When COVID-19 started, CPD almost stopped
Nursing Standard survey reveals nurses’ concerns about training and learning, but also highlights innovation
- More than half of our survey respondents said they undertook no CPD during the peak months of the COVID-19 pandemic
- While some nurses reported patchy or insufficient training after being redeployed, others said they used the pandemic period to focus on reflective practice and read up on the virus
- How some workplaces have used technology and online sessions to enable or improve remote learning
Almost eight out of ten nurses (77%) have had their training and development disrupted by the COVID-19 pandemic, an exclusive Nursing Standard survey suggests.
More than half (55%) of the 2,026 people who responded to our question about continuing professional development (CPD) said they did not undertake any CPD during the COVID-19 peak, while 22% said they did less than normal in this period.
Training cancelled during the pandemic
Nursing Standard’s online survey, open to all UK nursing staff from 8-19 June 2020, heard that many were affected by the cancellation of study days, face-to-face training and conferences amid the immediate focus of tackling the pandemic and the restrictions of lockdown and social distancing.
One even spoke of snatching time to do their CPD while self-isolating.
View our COVID-19 resource centreWorryingly, some respondents told us they were unable to access induction and mandatory training, including on infection control, manual handling and cardiopulmonary resuscitation.
23 March 2020
social distancing measures were announced by prime minister Boris Johnson
But for some people, the COVID-19 pandemic created interesting training opportunities, including the chance to learn new skills on secondment.
Some respondents said they used the pandemic as an opportunity to focus on reflective practice and to keep up with the rapidly developing information on the virus and best practice guidance.
Lack of access to CPD is not a new problem
Undertaking CPD is an essential part of maintaining registration with the NMC. All nurses must complete 35 hours of CPD every three years to revalidate.
A joint statement on CPD, developed in 2019 by the RCN in partnership with other health professional bodies and unions, emphasised the importance of healthcare staff accessing CPD, which is generally considered to be separate to mandatory training.
The principles statement says: ‘CPD and lifelong learning support a workforce that is capable of designing, delivering, evaluating and improving high quality care and services.’
But even before COVID-19, there were concerns about access to CPD.
The RCN has previously condemned cuts to Health Education England’s CPD budget, which fell from £205 million a year in 2015-16 to £83.5 million in 2018-19.
The government announcement of an increase in 2019 was not enough to make up for the years of cuts, the college says. In addition to this, even if nurses have been able to secure training, they do not always manage to get time off work to attend, it says.
COVID-19 gives some nurses more time for study and others, none at all
55%
of nurses have undertaken no training or CPD since the start of the pandemic
(Source: Nursing Standard survey, June 2020)
The Nursing Standard survey responses reveal a wide variety of experiences when it came to accessing CPD.
Some nurses said they felt busier than ever, without the time or energy to devote to CPD. Several said they were too exhausted by work to think about training.
One respondent said: ‘Impossible, as have been made to take on so much extra work. Capacity was an issue before COVID-19, nurses are being pushed to breaking point.’
For others, it gave more opportunity to study, as they were working from home, some clinical areas were quiet or they were shielding for health reasons. One nurse carried out CPD while isolating at home waiting for her husband’s COVID-19 test result.
One respondent said: ‘I'm doing it now as wards are overstaffed waiting for non-urgent wards to reopen.’
Another said: ‘If anything, working remotely I have been able to commit more time to this.’
Some pointed out that while training events and face-to-face learning may not be possible, not all CPD is this formal and individuals can seek out opportunities to learn. One nurse said they learned how to do mask fit testing and also received care home infection prevention control training as a result of the pandemic.
Another said: ‘I have committed time to studying the pathology and management of COVID-19, also refreshed my knowledge on sepsis and other related respiratory and cardiac conditions.’
bite-sized learning opportunities online
Online support for training and development in lockdown
Another described how it brought about more training opportunities than normal.
‘Completed a clinical skills update, a core patient database and electronic prescribing update, and an updated basic life support session,’ they said.
‘Practised doffing and donning personal protective equipment (PPE). Training from intensive care unit (ITU) senior staff on ventilator care, ITU infusions, drugs and documentation. Read a lot about the virus, infection prevention and use of PPE as I didn't feel management were always providing correct information.
‘It's been different learning to what I would have normally done but I would say there’s been more of it.’
RCN professional lead for learning and development Gill Coverdale says the college rapidly made training available online to support members during the early weeks of the pandemic, including on infection prevention and control and end of life care, and launched two networks for care home staff and nurses returning to practice.
Efforts have been made to make the training easily accessible to staff, she says.
‘We have tried to make it bite-sized learning that is easy to engage with and suitable for nursing staff to access in between shifts or on the go,’ she says. ‘We know that face-to-face learning and courses are just not possible at the moment.’
