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FYPCHealth Visiting and School Nursing Preceptorship Pack

Addendum to LPT Preceptorship Policy 2014 for the use of Specialist Community Public Health Nurses (SCPHN)

Health Visiting and School Nursing

Updated September 2015

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Contents

Introduction ….. ….. ….. 3

Our Programme ….. ….. ….. 4

Competencies ….. ….. ….. 7

Training

Health Visiting ….. ….. ….. 14

School Nursing ….. ….. ….. 15

Appendices

Appendix 1 Review Sheet ….. ….. ….. 17

Appendix 2 Action Plan ….. ….. ….. 19

References, Websites and Tools ….. ….. ….. 21

Acknowledgements ….. ….. ….. 24

Signed copy ….. ….. ….. 25

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Introduction

Welcome to the health visiting and school nursing service here in Leicestershire Partnership Trust (LPT).

This pack has been put together and outlines best practice for newly qualified and new starter health visitors and school nurses to LPT. This pack works in conjunction with LPT Preceptorship Policy (2014).

This guidance will support both newly qualified and new starter Health Visitors and School Nurses to:

Adjust to their new professional role Fulfill their role as an independent, autonomous and innovative Heal th

Vis i tors (HV) and School Nurses ( SN). This guidance meets the requirements for health visiting in England in their first year of practice (Preceptorship Charter, Institute of Health Visiting 2013)

Definitions:

Preceptor:

An (NMC) registered practitioner who has been given a formal responsibility to support a newly qualified health visitor through preceptorship (DH 2010).

Preceptee:

The newly qualified health visitor and school nurse / new starter who engages in preceptorship (DH 2010)

Mentor:

An experienced member of the team who provides practical day to day support when the preceptor is not based within the same team (A HV Career DOH 2012)

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Our ProgrammeDuring the first 6 months of employment here in LPT, the following will support you to adjust into your new professional role as a health visitor / school nurse.

These are based on the Institute of Health Visiting guidelines on excellence in practice but are applicable to both health visitors and school nurses within LPT.

Sign DateYou will be matched with a preceptor.

The preceptor will be from your Neighbourhood, but not from the same team. Within the team there will be a named health visitor/school nurse/mentor for everyday support.

The preceptor will be motivated, confident, clinically and professionally competent to support you in refining your skills and improve performance in practice.

The preceptor is there to help you reflect, communicate and actively listen to you. They will be available and accessible at short notice to help you make and articulate decisions and judgments in your practice.

The preceptee/preceptor in LPT follows the LPT Preceptorship Policy with this addendum (Health Visiting / School nursing). The preceptor is able to support you when you do not have the information to make an informed decision.

The preceptee in LPT is expected to follow the LPT HV Standard Operating Guidance (2015)for Family Health Visiting / School Nursing Standard Operating Procedures, Healthy Child Programme. They are expected to complete the New Starter Training Programme which includes all the role specific training identified for Health Visiting/School Nursing practice. They are expected to keep their skills and knowledge current and appropriate for safe health visiting/school nursing practice and maintain active professional registration with the relevant health regulator (NMC 2015).In addition, the preceptee is supported through our management approach which is led by the Clinical Team Leader and includes:

Induction to their Neighbourhood and organisation, including locality meetings

Induction meeting with named preceptor, CTL A personal development plan within the first 3 months of

starting with the organisation. (See paragraph 5.2 and 5.3 of Appraisal Policy November 2014)

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CTL to identify suitable clinical supervision group for preceptee to attend

A planned, structured introduction to your workload At the end of the first year, there will be a review of the

PDR. At the end of the 6 month preceptorship the

Leicestershire Clinical Assessment Tool (LCAT), New Birth Visit ( HV), Health Needs Assessment or Continence SN AssAssessment Assessment depending Structure approach to Preceptorship

A face to face, documented meeting with preceptor every 4 weeks and with the CTL every 4 week. Different meetings

In addition to preceptorship, all new staff must have clinical supervision a minimum of four times per year as per Trust policy.

