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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
Returning to Nursing Practice Navigate every step of returning to nursing practice with this accessible guide Returning to Nursing Practice offers a step-by-step guide to navigate the challenges of returning to work after a practice break. It advocates renewed career pathways in healthcare for nurses rediscovering their professional identity and confidence. Common features of RTP courses are discussed including updating study and clinical skills and the importance of reflective practice. The book highlights the practical, psychological, and community-oriented aspects of returning to the profession and is an invaluable resource for any nurse considering or embarking on this journey. Returning to Nursing Practice readers will also find: * Content designed to re-familiarise the returning nurse with updated healthcare practice * An easy-to-use and readable style, supplemented throughout with figures and illustrations, and hints and tips from previous returners * Careful attention to the student and practice assessor relationship, and the value of peer support, and well-being Returning to Nursing Practice is essential for nurses undertaking RTP courses and lapsed registration nurses considering a return to practice.p>
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Seitenzahl: 464
Veröffentlichungsjahr: 2023
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Returning to Nursing Practice
Confidence and Competence
Ros Wray and Mary KitsonUniversity of Northampton Northampton, UK
This edition first published 2023
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Cover Image: © Cover Image and Illustrations by Cecilia Wray
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Set in 10.5/13pt STIXTwoText by Integra Software Services Pvt. Ltd., Pondicherry, India
Contents
Cover
Title page
Copyright
Preface
Acknowledgments
CHAPTER 1 Your Time to Return
Your Nursing Identity
The Starting Point
Why Did You Leave?
Is It the Right Time to Return?
What Have You Been Doing since You Stopped Nursing?
The Test of Competence: An Alternative Route to Re-Registration
Financial Issues
Thinking Ahead
References
CHAPTER 2 Preparation
Current Roles and Commitments
The Return to Practice Course
Application
Entry Requirements
Learning Differences
Professionalism
Admission Days and Interviews
Numeracy
NMC Professional Standards
Course Content and Structure
Planning Your Practice Placement
Supervised Practice Hours
Specialist Community Public Health Nursing (SCPHN)
Midwifery
Preparatory Study and Reading
Are You Ready?
References
Useful Website
CHAPTER 3 Bridging the Gap
Sharing Hopes and Fears
The Gap
Self-Efficacy – A Helpful Concept
Confidence and Competence
Self-Assessment
The Language of Nursing
What Has Been Happening Whilst You Have Been Away?
Professional Values
References
CHAPTER 4 Practice Placement
First Steps
Practice Provider Induction
Finding Your Feet
Team Working
Belbin’s Team Roles
Practice Assessor and Practice Supervisors
Confidence and Competence
Decision Making and Leadership
Understanding Scope of Practice and Your Chosen Field
How Will I Be Assessed?
Your Support Networks
References
Useful Website
CHAPTER 5 Reflective Practice
Stories
Self-Awareness
Introducing Reflection
Dipping into the Theory!
Models and Frameworks and the Reflective Process
Borton (1970) And Driscoll (1994, 2007)
Reflective Thinking and Writing Skills
Describing
Choosing Your Experience
Gibbs Reflective Cycle (1988)
Analysing
Future Learning and Action
Being a Reflective Practitioner
References
CHAPTER 6 Caring for Yourself
Course Progression Points
Self-Care: Managing Your Well-Being
Body: Physical Well-Being
Mind: Mental Well-Being
Spiritual Well-Being
Heart: Emotional Well-Being
Resilience
Compassion
Compassion Fatigue
Burnout
Balance
References
CHAPTER 7 Returning to Study
Preparation
Time
Place
Personal Learning Styles
Understanding Course Requirements
Learning Outcomes
A Framework for Academic Writing
Knowledge for Practice: The Evidence Base
Reading
Libraries
Referencing
Assignment Writing Process
Planning
Writing
Editing
Personal Tutorials
Additional Resources and Support
Achievement
References
CHAPTER 8 Re-Entering the Workforce
Celebrating Success
The NMC Re-Registration Process
Career
Job Applications
Interviews
Bank Nursing
Recruitment Agencies
The Independent Sector
Indemnity Insurance
Preceptorship
Cultural Competence and Cultural Humility
NMC Personal Re-Validation and Your Continuing Professional Development
References
What I Have Learnt about Myself
Index
End User License Agreement
List of Illustrations
CHAPTER 01
ILLUSTRATION NO. 1.1 Young mum with...
CHAPTER 02
ILLUSTRATION NO. 2.1 Student buying book.
CHAPTER 03
ILLUSTRATION NO. 3.1 Peer support.
FIGURE 3.1 NHS Culture of Compassionate...
FIGURE 3.2 NMC code.
CHAPTER 04
ILLUSTRATION NO. 4.1A First day.
FIGURE 4.1 Maslow’s theory (1987).
FIGURE 4.2 Tripartite support and...
