TA:  I'm just going to start with just a really open easy question, which is really What would you say are the key differences between mandatory training and using OERs to do CPD, that is all self-chosen and self-directed, and obviously that's the latter, that I really want to focus on, but I'm interested in what you think the differences are.

P17:  So, in my mind, mandatory training are, structured training opportunities, to allow, for procedures to be done every year, to make sure that we are following through the right protocol and processes, such as manual handling and basic life support, that's going to basically give patients that standardised care, no matter where they are in the hospital, from every single member of the faculty, from the cleaners, all the way up through. Everyone has to follow through the right protocols, while doing CPD is about enhancing my own knowledge, taking an opportunity to develop a skill, learn something new, develop myself, and if I'm going to be. The, appreciate here, with looking from the apprenticeship point of view, this off the job learning, so learning that's not within my normal role, but away from me, to enhance my role by learning something new.

TA:  OK. Yeah, that's a really nice link to the [nursing programme]. That makes a lot of sense, yeah, I can see that. So, the next question I'm going to ask you is quite a broad question, but it is based on some of the content that I got from my stage one interviews. So, what skills do you think nurses need, to be able to work in our modern, current, NHS? What kind of skills they need, across the board, really?

P17:  That's a big question, Tanya. That's a big question. Definitely from a core, communication, key communication, but not just standardised, verbal communication, but more in depth knowledge of non-verbal cues, non-verbal ways of how patients can allow, let the nurse know what's going on. I really think the use of sign language, you know Makaton, British Sign Language, American Sign Language, some sort of advanced communication, to help those patients who are feeling, marginalised. Being and feeling like they are being listened to and made to feel more comfortable. And that's the same with any of our patients that come from overseas, with translation services, and a better way of helping with that translation. From there I also think skills, I mean modern day nursing is nowhere near the way it was back in Florence Nightingale’s time. And I did a little piece myself, in my PG cert, of looking, and Florence Nightingale wouldn’t actually recognise modern day, nursing, so more advanced diagnostic understanding, more advanced clinical skills, being able to help assess patients and have that better understanding of that clear clinical assessment, because by having the, even if they're not doing it themselves, having the understanding of that can help with explanations to patients. It will help us understand the patient journey and help to give that more personalised, patient centred care, as well as we now move into the future, we need to have most of our staff on digital skills. So, we need to have an uptake in digital knowledge and able to use online systems. We have so much of our workforce still find it difficult to even switch on a computer, never mind documenting all their notes and accessing blood results and putting through requests. And that's whenever we have a lot of mistakes that happen, and many hospitals, if you look at some of the London hospitals and how they've got one new system called CRS. And that system has every piece of information from multidisciplinary to, multidisciplinary notes, to x-rays, blood results, CT scans, all in one system that allows every member of that team looking after that patient, to see that journey from every person's perspective. So, that will enhance that patient’s experience, and no more having to repeat the same questions, and trying to find that information, or information being lost, all in that same situation. And looking down towards [local county name] area, we have like 16 different settings for them to get on to, so understanding how the computer, so you can see why people are shy of using the digital services. So, trying to get more, if we train them up and give them more experience and more expertise, we're then able to navigate these different systems, that will help to give a better patient care. I could go on for the rest of this chat about what skills [brief laugh TA], that we need, but we definitely need to be focusing on more of the enhanced learning skills, and moving away from, while keeping our traditional understanding, but ways of having that more in-depth experience to. I just spoke to one of my student learners and they did a whole session with the nurse on fluid balance charts, and actually blew her mind, of why they're useful and why they're in-depth, instead of just telling people, oh, write down the fluid balance and calculate at the end, but that the actual training of understanding the rationale behind that, and she's able now to help patients more carefully because she understands what's needed. I think we need to break that barrier down that once was medical learning, and break that more for our nurses, because we are progressing even further.

TA:  Okay. That leads quite nicely on to thinking about OERs. Any nurse can access any OER, whether, whichever profession it is for really, and so they could technically access medical OERs as well. So, how do you think that we should then start to prepare people, or how do you already prepare people for finding and using OERs, and understanding them?

