Demographic questions and confirmation of consent.
*****

TA: Thank you. Can I start by asking what was the context that you've used the open learning materials for your continuing professional development? Were you asked to use them, or did you choose to use them? 

P11: A little bit of both actually, so initially, it was because it was a part of my mandatory training at work. Then as my career developed there were some aspects of the online programmes that I could do to help better my own education. So, I started to use other services, like the [clinical speciality] day, and then looking at different aspects of managing care, and blood transfusion, and ‘Prevent’. Before ‘Prevent’ became the ‘Prevent’ that we have now, it was started off on the e-learning. I did that try and help my own department because of different cases that came through. I thought oh, I'm quite weak in this area, I need to do self-study. I need to build myself up if I'm expected to lead this department and I'm expecting staff to come and ask me questions. I need to get some learning.

TA: Okay, thank you. Have you heard the term open education resources? Are you familiar with that term?

P11: No, I’m not.

TA: Okay. What name would you give to the learning that you do, online?

P11: E-learning.

TA: E-learning. Okay, I'll refer to e-learning throughout the interview then. First of all was, can you tell me about your experiences of finding or of actually using and accessing e-learning?

P11: So, when I worked up in [Trust name] in [city name], we all were signed up to it. So, initially we did the internal department, and then they realised that putting on courses, there wasn't enough courses to put staff on to. Staff were getting out of date on mandatory training. We were all then signed up for the e-learning for health, and then from there we worked on and managed to narrow down, because when you go on the e-learning for health the actual catalogue is just massive. It can be so intimidating and hard for junior staff, and even myself, to navigate through the system. What we've done, my learning team back in [Trust name] is that they narrowed it down to, oh, you’re an [clinical speciality] nurse, so you click on the [clinical speciality] tab, and then it gives up relevant training for that [clinical speciality] post. But you can also click on other tabs if you wanted to explore, so that's how I started to develop it. It was quite difficult initially to navigate, but once you start using it a few times, it is easier. My biggest issue was when you were trying to enrol and then you have to try and get through and then sometimes it didn't work, and if you clicking and clicked on the wrong one and it's sort of mixed up. After a while you start to get used to which ones that you can click on, and which ones that you can use.

TA: Okay? So did you find you just couldn't enrol on to some of them then, when you were trying?

P11: Yeah.

TA: Okay. And how did that make you feel? What was that like?

P11: Extremely frustrated. It might have been because I was trying to do it on a night duty or when it was quiet in the department. Because you plan to do the training and work is giving you time to do the training. Just say we were on a study day or if we were on an office day and like, oh, can you do this training, or you’ve got a chance to do this work. You log on to one of them and then you keep coming up with an error, or a systems error, or it's not available anymore. Then you start to panic because, like, oh, my God, I'm out of date. I've been told that if I don't have this done I don't get to get my pay increase, or my appraisal doesn't get sorted, so it does become a worry. So, you send emails off to all these different people and there's different reasons. You're never really told exactly what was wrong, but then you're given a new link to a new one and now that works, but it's the explanation of why it didn’t work in the first place isn't given. For me it's really hard because I like to know exactly what went wrong, or what was going on. I'm sitting going, even now I'm sitting going, what was wrong with that back then? It was hard, but I think more explanations and maybe the user guide could have been a bit helpful for that navigation.

TA: Yeah. Did your Trust do that user guide, or was that just the basic user guide from e-learning for health?

P11: Basic guide from e-learning for health. The Trust just answered questions 3 or 4 days later which was another frustration of mine. I don't like to wait 3 or 4 days later. I like to get it. I don’t like to wait around, so you can guess my anxiety levels and frustration was getting more and more.

TA: Okay. So, you obviously talked to people, or tried to talk to people in the Trust. Did you send a message to e-learning for health?

P11: Yeah.

TA: If the link was broken, did you just report the broken link? And then they just fix it?

