Demographic questions and confirmation of consent.
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TA: My first question is going to be, when you're thinking about using free online learning for your own purposes, for CPD, just talk me through how you find it, or what decisions you make about using free online learning.

P21: I suppose I listen to a lot of recommendations to start with, and I always earwig what other people are using and doing. When it comes to non-professional, then I will probably do a video search, or a Google search, to look at stuff. So, most of the stuff that I cover when I'm professional, tends to be handed down to us, so we get sent links to things. So, I, to be fair, don't have to go searching very much, because you know where the stuff is when you need it.

TA: Okay. And is that tending to be mandatory training, or is that stuff that you're looking at for your own interest, or for teaching, or for learning about something for teaching or?

P21: Yeah, it could be for both. So, I am, I tend to be a bit of a student, for other things as well. So, when it comes to learning for professional, I tend to go. I tend to look for the key websites, the key organisations that may have information, so for example, when I was a [clinical speciality] nurse, I knew that I could go to [National Charity name] and access their online stuff straight away. So, I've built up an inventory in my head, over many years, of where to go, so I've cut down the looking now and I go straight for the jugular, as they would say.

TA: Okay. That's interesting about cutting down the looking, just because you've been qualified a while and you've got these established networks now, of places that you know. Why would you trust them above something else?

P21: Why would I trust those above something else? I suppose because they've been, they've become validated by other organisations such as the NHS, who are partnerships with them, or universities have links to them, and I know that the information can be validated and verified elsewhere.

TA: Okay. All right. Thank you. You've said that some of your learning might be mandatory, some of it's out of interest, or whatever, for your own purposes. What's the difference between those two, doing open learning, for those two, different purposes?

P21: Well, the mandatory one is for career progression. You have to kind of hit those milestones. So, for example, when I was in the private sector and I was doing the care homes, I knew that we didn't have the luxury of the NHS sending us the stuff, we had to actually find it out ourselves. So, I knew that we had to hit the milestones for professional progression, meet the CQC or, as it was back in the day, the 1994 Registered Homes Act. So, I knew there were some things that, we had to evidence, that we had made an effort to learn, to keep up to date with. But, when you're in a larger organisation, it's a lot easier, because there's, you know, you've got access to a library, or you've got access to educational support staff, so it's much better. So, yeah, so it depends on where I am, as to where I tend to go for robust information, I suppose.

TA: Okay, that's quite interesting.

P21: Because I've worked in the private sector, I've worked in the statutory.

TA: Yeah. So that gives you a quite a broad perspective, and from the sounds of what you've just said, you've been looking for your own learning for quite a while then, because of working in the private sector as well. And it not being, because you're not sent on courses.

P21: Yes, in the private sector, you had to source, and pay for, you know. I paid for my own teaching, so I paid for my own City and Guilds course, and paid for my own Postgraduate certificate. I only took to certificate level, Postgraduate Certificate in management. So, I sourced, and paid for those courses, my prescribing, and the degree, with the backing of the NHS. And I paid for my own masters as well.

TA: I presume you didn't get any time or anything for that, either?

P21: I got support when I was in the private sector, in some of the care homes, with my learning, but actually I found it harder to get access to, the masters in the NHS, even though when you're recruited, you're told you have to do the course. They didn't then, fulfil that that requirement, and put us on the programme, so I actually had to leave, in order to do my Masters, myself.

TA: Gosh, okay, that's.

P21: I even offered to fund it myself, but they wouldn't. They wouldn't give me the training, they wouldn't give me the time off. They just said it wasn't a priority, even though they said it was a requirement, to be willing to do it, when we entered the programme.

TA: Gosh. I'm going to move on to just thinking about the free Internet-based learning that you have accessed, and that could be for any of the things on the board behind me, or stuff that you're already used to using. How do you assess the relevance and accuracy of the materials, or? You know, tell me about how you assess the quality of the materials?

P21: That's a good point. Okay, so I've used the RCNi, resources, and NHS Professionals. I probably would shy away from using LinkedIn. I joined it when I was doing my Masters over a decade ago, but quickly learned that it was. I struggled with it, like I struggle with Facebook. I really don't like being contacted by people I don't want to be in contact with. So, I'm not socially shy, or unwilling, I just, you know, I like my friends.

TA: Yeah, you want to control your own network, rather than

P21: Yes.

TA: Okay. So, with all those things when you've gone to any of those, or any of those, all the other sites that you've actually used, how do you then assess the quality or accuracy of the materials?

