E     I     P
		National Review of Specialist Nurse Education
		97/2 R. Lynette Russell Lindsay Gething Paula Convery
		The Faculty of Nursing The University of Sydney
		Evaluations and Investigations Program Higher Education Division Department of Employment, Education, Training and Youth Affairs

©  Commonwealth of Australia 1997

ISBN 0 642 23628 3

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior written permission from the Australian Government Publishing Service. Requests and inquiries concerning reproduction and rights should be addressed to the manager, Commonwealth Information Services, Australian Government Publishing Service, GPO Box 48, Canberra ACT 2601.

This report is funded under the Evaluations and Investigations Program of the Department of Employment, Education, Training and Youth Affairs.

The views expressed in this report do not necessarily reflect those of the Department of Employment, Education, Training and Youth Affairs.

Table of Contents

Acknowledgments
About the Authors
Executive Summary
Recommendations
1. Description of the Project
2. Results and Discussion
Appendix A: Questionnaires
Appendix B: Organisations and their Staff who Contributed to the Project
Appendix C: Statistical Appendix
Bibliography

E I P

Acknowledgments [Next Chapter] [Contents]

This project was funded by the Evaluations and Investigations Program of the Department of Employment, Education, Training and Youth Affairs. It was based in the Faculty of Nursing at the University of Sydney which provided administrative support and assistance.

The advisory team for the project comprised:

• Ms Rosemary Snodgrass, Director of Nursing, Royal North Shore Hospital;
• Ms Debbie Picone, Director of Nursing, Concord Repatriation Hospital;
• Ms Lorraine Ferguson, Area Manager (Nurse Education), Professional Development Centre, Royal North Shore Hospital;
• Dr Christine Duffield, Professor, Faculty of Nursing, University of Technology, Sydney;
• Dr Vincent Martin, Director, Research Infrastructure and Collaboration Section, Higher Education Division, Department of Employment, Education, Training and Youth Affairs; and
• Mr Peter Nicholson, Director, Educational Developments and International Section, Higher Education Division, Department of Employment, Education, Training and Youth Affairs.

The advisory team was appointed by the Department of Employment, Education, Training and Youth Affairs as a consultative body to work in an advisory capacity on matters such as scope of the project and methodology. Advisory team meetings were held on a biannual basis.

Acknowledgment is given to Professor Margaret Dunlop for her valuable input into the project.

Appreciation is expressed to staff of the organisations listed in Appendix B who contributed to the project through assistance with data collection, participation in discussion groups, and preparation of submissions.

Appreciation is expressed to Dr Boonseng Leelarthaepin who conducted computer-aided statistical analyses and to Ms Kellie Warrington and Ms Michelle Fitzgerald for the production of this report.

E I P

About the Authors [Next Chapter] [Previous Chapter] [Contents]

Professor R. Lynette Russell (PhD, BA(Hons)(N’castle), RN, CM, DNE(NSW), FCN(NSW), FCNA, MACE) is the Dean, Faculty of Nursing, The University of Sydney. She has extensive experience within the health care sector as a registered nurse and educator, and as an educator and academic within the higher and further education sectors. Her own areas of clinical nurse specialisation are ophthalmology nursing and cardio-thoracic nursing. She is an active nurse historian and her publications in this area include From Nightingale to Now: Nurse Education in Australia.

Associate Professor Lindsay Gething (PhD, BA, MAPsS, Psych Reg (NSW)) is Coordinator of Research within the Faculty of Nursing at The University of Sydney. She is a psychologist with extensive experience in research and education within the health care area. She is team leader of the Community Disability and Ageing Program and has published widely in professional journals. Her books include: Working with Older People; Person to Person: A Guide for Professionals Working with People with Disabilities; Lifespan Development; and Managing Research Effectively.