P11: Yeah, they do. And then they send you a new link and stuff like that, but again that can take time, and with working full time and the pressures within the NHS, when you do get the chance to do the work, and you have to wait 4 or 5 days for a reply it's really frustrating. In 4 or 5 days my workload is going to be completely different than it was, today. I had the time to do it, then and there. Now I have to find a time in the next month or 2 months to get this work done.

TA: Yeah. And you referred back there to study days or office days, so did you routinely get given time to do the learning?

P11: Luckily, in my Trust, yes, we did.  Every month, my matrons organised that we had a team day. When I band 5 I was in a team, but when I was a 7, I ran a team, and that day resulted in education and development. But half of that, there's about 3 or 4 hours at the end of that day, every staff member got to go up to the computers and was able to do their mandatory training, and their e-learning for health and different modules, as a way to help increase education. We found that if we didn't do that, staff just weren’t engaging, not that they didn't want to do it, it's just that they're working full time. Their days off are their days off.  She felt like if they did, if we managed to give them some time during paid time, they could get the work done and our mandatory training, and actually expanded e-learning for health was increased, then we got the effects back from our staff. We weren't on any of the red charts for mandatory training anymore because of giving the staff time to do it within their working day. 

TA: Thank you. Has that reflected elsewhere where you've worked, or have you had to sometimes do it in your own time? 

P11: Oh massively. When I went to [Trust name] we had to do everything in our own time.  I used to, sneakily, as band 7, allow some of my staff to do it on night duties and stuff like that, but in general terms we had to do it in our own time. We were picked on, like we were challenged quite a bit when staff were outdated, even though it'd been really busy, especially during COVID time. It was still' why is your mandatory training not done'?  The staff were just so tired during the shift that at home they don't want to be spending 6 hours on a computer, at home. There was a massive difference where the staff when I was in [Trust name], we were given paid time to do our mandatory training and [Trust name] we weren’t. That also showed whenever we had to go through our teams and we had to go through our statistics. Our mandatory training numbers were quite low. 

TA: Okay, so you think there was a correlation between the two?

P11: Definitely a clear correlation between the two. It's not that staff don't want to do it. For staff, I mean, I'm going to be honest with you. I've had these conversations with some of my 'offenders' at [Trust name]. I put that in really broad terms as what the management used to call them, but when I said to them, you know, it's really important for your mandatory training. Before I had chance to finish my sentence they were explaining to me why it's so important but, they're so exhausted that they don't. It's not fair that the only day that got off that week, or two days they have off that week, is to sit behind a computer and do all that work. That's something that I couldn't argue with. I think it is up to us within Trusts to, if this is something that we want students and staff to do, we need to provide the environment to allow them to actually do that.

TA: Yeah, because you've been qualified [xx] years, you might have experienced different ways of doing CPD prior to the e-learning, did you?

P11: I have. When I first started in [city name] in [Trust name], it was before we started doing mentorship and everything else internally, we were off for external courses. So, I have external certificates for mentorship, sign off mentorship. I have external for my IV medication and venepuncture, which is good because I can take that to any Trust and use that as my evidence, compared to the internals that are not necessarily kept. I've also done external [clinical procedure] courses. I've done [list of clinical procedures], as well as the [postgraduate courses] as well as CPD.

TA: Did you get time to do those?  Did you get funding for, to do those?