ILLUSTRATION NO. 4.1B Gaining confidence.
FIGURE 4.3 Comfort Zone Model...
FIGURE 4.4 Three-bucket model...
CHAPTER 05
FIGURE 5.1 The Johari Window
FIGURE 5.2 Reflective theory diagram...
FIGURE 5.3 Borton (1970) and...
FIGURE 5.4 Gibbs reflective cycle
ILLUSTRATION NO. 5.1 Cat and lion.
CHAPTER 06
ILLUSTRATION NO. 6.1 Doing yoga.
FIGURE 6.1 Stress bucket. Source...
FIGURE 6.2 What keeps me...
CHAPTER 07
FIGURE 7.1 Mind map of...
ILLUSTRATION NO. 7.1A Night owl – Early...
ILLUSTRATION NO. 7.1B Young mum studying...
FIGURE 7.2 Blooms taxonomy. Source...
CHAPTER 08
ILLUSTRATION NO. 8.1A Celebrating success.
ILLUSTRATION NO. 8.1B Health Visitor’s home...
Guide
Cover
Title page
Copyright
Table of Contents
Preface
Acknowledgments
Begin Reading
What I Have Learnt about Myself
Index
End User License Agreement
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Preface
Welcome to Returning to Nursing Practice: Confidence and Competence. This book is intended as a guide for those contemplating or undertaking a return to their practice role. If you are thinking about going back to your profession after time away, we know that you may also be apprehensive. There may be a sense of lost skills and knowledge, a practice gap that is too wide or a fear that you will not be able to cope with today’s working pressures. These are entirely understandable feelings shared by nurses, teachers, social workers and many others. Professional roles such as these are both fulfilling and demanding, carrying at their core ethical responsibilities and a commitment to give to others. There are skills to refresh, knowledge to renew and an identity to reclaim. This is a journey back to confidence and competence. Over twenty years of involvement in supporting returning nurses and health visitors has afforded us insights into what it is like to travel this path. We hope here to both inform and reassure by sharing with you what we have learnt.
Our approach is largely generic across all nursing fields because we wanted to highlight the fact that by far the most significant aspect of returning to professional practice is that it is a shared experience. In some areas our discussions may lean more towards one field than another and, at this point, we must note that we have made only brief mention of midwifery; however, again, as so much of returning to the healthcare professions embraces common ground, we hope returning midwives will find something of value here to take away. Our intention has been to be as inclusive as possible, drawing on and representing examples from across the range of practice specialties.
We have included points of academic reference whilst also aiming to sustain a light flow of reading. We wanted above all to communicate usefully, creating a book which feels friendly and informative. One of the challenges for us has been to find a balance between these two settings, and we hope that this has been achieved. You will find published sources and web links for further reading listed at the end of each chapter. We have endeavoured to be consistent in our terminology, but we are also conscious that returning nurses will have varying orientations to different frames of reference depending on when they were last in practice. As mature nurses we are most comfortable with the term ‘patient’ to refer to individuals who receive care, and so this is what you will see most often in the text. However, occasionally we have also used ‘service user’ and ‘client’.
There are now a range of routes to choose from when considering a return to nursing. We have outlined these in one of the early chapters. However, our focus is the Return to Practice course because this remains the most popular choice for returning nurses. We believe the reason for this is that students gain invaluably from the support of others embarking on the same journey. Every cohort becomes a small community of fellow travellers who help each other along the way: encouraging, informing, giving each other lifts and often forming solid friendships. They are a courageous, kind and resilient band of individuals and this book pays tribute to their endeavours.
Specifically, we are indebted to the many nurses who have contributed to this book, either directly or indirectly. Their thoughts and feelings have been captured in the Words of Wisdom boxes found throughout the book. Some of these provide a summary of comments from returning students across many cohorts and some reflect the views of individuals. We hope to act as a channel enabling you to hear their voices with the hints, tips and reflections that they have wanted to pass on to you.
The book is organised into eight chapters. We begin with a short opening chapter which addresses the personal decision making involved in a return to nursing. We also consider what nursing identity might mean to us all and set the scene for the start of your journey back to the profession.
Once your decision has been made, Chapter 2 focuses on the practicalities of the next steps. Advice is given about when might be the right time to start a course, with an emphasis on managing self-expectations and maintaining a work-life-study balance. Guidance is provided on course application, course content and placement arrangements. Comparative aspects of community and acute settings are discussed with reference to the four nursing fields and specialist community public health nursing.
Chapter 3 is entitled ‘Bridging the gap’ referring to the in-between years since a returner last worked as a registered nurse. Returning to practice is first and foremost about regaining confidence. We acknowledge the hopes and fears that individuals often experience when they start the course and highlight the way in which cohorts tend to bond together, offering each other valuable peer support. The chapter focuses on knowing self and the importance of self-assessment and self-efficacy. With growing confidence comes competence, the two going hand in hand throughout the return journey.