P17:  It's a culture. We need to change culture aspects of what nursing is. Have more, have a more open system to show them which training sessions they can have. So, education boards, education signposting, but around making the nurse feel that it's relevant for them to do that, because many times I've had over my career, where I was told, well, that's not within your job description, so there's no point in you doing that. That job description, it now is a part of that job description, and this was about 10 years ago I was told that it was never going to be a part of my job description, and we can see how that moves, but we have still have the day off. That's not what I used to do back in my day. That's not what we do as nurses, and we need to start changing the culture of breaking those barriers down, because as nurses, we do find that very hard to support and grow each other. We are very much, we don't like change at times, and we like status quo, and we're not very good at accepting new people’s thoughts and ideas very easily. It takes a little bit of effort and a little bit of breakdown for that to happen, and I think we need to tackle that sort of situation, promote education boards, promote having an education link within each ward, within the senior team, to help do like a monthly, like newsletters, to try and alert staff this is what's going to go on. That's one of the projects I did up in [Trust location] was myself and one of the medical doctors. We did a weekly, sorry a monthly bulletin and we went through what training sessions were coming up in the next six months, who can attend, which location, is it going to be a physical session, is it going to be an online session. And I helped him run his, ECG rhythm course, which is credited by the, GMC, and, but nurses could attend that. Nurses were free to come and attend for learning that high, intense ECG reading, and having that list where people can go, coming forth and getting volunteers to teach and that, really helped open up and let more staff go to these sessions, rather than keeping it for them to try and discover, themselves, so it has to be some responsibility from each ward, to try and promote this.

TA:  Okay. That's really interesting what you're saying. I can sense the sort of dissonance between the fact of directing people through education boards and link people, and everything, to specific resources, and also students or staff going off on their own to find them. And obviously the move with the NMC is for us to go off and find education, which is why I'm doing the research. But how do you think we manage that dissonance? How do you think we get that mind shift, and prepare students or staff to actually go off and do things on their own?

P17:  I think it has to start off, in the university. One of the things that I'm quite proud about is, the unit that I'm unit leader on, is that we do flipped classroom approach, so where the students are, they are the leaders. They are directing their learning, and in the seminars, the seminar leads are the facilitators, so we're there to help bridge any gaps, and bridge any sort of confusion that they may have. But they are directed to do their own learning, to go and look at some research, to look at different articles, and those. And you can tell the ones who are really invested, and they do a lot more stretch reading around the topics, compared to people who are just getting the basics done and moving on. And getting that idea behind them now, will help whenever they go into practise, that will continue to go, so they'll come up against something new, and they’re like, oh I'm gonna write down what this is, and I'm gonna go and look it up. I'm going to look at this new procedure. Oh, what was that done? Oh, this is a new way of using a new different machines, so I'm going to go and look at my e-learning for health, I'm gonna look at my online training platform and try and get it. So, we need to start that inquisitive nature back in their training days, and with that, if we break down those barriers of letting nurses expand their own knowledge and taking responsibility for that. And that could be very well is, within the ward setting of promoting it and rewarding those nurses that does go beyond what their basics are, and getting them to potentially, in, they're a good way of adding that in with change management. So, they've done this extra course on this new procedure, or this new treatment, or this understanding, potentially then we can give them responsibility to pass that information on to the rest of the staff, or change something within the unit, and it will help that ownership, and then if more people see the ownership, then the more likelihood to, they want to scratch themselves on the area that they're interested in. So, we have to try and reward, and it's sort of like the carrot and the stick. We need to give the carrot a lot more, and reward our staff members, or our students, for this excellent attempt of developing themselves.

TA:  Okay. Thank you. And how does that then fit in, do you think, with the fact that we're training students in the university for a profession where we've got to let them demonstrate, or make sure that they demonstrate specific competencies and knowledge at the end of it? And, how does that fit in with helping them to learn to go off and do things on their own?