If the HV/SN has not completed a recognised mentorship course this training must be undertaken within the first year of practice. Once completed this should be recorded on the Trust mentor database. Please record date of course on ESR.

It is a recommendation that HV/SN within the first year of practice attends a leadership course or programme.This is the Edward Jenner Programme initially and then to follow Trust Leadership Programme. http://www.leadershipacademy.nhs.uk/programmes/

Preceptor/Preceptee supports the development of meaningful experiential learning and the ethos of lifelong learning. This can be achieved through collaborative reflection, using a tool of choice by the Preceptee

Continued Professional development (CPD)A professional reflective diary (portfolio) using models of reflection is required, utilising critical thinking as evidence (The Prep Handbook Oct 2011) (see LPT Preceptorship Policy)

Record KeepingAt each meeting a written record of the following must be documented.

Achievements Areas for development (action plan) Special interest Areas of concern with on-going monitoring of progress

record A SWOT analysis tool can be used to identify strengths

and weaknesses

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Team SupportEvidence from DH, Preceptorship Framework, 2010 says

Stability of team members A safe open approach in the team Review of caseload

Is essential for the preceptee to feel supported. This is monitored by the CTL through one to one meetings or through allocation meetings

Concerns about Preceptee Complete action plan demonstrating gaps in knowledge

and skills Preceptor must inform CTL and line manager

GovernanceThe preceptee should have a clear understanding of clinical governance procedures within LPT so they can provide a safe, quality service- improving patient/client care. This includes for example:

Understanding how to access Trust policies and procedures

Follow NICE Guidance relevant to their practice Understand how to report an incident Understand how to report a risk How to deal with a complaint Understand how to undertake audits

The importance of Research and Development to clinical practice

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Competencies – Health Visiting and School Nursing

Section 1 – Growth & Development

Growth measurement Developmental assessment: social, physical, emotional, Antenatal - 0 –

5 years , 5 – 19 years Universal Plus / Partnership Plus Children with complex health needs / outside normal parameters

Section 2 – Building Community Capacity

Immunisation Programme Nutrition & Obesity Teenage pregnancy Breast feeding Maternal mental health Child health promotion programmes

Section 3 – Avoidable Injury/Minor Illness

A &E referrals Minor ailments / injury

Section 4 – Professional Skills

Code of conduct NMC documents: scope of practice, record keeping Professional development Mentorship Communication Leadership

Section 5 – Safeguarding

Early Support Categories of abuse Referral process Contribution to child protection plan Domestic Violence Actions to take if there are disagreements

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Section 1 – Growth & Development

Competency Sign DateHV /SN has the knowledge and skills to review the growth and development of a child relevant to their field of practice ( Healthy Child Programme)Is able to plot and interpret growth measurements on centile charts and give the appropriate advice based on clinical judgment and make any necessary referrals (WHO, guidelines)

Health visitors within LPT follows the Standard Operating Guidance (2015) for HV which clearly defines the minimum standard required for all Universal Contacts

Antenatal New birth contact 6 weeks 3 / 4 months 1 year 2 year

Health Visitors have the skills to assess and promote speech and language development from 0 – 5 and is able to refer appropriately

HV/SN understand their role with targeted intervention and the universal plus packages of care

Proactively promote bonding and attachment and know when to intervene.

Behavioural issues Emotional Health and Wellbeing Issues

and understand when to refer on to CAMHS services

Health Visitor has understanding when children fall outside normal parameters and how these should be referred. For example

Neonatal Jaundice Neurological disorders and how to test for them e.g. –

reflexes – gross motor skills e.g. SMA Abnormal external genital appearance

e.g. Hypospadious Tongue tie Gross motor development delay eg not sitting by 10/12

months, cannot walk or bottom shuffling at 18 months

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HV/SN demonstrates the process of a seamless transition from one service to another. The importance of the one to one meeting between the HV/SN for those who are universal plus or partnership plus. This contact is documented within the SystmOne record.

