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6. Nursing careersThis chapter explores a range of issues related to nursing careers. It examines strategies to raise the image of nursing and what is needed to attract people, particularly from underrepresented groups, to consider nursing as a career. What opportunities does a nursing career offer? What are the pathways available within nursing careers? What transition mechanisms are available to help nursing students transfer to the workplace, to re-enter or to transfer between different levels of nursing? The Review commissioned research specifically on this issue, The Nursing Career Pathways Project (Price, Heartfield & Gibson 2001), 6.1 The image of nursingMedia attention on nursing and the nursing profession is usually industrially focused and can be negative. During the course of this Review, we were continually pressed to market a positive image of the nursing profession, one which that encompasses all its members (enrolled nurses, registered nurses, nurses in various speciality areas, nurse educators, nurse managers and nurse practitioners). In an article in September 2000, the Dean of the School of Nursing at the University of Washington discussed the image of nursing that had been perpetuated over time as being one of manual labour mostly performed by women, and likened it to motherhood (‘an essential but unpaid contribution to the work of society, with rewards that are largely intrinsic to the job’), and said that this misconception of nursing was perhaps the root of the present nursing shortage (Wood 2000). As Wood outlines in her article: Moreover, the faces behind the touching hands have changed. Today’s nurses are increasingly male, increasingly from diverse ethnic backgrounds, increasingly drawn to nursing from other professional careers. They come to nursing school because they want to make a difference in the world, and they leave with the tools to do just that … Nurses in the 21st century perform critical services at every level of need. Nurses help families learn to care for children who are able to live at home with serious health problems, sometimes requiring the use of complicated breathing equipment. Nurses who practice in hospitals make life-saving decisions and detect possibly fatal complications. Nurses in community health make changes in the community to benefit entire populations, some by instituting changes in public policy … In these and hundreds of other ways, the work of nursing has deep intellectual and scientific roots. In addition to the many practice roles of modern nursing, today’s nurse scientists also make important contributions to health care research that are not widely known or appreciated. In the Nursing Career Pathways Project (Price et al. 2001), the authors refer to the fact that the diversity offered by careers in nursing is one of the profession’s greatest strengths and should be promoted. A comprehensive nursing degree for registered nurses and the recent developments in the diversification in the preparation of enrolled nurses enable nurses to obtain employment in a wide and varied range of locations, including:
6.1.1 Marketing nursingMuch is being done across Australia by different government and non-government organisations and groups to promote nursing in order to encourage people to consider nursing as a career (see Attachment 6.1). A number of State health departments have undertaken successful nurse marketing campaigns in the past few years, such as Western Australia’s Are you Good Enough to be A Nurse? campaign or the South Australia’s Nursing Takes You Places campaign, and the more recent Victorian Government’s advertising campaign aimed at attracting nurses back into Victoria’s public hospitals.In submissions and responses to the Review’s Discussion Paper, there was clear support for an active integrated marketing campaign, which would address nursing shortages, but which would also be aimed at highlighting the diversity in a nursing career and the possible career pathways into and out of the profession. By doing this, it is hoped to attract school students and others into nursing, to encourage nurses who have left the profession to return, and to help retain the current nursing workforce. There was a call for a well planned professional marketing campaign that strategically targets specific groups. As one respondent noted: Successful marketing of any service demands a professional approach by a professional group whose expertise has been demonstrated by results. It would seem inappropriate for any nursing organisation to undertake this on the basis that they are an organisation. It has been shown to be valuable in Western Australia to conduct campaigns aimed at attracting and retaining nursing staff so creative campaigns, incorporating career materials are useful and successful as has the reality television shows depicting real life nurses in situations that reflect their expertise, knowledge, perception and understanding. Nurses are always well thought of by those who encounter the system and information on career pathways should be developed that accurately depicts the contribution nurses make to society and the sacrifices they endure in order to do so. (Catholic Health Australia, response to Discussion Paper) There is certainly an identified need to promote a positive image of nursing, and the different mechanisms for doing this nationally should be planned strategically with professional marketing advice. Considering the highly successful campaigns in the differentjurisdictions, we do not propose a national campaign at this time. The proposed National Nursing Council of Australia (NNCA) might profitably explore how to bring together these different nursing campaigns in a way that will be the most cost effective and meet local variation. Recommendation 9—The image of nursing To develop and improve the image of nursing: a) the value, contribution and benefits of a nursing career should be promoted b) expert advice should be sought to develop a national marketing profile (brand) for nursing:
Proposed responsibility: NNCA with advice to governments and other employers 6.1.2 Nursing information and careers promotionThe Australian community has embraced the Internet enthusiastically and the majority of key stakeholders in the nursing community have developed comprehensive websites with information about nursing. An integrated national professional nursing website to provide information on a range of nursing issues would promote a positive image of nursing. The website could link to relevant National, State and Territory sites across Australia, including Commonwealth State and Territory health and education departments, nursing registration authorities and various Australian nursing organisations. We support the concept of a webbased portal to promote the nursing profession and to draw together the wide range of quality nursing information available on the Internet. Careers information must be readily available and marketed to potential nurses, the community and the existing workforce. Submissions and comments noted the apparent lack of comprehensive up-to-date careers information in schools about nursing, and suggested that more work was needed to raise the profile of nursing to young people to encourage them to consider a career in nursing. Indeed, in