P17:  Well, if you look at some of the some of the ILOs [intended learning outcomes] of some of our units and the overall NMC code that we're having through, especially with the idea of the NMC code being changed in the next year or so, we're going to be looking at, our being able to try and help enhance that, and making it and, sort of so, changing up the assessment process, that we are going to be offering, and I think that's something we're discussing for our new curriculum in [University town], is making that more, the process more fluid, allowing them to bring their own expertise. And that's, and we can see this already in our safety modules, or in our patient health, public health modules, or in our team working service improvement where they're going off and looking at their own topics, or looking off their own information and trying to come together with a project. And working in groups, and group working, and using team based learning is a way to break down those barriers, to open up those doors, because we can then get each member of that team to and take what they know, and bring it in and have to enhance that. So, I think that's the sort of key learning, of changing, instead of having the 3000 word essay, individual, bring in more group projects and more group work, peer assessment, and having those sort of angles will encourage students to reach out and be rewarded for that reaching out.

TA:  OK, thank you. You've made quite a few references to directing people, so keep focusing and just re-shifting around this whole area. And you've made a few references to directing people to resources, or signposting them. I'm just wondering, what you think about what that does for nurses being autonomous professionals? If we're relying on people? One of the things that came up in the stage one interviews was that lots of people want to be directed to resources, and you talked about obviously mandatory training. We are very focused. It is very directed. 

P17:  Yes. 

TA: But in the sense of being an educator, do you think there's anything linked to our education roles or anything, in relation to directing students to relevant and appropriate learning, or should that not even be a consideration?

P17:  No, I think that directed, direction should always be there. A learner is in nature, someone who wants to learn, someone that wants to develop, but if you put someone who wants to learn and develop into a library and told them to learn, what they going to learn? There are so many books. Being a guide, being a facilitator and being a guide is different from traditional upfront, telling you what to do. But a simple direction and helping to guide them in the path that they're having, and that comes through that personal discussion and that personal development plan. We need to move away from that great mentality of, every undergrad nurse should be following this, and move towards, and I bring it up again about the apprenticeship programme, because it's something that's quite big in the media, quite big that we're doing here in [university town], but each of those apprentices has an individual journey, and I see, and I meet with my apprentice every 12 weeks, and with that I can see where, which areas they need to grow and advise them, and we can then sort of direct them and help guide them to ways to enhance their own knowledge, and development in different routes. So, each one of my 20 apprentices have an individual plan of how they're going to progress. So, we're not painting everyone with one brush, which mandatory training does. We are helping people grow and helping people manage their own learning, and their own development, and look at different, in different areas. And that's what I love about the apprenticeship programme, is that we have, first of all we have to do it, as a part of Ofsted and everything else, but it's given us the opportunity to show that once we help you, be that guide and that be that facilitator, students do want to develop. We have one apprentice that has done that and has got the [Trust location] scholarship, and that's because she's a great interest in palliative care. The rest of her class didn't go for it because it wasn't that, that they were interested in, but she, when we were able to guide her and support her in that direction. So, there is a difference between blanket statements and blanket telling them what to do, than being that sort of spiritual guide and that sort of, facilitator, and help opening up doors. Because, sometimes, and especially in education, doors can be closed, and sometimes you need someone in just to open that door, open the crack, so you can have a quick little look inside to see if that's suitable for you, rather than just completely jumping in, because a lot of times, I know back whenever I was doing some extra training back ten years ago, I did a module or did a course thinking it was going to be really good, it's going to really help me. But in the fact, at the end of the course, I didn't get the relevance, but if I had someone who was able to open up that a little bit and show me what might this come out of, I might have wanted, decided to go and do something else instead. So, it is having that facilitator and having that sort of that guide, just to help. And I think there's a difference between that and direct direction.

TA:  OK. Thank you. That's very useful. Have you ever directed any student specifically to any OERs, or worked with any students on OERs or anything like that? Could you just tell me a little bit about that?

P17:  I have indeed, actually. I've had one of my students is a very big enthusiast of A&E nursing. And so, they're in the third year and they want, and they're applying for an A&E job. And so, I was still directing them into more sort of looking at, sort of resuscitation, trauma aspects. And there was just little online trauma course and resuscitation course, just for bridging those gaps, so not full Resuscitation Council, but just managing major haemorrhage, and those sort of aspects. So, whenever they go for that job, they have a bit of a better understanding of A&E sort of emergencies, and I'm glad to say that that student is now a band 5 in an A&E department, so I'm really happy that it sort of helped out, but it is, and that's why it's really important to have that personalised understanding of that student, because I could have sent someone who had no interest in critical care down that route, to those training programmes, 
and they wouldn’t have got much use of it, besides having it on their names, they wouldn't have been able to take that information and use it for potential, future development.

