Facilitating flexibility in postgraduate nursing education through entrustable professional activities to address nursing shortages and career prospects

AIM

To communicate how the Dutch postgraduate nursing education landscape was redesigned using entrustable professional activities (EPAs). The goal of this initiative was to reduce training time, enhance transfer across nursing specialities and contribute to a better-aligned continuum of initial education, postgraduate education and continuing professional development.

BACKGROUND

Nursing shortages continue to worsen worldwide. An approach to address this growing shortage is to create a more flexible postgraduate training structure, offering training in the just-in-time and just-as-needed models. EPAs can be used as building blocks for training and assessment. Experience with EPAs (i.e. units of professional practice that can be entrusted once a trainee has demonstrated the required competencies) in health professions education, including nursing, is rising rapidly. While EPAs are largely used to create training flexibility within a programme, they can also be used to create flexibility across programmes. In 2018-2022, training hospitals and education institutions in the Netherlands collaborated in the CZO Flex Level Project to redesign the postgraduate nursing education landscape using EPAs.

DISCUSSION

The implementation of a flexible postgraduate nursing education model nationwide will face several challenges. An overview of these challenges and suggestions for future research on the effects of the new structure on nursing competence, satisfaction and career development are provided.

CONCLUSION

EPAs can imbue flexibility within and across training programmes. Designing an EPA-based educational landscape requires nationally coordinated efforts.

IMPLICATIONS FOR NURSING POLICY

Redesigning educational structures to allow for more flexibility is critical to address major societal challenges in healthcare.

Preceptors' considerations when entrusting professional activities to postgraduate nursing students: A qualitative study

BACKGROUND

Nurse-preceptors regularly struggle to evaluate students' readiness to take care of patients unsupervised, even with sophisticated workplace-based assessment tools. Preceptors' gut feelings are not always captured well, but are critical for judgement of readiness for learner entrustment with care tasks. Studies in medical education report features that clinicians consider important when trusting students with clinical responsibilities that might also apply in nursing.

OBJECTIVES

To unravel preceptors' considerations when entrusting professional activities to postgraduate nursing students. The findings may contribute to the improvement of workplace-based assessments and the training of preceptors.

METHODS

Thematic analysis of semi-structured interviews with sixteen nurse-preceptors from three postgraduate nursing specialisations in Dutch hospitals.

RESULTS

Three themes emerged: CONCLUSIONS: For preceptors of postgraduate nursing students, entrustment requires more than merely insight into objectively measurable competencies. Entrusting is accompanied by subjectivity related to what preceptors expected of students. These expectations are in line with suggested factors in the literature-capability, integrity, reliability, agency, and humility-considered before entrusting students with clinical responsibilities identified in medical training. Entrusting is also accompanied by what preceptors realise about their own role in entrustment decisions. Combining different information sources made assessment more transparent and the implicit more explicit.

The viability of interprofessional entrustable professional activities

Interprofessional education (IPE) and entrustable professional activities (EPAs) represent two topics in health professions education that have attracted significant attention in recent years. IPE (when different health professionals learn with, from and about each other with the aim of optimal care) has an inherent focus on the collective. EPAs (units of professional practice that can be fully entrusted to a trainee, once he or she has demonstrated the necessary competence to execute this activity unsupervised) have a focus on the individual. Attempts to relate the two may cause friction and the question is: can they be reconciled? Are interprofessional EPAs or team-EPAs useful concepts and if so what should they look like? The authors argue that most work in modern healthcare involves interprofessional collaboration. Some EPAs have an inherent strong interprofessional nature, such as emergency teamwork, running multidisciplinary team meetings, and surgery. Other EPAs are less inherently dependent on interprofessional collaboration. The authors conclude that neither interprofessional team-EPAs (for which a team can or should be certified), nor IP-EPAs for individuals, as opposed to other EPAs, are viable concepts. However, the authors do not question that certifying health care professionals and entrusting trainees with most clinical tasks will require to ascertain their competence in interprofessional collaboration. This must be included when assessing learners for most EPAs and making entrustment decisions. This can help to strengthen interprofessional competence in the clinical workplace.

Motives and activities for continuing professional development: An exploration of their relationships by integrating literature and interview data

BACKGROUND

To effectively enhance professional development, it is important to understand the motivational factors behind nurses' engagement in particular types of learning activities. Nurses have various motives for professional development and utilise different learning activities. Not much is known about how these relate.

OBJECTIVES

The aim of this study was to explore the relationship between nurses' motives and activities for continuing professional development, by examining in which types of learning activities nurses engage, with which motives, and whether certain motives are associated with certain learning activities.

DESIGN

A qualitative study using semi-structured interviews.

SETTINGS AND PARTICIPANTS

Twenty-one nurses in academic and general Dutch hospitals participated.

METHODS

Interview data on nurses' learning biographies were analysed using a literature-based framework on motives and learning activities for continuing professional development. As recent classifications of nurses' motives for professional development were absent, the literature was reviewed for motives, using three databases. The interview transcripts were analysed for motives, learning activities and their relationships.

RESULTS

Nine motives and four categories of learning activities for continuing professional development were delineated. Increasing competence was the primary motive that stimulated nurses to engage in self-directed learning during work, and in formal learning activities. To comply with requirements, they engaged in mandatory courses. To deepen knowledge, they registered for conferences. To develop their careers, they enrolled in postgraduate education. Five other motives were not mentioned as frequently.

CONCLUSIONS

Specific motives were found to be related to engagement in particular learning activities. Nurses could use these findings to increase their awareness of why and how they develop professionally, and managers and human resource development professionals could develop approaches that would better suit nurses' needs.