their research project, Price and colleagues (2001) conducted a search of a range of careers and government authority websites on nursing careers information and found a level of invisibility. The Commonwealth funds a range of career information projects, principally the Job Guide and the soon-to–be-released, Internet-based, National Career Information System (NCIS). The Career Education Section and Career Information Section of the Commonwealth Department of Education, Science and Training indicated to us that they would be pleased to provide advice and would also facilitate the creation of appropriate links with the NCIS. There are a number of strategies and initiatives that could be developed in a coordinated manner to promote a positive image of nursing and the nursing profession in Australia. This could include marketing campaigns, a coordinated web-based portal and other proposals to raise an awareness of nursing in careers information. This is a matter best progressed by the NNCA in consultation with all stakeholder agencies and nursing bodies. Recommendation 10—Information on nursing To provide coordinated and ready access to information on nursing to the public and other stakeholders, the NNCA should: a) maintain an information base of recruitment and re-entry programs, assessments of their effectiveness and advice on best practice b) develop a web-based portal for Australian nursing. Proposed responsibility: The NNCA Accordingly to Price and team (2001), there was also misclassification of nursing in some key career publications. For instance, they claim that nurses were classified in Department of Employment, Workplace Relations and Small Business material as a group of paraprofessionals, at variance with the Australian Standard Classification of Occupations (ASCO) classification of nursing as a profession. This lack of visibility and misclassification in nursing careers publications should be quickly addressed by governments to ensure their reference to nursing occupations is consistent with ASCO and reflects the professional status of nursing. Recommendation 11—Government and employer information on nursing To ensure that nursing is portrayed as a profession in government and employer information, all levels of government and other employers of nurses should: a) review their recruitment and promotion activities to ensure they reflect the professional status of nursing and the valuable social contribution made bynursing through its diverse roles and practice b) review their classification of ‘nursing’ to ensure it is consistent with theAustralian Standard Classification of Occupations (ASCO) classification, in order to reflect the professional status of nursing. Proposed responsibility: Commonwealth, State and Territory governments, and other employers of nurses 6.2 Attracting different groups into nursingEducation providers, health agencies and government initiatives are doing much to attract people from a wide range of backgrounds into nursing by recognising and addressing the particular challenges faced by the different groups. Nursing should make attracting men to the profession a priority. In seeking to do this it might well research how the airline industry has been able to change the profile of what used to be largely a role for female to the more gender neutral role of ‘flight attendants’. 6.2.1 Rural and isolated nursesCommonwealth, State and Territory health departments have all developed initiatives specifically for nursing students residing in rural and remote areas, or otherwise initiatives to encourage students to consider nursing in those areas. They also offer other scholarships either specifically for nurses or for nursing students that can also be accessed by nurses working in rural and isolated places (see Attachments 6.1 and 6.2). Education programs have been designed specifically for rural and remote area nursing, such as the Remote Health Practice Program at Flinders University and the Centre for Remote Health, Alice Springs and the Postgraduate Program in Applied Health Science (Rural and Remote). It is interesting to note the lead these programs are taking in the area of interdisciplinary education. We also note and support the rationale behind the current National Rural Health Alliance project, Action on Nursing in Rural and Remote Australia (CRANA, AARN & ANF 2002), which aims to set out a five-year plan for the way nurses work in rural and remote areas. National Rural Health Alliance Project—Action on Nursing in Rural and Remote Australia The National Rural Health Alliance (NRHA) is the peak national body working to improve the health of Australians living in rural and remote areas. The Alliance comprises member organisations, each of which is a national organisation in its own right. The 21 represent both the consumers of health services and the health professionals providing service to non-metropolitan areas. As part of the Action on Nursing in Rural and Remote Australia project, three documents were developed for public consultation. The Issues Paper, recently prepared by a number of its member organisations in conjunction with the Australian Council of Deans of Nursing, the Australian Nursing Council Inc. and the Royal College of Nursing, provides an overview of the challenges facing nursing in rural and remote areas. The paper explores many issues in common with the National Review of Nursing Education, but specifically in the context of working rural and remote areas issues such as scope of practice, advanced practice, nurse leadership and management, models of care provision, the impact of workplace environment, the image of nursing in rural and remote areas, workforce planning, and educational requirements. The Issues Paper sets out recent initiatives across all jurisdictions in relation to nursing in rural and remote areas. It raises the concern, however, that initiatives are not developed with any coordinated national approach, and that a more integrated strategy is needed to deal with rural nursing education and workforce issues. The other documents in the Project are a Vision and Required Conditions document and a Key Recommendations for Action document. These set out a five-year plan for the way nurses work in rural and remote areas and how they are managed and supported and utilised in the workplace, with an emphasis on multi-disciplinary teams of health professionals from various fields adequately prepared and supported to work in rural and remote practice. All three documents were made available for comment to June 2002 on the NRHA website at www.ruralhealth.org.au. A number of events and activities are planned as part of this project, but the Project Organising Committee indicated that the first major face-to-face event will be held after the release of the report from the National Review of Nursing Education. 