TA:  Yeah. Perfect. And that's exactly the kind of individualised directing or guiding you were talking about before, isn't that really? 

P17:  Yes.

TA: So, have you ever used any or directions due to any resources that are not held in like common places like e-learning for health, or LinkedIn learning, or some of the things that are on the board, behind me?  Have you ever had an experience of doing that, or has any student ever come and said they found something on the Internet?

P17:  I kind of try and avoid, so whenever people do say to me they’ve found these, courses on the Internet, that are not accredited to either some of the ones that you have behind you, I do advise them to go away, and that's because the ones behind you has been accredited. It has been looked at it. It's been evaluated, and been deemed to be proper content, and content that is up-to-date, evidence based, and random courses off the Internet, without taking time to do that research and understanding where they're coming from, it can cause more harm than good, so I do sort of direct them towards the ones that behind you so RCN. I have directed a lot of people to the RCN courses, which they do some really good courses put on at the moment, and there's ones from Resuscitation Councils and stuff like that. And again, GMC. I have directed a lot of people towards some GMC accredited courses that nurses can attend to. So, that's the only one that not on the list [reference to the list of example OERs on the screen backdrop] that I have sent them towards, but I try and be careful, because I really want ones that have been, peer reviewed, evidence based and can uphold in practice, rather than sending patients off, but there's no point of sending someone off to do an American course on American medication which we don't use over in this country. It's just a complete waste of time and that can cause problems. I've had this, working with first years who are using bad research, and using American research to design a plan, a care plan for a British patient, and we do things a little bit differently, and so they failed their assignment, because they were working off an American medication regime. And so, the understanding of the different, the differences is very important, and this is really important for any outside education, is understanding, is it relevant to the, to this country, for one? Is it been accredited as evidence based? Is it ready, to be used?

TA:  Yeah. So what sort of skills do you think they need to specifically ask those, or answer those questions for themselves when they're, looking at them?

P17:  So, definitely carry on doing their research modules, which I didn’t think I'd ever say that, but it's so true, understanding and especially like looking at year 2 research for professional practice. And they go through looking at sort of, journals and how you see if it's a relevant journal. If it's a journal that's worthwhile. What was the focus group of that journal? Is it a small focus group in Richmond talking about the working poverty class? You know, it's not going to be very relevant. And so, getting them to understand that, then making them when we do, so it is about slowly getting them used to understanding research from behind the scenes, and then they can then start to look at the accreditation of the courses and the systems that they're able to use, and be able to evaluate themselves. And of course, having an open dialogue, and getting them to say that even if you're in practice, if this is a course that you're interested in, speak to your line manager, speak to the education team, because every Trust has a dedicated education team, and they could run by, and says oh, I found this. Is it relevant? And I know, [trust name] for instance, they've got a fantastic practice development team, and they would answer any of these questions for them, or in the university, any member of the faculty, would be happy to answer those sort of questions of, a learning environment. But definitely, undergrad research modules very important, and that's something that Trusts might think about doing for their, band fours, band threes and band twos, is how giving them like, not saying that they need to have the same in-depth, but a little bit understanding of the behind the scenes of what's happening, because a lot more times, those are the groups that we're seeing, are taking on more of the responsibilities of the nurse, and we need to get them also, up to date on why we do things, evidence based and those sort of aspects.

TA:  Yeah. OK. So, you also gave like a hint there about needing dialogue, almost. So, you were saying if somebody's not sure, they can come and talk to somebody else about it, or something like that. If people are doing OERs, they might be doing those on their own, mightn’t they? 

P17:  Yes.

TA:  So, do you think there's anything we should be thinking about, setting up, or encouraging, in terms of creating some way of feeding back, or dialogue, if they are doing OERs on their own?

