Editorial

Workplace learning: A continuing concern in nurse education

Debra Jackson
Professor, Faculty of Nursing, Midwifery and Health, University of Technology, Sydney (UTS), Broadway NSW

Roger Watson
School of Nursing and Midwifery, University of Sheffield, Sheffield, United Kingdom; Hong Kong Polytechnic University, Hong Kong

PP: 003 - 005

Article Text

As a practice discipline, nursing has a long and well-established history of teaching and learning that occurs in the clinical environment (Mannix, Faga, Beale, & Jackson, 2006). For many years, the workplace, as a site of clinical learning, was taken-for-granted and viewed as unproblematic. Nurse education was largely based in the health sector, and it was simply accepted that placing learners into the clinical environment meant they would have opportunities to learn, and that appropriate learning would occur (Jackson, 2009; Mannix et al., 2006). However, the major changes to nurse education that occurred late last century meant that many nurse education programs were no longer wholly conducted in the health sector. These changes have been the catalyst for educational providers to re-visit workplace learning, to consider the value of workplace learning, its place in contemporary nurse education and to consider possible alternatives to workplace learning.

Recently there has been increasing concern about threats to the supply of adequate quality clinical learning opportunities to meet the demands of the undergraduate education sector (Cross, 2009; Mannix, Wilkes, & Luck, 2009). The pressure on the acute and community sectors for clinical places has meant that alternative sites and models of clinical learning have been sought. In the Australian context, venues such as residential care facilities which may have previously been overlooked and not viewed as optimal sites of workplace learning are now relied on to ensure that undergraduate students are able to gain adequate workplace learning opportunities. This situation is mirrored in the UK where, despite one hand of the UK National Health Service (NHS) funding nursing education; the other hand is thrown up in horror at the prospect of the need for more clinical placements. Imaginative solutions have to be found and like the Australian situation, these will likely include the private sector nursing homes and a significant move to including more primary care placements and, indeed, emphasising primary care in newly validated nursing programmes (Nursing and Midwifery Council, 2010). This could be viewed as being progressive, or as a virtue being formed out of necessity.

The use of mannikens is common place and these are becoming increasingly sophisticated and more lifelike compared with the inanimate, inflexible and, frankly, pointless 'dolls' that we encountered in our training days (Watson & Thompson, 2009). The increasing sophistication of these mannekins is remarkable and, undoubtedly, they have an important role to play in specific, clinically clear situations such as physical assessment, acute cardiac and respiratory care; intensive and critical care and a range of emergency and clinical skill However, with less time being spent with patients and more with - seemingly - animate mannekins, the potential effect on nurses' caring and interpersonal skills needs to be considered. After all, an anaphylactic reaction can be simulated using a mannekin; counselling the partner of someone who has just died suddenly, unexpectedly and in huge distress as a result of an anaphylactic reaction cannot. Mannekins help prepare people for success and the minimisation of failure - both worthwhile, but clinical practice is not like that.

Therefore, while there are undoubted benefits associated with simulation technologies as an adjunct to support learning (Cooper et al., 2010), these technologies cannot replace the learning that occurs in the workplace. Furthermore, controlled clinical experiences such as those provided by simulation cannot prepare students for the socialisation and interpersonal aspects of working in busy clinical environments in the same way that authentic workplace learning can do. Research has shown that within the clinical environment, students can be presented with opportunities to negotiate some of these problematic aspects of practice that await them in their future careers as registered nurses (Jackson et al., 2011).

However, simply being in the workplace does not mean that optimal workplace learning will take place. There is literature to suggest that certain qualities or characteristics of the workplace will optimise it as a learning environment (Jackson, 2009; McCormack & Slater, 2006). Previous literature has highlighted the advantages of positive workplace learning cultures, and also acknowledges the difficulties and challenges associated with achieving such cultures (McCormack & Slater, 2006). In a seminal case study that sought to evaluate the role of clinical education facilitators, McCormack and Slater (2006) found that, while the clinical educators had a crucial function in coordinating learning and teaching activities within a facility, they had little impact on the development of a positive learning culture in the clinical workplace. These findings reinforce the idea that simply placing students in a clinical workplace, does not mean that they are in an optimal learning environment.

Clearly, and as revealed in findings by McCormack and Slater (2006), it is not possible for a single person, such as a clinical educator or facilitator, to single-handedly create a positive learning culture in a workplace. Everyone, including learners, has a role to play in contributing to positive workplace learning cultures. Obviously the attitudes of staff and their willingness to interact with generosity to help learners is a major variable that has been shown to enhance the workplace learning experience (Jackson & Mannix, 2001). Similarly, it is important that learners enter a clinical environment with a positive attitude and a willingness to make the most of the learning opportunities they are presented with (Mannix et al., 2009).

Furthermore, like the learning that occurs in formal educational settings, workplace learning needs to be framed in the context of learning theories, with clear understanding of learning opportunities and objectives, and should incorporate the systematic and planned evaluation of learning experiences and outcomes. In this way the efficacy (or otherwise) of workplace learning in various contexts can be identified, and steps implemented to improve and optimise learning experiences and outcomes. Such approaches will make it possible to draw comparisons in the learning outcomes achieved at various workplaces, and also for new models and approaches to optimise workplace learning for nursing. The importance of workplace learning to nursing means that it is well worth our intellectual investment to ensure that workplace learning is the best we can make it.

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