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Report From a National Survey Of Health Service Facilities for the National Review of Nursing Education 20017. Post Graduate Students (RN/RN Division I)
7.1 Background DataPreparation of specialist practitioners is a feature of many collaborative arrangements between universities and health facilities. A series of questions were asked about these arrangements, which may increase teaching responsibilities of health facilities. The next series of questions addressed issues related to post graduate students. Health facilities were asked to indicate whether or not they had an agreement with a university to provide clinical experience for postgraduate students and the responses appear in Table 31. Table 31 - Facilities with an agreement with universities to provide clinical experience for postgraduate nursing students (n = 116)
A total of 116 (26.9% of 432) facilities indicated they had an agreement with one or more Australia universities to provide clinical experience for postgraduate students. Public facilities constituted half (50%) of those who reported having such an agreement. Charitable organisations reported least frequently that they have agreements, a similar response pattern to placing undergraduate students. Similarly institutions may have agreements to provide clinical placements or supervised experience with more than one university, given the specialised nature of many health facilities. Table 32 indicates responses to a question on the number of agreements. Table 32 - Mean number of affiliations with universities by organisational category (n = 116)
On average, public institutions have arrangements with just under 2 (mean 1.9, SD = 1.1) universities, while charitable Institutions have an arrangement with 1.4 (SD = .9) universities. In this context, the large standard deviation and range of values suggest there is a high degree of variation within the different organisational types but again some were area or regional facilities while others were single stand-alone institutions. These data are analysed further in Appendix III where in the public institutions 23 health facilities have either 1 or 2 affiliations. Likewise 21 private for-profit institutions have an affiliation with a single university. Therefore, the majority of institutions that responded have affiliations with a single university. In terms of maximum numbers of affiliations both the public and private non-profit have 7 and 6 affiliations respectively. However, the absence of agreements does not preclude having postgraduate students who require clinical experiences. This is particularly true with postgraduate students where employers may be unaware that some of their staff are enrolled or undertaking programs in which there is a clinical component. This is more likely to occur where the clinical component is largely unsupervised, as opposed to courses such as midwifery, where clinical placement is essential as is the provision of clinical supervision. Health facilities were asked to indicate the average number of weeks per year they provide clinical experience for postgraduate registered nurses (Table 33). Table 33 - Number of weeks postgraduate students are provided experience by organisational category
On average, public hospitals had students for the greatest number of weeks per year (25.5) ranging from zero to 52 (for all categories of organisation). The charitable category reported the least number of weeks (mean 5.1) in which students are in the facilities. Again the standard deviation and the range of values were very high and speak to the variability in scores within categories. This is not surprising given that some programs such as midwifery extend well beyond the usual semester length. To determine the range of clinical experiences provided to postgraduate nursing students, health facilities were asked to indicate from 15 items, the type of clinical experience provided. Respondents could select more than one option and/or add to those provided. Responses appear in Table 34. Table 34 - Frequency and type of clinical experience provided for postgraduate students by organisational category
[Sorted numerically by total responses] The public institutions offer the greatest number and variety of opportunities for specialty experiences. Except for midwifery, the charitable institutions offer fewer opportunities than do the others by specialty service. 7.2 Support ProvidedAs with undergraduate registered nurses and trainee enrolled nurses, health facilities were asked to indicate the organisational support they provide to postgraduate nursing students. A range of 17 options was presented and they appear in Table 35 in descending rank order based on the total responses. There is little difference between categories of institutions for this question. Table 35 - Frequency of support mechanisms provided for postgraduate students, by category of organisation
(Sorted by total responses) Parking (n=134), a buddy system (n=129) and libraries (n=122) are the top three supports offered by respondents overall (Table 35). Child care (n=9), sports facilities (n=13) and accommodation are least likely to be offered by any organisation. Health facilities were also asked to indicate the support provided by the universities to them when providing clinical experience for postgraduate students. There were seven options provided and these appear in Table 36 in the order in which they appear on the questionnaire. Table 36 - Frequency of supports provided by universities to health facilities for postgraduate students by organisational type