P17:  So, if we're looking at staff nurses and the Trust, that could directly tie into their appraisal. So, when they do the appraisal, and I liked to do this whenever I was doing my appraisals in practice, where I said and I used to have a box for any additional learning that you've done by yourself, and they’d come in and they’d bring in that information, and we can discuss how it's relevant, how you can impact that in the department, is a way that maybe do a little teaching session, with the rest of the staff. Because it’s about giving people ownership of new projects, is a great way to help that change management. And getting, because it is taking that ownership, and once you have that ownership, change can be done, much smoother transactions. With that, you could also do just drop in sessions, and many Trusts are now doing like monthly drop in sessions for, from their education leads in each unit, and so they can pop in and just drop in for. It could be morning handover, or it could be at the end of the shift, just a little, quickly. So, has anybody done any extra training? Does anybody want to talk about it? So, have a more of an open interface, and by talking about it more, having this interface is opened up more. It will allow for better, free thinking conversations, about different practices and different treatments, and I think I get this question quite a bit, is that, oh, what you've been qualified, for so long. If you get told that things are different, how do you respond? And it happened to me, about a year ago. I went in and they changed the protocol, and I was like, OK, then teach me. Teach me this, new protocol. And by having this openness from top to bottom, it will make people more underneath feel like, yes, they can just be open and say, OK, I don't know this. That's learned, rather than getting peoples defences up and shields up, and thinking well, that's not how I’ve done it, or it's not how I used to do that, because I could have very easily said that I've been practising for 14 years. I don't do it this way, but what's the point? Because it's a new, evidence based way of managing this. So, it is about having those sort of interfaces and dialogues. 

TA:  Yeah, you're almost proposing that it's safe to say you don't know something, because then people can be open and, talk about it, and learn about it, than if you pretend you know, then no dialogue happens, and then everybody stays ignorant, don't they really?

P17:  Yes.

TA:  Okay, thank you. Thinking about then, if an open education resource that somebody might access, might not have really big triggers, like it might be feasible to put it into a UK context? Or it might be similar to the context of the one that they're working in, but it's not quite right. So, do you think that those resources could still be used? And how might you think they might be used, if they could?

P17:  So, that's a bit of a difficult conversation because the time that a nurse has, or student has, can be quite limited, and it's really important to try and get them to focus on training opportunities and development that is going to be suitable for them. While you don't want to discourage development, but you also want to get them to think about how that learning is going to impact their job, and if they want to have time to do that, because if they're focusing on a module that's not going to have a relevance in their day-to-day operations, yes, it's going to be good for them to learn something new, it's great for their own development, but that's time they're going to be spending off their class, off their work or off their class, and that can cause a lot of pressure to build up, a lot of stress to build up. So, having it more relevant and focusing on those areas, but still be able to allow a bit more of an open understanding. So, if it's sort of adjacent to their role, having that opportunity as well, but not something that is completely off in the background, you know working in a care of the elderly ward, but wanting to do training on children's, communication skills, for instance. While technically you could argue from the adjacent point of view, that if family members come up with children, you have a better understanding and better to help, but if you do something that's completely left field, then it's not going to be relevant to the job and it's going to be extra stress on to their already busy schedule. So, it is trying to get them to see, is it worth it making the call, how that's going to help them develop. And that's why by bringing them and giving them ownership of that training, and getting them to take it forward, and use that as a change process, that's whenever you start getting people to start thinking, OK, this is a programme, is it relevant? Is it going to help me? Is it going to help my patients, and going to help my own development? And getting them start thinking about that before they take on a new, research, or a new training programme, will help them whittle down. Because, if you look at e-learning for health, there's thousands and hundreds of different training situations. You know you can start from the stop and by a whole lifetime,  and you still wouldn’t make it to the end. So, by giving them those skills and getting them to understand those, and making those decisions, we're going to be able to help focus their own minds and then, and sometimes things can be left field, which is good, but I want them. But whenever I used to get it, whenever I used to have some of these left field situations, they would have to explain to me why they think it's relevant, and how they can implement that. And while I'm not going to say they're incapable, and going to say yes, you can do it or yes, you can't, it's just about that development working as that team, and working as a guide and that support structure, to help them see that, because then once they get more experienced, then your guide work doesn't really need to be done, and they become the guide to the next person. And so that's, so it becomes more of a traditional, where you're help supporting the next person along that line, and that in turn helps with their own development, because they take on more leadership and management skills, which then will help them in their future development. So, it can be such a symbiotic relationship with this guide and support, and try and get them sort of thinking what is best for them, and what is best for how they can develop it.

