A healthy outlook: A growing number of nurses are taking advantage of the opportunity to enhance their skills

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The Independent Online

The last thing Amanda Featherstone expected to do in her role as a practice nurse in a GP's surgery was to study for a Masters degree. But last year, she completed an MSc in strategic leadership and expert practice (for nurse practitioners) that has enabled her to do many of the things GPs traditionally did.

What's more, she enjoyed the course. "It taught me to be a critical thinker, have a wider knowledge base and better debating skills. It was hard to fit in around three young children and a job, but it was worth it because it was all so stimulating."

Best of all, she says, it set her up for continuous ongoing learning. "I'm stretching myself all the time now."

CPD for registered nurses and midwives is statutory, but only up to a point. What many people don't realise is just how much of it is available beyond the call of duty. Nor do they realise the seniority of roles – including prescribing nurses and nurse consultants – that training can lead to.

City University London runs CPD modules in subjects including sexual health and HIV/Aids, chronic heart disease management, physical assessment, and communication and role development. Tutor Dr Kathryn Waddington points out that nurses who entered the profession with a diploma are increasingly being encouraged to top-up to degree level, at which point a range of short and long courses (including Masters and even doctorates) become available. The leadership module, which she teaches, is particularly popular – not only among nurses but their bosses. "Since the publication of the NHS Plan in 2001, there has been an emphasis on the fact that leadership is crucial."

CPD is not without its challenges, she admits. "We know, for example, that some nurses have had difficulties negotiating study leave."

Dame Betty Kershaw, education adviser at the Royal College of Nursing (RCN), agrees. "There is some very good training out there, but we are disturbed that some nurses have difficulty accessing time off to study, with a growing number doing courses in their own time."

Examples include small GP practices where there may only be two nurses (in bigger ones, it's easier to arrange cover) and in nursing homes where the nurse is the only one on staff. "We're even hearing reports of some nurses having to do statutory updating in their own time – in areas such as resuscitation training and health and safety training," she says.

Kershaw adds that some nurses have to fork out for fees. "They might, for example, want to do a Masters with four modules, only three of which are directly relevant to what they're doing so they have to pay for the additional one to make up the programme."

Nonetheless, RCN points to the vast number of seminars, workshops, study days and qualifications that nurses and midwives are attending with enthusiasm. "In the last 10 years, there has been a huge shift from CPD being 'something I have to do' to 'something I see the value of doing and wish to take up every opportunity to develop'," explains Kershaw.

As many areas of nursing and midwifery continue to experience rapid change, Kershaw expects CPD to become even more critical in the next few years. "The Government, for example, wants to move a lot of nursing from an acute setting into the community and they'll need to cross-skill nurses accordingly."

Dr Richard Hatchett, principal lecturer for adult CPD at London South Bank University's faculty of health and social care – whose subject areas range from nursing as a therapy to normality in midwifery practice – says the NHS has become far more strategic in the way it approaches CPD.

"We've moved from them saying, 'Here's a course, do you fancy doing it?' to 'Let's work out what training would be relevant to your job and where you want to go in your career'," he explains.

Given the difficulties around accessing time to train, many CPD providers offer a flexible approach to learning. "These professionals are busy, so it's important they can take the learning at their own pace," says Dr Warren Turner, assistant dean of the University of Derby. "We've also tried to offer as many modules as we can in e-learning or distance learning format, and the third thing we stress is the importance of work-based learning. So if a nurse is doing a piece of work anyway with specific learning outcomes, we'll negotiate an individual learning contract with them, which may contribute to a module."

Turner adds that because courses are worked out in partnership with NHS trusts, practitioners can rest in the knowledge that what they learn will be clinically relevant. "We try to make it enjoyable too. After all, we'll only create a demand for people wanting to come back if we make it relevant and pleasurable to learn."

Dr Carol Taylor, programme leader of the professional doctorate at Manchester Metropolitan University, reports that growing numbers of nurses are studying for a PhD. "Among those who do the doctorate are people who are already consultant practitioners or who are aspiring to become one. Or they might just want to be more engaged in policy making or steering and developing practice within their senior role. I think what really appeals to them is the opportunity to study to doctoral level without having to give up their jobs for a purely academic role."

The PhD takes five years part-time. "It's challenging, certainly at first, but it's enjoyable and stimulating too and people get a lot of support."

At Edge Hill University – where the vast range of CPD modules range from contemporary critical care to anaesthetic care – Kate O'Brien, academic lead for CPD undergraduate programmes, says nurses and midwives enjoy learning with other professionals. "They work in a multi-professional practice, so it makes sense for them to learn in this way," she says.

It's not just universities that provide courses. Professional bodies lsuch as the RCN, for example, have trained over 300 midwives across the UK in the use of hypnosis during labour. Likewise, the Caritas School of Reflexology trains large numbers of midwives.

"Midwives probably have the longest history of CPD than any profession because it was made statutory in the Thirties, so it's very much part of our culture," says Sue MacDonald, education and research manager at the Royal College of Midwives. "What's changed, however, is that whereas in the past you could expect to be sent to things, nowadays there's more opportunity for midwives to be proactive about the training they want to do."

'I have increased my confidence'

As a result of completing an MSc in interprofessional practice at City University London, Briony Ladbury is about to progress into a strategic role in child protection at NHS London.

"I've been working in child protection as a designated nurse since 1996. Obviously it's a role that involves working in a multi-disciplinary team and so my boss suggested I do a Masters in interprofessional practice. She knew I was ambitious and pointed out that any senior post would require a qualification at this level.

I felt apprehensive about doing a Masters because it was so academic. But actually, nothing about it was overwhelming and every week, there was a penny-dropping moment. It was also a great opportunity to meet senior people from other agencies. I particularly liked the way the course had a focus on psychodynamics. As a nurse working in child protection, I'm very used to working with difficult families and I'm still using what I learned on the course when dealing with them. I also use that side of the teaching in my dealings with other professionals.

I used to get nervous stating what I think, but since completing the three-year course, I have increased confidence and competence and quite often in strategic meetings, I realise how far I've come. The other thing the course did was enable me to read and assimilate information faster and my writing skills are better too. I felt quite grumpy at the thought of writing 2,000-word essays at the start of the course, but it's made me think smarter and shorter, which is good.

Although I'm in a similar role to the one I was in when I started the course, I've grown in it and now have a team of 12 people who I supervise. From January, I'll have a new role as senior strategic safeguarding children adviser for NHS London, so I'm moving on up and pushing myself into places I'd never have dared before. If I wasn't 58, I'd have gone for a PhD next. But never say never."