Elisabeth Jacob

The evaluation of a successful collaborative education model to expand student clinical placements.

Worldwide, universities have been encouraged to increase the number of students enrolled in nursing courses as a way to bolster the domestic supply of graduates and address workforce shortages. This places pressure on clinical agencies to accommodate greater numbers of students for clinical experience who, in Australia, may often come from different educational institutions. The aim of this study was to develop and evaluate a collaborative model of clinical education that would increase the capacity of a health care agency to accommodate student placements and improve workplace readiness. The project was undertaken in a medium sized regional hospital in rural Australia where most nurses worked part time. Through an iterative process, a new supported preceptorship model was developed by academics from three institutions and staff from the hospital. Focus group discussions and interviews were conducted with key stakeholders and clinical placement data analysed for the years 2004 (baseline) to 2007. The model was associated with a 58% increase in the number of students and a 45% increase in the number of student placement weeks over the four year period. Students reported positively on their experience and key stakeholders believed that the new model would better prepare students for the realities of nursing work.

The changing skill mix in nursing: considerations for and against different levels of nurse.

AIM To investigate the current literature to gain an understanding of skill mix, why it is being manipulated and how it affects patient care and health-care costs. BACKGROUND Due to workforce shortages, economic constraints and increasing patient acuity, employers are looking at methods of providing patient care whilst maintaining costs. Registered nurses make up a large percentage of the health-care budget. The manipulation of skill mix (i.e. the percentage of registered nurses available for patient care) is seen as one method of managing the increasing cost whilst still ensuring patient care. EVALUATION Research literature was used to determine the current use of skill mix and its impact on patient care and health-care costs. KEY ISSUE The use of a higher proportion of registered nurses is associated with better health outcomes, shorter length of stay and reduced patient morbidity. CONCLUSION Economic savings from substituting registered nurses with other health professionals may be offset by increased patient length of stay in hospital and increased patient mortality. IMPLICATIONS FOR NURSING MANAGEMENT When evaluating nursing skill mix, a higher percentage of registered nurses may result in health-care facility cost savings by providing a shorter length of stay and decreased patient complications.

Scope of practice for Australian enrolled nurses: Evolution and practice issues

Abstract Significant changes to the scope of practice for enrolled nurses have occurred in Australia over the past decade. These changes, which are largely a consequence of staff shortages and economic pressure, have resulted in increased role confusion and overlap between enrolled and registered nurses in Australia. This paper presents a brief history of the enrolled nurse in Australia followed by an overview of the current situation and emerging trends in the education and employment of these nurses. Definitions and approaches to scope of practice are described and emerging issues within Australia raised and discussed. A review of the literature found the number of enrolled nurses and the roles they perform have changed significantly in Australia following the introduction of the enhanced scope of practice. Further research is required to better define and delineate between the different nursing roles and to explore broader frameworks to analyze, describe and define these roles.

Expanding the clinical placement capacity of rural hospitals in Australia: Displacing Peta to place Paul?

In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines. Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE). Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas.

Similarities and differences in educational preparation of registered and enrolled nurses in Australia: An examination of curricula content

Abstract Background: Variations exist internationally in the types and numbers of nurses registered to practice. Whilst the United Kingdom has phased out second level nurses, countries such as Australia, New Zealand, Singapore and the United States have maintained a two level system. In Australia, the two levels of nurse authorised to practice are the registered nurse whom complete an undergraduate nursing degree, and enrolled nurse (EN) whom complete either a certificate or diploma programme. Recent changes to educational preparation and resulting scope of practice for ENs have resulted in increased confusion between roles and expectations of the different levels. Aim: This paper reports on findings of a study aimed at identifying differences in educational preparation of the different levels of nurse in Australia. Method: Course coordinators from nine organisations offering pre-registration nursing programmes completed self-reporting questionnaires designed to obtain information on types and lengths of courses, and details of curricula including course objectives, teaching and assessment methods and content areas. Results: Comparative analysis of survey responses identified similarities and differences between registered and EN programmes. Common areas included teaching and assessment methods, core theoretical units and general nursing skills. The diploma and degree programmes appear aligned in most theory and clinical skills. The main difference identified existed between skills taught in the two EN programmes. Conclusions: Findings further add to confusion regarding registered and ENs in Australia. Further research is required to determine expectations of employers and other major stakeholders with regard to the differences.

Comparisons of the educational preparation of registered and enrolled nurses in Australia: the educators' perspectives

Similar to the U.S.A., New Zealand and Singapore, Australia registers two levels of nurse, the degree or postgraduate entry prepared registered nurse and diploma or certificate-prepared enrolled nurse. Over the past decade, significant changes have occurred in educational preparation of enrolled nurses. This has resulted in enrolled nurses undertaking many roles and responsibilities previously undertaken only by registered nurses. An exploratory qualitative research study using interviews with educators of both registered and enrolled nurses was undertaken to investigate differences in educational preparation of registered and enrolled nurses in Australia. This paper describes perceptions around how participants viewed educational approaches and different cohorts, types and levels of students. Similarities included topics covered and the majority skills taught, although high acuity skills remain a difference between the levels of nurse. Differences were also found in type of student, educational background and teaching methods.