TA: Thank you. I just wrote down critical appraisal about roles, because essentially when nurses are doing their CPD, in order to demonstrate evidence to the NMC, it should be relevant to their role. So, they shouldn't be doing something left field, the same way that they shouldn't, if they're in your department, and you're encouraging them. But, I like your idea about the guides going forward. So, capacity building I suppose, of people to be those guides and leaders going forward is really useful. Thank you. Have you ever used any OERs where you've been able to change them? Or do you understand the regulations, or the laws, or the licences about changing OERs?

P17:  No, unfortunately not. It's not. It's not within my experience, unfortunately.

TA:  Yeah. And would that put you off using them, and changing them?

P17:  No, not at all. But for me to do that, I will have to speak with the relevant bodies, find out, the reason, the rationale they're this way. Speak to them about my ideas for change, and how they could be implemented, because we have to work through compliance issues, we have to work through, if we're following through the legislative, the legislation. I mean, ensure it's, it still fits its purpose, and that's the important thing is making it fit for purpose. I would not have known this if I was still as a band 7/band 8 nurse in practice. I have this better understanding since I've joined academia. So, that was, I do want to make that clear, as well, that I've learned that while working here in [university name], about the compliance angle on how you can change things, because a lot of people, and a lot of staff, especially senior staff in the hospitals think that once they're up there, we can't have a change. We can't do anything. We can't. That's what's there, we can't input anything. But now I know that everything has, is negotiable. Everything can have a negotiation and we can change things for the better.

TA:  Yeah. And all those things on the board would tend to have licences which are not, well, they're copyrighted materials. Normally they can't be changed anyway, but if you were to find something else on the Internet, maybe something about A&E nursing that was just randomly produced by somebody, that might have a Creative Commons copyright? So, that you could actually change the content. So, I don't know how we help people in practice to understand that, because as you've just said, you know, being in practice yourself, you wouldn't have known this, about the learning material already up on the board.

P17:  No, but it could be built into staff development, because if I think back to my Band 6 and Band 7 course, and I think a lot of Trusts need to do that more, so you have like matron skills, where new matrons learn how to, for that role. And I think it should be the same thing. I think there should be band 7 school, and band 6 school, because we have a lot of new sixes are moving up through their ranks a lot faster these days, than what it has been beforehand, and we need to improve that, and make that much more successful. So, by jumping from, going in and learning about band 6, we could talk about, education options, and have that as a section within those training days, because as I said, a lot of this learning and development, it needs to be top up. It needs to be breaking the barriers from the top, to give the people below the opportunities to develop, without being that restrictive, because that's a lot of times, it's the ceiling that keeps a lot of good band fives down, and we need to sort of break that ceiling and open that up.

TA:  Yeah, and I could almost think back to your very early point about directing people. It needs to be relevant, but at the same time, you need to free them to be able to expand as well, and things like that, don't you? Thank you. So just, I'm going to have one final question then, as is always the way, is there anything else you'd like to tell me about using open education resources as CPD? Broadly, from your experience, you know whether it's how we help people to use them, or whether they're a good thing, or a bad thing. Whatever you'd like to tell me, if there's anything else you'd like to say about using OERs as CPD.