6.2.2 Students from diverse cultural backgroundsA research project undertaken for this Review, Nursing Education in Multicultural Context (Eisenbruch et al. 2001), surveyed universities and schools of nursing on their approaches to the multi-cultural context of education. Many of those surveyed reported on a range of strategies they had put in place to attract culturally diverse students into nursing, including language support, the inclusion of different cultures in promotional materials, and cultural support or study centres. However, many faculties also noted that recruitment issues relevant to students from multi-cultural backgrounds were common to all potential nursing students, and would best be addressed by raising the profile of nursing as a worthwhile career choice.When examining the multi-cultural diversity of the Australian nursing workforce, Eisenbruch states: A glimpse at the diversity of the Australian nursing workforce is provided through a sample of data collected by the NSW New Graduate Recruitment Consortium in Sydney… This Consortium provides a service that places new graduates in nursing positions. All Area Health Services in the State participate. Using data collected over a four-year period (1997-2000), results show that an average of around 330 applicants per year (18-20% of total applicants) speak a language other than English. Approximately 20 per cent speak a second language, the most common during these years being Tagalog, Mandarin, Hakka (Chinese) and Spanish. Between 12 and 14 applicants each year are fluent in Sign Language. (Eisenbruch et al. 2001) There are some challenges in promoting nursing to some cultural groups. Many parents from different cultural groups (such as Greek, Middle Eastern and Vietnamese communities) consider that nursing lacks status as a profession. Given the diversity of background of many Australians, it is unfortunate that students from multi-cultural backgrounds are not proportionally reflected in student numbers. As one respondent to the Review Discussion Paper noted: Given the multicultural nature of Australia generally, and the fact that already 1 in 4 older people are from culturally and linguistically diverse backgrounds, it will be important to actively and positively promote nursing as a career in such communities. Other innate skills (such as language and cultural understanding) that workers from culturally and linguistically diverse backgrounds would bring to nursing will be beneficial to acute health as well as to aged and community care services. (Aged and Community Services Australia, response to Discussion Paper) Different government and educational institutions are undertaking initiatives to address issues surrounding their multi-cultural employees. The Eisenbruch report (2001) cites an example from the South Eastern Sydney Area Health Service, which began the Bilingual Human Resource Project in mid-1999 to increase the appropriate and effective use of language skills of mainstream staff within the Area Health Service, 32.7 per cent of whom were identified as speaking a language other than English. While some strategies are evident for achieving a representative cultural mix, we note that there is little government action in this area compared to initiatives for rural students and Indigenous students. 6.2.3 Indigenous studentsWe heard considerable debate about the difficulty of retaining Indigenous students in nursing education. The Commonwealth provides funding support for Indigenous students through a component of operating grant allocated to the Indigenous Support Funding program to meet the special needs of Indigenous Australian students and to advance the goals of the National Aboriginal and Islander Education Policy. In 2001 funding of over $23 million was provided for a range of activities including the establishment of Indigenous Education/Support Units, assistance with study skills, personal counselling, and cultural awareness activities (DEST 2002a, pp. 90–92). There are also nursing scholarships provided by States, Territories and the Commonwealth, either specifically for Indigenous students or which can be accessed by Indigenous students (see Attachments 6.1 and 6.2). The Review has noted the work of the Indigenous Nursing Education (INE) Working Group which was established by the Office of Aboriginal and Torres Strait Islander Health (OATSIH) in 2000, and includes representation from the Congress of Aboriginal and Torres Strait Islander Nurses and the Australian Council of Deans of Nursing. In November 2001 this group produced an Issues Paper and Strategic Framework Indigenous Health in Core Nursing Curricula, and the Development of Recruitment and Retention Strategies (OATSIH INE Working Group 2001) as a consultation draft. The report of the Indigenous Nursing Education Working Group is currently being finalised.In May 2002 the Australian Health Ministers’ Advisory Council endorsed the Aboriginal and Torres Strait Islander Health Workforce National Strategic Framework. One of its objectives is the need to increase the number of Aboriginal and Torres Strait Islander people working across all the health professions, including nursing. An Aboriginal Health Workforce Working Group will progress the objectives of the framework. We support the continuation of the work of the Indigenous Nursing Education Working Group, and the planned Aboriginal and Torres Strait Islander Health Workforce Working Group, in efforts to improve the recruitment, retention and support of Indigenous Australian nursing students. We also note the work of many other groups, educators and employers who have worked together to develop innovative courses to assist Aboriginal and Torres Strait Islander students access training and to have exposure to the working environment. We considered the following case study of an initiative of the Booroongen Djugun Aboriginal Corporation to illustrate how these type of programs can be managed. Booroongen Djugun Aboriginal Corporation Booroongen Djugun Aboriginal Corporation is a specialised venture which incorporates an aged care facility, a training college, and centre-based and outreach community service programs. The Booroongen Djugun College is a registered training organisation that conducts industry-approved, nationally recognised courses. The courses have been developed especially for Indigenous students and are conducted on the College’s Kempsey campus and also at other centres throughout New South Wales. Linked to the College is Booroongen Djugun Aged Care Facility, a unique facility situated in Greenhills, on the Mid North Coast of New South Wales. It was established to provide care to Aboriginal frail aged, aged and people with a disability, who could not be cared for in the community. Its services have been extended, as a result of the high demand for aged care in the Kempsey area, to also provide high-quality care to non-Aboriginal people. In linking the two arms of Booroongen Djugun together, students can have classroom training linked to hands-on practice in a structured workplace environment which is connected to the spiritual feelings of Aboriginal people. Outreach training is also available through the College. For instance, in 2001 85 students were enrolled in the College’s Newcastle branch. Courses offered were Certificate III in Community Services (disability work), and Certificate IV in Aboriginal Health and Torres Strait Islander Health. The VET in schools program combines studies for the Certificate III in Community Care Services with hands-on training at the College’s aged care facility, Macksville Hospital and within the College itself. Students from Years 10–12 attend Booroongen Djugun College one day a week while undertaking the Certificate III course. www.booroongencollege.nsw.edu.au 6.3 Career pathwaysNursing career pathways need to identify the diversity of nursing roles, and what is expected of them in terms of the education, training and employment needs of the different nursing groups. Price and colleagues (2001) suggest that career pathways for nursing need to be structured in such a way that they demonstrate the diversity within nursing not only to nurses and those interested in nursing as a professional career, but also to educators, policy makers and the wider community … Nursing career pathways need to incorporate choice, recognise skill development, and provide a framework to set out the goals and strategies to achieve them … They need to be flexible to accommodate individual life experiences, access to information, personal decision-making and emergent changes to health care systems. They need to be responsive to health care needs and contribute to health outcomes for all Australians, and incorporate and respond to Australia’s cultural diversity. The authors propose a framework for developing nursing career pathways which includes the following elements:
