An adapted model of the Collaborative Learning in Practice approach was developed to support student placement capacity
In 2019, the government pledged to increase the registered nursing workforce by 50,000 posts. In support of this, an acute hospital trust increased its clinical placement capacity for student nurses by adapting the Collaborative Learning in Practice approach. It introduced a learning bay to practice learning environments and used a coaching supervision model for students. The project increased clinical placement capacity, and feedback from both students and staff was positive, leading to consideration of expanding the model into other areas and regions.
Citation: Rajan T et al (2024) Student nursing placements: Collaborative Learning in Practice. Nursing Times [online]; 120: 2.
Authors: Tiji Rajan is safeguarding adults adviser, Central London Community Healthcare NHS Trust; Caroline Foley is pre-registration and capital nurse lead, London North West University Healthcare NHS Trust; Sharin Baldwin is senior health visitor research lead, Institute of Health Visiting, and Maternal Early Childhood Sustained Home Visiting programme adjunct fellow, Western Sydney University. During the innovation, all three were at London North West University Healthcare Trust.
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In 2019, in response to nursing workforce shortages, the UK government committed to recruit 50,000 more full-time-equivalent nurses in England by 2025. One workstream used to achieve this goal was enrolling more student nurses onto pre-registration programmes (Department of Health and Social Care, 2022), which increased the required clinical placement capacity. To meet this need, Health Education England launched a clinical placement expansion programme in 2020 and invited clinical providers to bid for funding.
London North West University Healthcare NHS Trust (LNWH) was successful in securing this funding and used it to appoint a lead project nurse to develop, implement and operate a bespoke Collaborative Learning in Practice (CLiP) approach to support nursing and nursing associate students’ learning in practice. In other settings, the model has been shown to increase student placement capacity (Kane and Bunce, 2022).
CLiP is based on the concept of coaching, which focuses on developing students’ confidence, competence and performance through enhanced mentoring skills. Students are encouraged to take the lead in their practice, caring for a patient group and supporting their own learning through identified daily learning outcomes. The students are coached by registered staff, with additional mentor support from a practice supervisor or assessor (Lobo et al, 2014).
CLiP was developed in the Netherlands and adapted for UK care settings by the University of East Anglia (Hill et al, 2020). It has since been rolled out across different trusts, each with its own adaptations. Evidence suggests that this model of learning encourages students to take greater responsibility, and they report being more satisfied with their clinical practice compared with students undertaking a more traditional type of supervision (Hellström-Hyson et al, 2012). A systematic literature review by Williamson et al (2020a) also identified that CLiP might:
- Increase placement capacity;
- Reduce the burden on practice assessors as mentors;
- Improve qualified nurses’ job satisfaction;
- Improve nurse recruitment and retention.
This article discusses the adapted model of CLiP that we developed at LNWH, known as Project Coach.
What is Project Coach?
Under the Project Coach model (Fig 1), a learning environment, known as the learning bay, is identified on the ward each day. In the learning bay, one to three students at different stages in their training work as a team to manage the care and treatment of a group of patients, with indirect supervision from a registered nurse.
The students lead on all aspects of patient care, including working with multidisciplinary teams and delegating work to others, as appropriate. They request registered nurses’ support with activities that require direct supervision, such as medication administration, venepuncture, cannulation and other clinical proficiencies. They learn to use critical thinking approaches and to apply knowledge and skills to inform the care they are providing. They support and learn from each other, develop their communication and organisational skills, and explore their leadership potential.
The adapted model includes flexibility around the selection of the learning bay; this exposes students to a range of care procedures and treatments. Daily objectives are not set, allowing students to learn from the unpredictable nature of care and to acquire holistic knowledge and skills. The student nurses work with a range of practitioners, including internationally educated nurses, healthcare support workers, nursing associates and students from different universities. Ideally there are three students per learning bay, but it operates if there is at least one student present, and there is always a registered nurse present in the supervisory role.
