Demographic questions and confirmation of consent.
*****
TA: Okay, the first question is really broad. It really is, what would you like to tell me about your experiences of using e-learning, or the context of how you came to do it, or your feelings about using it?

P4: Well, I've been nursing a very long time.  So, I've plenty of experience of face to face, and online learning for health care.  I do think the COVID did change things to much more of an online system. So of course, that was the change. But for me, I have always got a lot of value of face to face learning. I think a lot of nurses are as much any product or anything you're learning about. It's very much in nursing, watch somebody do it once, do it with supervision, and then do it unsupervised sort of thing, and you can watch a, video online, can't you? And you can be told what to do online.  But sometimes until you've handled the product or tried to push something in the machine or something, it becomes real, and also, learning from other people it, you just don't get that interaction, do you? I have been on lots of group sessions as well. Those are good, but then you have to wait for everyone else to stop talking. Sometimes it's just when you watch someone else do something, you think oh, they're doing it that way, you know. Nursing is a very practical job, isn't it?  Although there is a lot of academic as well. So, I've got good and bad of e-learning, really, because some of it I find incredibly tedious.

TA: Okay, well start by telling me a little bit more about that then, that'd be great. 

P4: Okay. So, in terms of things like mandatory training, things like that you have to do every year this GDPR, and mental capacity, and, particularly when you've been doing it for many, many years. I don't think I need to answer 20 questions at the end of an online module to prove that I read it, and that I wasn't sleeping, and I just didn't just press skip, skip, skip, do you know what I mean? 

TA: Yes.

P4: So, I think 20 questions, almost designed to catch you out, so that you only get 60% or something, and you have to repeat it because you have to get 80 to pass or something.  So, I think you do need to. I think, perhaps things that we’re just required to do an hour of every year, at the end of it 4 or 5 questions. Particularly as that is not my line of work as such, do you know what I mean? I mean, some things are more relevant than others, but radicalisation or Prevent, yes I'm aware of it, yes I know that I'm to report things to certain things, but it's not my job on a day to day basis, so, I don't actually need to. I'd rather spend much more hours on xxx [clinical speciality] or something that the benefited my career. Do you know, does that make sense?

TA: Yeah, that does make sense. And you’ve just mentioned relevance there. I wonder if you could just say a little bit more about that. Your thoughts about the feelings, or feelings about what you've had to do, and the relevance of it, the learning?

P4:  There's an awful lot, there's too much mandatory training, I think in the NHS.  So, for the last, until very recently, when I've moved into [clinical setting] again, back with xxx at the hospital. For the last 18 years I've been a [clinical speciality] nurse in [clinical setting]. So, there the rules are always slightly different, because they say ‘oh, have you done your mandatory training’? but nobody's actually checking what you're doing or anything. But of course I am keeping up to date with infection control, and all the ones that I'm required to do, but a lot of them aren't so relevant to my practice, and could be done in a very much more condensed fashion. I don't think I need to spend an hour on conflict resolution level one, and [clinical role], yes, a quick update, but I've been doing that day in, day out. GDPR awareness, I mean it just goes on and on and on.  And that is you know on the day to day basis for my patients, which is what I'm all about. There's too much mandatory training. We don't need to do 3 hours of each level, 1, 2, and 3 safeguarding every year. I think they have dropped it now to maybe 2 or 2 years, but it's too much.

TA: Yeah.

P4: There’s too much straight, and a lot of it we're required to do in our own time, which to me, this is for my employment. I don't need to know how to use each individual [clinical equipment] for my personal enjoyment. I need it for my job, don't I, so I do feel that there is an obligation for the employer to fund that, personally.

TA: Yeah. Do you want to tell me a little bit more about that, you know, about that whole experience of doing learning in your own time, or needing to, and the feelings associated with that?

