Access to location policy and prodcedure manuals
Supervision requirements and expectations
Delegation criteria - allied health assistants
This document is for those who employ and manage allied health professions, with the aim of supporting newly qualified practitioners as they make the transition from student to qualified health professional (transition-to-practice). Potential readers include directors of allied health, technical and scientific staff, as well as professional leaders, allied health team leaders and managers. In part, the aim of the toolkit is to encourage the sharing of knowledge and resources within and between District Health Boards (DHBs), and to encourage the development of national networks supporting discipline groups and specialist work areas. Much of the information within the document may be familiar and the actions suggested may already be in place in DHBs.
This toolkit has been developed to provide a guide that can be incorporated into new graduate and DHB orientation programmes. Each section includes organisational cues – items that are likely to already be in place or would be easy to manage with existing resources, as well as links to sample documents stored in the Allied Health section of the District Health Boards New Zealand (DHBNZ) Nexus site.
The toolkit includes information on:
This initiative is part of a drive to share Allied Health’s best practice policies and guidelines within DHBs nationally. Such information sharing has become increasingly valuable and could play a key part in developing sound organisational processes. DHBNZ has set up a document repository which can be accessed via links on the Allied Health homepage: http://www.dhbnz.org.nz/Site/Allied-Health/Default.aspx. This facility allows DHBs to deposit and retrieve documents and share information. The aim is to promote national collaboration, reduce duplication and set the platform for future knowledge sharing.
The material covered in this document is an addition to existing orientation resources and is aimed at the additional needs of allied health staff, particularly new graduates appointed to permanent positions.
This document assumes that the Privacy Act 1993, the Health Information Privacy Act 2003, the Health and Safety in Employment Act 1992, the Code of Health and Disability Services Consumers' Rights 1996 and other relevant legislation and policies are included in general orientation resources and are therefore not covered in this document.
Supervision, as defined in the toolkit, is the process of providing clinical oversight as part of the professional and learning support for new graduates. Supervision facilitates the development of the practitioner’s competency, knowledge and adoption of personal responsibility for their own practice to enhance patient safety and protection.
This assumes the workplace has accessible location manuals, or similar protocols, outlining policies and procedures such as needle stick injury processes, incident-reporting guidelines, and emergency procedures.
Organisational management means having responsibility for accountabilities, controls and obligations for employer | employee relations as per Multi-Employer Collective Agreement (MECA) provisions. Organisational management is two-fold, incorporating both professional and clinical leadership. Professional leadership models best practice, which in turn leads to improved outcomes for the employee, organisation and patients. Clinical leadership is an integral part of instilling appropriate clinical values and culture and leads to the implementation of good clinical governance.
Professional bodies are responsible for protecting the health and safety of the New Zealand public under the Health Practitioners Competence Assurance Act 2003 (HPCA Act) and the Social Workers Registration Act 2003.
The Allied Health New Graduate Toolkit emerged as part of the recommendations from the Allied Health Workforce Practice Readiness Survey Report (DHBNZ 2008).
The report was commissioned by the Allied and Technical Workforce Strategy Group (ATWSG), in collaboration with the allied health community and other interested sector parties. Its aim was to identify current issues and innovations in transition-to-practice and to make recommendations for strategies and programmes for allied health practitioners (AHPs) starting work in DHBs. The report identified one of the key workforce issues as the inability of the health sector to support transition-to-practice, in particular the support and mentoring of students and new graduates (DHBNZ 2008).
Research shows that the development of staff is linked to an organisation’s success in recruiting and retaining staff (Gerrish 1990). Evidence suggests new healthcare graduates experience stress during the early phase of initial employment. They reportedly often feel unprepared and unsupported in making the transition from student to confident practitioner. Structured support and a positive learning environment during this phase can make a difference to the confidence of the individual and contributes to and improves ongoing recruitment and retention (Field 2004; Gerrish 2000).
Evidence to support new graduate programmes in New Zealand is documented and demonstrated mainly in the nursing, midwifery and medical professions. Strategies to improve retention and turnover within nursing, in particular, found that new graduate programmes that had a continuing education component were successful in retaining staff (North et al 2005).