Themes crucial to a positive practice experience will be discussed in Chapter 4 including the relationship between the student and supervisor, and the importance of questioning, assertiveness and seeking support. This is a substantial chapter which addresses key areas of contemporary nursing practice such as team working, management and leadership, and clinical judgement. Neither true pre-registration student nurse nor staff nurse, the Return to Practice nurse stands alone; the role is defined as unique and explored with consideration of scope of practice and the importance of understanding your individual practice gap and the value of your professionalism and your prior knowledge and experience.
Whilst detailed coverage of the four nursing fields and Specialist Community Public Health Nursing is beyond the scope of this text, we have explained how field specific nursing competencies and professional standards may be met. The chapter continues by outlining the usual process of assessments along with links to references and resources.
Chapter 5 aims to provide a fresh and rounded view of reflective practice. We hope to re-enthuse those who can only remember reflection as an overused type of assessment, as well as draw the interest of those who are new to the topic. Through the lens of returners’ contributions, we consider the significance of stories, self-awareness and the reflective process to ongoing learning and change in nursing practice.
Returning to practice brings both joys and challenges. Studying again after a gap can be frustrating initially because everything feels slow and inaccessible; those first few weeks back in practice can be physically very tiring; and of course, nursing work is emotionally taxing. Suddenly, mind, body and spirit need to work in ways that they may not have done so for some time. In Chapter 6 we suggest a range of tips on how to maintain well-being during your return journey and beyond. Wherever possible, these discussions have been matched to course pinch points so that guidance feels meaningful and relevant.
Many returning nurses feel apprehensive at the prospect of studying again. The gap since they last attended a university can be as much as twenty years, or they may have trained in a school of nursing and therefore not encountered university study before. Chapter 7 acknowledges the diversity of student experience and aims to present some useful advice which will help to strengthen confidence. We hope to convey a sense of how it feels to study again after a break, picking up on key observations and advice that nurse returners have shared with us over the years.
The final chapter marks the completion of the return to practice journey and your arrival back in the professional workforce. Here we celebrate achievement and outline the process of NMC re-registration. We provide some information about preparing for job applications and interviews and share feedback from previous returners about the experience of being back at work.
Our final course day is one of celebration. These are a group of individuals glowing with achievement and sometimes surprised delight at what they have made possible. We have ended the book with their final Words of Wisdom as they share what they have learnt about themselves and prepare to embark on the next stages of their journey. Their stories and experiences have encouraged and enabled us to complete this book and continue our lifelong learning. We hope that it will inspire you with the confidence to undertake your journey back to your professional practice.
Ros Wray and Mary Kitson 2022
Acknowledgments
We are indebted to the many cohorts of returning nurses and health visitors who contributed so generously to the writing of this book. They have been happy to share their written accounts and Words of Wisdom for the benefit of future returners and we could not have achieved this work without their help. We would also like to acknowledge our colleagues for their supportive insights.
Special thanks and acknowledgements go to Ann Walsh, Lindsay Wells, Emma Williams, Gillian Siddall, Valerie Olivant, Michaela Macalister, Lara Lang, Sharon Lock, Tricia James, Chris Jones, Memory Kamhuka, Lisa King, Maria Hames, Susan Hayden, Beverley Hill, Justine Hill, Linda Hoe, Lynne Hoppenbrouwers, Laetitia Gamble, Karen Gibbons, Claire Frisby, Abbie Fordham Barnes, Rebecca Eames, Tracey Dyne, Frances Brookfield and Donna Bray.
We would like to thank Cecilia Wray for her illustrations, and Anne Hunt for her patient guidance.
We are also very grateful for the support and understanding of our close families and friends who have also lived with this project for some considerable time.
CHAPTER 1 Your Time to Return
At any given time, there are thousands of nurses living in the UK who are not actively registered to practise. Many are retired; some will never return, and some are taking a break. Between 2014 and 2021 almost 8,000 nurses did come back to the profession and for each one of these individuals there came a day when they decided to start that journey (Nursing and Midwifery Council (NMC) 2022). In this chapter we will explore the personal decision making involved in a return to nursing. There will be many questions which we hope to be able to go some way to answering. The discussion will highlight practical factors to consider including balancing competing commitments and identifying support networks.
When asked the inevitable question ‘Why are you doing this?’ many returners talk of a need or pull to come back to nursing. ‘It is my turn now’, they say. ‘I am doing this for me.’ Nursing provides many of us with a lasting sense of identity. Our past nursing histories coupled with life experience make a powerful combination (Morton-Cooper 1989). Despite writing over thirty years ago when returning to practice was more of a ‘movement’ than an established process, Morton-Cooper’s words endure, encouraging returners to perceive the value that their nursing skills bring in dealing with everyday challenges and stresses. Years of nursing often leave an individual drawn to the caring of others. Those qualities of listening and responding continue through life whether your professional registration is lapsed or active. Your nursing knowledge and skills may be out of date, but your impulse to care is likely to be as strong as ever. In addition, your sense of professionalism and your ability to assess and plan will also be alive and well. You will know that once a nurse always a nurse. All that remains is for you to find the confidence and competence to become again a safe and contemporary practitioner.
