Finger on the pulse of nursing

A federal review is examining the health of nurse education in Australia.

Australia is still heavily reliant on overseas-trained nurses

A major review of nurse education has been told students often face obstacles as they go from learning to doing, leaving new practitioners feeling unprepared for work.

The federal government announced the review, Educating the Nurse of the Future, the first major probe of the profession since 2002, at the start of the year.

It is being conducted by Steven Schwartz, former chairman of the Australian Curriculum, Assessment and ­Advisory Authority, who is due to report back at the end of the month.

Nursing is the mainstay of Australia’s health and aged-care systems. Despite an increase in nursing graduates, the country is still heavily reliant on overseas-trained nurses, and the most ­recent workforce assessment predicted an ongoing supply shortfall.

The review is examining interest in nursing as a career, the adequacy of the education ­system, and whether career paths for enrolled and registered nurses and nurse practitioners are relevant. It has received 83 submissions.

In its submission the Australia and New Zealand Council of Deans of Nursing and Midwifery says education efforts have been challenged by a dramatic increase in student enrolments, a reliance on international students and workers, and the complexity of the health system.

“Furthermore, feedback suggests that there is a mismatch ­between what health and education believe are the skills, knowledge and attributes required of an entry level, beginning practitioner,” council chairwoman ­Tracey Moroney writes.

“We believe that graduates from our programs are equipped with entry-level knowledge and skills but that time is needed to further develop and apply these skills to practice. Therefore, consideration as to how healthcare organisations support transition to practice is imperative.”

The council warns that embedded experiential learning has become “increasingly difficult”, with clinical placements becoming more expensive and universities sometimes having little say over the choice of supervisor or ­facilitator.

In its submission Universities Australia calls for clinical placements for future registered nurses to be expanded to other areas, beyond acute hospitals where many take place.

“The majority of care is delivered outside of hospitals in the community, often in those settings of identified workforce need such as aged care,” it says. “Increasing the number and duration of clinical placements in these non-traditional settings will help better educate, skill and distribute nurses to work in these areas.”

The Australian Primary Health Care Nurses Association agrees, saying in its submission: “Reorienting nursing education to increase the emphasis on primary healthcare is central to ushering in a new era in healthcare.”

The Australian Nursing and Midwifery Accreditation Council notes the increased demand for placements and “anecdotal reports of students undertaking professional experience placements in venues such as childcare centres and charity shops”.

“While an education might be able to build a case for the value of such a placement, it seems likely that students would gain more valuable experience in other more health-related community settings,” ANMAC writes.

Rather than nominate other areas for placement, ANMAC says it is “interested in the notion of accrediting professional experience placements as a means of ensuring that the placements are of a consistently high quality and all students have equal opportunity to gain valuable experiences”.

ANMAC has had feedback “describing the lack of confidence that many newly registered nurses feel” and suggests there also is scope for mandatory transition-to-practice graduate programs or an internship year.

The Australian Nursing and Midwifery Federation also points to the various problems in clinical placement — students and nurses “tell us regularly” — and the need for more scrutiny and research to ensure it meets appropriate an appropriate standard for participants and the system.

Despite those problems, the federation argues mandated hours of clinical placement for the bachelor of nursing should be increased to ensure new practitioners are adequately prepared.

“Supervision and support by experienced registered nurses are critical for a successful experience for nursing students while on clinical placements,” the federation writes in its submission.

“However, our members have expressed concern that at times there is no facilitator available to students. It is also essential that clinical facilitators/preceptors or buddies are experienced registered nurses who promote a positive learning culture, understand the importance of reflective practice and are able to provide appropriate constructive feedback from a profession-specific perspective.”

The federation, in one of the most expansive submissions provided to the review, also calls for more data to be collected and reported on student attribution rates and for the Nursing and Midwifery Board to ask new registrants about the support and education they have received.

The federation also recommends greater support for enrolled nurse graduates trans­itioning to practice in acute, aged, primary and community health settings, and incentives for organisations to hire upskilled nurse practitioners.