P4: Well I'm currently new in post, and obviously I've been doing xxx in [clinical setting] for 18 years, so I'm not new to xxx, but I've stepped up by changing job to being just a xxx nurse, and since joining, yes, they've asked me to do this mandatory training. I've done the mandatory training, but none of that so far has been based on the job. I mean, I have joined all of these various e-learning platforms, there's various companies that offer modules online. And I have spent literally, I think I've got about 14 hours so far, logged just next to me, of various modules, and they have been invaluable to me, to feel confident, going into my new job that I'm not actually, that I am fit for purpose, do you know what I mean?  So, they've been good to reassure me, but I do think the employer has a massive obligation to train people for the job they're expecting them to do, and so all of that has been in my own time. But they're not probably aware of how much I've done that. But I am, you know, I'm not going to put myself up for a job if I don't think I'm fit for purpose so. I think you know, but not everybody in nursing is going to have that, and you know, I've not got small children at home and all that sort of thing anymore, whereas I wouldn't be able to commit those hours, and perhaps that's why I haven't gone for that job in the past. You know I've been so busy in my own outside of work, that you don't have time. But work should be a work thing, and home should be a home thing, and I shouldn't be expected to sit on my sofa and do all these modules perhaps. I think there is a resentment to that because I think those are hours that are unpaid, and because nurses genuinely do care about what they're providing. Are you a nurse background? 

TA: Yes, I'm a registered nurse as well. 

P4: Right, so you get that don’t you, whereas other people go ‘well, why are you doing that’, you know, and it's like because I owe it to my patients. I'm certainly never going to blag anything, so I need to make sure that I've got my facts right, don't I. Does that make sense?

TA: Yeah, it does. Thank you. You said there about your employer not necessarily being aware of all the extra training you've done. Is that all extra? Would you like to tell me a bit more about that? If it is extra, why you chose it?

P4: Well, I chose to do it so that I was, so that I had to a bit of a set, a knowledge base, that also that I could, you know, if I write down on my sign off on letters that I’m xxx specialist nurse, I'd like to feel that I've at least done some modules that prove that I'm a level of education that would warrant that. I don't want someone to think that I, because realistically, you could turn up and not have that and people don't know you haven't got enough training. 

TA: You said that your employers might not be aware of all that extra training that you've done? 

P4: Yes, that again is another barrier. Okay, so they would like to know what training I've done, and I've obviously printed out certificates. But there's a whole, another online system to entering them, and it's very tedious. Again, I need to use my husband's scanner and scan all of them in and then into what they were, and it's a whole barriers. If I just had to literally photocopy it and put it in someone's in-tray that would be fine for me, but then there's a whole level of needing to send it online and a lot of nurses aren't IT background. I mean it's not a performance for somebody who does that all day every day, but that isn't my background, you know, I'm more into [clinical procedures]. Do you know what I mean?

TA: Yeah. 

P4: They've made it very difficult to try and share that information, but that won't be a problem maybe for the next generations who are much younger than me, who do IT and all their certificates are uploaded anyway, and they'll not find that an issue. But for me I find that an issue currently.

TA: Yeah. And I guess you'd like your employers to know at least and, acknowledge all the extra stuff that you have done.

P4: I think yes, it would reflect probably quite well, wouldn't it. They would think goodness, she is actually interested, where currently they don’t know and probably are all too busy to really worry.  As long as I turn up and do the job, they’re probably happy, but I think it's more than that for me.

TA: Yeah, thank you. You've talked a little bit there about evidence, about proving that you've done the training and things. And earlier on you said about evidence as well. So, on the system, for the IT mandatory training it's all recorded now isn’t it? 

P4:  Yes.

TA:  Have you got any specific thoughts or feelings about the fact that we need to seem to evidence everything?

P4: Well, again, it doesn't actually make you a better nurse because you've done that module. Some people will be able to read very, very quickly and perhaps just answer the questions once and get, you know, 100% on the module. But it doesn't actually mean you're applying that in practice does it? You know you might do the Mental Capacity Act, for example, but when it comes to deciding whether somebody actually has capacity to accept something or consent to something, you may not put that into practice, so, it's all very well me having a certificate in it, but it's only relevant if you're able to practice it, isn't it.

TA:  Yeah.

P4:  And I see a lot of that that we're just producing certificates because we have to have certain number of hours for CPD. Well, anybody who's really interested in their job will have far in excess of that, anyway because they would need to keep the skill on, but the NHS is requiring, you know. I think my job, my husband refers it to how it becomes partly your hobby, because you have to have a genuine passion and interest in pursuing things outside your own hours, which is a job that's not paid. You know, the salary of the hours that I probably put into it.

