Academic journal article Nursing Praxis in New Zealand

Preparing Registered Nurses Depends on "Us and Us and All of Us"

Academic journal article Nursing Praxis in New Zealand

Preparing Registered Nurses Depends on "Us and Us and All of Us"

Article excerpt

Introduction and background

Experiential learning or clinical education has been part of nursing since the commencement of formal training by Florence Nightingale (Pauling, 2006). In New Zealand, the transfer of nursing education to the tertiary sector has expanded nurses' engagement in scholarly activity (Wood, 2002), yet some would argue that valuable aspects of the earlier apprenticeship style of learning have been lost and that real nursing is more about exposure to clinical practice than about intellectual activity (Papps & Kilpatrick, 2002). Either way, the movement of nursing into higher education has not diminished the importance of the clinical setting as a major site for student learning. The nature of nursing as a practice profession mandates that clinical practice is an essential component of nursing education (Benner & Wrubel, 1989; Mannix, Faga, Beale & Jackson, 2006). It is a mandatory requirement that New Zealand nursing students experience a minimum of 1100 clinical hours (excluding simulated learning) within the 3 year, full time, undergraduate programme that prepares them to be registered nurses (RNs) (NCNZ, 2010). However, as the number of students entering nursing programmes has increased (Nursing Council of New Zealand, 2010), it is becoming more difficult to find placements that provide the clinical experience needed to adequately prepare them for RN practice. This, in turn, places pressure on clinical settings with resulting variability in the quality of student learning (Kaviani& Stilwell, 2000; Hutchings, Williamson & Humphries, 2005).

Preceptoring and buddying have been recognised and used as effective models of clinical education in nursing (Callaghan et al. 2009; Rummel, 2001; Waldock, 2010). However, much of the research supporting these models for learning has been undertaken in settings where RNs have had individually assigned patients and where RN numbers have been sufficient to provide continuous support via one-to-one teaching relationships with students (Luhanga, Billay, Grundy, Myrick & Yonge, 2010; Smedley, 2008). In the Auckland region, team nursing (wherein RNs, Enrolled Nurses, Health Care Assistants and student nurses work under the supervision of a registered nurse team leader who delegates tasks and/or allocates patients) has now replaced individual patient assignment to RNs in most in-patient settings. Thus, there are proportionately fewer RNs available to precept. Moreover, heavy workloads (Carlson, Pilhammar & Wann-Hansson, 2009) and roster variations do not adequately provide continuity of RN preceptors with the result that students are often sidelined and perceived to be a burden (Curtis et al. 2007; Jackson & Mannix, 2001; Zilembo & Monterosso, 2008).

Changes in the demands on nursing lecturers and an increasing expectation that they actively participate in research activity has compromised their capacity to sustain the levels of clinical support previously given to students (Duffy, Docherty, Cardnuff, Winters & Grieg, 2000). Difficulties associated with maintaining clinical practice while also keeping current with best practice in education compound this challenge and raise questions about who is best placed to support students' clinical skill development.

Thus, there have been sustained calls for education and practice to work together to better prepare the next generation of nurses (Napthine, 1996; Eliot, 2002; Frank, 2008; Benner, Sutphen, Leonard & Day, 2010). In New Zealand, funds from Vote Health and Vote Education via the Tertiary Education Commission support the undergraduate preparation of nurses yet government departments are currently suffering the adverse effects of fiscal containment. The country is short of doctors and priority is being given to the training and recruitment of medical practitioners (Health Workforce New Zealand, 2010; Annals, 2011). Staff-to-student ratios in clinical and educational nursing settings are deteriorating so prompting a need for new and smarter ways of working. …

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