Ms Paula J. Convery (RGN, ONC, BN) undertook registered nurse training at the Mater Infirmorum Hospital, Belfast, and subsequently specialised in orthopaedic nursing in Edinburgh. Prior to becoming involved in research she worked as a clinical nursing specialist in orthopaedics from 1988 until 1993 in Sydney during which time she completed a Bachelor of Nursing. She is currently completing a Masters degree in Public Health through The University of Sydney.

Statistical Consultant

Dr Boonseng Leelarthaepin (PhD, BSc, DipNutDiet, MDAA, FACBS) is the Educational Services Officer with the Faculty of Nursing, The University of Sydney. He is the Executive Secretary of the Faculty Research Committee. He is also a research consultant to the Sydney Nursing Research Centre, and has been involved with some of the research projects funded by the Centre. Dr Leelarthaepin’s specialisation areas include cardiovascular risk factors, nutrition, physiology of exercise, health promotion, lifestyle education, oncology/palliative care, computer application, research methodology and statistical evaluation.

E I P

Executive Summary [Next Chapter] [Previous Chapter] [Contents]

Over the last few decades there has been a rapid proliferation of nursing specialties and it is likely that this will continue into the foreseeable future. Reasons include:

• the continuing growth of medical and scientific knowledge;
• rapid technological advances; and
• the consequent growth and development of nursing knowledge and skills.

As a result, the field of nursing knowledge and its associated skills have become too vast and complex for any one person to master in full, meaning that specialisation within nursing has now become a necessity.

A further impetus for the development of nursing specialties is the increasing complexity of the health care sector and methods of health care delivery. Also important is the introduction of clinical career ladders which aim to encourage experienced registered nurses to continue to provide direct clinical care across Australia.

Along with the rapid proliferation of nursing specialties and nursing specialists there has been an equally rapid development of educational provisions offered from a variety of settings. There is now an urgent need to explore the existing provisions for nurse education following initial registration and to consider future needs of registered nurses and the settings in which nurses work. Such information will enable recommendations to be made to government, education institutions and employers to facilitate the development of programs which are responsive to current needs and, at the same time, are cognisant of emerging trends.

The major purpose of the project undertaken in this document was to report the development of recommendations for the current and future pattern of specialist post registration nurse education in Australia. These recommendations are based on a detailed analysis of current provisions, as well as on the perceived future workforce requirements. Recommendations were also driven by the need of members of the nursing profession to gain access to appropriate post registration programs in order to facilitate their career development and to enable them to meet the ever changing needs of the health care and the wider community.

The aims of the project were to:

1. assess the quality and quantity of current offerings in post registration specialist nurse education in Australia; and
2. determine what future requirements are envisaged in post registration specialist nurse education.

No comprehensive database on the provision of specialist post-registration nurse education exists in Australia. The need to develop such a database was regarded as an essential precursor to developing appropriate recommendations for future planning in this area and to fostering collaboration between sectors which provide education.

Information was gathered in 1995 and data collection was conducted in five stages:

• Review of Background Literature—A review of Australian and international literature provided access to journal articles, reviews, reports of committees, government reports and other material.
• Data Collection through Questionnaires—Parallel questionnaires were administered to four samples: university faculties, departments and schools; Colleges of Nursing; specialist nursing organisations and registered nurses. Information was gathered about current offerings and perceptions of future requirements.
• Consultative Forums—Results from the questionnaire data collection were presented to meetings held in Sydney, Dubbo, Brisbane, Adelaide and Melbourne. These groups discussed results in order to produce recommendations.
• Submissions—A newspaper advertisement and letters were used to invite submissions about the topic. People who responded to the invitation were provided with an information package. They then submitted their views.
• Development of Recommendations—Marked similarities emerged in material emanating from the first four stages. This material was integrated and used as the basis for developing the set of recommendations which may be found overleaf.

E I P

Recommendations [Next Chapter] [Previous Chapter] [Contents]

Consistency emerged among the various data sources about the issues concerning current provisions, how to address these and about the possible future directions for the provision of specialist nurse education in Australia.

