The deans’ list

Heads of nursing schools grapple with big issues all the time; here’s what’s front of mind for three such leaders now.

The reforms of the education minister, Christopher Pyne, have been a hot-button topic over the last few months – thrusting higher education into the spotlight.

Nursing school leaders haven’t been at the forefront of all the media attention but they face many of the same issues as leaders across all areas of study, such as questions of pedagogy, the role of technology, and funding changes.

In addition to these, they also handle concerns specific to the profession; nursing leaders are now having to think about balancing the need to address pending industry shortages with an increasing oversupply of graduates.

Here, three school leaders discuss the state of higher education in their field and where they would like to see it go next.

Professor Karen Francis, head of the School of Nursing, Midwifery and Indigenous Health, Charles Sturt University

We’ve seen a real change, I think, in the level of knowledge that’s required at the undergraduate level, particularly around the critical thinking aspect of practice.

We [are] also focused on developing leadership skills and working in teams, as well as being autonomous in making independent, evidence-based decisions about what is it we as nurses do.

One of the things we’ve tried to do is to ensure that our graduates are able to defend their actions and argue a case, irrespective of whom that case is being argued with – improving the status of nursing decisions through being able to defend actions initiated by nurses. So obviously, evidence-based practice is important.

We’ve also started to see increasing numbers of graduate entry-to-practice programs being offered, leading to initial registration as a nurse, and I think that’s an important move. This change in entry-to-practice options obviously reflects what’s happening in the other health disciplines. What we’re trying to do through that process is advance the practice of initially registered nurses.

Technology’s impact

It’s revolutionising the way we do business. In our organisation, we are in a major state of change, as are most universities. Given the nature of a regional university that is multi-campus, the use of technologies is necessary to ensure efficient and effective operations.

The use of technology to enhance the education experience has expanded exponentially, enabling the adoption of new approaches to teaching and learning. Using innovative technologies, we are able to expose students to a broader range of simulated opportunities that they can then work through to develop the skills [I mentioned earlier], including critical thinking, drawing on evidence to defend their decisions and working in and managing teams.

The budget crunch

Cuts are definitely making life hard, not only for us but also for clinical partners. [Everyone] wants work-ready graduates but the only way they become work ready is to have the opportunity to practice nursing.

Unfortunately, the funding we get to support nursing programs doesn’t cover the actual costs, particularly those associated with workplace learning. We are under constant pressure to deliver our programs within allocated budgets. Rising costs associated with accessing workplace learning venues have forced us, and many other providers of nursing education, to reduce this aspect of the curriculum to the [minimum 800] hours required by ANMAC.

This is a challenge for industry as well as the university and health sectors.

A four-year model

At this point in time I doubt that a three-year degree is still relevant. I think we need to move to four years to align with international standards and the other Australian health disciplines. The fourth year could be an embedded internship year that may include 12 months in practice with additional course work or just an extra year of course work followed by a supported graduate year that I believe [would need to be] standardised. To try and cover the content required to educate a [student] who will register as a generalist nurse in the three-year bachelor degree is becoming increasingly difficult. If you look at all the health programs, nursing and midwifery are the only ones that are three years, [although] Curtin offers a three-and-a-half-year pre-service program.

The longer you’ve got the students in a supported learning environment the more likely they are to graduate with a better skill set.

Professor  Maxine Duke acting pro vice-chancellor,  Faculty of Health, Deakin University

Certainly in our courses there’s a strong emphasis on quality and safety encompassing the national standards. We’ve always had a focus in this area but I think it’s even more important for the RNs we graduate today because of their responsibility as team leaders to ensure patient safety. The RN has a vital role in leading the care delivery team that includes enrolled nurses, assistants in nursing or unqualified personal care attendants – as someone who has overall responsibility for the patient’s safety.