The ATWSG encourages the sector to work together to prioritise new graduate programmes, to improve the value and profile of the allied health professions and to strengthen the future allied health workforce.
Scotland’s Flying Start National Health Service (NHS) programme is a model which encompasses principles that could be mirrored in the New Zealand allied health sector. The workforce readiness issues faced by the NHS are similar to those identified by the AHWSG – in particular, the key themes of recruitment and retention, careers, leadership, education, development, training and new graduate programmes.
The Flying Start NHS programme was designed to improve recruitment and assist new practitioners to make a positive and proactive start to building a career with NHS Scotland. A document entitled Facing the Future: ReportandAction Plan (NHS Scotland 2001) first highlighted the key themes that needed to be addressed to improve the recruitment and retention of nurses and midwives in Scotland. The Facing the Future group was charged with overseeing the achievement of goals set out in the document. The impetus for the Flying Start NHS and Flying Start Primary Care initiatives came from this group.
In 2005, the NHS Scotland addressed its workforce readiness issues by commissioning a national programme, with links to the NHS knowledge and skills framework and e-library, to support all newly qualified nurses, midwives and allied health professionals during the crucial first year. The programme was designed to support new practitioners, using web-based learning programmes with support from workplace mentors and an online community of peer support.
More than 8,000 allied health practitioners are employed throughout Scotland. They frequently work in multi-disciplinary teams and their education and ongoing professional development increasingly reflects this. The report Building on Success: Future Directions for the Allied Professions in Scotland (NHS Scotland 2003) sets out a vision for the evolving contribution of AHPs to care for the people of Scotland. This was followed by Framework for Role Development in the Allied Health Professions (NHS Scotland 2005; Scottish Executive 2005) which develops the theme of role development in the context of service re-design.
The document Delivering care, enabling health (Scottish Executive 2006) seeks to enable continuing improvements in the experiences and outcomes for patients, families and carers and provides a clear direction of care being delivered in multi-professional teams that are patient focused. It provides a mix of information, mentoring, coaching in workplace expectations, etiquette and skill development activities. It also recognises the challenges faced in the transition from trainee to qualified health practitioner, particularly if they trained in a different setting from that in which they are employed as a new graduate.
Attending to activities and information to ensure new graduates have a smooth start to their employment helps them to step out of a training role, into the identity of a professional. Welcoming them to the organisation is an important part of this process and has special importance for allied health practitioners who face the challenge of slotting into a large organisation. Welcoming new staff can be easy to overlook but the way people are treated when they first join an organisation has a significant bearing on how they go on to view that organisation and whether they choose to stay.
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Guide for Preparation – to be completed before the new employee starts |
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| Desk | locker | pigeonhole identified and named, telephone extension notified. |
| IT informed to set up email account, computer access etc. |
| Office supplies, equipment allocated, (eg, keys, name badge, alarm security door codes). |
| Welcome notice on team whiteboard | notice board. |
| Team, including administration and reception staff, notified of name of new employee, role in the team, and start date. |
| Mentor | preceptor | buddy identified, time scheduled to meet during the first day. Role includes socialising the new employee to the team, including them in informal team activities such as five-minute quiz, shared lunch. It can be hard for a new person to join in unless invited. |
| Mentor or preceptor to meet with the new employee during the first week. If the mentor | preceptor isn’t available they should make reading material available as a fill-in activity. |
| Meeting arranged with appropriate colleagues (e.g. administrator, buddy or mentor) to go over keys | swipe card | pin number access to workplace, use of office equipment, location of supplies. |
| Supervision arrangements made (if appropriate). |
| Encourage team to make time for shared morning, afternoon tea or lunch – preferably, on the employee’s first day. |
| Appropriate staff member (team leader or mentor) to check in with the new employee prior to the end of their first week. |
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New employee induction content guide The new employee should be given: |
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| Employment forms to complete. |
| Advice on wages | salary deductions, pay dates, method of payment, and location of payroll department/office. |
| Advice on processes for taking leave (eg, doctors’, dentist appointments, annual leave and sick leave). |
| Advice about contractual requirements (relevant to MECA/individual employment agreements). |
| IT support details, log on, passwords, relevant access to local drives. |