P21: Yeah.  How do you express your intuition? Okay. I suppose I would look to see where they were drawing their evidence from. I think it also, whether it rings true. I think I've probably got a divining rod in my head, but I, that's a very good question. How do I define it's good? I think I've probably got quite a good gut radar now, for things that aren't adequately detailed, and I think I've got a good gut for things that seem a little bit, flaky? Yeah. Ah, that's a good question. I don't know.

TA: You might not. I'm asking the question, but you might not because you're going to trusted sites, that are peer reviewed and validated. Then it might be that you’re not actively looking at things, but like, you say, if you've got a divining rod or a gut feeling, then you might come across something that's not, that you're not happy with. So, then you might think ‘ohh’ and change your view about something, so.

P21: I think, yeah, once bitten, twice shy. I don't go to sites that I don't feel are of benefit, and in fact I'm quite critical of students on the course, if they're using flaky sites. You've probably seen my feedback comments about using academic, robust academic resources to support your, knowledge and understanding. 

TA: Yeah. So, that leads quite nicely on then, I might come back to that about the assessing the materials, but you've talked there about the feedback, that you give to students. I'm really interested in how you think we should be preparing students to use these kind of resources, because they're available to everyone, and once they're qualified, the NMC says that, free Internet learning is one of the ways to go for doing CPD.

P21: Yeah, there's a lot on the Internet, that the students should avoid relying on. Yeah.

TA: Okay, and what? Tell me a bit more about that.

P21: Okay, so I think we need to be developing discerning, critical thinking about the materials that they rely on, and that they bring to their assignments, because I don't think it shows that they've searched appropriately, so they may not have used a database search, or they may not have used a peer reviewed article, or a book that has got a good forward from an organisation, or something, or that the person's perhaps from a university that's got a good reputation. So, what I'm really asking the students to do is pick quality material, rather than just doing a Google hit with the keywords. Even Google Scholar, I mean some of the journals that I read, I look at them using, and I'm thinking from Iran, from Israel. Can you not find something closer to home? In Wolverhampton, or something? You know, why be so obscure? Okay, you miss, you know, if it's to do with leprosy, then fair enough, you're going to have to go further afield than, you know, Birmingham suburbs, but for most of the stuff we need, we can probably pick it up from the UK quite cheaply, and it hasn't travelled as many miles.

TA: Yeah. And most of them [referring to the students] are in places, aren't they, where they can access, apart from the PVI [private, voluntary and independent service providers], they can't access the databases the same as students in the Trust can, but they have access to a wide range and a wide range at [education provider name] as well. So, do you talk to them about that in the classroom? Or, how do you kind of?

P21: I think, yeah. Yeah, I do. Despite what I see in their assignments, they are harangued. And so, for example, I introduce them to things like the Office for National Statistics, for data, because obviously that is data that has been accepted and is, you know, if it's on radio 4, it's good enough for my students, so I do. I do introduce them to new information and new ways of finding information, rather than just relying on journals, because there are some good websites out there. So yeah, the office for National Statistics. Is a good one.

TA: Yeah. Do you think the students are aware, that there is this free Internet learning, for when they've qualified? And that they can use towards their CPD, and revalidation, because the NMC does specifically state that this is one way to get, CPD.

P21: I don't know. I think a lot of them, because of the nature of the students that we’re getting, who have been HCAs, are still requiring to be led and fed. I'm not sure they're necessarily equipped, even by the end of the two years, to be independently learning, and sourcing quality material. They're still, that you need to tell me, you need to, I need to know. There's still this anxiety about, we haven't given them enough information. I know that the cohort that [colleague name] had before mine, they were struggling between understanding that the ILO's [intended learning outcomes] were conceptual, and the suggested structure was more concrete, and I was having to even, kind of explain that to them. So, the idea that they would go off and go ‘oh, do you know what, I'm going to go and find out, data from this’. We kind of have to open the window and say ‘out there, is a resource you can go and use’. 

TA: Yeah.

P21: You know, go and use it, and they still like to be, you know. I even joked about them being weaned recently. I said, you know, I have finished breastfeeding you, you're now onto solid food, you can chew it and swallow it yourselves. Yeah, it's. You do have to kind of say to them, you have to go out and find it, but they will have to make some mistakes themselves, like I did, when I was a young student. You know, I would. I remember going to websites, and someone saying to me, ‘oh, that's, you know, that's not reliable’. This is when the Internet was in its infancy, to be fair, but yeah, I think students are still expecting, the ones that we're dealing with anyway, even by the end of year 2, is to be told where to go and get the information from.

