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Changing the culture in nursing
A Strategy
Pauline M Dobson
Clinical Nurse Consultant, Immunology & Infectious Diseases Unit, John Hunter Hospital, NSW
Abstract
How often do we hear it said that Nursing should not seek to model itself after Medicine? There may however be some particular aspects of Medicine which we should choose to incorporate into Nursing, where these would enrich our profession. In particular, we should examine that aspect of the culture of Medicine which creates in senior practitioners a strong sense of both collective and personal responsibility to educate and nurture undergraduate and postgraduate medical students, as a contribution to the strength and growth of their profession. In Medicine, a host of practising senior clinicians provide regular education and supervision and act as role models for students, who are accorded respect as junior colleagues. This aspect of medical culture plays a central part in the passing on of knowledge, skills, judgement, attitudes and distilled experience, and is pivotal to the maintenance of the profession and its culture.
This generally does not occur in Nursing. Undergraduate students undergoing clinical practicums are more likely to be perceived as the responsibility of their university faculty. Although registered nurses do mentor students in the workplace, their contribution to the educative experience is often unstructured and may occur without reference to the nursing curriculum and its educational objectives. Outside of the university faculty, nursing does not have a cultural sense of responsibility to ensure that students receive the most comprehensive clinical preparation that it is possible to achieve.
Many university medical faculties support and maintain the tradition of teaching by offering to clinicians conjoint academic appointments with a totally nominal annual payment. For a tiny financial outlay the faculty thus obtains the services of a large number of senior practitioners willing to make time to provide formal and informal teaching according to the faculty's requirements and under its supervision.
University nursing faculties would do well to examine this model of conjoint appointments. Some faculties have attempted to address this issue by appointing Clinical Chairs and Clinical Associates. These positions are too limited in number to impact greatly on the education of undergraduate nursing students. To achieve a global culture change will require a much more widespread adoption of conjoint appointments.
Clinical Nurse Consultants are experts in their fields with many years of current clinical experience, and many have some flexibility in their roles which would enable them to accommodate teaching in their clinical setting, particularly given the support of nursing management. Generally, Clinical Nurse Consultants are an under-utilised resource for supervision of nursing students. The potential to enhance existing undergraduate teaching at a minimal cost is at hand. Nursing Faculties in these fiscally-challenged times should examine this option closely.
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