Definition of Terms

No clear acceptable definitions are currently in widespread use across Australia for the terms nursing specialist and nursing specialty. Such definitions are important to provide a clear understanding for future planning, determining workforce requirements, developing and offering appropriate educational programs.

Recommendation 1.1

That the following definition of nursing specialist developed by the International Council of Nurses be adopted for planning purposes by the health care sector, professional nursing organisations, the higher education sector, the nursing profession and government.

The nursing specialist is a nurse prepared beyond the level of a nurse generalist and authorised to practise as a specialist with advanced expertise in a branch of the nursing field. Speciality practice includes clinical, teaching, administration, research and consultant roles. Post-basic nursing education for speciality practice is a formally recognised program of study built upon the general education for the nurse and providing the content and experience to ensure competency in speciality practice.

Preparation and authorisation are in accordance with scope of practice and with the education and regulatory policies and practices for post-basic specialists in other professions.

(ICN Guideline on Specialisation in Nursing, ICN Geneva 1992:12)

Branches of the nursing field are seen to include clinical specialties, administration/management, teaching/education, research and scholarship and consultancies within the health, higher education and associated sectors.

 

Recommendation 1.2

That the following criteria be used to identify a nursing specialty and that these criteria be adopted for planning purposes by the health care sector, professional nursing organisations, the higher education sector, the nursing profession and government.

A specialty should present evidence that:

1. the specialty defines itself as nursing and subscribes to the overall purpose, functions and ethical standards of nursing;
2. the specialty is a defined area of nursing practice which requires application of specially focused knowledge and skills;
3. there is both a demand and a need for the specialty service;
4. the focus of a specialty is a defined population or a defined area of activity which provides a major support service within the discipline and practice of nursing;
5. the speciality practice is based on a core body of nursing knowledge which is being continually expanded and refined by research. Mechanisms exist for supporting, reviewing and disseminating research;
6. the specialty has subscribed to, or has established, practice standards commensurate with those of the nursing profession;
7. the specialty adheres to Australian requirements for nurse registration;
8. specialty expertise is gained through various combinations of formal education programs, experience in the practice area and continuing education. Educational program preparation and administration must include appropriate nursing representation; and
9. practitioners are organised and representative within a specialty organisation.

(The above is adapted from the ICN 1992:10; ANF 1995:2)

 

Nomenclature

Following rapid proliferation of nursing specialties there is a need to develop an acceptable nomenclature which, although manageable, would allow for the diversity of emerging specialties.

Recommendation 2.1

That as a matter of urgency, a nomenclature for nursing specialties be developed, reviewed, and adopted across Australia (see Recommendation 2.3). This nomenclature should be based on the criteria for identifying a nursing specialty given in Recommendation 1.2.

Recommendation 2.2

That this nomenclature should consist of a limited number of broad band nursing specialties each of which would contain multiple sub-specialties.

Recommendation 2.3

That the consultative group, established under Recommendation 5.1, set up a small working party consisting of representatives from national nursing organisations, the health and higher education sectors, and the Department of Employment, Education, Training and Youth Affairs. This working party should review the attached proposed nomenclature for specialty nursing programs and to provide recommendations to the consultative group on an acceptable nomenclature for adoption across Australia. These recommendations are to become part of the final report of the consultative group.

Recommendation 2.4

That graduate diplomas/masters be awarded in each of these broad band nursing specialties.

Recommendation 2.5

That the title of the award for nursing specialists include (i) nurse and (ii) the specialty which conforms with the major broad band nursing specialties in the nomenclature as developed in Recommendations 2.1 and 2.2.

Recommendation 2.6

That discrete courses be available in sub-specialties which can be used to gain credit for, and articulate with, graduate diploma/masters programs.

 

Credentialling

The need for consideration to be given to appropriate mechanisms of credentialling for nursing specialists is apparent from the literature and consultative forums.