TA: Yeah, I understand that. So, when you're using these e-learning resources, how do you go about using them? Think maybe, about some of the ones, not necessarily the mandatory ones, but the other ones that you've looked at in relation to your role. How did you find them?

P4: I have found them excellent, to be honest.  I mean, some of them, specific ones to, for example, [clinical specialty], or to, so recently I just did 3 months at the [COVID] vaccine centre, so I was required to do all the e-learning for that.  Although it wasn't new territory for me, thank goodness, because there's an awful lot more to know about it than just sticking a vaccine in somebody.  I mean, which became clear to my colleagues constantly asking other questions about you know, shingles vaccine, or flu vaccines, or why would you do this and not that?  And you know, these patients with serious leukaemias ? And you know there's a lot to know. And just to say to someone, yes, you do that hour mandatory training online. Some of the modules are fantastic, and it really does give you a foundation, but again it doesn't sometimes bring up a lot of the discussion around it. Nurses do like to discuss things as well, though, don't they? They do, because we learn so much from each other, and that has been really nice actually, joining a team. With the [clinical speciality] centre for example, there's colleagues you can discuss, and find out what training they're doing and what training, you know, and they suggest places that offer free modules! There's a big emphasis on that. But, you know a lot of them are excellent and really worth doing, and provide competencies and reassure you that you're doing okay.

TA: So, what is it that makes them, what is it that makes them excellent? Those ones.

P4:  The ones I particularly have liked have been the ones where they ask a couple of questions, and then you answer the questions at the end of the paragraph, sort of thing. You don't wait to the end of doing an hour of reading stuff, and then you have to answer these questions, and they trick you into something. Did you actually know the dates of the Francis Report or something. That isn't even relevant to you, to know what year it was. It doesn't even matter, does it? What year? The fact is it was horrific, you know. You know it's things like you kind of want to answer the questions there and then to check that you've got enough knowledge to move on to the next thing. So, if they're asking a couple of questions it just kind of helps you. Those are the ones that I’ve liked, with regular questions as well, but not that I need to write a whole spiel.  It just, which ones would you do? Or you know, which 3 out of the 5 would you do? Or, that's what I like, because it's  sort of reaffirming straight away, and you get to the end and you've answered probably 5 questions, and it says you've passed because you've got all 5 at the end of the 20 minute section.  Do you know the sort I mean?

TA: Yes, I do. And have you had any opportunity to interact with other people within any of these courses that you've done?

P4: Yeah, so a lot of the learning over COVID, it was done as group, you know. So sometimes we had the cameras on, or sometimes it's only the person raising the question that has the camera on. I do quite like to see people, just because I feel that you're still there, rather than me just talking into the ether. Yes, and having feedback, being able to ask questions at the end of an immunisation thing, or you know, whatever.  And that, is really great, you know, and we do need that, so live broadcasts are better. If you're going to do an online module, then it's better to have somebody there to ask the questions, because sometimes you get to the end and it's like ‘well, I've written down these questions, and I'll have to wait till I get into work to ask them’, of the other girls who will know the answers. But, by the time you get there the moment’s passed and you move on don't you? And you never actually got the answer to the question that you wanted. Sadly, we move on to the next thing don’t we.

TA:  Yeah. You also talked earlier about, or made reference to IT issues, so, if I could just hear a little bit more about the IT side, how it's made you feel or what your experiences have been?

P4:  Well, I again, I'm quite trainable. If you train me, I will be able to do it next time, but if nobody shows you.  It was a bit, that COVID came didn't it, and we started doing online consultations and online everything, and we didn't have screens. We Were never set up for that. We didn't do anything. So, it was the camera was over here, and the IT, once you are shown stuff. But again, in in the Health Service, we're all just muddling through. There is so little formal training, and then again, it's the relevance to your job, because you might be shown something that you're never going to do, and if you're not doing it every week, by the time you come to do it in 6 months time you've forgotten. For example, they told me I could do my reflection, revalidation on an online thing, and I could join one of these things, and I could upload all my certificates. Well, someone showed me that in a you know, half an hour lunch break. Some rep came round. He was from some company and we were all shown that, given a login. I haven't used it, because I would have to do so much, so many hours to get all my stuff into it. None of these things are very user-friendly, and when you do want to use it, it's so long ago that I wouldn't know how to. So, the IT is a barrier, but I can see it's the way forward and I can see we should have. But I'm sat here and I have actually got a whole lever arch folder of all the certificates printed out, because again I know that I've got them all in hard evidence, whereas I've got various bits on various IT systems, but none of them are joined up. Because in the last 3 years I've worked in [clinical setting], I've worked independently from the vaccine centre, and now I'm in another Trust. So, none of those 3 are joined up.