YOUR NURSING IDENTITY
Your reasons for wanting to return may echo those first questions we can all remember being asked at interview about our choice of nursing as a career. Why do you want to be a nurse? What qualities do you possess that will help you to be a nurse? For many, responses tend to be based on caring principles and the desire to make a difference. The concept of care is one of the most important aspects of nursing. A positive correlation has been identified between intrinsic factors such as caring, helping and taking responsibility for others and the decision to become a nurse (Ben Natan and Becker 2010). Clearly differentiated from the ‘curing’ focus of the medical profession, nursing has traditionally been associated with ‘caring’ with nurses viewing care as a major part of who they are (Traynor and Evans 2014).
Words of Wisdom
Returning to professional practice is personally and professionally challenging. Our identities as nurses are shaped by our initial experiences of nurse education and our subsequent careers are equally shaped by the culture and practices we encounter. Returning to the register involves a leap of faith; will what we know and remember matter? Will we adapt and succeed as evidence-based practitioners? My own experience of Return to Practice was both humbling and liberating. My practice placement valued my experience, and my university tutor challenged me to think differently. Returning to the register allowed me to review my professional identity and rejoin the nursing family. I hope those who take this route feel as inspired and reinvigorated as I did.
A sense of professional identity starts to develop during our nurse education when we discover what caring means. As we progress and our knowledge grows, our core nursing values integrate with skills of communication and clinical reasoning. We think and feel and behave as a nurse. Although it may wax and wane through our lives, this sense of being never leaves us. Professional identity develops and evolves at different stages throughout working life (Tamm 2010; Bridges 2018). It is shaped and monitored by a professional code and defined by individual attitudes, beliefs and values. Bridges (2018) suggests that our professional identity relates predominantly to integrity, compassion and person-centeredness. These remain the core values of the nursing profession despite the changes in training and education as we journey into the 21st century. What patients cherish and remember most is kindness, empathy and compassion (NHS England/ Nursing Directorate 2013). As you would expect, these qualities continue to be championed in the NMC Code and nursing standards (NMC 2018a, 2018b). As a team we have personal experience of the trepidation commonly felt on returning to the clinical environment after a gap in practice. However, whilst the variations in technology, systems and processes will always present initial challenges, most significant is the fact that patients’ needs remain unchanged.
Words of Wisdom from a Returning Nurse on Starting a New Job
Having been in my role for four months I wake up every morning and look forward to going to work in the knowledge that I am making a difference to the lives of the patients in my care.
THE STARTING POINT
Returners will often talk about the point in time when they started to contemplate coming back to practice. For some, nursing a loved one has reawakened a sense of needing to care more widely again; for others, the frustrations of not feeling fulfilled by a current occupation may have sparked a sudden insight. Perhaps a chance conversation with a former nursing colleague has triggered memories. Some have always planned their return, perhaps to coincide with when their children commence school or when a family commitment is lifted; and some returning nurses have been surprised by the urge to respond to a perceived need, even if that means coming out of retirement.
Words of Wisdom
In December 2010 I took premature retirement from my nursing career due to organisational reconfiguration. At the time this was quite a life-changing move as it was something unexpected and not how I had planned my career would progress. For more than thirty years I had been passionate about people, patients and their care but at this time I remember the juxtaposition of feeling guilty for ‘letting people down’ and wounded as a casualty of NHS change.
My new situation allowed me the opportunity to realise a long-held ambition to own a restaurant and this was my focus for seven years. However, during this time I also needed to care for a poorly relative and this was the point at which I started to inwardly question my decision to leave nursing. Providing twenty-four-hour care helped to confirm my views that nursing was for me always a natural vocation. The positive impact that nurses can have on someone else’s life is an inspiring role to deliver.
In February 2019 I returned to a caring role and then reflecting upon professional and social responsibility I also joined the army of people in the fight against COVID-19. Becoming a vaccinator was predicated upon the achievement of nationally prescribed competencies and at the time I remember questioning whether I still had the skill, knowledge and mental agility to succeed. Thankfully I overcame my apprehension and that, together with support from my colleagues, gave me the confidence to consider returning to practice.
On one occasion at the vaccination centre, I was asked about my previous work history and replied that I had been a nurse. My colleague responded by saying ‘once a nurse, always a nurse’. Whilst this may not be true for everyone, it certainly has proved to be the case for me, and I have now successfully regained my registration.
