Soap Box
Your say about nursing issues
Helen Calabretto
School of Nursing, University of South Australia, SA
PP: 047 - 048
Article Text
Why university?
Attending university was inevitable. As a registered nurse with nine years clinical experience in a large teaching hospital I believed that my knowledge base was sound, my organisational ability was good and I was able to relate well with my peers and other health professionals. The nursing care I delivered was conscientious and competent. The question I asked myself was, 'What could a Bachelor of Nursing do for me?'
I filled out the appropriate form and returned it to the tertiary admissions centre. Within an air of scepticism, I selected the course I was subsequently accepted into as my first and only preference. The decision to apply for this course was merged with a desire for promotion and fear that I may be 'left behind'. I was offered and accepted a position to study one year full-time for my nursing degree. I accepted ambivalently.
During the first semester, I felt numb at the mere thought of churning out assignments full of theoretical jargon unrelated to 'real' nursing. That perception was soon to be changed. Discussion groups provided an environment in which to talk and learn from other nurses about different work areas and interests. We were treated as adult learners with many valued nursing practices and skills. Nursing theorists and various definitions of nursing were examined and debated. This process was enlightening and provided a framework in which to conceptualise. A review of the nursing literature emphasised a need for more research and formal documentation.
Personally, I have experienced something akin to opening a locked door: the university is the key, the tutorial group is the torch and my mind the darkness beyond the door. University has offered a unique learning experience which has made me realise that formal tertiary education for nurses is essential on a personal and professional level. For the professionalisation of nursing and the creation of a nursing discipline, we as nurses need a forum to examine, debate, and discuss issues pertinent to nursing today and the future. The university offers such a forum.
To say that university has altered my work practice would be inadequate. To declare that university has changed the way I think would also be insufficient. To admit that university has had a huge impact on my life and my perceptions is both certain and authentic.
Paula Bennett RN
Nurses - or not?
They arrive in ones and twos, some look immaculate, some not so smart. Some look awkward, some look shy, most of them are scared. They are first year students arriving for their first clinical placement on a 'real' ward with 'real' clients.
During the next three weeks it is my job, as the clinical educator, to teach and guide them through the basic skills of good nursing care and to help them learn how to become a 'professional nurse'. The first two or three days are difficult, as they get to know the ward, the clients, the staff, each other and me.
Slowly, over the three weeks, they gain confidence, and continue to practise and polish their skills. They begin to enjoy the work and the interaction with clients. At the end of the three weeks they have established a good base on which to build future clinical experience; at least most of them have.
There are often one or two students who show little initiative or interest in learning. They hide away with the clients and look bored during debriefing sessions. It is these students who are my greatest challenge! Can I convince them of the importance of a professional attitude? Can I make their time on placement more interesting, or valuable, and help them understand why we provide care in certain ways?
Many times I have worked hard with these 'reluctant' students, only to discover that they have given up nursing at the end of the first semester or at the end of the year. One particular student, on clinical placement with me three years ago, was extremely nervous. Much of my time was spent with him, guiding and encouraging him through his tasks. I discussed this student with the clinical co-ordinator who told me that he was excellent academically, so I persevered. At the end of the placement the student and I discussed the problems he had in handling clients, particularly when helping them with their bodily functions. I was astonished and dismayed when he told me that he didn't really want to be a nurse, but had joined this course because he couldn't get into the librarian course. The student left at the end of the first semester and has now almost completed his librarian course.
My initial dismay, when I heard that this student was going to change courses, later turned to anger. I had put so much effort into helping him and it was all wasted! I felt guilty, because a student who really wanted to be a nurse may have needed my help, while I was busy with the 'librarian' student.
Aside from my personal feelings, so many resources, human and otherwise, had been wasted on this student who wanted to look after books not people! Nursing is not like a librarian or mechanics course, we are dealing with human beings. I am concerned that students, who have no interest in caring for people, could jeopardise clients' safety and comfort. There is also the possibility that their disinterested attitude could rub off on the other students.
Unfortunately this was not an isolated case. I heard two other students state that they did nursing simply to get into university in order to transfer to another course later. I was curious as to whether this occurred in other universities and decided to undertake a literature search for the past five years on attrition from nursing. No research papers were found that specifically discussed student attrition from nursing. Most of the research papers are American and they may have different entry criteria and rules regarding courses.
At my institution, of a particular cohort of 164 students, 33 had already left by the beginning of the following year. Six of the group had transferred to other university courses. It would be interesting to know how many of the students who left the course had made nursing their first choice in their list of preferences for university admission.
Ideally, all students accepted into the nursing degree course would have placed nursing as their first choice. If this was not the case, I believe that the student should be interviewed. This should establish whether the student has sufficient interest in caring for people and is a suitable candidate to undertake a nursing degree-a profession responsible for human support, protection, and guidance.
It is potentially dangerous to allow students, who have no real interest in being a nurse, to care for ill or frail people when they are at their most vulnerable.
If we can ensure that all students taking a nursing degree actually want to become professional nurses, then human and material resources will not be wasted. Educators will have greater job satisfaction; knowing that their knowledge and effort is developing students who want to become nurses. Most important of all, clients will not be exposed to students who have no interest in caring for them.
Rosemary Jones RN
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