Research has found that, while newly qualified midwives are competent to practise, they would benefit from preceptorship programmes providing a structured, supportive culture to enable them to develop their confidence to become autonomous, accountable practitioners (Avis et al, 2013). Structured preceptorship programmes support newly qualified midwives to enhance their clinical skills and develop their care planning and managerial skills, along with helping to socialise them into the workplace (Feltham, 2014).
The Nursing and Midwifery Council (NMC, 2006: 1) defines preceptorship as ‘providing support and guidance enabling ‘new registrants’ to make the transition from student to accountable practitioner, to practise in accordance with the NMC (2015)Code and develop confidence in their competence as a nurse, midwife or specialist community public health nurse.
To facilitate this, the new registrant should have learning time protected in their first year of qualified practice, and access to a preceptor with whom regular meetings are held.
The ‘contract’
Preceptorship is a ‘contract’ between the new registrant and the preceptor, as both parties have responsibilities within their professional relationship. The new registrant must: practise according to the Code (NMC, 2015); proactively seek out their preceptor once in post; demonstrate self-awareness by identifying personal learning needs and developing an action plan to address those needs; understand the requirements of their role and their responsibilities to their employer; and demonstrate the ability to be a reflective practitioner by seeking feedback from their preceptor and colleagues to inform their future practice.
In turn, the preceptor should support the new registrant in their transition from student to a confident, competent practitioner who provides sensitive, individualised, evidence-based care within the multidisciplinary team, according to the terms of their contract. The preceptor should give positive feedback on areas of good practice and constructive support with regard to areas for development. The nature of the relationship should be dictated by the new registrant's needs and particular work environment.
Case study: Milton Keynes
The NMC recommends a period of preceptorship of not less than 4 months, although it acknowledges that this period of formal support should be tailored to the needs of the individual, the availability of the preceptor and local circumstances (NMC, 2006). Kate Ewing is a member of the midwifery practice development team at Milton Keynes University Hospital NHS Foundation Trust. Her role in the team is to provide back-to-basics training initiatives, develop the preceptorship programme and oversee mentorship in the unit.
The journey to becoming a practice development midwife: Kate's story
I began my nurse training in 1995 and then went on to specialise in acute medicine and then cardiac care. This was a fast-paced, exciting environment that I loved; however, following my personal experiences of bereavement I felt the need to change direction, so I started the 18-month midwifery degree in 2000. I worked as a rotational midwife for the next few years, but after having children I left midwifery for 5 years, returning in 2010 following a return-to-practice course. Returning after such a long break was a challenging and stressful experience, but it has given me a great insight into the support needed for staff who are new to practice.
Working clinically, I strived to deliver a high standard of evidence-based care and I found that I particularly enjoyed mentoring students and supporting junior colleagues to develop their skills. When the opportunity arose to join the practice development team (PDT) it seemed a perfect fit—I jumped at it!
What does practice development entail?
I joined the PDT 19 months ago and quickly discovered that the role encompassed far more than I had originally anticipated. I was prepared for providing clinical support and developing teaching initiatives to maintain and develop clinical standards throughout the unit, but running a recruitment programme and line-managing all the preceptees were unexpected challenges.
My colleagues and I run a successful protected training week every month, which all midwives, maternity care assistants and nursery nurses attend annually. It encompasses both midwifery skills updates and mandatory training, including an obstetric emergency day, which has received great feedback. As a team, we actively promote multidisciplinary training in the unit through PROMPT (Practical Obstetric Multidisciplinary Training), weekly cardiotocography meetings and emergency skills drills.
Practice development gives me the opportunity to stand back from clinical practice, assess what training would improve clinical standards, liaise with colleagues and area managers, and then research and develop training packages.
Why preceptorship?
My interest in developing and maintaining an effective preceptorship programme for our midwives stems from my personal experiences. I have experienced three preceptorships in my career—firstly as a nurse, then as a midwife and, finally, as a return-to-practice midwife—so I am aware of what is needed to create a supportive environment. I remember very well the fear and uncertainty you experience as you make the transition from student to autonomous practitioner. An extract from my reflective diary after my first shift as a qualified midwife states:
‘I feel like someone is going to catch me out and tell me to hand back my uniform, I am an imposter midwife who knows nothing! Maybe L-plates should be handed out, so people will give you a break.’
Our aim for our preceptees is that they have a clear support network established and developmental goals to work towards, allowing them to create a preceptorship period that meets their individual needs. We are proud, as a unit, that all staff take a lead in supporting our newly qualified staff. We have a strong team of clinical band 7s who provide the first line in clinical support in practice, in addition to our band 6 midwives working alongside preceptees on a daily basis.
As practice development midwives (PDMs), we provide clinical support in practice. This involves visiting clinical areas and offering time to assist with practice questions and support the development of extended skills; for example, suturing and cannulation. I feel part of our role is to aid the development of clinical confidence without becoming a mentor taking over the responsibility of care, as this can undermine the preceptee as an autonomous practitioner. In addition, we have established a PDT referral system for staff identified as needing extra support in certain areas to gain confidence.
What does the preceptorship programme at Milton Keynes include?
There is general guidance from the Department of Health (DH, 2010) on the framework that effective preceptorship should take; however, each Trust interprets this guidance to develop its own preceptorship programmes. Locally, I have found there to be big differences in what is on offer for newly qualified staff—it is definitely a good question to ask at interview.
I am proud of the preceptorship programme we have in place; it has received great feedback (Box 1) and is proving very attractive to new midwives from other Trusts. Midwives new to the Trust receive a structured programme for the first month of practice as a supernumerary member of staff. This month would include:
Following this month, clinical rotation to all areas begins and is allocated for the year ahead. Our preceptorship programme also includes:
We have had quite a few of our proactive preceptees completing their portfolios to achieve a band 6 within 9 months—the sign of a successful preceptorship programme and hardworking midwives!
What does the future hold?
Moving forward, we are keen to extend our established support networks by developing a buddy system within the unit. This will involve linking new preceptees with a midwife who has recently completed the preceptorship programme, who will be able to offer support and guidance in completing the portfolio. Currently, as PDMs, we are fulfilling the role of preceptor, which is not ideal; I feel it would benefit our preceptees greatly to have a named clinical link to contribute to this process.
This year, we have listened to our preceptees and are restructuring the portfolio to show a clearer progression in the development of practice. We are also liaising closely with the practice development nurses to ensure the shared study days we have introduced have an increased midwifery focus.
Providing a preceptorship programme to suit all is an impossible task, as all newly qualified staff are individuals who have qualified with a wide range of clinical experiences. The more individualised we can make preceptorship, the better, to enable and empower new midwives to make effective use of this exciting time.
Conclusion
Preceptorship is ‘a means of providing structured, focused support and guidance’ (Chief Nursing Officers of England, Northern Ireland, Scotland and Wales, 2010: 36) to newly qualified midwives. There is research and anecdotal evidence to suggest that such support has a positive impact on newly qualified midwives' socialisation into their chosen profession and reduces attrition rates. The role of the midwife is emotionally and physically demanding and so initiatives such as preceptorship programmes should be available to all new registrants as they make the transition from novice to expert.