TA:  Right.

P4:  So, the training is with one, do you see? So, that's why I'm keen that I've got my own printed out version.  You know, if anyone said ‘oh, did you have?’, and anything came up, I've got evidence that I did do all of that. It could get lost as I may not be able to log into those systems, having left them.

TA:  Yeah.

P4:  And I didn't print everything. I wasn't thinking that when I left. Oh, my goodness, I need to print everything off that I've ever done. 

TA:  So, did you experience any IT issues trying to access any of the learning specifically, any of the little modules that you've done, or the mandatory training systems?

P4:  No, I'm quite all right, you know. They’re normally quite a straightforward login system. Normally, you have some sort of login to access them, but I find most of them are set up, at the right level that you can easily get on to there. So, that's not been a problem.

TA:  Okay

P4:  Even for a non IT person.

TA:  And there is, for some people, you know, for a range of factors. I'm going to go back to time management, or thinking about your time. And you did state you've already done a lot of this in your own time. So, how do you manage your time for learning, or how do you work out where and when you're going to access your learning and things?

P4:  Yeah. It's about fitting it in. I mean, the trouble is there's often new things that come up at work aren’t there, in the day, and I do try and do it of an evening. But that's not good. I'm actually exhausted normally.  You know, you've given that, you've been gone from sort of 7 in the morning, and it's now 7 o'clock in the evening, you've had dinner and you're sitting down, but that would be when I would do it, of an evening.  Because it's not going to happen in the work day time, because there isn't time. In fact, they are trying to just currently do protected time, in my current job. They're looking at doing some protected time for e-learning. But the first week that that happened last week we were required to do other stock cupboards, and ordering. I thought if this is going to be protected time, I thought I was going to, perhaps do a module on something, or, you know, update on the latest [medical device] or whatever.  I thought someone was going to either train me, or I would look to the stuff that I wanted to, but so far the first week that it kind of was called protected time, it became a stock ordering and catching up on phone calls to patients. Time for learning or development, but it didn't happen, in week one, so I'm thinking if it doesn't have week one by week 5, you default back to the patient after that. But, week one, yeah, we're going to have to try something that is slightly different, or be a bit firmer. But us nurses are always distracted by what needs to be done, aren't we, rather than developing ourselves. I would say that an awful lot of my colleagues don't come home and do any learning because they've got family. If my husband's travelling, then I've got time to do it of an evening, but again, that's commitment and dedication. Not everybody is going to be having that time or thinking that are they?

TA:  No, and what your feelings about having to do in your own time, you know. How does it make you feel?

P4:  I'd like it to be something that was fitted into the day, but I can't see, I'm in the health service, we are pushed to absolute, you know. I can't tell you the last time I had a lunch break at my last job. In fact, I left because I really would say I was burnt out. It was either it was going to give, or I was going to give. So, that is the sad reflection. I mean that it, I don't believe striking is the way that we go about changing things, but I think something's got to change in the health service, because the staff that are there, some of us are giving up a 100%, and you can't give more than that, can you?

TA:  No.  Although essentially you are by coming home and doing your extra learning as well.  

P4:  Which nobody is aware of, because that is when the modules get done, because otherwise somebody will say, ‘oh, you've got to’. And in fact, even in [clinical setting], they started saying, ‘oh, if you've done it, you know we'll, you know, perhaps give you £10 extra if you've done a module’.  It’s like ‘no, give me the time to do it while I'm there’, you know, and, but there isn't time for that. 

TA:  Yeah. 