Educators' expectations of roles, employability and career pathways of registered and enrolled nurses in Australia

In Australia, like other countries, two levels of nurse are registered for entry to practice. Educational changes for second level nurses in Australia have led to questions regarding roles and career options. This paper reports on interviews with nursing course coordinators to examine educator expectations of roles and career pathways of registered and enrolled nurses. Coordinators of eight degree (registered) and diploma (enrolled) nursing programs were interviewed to determine their opinions on roles and careers that students were prepared for. Transcripts were thematically analysed. Educators reported similar graduate roles, although high acuity care was primarily the role of registered nurses. Career expectations differed with enrolled nurses having limited advancement opportunity, and registered nurses greater career options. Health organisations were unprepared to accommodate increased practice scope of enrolled nurses and limited work practice through policies stipulating who could perform procedures. Organisational health policies need to accommodate increased enrolled nurse skill base. Education of practising nurses is necessary regarding increased scope of enrolled nurse practice to ensure they are used to their full potential. Increasing patient acuity requires more registered nurses, as enrolled nurses are unprepared to care for complex or deteriorating patients.

Senior nurse role expectations of graduate registered and enrolled nurses in Australia: content analysis of open-ended survey questions

Abstract Changes to educational preparation and scope of practice for enrolled nurses (ENs) in Australia have impacted on role expectations. This paper reports results of a survey of senior nurses in Victoria, Australia, regarding opinions of the differences in role expectation and scope of practice for graduate registered and ENs. Content analysis of open-ended survey questions was used to identify themes in the written data. Results identified education, skill level and responsibility as differences between the levels of graduate nurses despite many respondents perceiving there to be no or little difference in graduate roles.

Senior nurse role expectations of graduate registered and enrolled nurses on commencement to practice

OBJECTIVE This paper reports on a project to examine the expectations of senior nurses regarding graduate roles of registered and enrolled nurses educated in Victoria, Australia. METHODS Participants completed an online survey to indicate whether predetermined competencies were in the roles of graduate enrolled or registered nurses or not in the role of either nurse. Chi-squared analysis was used to identify differences between participant groups. RESULTS Participants expressed variations in role expectations for the different level of graduate nurse. Although basic nursing care was undertaken by both graduate enrolled and registered nurses, no specific role was identified for enrolled nurses. Differences were found in the opinions of senior nurses over the roles of graduate nurses, demonstrating considerable variation in expectations. Management, education and research roles were not identified as the role of either nurse on graduation. Differences were found in the expectations of the different senior nurse groups regarding the roles of the enrolled nurse, particularly in the new skills taught in the enrolled nurse diploma program. CONCLUSIONS Confusion exists regarding the roles of both types of nurse on graduation. Further research across Australia is required to clarify the roles of the different level of nurse in different practice contexts.

The role of the family in supporting the self-management of chronic conditions: A qualitative systematic review

AIMS AND OBJECTIVES To explore the contribution of family members in promoting and supporting the self-management of chronic conditions amongst adult family members. BACKGROUND The prevalence of chronic disease continues to grow globally. The role of the family in chronic condition management and support for self-management has received little attention. DESIGN A systematic review of qualitative literature using the Joanna Briggs Institute approach for qualitative systematic reviews. METHODS Ovid (MEDLINE, CINAHL and PsycINFO) were searched for the period of database inception-2016. The QARI (Qualitative Assessment and Review Instrument) critical appraisal instrument was used to assess the quality of each study. Using the Joanna Briggs Institute-QARI data extraction tool, findings related to the family role in the self-management of chronic conditions were extracted and each finding rated according to Joanna Briggs Institute-QARI levels of credibility. Findings were categorised and synthesised to produce a final set of aggregated findings. RESULTS Families were key in constructing an environment that was conducive to family engagement and support. Adaptation within the family included maintaining cohesion between family members, normalisation and contextualisation of the chronic condition. CONCLUSIONS Whilst evidence on the value of the family in promoting positive health outcomes is clear, research on how families can specifically support the self-management of chronic conditions is emerging. RELEVANCE TO CLINICAL PRACTICE Family adaptability has been found to be the most powerful predictor of carer depression. Families may need support to change their home and family organisation to adapt to the challenges they face overtime. Change in roles and subsequent adaptation can be stressful, even for those family members at a distance. Nurses working in hospital and community settings can play an important role in assessing how families are adapting to living with chronic illness and to explore strategies to cope with challenges in the home setting.