Ready to hit the ground running

The ongoing challenge of providing quality clinical placements for students finally has national leadership and vision, write Kim Usher and Jane Mills.

One of the most challenging problems for nursing in Australia is providing the on-the-job training – or clinical practicum – component for pre-registration education.

For the first time in our country’s history, we have national leadership and a vision for the education and training of health professionals that is backed by substantial resources.

Pre-registration nursing education in Australia transferred from hospital-based apprenticeship training to the tertiary sector in the 1980s with the promise of professional recognition resulting in a more knowledgeable and highly skilled nursing workforce. Since this time, however, nursing education has been plagued by challenges largely associated with the clinical practicum component of pre-registration courses.

Concerns about the adequacy of clinical practicum that have been levelled at the higher education sector include inadequate linkage between course content and clinical experience, insufficient hours of clinical experience, the development of a theory/practice gap, the currency of clinical teachers and the competency of new graduates and their inability to “hit the ground running”.

Heads of schools of nursing across Australia have struggled to find solutions to these challenges over the past two decades while managing escalating and often crippling associated costs. In turn, the higher education sector has also levelled criticism at the practice arena, particularly in relation to the increasing costs of clinical practicums, failure to offer a sufficient number of quality clinical placements and concern about the lack of access to specialty clinical areas such as mental health and rural and remote.

As a result, clinical practicums are the cause of much staff and student concern resulting in student dissatisfaction and tension between academics and clinicians. More recently, this issue has led to delays in undergraduates’ course completion, graduation and registration to practice.

Past failures of the practice and higher education sectors to work together to resolve the issue of appropriate and timely clinical practicums has led to a call for improved partnerships between key stakeholders. While the intent of both sectors has undoubtedly always been to establish partnership relationships and arrangements, the current national health reform agenda provides a tangible reason for partnerships to be more than a relationship of convenience and conscience.

The recently launched Health Workforce Australia five-year strategic framework (Health Workforce Australia, 2011) offers real hope for both clinicians and academics who have struggled over time to find ways that will better prepare a workforce for the future. In particular, Domain 2, with its focus on developing health workforce capacity and skills development, provides concrete strategies that are much more than a simplistic solution of increasing higher education providers’ capacity to pay for clinical practicum.

For the first time in our country’s history, we have national leadership and a vision for the education and training of health professionals that is backed by substantial resources. Not only this, the profession of nursing is being paid equal attention and valued as highly in the planning for future sustainability as our colleagues in medicine and allied health.

As the political climate experiences a paradigm shift in the balance between acute and primary care, and traditional hierarchies of healthcare professionals’ influence and power, it is timely for nurses to also rethink the approach they take to planning, establishing and consolidating partnerships.

Optimising clinical practicum opportunities for nursing students will require us to think both vertically within our profession, and horizontally across professions. While the concept of interprofessional healthcare professional education and training has been found to be effective and has support from professional bodies in Australia such as the Royal College of Nursing Australia, the integration of these types of opportunities for learning is not integral to every nursing curriculum.

Sectorial resistance to partnering with the broad range of healthcare professionals in the education and training of undergraduate nursing students will limit the type and quality of clinical practicum available to us now and in the future.

In order to future-proof ourselves in both the clinical and higher education sectors, we need to think beyond our traditional boundaries both within and outside our profession. The challenges around the clinical practicum component of pre-registration nursing courses in Australia are paralleled across the globe.

Clearly the way forward is the development of effective partnerships between the health and education sectors to ensure graduates are well prepared to deliver safe and effective care to consumers. Nursing in Australia is now well placed to develop effective partnerships and should take a stand to lead the way in these developments both nationally and internationally.

Professor Kim Usher is director of research and research training at James Cook University. Dr Jane Mills is deputy head of school at James Cook University.
A fully referenced version of this article is available upon request.

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