“I’ve done an immunisation course. Can I give injections now?”.
Clinical competency and immunisation in practice.
By Alys Bunce (RGN, PGCE)
Clinical Trainer in Phlebotomy, Travel Health and Immunisation.
It’s a great feeling having completed your immunisation course and having that certificate in your hand. For many people, gaining that extra skill that enables you to expand your job role is a proud moment. And so it should be. Courses, like the two-day foundation immunisation one, are often demanding, intense and require a lot of brain power and academic skills which doesn’t come easy to everyone. You will have certainly earned that certificate!
But what exactly does that certificate enable you to do? It’s tempting for both employees and trainees to see the certificate as an end-goal; an official piece of paper that declares unwavering competency. However, whilst it is a significant milestone in the journey, it is only just the beginning in reality.
Let’s take a look at the national standards for immunisers.
It must be highlighted first that the guidance is suggesting MINIMUM standards one must achieve before immunising. That word is important. And in the competencies outlined there are three main areas to consider before commencing the task of injecting someone with something:
- Part one: knowledge.
- Part two: core skills.
- Part three: clinical processes and procedures.
The very first box-to-tick in part one of the competencies, is that the immuniser must have completed a two-day (or equivalent hours) immunisation course covering sufficient detail around the vaccines for which they will be delivering. Your course certificate certainly helps you tick this box. In fact, most of the competencies in part one (‘knowledge’) can be covered in an immunisation course or at least start you off. Things like competency 1f: “understands the different types of vaccine, is able to state which are live and which are inactivated”. Yep. We cover that.
However, after this there are many other competencies to achieve in part two, such as basic life support skills and all the other related mandatory training courses that go hand in hand with immunisation. These will need to be completed as additional courses or local training. Some examples are safeguarding, consent and infection control. Then there is all the related local policy-reading one must learn about. These are not things that can all be comprehensively covered in a two-day immunisation course, especially as every individual practice will have their own specific list of things to check off.
Then there is more practical learning to be done around the clinic processes and where everything is kept . How the day normally runs at your practice, and how to operate the documentation systems. Finding out who you go to for what, and who’s in charge when someone is on holiday. And if you’re a registrant, you will have a massive pile of PGD reading and sign offs to do on top. You can’t really get this information from an external course.
Following a course, this is an essential recommendation in the minimum standards. And is probably the part where you will learn the most. Most of the ‘part 3’ competencies are about you demonstrating that you can DO certain things once you get back into your workplace, like competency 3a; ‘Checks patient identity and patients records prior to vaccination to ascertain previous vaccine history’, for example. Not just about ‘knowing’ that it needs to be done.
Then there’s the supervised practice.
On all courses we aim to take you to a higher level of learning and encourage you to apply your new knowledge with discussions, quizzes, and a bit of practice on a fake arm along the way. But once you get into practice, it’s a whole new level of applying knowledge. And this is HARD without a work-based supervisor around when you’re starting out.
‘Knowing’ and ‘doing’ are two distinct things.
Look at this model here based on Miller’s pyramid of competency which illustrates the levels between novice and expert.
A classroom-based immunisation course can only really start you off there and the real application of learning comes with further repeated practice and applying that knowledge.
In practice, you are greeted with the nuances of spending your days dealing with the general public. You have to make difficult decisions, have tricky conversations, and have to weigh up various deltoid presentations. Curveballs come your way, appointments run over, supplies need ordering and managing. You have your ‘off’ days. And so do your colleagues and patients. You might make and witness mistakes, and when you do you will be glad of your supervisor to help you deal with them.
So, ‘how many supervised observations in practice do I need before I can go it alone?’
There are no nationally defined maximum or minimum number of supervised sessions you must have in practice (although your practice may have determined some local numbers). But whoever is doing the signing-off part and trusting you to do this safely and well, needs to be satisfied of your competency. But like the ‘how-long-is-a-piece-of-string’ question, this takes as long as it takes. Importantly, YOU need to be satisfied too and feeling confident. This won’t come overnight or after a few brief stabs of a fake arm in a class. It takes practice. Some learners will take longer than others and that’s OK. Your workplace needs to be patient there.
So, let’s look at the initial question again. Does the certificate make you ‘ready’?
It can certainly prepare you and get you off to a great start. But ultimately, a two-day course is just the tip of the iceberg.
Dovetail courses teach future immunisers all the theory they can possibly squeeze in to better equip their delegates to start the wonderful journey into immunisation. But we recognise that the learning process needs to continue beyond the course. For this reason, we also provide a detailed self-directed workbook incorporating the standards in the guidance to help delegates to continue their learning long after the course has ended. The supervisor can then take over the reins and help the learner to complete it. The immunisation tutors recognise that it can be a lot to take in over a two-day course. We also recognise that no one will take in every single word. In fact, it might be only a fraction that gets digested. Two-day courses can be intense! You will likely need to revisit some material or want to read in more depth afterwards. We encourage this, and our workbook offers you the structure needed to do this.
And don’t worry. If you join a course, you will usually be greeted with a cup of tea, a welcome smile, and an understanding that everyone learns at different speeds and in different ways. We will support you and guide you towards the right direction for your next steps after the course.
And trust us when we say this; we will be just as proud as you when we know that certificate is in your hands. We love seeing new immunisers in the world and we are just as excited as you are to get you going. Every time you give a vaccine you could have saved a life - or a great deal of suffering.
But remember that this is a process.
Even those 20 years down the line still have loads to learn hence why the national standards advise an annual update course at minimum. A certificate is just a bit of paper (or these days a PDF). It’s how you apply it that counts so make the most of it. But don’t see all the other competency points as a chore or a box to be ticked. Find the enjoyment in learning such valuable skills.
Take responsibility for your learning, find the joy, and see it as a continuous learning process, and you are sure to be a fantastic immuniser.
Hope to see you on an immunisation foundation or update course soon!
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