Professional protectionism; a barrier to employing a sonographer graduate?

Factors influencing sonographer-led bowel ultrasound services in the UK

INTRODUCTION

There is a growing understanding of the potency of bowel ultrasound leading to an increasing application of ultrasound in examining different bowel conditions. However, sonographers' involvement in bowel ultrasound is under-researched. This study investigated the factors influencing sonographers' experience in adult bowel ultrasound.

METHODS

A convenience sampling method was used to promote the study in April 2021. A mixed methods online questionnaire was utilised to explore the participants' views. Quantitative data were analysed using descriptive analysis on Excel, while qualitative data were analysed using inductive thematic analysis.

RESULTS

Almost half of the participants (53%; n = 16) indicated low confidence in using ultrasound to examine the bowel for abnormalities. While 63% of the participants reported having high confidence in examining the bowel for suspected appendicitis, 70% (n = 21) reported low confidence in carrying out ultrasound in examining Inflammatory bowel disease. Furthermore, 23 participants (77%) indicated a high interest in bowel ultrasound training. Qualitative findings revealed mixed opinions on bowel ultrasound practice. Factors influencing sonographers' experience are the need for more training opportunities, preference for other imaging modalities, management challenges, radiologists' influence, sonographers' perspectives, and positive perspectives.

CONCLUSION

Several factors influence sonographers' confidence in using ultrasound for bowel abnormalities. However, the findings emphasise the need for more research into the future design and implementation of sonographers' bowel ultrasound training.

IMPLICATION FOR PRACTICE

This study brings new insight to an under-researched area on the scope of sonography practice, highlighting some sonographers' experience, opinions, and involvement in bowel ultrasound. It further strengthens the argument for more training to be made available to sonographers on bowel ultrasound.

A mixed method study into obstetric sonographer-led-discharge and other forms of sonographer role extension

Introduction

Sonographer-led-discharge was proposed in a maternity unit to provide a holistic service, cut waiting times, ease staffing pressures and increase job satisfaction. This study explored sonographers’ experiences and perspectives of this new extended role and other areas of non-obstetric role extension. Understanding these will inform future practice and the success of the proposed obstetric sonographer-led-discharge and career structure.

Methods

A mixed methodology, cross-sectional study was performed, with a purposive, non-probability sample using an online data collection tool. The data were analysed using descriptive statistics and thematic analysis.

Results

In total, 93 sonographers participated in the study. Of these, 25% of sonographers currently practising obstetric ultrasound said they would not undertake the proposed obstetric sonographer-led-discharge role extension although 90% of the participants said role extension provides job satisfaction. Several themes emerged from the data, including job satisfaction, benefits to the hospital, improved patient pathway, time, personal factors, litigation and intra- and interprofessional resistance. A total of 54% of staff currently performing a role extension have experienced either inter- or intraprofessional conflict and only 48.5% said their workload was manageable.

Conclusions

The data collected suggested that, with training and support, the proposed obstetric sonographer-led-discharge role is an appropriate role extension for sonographers. These findings support the premise of the proposed sonographic career structure, although the inter- and intraprofessional resistance identified in the study could form a significant barrier if it is not appropriately considered and managed.

Degree apprenticeships for the radiography profession; are clinical departments ready?

INTRODUCTION

The recently approved degree apprenticeships for diagnostic and therapeutic radiography and sonography offer a new route into the professions in the UK. The work based nature of apprenticeships is reliant on employers embracing the positive impacts they can offer; however recent studies highlight there is still a lack of understanding around radiography apprenticeships. This study investigated diagnostic and therapeutic radiography and sonography managers' perceptions of and readiness for degree apprenticeships.

METHODS

Qualitative and quantitative data was collated by an online questionnaire survey to capture employers' perspectives of degree apprenticeships. Participants (n = 17) were recruited through social media and advertisements in professional journals and websites. The numerical data was analysed using descriptive statistics and framework analysis was used to analyse textual data.

RESULTS

Almost all the participants were planning to employ apprentices, believing they would increase the diversity and sustainability of the workforce. Three themes emerged; barriers and facilitators to employing apprentices, impact of apprentices on the local workforce and impact of apprentices on the wider workforce. Managers raised concerns about the cost of apprentice training however, encouragingly, none of the participants identified extreme challenges in employing apprentices.

CONCLUSION

Recommendations were formulated to increase awareness, understanding and employment of apprentices. Further clarity was needed on the role of mentors and the academic and practice education split and strong collaborations between clinical departments and higher education institutions was imperative.

IMPLICATIONS FOR PRACTICE

With careful implementation, degree apprenticeships can help widen participation, grow the workforce, and facilitate support worker career development.

