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A student perspective: newly qualified paramedic programme

02 June 2017
Volume 9 · Issue 6

The recent success of implementing ‘band 6’ paramedics has shown the growing value of the profession, and is now offering a career development package as envisioned by the College of Paramedics (2015). However, newly qualified paramedics (NQPs) are required to complete a maximum two-year ‘band 5’ consolidation period (Department of Health, 2016; Scott et al, 2016), which may impact positively and negatively on the profession. This comment aims to open a discourse on defining the purpose of a NQP programme, and how this might impact future students entering the profession.

According to the College of Paramedics (2015), a paramedic is an autonomous allied health professional who delivers treatment to critically ill and injured patients within an emergency, urgent, and unscheduled setting, both pre- and in-hospital. NQPs can suffer a ‘reality shock’, in which they find themselves required to fulfil this role as a lead clinician in a minimally supervised setting (Gregory, 2013). The NQP programme aims to demonstrate the transition of novice paramedics to experts; under clinical supervision the NQP practices in accordance to national and local policies, garnering experience, whilst improving organisational retention (Department of Health, 2016).

Experience

Without doubt, NQPs lack experience. However, this does not preclude the fact that an NQP is still a registered paramedic, and must act in accordance with the paramedic standards of proficiency (Health Care Professions Council, 2014). As experience and expertise develop, clinical decision-making improves (Donn, 2017). Smith et al (2013), established that paramedics of all experience levels were aware of critical time pressures, but that more experienced paramedics were better at resource management and developing rapid treatment strategies.

Moreover, Thompson (2015) found that NQPs lack confidence due to experience and exposure during pre-registration mentorship. Although a small qualitative sample, this demonstrates that transitioning to a lead clinician might require continued development post registration. However, in essence, this declares that university programmes are insufficient in providing adequate training to autonomous practice. Kennedy et al (2015) support this claim, finding in a small literature review that feelings of being out-of-depth were a common theme. This is similarly reflected in other healthcare professions such as nursing, where such feelings are allayed with improved confidence, competence and knowledge during transitional programmes (Rush et al, 2013; Edwards et al, 2015).

A counter argument is that current student paramedics are exposed to many more multi-professional learning opportunities (Jennings and Rae, 2016), at a time where pre-registration paramedic programmes are at their longest, resulting at bachelors of Science level graduates (Williams et al, 2016). Additionally, Alexander et al (2009) found a negative correlation between American paramedics' commitment to an organisation and level of study, citing that increased factors of autonomy, responsibility, and intellectual challenge may play a role in the poor organisational retention of paramedics at bachelors level. Research should further investigate these factors within the UK.

Retention

Paradoxically, the post-registration career framework (College of Paramedics, 2015) might drive paramedics further away from the frontline, where there continues to be a national shortage with an ever-increasing demand on the profession (National Audit Office, 2017). The NQP programme attempts to remedy this by stating that the two-year consolidation period will aid retention and provide ongoing support from the employer. Rush et al (2013) discovered that retention was improved when newly qualified nurses attended formal transition programmes. However, these programmes yielded optimal retention when they lasted between 9 and 12 months, which was more cost beneficial.

Furthermore, the Urgent and Emergency Care Review (NHS England, 2013) identifies the opportunity that paramedics with additional training, skills and scope of practice will be capable of discharging patients at scene, reducing hospital admissions. It is important to note that this is primarily focused on paramedics in the pre-hospital emergency setting. Paramedics now have opportunities to step beyond this backdrop into areas such as GP practices and walk-in centres (Quaile, 2015). Whether the NQP programme incorporates or detracts from this element is called into question, and needs to be investigated further.

In order to improve retention, it may be beneficial for organisations to offer ‘post NQP’ graduate clinical programmes that continue to enhance specific skills in critical and urgent pre-hospital care. The College of Paramedics career framework (2015) promotes further academic education in differing realms like research, education, leadership and management. This may result in individuals targeting services that offer this opportunity, depriving essential frontline services that require the commitment of delivering high quality and effective paramedic care (Peate, 2015).

At the time of writing, the duration for being declared a fully autonomous paramedic capable of clinical leadership, and unsupervised effective decision-making is now five years. Whilst this promotes safe practice, ensuring continued public confidence in the profession; the expectancy-value of undertaking such a career might discourage and demotivate those capable of travelling such a path (Eccles, 2009; Wang and Degol, 2013).

Conclusion

The NQP programme aims to improve the transition from student to fully autonomous paramedic, decreasing the ‘reality shock’ and providing further support and experience that paramedic practice demands. Previous research on similar health professions has shown this to be effective in improving confidence, competence, and knowledge. However, factors such as desire for autonomy, responsibility, and intellectual challenge might drive NQPs away from the frontline upon completion of the programme.

Retention is an ongoing issue, and the duration of the current NQP programme may not be beneficial or cost effective. To improve this, research should investigate the duration of the NQP programme, and establish whether exposure to additional settings such as walk-in centres, or developing further ‘post NQP’ critical care programmes will benefit retention, career development, and patient care.