In addition, [we’re] helping RNs understand the scope of practice of those they work with. It is important that each member of the team understands the boundaries of the others’ knowledge and skill, whether it is an enrolled nurse and what they can and can’t do or an assistant in nursing and what they can and can’t do.

Another [important area] is the understanding of clinical governance. It’s the role of the RN in preventing adverse effects through their knowledge of the way systems and context affect care delivery. And if adverse events do occur, then it’s the RN’s role in the root cause analysis and understanding the context of the situation where error occurred.

Popular courses

The critical care suite of courses – intensive care, cardiac emergency, perioperative – are still probably the mainstay of the types of postgraduate courses people want.

I think there’s also an added emphasis now on interventional work – interventional cardiology and radiology. Nurses are being involved much more in interventional procedures in the radiology department. They may have worked [in these areas] for a long time without postgraduate qualifications, but it’s now becoming extremely complex as well as extremely common and many are seeking recognition of their specialisation and accompanying education.

[On the other hand], nurse practitioner roles probably haven’t grown as much as we might have expected.

Clinical leadership and the management of deteriorating patients, whilst not a whole course, is to some degree an important part of all courses.

Upcoming nurse shortages and the role of the university

The number of students that we were encouraged to enrol to meet an expected shortage coincided – or actually collided – with a change in government policy around funding and bed closures.

My understanding is that the shortage is still projected. We have a short-term glut, we will once again have a big shortage. The workforce planning for health has never been optimal, we’re always in a glut or a deficit. I’m really not sure why.

In answer to your question about what can universities do, I think we probably don’t want to reduce our intakes because we are headed for another shortage. The challenge is to keep graduates in the system so their skills and knowledge are not lost to nursing and healthcare.

Professor  Carol Grech head of the School of Nursing and Midwifery, University of South Australia

The University of South Australia has experienced strong demand for postgraduate specialty courses in critical care, cardiovascular nursing and mental health, but somewhat less so in aged care. This may reflect a shift of emphasis through government funding structures and programs such as Live Well, Die Well that are designed to deliver care in homes and community settings, rather than residential or high-care facilities, where many RNs are employed. Therefore, postgraduate courses in aged-care nursing need to reflect more contemporary models of care to be relevant to nurses working with older people.

In South Australia, the government has recently announced funding for 100 nurse practitioner positions and this will provide real opportunity for specialist nurses in health priority areas – including caring for people with dementia, musculoskeletal conditions, diabetes, cardiovascular [illnesses] and cancer – to undertake approved master’s programs leading to endorsement as a nurse practitioner.

The way of the future

All universities are grappling with what the future of higher education may look like pending the Senate passing reforms that have the potential [to make] students and graduates carry forward significant debt as a result of undertaking a degree.

In terms of the way in which we educate nursing and midwifery students, I think there will be significant challenges to meet consumer demands around infrastructure, flexibility of course delivery, value for money and graduate employment. Like the University of South Australia, many universities across Australia are now offering flexible online modes of delivery complemented by residential, on-campus intensives. I believe we will see more sophisticated use of both digital learning applications and simulated learning environments, particularly around the challenges with clinical placement shortage, which I don’t see changing in the medium term at least. What shouldn’t change, however, is the need to educate nurses and midwives [in delivering person-centred care that reflects best evidence and fundamental caring qualities of compassion and kindness.

Employment opportunities

There are not enough transition-to-professional-practice program (TPPP) places for all graduates in South Australia across the public and private system. However, we are finding that many nursing graduates are gaining employment in the health industry outside traditional TPPP pathways.

Universities work on a demand system and the demand for nursing and midwifery undergraduate programs remains high. This is important, as government workforce predictions continue to show there will be a shortage in the next few years. If universities were to cut back entry places on the basis that not all graduates are gaining TPPP places, then the flow-on effect for the delivery of health services in the future could be catastrophic.

In my view, what needs to change is the approach to transition programs, away from current models [and towards] more flexible programs graduates and experienced nurses (if needed), can tap into to support their learning across health settings.

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