Editorial
Committing to the future
Debra Thoms
Chief Nursing and Midwifery Officer, NSW Department of Health; Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Sydney NSW
PP: 3 - 5
Article Text
As the number of countries around the world preparing registered nurses (RN) in universities and equivalent higher education institutions increases, it is not uncommon to read of concerns in both the academic and popular literature about the practice of newly registered nurses as they enter the workforce. Some of these comments will refer to what are seen as problems of the preparatory education undertaken in tertiary settings and Australia has not been immune from such commentary. In 2010 it will be 25 years since registered nurse education was fully transferred into the higher education sector in New South Wales, thus bringing to a close the era of hospital-based apprenticeship-style education for registered nurses in this State.
Registered nurses entering the workforce in Australia now complete, as a minimum, a 3-year undergraduate degree leading to registration. As in other countries, the nurses who were involved in achieving that change were focussed and committed to the future of the practice and profession of nursing. Since that time there has continued to be much debate about the decision and the changes to nursing in the following years. Nursing is a practice discipline and as such there is continued learning throughout our careers. At all stages we fi nd that there is new knowledge and changes in practice not only in clinical areas but in education and management that we need to become familiar with and apply. Our ability to manage change develops over time as we grow, through encountering change on a continual basis not only as a feature of our work but of life.
Socialisation
We build our practice not only through formal education but through socialisation into practice by other practitioners (Benner 2000). How many of us remember what it was like on the first day of our nursing education, or the first time we had responsibility for a team on the ward or unit, caring for a group of patients, or undertook a new procedure? It is easy to forget the fears, anxieties and trepidation as we encountered many new experiences and challenges and to sometimes fail to recognise those reactions in others as they grow and learn.
Equally how many of us can remember the role or support we were given by other members of staff? Sometimes this was in the form of an appointed preceptor or mentor and sometimes it was in the day to day conversation as part of a team as we went about our daily work. These people helped ease our path and contributed to our growth. Just being with an RN did not guarantee learning and often the demands of 'work' interrupted, delayed or even prevented learning opportunities and we still had discrepancies between theory and practice (Andrews & Wallace 1999).
It was not a perfect system and the current system is not necessarily perfect either, but it does provide a more appropriate base for the registered nurse to build their skills and knowledge in the workplace. There is one aspect though that did seem to be more prevalent 25 years ago than it is currently in this State and that relates to the role of the registered nurse in mentoring and/or preceptoring in the workplace.
Importance of Preceptors and Mentors
The role of the experienced registered nurses included an expectation of teaching and mentoring more junior and less experienced members of staff. Preceptor and mentor are often confused terms and I have used preceptor here to mean support in the clinical setting which enables critical reflection and dialogue with a trusted colleague that supports growth and development of the individual in their practice. As time has gone on we have seen the establishment of formal education roles such as clinical nurse educator within a number of wards and units. These roles have been extremely valuable in an increasingly complex environment with an acute mix of patients. Yet there seems at times to be a reluctance on the part of many nurses to participate in providing education and support to colleagues at the unit level. By this I do not mean formal education programs but the less formal preceptoring relationships that can prove so important to a nurse who is new to practice or an area of practice. These relationships have other benefits such as contributing to the building of positive team relationships and indirectly a more supportive work environment. They are also vital for the future of nursing and patient care.
Selection and Preparation of Preceptors
The role of a preceptor is not easy and is not a role that every nurse is necessarily suited to undertake nor interested in undertaking. There are an increasing range of demands on registered nurses in the workplace related to workload, staffing practices, complexity of care and the provision of care within the allocated resources. The role of the Nursing Unit Manager (or ward manager) has changed over time with many these days taking on an increased administrative load which may also take them away from the ward itself. Thus the Nursing Unit Manager is not as evident in directing, guiding and assisting staff in general nor facilitating those in preceptoring roles. Recognition of the contribution made by staff who undertake roles as preceptors is not always forthcoming, thus indirectly discouraging and potentially reducing the value that is placed on these important roles. Preceptors are usually from among the staff on the unit who display a high level of clinical knowledge and also provide a level of clinical leadership on the unit. Selection of suitable staff to undertake the role is important for long term success. While it is still the case that in many instances there is limited preparation of staff to undertake the role of preceptor and they essentially learn 'on the job' it would be ideal to ensure that there has been suitable education made available for those who wish to become preceptors. There are a variety of approaches to preparing staff for the role reported anecdotally and it is one of the challenges into the future to ensure that staff are well prepared for such roles. It may be of assistance to build such roles into development opportunities and to recognise more overtly the positive contribution they make not only to new staff but also to the individual.
