Specialist education and practice in nursing: an Australian perspective

Registered nurses' self-perceived level of competence following completion of a specialist graduate certificate

Utilising the Competency Standards for Specialist Critical Care Nurses (CSSCCN) as a framework, this study sought to examine the perceived level of competence (PLC) of the graduates of a Graduate Certificate in Intensive Care Nursing (GCICN) and the level at which the GCICN influenced the graduates' PLC. A rating scale of 1-5 and an open-ended questionnaire were utilised. The graduates' mean PLC in the competency 'engaging in research' was rated as the lowest and 'recognising own abilities and professional competence' as the highest. Graduates of 1991-1994 rated their PLC on all the competencies lower in comparison to graduates of 1995-1997. Graduates' PLC on enabling and clinical problem solving domains were rated better than the reflective and leadership domains. A significant correlation was demonstrated between the graduates' PLC and their perceptions as to the course's influence on their PLC.

Clinical nurse specialists as entrepreneurs: constrained or liberated

AIMS

This qualitative study explored the experiences of two groups of clinical nurse specialists--continence advisors and tissue viability nurses--working in primary care in the UK. In particular, the study focused on how clinical nurse specialists' relationships with other health-care professionals had an impact on their role.

BACKGROUND

Clinical nurse specialists are recognized worldwide as having expertise in a given field, which they use to develop the practice of others. Additionally, clinical nurse specialists share many of the characteristics of entrepreneurs, which they use to develop services related to their speciality. However, little research has been conducted in relation to clinical nurse specialists' experiences as they attempt to diversify nursing practice.

DESIGN/METHODS

An ethnographic approach was adopted comprising many elements of Glaserian grounded theory. Data were collected via participant observation and face-to-face interviews with 22 clinical nurse specialists.

FINDINGS

Services provided by clinical nurse specialists were not static, clinical nurse specialists being the main drivers for service developments. However, clinical nurse specialists encountered difficulties when introducing new ideas. Given their role as advisors, clinical nurse specialists lacked authority to bring about change and were dependent on a number of mechanisms to bring about change, including 'cultivating relationships' with more powerful others, most notably the speciality consultant.

CONCLUSIONS

The UK government has pledged to 'liberate the talents of nurses' so that their skills can be used to progress patient services. This study highlights the fact that a lack of collaborative working practices between health-care professionals led to clinical nurse specialists being constrained.

RELEVANCE TO CLINICAL PRACTICE

Health-care organizations need to provide an environment in which the entrepreneurial skills of clinical nurse specialists may be capitalized on. In the absence of an outlet for their ideas regarding service developments, clinical nurse specialists may remain dependent on the mechanisms witnessed in this study for some time.

Clinical nurse specialists and the practice of community nurses

AIM

This paper presents the findings of a study of the roles of Clinical Nurse Specialists and community nurses working in primary care.

BACKGROUND

Clinical Nurse Specialists are recognized internationally as expert practitioners who could facilitate the implementation of evidence-based practice. However, others may misunderstand their role and greater support may be required if organizations are to capitalize on the skills of Clinical Nurse Specialists.

METHODS

Elements of 'Glaserian' grounded theory in a broadly ethnographic approach were used to gain an understanding of the perspectives of 22 Clinical Nurse Specialists working as tissue viability nurses or continence advisors and 19 district nurses in one health region in the United Kingdom. The data were collected in 2001-02.

FINDINGS

Clinical Nurse Specialists were keen to use their expertise to inform the practice of community nurses. However, they encountered difficulties when seeking to introduce changes in practice. Although Clinical Nurse Specialists were acknowledged as enabling rather than deskilling community nurses, receptivity to Clinical Nurse Specialists' ideas was dependent on what community nurses viewed as their own roles. As advisors, Clinical Nurse Specialists were dependent on the use of persuasion and vicarious power to bring about desired changes. These approaches are consistent with traditional approaches to change management as opposed to contemporary approaches to practice development.

CONCLUSION

If Clinical Nurse Specialists are to reach their full potential and use their expertise to inform the practice of others, organizations need to recognize these posts as central to practice development. In particular, a framework is required which enables practice developers to use more inclusive approaches when seeking to bring about changes in practice.