A key concept of Project Coach is that students take responsibility for their own learning. This is done through coaching: the supervisor encourages the student to identify their own learning needs and how they might achieve them. Good communication skills are essential, as the supervisor needs to use several different approaches, such as:
- Asking probing questions;
- Challenging the student’s perspective;
- Empowering them;
- Coaching them to maximise their own performance.
The supervisor and student(s) negotiate on the frequency of reviews during the shift.
Developing the model
We began the project in July 2021. The trust’s clinical practice facilitation team established an implementation plan. This involved developing a project preparation pack for the proposed practice learning environments (PLEs), which outlined the vision of Project Coach and helped them create a learning bay in readiness to facilitate the model.
We offered PLEs the opportunity for the project lead nurse to visit them, where they would meet staff, respond to questions and attend ward meetings with all staff disciplines. The learning pack also enabled PLE staff to work collaboratively with the project lead nurse towards an agreed implementation date identified by the PLE.
Each PLE had a named education link nurse and Project Coach champion, who worked as a link between the clinical practice facilitation team and nursing students on placement. PLEs also collaborated with practice development nurses and ward managers to allocate student nurses and raise any concerns about the placement. We assigned identified registered nurses to lead Project Coach in each PLE to enable the project to run seamlessly.
The trust’s placement coordinator was notified of the launch date for each PLE. This enabled them to allocate sufficient students at different stages of their training. They allocated at least nine students per placement. They used a weekly rota, which ran from Sunday to Saturday, on long day shifts; Project Coach did not operate during night shifts.
We also prepared students for the placements by explaining the Project Coach model. In total, preparing the PLEs and students took around one month.
Our aims were that Project Coach would benefit not only students, but also patients, the PLEs and the wider organisations. The planned benefits for students were, in comparison with traditional supervision:
- Enhanced engagement;
- An improved learning experience;
- Enhanced confidence and competence;
- Opportunities to practise leadership behaviours and consolidate learning;
- Leadership skills being developed more quickly, due to increased involvement;
- Being supported to align with the Nursing and Midwifery Council’s (2018) standards;
- Improved team working and a sense of belonging;
- Experience of coaching, which creates a positive learning environment (Lobo et al, 2014).
We anticipated that Project Coach would benefit patients by facilitating:
- Increased contact with staff;
- Reduced frequency of falls;
- Improved skin integrity;
- Improved communication of needs with staff.
- For PLEs, the aims were to:
- Increase clinical placement capacity;
- Allow services, wards and departments to support more students;
- Reduce the burden of supervision;
- Allow students to take the lead on day-to-day patient care;
- Improve the clinical learning culture;
- Provide opportunities to involve and develop the whole team;
- Share supervisory responsibilities for students.
The project aimed to benefit organisations by:
- Improving staff recruitment and retention;
- Creating a positive learning environment culture;
- Increasing staff motivation;
- Improving patient care.
Progress to date
Project Coach is now offered in 18 wards across the trust’s three hospitals. Having one learning bay in each of these wards has increased student nurse placement capacity from 160 in July 2021 to 246 in December 2023 – a 54% increase.
We gathered feedback from students, practice supervisors and assessors using an online evaluation form. This was accessible through a QR code, which we made available in all PLEs. The response rate from students was 63% (n=111); from practice assessors and supervisors, it was 48% (n=85). The evaluation data was positive. Similar to the findings of research into other CLiP models – namely that by Williamson et al (2020b; 2020c) – students said they feel more confident about becoming registered nurses after practising in learning bays and reported finding the experience beneficial:
“My assessor gave me the opportunity to lead the bay, and I really found that positive for my learning.”
“I was more hands-on and involved in the care of the patients I was assigned.”
Students also highlighted that, by practising together, they had increased opportunities to learn and gain skills, competencies and knowledge. Third-year students reported being able to identify second-year students’ learning needs and supporting them through the project. These findings are consistent with those of Markowski et al’s (2022) CLiP pilot study, which was carried out on a midwifery ward, in which students enjoyed the peer support and reported a gain in confidence and skills.
