The Practice Facilitator Role: ‘The everything facilitator’ within pre- registration nurse education in practice

Background
The importance of ensuring student nurses being well prepared to deliver healthcare in a constantly changing environment has been a policy priority. A new practice facilitator role was introduced in the early 2000s in response to specific national
policy initiatives which aimed to enhance pre-registration nurse education. The literature demonstrated a few similar roles were introduced in the UK. Limited research has been undertaken in respect of these roles and none explored role development over time.
Aim
This study’s aim was to explore the way the practice facilitator role evolved in a real-world context over time and its impact on pre-registration nurse education.
Methodology and methods
A pragmatic epistemological perspective informed the research which used a qualitative, multiple case study methodology (Yin, 2009). Study participants (n= 57) comprised key actors engaging with the practice facilitator role (9 practice facilitators, 3 Trust education leads, 3 HEI heads of department, 26 mentors and 16 link lecturers). Data was collected through one-to-one semi-structured interviews (n = 15) and focus groups (4 mentor and 3 link lecturer).
Data analysis
The data was analysed using Braun and Clarke’s (2006) model of thematic analysis.
Results
Three major themes and an overarching theme were identified which broadly reflect the way the practice facilitator role evolved over time. Firstly, in the frontline describes a managerial focus centred on establishing systems to control access to and management of practice resources. Secondly, everybody knows them and they know everybody whereby practice facilitators have assumed a critical frontline decision-making role influencing student outcomes and at the same time displacing the link lecturer role. Thirdly, de facto gatekeepers to the profession where practice facilitators have developed a close reciprocal relationship with mentors through whom they exercise a quality assurance function to ensure robust assessment of students’ practice and transition to qualified status. These were encapsulated in an overarching theme the everything facilitator.
Discussion
Lipsky’s (2010) concept of street-level bureaucrats provided an analytic framework to interpret the results where practice facilitators were found to possess the characteristics of street-level bureaucrats. Crucially, they were found to occupy a
unique spatial location across, between and within the Trusts and HEI at frontline strategic and operational levels, conceptualised as interstitial spaces (Furnari, 2014). This allowed practice facilitators to have a significant impact on pre-registration nurse education. It is argued this is a development of Lipsky’s street-level bureaucracy.
Conclusions
The results indicate that practice facilitators function at both strategic and frontline operational levels, working uniquely within the ‘interstitial spaces’ (Furnari, 2014) of pre-registration nurse education. Their current way of working is significantly expanded from the original policy intentions. Moreover, the development of the role has been accumulative rather than sequential. The implementation of policy initiatives and the way the role has evolved is explained by the application and development of Lipsky's (2010) street-level bureaucracy with occupying the interstitial spaces (Furnari, 2014).