Health Visitor has knowledge on Newborn screening blood test Informing parents about the screening results. Record in child’s record

(See HV SOG) Locality blood spot testers Pathway

Non-Medical Prescribing - demonstrate proficient knowledge and skills including

Record Keeping GP liaison and timely sharing of information re: what has

been prescribed. Codes Safe storage Electronic prescribing and supervision

All HV/SN should be skilled in Electronic recording Caseload assignment, management and prioritisation (eg

time management) Are able to signpost to relevant organisations, websites,

and social media sites and use evidenced based leaflets (as cited in the SOPS).

HV/SN understands consent, confidentiality and adheres to Fraser Guidelines.

HV understands maternal mental health assessment (see HV SOG)

HV/SN can assess and act appropriately in response to Domestic Violence (inter-professional communication skill LSCB guidelines)

HV promotes mother and child bonding and attachment (Solihull Training)

HV/SN know how to manage fabricated and induced illness (FII) especially the record keeping aspect and appropriately timed information sharing.

Movement in / out HV/SN knows how to complete electronic records/ PHCR

and follow local guideline for transfer of records

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Section 2 – Building Community Capacity

HV/SN has knowledge of the current national immunisation programme. As nurses HV/SN they may be required to support national immunisation programmes

Health visitors have knowledge of and will adhere to both national guidelines and local breast feeding policy, actively promoting breast feeding

Health visitors have the skills and knowledge to discuss correct formula feeding in infants, including teaching the safe preparation of formula feeds.(DH guidelines)

Health visitors demonstrates adherence to local nutrition policy. Can discuss weaning competently in line with local and national guidance and provide support to clients in this area including advice on iron deficiency, colic and premature infant guidelines http://www.lnds.nhs.uk/_HealthProfessionals- DietaryLeafletsforaHealthyLifestyleDifferentConditionsIllnesses.a spx

HV/SN has the knowledge and skills to deliver health promotion programmes such as obesity and healthy lifestyles.HV/SN has an understanding of the demographic and health needs of the neighbourhood.School Nurses will have completed their school health profile. HV/SN knows how to access the ChiMat statistical profiles for each neighbourhood.

HV/SN has the knowledge and skills to identify any risk factors relating to physical and emotional health and is able to make appropriate referrals using the relevant Public health NICE guidelines.For examplePH1 Brief interventions and referral for smoking cessationPH14 Prevention of the uptake of smoking by children and young people

HV/SN can work in partnership with others to support teenage pregnancy strategies including signposting, as appropriate, to more specialist agencies

HV/SN is able to discuss sensitively a range of contraception methods and signpost clients to local services following Fraser guidelines

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HV is able to lead both child health advice clinics and Healthy Child Programme Clinics referring appropriately.SN is able to lead a continence clinic and refer appropriately.

HV/SN has knowledge of and is competent to deliver the current healthy child programmes (DOH 2009) using relevant NICE guidelines and evidenced based practice pertinent to the practice

HV/SN has awareness and is able to accurately follow guidelines and policies.

Standard Operating Guidance (Health Visiting/School Nursing)

Standards of proficiency for Specialist Community Public Nurses – School Nursing (NMC 2004)

Healthy Child Programme 0 – 5 years and Healthy Child Programme from 5 – 19 years

Guidelines for record and record keeping (NMC 2009) LPT Children’s Safeguarding Policy & LPT Safeguarding

Children Practice Guidance (2013) DOH: National Service Framework (NSF 2004) The Children Act (2004) LPT Infection Prevention and Control Policy (2012) Getting it Right for Children, Young People and Families

DH (2012) NMC - The Code. Standards of Conduct, Performance and

Ethics for Nurses and Midwives (2015) LPT Corporate Working Guidelines (2012)

This is not an exhaustive list.

