Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Theory before Practice: Implicit Assumptions about Clinical Nursing Education in Australia as Revealed through a Shared Critical Reflection

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Theory before Practice: Implicit Assumptions about Clinical Nursing Education in Australia as Revealed through a Shared Critical Reflection

Article excerpt

INTRODUCTION

In Australia the transfer of nursing education into the higher education sector in the period 1985-1994 was assisted by the decision of nurse leaders to adopt a single outcome measure for all nursing graduates, a national competency standard for the registered nurse (Percival, 1995). This decision provided curriculum designers in higher education institutions around Australia with the scope to develop programs of study that met local needs, while ensuring that the graduates met a minimal national standard.

While higher education institutions and hospitals partnered locally, the diversity of curricula was not an issue. However, with partial deregulation of the higher education sector and increasing shortages of skilled nurses, many health agencies began to partner with multiple higher education institutions to provide work experiences for nursing students. Clinicians today are confronted by students from different tertiary providers, with different curricula, and different levels of preparation. Clinicians' taken-for-granted assumptions about how students learn, which inform 'operational' models for workplace learning are being challenged by the diversity of students, as well as diverse curriculum expectations, in their workplace. This often leads to tensions in the work unit that can reduce opportunities for learning.

As with other jurisdictions, one university in one jurisdiction of Australia had enjoyed an exclusive relationship with its partner health service. The introduction of nursing students from other higher education institutions resulted in increased tensions that were diffi cult for staff to explain. In discussing this situation with a senior colleague, and considering feedback on their experience from staff, one author (LS) questioned the cultural expectations within the work unit. This paper reports on a shared critical refl ection of both authors on clinical education practices.

BACKGROUND

Clinical education for pre-registration nursing students has provided signifi cant challenges for nursing educators interested in preparing a competent, critically thinking, graduate nurse. Despite the plethora of studies done to date, clinical education has not progressed (Levett-Jones & Lathlean, 2008). The value of pre-registration clinical education to nursing is not contested in the nursing literature. What is contested is how much emphasis in curriculum should be on practice and how to best facilitate student learning in the workplace.

One key element is consistently reinforced in the plethora of nursing research studies of clinical education done to date. Students' access to appropriate clinical experiences, and therefore learning, are dependent upon clinicians' openness to student presence and inclusion of students in their everyday practice. In the last 30 years, a range of clinical education models has been developed and trialed to determine the 'best' way to enhance student access, without returning to the apprenticeship model of training found in hospital-based programs. More recently, the term 'belonging' has been coined as a way to acknowledge students' requirement for access to worthwhile practice experiences (Levett-Jones & Lathlean, 2008).

Theoretical development in the discipline of work-based learning suggests that learning is dependent upon 'engaging in work activities that are novel and thereby extend the individuals' capacities, securing appropriate guidance from experienced coworkers, and being able to access practice in prized tasks' (Billett, 2002, p. 29). Billett (2002) suggests that opportunities for students to engage in clinical practices are shaped by workplace practices grounded in unique histories and traditions. Following Billet, it is then logical to assume that some of the history and traditions of pre-registration nursing education, grounded in the apprenticeship model of hospital-based programs, continue to exist in contemporary health services. …

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