P11:  Yeah. My Trust had a very good education program, in [Trust name]. If a course comes up and it's suitable for the actual unit that you're working in, you had to put in a small essay saying why you want to do the course, how it's going to improve patient care, and your practice and the department. It's decided by a programme team and your line manager, and it also helped make sure people weren't put on the course just for their own development, who didn't really want to be on it. You had to prove that you wanted to do it, and then afterwards you had to again, show, while you're in the department, the changes that you wanted to make. I really felt that back then that was a really good way, because it makes you about the course and you're picking the course for the right reason because we all had an education budget that we could apply for, but it had to be shown that you wanted to do it. Nowadays when I have done training and have written training, I find that the mentorship, for instance, or the assessor and the supervisor, it's done because they need it, for their band 6 and their development.  Whenever I had to choose it, it was because I wanted to do it, and I had to show that it was something that I was eager about. I think that's in my mind, a really good way of doing it. I think, and even to a small standard, if we still do that now it's a good way to get staff to think about is this really the course that I want to do, and what can I get out of it? What can I impact when I do the course? That's something that I like to think about for any sort of external courses that I do, even now. Is it going to benefit me? How is it going to benefit me? How is it going to benefit the work I’m doing now? That's how I choose to do a course. 

TA: Yeah. With that in mind then, when you're looking at courses, say for e-learning for health and other courses, has that made a difference in what you can choose to do and how you can?

P11: Yeah. That process I learned when I was a junior nurse has helped me carry on.  I just don't do a course on e-learning for health just for the sake of it. I do it because this is an interesting course and because I came up against this situation in practice and this is going to help me for further development.

TA: Yeah.

P11: I always find the ones that I picked were very much the mental health and those management situations, because my training didn't necessarily cover it the way the training does now, where we have that in integrated units and courses. My training was very adult specific. I'm working in [clinical specialty]. I realised there's such a big mental health gap, so I always felt myself out of depth and nervous and anxious initially, and that kind of shows, so patients then fed off that and got themselves more anxious. Going through the training of [protocol] and managing mental health, that was able to help me make an impact with a lot of patients. It's the same with some of the physical ones that I did. There is a lot of like clinical assessments and [clinical procedures] on e-learning for health, that helps. You have your own training but these extra ones helps to hone that training a bit. I find that while I was trained in [clinical activity] 11 years ago, 10 years ago. [Clinical activity] has changed massively since then and there are different concepts. By doing an updated e-learning for health, it allowed me to grasp the latest concepts, the latest research, the latest information, and able to implement that into my practice. That's what I use it for mostly now, is to keep myself up to date because I'm now in the [academic] role.  I'm not necessarily as practised as what I used to be, so doing e-learning for health modules now for different aspects of my job helps to keep me refreshed and up to date with new protocols, and new procedures, and new ways to manage patients in [clinical speciality].

TA: Have you been ever allocated, modules to do that you have felt were not relevant to your role?  And if so, how did that make you feel, and did you do anything about it?

P11: Yes, I have. I've been allocated when some of the ones that my managers in different departments I've worked in felt that it was necessary for us all to have. It was just a tick box exercise, and they didn't actually care about it. They didn’t care about the impact of that course on the department. It was just that the [Trust] just decided that this is what we need now, due to a certain incident. It wasn't actually relevant to the practice that we were doing. It was frustrating because my time is limited, my educational time is limited because I have to work 12 hour shifts. For me to have some time to actually do this work, you know a topic that is not going to help me, it's just going to be a tick box exercise. It doesn't really give me confidence or motivation to actually do it properly. I will be honest, those units that I was forced to do, it's fine, but skip to the end and answer the questions and if I get it wrong, retry it. Retry it until I passed. There was no motivation for me to actually work through the module, compared to the ones that were relevant to my job. I actually worked through the module because I realised that I could learn some things through that. As a band 5 you can't really do much. You can report it to your line managers. A band 6, similar. You can report it to your band 7. As a 7, I tried to speak out about it and then I was shut down to say that this is the Trust policy, and this is what you have to do. It is quite demotivating that you’re told that, even though you're trying to explain and check if there is another unit that's similar to what you want, that can be more impactful from a [clinical speciality] point of view, because what you're making us do is [clinical setting] based work, and most of my staff are not going to recognise any of this information. 

TA: Yeah.

P11: That was what I tried to explain to them but they weren't willing to try and do an [clinical speciality] specific one, something that's going to be relevant for my staff to get them to do the work.  

