The Scope of Nursing in Australia: A Snapshot of the Challenges and Skills Needed
7. Discussion
Based on the information and insights gained from the study, implications for the National Review of Nursing Education can be drawn out. The following outlines the terms of reference for the review and where relevant suggestions are made drawing on new understandings gained through the discussions with 38 participants across the 17 key areas of nursing practice within Australia.
Models of nurse education and training to meet the emerging labour force, including practical training, processes for articulation between different levels of competency and professional expertise and re-entry into the workforce.
The most prevalent point made by nurses interviewed was the move towards a greater clinical component in nursing education. However, an emphasis on theoretical knowledge and associated research skills are also important elements of education that must be maintained. Essentially, a balance is required between the academic and practical elements of nursing education, which means innovation in the ways in which quality contextual practice for nurses can best be achieved. Nurses move around Australia and to date, barriers exist that are often linked to differing State or Territory restrictions. There is a need for a national curriculum that is broad but also allows for specialisation into particular areas of nursing practice. Analogous to this view, it has also been suggested that there should be:
- More significant interface between the universities and the workplace;
- A greater contribution by the workplace in developing the nursing curriculum;
- Guided contextual learning with appropriate resources to support;
- Mentoring and preceptorship. These are key initiatives that would facilitate the growth, personal and professional development of nurses as lifelong learners. Mentors could be those senior role models not necessarily located in the same setting. Preceptors are located in the same setting to precept through a new environment or context;
- Greater placement in the community - not just in acute setting; and
- Increased time for graduate registered nurses to be initiated into the workplace before having full load responsibility (possibly a paid intern year).
Many nurses interviewed, in particular enrolled nurses, were frustrated with a lack of career direction and recognition of experience within the enrolled nurse position. Suggestions of how to combat this are:
- the introduction of an Advanced Skills Enrolled Nurse position. This position has recently been employed in Western Australia. It provides for the recognition of senior, experienced enrolled nurses on the wards and creates career pathway opportunities for them; and
- an increase in the application of the nurse practitioner role.
The types of skills and knowledge required to meet the changing needs of the labour force involved in nursing;
According to some there has to date been a fragmented approach to education for nursing with little or no fundamental agreement on what we are educating for. Nurses interact with a diverse range of people daily, regardless of the context of that practice. As a consequence nursing education needs to make better use of other disciplines and groups in education.
Overwhelmingly there is a sense that educational preparation of nurses today must prepare them for the future, the constant and dynamic changing world of health care that moves swiftly from the acute hospital into acute care in the community, interfaces between and an ageing population. Education needs to allow for flexibility, to educate nurses to be flexible, to think laterally, to problem solve and consider what might be not what is or was.
There is too much emphasis on acute based or disease based models. From the insights gained from the diverse range of nurses interviewed, core building blocks include:
- communication and people skills;
- life experience;
- problem solving;
- life long learning;
- IT and information literacy;
- negotiation and conflict resolution;
- health promotion;
- education and disease and injury prevention; and
- a knowledge of people and their social context, local environments and networks, time management and working with and alongside others.
Leadership and management skills are also required if nurses are to develop nursing where a balance between educating for autonomy and interdependence is achieved.
Mechanisms for both attracting new recruits to nursing including those from different age groups (both male and female) and encouraging the commitment to life-long learning of those already engaged in nursing.
- applying a more positive portrayal of nursing in media;
- diversifying contemporary understandings of nursing work amongst those nurses already in practice;
- fostering an environment of supported learning either through paid leave or replacement staff; and
- role modelling by senior nurses.
The changing context of nursing and health requirements and the levers influencing these changes:
- fast turnover from acute hospitals - forcing an increase into community care;
- increase recognition of the advantages of patients staying in the home eg. palliative care;
- increase in focus on holistic care and rehabilitation;
- ageing population and the associated increase of chronic disease;
- increase in technology; and
- increase in need for independent decision-making.
The links between nursing, medicine and other groups in the health workforce (including) those with no health qualifications) in the provision of health services:
From the analysis of models of working with others, it has been found that:
- an increase in PCAs creates a need for their management and supervision. However, their role in supporting nurses should not detract from or replace nurses participating in certain interactions necessary for assessment eg. showering;
- while there is an increase in the need for greater collaboration between health professions, there is also a decrease in the ability to access resources because of budgeting constraints;
- strategies need to be developed to facilitate mutual respect between doctors, nurses and other health professionals;
- on the whole, nurses tend to work within a team environment with other allied health professionals, although there is an emphasis that nurses are present 24 hours a day.
Any comments or queries should be sent to: highered@dest.gov.au
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last updated on Tuesday, 04 December 2001
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