Hidden gems

The role of our support workforce in developing the registered physios of the future 

CPD: Hidden Gems

Last month, education adviser Nina Paterson addressed our student members. They were told how hard their lecturers are working at the moment to ensure their learning stays on track during such disruptive times and, for those able to continue to access practice education, not to feel concerned that this may currently look and feel different from ‘normal’ times.  

Through that piece Nina actually spoke to us all, challenging us to maintain students’ learning and to look to the future, despite difficult times, urging us to continue to build diverse placement capacity.  

There is a heavy demand looming, in the months and years ahead, on our workforces. With this comes an urgency to grow and sustain practice experience for our students and to continue to support other learners in practice settings too. Ultimately, it is them that we will come to rely on to meet increasing demand, to evolve our profession’s offer, and – let’s be clear on this – to provide the high quality care and rehabilitation we expect for ourselves and our families should we come to need it.   

In order to be assured that a skilled, competent and confident workforce will be there for us, we must take action and, however challenging it may feel, we must do it now. We must expand placement capacity, we must embrace different options for placement provision and we must be open to different models of supervision and learning experiences for our students. 

Supporting students and learners is everyone’s business 

My personal belief is that one way to make this happen is to change how we think about and articulate our sense of ‘team’.  

We know that the best teams comprise a diverse membership and through this diversity these teams thrive. How might it feel and what might we accomplish if we saw students as permanent members of our teams - albeit the individuals in those team roles changed frequently - bringing with them their own unique contribution to patient care, service improvement and culture of learning ? No-one would be asked ‘who can take a student?’ rather, we would collectively question, ‘how will every member of our team make a difference to patients today and how will we learn and support each other while doing that?’ It would still be necessary to have someone named as the practice educator in the team holding overall accountability for student education, but all team members would understand their contribution to a shared responsibility of nurturing and educating the members of the team who just so happen to be students or learners.  

This notion of shared contribution and responsibility for student education on placement brings me neatly to the thrust of this month’s article. Broadly this is a call to action to think differently about a team’s structure and culture in order to expand placement capacity. Particularly, though, it enables me – as the professional adviser who leads on support worker development at the CSP – to unashamedly pick up one of my favourite topics: the ill perceived and poorly understood capability of our fantastic support workforce.  

The skills and capabilities of support workers 

In my proposition, that every team member should have a formal responsibility to support and educate colleagues who happen to be students, what contribution might support workers make? 

There will be few teams in practice that don’t have at their core a skilled and experienced support worker. While many support worker team members might be asked to ‘take the student for the afternoon’ how often does this occur as a respected, valued and formalised part of placement education? If it did, how might that enhance the team’s capacity to support students? It’s likely that the approach to involving support workers in student education currently is more the former than the latter.

Sadly this may be due to the continued prevalence, at every level in practice, of historic and outdated misunderstandings and misperceptions regarding the support workforce’s: 

  • qualifications  
  • practice skills 
  • technical competence 
  • high level of communication skills 
  • experience in person centred care approaches 
  • knowledge of local systems and processes  
  • abundance of noticing, coaching and caring talents  
  • years of clinical and life experience  

If you are a practitioner, educator or student who does appreciate and understand this list of support worker attributes then you will be joining me in asking: why wouldn’t we involve support workers in the practice education of students?   

Consider also the importance of future registrants having a thorough understanding of the role and commensurate levels of capability and competence at different levels in order to practise safe and appropriate delegation. Importantly this is included in the HCPC standards of proficiency for physiotherapists (standard 9).