TA: Yeah. Do you ever tell your employers about extra learning that you've done, because it feels like you do extra learning above and beyond? 

P11: I haven’t, when I was in practice, because it never came up. They've never asked, what have I done? It’s never, which is something that I always find a bit unusual because we want to know if our staff are doing extra work, or extra development. In the university, yes, because they're interested in what you're doing. During your appraisals or workload planning you get asked what else you've done. Have you been doing anything different? What else have you been doing, anything interesting? It's because, it's not that they're asking to check the box, they're asking because they're actually interested, and maybe they want to do the same thing as you've just done. I've found that quite a bit while working within the university, compared to actually in practice, because in practice they just want to know that you've ticked all the boxes and you've moved on. I did however have a fantastic matron, and I don't think you'll mind me, mentioning her name. [Matron name], who I worked with up in [Trust name], and she was the first person that in appraisal she had a different box to ask any additional stuff you've done in your own time. And because she was proud to see that her staff were developing themselves, she rewarded all the staff. Her [grade] 7’s, whenever we did stuff like that, she came to reward it. She came in and she changed her shifts, and she did a shift for 6 until 12 at night, so any of the [grade] 7’s on night duties got to be clinical for 7 to 5, instead of being in charge of the department. So, 7 to 12 we were able to go in the [clinical area], to work in [clinical area] to use any of the extra skills that we learned, or if we did some [clinical skill] training we could go and do that. The way she arranged it for us so that we could practice these skills that we learned I thought that was really good. It motivated me to continue to learn more because I knew that, yes, she's going to support me with any decisions that I made. But she was one of many matrons I've worked under and she was the only one who ever wanted to do that. Yeah, it just shows sometimes somebody who's interested in their team, you know for [Matron name] her team was very important to her, and she pushed us to be, even if sometimes we didn't want it to be, she pushed us to be the best people who we could be.

TA: Okay. Obviously that’s rubbed off on you, hasn't it, in your practice? Have you ever actually used any of your e-learning as evidence for revalidation at all?

P11: Yes, I do. I use it all the time, whenever I do my revalidation hours. I print off any of my certificates and I use the hours that are indicated actually on the unit. If it's an hour long, or 3 hours long. I add that for my revalidation. I always keep the certificates in case the NMC ever wanted to review that. I always have my big portfolio that I keep, and I keep all my certificates in it. I found that was handy to have because then I always have that evidence for interviews, or anything else.

TA: Yeah. Do you ever reflect on any of the e-learning?  You have to do a clinical reflection, or something like that, or you have to choose some reflections to share with another qualified nurse. Have you ever used any links to the e- learning?

P11: Actually no, I haven't. I have reflected on my own practice as a separate thing. By doing a training, I then reflected on a situation that led me to do the training and one of them, as I said beforehand, was [clinical procedure]. That was because I tried to help out a situation and got [action] myself, so I did the extra training. I realised potentially it's how I approached the situation. Actually, I do talk about it when I'm teaching, or I do talk about it with other nurses but not in a formal sort of self-reflected way. I have used, when I talk about my training, I've used it within my revalidation regarding those situations. I like to always give a bad example. I don't believe in always giving them good because I know that they'll see right through that. I think that is such an important factor is to realise that we're not perfect. What can we do to stop a bad situation from happening?

TA: As a manager, do you expect to see certificates from your staff if they've done e-learning?

P11: Yes. All my appraisals, I expect my staff to come in with their mandatory training certificates, as well as any further e-learning for health. It’s just to show that they’ve done it, because then I usually alter people’s hours on the system. So, if they have done it and they’ve had to do it in their own time, I give them back 7 hours, on the system. When I used to do the rota, I used to give them 7 hours less a month. I had to put it in as training.  

TA: Okay.

P11: I believe that staff should be rewarded, and it should be done within their time off there, because the benefit of them doing it is going to benefit me in the long run. But they have to come to me with the certificates to prove that you’ve got it.  