Demonstrates knowledge of all services and facilities available to clients in the neighbourhood that they are practicing in.

Section 3 – Avoidable Injury/Minor Illness

HV/SN has the knowledge and skills to support parents in preventing avoidable injury and maintains professional knowledge. They can advise and sign post if appropriate on a range of common childhood ailments

HV/SN Is able to follow up A & E / out of hour attendances where appropriate

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Section 4 – Professional Skills

HV/SN maintains continual professional development as per NMC recommendations for registration. This should include an awareness of both local and national policy.

HV/SN is aware of the roles and responsibilities regarding the mentorship of students and colleagues.

HV/SN demonstrates the ability to record patient data accurately in line with local policy, maintaining professional standards and updating records as required.HV/SN to be informed of the use of carbonated body maps to record marks to babies and children.

HV/SN is able to use the common assessment framework triangle in record keeping and is aware of its relevance in assessment and referral

HV/SN is able to demonstrate an awareness and understanding of the NMC Code of Conduct and its impact on their professional practice

HV/SN is able to communicate effectively with service users, as individuals, families or part of a group. The HV/SN should be an advocate for their families, the community and influence policies that affect health.

HV/SN Is able to demonstrate the importance of seeking client consent prior to any intervention

HV/SN non-medical prescribers demonstrate ability to maximise prescribing skills for example has knowledge of safe use of over the counter emollients (LPT Non-Medical Prescribing Policy).

Before the completion of the preceptorship they must have undertaken a LCAT assessment

Section 5 – Safeguarding

Demonstrates knowledge of Local Safeguarding Children Board Procedure’s and LPT policies and practice guidance that relate to children and adults in need of safeguarding. .

LSCB web address http://lrsb.org.uk/

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HV/SN is aware of the location of all documents describing local policies and procedures associated with safeguarding – both electronic and in paper formatHV/SN has the skills to plan, implement and evaluate support packages as appropriate for families (Universal, universal plus and partnership plus and community). Maintains 3 yearly safeguarding trainingHV/SN attends Safeguarding Level 3 training ( date recorded)

HV/SN is aware of the support that is available for safeguarding concerns from peers, safeguarding supervisors, CTL’s. They are also aware of the role and responsibilities of the safeguarding teams for children and adults, as well as the Specialist Nurse for Domestic Violence and know how to access their support, if required.

If possible during the induction programme, they should meet with named nurse within 4 weeks of commencement. They should receive safeguarding supervision in line with local policy.

Prior to having sole responsibility for a safeguarding case the newly qualified HV/SN should shadow and then jointly manage a case with either a colleague or their preceptor (to be agreed locally with CTL) This should include: attending case conferences, core groups, writing reports, using templates on S1 and supervision.

Newly qualified HV/SN should be supported at case conferences up to a year

HV and SN’s new to the organisation should have their knowledge and skill reviewed and a plan of support put in place dependent on past safeguarding children experience.

Section 6 – Medical Devices / Equipment Requirements

Scales (WHO growth chart training available) Measuring mats for babies (WHO growth chart training

available) and Leicestershire height measures. Head circumference measuring tape (WHO growth chart

training available) How to access Dunmow Measuring Mats for children with

Special Needs

Training

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Essential to Role Training – Health Visiting

The following is a training framework that a qualified health visitor practicing in Leicestershire Partnership Trust is required to undertake so they are competent to deliver all elements of the Health Child Programme (2009).

This training supports Trust policies, the Health Visitor Standard Operating Procedures 2012, National Health Visiting Core Service Specification and the Nursing and Midwifery Council Standards of Conduct, Performance and Ethics (2008).

This training is undertaken as a comprehensive two week programme for all new starters within the organisation.