Global shortages in the healthcare workforce had prompted the World Health Organisation (WHO 2020) to designate 2020 as the year of the nurse and midwife. This acknowledgement and celebration of these important roles was intended to raise the profile of the profession and advocate for additional investment. Unfortunately, the initiative was overshadowed by the COVID-19 pandemic which continues to challenge all aspects of society and healthcare provision across the world (Moynihan et al. 2020).
Despite the destabilising effects of so much of our day-to-day life including family relationships, travel, education, working practices and supply chains, nurses rose to meet the needs of those most vulnerable, adapting practice and protocols to provide care throughout. New ways of working and organising care were swiftly put into place. Vindrola-Padros et al. (2020) highlight that supportive work environments are crucial for motivating staff during times of challenge; without the usual bureaucratic red tape, practice can be modified and adapted very quickly. The NMC temporary registrar is a good example of this response. Thousands of nurses who had left the register through retirement or change in career were urged to return to the workforce to utilise their experience and skills and be part of the NHS COVID-19 workforce. The NMC temporary register opened in March 2020 and was still recording over 13,000 active nurses in August 2021 (NMC 2021a). This upsurge in returning nurses to the workforce during the pandemic is testament to lifelong passion and dedication to the profession.
The COVID-19 pandemic has also put a spotlight on nursing as a career. Applications to study nursing have risen by a third not just from school leavers but also from older adults seeking a change in career direction (UCAS 2022). This is positive news in the face of an overall decline in UK nursing numbers: 11.3% of registered nurses (around 27,000) left the profession in 2021 (NMC 2022). Demographic figures are also a cause for concern as within the next few years it is anticipated that an increasing number of registered nurses will be eligible to retire. Current workforce analysis predicts that the current shortfall of 50,000 nurses could rise to nearly 64,000 by 2024 (The Health Foundation 2022).
Subsequently, more investment is proposed in the NHS workforce with training of health professionals across all sectors. Attention has also been paid to the working conditions of NHS staff with the launch of the People Plan in 2020/2021, set up to encourage a more inclusive supportive work environment. We will return to this subject in our chapter on well-being.
WHY DID YOU LEAVE?
Words of Wisdom
I feel I need to say how I came to leave nursing originally. My main reason was my young family at the time, with it often being difficult to manage being there for them as I had no alternative childcare available. This has improved vastly since but, although not going back to nursing was one of the hardest decisions, it felt the best option for us as a family. I had considered returning to nursing a few years before and even made enquiries with the course leaders. However, I continued to put off taking it further as my family always seemed to need me. I have realised now that they are always going to need me, but as they have become teens and young adults, they also need that increased independence. The year I finally made the decision to return was the pandemic of COVID-19. I felt frustrated that I was not in the nursing workforce with having skills and knowledge that could have helped my colleagues and patients at their crisis point. I suppose COVID-19 was a catalyst in my decision to return.
It may help to think back to when you last nursed. Were you working in the acute sector, or were you community-based? If you were a single person with few commitments, a demanding and fast-paced job may have felt exciting and rewarding; however, if you now have a family and an elderly parent to support, you may feel that a slower or less acute environment would suit you better. Many nurses leave the profession for family reasons, whilst others may move into a managerial role or a different career entirely. Statistics show that whilst nursing registers as one of the most rewarding jobs, it also carries a heavy emotional burden. It may be that a past nursing role prompts memories of strain and fatigue. In 2014 a literature review carried out by Health Education England (HEE) acknowledged that the most common cause of nurses leaving the National Health Service was work-related stress (HEE 2014). It is important to reflect on your time as a nurse and to ask yourself what you valued most, and what was difficult to cope with? These are vital considerations which will help guide your direction of travel as you think about your return to the profession. Sustaining and balancing your well-being as a nurse is fundamental to a successful return to the profession and we will be looking at this in detail in Chapter 6.
IS IT THE RIGHT TIME TO RETURN?
Judging when to return requires careful thinking and planning. Many nurses leave the profession to have children. The start of full-time education for children can mark a significant transition for all family members, and it can provide parents with the opportunity to return to careers. However, with good childcare in place, it may be possible to consider returning when a child starts nursery. It is important to tune into what feels right for all concerned; this may mean reviewing how existing arrangements could be expanded or modified to accommodate your plans. We would advise that you talk to your family about what might be possible and look further afield to see who else may be happy to help.
ILLUSTRATION NO. 1.1 Young mum with children and calendar.
It is possible to get the timing wrong. We remember one applicant who desperately wanted to come back to nursing, but who arrived for an informal chat with three young children in tow, all under the age of five. She did have some child-care in place and willing parents to hand, but as we talked through the course and placement requirements, she began to see a reality of rushed journeys to and from practice, school and childminders and evenings torn between studying and bedtimes. It was too early. She left disappointed. However, she did succeed in returning to nursing a few years later when able to balance her personal commitments more comfortably. The next section examines issues related to family and young children in more detail.