Recommendation 3.1

That the credentialling process currently under discussion by the Australian Nursing Federation, National Nursing Organisation group be adopted after further discussion and development which should include substantial input from all target groups (that is, health and higher education sectors, professional nursing organisations, and government organisations such as state/territory statutory nursing authorities and the Australian Nursing Council Inc.).

Recommendation 3.2

That the accepted credentialling process be implemented by no later than December 1997.

Recommendation 3.3

That by 1998 the minimum initial qualification for nursing specialists be at the post-registration graduate diploma level and by 2003 this qualification be at masters level. This requirement should be incorporated into the relevant industrial awards.

 

Influences on Specialist Nurse Education

The project revealed a range of factors which must be taken into account in the planning and delivery of specialist nurse education in order to meet changing community and workforce needs.

Recommendation 4.1

It is recommended that the following factors be taken into account by the health and higher education sectors, government and the nursing profession in the planning and delivery of specialist nurse education:

1. changing nature of health care delivery within the Australian community;
2. emergence of new areas of nurse specialisation which meet the criteria given above for approval of nursing specialties;
3. future development/s of the role/s of nursing specialists;
4. demand by potential students in conjunction with workforce requirements (that is, market forces); and
5. appropriate spread of nursing specialist programs across Australia in terms of: demographic trends and geographical location.

 

Pattern of Courses and Programs

Throughout the report the terms course/program are used interchangeably and refer to educational offering in a speciality area.

Results for the project demonstrate that provisions for specialty nurse education across Australia are in urgent need of a complete review. Currently, courses/programs are offered in a wide variety of settings (including the health care and higher education sectors and by professional nursing organisations). Additionally, courses/programs vary in a number of characteristics including:

• length;
• mode of offering;
• balance between clinical/theory components;
• student intake size;
• eligibility criteria; and
• qualification gained (non-award, award at all levels).

No clear explanation can be given for these variations, other than historical factors, the rapid proliferation of nursing specialties, the lack of an agreed framework for the provision of specialty nurse education across Australia, and limited mechanisms through which interaction and agreement can be achieved between the major providers of this education. As a result it is possible that a qualification for a nursing specialist may be gained through completing courses/programs which have many differing characteristics. Nursing specialists may, therefore, hold markedly different qualifications and yet be working in similar occupational role/s.

The result has been confusion for potential students and difficulties for employers in determining the appropriateness of specific qualifications for particular job situations. Other consequences are duplication of educational provisions across more than one sector with the concomitant drain on resources (both financial and in terms of personnel), and the perceived need for those working in nursing to undertake multiple educational programs when it is believed that qualifications held to date do not meet career aspirations, professional standards, and/or workforce requirements.

The responsibility for, and concerns associated with, specialty nurse education in Australia are spread across a number of government portfolios. This contributes to problems in planning for, and the provision of, such education. Thus, cross-portfolio consultation and discussion is of critical importance.

Recommendation 5.1

That a consultative group be established with one nominee from each of the Department of Health and Family Services, the Department of Employment, Education, Training and Youth Affairs, as well as State Departments of Health (up to two members—one representing large States, one for small States), Australian Council of Deans of Nursing (two members—one representing large States, one for small States), Australian Nursing Council Inc. (one member), Specialty Nursing Organisations (up to two members), and from either the Royal College of Nursing, Australia or the New South Wales College of Nursing (one member).

This consultative group should be established within three months of the release of the report and should operate for up to twelve months. It should consult widely during its deliberations. By the end of this period the consultative group should present a series of recommendations on the following:

1. an agreed framework for the provision of specialty nursing education in Australia;
2. time frames for the adoption of this framework across all sectors providing nursing specialty education;
3. the appropriate level of qualification for entry into specialty nursing practice;
4. time frames for the adoption of these levels across all sectors;
5. a planned reduction of any unnecessary duplication in course offerings; and
6. appropriate geographical spread of course offerings to meet the education needs of nurses and the current and emerging workforce needs of the health care sector.