A study of continuing nurse education in Malta: the importance of national context

The literature recommends that in the light of the constant changes in the contexts in which nurses perform [Buerhaus, P., 1997. The future of the nurse labour market. Image 29(4), 313-318], nurse education systems should incorporate specialised and continuing education [Lenera, V., 1987. The Nurse and the Future: Role and Function. In: Health Care and Nurse Education in the 21st Century. Commission of the European Communities, Brussels; Castledine, G., McGee, P., 1998. Advanced and Specialist Nursing Practice, Blackwell Science Ltd., Oxford; Chiarella, M., 1998. Developing the credibility of continuing education. Nurse Education Today 10, 70-73 ]. Using a qualitative approach, the research study reported in this article explored views of student and qualified nurses in Malta about such educational opportunities. Data were collected using questionnaires administered by post to student and qualified nurses in Malta (n=172) [Fenech Adami, M., 2002. An exploratory study of the adequacy of the nurse education system in Malta. PhD Thesis. University of Aberdeen.]. In congruence with the literature, the findings revealed widespread support for and interest in specialised and continuing education in general [Nolan, M., 1994. Continuing professional education: identifying the characteristics an effective system. Journal of Advanced Nursing 22, 551-560; Wilson-Barnett, J., 1994. Evaluating the clinical nurse specialist - a review. International Journal of Nursing Studies 31(6), 561-571]. However, some of the findings challenge that which is recommended in the literature. The findings should contribute to the effective development of specialised and continuing education opportunities in Malta. Moreover, by their divergence from the literature, these findings illustrate that nurse education should always be planned against a backdrop of the context in which it is to be delivered. In turn, the findings point out the importance of researching education within specific contexts rather than simply extrapolating research evidence and subsequent recommendations on nurse education from one national context to another.

Achieving collaborative workplace learning in a university critical care course

The purpose of this paper is to describe the development, implementation and evaluation of a new critical care curriculum based on the tenets of collaborative workplace learning. It also examines lecturers' and clinical educators' issues, and explores students' evaluations of the old curriculum compared with those of the new curriculum. Three data collection methods were used for this study. Comprehensive notes were maintained of the meetings conducted with lecturers, clinical educators and representative students during the development and implementation of the course. Three focus group interviews were conducted with students before the introduction of the new curriculum and three focus group interviews were conducted during first semester following implementation of the new curriculum. Quality-of-teaching surveys were also completed by two groups of critical care course students: one group before and one group following the introduction of the new curriculum. Major findings in this study included: developing a sense of ownership of the curriculum for clinical educators, clinical educators' difficulties with addressing their responsibilities, amalgamating theoretical learning with clinical practice, and tackling students' workload. This paper demonstrates the value of using the collaborative workplace learning approach in strategically addressing the challenges of developing and conducting a university critical care course.

Critical care education: an examination of students' perspectives

Specialist nursing education at the tertiary level is a relatively recent occurrence in Australia. With this move to higher education a variety of issues such as course duration, award level and clinical versus theoretical outcomes provided the impetus for this study. This study examined critical care nursing students' perceptions of undertaking post-graduate education within the higher education sector. Four themes arose from analysis of eight focus group interviews with a total of 42 students from 35 courses offered in eight universities across Australia. The first theme, student burden, included subthemes of financial, heavy workload and student-work conflicts. Student benefits, the second theme, encompassed financial and other benefits. The third theme, clinical experience, incorporated clinical capability, synthesizing, support required and clinical learning. The final theme of student attitude included the subthemes of individual, technology and course. Without student evaluations, curricular improvements including assessment and clinical experience will not evolve to the best of their potential.

Informal Education: A Hidden Element of Clinical Nurse Consultant Practice

A survey was conducted to investigate the amount of informal education provided by 16 community-based clinical nurse consultants (CNCs) in Sydney, Australia. The survey results indicated that the CNCs spent a substantial amount of time in informal teaching, of which only 3% was recorded as a legitimate educational activity. Findings from the survey support what has been reported in the literature, that skilled knowledge can be gained in the workplace when learners interact with experts. Through the avenue of informal teaching CNCs can positively contribute to quality nursing care by addressing on-the-job learning needs of community nurses.

Specialisation in nursing. A survey of reactions of Victorian nurses to the national review of specialist nurse education

This article reports on the opinions of specialist nurses practising in Victoria toward recommendations proposed in the National Review of Specialist Nurse Education (Specialist Review) (Russell et al 1997). Seventy-five nurses undertaking a range of specialist nursing courses offered by three educational providers (a university, major teaching hospital and professional organisation) completed a survey questionnaire to establish the extent to which they agreed with the major recommendations from the Specialist Review. Results showed strong endorsement for most recommendations but with less agreement about issues of minimum credentials and future provisions. Comparison of responses across age, experience, employment and professional education subgroups identified significant differences of opinions on some recommendations. Findings from this study are discussed in relation to the Specialist Review and to implications for the future development of specialist nursing education in Australia.