| Information on safety and security regulations, (ie, health and safety policy, evacuation and assembly areas, emergency procedures, issues and use of protective equipment). |
| Advice on organisational policies, such as smoking, alcohol, misconduct, appropriate use of telephone, safe | appropriate use of the internet policy, and expectations regarding access to personal email and social networking sites. |
| Introduction to staff “buddy” system which provides new staff with a colleague who can answer their questions – buddy need not be in the same profession. |
| Advice on infection control policies; flu vaccination | protection from infection. |
| A survival guide to first year of practice, including self-care: stress management advice, coping strategies and support mechanisms to help deal with starting a new | first job, being in an unfamiliar environment, or being away from family. |
| Information about the need to attend cultural awareness workshop(s) – Tikanga Best Practice and The Treaty of Waitangi. |
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Professional environment guidelines including:
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| Operational and fiscal awareness advice when working in the public sector, ie, awareness of resource constraints and value for money. |
| Delegation expectations and criteria. See section 6.1 – Delegation criteria – allied health assistants. |
| Follow up on orientation. This will provide an opportunity to recap on the orientation information after the first few months and revisit any issues that have arisen. |
| Orientation activities – content guide |
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Attendance at allied health orientation, in addition to the DHB orientation. This is a good opportunity to:
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New graduate | rotational staff orientation within the first month of employment. Components can include:
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| Guidance | training concerning new graduate transitioning and working within a multi-disciplinary team. |
Clinical supervision involves a scheduled meeting with a respected professional colleague for the purpose of reviewing progress and performance. It may include a review of practice, a discussion about professional issues, and feedback on all elements of practice. Supervision aims to develop and maintain the practitioner’s competent professional functioning while safeguarding patient care.
Elements of supervision include:
Clinical supervision for new graduate allied health professionals should be implemented and facilitated in a supportive and formal framework. Supervision will offer support and learning opportunities which will lead to the development of knowledge, professional practice, competency and confidence. Such a programme will endorse responsibility and therefore positively impact on patient safety and protection. In the context of the Allied Health New Graduate Toolkit, the success of a supervision programme will be dependent on implementation, facilitation and monitoring with the individual practitioner.
Supervision can be delivered in a variety of ways – on a one-to-one basis, clinical or professional supervision, group supervision or peer supervision. This will depend on the work role, the individual’s learning and development needs and the availability of suitable supervisors. It is important supervision is tailored to the needs of each employee and put in place as soon as possible after they begin employment.
Employees being supervised need to be aware:
| Occupational Group |
Supervision requirements | expectations |
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Alcohol and drug clinicians |
Drug and Alcohol Practitioners Association Aotearoa New Zealand (DAPAANZ) advises that supervision should be provided regularly, as determined by the complexity of the work being supervised. Supervision should be provided, at the least, by an equally experienced practitioner, preferably by a more experienced and knowledgeable practitioner and someone who has been trained in supervision. Whether supervision should be provided internally or externally, and individually or as a group, is a matter for the employer but the context of the practice being supervised should act as a guide. Supervision is about supporting and guiding the practitioner in the work for which they are accountable rather than for the personal development of the practitioner which should be sought privately. |
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Audiology |
New graduates are expected to complete the requirements for the New Zealand Audiological Society certification process, which includes a minimum of 11 months supervised practice. |
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Counsellors |
The New Zealand Association of Counsellors (NZAC) expects new graduate counsellors to be in regular supervision with a supervisor who is not a line manager or otherwise in a position of power. In the first year of practice they need to complete a minimum of 30 individual supervised one-hour sessions to be eligible for membership of NZAC. |
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Dental therapy |
There are no mandatory supervision requirements from the Dental Council of New Zealand (DCNZ) but mentoring is generally put in place for new graduates in public practice by the employing DHB. All dental therapists working in private practice must have a formal agreement with a dentist which states – “Dental therapists and dentists have a consultative working relationship that is supported by a written professional agreement." |