You will need to allocate nine months to a year when planning your return journey. Traditional Return to Practice courses can range in length from four to six months, and you will need to factor in additional time for application and re-registration processes. This does not mean that everything else in your life is on hold; but it does mean, that returning to practice will dominate. Most courses are part time (although they may not feel like it!), so a short holiday can usually be accommodated alongside. Any protracted time away, though, is best scheduled for the future. Similarly, if you have a part-time job with fixed days or hours, this may well be difficult to fit with days in placement where matching your Practice Supervisor’s shifts must take precedence for review and assessment of your practice to be feasible. Flexible part-time work and an understanding employer can be a supportive element in your return to nursing, especially if the work is healthcare related but it does require negotiation and transparency to avoid any potential conflict of interest from the existing employer.
Some courses are run several times each year, so it is well worth inquiring about different intakes if you do have an important commitment to work around. Many students opt to avoid the school holidays, preferring to commence a course in the autumn or spring. Planning in this way will ensure a smoother and less stressful experience.
WHAT HAVE YOU BEEN DOING SINCE YOU STOPPED NURSING?
Return to Practice students come with a wide variability in background. Some may possess little or no post-registration experience whilst others will have occupied senior clinical or management roles. You may have left nursing to pursue an alternative career or job. This is not uncommon. We have spoken to and supported returners who have started up businesses, become teachers or researchers, or taken up charity work. Their reasons for wanting to nurse again are of course multi-faceted, but many share a sense of incomplete fulfilment and a pull to contribute again within a purely caring role. Here is one returner’s story:
Words of Wisdom
I initially qualified as a nurse in the late 1980s and spent twenty-seven years wearing my uniform with pride. I qualified as an independent nurse prescriber, specialised as an urgent care practitioner and became a trainer and assessor for post-graduate nurses undertaking level 6 university training. In 2014, I had the opportunity to train as a Special Constable, volunteering in my community as a police officer. I found this extremely rewarding and made the decision in 2017 to change careers. I left the NHS and joined the police as a regular full-time police officer. I was happy in my role, serving as a front-line officer.
In 2019 the world changed with the arrival of COVID-19…. Many of my friends were still working as nurses and under enormous pressure. In late 2020 the ‘call to arms’ was made by the government to support the vaccine programme and I joined the NMC temporary nursing register. This allowed me to support the NHS, becoming a COVID-19 vaccinator and doing my bit to help my community. I requested a three-year career break from my role as a police officer to support the COVID-19 vaccination programme. This was granted with full support. I then made the decision that I wanted to reinstate my NMC registration.
I was fortunate to join the Return to Practice nursing course with Northampton University. The course was rewarding, and I particularly enjoyed the opportunity to reflect on my past and recent nursing practice. I successfully completed my course last year. I am now happy to be back in the NHS, working within the learning and development team as a clinical educator. I currently have no plans to return to the police. I would highly recommend the Return to Practice programme and hope my story has inspired you to re-join the nursing profession.
Healthcare assistant work can provide a useful platform from which to launch a return to nursing. Whether you are hospital or community-based, this role will bring you up to date with healthcare teams and settings and, most importantly, put you back in touch with patient care. It is crucial, though, to balance any work commitments with the demands of the course so that student hours and employed hours are co-ordinated, separate and well-paced.
Learning and teaching assistant work in schools is also favoured by nurses with lapsed registration. This role has relevance to parenting, and caring in a wider context, and may enable some to use their nursing experience as first aiders or within special needs. It provides a good precursor to returning to practice. Again, though, it is vital to negotiate a flexible working pattern whilst undertaking your clinical placement. For some returnees this may not be possible, and they may decide to resign their post before commencing the course.
Some individuals have remained in the healthcare sector but progressed their careers into management posts. They may have reached a point of needing to renew a lost connection with patients in clinical settings. If this is you, be prepared for those around you in your practice placement to soon perceive this wealth of experience, even if it is not obvious to you! You may feel that others expect you to perform at a higher level than feels comfortable or, more likely, you may expect this of yourself. Every returner will have challenges to manage; for those who have been used to a senior role in the past, the task may be to reset expectations and present yourself as a student who needs to learn and feel supported. Once you have found your feet and your own comfort level, you will be able to move forward with growing confidence. When you return to the nursing workforce you will initially find yourself in a more junior role again. Some welcome this and have no urge to return to management; others will find that their knowledge and skills takes them inevitably in that direction.
Occasionally returners join the course with no post-registration experience prior to their break. Often this is a result of individual personal circumstances. Following qualification and registration, one recent student was unable to take up a post because he was needed to care full-time for an elderly relative who had become suddenly unwell. However, he was able to secure an employment route for his return to nursing in an area where he was already working as a Healthcare Assistant. The benefits of working and learning in a team of known colleagues brought a sense of belonging and helped him to build the confidence required for his future role as a registered nurse.
