Running a residential care home is a complicated and specialised occupation – as the COVID pandemic brought to the fore in painful clarity. However, Registered Managers’ skills have to date been largely unrecognised in what they could contribute to nursing education.
In my role as Clinical practice Lead at the University of Exeter’s Academy of Nursing, I have led on a project to utilise this extraordinary skillset and experience in expanding the educational horizons of students on our pioneering MSci Nursing programme.
My own 35-year career working in or with social care included the harrowing experience of managing a care home through the COVID pandemic.
This crisis magnified the lack of staff, the chronic funding issues and the lack of regard for social care, and I now want to help make a difference by expanding our student nurse placement opportunities into social care, including domiciliary care, residential care, supported living and nursing home care.
There is research on the immense benefits social care holds for our students including where settings do not have registered nurses to supervise the students.
Last year, the Nursing and Midwifery Council (NMC) updated their guidance on students’ supervision during clinical placements to include Registered Managers of social care settings who are registered with the Care Quality Commission (CQC). This represents an important step in recognising the work and expertise of Registered Managers by the NMC (NMC, 2024).
At Exeter we are among the first to work with Registered Managers in supervising student placements. I believe that starting at the beginning, with our nurse leaders of the future, we have a chance to raise the profile of social care and can play a small part in the larger picture, ensuring a functioning integrated health and social care system.
Skills for Care recognise the value of this type of placement experience, stating that this will ensure a future nursing profession that has the skills and experience to work across a system (Skills for Care, 2024).
We’re proud to be leading this innovation at Exeter, where our four-year MSci dual adult/mental health programme was founded in 2019. It’s just one of the ways we progress our curriculum foundation based on our seven pillars of nursing.
Exeter nursing students have a diverse range of practice experiences, not only within the acute trusts but also with the Private Voluntary and Independent Sector.
Last year, for the first time, Registered Managers of care homes became Practice Supervisors on student placements in residential care home settings where nurses are not employed.
The initial phase involved two second year students undertaking a two-week placement focusing on the link between the GP practice and the social care setting in the same Primary Care Network (PCN).
This initial pilot demonstrated sound understanding of the benefits of interprofessional learning, and a clearer comprehension of person-centred care. Indirect supervision was provided by Registered Nurses from the Academy of Nursing.
In the second phase, five second year students took up placements in five residential care home settings for two weeks, from a GP practice or hospital setting. The Registered Manager acted as the students’ Practice Supervisor.
This project aimed to test the learning experiences of the student nurse in a social care setting with no registered nurses, and therefore explore the role of the non-nurse CQC Registered Manager in the Practice Supervisor role, and to introduce concepts of interprofessional learning in health and social care.
To evaluate the project, we interviewed students and Registered Managers, gathered feedback questionnaires and held a Registered Managers focus group meeting. Students also kept reflective diaries.
We found that students were exposed to and included in many interprofessional activities and practice. They got to explore effective communication skills with residents and understand the roles and responsibilities of various team members and professionals supporting the service.
They got hands-on experience of the vital importance of building therapeutic relationships with people living in social care settings was learnt in a professional complex environment. One student told us: ‘’It made me realise how people with learning disabilities can have a lot of additional needs that go unmet in hospital settings’’.
They gained a broader understanding of the healthcare system in a social care context by following residents’ complex health trajectories, appreciating how services outside of the NHS provide care in the community
Registered Managers interviews and questionnaires showed the positive influence of supervising the student nurse during their placement.
Care staff learnt from the student nurse and Registered Managers improved their confidence in supervising students.
They increased awareness for care staff progression into nursing and found the proficiencies easy to read and identify relevance to the social care setting.
They did not feel it was too time consuming, and overall enjoyed the experience, but felt a longer placement would be more beneficial.
In the words of one manager: “[the student] worked well within the team and we felt she learned from the team, medication round, wound care, catheter care, stoma care, handover meetings, the student nurse was keen and enthusiastic which really supported all our learning.’’
Exeter student nurses learnt to analyse complex healthcare situations from different angles, fostering critical thinking and creative problem-solving skills.
This comprehensive approach enabled the students to provide better care by addressing the physical, psychological, social and cultural aspects of health and social care.
The non-nurse Registered Manager as the Practice Supervisor demonstrated that this role is within their competence and experience and opens opportunities for further utilisations of these skilled social care professionals for placement expansion into this often miss-represented sector.
Lastly, the students’ perception of social care was changed, and this can support and help to tackle the stigma around this pathway career across nursing.
This educational project provided sound feedback of how interprofessional learning in nursing education prepares future nurses for effective collaboration, enhances their critical thinking and communication skills, and promotes person-centered care.
It reinforced the value of social care placements, replicating the feedback from other educational projects and research.
It confirmed that non-nurse Registered Managers are skilled, experienced and exceptionally valuable contributors to the Practice Supervisor role.
All this makes for a more rounded nurse, more able to meet the needs of modern care across a complex and changing sector. Our next step will be a longer six-week placement into residential social care.
If you are interested in taking part in this project of placement expansion into social care or would like to find out more about the Practice Supervisor role, please contact –
Cathy on c.rant@exeter.ac.uk. To find out more about studying Nursing at Exeter, visit: Nursing | Undergraduate Study | University of Exeter
