Education and Professional development

Welcome to this edition of the journal of nursing management focusing on education and professional development. All the papers in this issue have an important bearing on the future of the nursing profession and the significant contribution that nurses can make to improving healthcare systems. A number of papers in this edition highlight the current and predicted shortage of nurses. Given that nurses are globally in short supply, it is critical that solutions are considered and implemented to ensure that nursing staff spend their time doing what matters most to patients and service users, (Wilson) that new roles are introduced and systematically evaluated to support and enhance the care that nurses provide, (Spilsbury, McKenna) that nurse managers ensure supportive and empowering work environments (Laschinger); that new entrants to the profession are suitably qualified, assessed, and prepared and have career opportunities (De-Bell, Parker, Adlam, Livesley, Brunero, Hefferman) and that all have access to continuing professional development (Kelly, Green) and that future decisions about research investment focus on agreed areas of priority (Weiner). I am grateful to all the authors in this edition for their expertise, energy and willingness to share their learning with a wider audience. Whilst managing to retain an international favour with papers from the United States of America, Australia, Canada, and New Zealand this edition is comprised of a significant number of papers from the UK. This was not a deliberate intention, but reflected the range of contributors that had submitted papers aligned to the focus of this edition. Given the high blend of international authors in previous editions of this journal it is curious to note that education and professional development did not elicit the international response I had anticipated. I encourage a wider range of practising nurse and nurse manager to share their learning though the papers of this journal. I have often considered the delay between ideas that can improve healthcare and their implementation. As I prepared this editorial two papers confirmed this delay. Adlam et al. in New Zealand trace the discussion of a graduate entry qualification for the nursing profession in New Zealand to 1911 with diploma level entry occurring in the 1970’s and degree level being the only point of entry to the nursing register some three decades later. Green et al. trace the case for nurse prescribing in the United Kingdom to 1978, and it subsequent implementation three decades later. The paper by Wilson reminded me that the knowledge about successful quality management and associated techniques such as statistical process control and lean technologies have been well documented over the last 50 years. (Powell 1995); but adoption into healthcare has only recently become part of the management toolkit. Why is this, when more nurses have higher levels of qualifications, have access to more information and globally policy makers are championing change? I cannot hope to begin to answer this question in this short editorial, but hypothesise that most nurses lack the time and space to consider the wider issues. Thomas and Hynes citing the song and album title of the singer songwriter Bob Dylan ‘the times they are a’changin’ makes a solid argument for practitioners to deliver care in more than one narrowly defined sphere. The author asserts that if we continue to always educate, train or learn in the same way then we have the same result. Building on this assertion the authors highlight core skills that all professionals require: communication, problems solving, numerical skills, working with others and evidence based practice. This paper should be compulsory reading for all of the professional bodies that regulate healthcare education to stimulate further thinking. Building part of the evidence base for educational change in the UK De Bell and Branson outline the case for an all degree level entry route for nursing in England. It is rather curious that England with its history of developing a professional nursing workforce still has to adopt degree level entry as the required minimum academic level. This paper highlights the complexity of bringing about change and the possible subsequent impact on workforce development. Weiner describes important views on the areas of research priority within one hospital. Technically this paper outlines some important points about increasing response rates to surveys, having achieved a response rate of 60%, the pointers are worthy of consideration by others. Of real interest to nurses working at board level will be the outcomes of the 30 research areas. The top four are teamwork, staff morale and effects on patient outcomes, infection rates/control and medication errors. I suspect that this would hit the top priorities if a similar survey was repeated in readers care environments. Given these emergent themes and accepting that more detail is required to be known before one could confidently state that the areas exactly match across services, it would be really interesting to generate an international collation that could agree on a small number of research priorities, and with concerted effort and joint funding begin to address recurring themes. Very few readers will doubt the importance of staff undertaking roles that support newly developing practitioners. Hefferananet al. evaluate a preceptorship programme and identify the importance of managers selecting, releasing, supporting and monitoring preceptors to ensure an effective clinical learning environment. They also argue for nurse managers to explore the implications of this role in respect to the effective utilization of nursing staff resources and the achievement of value for money. This paper also highlights the confusion that exists between the use of the terms mentor and preceptor within nursing. If one extends the literature review to other health and social care professions one finds a myriad of terms used for people that seem to do very similar roles: a few examples include: Assessor Clinical educator Practice supervisor Practice teacher Clinical tutor Clinical supervisor For those that want to read more about these roles then Gopee (2008) and Spouse and Redfern (2000) have some useful observations to make. Having the appropriate tools that preceptors or mentors can use is a critical part of ensuring that the workforce of the future is fit for practice. Parker outlines her thinking on the assessment of practice and based on her PhD research asks if current tools are fit for purpose. She critically explores associated assessment systems seeking to discover if they are consistently applied, reliable and valid? From this work she proposes a new tool for assessing practice. This should be read by educationalists and practitioners that are keen to ensure the future nurses meet the future demands that newly completing practitioners will be expected to demonstrate. Helping the practitioners build on their initial registration Adlam et al. describes the setting up of an agreed supporting