THE TEST OF COMPETENCE: AN ALTERNATIVE ROUTE TO RE-REGISTRATION
You may feel overwhelmed with the thought of undertaking a course of study and spending a protracted time in a placement under supervision. It may be that no university in your area runs the course, or the logistics and timeframes may be impossible. Perhaps your registration has recently lapsed without you intending it to do so. In recent years, the NMC have tightened up their time allowances for re-registration, and this has inevitably caused some issues with nurses who for one reason or another – be it ill health, moving to a new house or caring for another – have been unable to meet the strict criteria for renewing registration and meeting revalidation requirements. Besides the traditional course route, it has been determined in recent years and highlighted in the new RTP standards that another route to re-entry to the register is needed to provide greater flexibility and acknowledge the value of nurses returning to the profession (NMC 2019; Scammell 2019). The Test of Competence (ToC) offers an outcomes-based route which is consistent and standardised and was initially introduced by the NMC in 2014 for internationally qualified nurses and midwives. In 2018 it became an option for UK registered nurses as a route to return to practice.
The ToC option has been channelled as a new pathway which assesses clinical skill and competence in real-world scenarios. It is a relatively new option for nurses returning to the register; it may suit some more than others. Nurses with lapsed registration, who contributed their service via a temporary register during the COVID-19 pandemic, may now find that the ToC provides a fast track to return to the profession. It can offer a speedier process and may appeal especially to those whose registration has recently lapsed and who still feel broadly confident in their knowledge base and in the prospect of performing skills under scrutiny.
There are two components to the test, and it is available across the four fields of nursing and midwifery.
Part 1 is a computer-based test (CBT) consisting of two parts – one clinical and one numeracy. The numeracy test consists of fifteen questions based on medication dosages and infusion/fluid balance calculations. The clinical section is a multiple-choice quiz which combines a clinical focus with overlapping generic questions for different fields of nursing. Part 1 is available in most countries throughout the world and can be accessed via a Pearson VUE test centre. It is possible to take the test in any order although nurses from overseas tend to take Part 1 first in their home country and then proceed to Part 2 once authorised by the NMC.
Part 2 is the Objective Structured Clinical Examination (OSCE). This is designed to test candidates’ ability to assess, plan, implement and evaluate care based on everyday practice scenarios. The test is only accessible in designated test centres in the UK. Currently, there are four test centres in the UK: these are located at the University of Northampton, Oxford Brookes University, Ulster University and Northumbria University.
It is possible to sit the CBT or the OSCE in any order but both components must be successfully completed within two years. The application process is through the NMC and there are links and resources freely available via the NMC website or alternative providers to support and prepare for the tests. Preparation materials include mock OSCEs, webinars and reading materials, information booklets, marking criteria and examples of the relevant documentation used such as observation charts.
The scenarios are structured so that you can apply your knowledge and skills to demonstrate person-centred care and best practice. The OSCE is made up of ten stations some of which are scenario-based and related to the nursing process framework: assessment, planning, implementation and evaluation. There are also two sets of three stations which test linked skills and two written stations assessing professional values and critical appraisal of evidence and decision making. Communication is fundamental to nursing practice and is assessed throughout the scenarios.
The ToC is designed to ensure you are a safe competent practitioner at the point of registration. The knowledge and skills assessed are aligned to the Future Nurse Standards (NMC 2018b) which are generic and apply across all fields of nursing: adult nursing, mental health, child and learning disabilities. This reflects the complexity of today’s nursing with many patients having co-morbidities that require highly skilled input from specialists from a range of disciplines.
This route can be pursued independently or with support from employers. Some Trusts offer employment routes for returning to the register; this may be an area worth exploring locally. There can be contractual requirements with this offer with some organisations proposing employment as a Healthcare Assistant for a set number of working hours in conjunction with supporting you through the ToC. This can be beneficial if you have not quite made up your mind about re-entering the register; the opportunity to work in a supported and supervised healthcare setting may give you the confidence you need to make this decision.
The employment-led approach can also work alongside the traditional Return to Practice course and for some students the chance to earn whilst undertaking the course is very beneficial. However, if this route is of interest and available, do be mindful of the contractual requirements as you may find combining working hours with the additional responsibilities of completing the programme demanding.
Both the ToC and RTP course options are available to returners to date, and it is up to the individual to choose which route suits their needs best. Both are professionally regulated by the NMC with information about where and how to apply accessible on the NMC website (NMC 2021b). The NMC and Health Education England websites also provide case studies from previous returning students so do take time to browse and get a sense of what both routes entail. It is important to weigh up the pros and cons before deciding. Currently it is not possible to update a Specialist Community and Public Health Nursing (SCPHN) registration via this route; however, specialist practice qualifications including SCPHN are under review by the NMC and so this may become an alternative option going forward.