Practice supervisors and assessors reported that students were more active and engaged in learning bays than in traditional forms of supervision. A ward manager identified that, following Project Coach, a second-year student was operating at the level of a third-year student in terms of their organisational and leadership ability. Staff also reported that students shared their positive experiences in the learning bays to others through word of mouth, resulting in student nurses asking to participate in Project Coach.
Because the project was successful in all the pilot areas, our aim is now to implement the model in all available adult inpatient PLEs, as well as introducing it to the paediatric environment. Beyond that, we plan to explore the possibly of operating more than one learning bay in each PLE, as well as implementing the model in critical care areas. This would further increase student placement capacity. The Project Coach model could also be upscaled and replicated across the region to achieve benefit on a wider scale.
In addition, the project has generated interest from other NHS trusts. Facilitation staff have visited our team to learn from our experience, so they can implement a similar model in their own organisation. A representative from NHS England’s clinical placement expansion project team visited a selection of our PLEs, including an early implementer and a fast follower, to explore the possibility of replication in other professional groups. We were also invited to share the project’s success at an NHS England sector meeting earlier this year, with the theme of sharing practice-based learning. The project has given us the opportunity to be innovative, learn from others and share our own experiences through networking, while contributing to the development and growth of the nursing workforce.
In a systematic review of the research literature about CLiP as a model for organising student nurses’ practice placement learning, Williamson et al (2020c) did not find any peer-reviewed publications written in English on this topic, concluding that it was an area that required further research. Our work, therefore, contributes to this body of knowledge, building the evidence base for CLiP approaches to support student nurses’ development.
Project Coach is an adapted model of the CLiP approach. It was developed by LNWH to increase clinical placement capacity for student nurses. The project achieved this, as well as positively contributing to the national workforce shortages in the NHS. It has also received positive feedback from students and staff. There are plans to implement the model in other areas of the trust, as well as in other organisations and areas.
- The UK government announced plans to recruit 50,000 more nurses by 2025
- Recruiting more nursing students onto pre-registration programmes has meant needing to increase clinical placement capacity
- A trust adapted the Collaborative Learning in Practice approach to increase its placement capacity
- With this model, students lead on all aspects of patient care and are responsible for their own learning
- The model has increased placement capacity and received positive feedback from students and staff
Department of Health and Social Care (2022) Policy paper: 50,000 nurses programme: delivery update. gov.uk, 7 March (accessed 5 December 2023).
Hellström-Hyson E et al (2012) To take responsibility or to be an onlooker. Nursing students’ experiences of two models of supervision. Nurse Education Today; 32: 1, 105-110.
Hill R et al (2020) Collaborative Learning in Practice (CLiP): evaluation of a new approach to clinical learning. Nurse Education Today; 85: 104295.
Kane A, Bunce J (2022) Collaborative Learning in Practice (CLiP) in primary care networks in the south-west peninsula: briefing paper. gpnen.org.uk, 14 April (accessed 15 January 2024).
Lobo C et al (2014) Collaborative Learning in Practice (CLiP) for Pre-registration Nursing Students. NHS Health Education East of England/University of East Anglia.
Markowski M et al (2022) Collaborative Learning in Practice (CLiP) in a London maternity ward: a qualitative pilot study. Midwifery; 111: 103360.
Nursing and Midwifery Council (2018) Future Nurse: Standards of Proficiency for Registered Nurses. NMC.
Williamson GR et al (2020a) Collaborative Learning in Practice: a systematic review and narrative synthesis of the research evidence in nurse education. Nurse Education in Practice; 43: 102706.
Williamson GR et al (2020b) Investigating the implementation of a Collaborative Learning in Practice model of nurse education in a community placement cluster: a qualitative study. The Open Nursing Journal; 14: 39-48.
Williamson GR et al (2020c) ‘Thinking like a nurse’. Changing the culture of nursing students’ clinical learning: implementing Collaborative Learning in Practice. Nurse Education in Practice; 43: 102742.
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