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Returning to nursing in primary care in Wales

Returning to nursing in primary care in Wales

Returning to nursing after a career break for whatever reason can be daunting. Coming back and working within primary care offers nurses – with varied backgrounds and experience – fantastic opportunities. Nurses with a UK registration who need to refresh and update their skills and seek employment within the NHS are welcome to apply for return to practice programmes.

Here in Wales, the Higher Education Institutions (HEIs) are currently supported by the Workforce Education and Development Service (WEDS),1 to actively encourage nurses with a lapsed registration to apply and secure places within HEIs. These places are fully funded and include course fees and the organisation of your placement. They also offer a bursary payment; currently £1,000 in Wales, along with WEDS-funded childcare vouchers subject to status and residing in Wales. The programmes meet the Nursing and Midwifery Council2 (NMC) standards for returning to practice. They are also validated by the NMC and offer a flexible, supported route to return safely to a career in nursing.

Applicants apply directly to the university of their choice in Wales, and information is available both on the WEDS site and Higher Education Institution websites. Selection processes throughout Wales may differ slightly but require nurses to have an existing UK lapsed registration and provide evidence of their PIN as well as meeting the HEI’s entry requirements and completing a successful interview. Applicants will all be required to produce current references and a statement of character, which tells the HEI about you as a person and your values as opposed to your performance within a role. You will also need a current disclosure and barring service check as well as undertaking occupational health screening. Nursing is currently seeing an all-time high in vacancies, accompanied by a spotlight on the NHS which has been examining existing staffing levels across all areas of nursing.3 This shortage of nurses within the NHS translates into a favourable climate for those individuals considering a return to practice, accompanied by a buoyant national recruitment campaign for those wishing to return.4

There are increasing opportunities for employment, particularly within the community setting, as a result of recent government policies and the changing landscape of the NHS.5 Our ageing population and people wishing to receive care within their own home environments means  that we need more nurses to care for these individuals and work within primary care.5 It is the role of the community nurse to provide care for this group of patients with complex health needs that has led to an increase in the types of services being provided within primary care that was traditionally offered to patients in hospitals.

The need for skilled individuals with nursing experience to work within the community setting lends itself very favourably to return-to-practice students wishing to follow a career within primary care. We now have a plethora of services within primary care, ranging from integrated health and social care teams, 24/7 district nursing, reablement teams, intermediate care, unscheduled care, out of hours’ telemedicine and continuing healthcare, all providing care to patients within the local community.

As a lecturer in primary care and public health – along with a district nursing background  – I was keen to encourage return-to-practice students to pursue a career within the community. I was fortunate to have the support from the Local Health Board partners in supporting the students appropriately. This is with a suitable learning environment in clinical practice, and an agreed strategy to support the sign-off mentors within their role to enable them to underpin the student experience in a fast moving, dynamic environment. The sign-off mentors are prepared in the university setting to support a return-to-practice student by attending a bespoke preparation session to help them understand the programme curriculum and what is expected of both them and the student during the programme. The sign off mentors are familiarised with the clinical portfolio and all the documentation they are required to complete prior to the placement of the student.

Sign off mentors are invited into the HEI at the beginning of the programme for a working lunch to meet with their students, before the students attend their placement. This has been invaluable for community placements as it enables the mentor and student to meet, and arrange times and venues for meeting which helps alleviate student anxieties. Often community staff are out and about in the local community which can make direct telephone access at specific times of the day challenging. In providing a meet-and-greet session, this has enabled the student to make initial arrangements, and assists in the smooth transition to clinical placement. This meeting also provides a further opportunity for mentors to discuss any queries with personal tutors or the programme manager.