TA: Yeah. And to some extent you can do that, because you've got some tried and tested, trustworthy sites, that you know of, that you can send them to. And they have to use some of those sites, like e-learning for health, don't they, through their employers and things, so they're aware of some of the sites.

P21: Yeah. I think it'd be helpful, if, I think more promotion. Yeah, I think the students could be contacted by these organisations, at the point of either entry onto a programme, or at the end of the programme, to say, you know, you've got a year's login to access this, this and this. I think it would. I think if the students were notified that they had got perhaps a postgraduate login, access for a year, before they had to subscribe, or before they had to do something else, then I think that might promote the use of it. So, for during their period immediately after graduation. What's the word I'm looking for, where they’re being mentored?

TA: Like preceptorship, or similar?

P21: Preceptorship. Thank you. So, I think what we could do is we could give them a preceptorship package, which has, for your mandatory learning and, or for your professional, development. Use these sites for your revalidation process and we could give them, you know, perhaps them a little packet of something, you know, electronic packet, of things to use.

TA: Yeah.

P21: And then, that might then kind of. It's again, part of a weaning process, from being told what to do, to going, this is where you can go and get the information you'll need.

TA: Yeah. And the reality is, that in the training, there's so much to fit in, isn't there, that actually you can't, you can't do all that as well. But then, what I'm finding so far is people are saying that the university, or the college, should be the places that we're preparing these people, who are going out into practice, so that they know the resources are there. 

P21: Yeah.

TA: Just, a bit, slightly broader, but it does. This is a slightly broader question. It does still relate to using free Internet-based learning, because it's about technology, and we are very much technology focused. There's so many fast developments happening in the NHS, I just wonder what sort of technical skills and knowledge you think nurses need, to be able to work effectively in The NHS, today?

P21: Well, the I think the obvious one is being able to draft a sentence, paragraph, page, argument in a succinct way. I'm struggling with getting them, they've learned how to write academically. For example, they're doing a reflective piece at the moment, and they equate writing in a reflective way, as being informal. And I'm having to kind of remind them, it's still an academic assignment. It still requires rigour to, the language that you use, it's just that you're doing it from a personal perspective, rather than from a, an anonymous perspective, but it's actually getting them to understand the nuances between the different ways of writing. Some of them have had prior experience in working in banks, building societies and things, and they can understand spreadsheets and they can understand report writing. There are others that have come from, sort of less academic backgrounds, that really struggle with actually understanding what an argument is. You know, to them an argument is where you fall out with somebody [brief laugh], you know. So yeah, it's actually, it's actually introducing them to the nuances of the English language, now an argument’s where you just have two, to compose, you know two comparisons, or two different arguments, and you look at the Ying's and the yang's between them, you know. You don't have to side with one of them, you don't have to be friends with the other, and you know, negate the other one. But it's just, I mean, a third of my cohort, for example English is a second language, and that's a huge number. I've never had to deal with that kind of, differentiation between languages before.

TA: Yeah.

P21: And I suppose as well, the other thing is with ChatGPT coming into the world now, that they're getting lazier with actually doing it. So, they're pumping it into ChatGPT, what they want. I mean, we all are to some extent, but they're using ChatGPT to get round the fact that they're not good at something, so they're never actually developing the skill. They're relying on an automated version of what it is that they want to say.

TA: Yeah. Do you think there's any place for ChatGPT, in terms of learn, professional learning, aside from obviously people want to write?

P21: Totally, and we're all encouraged.

TA: Tell me about how you see that being used.

P21: Yeah. So, they've just done their supporting student learning unit. What I say to them, is it helps you to organise your work, and it will help you to, be more comprehensive with what you talk about, so you can put into ChatGPT. You know, I say to the students, you can use for inspiration, you can use it to organise your thoughts. You can organise it to use it as a checklist, and to tick off that you've covered the key points. I said what you can't do, is ask them to do the work for you. You've still got to form, the connections and the arguments, the for and against something, you know, because a lot of them are you know, using it in too much detail, so that I can see. In fact, I can almost see where the same ChatGPT, the same ILO's have been put into ChatGPT, that the sentence, has come out. I mean, they've written their assignments recently, and they've written about CPD and I can almost tell you the order in which those comments about CPD are going to be listed. I mean, they don't come up on the similarity score, but it's pretty much, it's pretty much, you know, okay, you've ticked the five issues there, and you tick the six issues here, and yes, you mentioned the three points there, because that's what ChatGPT does. It's, you know, it gives them the key ones. So, yeah, so I think it's good. I think they need to be, they are a generation, under the age of 30, that technology doesn't seem to scare them as much. They need to be able to look at a website, and identify equipment, and you don't expect that, exactly. So, you know, they need to be able to navigate, technology in any job they're in now.