(Price et al. 2001) 6.3.1 Education pathwaysPathways tend to suggest a fairly linear progression. One way of mapping the alternatives open to nurses, which was suggested during the Review, is to conceive of options as being part of a careers matrix. These matrices should set out the numerous entry points into nursing studies, credit arrangements for previous experience, and articulation into other courses that provide access to related careers. The construct of matrices does not limit the discussion to nursing occupations only, but encourages the links to other related occupations to be explored. We met a number of people who had already made their own path through different parts of the system or who were planning to do so, including one nurse who started as an assistant in nursing and was undertaking a Masters of Midwifery degree. Others had completed Certificate III, had been working as assistants in nursing and were training to become enrolled nurses. Many enrolled nurses were undertaking courses to become registered nurses. Credit for experience and previous study is a developing feature of nursing education in Australia. Increasing numbers of universities give some credit to enrolled nurses who undertake pre-registration nursing courses. Access to a nursing career through a range of entry points increases the opportunity for some groups and individuals to become nurses. For example, lower socio-economic and Indigenous Australians may be better able to access a career as a registered nurse through a pathway beginning as an enrolled nurse or through one that starts as a trained care assistant with articulation into enrolled nurse preparation, as demonstrated in the Tripartite Agreement (for Indigenous Students) between Illawarra Institute of TAFE, Illawarra Area Health Service and the University of Wollongong. Tripartite Agreement—Illawarra Institute of TAFE, Illawarra Area Health Service, University of Wollongong The Tripartite Agreement between the Illawarra Institute of TAFE (Shellharbour Campus), the Illawarra Area Health Service and the University of Wollongong provides an educational pathway for Indigenous students interested in a career in nursing. The program is loosely called ‘The Tripartite Agreement’ because of the involvement of the three organisations. Prospective students are initially recruited by the Aboriginal unit within Shellharbour College of the Illawarra Institute of TAFE/Nursing Studies, or alerted to the course by other forms of marketing such as community radio or word of mouth. Students then complete a basic health course at TAFE, which introduces the student to Anatomy and Physiology and other health-related subjects including First Aid. Following successful completion of the introductory course students may apply to Illawarra Area Health Service for entry into the enrolled nurse program offered at Shellharbour College of TAFE. If successful in gaining entry to the program the Illawarra Area Health Service employs them during their studies and on successful completion of the enrolled nurse program students are offered employment for a period of two years as an enrolled nurse. Following the two years employment period with the Service the enrolled nurse may apply to the University of Wollongong for entry into the undergraduate nursing program (Bachelor of Nursing). The student can negotiate for advanced standing on admission. Following successful completion of the Bachelor of Nursing program, students are offered two years employment as a registered nurse by the Illawarra Area Health Service. Support is given to the student throughout the program. An advantage of the program is that participants can enter it at any level: Aboriginal Community Education Health Certificate, Assistant in Nursing, Enrolled Nurse Advanced Certificate or Registered Nurse Bachelor of Applied Science—Nursing. However, while the pathways already exist and are used, issues raised with us concerned the maximising of credit and the lack of infrastructure to support individuals who wish to progress through the system. Recommendation 12—Maximising education pathways To promote career transitions and opportunities for development in the education and training of care assistants, health workers, enrolled nurses, registered nurses, midwives, nurse practitioners, nurse educators and nurse managers, education providers should seek ways to: a) maximise the potential for Recognition of Prior Learning (RPL) and Recognition of Current Competency (RCC) in enrolment processes b) in consultation with local Indigenous communities, improve articulation pathways for Aboriginal and Torres Strait Islander peoples. Proposed responsibility: Education providers 6.3.2 Multiple entry points and learning optionsCareers information on nursing should highlight the range of entry points and learning options available for students or those entering nursing as a second career. Opportunities need to be created for professional development linked to promotion, and for continuing education to lead to specialisation in a field. Pathways from trained care assistant to registered nurse already allow for multiple entry and exit points and these should be clearly delineated so that all intending nurses can see the possibilities available to them. One such example is found in Port Pirie. Port Pirie Regional Health Service New Apprenticeship Scheme In 1999 the Port Pirie Regional Health Service, in partnership with the local TAFE college, designed a training program where students undertake the 12- month Certificates II and III in Community Care as the first stage towards an enrolled nurse program. During this time they are employed on contract to work in the hospital’s aged care facility for 15 hours per week. At the completion of the contract, those wishing to continue their training to enrolled nurse status, are offered employment on the same contract basis. These students work in the acute areas of the hospital for a further 12 months or until they become enrolled nurses. They are then eligible to apply for any vacant enrolled nurse positions, including the graduate enrolled nurse program. The New Apprenticeships schemed at Port Pirie Regional Health Service commenced in February 2000. The program has been very successful with all 10 participants gaining Certificate III qualifications. Four of them remained on staff and are going on to complete their enrolled nurse training. If they do complete, they will be eligible to enter the hospital’s scholarship scheme, attend a university as an external student, obtain a degree in nursing and become registered nurses. The scholarship secures the financial support of Port Pirie Regional Health Service for further study. In 2002, school leavers were the target group for recruitment rather than unemployed persons with 10 young school leavers commencing in February. 