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Dietetics |
The Dietetics Board requiresall entry level dieticians to be supervised for a minimum of one year. The revised Registration Competency Requirements are in transition in 2010, which means that all entry level dieticians are now required to be under practice supervision for the first year of working in NZ. New graduates receive the Board’s ‘Practice Supervision Guidelines and Agreement’ with the registration package. All supervision programmes must ensure that the Continuing Competence Programme (CCP) has been established and the CCP criteria and requirements are being met. |
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Occupational therapy |
The Occupational Therapy Board of New Zealand (OTBNZ) requires all new graduates to undertake weekly supervision for their first 12 months of practice. Their supervisor must be a NZ-registered occupational therapist with a current practising certificate, with no condition on scope of practice. The condition remains in place until the new graduate applies to have it lifted. Refer to OTBNZ website www.otboard.org.nz for further information. |
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Optometrists |
New graduate optometrists receive full registration without any mandatory supervision requirements. |
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Pharmacy |
A new graduate mentoring programme is currently being developed by the NZ Hospital Pharmacists Association. |
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Physiotherapy |
The Physiotherapy Board of NZ recommends a minimum of one hour of professional supervision and one hour of performance monitoring (one-to-one) monthly. The supervisor should be a senior physiotherapist and may be a practice supervisor | section head for the first three months. The Physiotherapy Board does not stipulate minimum supervision requirements. |
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Podiatry |
Podiatry NZ is working towards a four-year course, with the fourth year being a work placement within a variety of clinical settings. The aim is to improve workforce readiness and the quality of graduating practitioners. Currently new graduates are able to enter the profession without supervision. |
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Psychology |
The New Zealand Psychologists Board recommends that supervision take place for a minimum of two hours per month for psychologists who work full-time and one hour per month for part-time psychologists (6 | 10ths or less). The frequency of supervision may need to be increased in some situations, including (but not limited to):
Source: http://www.psychologistsboard.org.nz/documents/SupervisionGuidelinesFINALFORPUBLICATION200510.pdf Following these guidelines, it is usual for a new graduate psychologist who works full-time to have an hour of clinical supervision per week. |
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Psychotherapy |
Psychotherapy Association guidelines stipulate weekly supervision until full membership is attained; the Registration Board has not yet set detailed expectations. |
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Social work |
Aotearoa New Zealand Association of Social Workers (ANZASW) requires practising social workers to have access to at least one hour per month of supervision to achieve competency in practice. Some members may require additional hours, depending on their clinical contexts. In their first year, new graduates are required to have a minimum of one hour core social work supervision per week. The Social Work Registration Board (SWRB) demands 200 hours of supervised practical experience in social work following the award of a recognised NZ qualification or equivalent. |
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Speech language therapy |
The NZ Speech-Language Therapy Association (NZSTA) provides a period of provisional membership during which new graduates are supervised. For a new graduate working full-time, this would amount to no less than 36 weeks supervised work, with a range of activities involved, including observation of the graduate’s work, conferring regarding treatment strategies and evaluating clinical records. The supervisor must hold full membership of NZSTA. Source: |
| Name | Details |
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Dental Council |
Ph 04 499 4820 www.dcnz.org.nz |
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Dieticians Board |
Ph 04 474 0746 www.dietitiansboard.org.nz |
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Occupational Therapy Board of New Zealand |
Ph 04 918 4740 www.otboard.org.nz |
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Optometrists and Dispensing Opticians Board |
Ph 04 474 0705 www.dispensingopticiansboard.org.nz |
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Pharmacy Council |
Ph 04 495 0330 www.pharmacycouncil.org.nz |
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Physiotherapy Board of New Zealand |
Ph 04 471 2610 www.physioboard.org.nz |
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Podiatrists Board of New Zealand |
Ph 04 474 0706 www.podiatristsboard.org.nz |
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New Zealand Psychologists Board |
Ph 04 471 4580 www.psychologistsboard.org.nz |
| Psychotherapists Board of Aotearoa, New Zealand |
Ph 04 918 4727 |
| Social Work Registration Board |
Ph 04 931 2650 www.swrb.org.nz |
For further clarification on the scopes of practice under the HPCA Act, refer to the appropriate regulatory authority.