We have close working relationships with practice facilitators, practice educators and sign off mentors, with regular meetings throughout the academic year, as well as tripartite meetings with both student and sign off mentors in practice during the programme. All staff involved with the return to practice programme participate in the recruitment of students and carry on this engagement throughout the programme. This coming academic year we plan to introduce a multi mini interview (MMI); a values-based system of recruitment which has been evaluated exceptionally well within the School of Healthcare Sciences, mirroring other programmes. This will involve academics, clinicians, support personnel, service users and students. This style of partnership working has developed a collaborative approach to the student experience and resulted in the increased recruitment of return-to-practice students to the community setting, and – upon successful completion of the programme – contributes to the production of a workforce fit for purpose within primary care.

The return-to-practice programme within Wales offers equal weighting to both clinical and academic achievement, it ensures the student is able to become immersed in the HEI student experience as well as gaining confidence and competence within the clinical environment.2 Collectively, this develops the individual in utilising evidence-based care and becoming a critical thinker and knowledgeable doer as suggested by the NMC.6 The return-to-practice programme offers this enlightening experience to those with a myriad of both life and nursing experiences, and from a variety of fields, bringing them together in a melting pot of enthusiasm and motivation that is synonymous with community nursing. Recent years have demonstrated a slow decline in the number of district nurses educated across the UK, despite the positive impact the expertise of the district nurse and their specialist practice qualification has on improving quality outcomes for patients.7 The recruitment of the return-to-practice students to the community setting has the effect of reinvigorating individuals who want to resume a career in this field of nursing and the unique setting they work within. It is a recognised privilege to be invited into somebody’s home and provide care for them and is part of the rewarding experience felt by many community nurses.7

The programme involves a minimum of 75 hours in practice and five taught days as determined by the NMC.2 However, many programmes reflect HEI modules and how post registration modules are delivered with set study days, directed study and self-directed study accompanied by clinical practice hours supported by a sign off mentor. This could entail a 30 credit module at level six run over 15 weeks, with 150 clinical hours and 12 taught days, depending upon HEIs selected.

There are academic and clinical assessments to ensure students are competent and confident to reactivate their registration and fit for purpose. This mode of delivery for adult learners can be demanding but it does prepare individuals for the challenges of caring for patients in a busy national health service. It enables students to develop confidence and competence in a supported environment, giving them opportunities to practice skills in clinical skills suites before entering practice, and engaging in the higher education student experience. Evaluations of the programme to whom I am involved with from students are excellent.

We have seen an increase in the number of students who return to the community setting, continuing to engage with higher education and going forward to complete both BSc and MSc degrees with SPQ or a community focus. This has had a positive impact upon the teams that they work within, the care they provide and their own personal professional development. This group of nurses are also helping to meet the government directives of shifting services into primary care where we know 90% of the population engage with services.5,7

Nationally, we are seeing a focus upon primary care, and nurses wishing to return to nursing are well placed to resume their careers here. The experience gained from my involvement with this programme demonstrate this, with students gaining a variety of roles across primary care upon completion of the programme, and activation of their registration. Nurses may return to bank nursing in the community setting, practice nursing, or a range of roles within primary care spanning all bands pending previous experience.

It is a pleasure to be a part of this process and facilitate the development of nursing in this area of practice, and I would urge those considering to return to nursing to seek out opportunities within primary care.

The successes and rewards of these motivated individuals demonstrate the positive contribution they can make within our workforce and are inspiring in their pursuit to care for patients within primary care.


1. Workforce, Education and Development Services. Return to Practice For Nurses, Midwives and Specialist Community Public Health Nurses (Health Visitors). (accessed 3 March 2016).

2. Nursing and Midwifery Council. PREP Handbook. (accessed 3 March 2016).

3. National Institute for Care and Health Excellence. NICE releases safe staffing evidence reviews. (accessed 3 March 2016).

4. Higher Education England. Return to practice. (accessed 3 March 2016).

5. Welsh Assembly Government. Setting the Direction. (accessed 3 March 2016).

6. Nursing and Midwifery Council. NMC Code. NMC, 2015.

7. Queens Nursing Institute. 2020 vision, 5 years on. QNI, 2014.

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With a growing need for community care, nurses wanting to return to practice can make a difference. But how can nurses re-enter the profession and what does returning to practice really involve?