6.3.3 VET-in-schoolsOne approach to introducing young people to the possibility of careers in nursing is through VET-in-schools programs. A number of State education departments have reported success with their VET-in-schools program, and the following case studies show how this arrangement can work. Some provide experience in settings where nurses work, others show planned pathways from school to nursing, many of which combine general studies, vocational studies and work. Three examples of programs for senior schools students are summarised below. Launceston Presbyterian Nursing Home for the Aged Students working in aged care at Launceston Presbyterian Nursing Home for the Aged carry out work tasks as part of a structured workplace learning program. The nursing home provides accommodation for 75 high care and low care residents. The nursing home became involved in student work placements after being approached by a VET teacher from Launceston College. The nursing home has found benefits in bringing senior high school students into the home to develop skills under the guidance of experienced aged care professionals. The nursing home reports that recruitment costs are lowered because the home can draw on a pool of trained workers already familiar with the facility. The mentoring role staff take on with the students has developed their training and supervisory skills. Since 2000, more than 60 students from Launceston College have participated in the program each year. Studying for their Certificate II or III in Community Services (Aged Care Work), they develop skills in occupational health and safety, first aid and manual handling before entering the workplace. They then complete the nursing induction course and spend one day a week at the home for approximately 26 weeks. During this time, students are teamed with a staff ‘buddy’, and are involved in diversional therapy activities such as bowls and reading. They also assist with more demanding tasks such as showering and personal care of residents. More than 75 per cent of students have been offered jobs in the industry or have opted for further industry training (ECEF 2002). Ceduna Hospital Nursing Traineeship Pilot In the Ceduna Hospital Nursing Traineeship Pilot Project, school students from Years 11 and 12 have been encouraged to consider nursing as a career option. Students were asked to volunteer for the program in which they could undertake training to start them on a nursing pathway. The students went through a selection process involving voluntary work experience, a written application and an interview. Four students were selected to participate. Utilising a school-based New Apprenticeship model, the program was facilitated by an approved local group training company and relied on close links being formed between the students and their parents, the school, group training company and health services. The program ran over a two-year period. During the first year, students completed Certificates I and II from the Community Services Training Package. They undertook a mix of theoretical studies at TAFE and on-the-job work experience in residential aged care units. The group training company was able to utilise the Commonwealth employer incentives to pay the students for the time they were in the facility, thus making the students effectively an extra staff member at no extra cost to the unit. When the student was not undertaking clinical placement or TAFE they were still involved in their normal school studies leading to their South Australian Certificate of Education. The second stage of the program was designed to follow as a pathway when the students finished school. The trainees would have continued to work at the local health unit as nurse assistants employed by the unit, rather than the Group Training Company. Again, Commonwealth employer incentives would be utilised to assist with the employment costs. The students would have been able to continue their studies to complete Certificates III and IV and on to become enrolled nurses if they chose. Of the four students who initially undertook the program, three continued to tertiary studies in nursing. Despite the small numbers involved, the program demonstrates how rural communities can develop models to effectively engage young people at school and help them move through a pathway towards nursing. Care and Health Industries Pathways for Schools—South Australia The Care and Health Industries Pathways for Schools (CHIPS) is part of a model for the development of vocational education in schools to meet the requirements of the South Australian Certificate of Education. The CHIPS framework includes five streams from the Community Services Training Package, four at Certificate II and one at Certificate III. In addition, there is a pathway that opens into Leisure and Health studies through TAFE SA. The four pathways at Certificate II are Aged Care/Disability Care, Children’s Services, Youth Work/Community Work and Leisure and Health The framework is based on an accredited curriculum for Community Services and Health at Certificate II and consists of a specified number of common compulsory units of competency and specified numbers of elective units of competency. After consultation with industry, training and teacher representatives, the CHIPS units of competency have been identified as appropriate for delivery to secondary students. CHIPS is designed as a two-stage program. The first stage, the compulsory units of competency, provides a general understanding of the care and health industries and some experience in the workplace doing real tasks, thus helping students decide if this is the pathway they wish to follow. The second stage offers students a more in-depth look at aparticular area. It requires a higher level of involvement with clients and residents, and a greater knowledge and skills in specific industry units of competency. CHIPS defines a specific sequence of units of competency, and it is recommended that some of these be completed before students undertake work placement. As a generic model, CHIPS is designed to expose students to at least two different streams in CommunityServices and Health. Work placements in two different industry areas are also recommended, so students may broaden their horizons beyond their current understanding of Community Services and health. Compulsory units of competency—must be undertaken before a student can go on a work placement and must have a Community Services and Health focus. Some compulsory units of competency may be taught as part of a generic VET program. Elective units of competency—the compulsory units of competency are followed by electives from a specific area. It is expected that the students will study at least two of these areas with a combination of on- and off-the- job assessment. Work placement—meaningful tasks should be undertaken to enable a real understanding of the nature of the specific industry, assessment of learning outcomes/competencies should be based on real tasks, and a minimum of 10 days is encouraged (for example, two places of five days in each workplace). 