Distance learning programme: a triage ‘top-up’ for redeployed staff
chance to undertake training when most
have been cancelled’
High levels of staff sickness due to COVID-19 meant a shortage of triage-trained nurses at the Royal Bournemouth Hospital emergency department (ED).
As triage is an essential safety skill, the department needed to increase the numbers of trained staff.
ED practice educator Jen Wilkins realised a different approach would be needed to the usual full face-to-face study day followed by a number of supported shifts and then an assessment.
She created a distance learning programme with a theoretical self-directed learning document, assessment activity workbook and competency assessment. The programme can be completed while respecting social distancing measures and it enables a large number of staff to be trained without affecting service delivery or staffing levels.
Ms Wilkins says: ‘Staff feedback has been positive; overall, staff are pleased to have the opportunity to undertake training at a time when most has been cancelled. Those staff who have previously performed triage but who have not recently worked in emergency care report feeling reassured at being able to “top-up” their skills.’
Read more about Ms Wilkins approach to training during the pandemicUsing technological tools to maintain CPD training
38%
of nurses redeployed due to COVID-19 did not get sufficient training
(Source: Nursing Standard survey, June 2020)
While Ms Coverdale would be concerned if employers were not starting to improve and restart CPD and mandatory training packages now, she says that nurses also have a role to play in their own training.
‘Nurses are accountable for recognising what training they need, and where their knowledge gaps are,’ she says. ‘Learning and development should be a partnership between a nurse and their employer.’
Some organisations have found that new technology has helped them deal with some of the training challenges they have faced.
West Suffolk Hospital has used Virti, a company that provides virtual reality and artificial intelligence, to provide training using headsets, though modules can also be accessed from smartphones, tablets and laptops.
West Suffolk Hospital clinical skills and simulation tutor Tom Woollard says: ‘We’ve been using the technology in our intensive care unit to help train staff who have been drafted in to deal with COVID-19 demand.
‘The videos we have created and uploaded are being accessed on this platform by nursing staff, physiotherapists and operational department practitioners to orient them in the new environment and reduce their anxiety.’
This has made a vital difference during the pandemic, he says.
‘The tech has helped us to reach a large audience and deliver formerly labour-intensive training and teaching that is now impossible with social distancing.’
Redeployed staff in place, but their training less so
COVID-19 prompted service changes in the NHS on an unprecedented scale.
A quarter (25%) of the 2,338 nurses who responded to our Nursing Standard survey question about redeployment said had been redeployed.
For the vast majority this was for operational reasons, with a small minority redeployed to protect their health or that of their family (3%).
When it came to preparation for the new positions, 35% said they received sufficient training, but 38% said they did not. While some nurses spoke about good quality, easily available training, responses revealed a wide spectrum of experiences, even with the same employer.
One nurse reported being well trained for their first deployment, but not their second. Another respondent said they started in their new area later than the rest of the redeployed staff and missed the training.
‘I had not worked on a ward for over five years so was deskilled. It was difficult to get upskilled due to so many redeployed staff on the same ward at the same time’
Survey respondent
One respondent said: ‘We were supposed to have a week of training to learn about adult nursing care, such as rolls and proning, and how to use the different adult ventilators and ventilator settings. None of this occurred, in part due to an unexpected surge in patients.’
Back on the ward, but with little preparation
Nurses who had not worked on a ward for many years highlighted the stress of being expected to step swiftly into these roles with insufficient preparation.
Many said they had to learn on the job, which left them feeling vulnerable and unsupported.
‘While training was given, staff who hadn't worked on wards for up to 20 years were expected to be fully equipped to walk on to wards and take full caseloads and manage patients in a completely unfamiliar environment, routine and way of working, which caused significant stress and anxiety,’ one nurse said. ‘Ward staff lacked empathy, patience and understanding for these nurses.’
The sheer numbers of redeployed staff also made it difficult for newcomers to be trained by permanent staff.
‘I had not worked on a ward for over five years so was deskilled,’ one said. ‘It was difficult to get upskilled due to so many redeployed staff on the same ward at the same time.’
A specialist nurse who received little preparation to go back on a ward said they were relieved that the unit was not busier: ‘Luckily the ward never reached full occupancy but if it had, I would have felt unprepared.’
Others were happier with their experience: ‘Brief but sufficient, learned more on the job,’ one said, while another commented: ‘Training was quickly and easily accessible’.
The RCN produced guidance for staff redeployed during the pandemic, which says the employer is responsible and accountable for ensuring staff have the necessary skills and knowledge to take on work. All redeployed staff should receive an induction on their new clinical area.
But it also reminded members they must work within the limits of their competence, as set out in the Nursing and Midwifery Council code.
Erin Dean is a health journalist
Further information
- RCN joins health bodies and unions to launch principles for continuing professional development
- RCN guidance: Redeployment and COVID-19
- NMC: Continuing professional development