Letters to the Editor:

I applaud the manager of the surgical ward in Brisbane who highlighted an immensely important issue in nursing education (NR, July, p.11). It has taken me some time and thought to put this response together because I care passionately about this subject. In the 18 years that I have been involved with nursing student clinical education in various roles in Brisbane, I have just about given up hope that anything would happen to sort this out. To me, it seems like the students are in a similar situation to the child of divorcing parents who cannot stop fighting. (In this case, education and clinical services are the warring parties.)

There is a vast array of issues to discuss here, but for the sake of brevity, I will limit myself to the financial side of things, since money talks. There was a time when there were clinical facilitators who worked for the university to support clinical teaching. There still are positions in some locations but the trouble is, these positions cost money.

Clinical facilitators were hired casually, never really given much support, education or job description, and definitely no career path. Being a clinical facilitator is an easy job to do badly, yet a very difficult job to do well. Long story short, facilitators were easily cut out of the picture due to the ad-hoc nature of their employment. Additionally, they may have looked irrelevant on paper due to their lack of connection to the actual curricula of the various programs. Cost shifting now rears its head. The universities, like the rest of us, have budget targets to meet, some hospitals began to (finally) think that they might need staff in the future and so cost has been shifted to the willing.

Some public hospitals in Queensland charge for clinical facilitation. I know this from personal experience of receiving the accounts to be paid in my current educational role. In my experience, the private sector has been open and flexible when it comes to taking students. Those who do so are to be congratulated for their vision. Nonetheless, all of this is an economic sideshow because payment to the facility or health service still does not guarantee quality clinical teaching. Poor quality control in clinical facilitation offers no guarantee either.

Perhaps, somehow, payments can be linked to the clinicians who are carrying the load of clinical teaching? Maybe clinical facilitation could become a ‘real’ job, with a research profile and career trajectory? I certainly don’t have the answers, but I do know that there must be some sort of professional leadership offering a structure instead of the poorly considered, ad-hoc system we seem to have now. We require solutions to meet individual learning needs - both of the student and their clinical teacher, however titled.

Sue DeVries, Vice-Chair, Queensland Chapter, RCNA and Education Coordinator, Aged Care Queensland Education Institute.

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I am an older nurse working in an acute cardiac setting. I am both hospital and university trained. I am only too willing to pass my years of knowledge on to others if they wish to accept it. I find that in Queensland, students are regularly “dumped” into the hospitals for their practical education and are only allocated areas when they meet with the hospital facilitator. Some of the students are willing to learn and ‘hang on’ every opportunity but many are well versed in theory but have a limited understanding of the practical side of their placement. This is where the hospital nurses come in. We are expected to be teacher, trainer, informer and mentor to the students - some of whom really don’t want to be here. We have no reduction in workload and so I feel both patient care and student education are compromised. This is a situation that I am very unhappy with.

I often go home stressed at the end of a shift because I feel I have not given my best to both patient and student. I feel one solution could be for students to study the component, for example, cardiac surgical in the university for a given time and then come to the hospital for practical education. This would help as the student would be more enlightened and the buddy nurse would feel less pressured. I do look at the student as our future but I feel the communication between universities and hospitals is far from effective. I hope a solution can be reached soon for the benefit of patients, nurses and students.

Pamela Ward, Acute care nurse, QLD

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