FINANCIAL ISSUES
Any change in direction in life or career can be challenging. Family finance was identified by the NMC as one of the main barriers to re-joining the register with 58% of returners citing it as a concern (NMC 2019). It is a difficult decision to make particularly with rising household costs and, of course, a matter for individuals to work out income and expenditure to see where and if adjustments can be made. The usual practical tips apply including setting a limit on spending, checking tax codes and benefit eligibility – all things which may help draw additional income in the short term.
Return to practice courses have been government funded as a part of a wider workforce recruitment strategy. This means that your course fees will be funded by HEE, the organisation responsible for the education and development of the healthcare workforce (Health Education England 2014). You will also be provided with a payment to help cover some of your travel costs and expenses whilst undertaking the course. Details of this funding can be found on the HEE website along with a variety of resources which provide a very good starting point if you are returning to the profession.
Since 2014 HEE has been instrumental in supporting almost 8,000 nurses back into the workforce (HEE 2021). The vision of HEE is to supply the NHS with a skilled and competent NHS workforce to meet demand to ensure safe patient outcomes. Their wider strategy aims to develop systems which enable the range of allied health professionals to return to practice and this, of course, is crucial to maintain safe staffing levels. Circumstances can change with governments fluctuating from funding to non-funding according to the times. The prospect of a funded course is an important incentive for those individuals coming back to the workforce following time out with family; for others already in employment, making the transition back to a period of education could result in a temporary income shortfall.
THINKING AHEAD
Whatever your background, it can be helpful at this early stage to have some thoughts as to your future career direction. A long-term goal – such as moving from nursing to health visiting – will require some stepping-stones. In this instance, your first thoughts may be on updating your acute nursing skills through a ward-based placement which reflects your previous experience. Following re-registration, you may then decide to spend twelve months working in inpatient general medicine to build further confidence and consolidate your nursing skills before perhaps taking a community nursing role with a health visiting team. It would then be an additional step to undertake your health visiting training.
You may not yet know what you want to do once back on the register. Some returners are happy to look around gauging their thoughts and feelings with ‘a toe in the water’ before deciding on their next move. For many, the notion of a big career plan may not chime with current thinking or circumstances; self-fulfilment may be about returning to the heart of the nursing role, caring again for patients and enjoying the camaraderie of a nursing team. Job opportunities will arise whilst you are on the course, and we would encourage you to pursue those of interest; remember that your time in practice placements will also enable informal conversations about potential vacancies. Most employers are keen to recruit returners who they know have much to offer and whose progress back to professional competence they have been able to follow. Interviews and appointments often happen during the course with provision for interim roles to cover the period between successful course completion and NMC re-registration. There is, therefore, no wrong time to apply for posts: the message is that once enrolled on your course, the job market is open.
This could be something that you have toyed with for a long time either as a closely guarded secret or as a threat to errant teenagers! It may be that your circumstances have changed, and this is a decision that has come about sooner than you anticipated. Whatever your reason, a return to nursing is a major decision but also a frequently travelled path. Hopefully, we will be able to provide some insight and practical advice as you make your journey. We can also reassure you will not be alone – others will be travelling with you!
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CHAPTER 2 Preparation
Once you have made the decision to return to nursing, planning is crucial. The first step is to gauge your current set of circumstances. You will need to weigh external and internal factors so that you have a clear picture of where to most channel your energies. An initial quick self-inquiry may help you to shape your preparations. Here are some questions that may be helpful:
What roles do I now have in life?
Does this differ to when I last nursed?
What and who will help me?
What type of nursing am I most familiar with?
Where do I want to be in a year’s time?
What are my strengths?
What could be a potential source of difficulty?
CURRENT ROLES AND COMMITMENTS
A role can be defined as ‘a position or purpose that someone has in a situation, organisation, society or relationship’ (Cambridge English Dictionary 2022). Roles in life span the breadth of our human experience, appearing in cultural, social and work contexts. They can evolve, develop, intertwine and disappear. Some may be lifelong such as our gender or being a sibling; some are more temporary and situation-specific such as acting as an eyewitness or an interviewer. Once we accept or acquire a role, we also take on the responsibilities that come with it. So, for example, if you have agreed to work in a charity shop for four hours every week, you have an obligation to comply with the requirements of that position. It could be argued that mature working adults tend to have the most roles and therefore perform the most juggling! The key, of course, is to be aware of how many roles you have so that you can avoid the strain that can arise when they become overloaded or conflicted (Creary and Gordon 2016).
A useful exercise is to write down your current roles and obligations. It may look something like this:
Parent
Spouse/partner
Sibling
Daughter/son to elderly parent
Home maker
Part-time charity worker
Neighbour
Friend
Dog owner
Jogger