TA: Yeah, there's lots of lovely examples there, of how you're actually doing that, which is really powerful. It's almost about adaptation, isn't it? So, you're supporting them, to be adaptable, through the work that you're doing. Is that how you see it?

P21: Yeah, well, that's what. That's why I think the [nursing] role is particularly different. Yeah, I mean, this is what I've been telling them about the [nursing] role, compared to the [nursing] role, because the [nursing] role is telling them that they're going to be able to, drop in work. Whereas, with the [nursing] role, with the boundaries, you know, you’re adult trained, you’re children trained, or you’re mental health trained. The way their role is, I mean they can, it's a passport to anywhere, and so they've got to be adaptable. They’ve got to be able to function in these different areas, because if they apply for a post, it's just, they're just going to be, you know, they can be picked up quite quickly.

TA: Yeah. And I think adaptation is key, with like all the new technologies and learning to work in today's NHS, it's all about adaptation, because everything's moving so fast, that you don't have time to stand still for more than a few minutes, do you, before something different is hitting them, so that, it sounds from what you've just described, you're teaching them that and supporting them with that.

P21: Well, they've just to say, they've just been doing their [assignment name], and we did [unit name], and I, and [colleague name] knows this, but I actually stopped one of their presentations, because they hadn't applied anything. They hadn't investigated anything. They literally just cut and pasted from the websites. And I just said to them, I don't know what you've been doing for three hours, but sit down and this is how you, this, you know, listen to how you should have done it. And the other presentations were quite reasonable. 

TA: Yeah. So, these free, online, learning resources, they're often done independently, aren't they? So, people do them, you talked about doing it out of work time, or doing it in your own time, or paying for it, if you have to pay for it, and there's often nobody to talk to, so, how, what? Tell me about how you see people taking that learning back to practice? If you do.

P21: I suppose, if there's a learning culture in the organisation they work for, then there may be opportunities to, cascade that learning down. So, it may be that you know, you're a link nurse for something, and you're asked to go out and investigate, you know, storage of bed linen or something like that, or, you know, new equipment like a hoist, or a sling, or a different way of moving somebody. So, you know, you could get them to cascade that learning down, and do hand overs and presentations to groups. Or, it could be that if you've done it independently, you could, you know, you could say to your team lead, would it be alright if I had ten minutes in the handover, just to talk through some things that I've covered over recent, you know, covered recently? I think it depends on how the culture is within the organisation, when they offer to, you know, they look to inspire people to do things, and then you can obviously look at competition as well. If there's a band six going, you can guarantee that someone, will have done some homework somewhere, and want to be promoting themselves, as you know, the new band six. So, I think, you know, that's when kind of, you know, if you can say to them ‘this will link to your career progression, your appraisal’. I suppose it's, that again comes down to good leadership, doesn't it, that you’re inspiring people to do more than just the contractual hours.

TA: Yeah. So, you've said that about learning culture and organisational culture. Tell me about what you feel about the organisation, and what influence they should or shouldn't have, or.

P21: I suppose because I'm outside of an NHS organisation, again, but it, the organisation recognises, development.

TA: So, they should be recognising at least, the effort that people are taking to.

P21: Yeah. Yeah. We used to have PREP (post-registration education for practice) days. I can remember that, when PREP first came in, the days before that died. But yeah, we used to get, when we contracted the qualified staff, we used to give them PREP days, and we'd say to them, you know, this is your holiday, and these are your PREP days, and you can book it as a PREP day. Just let me know what you want to do, and if you want us to liaise with another organisation so you can go and shadow or something, then we'll do that. But that was in the private sector. We used to say we used to organise PREP days for them. I think it would perhaps be nice if, even once registered, when the nurses are qualified, that they still get update days, that they actually have some time out, some supernumerary time, and perhaps it may be that the educational organisation within that culture, you know that organisation, could set things up, to say, you know, this is available, or that's available. We've got links, so you could go here, or you know, spend a day with the ambulance service, or spend a day with the blood transfusion service. Something like that, just to, you know, make avenues for them. It's hard, negotiating a day out on your own. Yeah, I think perhaps if we could go back to the old PREP days. I think that might be nice.

TA: What you're describing there is still led by educators really, isn't it, or by people who've got experience?