Universal

Antenatal - Promotional Interviewing, Breast feeding. Healthy Child e learning package, Maternal Mental Health

New Birth Visit – Growth Chart ( WHO), Spinal Muscular Atrophy , Blood Spot, New Birth Baby Examination , Maternal Mental Health, Hearing Awareness , Breast feeding , Immunisation update, Neonatal Jaundice

6 week - Growth chart (WHO), Breast feeding - infant nutrition, Maternal Mental Health.

3 /4 month - Nutritional update, Promoting development, Keeping Safe, Oral Health, Maternal Mental Health

1 year - Healthy Child e learning package, Solihull Positive Parenting, Maternal Mental Health, Oral Health

2 year - Ages and Stages Healthy Child e learning package, Solihull, Positive Parenting, Communication from the Start

All - Non-medical prescribing updates for V100 health visitors / school nurses who hold a non-medical prescribing qualification

Universal Plus Solihull Continence Maternal Mental Health / Perinatal mental health Child development tools such as Ages and Stages, Contraception Update

Building Community Capacity Building Community Capacity Smoking Brief Intervention Motivational Interviewing Think Family Drug/alcohol /substance misuse awareness

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Essential to Role Training – School Nursing

The following is a training framework that a qualified School Nurse, practicing in Leicestershire Partnership Trust, is required to undertake so they are competent to deliver their element of the Health Child Programme (2009)

This training supports Trust Policies, The School Nurse Standard Operating Procedures 2012, and the Nursing and Midwifery Council (NMC) Standards of Conduct, Performance and Ethics (2008).

Universal Self-Harm. LPT training once only NCMP Nutrition update 3 yearly Promoting Healthy Weight Nutrition update 3 yearly Continence care 4 day course – 3 yearly update Support for parents and carers Motivational interviewing once only, Solihull training once only. Teenage pregnancy and sexual health Safer sex project training 2 yearly All - Non-medical prescribing updates for V100 health visitors / school

nurses who hold a non-medical prescribing qualification

Universal Plus Solihull Child and Adolescent development tools such as Mary Sheridan, Tanner PGD training EHC training

Building Community Capacity Building Community Capacity Smoking Brief Intervention Motivational Interviewing Think Family Drug awareness

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Appendix 1 – Review Sheet

Name Base

Job Title

Clinical Team Leader Preceptor

Date Date of Completion

Commencement to post: Initial Assessment date:

Start of Preceptorship:

Clinical Supervision 1

2

3

4

Appraisal after 3 months:

Appraisal after 12 months:

LCAT Assessment:

New Starter Training From: To:

Cc Personal File

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Appendix 2 – Action Plan

Action Plan for:

Date Commenced HV/SN Signature

Team Leader Name Signature

Preceptor

Objective Plan to achieve objective with timescale Comments Date achieved

1. Initial self-assessment to identify strengths and gaps

2. Undertake identified mandatory and clinical skills training to underpin health visitors/school nurses knowledge and skills

3. Placement within another health visiting/school nursing team to broaden experience, if needed

4. Alternative learning experiences to develop and enhance practical skills and knowledge as identified in self-assessment

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5.

6.

7.

8.

9.

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References

Amadio (2012) Professional Briefing - Guidelines for Managing Vacant Caseloads, Unite the Union in Health

Boyd E and Fales AW (1983) Reflective Learning: Key to learning from experience.Journal of Humanistic Psychology. Vol 23 no 2 p 99-117

Canham J and Bennett J (2002) Mentorship in Community Nursing: Challenges and Opportunities Blackwell Science London

Department of Health (2009), Healthy Child Programme from 0 - 5 years, DH

Department of Health (2009), Healthy Child Programme from 5 – 19 years, DH

Department of Health (2004), National Service Framework, DH

Department of Health (2004), The Children Act, DH

Department of Health, (2012) Getting it Right for Children, Young People and Families, DH

Department of Health (2012), Health Visitor Teaching in Practice: A Framework Intended for Use for Commissioning , Education and Clinical Practice of Practice Teachers (PTs), London, DH

