To take the process forward:

• We implemented a specific Staff Nurse Development Programme to attract qualified nurses from a wide range of backgrounds (including newly qualified) on a two-year fixed term contract with an expectation they would have demonstrated sufficient development in the role to commence the SCPHN course. It was also anticipated that understanding the HV role would reduce drop out later.
• We worked with the Professional Development Lead for HV to review the core competencies and make amendments to include additional elements for this new role e.g., attendance at Learning Circles, protected time spent with a HV, additional safeguarding.
• There was also collaboration with the Clinical Practice Teachers as they would be working closely with the DSNs to ensure they would be ready to undertake the SCPHN programme. They were enthusiastic about this project and could see the benefits for DSNs as future SCPHNs and HVs.
• We requested support from the university when interviewing so that they DSN candidates were interviewed using the same process as the SCPHN students and often on the same day. This enabled us to fast track them, so no further interview was required. We were also able to offer suitable candidates a place on an upcoming SCPHN course or suggest to potential SCPHN students that taking a DSN role would be advantageous to their development. As the DSN develops in practice there is the additional opportunity for learning alongside the practice teacher and other HVs in the team. The DSN can develop academically for writing at a higher level through reflections etc., which are guided and supported by the practice teachers.

Berkshire Health Visiting service now has a well-established developmental staff nurse programme. The role is accepted by all staff grades and well defined. There is one DSN in each locality. This has been instrumental in maintaining enough students on the SCPHN course and the ongoing challenges to HV recruitment.

The majority of DSNs go onto successfully complete the SCPHN programme. However, this system is not infallible, and we have small numbers who decide not to progress further.

The impact:

• DSNs – were better prepared to undertake the SCPHN course, having a good grounding in elements of the Healthy Child Programme, attended learning circles, and had had the opportunity to discuss the course with current students and practice teachers. They were also familiar with Berkshire policies and processes.
• Practice teachers –already had a knowledge of the DSNs and were able to identify if anyone would benefit from delaying or bringing forward the start of the SCPHN course and the DSNs were anxious but less stressed about starting the course overall.
• Service – knowledge that we are ‘growing our own’ when recruitment remains challenging.
• Vacancy levels – staff in localities were keen to have “their DSN” back after successfully completing the course (which mostly happens) and take a real ownership and pride in their achievements. Reduces vacancy level.
• Commissioners – able to assure them that we are doing everything possible to develop staff in challenging times.

Benefits:

• It has increased numbers on the SCPHN programme which had dropped dramatically post Covid.
• DSNs – better prepared for the SCPHN course and there has been a (small) reduction in numbers not successfully completing.
• Service – ‘growing our own’ and requirement to remain with BHFT for two years post completion of SCPHN course, leading to improved retention within the Trust/more stable workforce.
• Improved career development – staff nurses not on the DSN programme can see their colleagues progress and are actively supported too should they wish to develop towards undertaking the SCPHN course.
• Streamlined interview process alleviated the need for an additional interview.

Challenges:

• Recruitment into DSN role due to local and national shortages of nurses. Ongoing recruitment due to short time in role.
• Managers/teams/staff – Understanding that the DSNs will be in the team for a finite period created some resistance as there was unhappiness that the teams might not see the benefit of upskilling them.

Learning/Future Plans:

• The DSN/SN role has only been accessible for qualified nurses and not midwives.
• The review of title and change to Community Practitioner has enabled the role to be extended to our midwifery colleagues.
• Discussions with the university to review how we attract nurses into the community when newly qualified and changing traditional messages.