P21: Well, until you can run on your own, because once you're newly qualified it's like being a novice driver, isn't it? You know, you haven't got your instructor sitting next to you going ‘well, I'd try a three-point turn here if I were you’. Yeah. You still need people to kind of take you, by the hand and say, okay, I'll do the introductions for you, and then you're on your own. But, as I say, I'm forty odd years on now, so I can kind of just go I want to learn this. That's what I've got, you know, I'll go and find it.

TA: So, what's made the difference, then? What do you? Tell me about what you think has made the difference between, like, before, and now you have the autonomy, and the direction, to just go and find what you want. What makes that difference?

P21: There's people on. The problem is I went into nursing with a degree, so I had already got that background, so I'm probably not your, atypical. I'm an atypical nurse, in that sense, and I've always said I'm a student with a job. My job pays for my learning.

TA: So, it's a bit about being driven then? 

P21: It is just about being driven, absolutely. You've got to have that kind of gut motivation, because, yeah. So how we select people to do the programme. I suppose we have to say to them, what is your long term goal? What is your plan? What's your five/ten year plan? I think then perhaps we can identify those that are more willing to learn. I've got some students who, you know, do so much background reading, that actually they can't see the wood for the trees. I've got a couple of my group that will throw references, as if it’s like confetti. They don't make use of them. They've got a reference list twice as long as their assignment. I tell them ‘you don't need to do quite so much as that, you know’. And then there are others that will go to geek medics and, you know, Encyclopaedia Britannica and you're going, ‘oh, God Almighty’. I don't know. I'm not your usual, RN really.

TA: Yeah, but then everybody's unique, aren't they? And there are some people who will be driven educationally, and some who will just be glad to get the qualification, and go off and work, and just take direction from other people. So, it's about working with that balance, I suppose, and signposting. But, you said about signposting really towards the end of the course.

P21: Yeah, I think if we could get a Preceptor pack, and say, look, you know over the next year, this is what you need to be looking at exploring, and resourcing, so that, you know, you're set up for the next five to ten years. I think that might be helpful.

TA: Yeah, almost planning then, really.

P21: Yeah.

TA: Because, when you first qualify, and register, that three years, even for us who’ve been qualified some time, that three years feels like it's ages away, doesn't it, before you’ve got to revalidate, and all of a sudden it's there, and you think ‘ohh gosh, what am I going to use for my examples’?
Speaker: Yes.

TA: And so, it's about planning to say, alright, I'm going to do this, that and the other and I'm going to show you how that's enhanced my patient care, whatever. My final question is if you've got anything else you want to, say to me, about how you think nurses should be prepared to use these kind of, free, online, learning resources?

P21: Okay. I think perhaps the NMC, as part of the revalidation, could, look to ask them, perhaps from a qualitative point of view, how they’re finding learning, and then perhaps we can identify which nurses are struggling, to either be motivated, or to source the information they want. But, yeah. I think at the point of revalidation, perhaps NMC could be saying, you know, what is it that is causing you to lose momentum, or to maintain your momentum. And then, but it will come down to the locus of control, and it won't be. Some people will be completely driven, and others will have to be dragged.

TA: Yeah. And it's always been the way. It's not anything new, is it? It's always been the way.

P21: But I suppose if you know, if you can dangle a carrot, it might motivate them to move. You know everyone likes promotion and extra money, don't they. I suppose there could be some behavioural tricks and tips that we could stick at the end of a course for them, to say ‘look, you know, if you're achieving these academic credits, then you know, there'll be some monetary value in it. But I don't know. 

TA: Yeah. Because at the moment there is a feeling that the value that's placed on the learning, either by the organisation because they don't have to fund it anymore, and they let the nurses go and do it themselves, or by the NMC because they they've just thrown it out there, that this is a good, flexible, cheap way to do learning, doesn't place a lot of value necessarily, does it, on that professional development?

P21: No. And people, I mean, I have to say this probably was me, was that unless I came away with a qualification, or some sort of certificate, certificated learning, it was ‘am I wasting my time?’ So, you know if it had the ENB number (English National Board) attached to it, or if it had, you know the City and Guilds code attached to it, then I could stick it on my CV. But these courses, unless there's something accredited at the end of it, or gives you permission to do something, like I remember doing the wheelchair assessment course, all of a sudden I was allowed to do wheelchair assessment, so I could put that on the CV. If it allows you to, if it moves you forward in the pecking order, then I think people are more motivated to do it, but if it's just for learning for learning sake, a lot of people won't see the benefit.

TA: Yeah. OK. Thank you.