period for new graduates in New Zealand. The challenges faced by many new graduates during their first year of practice are well known and generally well understood. Many solutions have been devised, but it seems that financing the solutions becomes problematic. A financial package is supporting the New Zealand approach, and it is expected to be a cost effective way of ensuring that nursing does not face a critical shortage. As further work is being undertaken to evaluate this work it will be interesting to read further outcomes. Ensuring that sufficient staff suitably equipped for progression to demanding roles that will become vacant has been described by Brunero et al. within Australia. A significant aspect of this project is that leaders are being prepared for new roles, before actually taking up the posts. A number of commentators and writers in the school educational literature have identified the importance of preparing staff for leadership, prior to entering such posts. Where such preparation has been provided, school outcomes have been shown to be more effective, (Fidler 1997). The work described by Brunero et al. builds on firm foundations and nurse managers yet to adopt such schemes would be well advised to consider learning offered from this evaluation. Once new staff have been appropriately inducted and supported naturally some of the staff will aspire to work as advanced practitioners. Livesley et al. describe an effective partnership; work based learning approach that helps develop advanced practitioners that are fit for practice, purpose and award. The confusion about who counts as advanced practitioners generally appears to be a UK debate although the evidence for the benefits impacting positively on patient care is now emerging albeit in the ‘grey’ literature (NHS Evidence 2009). Given the need to consider new roles to provide care Spilsbury et al. outline the introduction of assistant practitioner (AP) roles into the UK skill mix and reflects an international trend of introducing more flexible working at all levels throughout the nursing workforce. This paper highlights the critical need to remove the confusion about roles that lie between a support worker and a professional. The contribution of the AP role is worthy of future study and hopefully lead to a better understanding of their contribution to healthcare, but also inform skill mix decisions. Building on the new and developing role ideas, McKenna et al. draw on a range of literature that articulates the complexity of introducing new ‘extended’ roles into the workplace. They point out the importance of continuing professional development required to support new roles and the importance of ensuring that all members of the workforce understand and contribute to the new roles with clear input from those developing new roles and those that will loose elements of their role as a result of the change. Patients require care twenty four hours a day and Kelly et al. identifies the continuing professional development needs of nurses that provide care during the night and a group that have seemingly received very little systematic evaluation. Whilst many organisations require staff to work shifts that encompass both day and night working, this is not the case in all situations. The CPD needs of this group of staff are not well known and very few empirical studies have been reported. The authors of this paper failed to find any papers that considered the nature of caring at night and the education required to deliver it. To meet the educational needs of this group of staff requires significant flexible thinking by education providers, mangers and staff themselves. Meeting the educational needs of other groups of practitioners is emphasised by Green et al. They report a training needs analysis for non medical prescribers in one English Health Authority. Overall the findings identify that short face to face courses were the most popular and useful, and needed to be advertised well in advance. What does strike me though is the clear demand from practitioners for short courses that focus on their day to day practice, have clear learning outcomes advertised in the literature and are delivered via face to face modes. Given the well known educational theory that one should recognise the learning preferences of the learner (Cartney 2004, Honey and Mumford (1986) this paper highlights the need for education providers to know their users preferences. Open and distance learning and blended learning methods suit some situations and some groups of people, but during my time as an educationalist I have noted that many healthcare staff prefer face to face activity for most of their learning. I had thought that certain topics lend themselves more to open and distance learning, but anecdotally I am not sure that this is the case. It would be valuable to undertake a systematic investigation into the preferred learning styles of healthcare workers generally to inform future investment decisions. Involving others in developments is a loose thread that runs through this edition and Laschinger et al. investigate the impact of empowering work conditions on nursing staff, and recognising the high numbers of nurses that will be retiring identify the effort that is required to attract and retain new nurses. For nurse managers this paper provides some important insights into effective retention and care improving messages. Whilst I am not keen to provide extracts for readers, the following quotation from this article warrants consideration by every nurse manager and I would argue all board level members: “When nurses have the tools they need to practice professionally, they experience greater vigour…as they engage with their patients, are more likely to be enthusiastic and proud of the care they are able to provide…” Providing a summation of key learning points for me in this edition Wilson though a ‘productive ward’ initiative sums up many of the key lessons for managers in this paper. In this project nurses are directly engaged in transforming their working environments, the hospital management board is engaged in supporting the initiative and professional development is focused directly on and takes place in the workplace. Key improvement metrics are used to measure progress and improvements in patient care are used as the measures for success. Whilst many fads and fashions have come and gone in nursing, this one has been built on solid foundations and is worthy of consideration. In summary to make best of all the resource we have to improve healthcare through innovation and improvement and this has to be faster than a 30–50 year period from idea to inception. This requires decisive leadership and many of the papers in this edition mention the importance of leaders in organisations making change happen. Notwithstanding the gender bias of the following quotation ‘The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore, all progress depends on the unreasonable man’ (Shaw 1903) How unreasonable are managers, that read this edition. willing to be?

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