Development plans enhance the partnership between the employee and organisation and, if linked into the organisation’s service drivers and framework, can provide systematic improvements in healthcare and patient services.
Development plans should promote benchmarking and learning from best practice as well as setting goals for educational, professional and clinical development. The development plan should also include an arrangement for regular feedback. This should include analysis of individual learning, communication styles and needs.
| Guide to toolkit content |
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| New graduate | rotational staff complete a professional development plan (PDP). PDPs may also be aligned to the regulatory authority or professional body requirements and recommendations. PDPs should identify areas the individual would like to increase knowledge in and that meet rotation learning objectives. PDPs should be undertaken | implemented with new graduates in the timeframe appropriate to the organisation. |
| Goals should include: any core team objectives, discipline-specific objectives and any learning requirements. |
| Plans should link into overall organisational service drivers and meet regulatory authority requirements. |
| Staff should be given the opportunity to discuss issues associated with remuneration at any stage – e.g. progression to merit steps, career progression appropriate to contract requirements. |
| Plans should include a clinical career pathway – provides generic structure for allied health new graduates and allows both enrichment and progression plans for practitioners. |
| Plans should explain how clinical leadership within the organisation is structured. |
A practitioner’s professional development can be enhanced by developing a professional portfolio. Professional portfolios encourage the practitioner to continually build on existing knowledge and seek new skills and knowledge. They record the process of learning from experience as the practitioner encounters new challenges. Professional portfolios document professional practice, continuing training and education, and record decision making and professional judgement, clinical supervision and evidence-based practice.
Professional portfolios can also showcase the practitioner’s publications, research projects, teaching presentations and professional achievements.
| Professional portfolio content list |
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Professional portfolios could include the following. 1. Introduction. 2. Organisational policies. 3. Registration body competency requirements. 4. Personal information:
5. Professional development plans. 6. Supervision. 7. Evidence of professional development. 8. Research projects, teaching presentations, publications, achievements. 9. Practice – decision making and professional judgement, evidence-based practice, reflective practice and reflective writing. |
Professional Portfolio Template.doc
Professional Development Portfolio.doc
Professional practice resources and support within an organisation can prove invaluable to a new graduate’s integration into the organisation. Providing guidelines and additional support helps the practitioner gain knowledge and enhances performance.
| Guide to toolkit content |
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Allied health graduate pack (could be hard copy and | or education sessions and | or online information | assessments) including information onself-care; transitioning from allied health student to allied health professional. Other topics could include:
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Profession-specific support. This can include buddies, peer mentors, tutorials | seminars for specific topics, e.g. journal clubs and rotational meetings, coffee club, peer reviews. |
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Professional practice guidelines for all allied health staff from new graduate to career and salary progression levels. |
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Professional development groups – new-to-practice group led by experienced health professional. This can be a group that includes a range of disciplines or, in larger DHBs, can be a discipline-specific group. |
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Topics to be covered include:
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Guidelines for membership of professional associations, credentialing or warranting. What would be considered as a minimum (to be consistent between the allied health professions) to maintain competency, registration, warranting and so on. |
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Review of HPCA Act | Social Workers Registration Board requirements, ie, reporting requirements, competence (scopes of practice). |
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An expectation to be available for weekend and on-call work, if applicable, (implemented within timeframe appropriate for the organisation). |
End of Rotation Feedback Form.doc
Educational opportunities provide the individual with practice-based learning and encourage continuous improvement. They enable the individual to assess their current activities and plan appropriate educational needs where necessary.
No matter how experienced a health worker is, everyone can benefit from educational and learning opportunities, and a culture of continued learning should be fostered as part of the culture of a successful organisation.