P4:  We are all required to do all these things to keep our registration, and sadly I do think that the NMC have asked us to jump through all these hoops, and all nurses are doing probably far in excess of that, just because they're not documenting every session they had on perhaps, the new [medical device], or whatever, it doesn't mean, they weren't learning every single day, because I don't think you can go to work and not learn in nursing, can you?

TA:  No. You said you've been qualified somke time so you've seen changes in the way that CPD's been done over that time. Do you have any particular thoughts or feelings about the changes towards e-learning, from previous?

P4:  We're expecting an awful lot of nurses, aren’t we.  We are expecting a dedication, I mean vocation doesn't come close, does it? We are expecting people, and this is not a highly paid job. If I was paid an executive job you would get that. You know, we're not being paid the same as the doctors, and yet I've got more training than most of the doctors.  You know, I've been a nurse, I've been a midwife, I've been in [clinical setting] for years. I'm now specialising in one field. I have a lot of experience, and I'm paid half of what a doctor would be paid, so, you know, more fool me.

TA:  Yeah, it is difficult isn’t it, it is very challenging. 

P4:  Yes, but I still care about my job, so I still go.  I think they're relying on people though, and they do rely on nurses’ good nature, don’t they, to do all this in their own time, a lot of it. But however, I have just joined this trust [county name], and they provided a one week introductory week, so they did do most of their mandatory training in that week. So that at least got you off to a good start. Obviously, that's not relevant to your job, but that does tick all their boxes in terms of making sure their employees have done resuscitation, and you know, so that everybody starts with the right basis. So, I did think that was very positive. But I wonder in a year's time, when most of these expire, whether I'll be given, I certainly won't be given another week of training time.  So, I don't know quite how that fits in after that period of time.

TA: Yeah.  Just going back to the learning that you did, that, you know, like some of the free learning that you've done, have you ever taken any of that learning into practice, or shared it with other people in practice, or anything?

P4:  Always, always, absolutely everything. I mean, I had 2 colleagues where I worked previously, who really were not that into the learning.  Well, they were into the learning if I told them it, but they probably wouldn't put themselves through, and they certainly wouldn't read it in the evening. So, if I’ve looked something up, or if I've done a module or something, then I would definitely feed that back.  You know I'd say, ‘oh my goodness! Did you know you know, the new [clinical procedure], or the new something? We've got to do this now, and we've got to do it this way, and this is what they're suggesting now’.  So, always sharing. If that's the only thing, you've got to share with your colleagues haven't you, because we haven't all got time to read everything either.  So, if you've picked up something you definitely need to be sharing. But that's why we need time to communicate, and they lost a lot of that in terms of not having handover times now, or you do, but literally you're spieling off something very, very quickly.  It is invaluable in nursing, because that is how you learn isn't it, when someone else has read something or someone else says ‘have you seen this new product, or dressing or something’? And everyone says, ‘how do you use it’? And if you get one out and show, demo somebody that, if not, we just leave with our own knowledge and we're not improving the team, which it's a team sport isn't it, nursing. 

TA:  Yeah, it is, it is, and I suppose from, that links back to the face to face learning on courses that you might have done as CPD before, and it, and that is a bit different isn't it to e-learning?

P4:  I do miss that.

TA:  If you are in a classroom with somebody.

P4:  There is a bit of networking with that, you know you once a year you had to go to your [clinical condition] update or [clinical procedure], so there was that chance for networking. There was also that opportunity to offload a little bit in nursing to say, ‘oh, my goodness! Are you doing it like that in your [clinical setting]? Do you get 20 minutes for that appointment, or we only get 10’.  And then you can go back and you can fight your corner and you can learn something else, or say ‘actually, well we do something else in our appointment as well, so you know, that's how I justified doing, you know’, and so that always gave me.  But again, it's learning from other people, isn't it, and you never stop learning I think. You can't, can you, because you can't stand still in the NHS. We've come so far haven't we, but I don't think always for the better.  I honestly do think it was almost a sad day when nursing became so much a university based thing, because it, some of the loveliest nurses are those that care about people, and that you can learn the skills as you go along, but if you actually care about people. I've had way too much experience of students coming through, who say this is a stepping stone to a ‘management role’ and I never saw myself even progress up to the sister level. I really aspired to that and I got there, but I got there not ever thinking that was what I would choose for myself, sort of by default, by longevity and default. I do think that it's not about classroom based is it, nursing?  It's really not. I do think yes, education is really important. We don't want people who are not able to learn to a certain level. but you can certainly learn a field in nursing can’t you, without having to be perhaps a graduate. 