These recommendations should be submitted to the appropriate Federal and State government departments for endorsement and adoption.

A beginning framework is given later in the report for discussion by this consultative group.

Recommendation 5.2

That the framework agreed to by the consultative group to be used to review current provisions for specialist nurse education leading to these being restructured across Australia.

Recommendation 5.3

That following the development of this new structure, information should be made widely available to registered nurses, employers, professional nursing organisations, providers of specialist nursing programs including the higher education sector, professional nursing organisations and the health care sector. It is suggested that the Australian Nursing Council Inc. (ANCI) and the state statutory nursing authorities are appropriate organisations to undertake this activity.

 

Future Educational Provisions

The data provided clear support for the continuation of multiple providers of specialist nurse education, both within the higher education and health sectors and by professional nursing organisations, and for fostering cross-sector provisions.

It was stressed by respondents that educational provisions should be able to adapt to current and emerging workforce needs as well as to the changing needs of the community in general.

Respondents argued strongly for educational provisions to be flexible in modes and methods of delivery. Concern was also expressed that educational provisions should facilitate portability and credit transfer across programs and sectors and should allow for different entry requirements. Parity and level of awards across sectors were also seen as important considerations. Many respondents expressed the view that a ‘clinical’ component, strongly informed by current practice, should be the core of these educational programs. Further it was seen as essential that
up-to-date clinical nursing specialists should be involved in the development and teaching of these programs.

Data provided by organisations which provide educational programs clearly demonstrated extensive duplication of course offerings within the same geographical setting, within the same specialty area, by the health and educational sectors and by professional nursing organisations. At the same time the data also demonstrated that provisions are not always available across all states and territories or across different locations within a particular state or territory. This means that entry to these programs is difficult for many potential or current nursing specialists.

Recommendation 6.1

That where health care institutions and professional organisations continue to offer courses for nursing specialists at graduate certificate, certificate, and non-award levels, these should articulate with relevant graduate diploma/masters level programs.

Recommendation 6.2

That higher education and health care institutions should develop and publish formal arrangements to facilitate Recommendation 5.3.

These arrangements should include provisions for credit transfer and to facilitate portability of enrolment.

Recommendation 6.3

That entry requirements into these programs should be flexible, and should include consideration of applicants’ relevant clinical experience, expertise, and professional qualifications, as well as award qualifications from the higher education sector. Such entry requirements should ensure, however, that candidates for these programs have the potential for success.

Recommendation 6.4

That educational programs should be flexible and offered in a variety of modes including full-time, part-time, and by distance.

 

Collaboration between Educational Providers

Collaboration between sectors which provide education for specialist nursing was an important issue for all groups of respondents included in the project. A clear view emerged that the preferred mode of offering education entailed collaboration between the health and higher education sectors. Although examples were given of successful collaboration and mechanisms were suggested for alternative forms of collaboration, additional stimulus is required to encourage wider adoption of this form of educational provision.

Recommendation 7.1

That initial qualifications for nursing specialists in a clinical specialty be offered from the health and higher education sectors with a collaborative approach being the preferred option.

Recommendation 7.2

That mechanisms be established for fostering collaboration between the health care and higher education settings. These mechanisms should include:

1. joint appointments across the health and higher education sectors;
2. the establishment of additional clinical chairs of nursing;
3. staff exchanges between both settings;
4. joint involvement in curriculum development, implementation and evaluation; and
5. participation of staff from each sector in a wide range of committees across each of the sectors.

Recommendation 7.3

That the Higher Education Innovations Program and the Committee for University Teaching and Staff Development fund a number of innovative pilot projects which involve cross-sector collaboration (i.e. between the health and higher education sectors) in the provision of specialist nurse education programs.

A requirement of funding should be that outcomes of each project relevant to stimulating collaboration across these two sectors are widely disseminated to specialist nurse education providers, professional nursing organisations and relevant government bodies.

[Return to Top]