Rewards
Despite the many challenges of these roles there are rewards. Dibert and Goldenberg (1995) found that the benefits and rewards most valued by those who had undertaken roles as preceptors were the opportunity to assist staff to integrate into the unit, to teach and at the same time to improve their own teaching skills. They also noted the opportunity to share knowledge and that individuals gained personal satisfaction from the role. To foster a continued commitment to the role it is important to value, acknowledge and nurture these individuals who take on the role of preceptor (Dibert & Goldenberg 1995).
Relationships with Undergraduate Nursing Students
While there is a level of acceptance of the role of nursing staff as preceptors for new staff I would suggest that there is less acceptance of the role with undergraduate nursing students. It is not unusual to hear commentary about the role of education providers in providing support and supervision for undergraduate students. What does not seem to always be appreciated is the contribution that registered nurses can and do bring to the preceptoring of students. It is especially in the last year of an undergraduate program that I would suggest that the time spent with a competent and experienced registered nurse can be the most valuable.
Newly graduated registered nurses are often subject to criticism by existing staff due to a perceived lack of 'work readiness' but I wonder if these very staff have perhaps not contributed to this occurring. There is still an expectation on the part of a number of registered nurses that the newly registered nurse will perform as the newly graduated nurses did from the apprenticeship style systems.
I would argue that one of the many differences between the two models of education is that these same registered nurses actually mentored the apprentices during their education to a much greater extent than they are prepared to do today. This preceptoring and the development of the relationship contributed to the performance of the registered nurses immediately after graduation. The practice of nursing is complex.
Growth of practice is enabled for the newly registered nurse as through experiential learning they apply and integrate the theory and skills learnt to some degree in isolation as part of their education program (Benner 2000). Practitioners develop notions of good practice that are constantly being worked out and extended through experiential leaning and preceptors enhance and assist this learning (Benner 2000).
We have an opportunity to provide that support for the development of registered nurses in the clinical placements and student experience, especially in the third year of the undergraduate program. Instead of waiting until the first year of practice as a registered nurse to preceptor a nurse why do we not start this happening within the education program? Why is it not readily and universally accepted that we still have a role within the education program and cease continuing to expect that all components of the education program are the sole responsibility of the university provider? Those nurses in formally appointed educator roles will still have a major role to play but it is the day to day learning in the delivery of care under the guidance of a well qualified and supportive preceptor that will make a major contribution to the growth and development of the neophyte registered nurse.
A Partnership
If we as nurses are truly committed to the future of the profession then we must play an active part in building a continuing presence and essence of practice in new entrants to the profession and not expect that it will be largely undertaken by others. This needs to be a partnership between the practice and the academic sectors and not a competition or shifting of responsibility back and forth with an attached language of blame. This is not to say that it is an easy task amid the many demands on nurses within the workplace, but if we fail to recognise and in effect abdicate our role in the development of the nurses of the future, I would suggest that we lack a commitment to the future of the profession.
References
Andrews M and Wallace M (1999) Mentorship in nursing: A literature review. Journal of Advanced Nursing 29(1): 201-207.
Benner P (2000) The wisdom of our practice. American Journal of Nursing 100(10): 99-105.
Dibert C and Goldenberg D (1995) Preceptors' perceptions of benefits, rewards, supports and commitment to the preceptor role. Journal of Advanced Nursing 21(6): 1144-1151.
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