it into your life and that. I know loads of other people that just do it when they get home. They just do that because it's just simpler. because they’ve got to get their job done they don't get the protected time. I’m not just talking about people who are on an [organisation name], I’m talking about people who are employed by the Trust. Even as a manager I’ll be saying to a junior nurse oh no, you do need to, I don't expect to do this in your own time. But me saying that I don't expect you to do this in your own time, but then there isn't any time for them to do it because of the clinical load, which has just got worse over the years because of the situation within the NHS. It's not realistic, is it? I can say to somebody who I’m line managing, I do want you to do that after lunch and then some urgent situation comes in, and then you can't not deal with the patient's situation. So, it's a bit of a tricky one, and I do think that that's sort of. You know I have spoken to other people and you know it's a bit of a theme that people are doing this sort of thing in their own time, and the expectation is more and more that you would be just fitting it in, rather than having the protected time. And furthermore, I know I’m not the only person who does that click, click, click thing! Does the assessment and does the click click, click, and I don't feel good about that. You know, that's not good is it. I don’t feel good that I do it and I don’t feel good that I know my colleagues are doing it, because that's not, that's not right, is it? You know the training is there for a reason. but if you're not given time to do it, and you're already stressed and burnt out, what are you supposed to do? You have to take shortcuts.

TA:  Well, when, especially when you talk about that in the context of them making it easy to give you as much work as they think is relevant based on the tags that are attached to you.  

P2:  Yeah, if there's some stuff that's not appropriate, then they really shouldn't. They need to be as efficient as possible, in terms of. And I think they should listen. If you say I’m not doing this in my role then they do need to take that on board, and you shouldn’t have to argue about it really.  

TA:  Yeah. You talked about face to face being valuable because you can interact with others and ask questions and things. I just wondered if you wanted to tell me any more about that in the context of the e-learning?

P2:  Yeah, so I suppose a good example, the one that I think sticks out in my mind and I've thought about this outside of this interview quite a few times is when it comes to safeguarding. If you are doing safeguarding adults, safeguarding children, you're going to get a lot from the e-learning because all the information is there. I know the content's there. The videos are there. It's thought provoking. But what's lacking is that opportunity to discuss real life situations that nurses will deal with. I can't believe any nurse wouldn't have had a situation where they're wondering about somebody, an adult or a child, and how best to manage that situation, or to hear reflections from other clinicians or the facilitator which might get you to think about your own clinical practice, and how you might do something differently when you are responding to a situation. Or, to have the opportunity to just kind of get stuff off your chest as well. And if you think about the current situation that women in the NHS, and in society, where there's a lack of resources. Services are incredibly stretched. When you read on e-learning about what you should be doing, and how you should be dealing with situations, that's telling you the ideal world. That's not what's often feasible in practice. You might in practice make a phone call. Okay, slightly different example. Let's just talk about something where you might have to call an ambulance for somebody. I've done training, basic life support face to face. They'll say to you right, if this happens, you call the ambulance. Well, then you can have the conversation when it's face to face about, well, yes, but the ambulance won't come. I've been in the situation where the ambulance did not come. So, it's not just about what you should be doing based on policy, research. It's also about reflecting on real life situations which you can't do in e-learning in the same way. If you can have that conversation of, well hang on a minute, what if, then other people will talk it through with you. Do you see what I’m getting at? That's what's lacking. I do think there is some e-learning which it shouldn't really be e-learning, I don't really think. It's better than not having any learning at all, but in truth, when it comes to something like safeguarding. If I think about the training that I've done, the things that stick in my mind are the conversations that were had around real life situations, either from myself or from somebody else, where you can then be thinking critically, reflecting, and making decisions which will influence your practice and other people's practice, in a way that you're not going to get from e-learning. That's my view.

TA: Yeah. And have you experienced anybody, including yourself, talking about the e-learning that you’ve done in that context, to kind of try and add that element in or anything?

P2: No. Because if I think about it I haven't had to do any face to face statutory and mandatory training now, I think, apart from the basic life support. So basic life support, you always do that face to face because it's practical. I can't remember the last time I had to do childrens’ or adults’ safeguarding face to face. Yeah.

TA: So, would you take the learning that you did online?  Would you then go and discuss that with somebody in practice?

P2: I wouldn't do. I wouldn't take the learning and go and discuss it with someone in practice, no. But if I had a clinical situation I was concerned about, then I would go and discuss it with somebody, so I would not take my learning unless there was like a key thing that I felt really concerned about. Maybe that's because I’m a bit older and I've been in nursing a long time? I think if I was younger that might be different, because that might be something that you discuss in your one-to-one with your manager. But then it’s hard for me to know because when I was younger and I did require that level of supervision and support from senior staff, I didn't, e-learning wasn't really so much of a thing. That doesn't mean, I do know that there's still things I can learn and that I can reflect upon and I would need support with. But then, I would just talk to someone about that specific thing at the time. I might have a clinical situation and one of the good things about the team where I work is, it is a team. It very much is a team at the [clinical specialist] centre, so when I do shifts there, especially because I’m not working there all the time anymore, there's definitely going to be clinical things that I’m not completely sure about. I'll come out of the room and talk to one of the other nurses, or talk to the doctor, which I really like. You know you’re not isolated. They they have an MDT, and I often work on a Wednesday. That might be the day that would work, and then I can come sit in their MDT, so I’m still learning. I wouldn't take the actual thing that I'd done in that session. No, I don't think so.

TA:  Okay. Thank you. Is there anything else you wanted to tell me about your experiences of e-learning, to finish?

P2:  Not really. I suppose, just to sum up, my key feelings about it are that it's usually really easy to use. It's straightforward. They are well done, you know the content is good. You can see that a lot of thought's gone into it and they try to make the sessions, by teaching you in different ways, with little videos and quizzes and things like that. I just feel that it's a shame that there is an expectation that a lot of it you will do in your own time, which sometimes is fine, and sometimes it's not fine at all, because of the amount. If it's just an hour thing, it's no big deal. Some subjects are more appropriate for face to face I think, and when I say face to face I don't necessarily mean, you know Teams meetings can work. I've done some really good training online which have used sort of online programmes, but then they’re delivered by a facilitator and there’s options for discussion, especially when it's in a small group and everyone keeps their camera on and you are encouraged to speak. That's my main feelings about it.

TA: Okay, Thank you.

After the recording was switched off there was a brief conversation where P2 discussed how she ‘physically took the learning to work’ as notes in her pocket, ‘consolidating the learning’.  Also brief reference to battling about how to approach the learning/professional conscience.  Need for choice but acknowledging that knowledge evolves over time, greater consciousness about knowledge and some discussion about unconscious bias and challenging thinking.  Confirmation of not feeling great about passing assessment and missing out on what might have been learnt.