6.3.4 Enrolled nurse educationPrice and colleagues (2001) outlined the different entry points and learning options for enrolled and registered nurses in their Nursing Career Pathways project and provided some ideas about career pathways and options. Figure 6.1 outlines some of the options and opportunities available for enrolled nurses. Entry into enrolled nurse education can be via various options, including mature age entry, and those with Certificate III/IV articulating to Certificate IV/diploma level (depending upon the State or Territory). Further, Year 11 and 12 students can enrol directly into certificate or diploma level courses, or can build on VET-in-schools courses they completed previously. People with a Certificate IV or a diploma in enrolled nursing have a number of career and professional development/ongoing learning options. They can choose to undertake further VET courses in nursing specialisations, additional certificates or change to a related technologist occupation. They can decide to undertake staff development courses, or more informal personal development courses. They also have the option of undertaking tertiary studies, either a Bachelor of Nursing, or perhaps a degree course in another related field of study, such as health management or administration. Figure 6.1 Entry points and learning options for enrolled nurses
Source: Figure 6 Price et al. 2001 6.3.5 Registered nurse educationFigure 6.2 outlines some of the possible entry points and learning options for registered nurses. As with enrolled nursing education, the options are numerous. Entry to a Bachelor of Nursing can be via direct entry with the required university entrance score, from Certificate IV/Diploma for enrolled nursing, mature age entry or entry via a related disciple as a graduate or student. Upon completion of a bachelor degree, registered nurses have a variety of career options and opportunities available to them. Studies for various certificates can also be undertaken through other providers than universities, such as the NSW College of Nursing or hospitals. Specific postgraduate programs are offered through universities in nursing related specialisations or in other fields at graduate certificate, graduate diploma, masters and doctorate level, including opportunities for research. Figure 6.2 Entry points and learning options for registered nurses
Source: Modified from Figure 5 Price et al. 2001 6.3.6 Links to employment during educationDuring the course of this Review we were presented with numerous examples of nursing students (both enrolled and registered nursing) being employed in the nursing industry while they were undertaking their studies. McKenna and colleagues (2001) stated that ‘TAFE institutes across States and Territories (excluding New South Wales) reported that between 25 and 75 percent of Enrolled Nurse students were employed in areas related to nursing’ (2001 p. 23). Duffield and team (2002) found in their study that some institutions employ students as Assistants in Nursing. Public institutions are less likely to employ students than private institutions. The three sectors, private for profit, private non profit and charitable utilise student as AINs at fairly similar levels (46 to 51 per cent) compared to the 24 per cent of public institutions. We noted with interest comments by Southern Health in Victoria about a strategy that could help student nurses gain more experience in service facilities by working during their studies (that is, student fellowships) and that existing partnerships between universities and hospitals could be explored to offer employment to students under a fellowship scheme while they are studying. The fellowship model currently in place at Southern Health and in collaboration with Deakin University allows for learning while working outside the curriculum … The student is responsible for looking for the part-time employment opportunity (supported by education and service) … An advantage of student fellowships is that students develop a sense of belonging, learn the culture of an organisation and have more clinical experience. The main disadvantage is the students may be enculturated by an organisation and not have the opportunity to experience other philosophies of care. This could be overcome if universities, industry and Governments developed statewide models of student fellowship. (Southern Health, response to Discussion Paper) We heard mixed comments about students being employed in some capacity in work related to nursing during their studies. Our support for student employment is premised on the separation of employment from any educational requirements, including the clinical placement component of their studies. We do see some benefit of exploring this issue further for both the health, aged and community care sectors, and the students. We therefore consider that this is an area the NNCA should examine with a view to a national approach that would enable nursing students as employees to ‘practise’ at their level of competency. Recommendation 13—Student nurse employment With a view to achieving national consistency, the NNCA should examine the financial benefits and experience that might accrue to student nurses (and the implications for the workplace) from their employment in the health workforce at their level of competence (but not as part of the requirements of their educational program). Proposed responsibility: The NNCA 6.4 TransitionTransition between different roles will be an increasing feature of the workplace of the future. the high levels of specialisation develop they will also be rapidly overtaken by changes in knowledge and technology. Opportunities to progress to work requiring a higher levels of competency will be needed to ensure a workforce for the future. There will also be times of withdrawal from the workforce due to family or other commitments. Consequently, the need for organisations to include transition processes and support will increase. To support these transitions (whether the service is to acute patients, the elderly or the community), organisations will need to develop strategies to encompass transition processes as part of normal operations. To achieve this will require some investment in educational infrastructure and teaching expertise in clinical areas. One important transition is that from education to the role of professional. The Organisation for Economic Co-operation and Development (OECD) report Knowledge Management in the Learning Society (2000) notes that there has been little concentration on the learning that occurs in the workplace, despite the lack of satisfaction of new professionals with this transition. It identifies the growth of mentoring of new professionals as an important development, not just for the new professional but also for the mentor and the organisation because of the capacity for this arrangement to promote innovation. The report argues that when theoretical knowledge and practical knowledge interact the conditions for innovation