Department of Health , (2011), Health Visitor Implementation Plan 2011-2014, London, DH

Department of Health, (2010) Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals, DH

Greenwood J (1993) Reflective Practice: A Critique of the work if Argyris and SchonJournal of Advanced Nursing Vol 18 p 1183-7

Johns C (2002) Guided Reflection Advancing Practice. Blackwell Publishing Oxford

Kember et al (2001) Reflective Teaching and Learning in the Health Professions.Blackwell Science London

Kitchener KS and King FM (1990) The Reflective Judgement Model: Transforming Assumptions about Knowing. IN Mezirow J et al Fostering Critical Reflection in Adulthood. Jossey-Bass San Francisco

Kolb D A (1984) Experiential Learning Experience

Leicestershire Partnership Trust, Preceptorship Policy (2014)

Leicestershire Partnership Trust, Safeguarding Policy (2012)

Leicestershire Partnership Trust, Children’s Safeguarding Policy & Safeguarding

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Children Practice Guidance (2013)

Leicestershire Partnership Trust, FYPC Standard Operating Guidance for Family Health Visiting Healthy Child Programme (2015)

Leicestershire Partnership Trust, Infection Prevention and Control Policy (2012)Leicestershire Partnership Trust, Corporate Working Guidelines (2012)

NHS England (2013), Putting Patients First. The NHS England Business Plan 2013/14 and 2015/16. London, The Stationery Office

Nursing & Midwifery Council (2015) Standard of Conduct, Performance and Ethics for Nurses and Midwives

Nursing & Midwifery Council (2004) Standards of proficiency for Specialist Community Public Nurses – School Nursing

Nursing & Midwifery Council (2009) Guidelines for record and record keeping

Richardson G & Maltby H (1995) Reflection on Practice; Enhancing Preceptee Learning. Journal of Advanced Nursing. 22.(2) p 235-243

Schon D (1983) The Reflective Practitioner. New York. McGraw Hill

Sheridan M (1997) From Birth to Five Years Childrens Developmental Progress, Routledge

Tanner J (1990) Foetus to Man, Harvard University Press

Taylor B (2000) Reflective Practice. Open University Press Buckingham

Websites

Institute of Health Visiting: www.ihv.org.uk

Child and Maternal Health Observatory: www.chimat.org.uk

Leicestershire Nutrition and Dietetics Service: www.lnds.nhs.uk

Leicestershire Partnership Trust: www.leicspart.nhs.uk

Local Safeguarding Children Board: www.lrlscb.org

National Institute for Clinical Excellence: www.nice.org.uk

NHS Evidence: www.evidence.nhs.uk

Nursing & Midwifery Council: www.nmc-uk.org

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Tools

SWOT Analysis Tool Denver Development ToolAges and Stages Questionnaires (Squires, J., Bricker)

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Acknowledgements

Nicy Turney, Senior Nurse – Professional Lead, Health Visiting

Margaret Clarke, Senior Nurse – Professional Lead, School Nursing

Filippa Howells, Practice Educator

Mandy Amin, Practice Educator

Claire Silcott, Named Nurse Safeguarding Children

Sue Troy, Named Nurse Safeguarding Children

Jo Chessman, Clinical Team Leader

Sally Clare, Specialist Nurse Domestic Violence

Maureen Curley, Locality Manager

Chris Buzzard, Service Manager

Jo Hackman, Named Nurse

Theresa Farndon, Locality Manager

Carolyn Corbett, Professional Lead, Safeguarding

Roma Boobyer, Named Nurse

Neil Hemstock, Lead Nurse FYPC/Specialist Clinical Director CAMHS

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Preceptorship has been successfully completed.

Please comment and demonstrate the evidence in the portfolio and the rationale that the various competencies have been based upon.

Sign (Preceptee) Date

Sign (Preceptor) Date

Sign (Clinical Team Leader) Date

cc personal file

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