TA:  I suppose, what I felt I was picking up from what you were saying then, was that the classroom learning was really valuable for the reflection, the reflection and the sharing bit. And maybe that's different in e-learning?

P4:  Yes, I think it is very different, unless you've got a, a core little group that you're going to go back, it is different because you're not actually, unless I felt that there was something relevant to share with my colleagues, I would perhaps not be sharing any of this xxx stuff with  my colleagues, because they are very knowledgeable in that field and been doing it a lot of years, whereas for me I found it quite exciting actually. I felt quite empowered by a module. I felt like it's reaffirmed that I'm not so lacking in knowledge, but there's areas that I'd certainly need to improve on. And it's given me that knowledge to know where to look for further information, you know, to acknowledge the gaps in my knowledge, but there isn't that reflect, there isn't feeding it back in the same way with online is there, for e-learning?

TA: No, there’s not. I’ve got just 2 more questions. One of them is about the learning resources that you accessed of your own volition, the free ones and the ones of interest. Does it feel any different doing those, to doing the mandatory training, and what the Trust or your employers have said you have to do?

P4:  These have been far more beneficial to my day to day life and to the benefit of the patients and the care I provide. So yes, mandatory training. Do it, but do it on a very condensed version, you know. 3 hours on of CPR mandatory training, for example. Yes, I need a refresher, but goodness me, I don't need to sit there for 3 hours with Resusi-Annie. I've done it a lot in practice. Yes, I haven't done it perhaps so recently, but I would fly into action and give it my best shot, do you know what I mean? But I don't need to sit there for 3 hours and kneel on the floor, just to you know, maybe 1 minute of it, not for 3 hours.  So I think we need to choose our, we need to pick our battles.  We need to pick our fields, and yes, far more beneficial what I've done myself and looked out. I've actually had to seek it out myself, which I feel is a little bit, no-one said to me, when I started my job ‘listen, we'd like you to do these, this modules with these people, these modules with this people’. Nothing. Just ‘we'll give you a list of competencies.  By 6 months you probably need to make sure that you've got them all signed off’.  But no way of who, where, what, and when I'm to do that. And I've kind of assumed that this is in my own time. But I need to go back to them, I’m supposed to have a meeting, and say ‘how much of this is in my own time? And what are you actually providing them for this? Because, so far I've just done it all myself, but that's only because I've got the time. But I wouldn't have the time if my family were very dependent on me right now.

TA: Yeah.  Is there anything else apart from time do you think that's driven you to go and look for those things that you have chosen to do?

P4:  Because I'm not going to turn up for a job and not do a good job, and because this is a role that there is nowhere to hide.  You can’t, those days in nursing where people disappeared off, to take someone to X-ray for 3 hours and never came back. You've actually got to be there. The nurses that are there are going to get the, in the firing line and be asked the questions, and I don't want to be caught out. I want to know that, know my facts, so that I've got good knowledge to share with my patients.

TA: Yeah. Thank you. I appreciate that. So, I suppose finally, my thing, last question is, is there anything else you want to tell me about your experiences, or your thoughts, your feelings about using e-learning as CPD?

P4:  I think it's really good. I think a lot of it is very valuable and it has definitely improved my performance, individually. There's still a huge place for nurses need to offload. Is it reflecting? Is it sharing experiences? We mustn't stop that and the minute we do, that's where it's breaking down.  But, again, with e-learning, it's very good, because you haven't got to travel, you know. For example, just, some courses are in London. For some we've got to travel, and they stopped paying expenses for the travel. If I'm expected to go to a conference in London and pay £27 on the travel, that’s going to be a real barrier for most people, in this, you know. So, I think that's where e-learning has been really good, but wihin local areas, to have local groups is really, really, good.

TA: Okay.  Thank you.