exist so ‘mentoring can be the midwife of innovation’ (OECD 2000, p. 55). Hargreaves (2000) also explores the theme of becoming a professional, which he describes as ‘becoming a full member of a community of practice’. To achieve this, individuals need the appropriate knowledge and skills but also the relevant identity, both of which are acquired by participation. In becoming a professional he claims that: Novices learn not merely to talk about the practice of their profession, but within it. Learning is not merely a condition for membership of the community of …, but it is itself an evolving form of membership (OECD 2000, p. 225). Since nursing education moved from the hospitals to the universities, there has been much discussion about the readiness of the new graduate. The Reid Review (1994) has an extensive discussion of this issue and the same issues were raised again in the current review. The disparity between the expectations of the care services and those of education of new graduates does not appear to have been resolved. Indeed, the current difficult working environment may well have exacerbated it. However, the view that graduates perform confidently within six months of graduation has not changed (Duffield et al. 2001). Graduates of nursing degrees are prepared as entry level practitioners of a profession that works in many different settings. As such, each new graduate will need time to adjust to a particular practice setting as well as time to develop as a confident member of the profession. When stronger partnerships between education and practice sites occur we hope that there will be better agreement on the expectations of new graduates. The 1994 review had as part of its terms of reference the question of whether an internship should be included before registration. Like that Committee, we do not support an internship for the following reasons:
6.4.1 Programs for new graduatesNew graduate programs are offered to nursing graduates as part of the transition process from university to employment as a nurse. There are few graduate programs for enrolled nurses. Although in some States there is a big investment in these programs for new university graduates, the amount of funding provided varies and the accountability for the funding is not specific. Some non-government facilities also offer graduate programs, sometimes with State government support. The access to new graduate programs also varies. For example, the Tasmanian Government is committed to offering all new graduates a graduate program. We hold the view that all new graduates, enrolled or registered, should have access to a transition program. Respondents to the Review also suggested that the quality of programs varies. Since the programs depend on the support available in the facility, in times of shortage it is difficult to provide appropriate support to the new graduate. The interdependence of these factors is well presented in the following statement from Southern Health: On completion of education and training nurses face a period of adjustment where they are required to bring together their theoretical and professional knowledge. A concerted effort by universities, Government and health care agencies needs to be made to ensure that transition year programs adequately assist the new graduate for their new role. It is essential that new graduates have an appropriate level of clinical ability when joining the workforce both following undergraduate and postgraduate courses. Measures that could be undertaken to facilitate this process are: • an active recruitment and retention program for experienced nurses. The aim of this suggested strategy is to ensure that there is an appropriate staffing profile to ensure graduates have adequate support during this transition period, • a standardisation of graduate nurse programs nationally that acknowledges what graduates have been taught, their level of competency and realistically identifies the knowledge and skills they require to be effective members of the workforce. (Response to the Discussion Paper) In summarising the issues, Southern Health raises a matter that was also part of the discussion of the Reid Review (1994). While the 1994 review did not support standardised programs it did suggest a review of the ANCI competencies to ensure that they meet the expectations of employers of beginning practitioners as well as the registration boards’ expectations for registration (Reid 1994, p. 241). To a degree, this is the same issue we raise in Chapter 7 when we address the lack of consistency in the interpretation of the ANCI competencies between nurse registering boards and universities. To encourage greater quality and consistency we propose that the ANCI develop minimum standards for transition programs to be endorsed by the NNCA. The principles that underpin these standards should include that the transition programs for new graduates should:
Recommendation 14—Standards for transition programs To ensure consistency and quality in the development and delivery of transition programs: a) a national framework should be developed for transition programs to provide guidelines and standards for institutions b) State and Territory nursing registration boards should accredit transition programs c) employing institutions should be responsible for meeting the standards. Proposed responsibility: ANCI in consultation with the NNCA, State and Territory nursing registration boards and employing institutions 6.4.2 Continuing clinical developmentIn comments to the Discussion Paper there was a strong call for adequate funding and a range of other support options to be provided for continuing development for nurses. These included:
Other suggestions were about paid study leave, and the establishment (or maintenance, where they are already in place) of professional development/education units and clinical nurse educators. We also recommend that all State and Territory governments commit to transition programs and that they build up the clinical support infrastructure to promote clinical development for all nurses. Further we encourage governments with their respective responsibilities to encourage transition support programs in aged care. Recommendation 15—Continuing clinical development of nurses To promote the ongoing development of nurses’ clinical competencies in the workplace, Commonwealth, State and Territory national health funding arrangements should dedicate funds to the provision of: a) clinical development support in healthcare settings for nurses at all levels and the necessary infrastructure for education and training in the healthcare system b) transition to practice programs for new nurses, both enrolled and registered, and for nurses returning to the workplace c) support for these developments, including preceptorship and mentoring. Proposed responsibility: Commonwealth, State and Territory health ministers Recommendation 16—Continuing clinical development of nurses: aged care To promote ongoing development of nurses’ clinical competencies in their workplaces, Commonwealth, State and Territory aged care responsibilities and funding arrangements should: a) endorse and ensure continuing support for the standards and guidelines for residential aged care services in relation to the clinical education of nursing staff as outlined in the aged care