The public institutions are more likely to report receiving library access, honorary appointments and supervisory staff from the universities. The charitable category noted few benefits. 7.3 Satisfaction with Postgraduate StudentsHealth facilities were also asked to indicate using a Likert scale the extent to which they believe that current postgraduate nursing courses prepare specialist nursing practitioners. Responses ranged from '1' for 'poor' to '4' for 'excellent' and appear below in Table 37 according to the category of institution. Table 37 - Extent to which postgraduate nursing courses prepare specialist nursing practitioner 1=poor/ 2=fair/ 3=good/ 4=excellent
The mean in the public institutions is slightly higher than in the other three which are similar with similar standard deviations. When the median is examined respondents from the private-for-profit category believe that the preparation of specialist nursing practitioners by postgraduate nursing courses is only 'fair' (median 2). For the remaining three categories the median is the same (3 - good). Figure 11 provides an analysis of these results according to the Likert scales and by category of institution. Figure 11 - Satisfaction with the preparation of specialist nursing practitioners by category and Likert responses
The results in Figure 11 are interesting. The most frequent response for all four categories of institution is 'good' (3) followed in some instances quite closely by 'fair' (2) (see for example the private not-for-profit category). All four categories have respondents which indicate that the preparation of specialist nurses at the postgraduate is 'poor' with the public category least likely and the private for-profit most likely to indicate this. No respondents in the charitable category rated the preparation as 'excellent' but this category has the smallest number of respondents so must be viewed with caution (see Table 31). 7.4 Collaboration between Health Facilities and UniversitiesSpecialisation at the postgraduate level requires access to specialist clinical facilities which can only be provided in the clinical environment. Therefore educational delivery of programs in partnerships between educational and health facilities may be an important factor in preparing specialist practitioners and in the evaluation of their abilities to meet service needs. To this end, health facilities were asked to indicate their involvement with universities in a range of educational activities. Table 38 provides data on health facilities' involvement in postgraduate activities (more than one response was possible) while Table 39 provides data on contractual arrangements for workshops and inservice courses. Table 38 - Frequency of health facility involvement in postgraduate nursing education activities
Having sitting members on some university course committees (n=69) was identified by respondents as the most frequent activity in which organisations are involved (Table 38). One hundred and forty five respondents indicated they have no role in specialised postgraduate nursing education and nearly one quarter of respondents (23.6%) would welcome an invitation to contribute to postgraduate nursing course design. Health facilities may have contractual arrangements with universities whereby some continuing education or inservice type activities may be offered in addition to formal courses. Table 39 indicates the number of institutions which in the last five years have contracted an Australian university to offer/teach a postgraduate nursing course or workshop for their staff. Table 39 - Frequency of health facilities contracting universities in the last five years
While the nature of these arrangements were not sought, from Table 39 there are indications that some health facilities are contracting higher education institutions to provide educational programs and workshops for their staff. More frequently this is occurring in the public institutions (8.8%) followed by the private not-for-profit institutions. As many of these latter institutions are smaller this is not surprising as it is unlikely that they have dedicated educational staff on their payrolls. 7.5 SummaryOf the 432 respondents to the survey, 116 have agreements with universities to provide clinical experience for postgraduate students. Of these 50% are public institutions and they provide a wider range of clinical specialties which reflects the range of service foci of respondents (Table 6). A variety of supports are provided by health facilities in all categories including parking, a buddy system and libraries. Very few provide child care. Preparation of specialist nursing practitioners was perceived to be 'good' (median for most categories is 3 on a Likert scale of 1-4). A variety of inputs are provided from health facilities to postgraduate course related activities. However, 37% of respondents are not currently involved in any activities and 27% would welcome the opportunity to do so. The mechanisms to improve collaboration between universities and health facilities could be strengthened with a view to enhancing the preparation of specialist nurses. |
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