TA: Okay. Similarly, when you've gone to your manager for an appraisal, have you had to take your printed certificates with you?

P11: Yep. That’s something that [manager] had us do, and from there I do it for everything. Even though some of my managers after [manager] haven't wanted any of them, I still bring it with me whenever I have my appraisal. I have a little book with all my certificates and everything I've done, and all my training, and every training that I want to do further, because I take appraisals very seriously. I think about what's my future? What do I want to do? How am I going to progress? I usually come prepared for that.

TA: Yeah. Can you access the system to see what your team have done?

P11: No. It's stupid because it's an online system and if it's attached I should be able to look up all my staff before the appraisal and see what they've done. But, because the systems don't talk to each other, which is one of my biggest pet peeves of the NHS, we have so many different systems, and none of them have ever talked to each other. It's one of my frustrations. We could just have a centralised system and it would be much easier.

TA: Have you been in a position where you've done training in one system, and then needed to repeat it because of being in another system, or not?

P11: Yes. I have done loads of training on like [clinical procedure] on different systems. I mean, I went to a different trust where you simply had to go through all the same training programmes, even though I was a trainer trainer. It was a tick box exercise. It had to be tick box that was taught by their staff, even though I was taught by the company that actually created the system. They still wanted me to go through their training protocols and to me it feels like it's just bureaucracy if we're doing a thing that I'd been talking about for years. I think I might be in the position to do it now, where doctors can go around place to place to do training and it's all recorded in the central server. If nurses had the same it would help with morale as well as cutting down bureaucracy. Because the training from one Trust should be able to be held from a different Trust, because they're using NMC guidelines. They're using NICE guidance. They're using all the same guidance as they're doing for theirs. We use one system here in the UK, but if you move from [city name] to [town name], you have to redo the entire training all over again, even though you've been doing it for 5, 6 years. It seems completely stupid to me. 

TA: Yeah. Okay. Can you tell me what you've learned as a result of using e-learning. Do you ever discuss your learning with colleagues, or do you ever think about applying it actually in practice?  Have you got any kind of examples of how you use the learning that you get from the e-learning?

P11: So, the [clinical procedure], because I think it's such an important factor in an [clinical speciality] department, and it doesn't matter if you’re mental health or physical health. It's such an important procedure. When I did the extra training, I then started to speak to my staff about it during different situations, about how they could [apply the clinical procedure]. From there some of my staff did the training themselves because they realised the value. They started to realise that needs to be changed from their own practice and it led to better patient care overall. We started implementing the learning as an unofficial mandatory part of [clinical speciality] training. Then we linked up with our, so they did the theory online, then we linked up with the [clinical speciality] team in the hospital to do some in-person role-play training. We used both packages together to help give staff a better training. 

TA: Yeah. When you're sitting doing your e-learning what are you thinking? How are you feeling? Does it make you feel engaged, or interested, or how does it make you feel? 

P11: It depends actually on the package. Some of them are designed to be really interesting, so you have a mixture of videos, flash, buttons to click on that you explore different sections. Some of the ones that I really enjoyed were the ones that had little information on the outside but then you click on different icons, and it expanded with more information in those sections. I have dyslexia so lots of information on a page, I just don't take it in, or I have to go over multiple times before I can do it. So, having little information first and then me being able to focus on different sections one at a time, I was able to follow it a lot more effectively. As well as that mixture of the pictures and the audio really helps me. Those sort of packages I am very much in support of and I do recommend to colleagues and my staff in my team, because it helped me and I was able to understand it. Those ones that have words after words, after words and just a lot of information on the page, I lose interest so quickly. Those are the ones I find I skip to the end and just try and answer the questions.

TA: Okay, thank you. Is there anything else you can think about that you want to tell me about your experiences of using e-learning as your CPD?