P17:  I think using OERs as CPD is a great way to reach many more staff than, individualised courses. At the moment, if you look at many Trusts and them trying to book on, I know we're talking about mandatory training here and not additional CPD stuff, but look at any of the extra courses that they're trying to offer now. They're booked out months in advance. Student, staff are waiting months to get any sort of training, and Trusts have now, are happy for someone to be a year out of date of their manual handling, because they don't have the facilities or the capacity to teach. And I know a lot of places are doing micro skills and development, and even then, those are booked out months in advance. So, having OERs will help them to give a lot more staff an opportunity to develop themselves and learn, but I think instead of it being an external factor, it needs to be brought more internally and worked within each trust more effectively, and having those links and it wouldn't be hard. It wouldn't be hard to say that in every education department should be someone who specialises in OERs, to be able to be there to help manage that, and as I said, just more of that direction, like oh, these are relevant to this section, and work with each department of how to streamline it. I mean, we're doing this for the apprenticeships and the wards are all doing this for apprenticeships and stuff now, about KSBs and getting them all settled into different areas. Why can't we do this for e-learning for health? Why can't we be able to look at different, like, oh, what may be good for this ward, if you do in your first six months, would be good for you to have a look at this one, this one and this one. And you can choose which one it is, and have little targets, that these are good for this one. This can help you. And then, from there, the student then starts to take it on themselves. But, because that boundary and that barrier has been broken about further development, it's going to help them then grow in confidence, about reaching out for further development. And I think that's the key, is the breaking those down and making them more included, and making it more cohesive is the way forward. And I think a lot of Trusts need to realise there is a lot of fringe services out there, if they just open up their eyes and instead of reacting, be proactive.

TA:  Yeah. And one thing that came out, as you said that was, do you think that people almost need permission to access, different things? The NMC have said we should go and access OERs, but people might need permission to go and do that, because let's face it, in the training, the point I alluded to earlier was we direct a lot of what they learn.


P17:  Yes.

TA:  Because it has to meet the intended learning outcomes, so, by the time they're finished, although we're supposed to be creating self-critical, autonomous practitioners, many of them still want to be told what it is they should be learning, so they almost. I don't know.

P17:  No, no. I completely agree. No, I completely agree with exactly what you said and this is the situation. The NMC says a lot of things and don't get me wrong, I'm an NMC registrant and I do respect them, but the NMC does say quite a lot of things. They say that we should be teaching them male catheterisation and venepuncture and cannulation, but no Trust is letting any of our students do that. So, the NMC can say quite a bit, but actually breaking down those barriers is the first way to get what the NMC has said into action. And actually, yes, it is about giving them the permission, because at the moment they don't think they can. If they're qualified, they don't know if they can do this. They don't know if they're allowed. We work in such a hierarchical profession, that we follow what we're told above. You'll get some who are radical, free thinkers, like myself, who doesn't always fit into the right places, sometimes. But, that’s not everybody. Everybody sometimes likes to toe the status quo, because we have our cliques, we have our situations within Trusts, and I think that is one of the things that we need to do is make it more open and make it more available for everyone. Yes, we are directing, and this is the same for our curriculums in uni, yes, we're following through the ILOs, which I'm hoping that will be changing in the new curriculum. Instead of ILOs, we are now looking at the KSB's and the NMC code, and having those as our bases, rather than. Because intended learning outcomes are now old fashioned, they're now out of date terminology and more about how we can learn, and from there we can start to get them to look outside. We'll still get people who like to do the status quo, but then we'll get some people who can expand on the knowledge, and I've got one of those who have just marked their exam and you know, it's an absolute wonderful exam, because she's looked, outside the box. She's looked at the previous content from last year, and used what we keep on telling them, the scaffolding curriculum, and she's used that to enhance her knowledge and her answers, which she got 98% in her exam, you know. So, it shows that when we do open that up and when we do try and encourage it, there is students who take advantage, but we need to get all of them on that same wavelength.

TA:  Yeah, and I suppose it's a rolling process. So, a bit like the guides going forward, the more people that know they have permission will tell others, of course you can look at that, you're allowed to, nobody’s stopping you doing it.

P17:  And then those little small voices start getting quieter, and quieter, and quieter, and quieter. And then they're no longer there, because they've retired and the new people are now in those places. And I think that's, and that's one reasons why I've joined higher education for, because I could help my department, but COVID, sort of, when I got a lot of staff from all over the hospital, I realised I'm only a drop in the ocean, and I thought by coming here I could sort of influence this a little bit more.

TA:  Yeah, until the next big change comes along! Thank you.