Radiographers' individual perspectives on sonography - A survey of European Federation of Radiographer Societies (EFRS)

INTRODUCTION

Radiographers can elect to work within many different modalities, one being ultrasound. Within Europe there are differing opinions about how much of a role radiographers should take in relation to the ultrasound examination, particularly report writing. This paper provides findings exploring the radiographer's views on working within sonography.

METHODS

In 2019 an electronic survey was disseminated to radiographer members by European Federation of Radiographer Societies (EFRS) national radiographer societies, following a pilot study. A mix of closed questions, free text, and scale responses aimed to investigate radiographers' practice, legal responsibilities, report writing, educational level and experiences of support and mentoring.

RESULTS

Of 561 radiographers participating, most (92%) reported performing ultrasound scans. Challenges with legislation, medical protectionism and lack of high-quality education restricted other radiographers. On average, the respondents have practiced ultrasound for 13.5 years. A total of 60% had postgraduate education and carried out a wide range of examinations. A full interpretative report, including advice on further investigations is performed by 52%, whilst 22% provide a checklist or descriptive report. Over 55% of radiographers took legal responsibility for the examination and the majority had clear protocols, good mentoring and support in the workplace. Peer review of their work was less common.

CONCLUSION

The result shows that in 21 (n = 25) countries radiographers perform ultrasound, however not without challenges. Educational levels range from no formal education or short courses to an MSc in ultrasound. Report writing practice differs across the EFRS countries responding to the survey, as does peer review to enhance skills and clinical practice.

IMPLICATIONS FOR PRACTICE

National Radiographer societies could review findings to support campaigning for a change in legislation and improvements to educational offerings in ultrasound.

Retention of radiographers: A qualitative exploration of factors influencing decisions to leave or remain within the NHS

INTRODUCTION

In many countries a widening imbalance exists between radiographer workforce supply and demand. Improving retention is a rapid method of workforce expansion which is gaining importance with policy makers and providers. To better understand the current leaver profile, this study aimed to identify why radiographers leave the NHS early, and what incentives are important in their decision to stay.

METHODS

A qualitative framework methodology used semi-structured telephone interviews to explore the perspectives of radiography managers, radiographers who have left the NHS, and those considering leaving. Purposive sampling ensured representation across radiography professional groups, geographical and organisational diversity, and stages of career.

RESULTS

Three over-arching themes were identified across all radiographer professional groups (n = 44): 1) Challenging working patterns and the impact on employee health and wellbeing; 2) Lack of flexibility in working terms and conditions; 3) Lack of timely career progression and access to CPD, and the need to feel valued. Radiographers were keen to express how they 'loved being a radiographer'; small concessions and changes to workplace culture might be the incentive to remain in radiography that some were clearly searching for. Manager participants recognised the need to offer greater flexibility in working patterns but this was challenging within financial and service delivery constraints.

CONCLUSIONS

While some influencing factors varied between radiographer professional groups, the three themes were consistent across participants. Failure to address these concerns will exacerbate the loss of experienced and highly trained staff from the NHS at a time when demand for services continues to rise.

IMPACT ON PRACTICE

Recommendations are presented related to three primary themes which will be a catalyst for sharing of best practice between radiology and radiotherapy centres.

Trailblazers: Stakeholder motivations for developing degree apprenticeships for the radiography profession

INTRODUCTION

Employer led apprenticeship trailblazer groups develop the occupational standard and end point assessment associated with a particular job or occupation. All degree apprenticeship programmes within England must align to these and for allied health professions, this is a new concept. Exploring stakeholder motivations for being part of the trailblazer groups is essential to inform subsequent curriculum design and implementation for this new model of education.

METHODS

Eighteen semi-structured interviews were undertaken across the three radiography related (diagnostic, therapeutic and sonography) trailblazer groups using a pragmatic constructivist approach.

RESULTS

Strong themes emerged around professional recognition, and conflicts between being 'educated' or 'trained', and between vocational and academic components of radiography training. Even within these pioneer groups there was a lack of understanding around degree apprenticeship programmes and their potential impact upon the workforce. Whilst the benefits on recruitment and retention of staff through widening participation were acknowledged, there were concerns around apprentice pay and mentorship. Evidence of professional protectionism was uncovered, balanced by professional pride and a strong desire for team working within and between institutions.

CONCLUSION

The study highlighted an urgent need for further research and awareness raising for employers and practitioners, prior to implementation of radiography-related degree apprenticeships.

IMPLICATIONS FOR PRACTICE

This is the first evaluation of stakeholder motivations related to the development of degree apprenticeships within the allied health professions. The results and recommendations for practise will inform the imminent implementation of degree apprenticeships for the three radiography related professions, facilitating a smooth transition to apprenticeships for clinical and education departments.