However, to involve support workers fully in practice education and to ensure their contribution is valued and effective requires us to address more than just how we structure our team approaches to student education. It requires students, educators, registered physiotherapists and support workers to: 

  • challenge conscious and unconscious bias about support worker capability and role scope. In particular, the skills and practices that – culturally – are viewed as the reserve of the registered workforce. I include in this challenging the notion that support workers don’t engage in clinical reasoning. It is not possible to work safely and effectively with any patient without drawing on a range of information and experiences to determine how to proceed at that moment in time. To suggest that support workers don’t clinically reason is to propose that they cannot work safely without direct supervision at all times.  
  • consider how the support workforce are spoken of in universities and how students are equipped to value the support workforce as they are prepared for placements.See what Sam Marsh, an MSc student currently out on placement, says about this on the following page. 
  • appreciate that educating, training and supporting colleagues with less experience falls in the scope of everyone’s role and at all levels of practice and NHS banding. 
  • understand that supporting students in practice is a skill in itself and ensure that support workers are adequately trained and educated to contribute to this activity.

Watch this space on this one as we wait for Health Education England to launch some online education modules to support exactly this. Developed by the AHP practice education team at the University Hospitals of Derby and Burton, the content on the e-learning for health platform is aimed at support workers preparing to take an active part in supporting students on placement.

Increasing placement capacity and enhancing quality learning experience 

I’ll return now to my unashamed use of this article on student placement capacity to promote the role, scope and capability of the support workforce. I hope I’ve prompted you to challenge how you think and feel about the place of support workers in student education. 

I’d encourage you now to undertake some self or team assessment of your beliefs and current practices.  

We have two resources which you should use to do this.   

  1. The support worker scope of practice in COVID guide can be used to challenge whether you have developed ways of working that truly optimise the capability of the support workforce during the pandemic. We include in this just how involved support workers can be at this time in supporting students in practice and it includes a helpful infographic for quick reference. 
  2. Our more detailed resource on support worker capability can be used to evaluate whether support workers in your team have been supported and developed to work at the height of their scope of practice and are contributing to the full range of tasks and responsibilities possible, including the practice education of students: Optimising capability in the physiotherapy support workforce.

After looking through these resources challenge yourself with these questions: 

As an associate member who is a support worker are you: 

  • working at the height of your capability in your role including making a contribution to the learning and development of all members of your team?  

As a registered physiotherapist in clinical practice are you: 

  • surprised that you may be consciously or unconsciously biased about the full range of tasks and responsibilities your support workers can undertake?  
  • supporting, developing and empowering support workers to work at the height of their capability and in new ways and different roles? 

As a physiotherapy lecturer are you:   

  • speaking to students about support workers in ways that teach them to value the contribution of the support workforce to the MDT and to their practice education? 

As a physiotherapy student are you: 

  • respectful and appreciative of the full capability of the support workforce and their role in teaching and supporting you in practice?  

If, after reading this, you or your team pledge to do something differently, or if you’ve reflected that you have some innovative practice where support workers are making a formal and significant contribution to student education and in turn enabling you to enhance placement capacity and quality learning experiences, please let us know.  

Please contact us at: learninganddevelopment@csp.org.uk

A student’s view 

Sam Marsh is studying at the University of Central Lancashire on the MSc pre-registration programme. He is currently on placement with the acute medicine team at Chorley and South Ribble Hospital. 

Since being on this placement Sam has learned a number of things about support worker practice that he didn’t know. 

‘They have the documentation skills to write legally binding and accurate patient notes…[and] …communication skills which enable them to feedback to therapists about details of sessions they have conducted – which in turn informs future treatment and care.’  

He says of his recent experience with support staff: ‘[They] have provided me with countless occasions of support,in both clinical areas and when I have sought advice regarding various questions or queries I had… Until experiencing the working environment, physiotherapy students do not know or understand the role of support workers, which is disheartening, as I now know through working with them day in day out, they are a valued member of the MDT and possess a wide variety of skills and knowledge.’  

Sam’s experiences lead him to believe that spending time with support staff and learning from them should be a core part of every clinical placement. He also believes this is crucial to ensure students develop a strong understanding and respect of their role; their level of knowledge and skill and their vital contribution to patient care and the wider multidisciplinary team. 

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