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Guide to toolkit content |
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New graduate | rotational staff receive area | department specific in-service education sessions, in addition to general team in-services. |
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Staff supported to gain the competency required to maintain designation in various professional areas. |
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Pre- and post-rotational placements, objective settings with senior clinician, in additional to annual review. |
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Monthly education sessions with topics determined by graduates (as well as usual continuing education opportunities). |
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Attend and participate in presenting at weekly general in-service and monthly special interest groups for different clinical areas. |
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Question | answer email list |website to share information with peers, so information sharing can be encouraged and facilitated. |
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Portfolio maintenance. |
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Support with career mapping. |
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Consider use of technology (video, teleconferencing or Skype) to connect graduates or access other support such as specialist advice or supervision. |
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Peer review. |
| Protected learning time |
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Establish expectations for frequency of supervision and document audits, peer review and one-to-one performance monitoring. |
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Foster and facilitate a peer learning environment where all clinicians act as consultants for each other. |
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Protected learning time per week if appropriate | possible (ie, reading and research time). |
Occupational therapy – the Continuing Competency Framework for Recertification (CCFR) for occupational therapists is a mandatory online programme. Graduate occupational therapists and their supervisors will need computer access to be able to carry out this requirement of new graduate supervision.
Understanding how to work with assistants is a crucial skill for new graduates. Being able to oversee and at times direct or sign off the work of colleagues, who may be older and have much more experience, can be daunting for the newly qualified practitioner. Seeking help from a mentor may be useful. It can also be helpful to understand the scope of practice and the challenges facing assistants and for clearly defining role accountabilities to patients.
Allied health assistants are an integral part of the team that delivers services to patients. The new graduate’s orientation programme should include a comprehensive overview of the role of the assistant and delegation guidelines. This part of the orientation programme should ideally be delivered to the new graduate by a senior clinician. It is important that the role of the allied health practitioner in relation to the allied health assistant is made clear to the new graduate and placed within the different clinical contexts in which the new graduate is working.
District Health Boards New Zealand. 2008. Allied Health Workforce Practice Readiness Survey Report Wellington: DHBNZ.
Field DE. 2004. Moving from Novice to Expert – the value of learning in a clinical practice: a literature review. Nurse Education Today 24(7): 560-65.
Flying Start NHS. Accessed via: http://www.flyingstart.scot.nhs.uk/
Gerrish K. 1990. Fumbling along. Nursing Times 86: 35-7.
Gerrish K. 2000. Still fumbling along? A comparative study of the newly qualified nurse’s perception of the transition from student to qualified nurse. Journal of Advanced Nursing 32(2): 473-80.
NHS Scotland. 2001. Facing the Future: Report andAction Plan. Edinburgh: Scottish Executive. PDF accessed via: http://www.sehd.scot.nhs.uk/publications/bb005dec2001.pdf
NHS Scotland. 2003. Building on Success: Future Directions for the Allied Health Professions in Scotland. Edinburgh: Scottish Executive. PDF accessed via: http://www.scotland.gov.uk/Resource/Doc/46729/0013995.pdf
NHS Scotland. 2005. Framework for Role Development in the Allied Health Professions. Accessed via: http://www.scotland.gov.uk/Resource/Doc/55971/0015377.pdf
North NH, Hughes FA, Finlayson MP et al. 2005. The cost of nursing turnover and its impacts on nurse and patient outcomes: A longitudinal New Zealand Study. Te Puawai, July. 25-30.
Scottish Executive. 2005. Framework for Developing Nursing Roles. Edinburgh: Scottish Executive. PDF accessed via: http://www.scotland.gov.uk/Resource/Doc/55971/0015376.pdf
Scottish Executive. 2006. Delivering care, enabling health. Edinburgh: Scottish Executive. PDF accessed via: http://www.scotland.gov.uk/Resource/Doc/152499/0041001.pdf
| AHP | Allied Health Practitioner |
| AHWSG | Allied Health Technical and Scientific Workforce Strategy Group |
| ANZASW | Aotearoa New Zealand Association of Social Workers |
| ATR | Acute Assessment Treatment and Rehabilitation |
| ATWSG | Allied and Technical Workforce Strategy Group |
| DHB | District Health Board |
| DHBNZ | District Health Boards New Zealand |
| CCFR | Continuing Competency Framework for Recertification |
| CCP | Continuing Competence Programme |
| HIPC | Health Information Privacy Act |
| HPCA | Health Practitioners Competence Assurance Act 2003 |
| MECA | Multi-Employer Collective Agreement |
| NHS | National Health Service |
| PDP | Professional Development Plan |
| SEHD | Scottish Executive Health Department |