P11: I'm being honest, I'm very much of an opinion that e-learning is a great tool to use. It works for different people in different ways, and I think that e-learning helps with introverts who want to increase their knowledge, but don’t want to be in a classroom in front of people because they get embarrassed. It does also help those extroverts, because then you can sort of go at your own pace. You don't have to follow a class pace and work through as a class, and the actual time they actually do it, is that I can do it on my own time. I don't have to be in class at a certain time. I can work through the module or work through the workbook when I want to. I can do it in the comfort of my own home which I quite like, but also what I like about it is that I could redo it again afterwards. If I go to a CPD class, once the class is over I might think okay, what does that mean again. So, a few days later, if I wanted to recap, I could just recap that module and go through the material, because once I've passed it, I can just go through those slides again. And I can just log on to my account and do it at any time, that's what I really like about the e-learning. I'm a very big electronic person and I quite like online products because I like online stuff. I like digital, you know. It's what I feel comfortable with. I've just done the [clinical procedure] and we were trying to get them to use the [paper resource], but in truth I only use the online rather than use the paper. So, e-learning for health really speaks to me as somebody who's more involved. I do understand those, and I do get the bar, your digital skills bar, especially with some of my colleagues who have been in the job for a long time, and computers weren’t necessarily a big thing then. But, for the younger staff  coming through, digital is the way that we've always grown up. Digital is what we've learned about, so, I think more Trusts needs to implement it, as a way of doing it, more effectively, and using the system more effectively, because at the moment they use it from the bare bones.  And I had a chat with some of the people off e-learning for health and they can arrange certain packages for departments, certain areas. It just needs to be discussed with them, and they can, and they're very happy to help set things up. It's just getting that proactiveness of the Trust away from the old thinking and trying to move into the future thinking. So, I think that in the future most of our mandatory training, and most of our training within the hospital will be done through digital e-learning for health packages, with in-person sessions, just to verify certain projects. But that can be done within departments with the use of train the trainer sessions. So, e-learning for health and then the train the trainer within the department can just make sure they're doing the manual handling properly, or they know how to use the equipment properly. We're going to reduce the need of long waiting lists for staff, because if you go to [Trust name], at the moment, there’s 6 months to a year's waiting list for certain monthly training packages, that could very well be all done through e-learning for health, with a trainer trainer to help fix it, at the end.

TA: Yeah. You talk about some people who are introverts and don’t want the embarrassment of being in a class situation.  Do you think there's anything lost by doing e-learning rather than face to face? 

P11: There is. It comes down to building up that community, but I feel that doesn't always happen anymore. When I first started doing CPD, I got to know people on my mentorship course. We got to link up and then after the course we were talking to each other. Nowadays, people go and do a course and they're one of the only members from their Trust, but they don't really make up relations anymore. I've done managing mental health in a non-mental health setting, but I went and did my work and left again and so did most of the other group. We didn't really interact with each other so the idea of some people who say that community is lost, but actually, we've lost it already because COVID was also one of the big factors that lost so many training factors, community-based. But there's nothing stopping that, you could build a community within e-learning for health so when you are doing a module, there could be another. It could be a chat rooms, there could be a lot more. People are more comfortable using chat rooms and using discussion boards, so you could use those for a discussion board for that module, and link it up together. There's different ways that you could still make a community by using e-learning for health, but for those who don't want to, you have that option for not doing that, if that makes sense.

TA: Yeah. Then the final thing is have you ever looked for any e-learning outside of e-learning for health, any like health related courses, or like free courses?

P11: I have. I've done some RCN online courses. They're not as good, I have to admit, as some of the e-learning for health. They can be quite basic and I have felt like I've wasted some of my time on the RCN ones. Not all of them, but some of them. I think the e-learning for health, it’s everything it says on the tin. You can see the preview of it beforehand, and that's the difference between some of the other ones I've used.  So, don’t get me wrong, some of the RCN ones have been helpful but I think they're just made for lip service rather than trying to give proper education.

TA: Okay, thank you. 