accreditation standards b) endorse and encourage the provision of transition programs for new graduate nurses, both enrolled and registered nurses, in aged care organisations. Proposed responsibility: Commonwealth Minister for Ageing There are a number ways transition to practice could be supported. The Queensland University of Technology has an interesting idea for transition support programs: An innovative strategy for the future development of transition support programs could be the instigation of a tendering process for the provision of a transition support service to complement organisational orientation within particular facilities/groups of facilities, eg. aged care. The successful tenderers, eg. university and health care service partners, would be responsible for delivering the educational and administrative elements of the program, would oversee its implementation and would be responsible for its evaluation. In fulfilling these functions program providers would work closely with health care service personnel to ensure the relevance, contemporary significance and operational efficiency of the program. (Queensland University of Technology, response to the Discussion Paper) Since transition support is an investment in an ongoing nursing workforce, governments need to prioritise this support in funding arrangements, particularly for new graduates. The loss of graduates, either at the point of entry to the workforce due to lack of available transition programs or in the first year after graduation due to inadequate support, is a matter of particular concern in times of short supply. It is also at these times that informal support for new graduates is likely to be less available, making it imperative that formal processes are well established. Recommendation 17—Transition to workforce: funding The Commonwealth, States and Territories should establish a system to allocate dedicated funds to (public and private) health and community care institutions to assist registered nurses and enrolled nurses in making the transition into employment, including the transition into employment of those nurses who have completed a re-entry program. a) Allocations should attach to the individual employee or registrant (and should be made on their behalf ) to institutions whose programs have been accredited for transition b) Transition programs should be encouraged in areas such as mental health, aged care, community nursing, and rural health, as well as hospitals. Proposed responsibility: Commonwealth, State and Territory health ministers 6.4.3 Re-entryNurses who have left the nursing workforce previously should be supported to assist their return to nursing. Re-entry courses should be easy to access, affordable, and should help nurses with lapsed registration return to the workforce. A number of State health departments fund refresher and re-entry courses, many into specific nursing areas where shortages are being experienced. To reduce the need for extended re-entry programs a long-term strategy would be to encourage nurses who have taken extended leave to retain a current level of experience and to keep in touch with the workplace. Creative programs to ensure skills are updated when not working in a clinical area are needed for a number of different groups, including nurse academics, nurse policy makers and nurses on leave. We encourage the development of such programs. 6.5 Ongoing learningPrice and colleagues outline the scope of ongoing learning opportunities for nurses in their report. Ongoing learning options include professional development courses, sessions conducted by professional nursing organisations or employers, personal ongoing learning contributions by each nurse, vocational education and tertiary educational options (2001, p. 32). When considering the ongoing learning options for nurses we examined the opportunities offered or taken up by nurses to enhance their professional development, career progression, maintain their currency of knowledge and assist in defining their career pathway opportunities. Within this group of activities is the preparation and development to work in specialist nursing fields. This topic is discussed in Chapter 7 with the more formal models of education and training. 6.5.1 Continuing educationOngoing professional development through continuing education is crucial to any nursing career pathway and to being a member of a profession. The Royal College of Nursing, Australia in the Position Statement Continuing Professional Development states Continuing professional development for nurses is essential to ensure that nursing practice is congruent with the health needs of contemporary society. Competence to practice is dependent upon updating knowledge and skills and the personal and professional growth of practitioners within a discipline. Professional development is a career long process. It is stimulated by experiential and other learning, which may occur in a variety of ways and includes, but is not limited to, formal award educational programs (RCNA 1998). Nurses should rightly expect to be offered opportunities for continuing professional development in their workplace. This development is often a key factor in retaining them in the nursing workforce and helping them develop their career options. Many submissions raised the cost-cutting and rationalisation of funding in the healthcare system that have impacted on support for continuing professional development for nurses. In its submission, the National Nursing Organisations argued that there is a lack of commitment by employer groups to ensure that nursing staff maintain best practice in clinical practice, nurse education and nursing research by providing conditions that allow staff to engage in continuing education. It stated that: budgetary constraints and staff shortages within the healthcare sector have seen the diminution of resources available for employment related nurse education, including nurse educator positions, classroom and teaching resources and study leave (NNOs, Submission No. 108 to the National Review of Nursing Education). In Chapter 2 we argued that nurses should demonstrate ongoing education to maintain competence and re-registration. In order to achieve this all nurses will need access to professional development materials and opportunities. Recommendation 18—Lifelong learning and nursing competency Given the challenging tasks undertaken by nurses and the rapid changes that can occur in technology, knowledge and skills, all nurses should be expected to undertake continuing education activities to maintain and enhance their professional competence and this should be taken into account in retaining registration or enrolment. To ensure this is possible: a) employers should develop strategies in their local areas to provide the opportunity for registered and enrolled nurses to keep their nursing competencies current so that they can retain registration b) employers could also provide opportunities to those not presently in employment to access appropriate fee-paying courses to maintain competency c) nursing organisations should develop educational material to support the maintenance of nurses’ competencies in relevant areas. Proposed responsibility: Employers, nursing organisations and individual nurses |
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