Preparing for going out on Clinical Placement or Practicum (Prac) takes personal courage… every Registered Nurse has been there… Personally, I think I loved all my pracs. I was able to choose a major theme for mine… no surprises… I chose mental health. Acute care and community… and loved every second. I am still in contact (and even have enduring treasured personal friendships) with some of my student-days lecturers and clinical facilitators/ mentors… some very special nurses! I remember I felt challenged with each new practicum…
IN real life…. a story for my student practicum days: I recall one experience on prac on an orthopaedic ward, where we had admitted a patient as ‘overflow’ from another ward… he had no orthopaedic problems… but he did have a tracheotomy tube in place (a consequence of smoking that he was quick to point out and recommend that smoking was a bad health choice to others)… he was a lovely fellow, and I was asked to look after him (under the supervision of a Registered Nurse). He was to be my patient load for the day… and I was determined that he would get the best nursing care known to humankind!
There was one problem though… there were no emergency dilators on the ward, should his tracheotomy tube dislodge. I was quick to note that these should be at the bedside in case of an emergency… staff around me were not too concerned about the missing equipment, after all, they wouldn’t have sent a high risk patient to the ortho ward! And… the Clinical Nurse Specialist was booked to do a round to see him each day… it should be fine!
I wasn’t satisfied with the responses I had from my ward nursing team… so I decided to discuss it further with my Clinical Facilitator when she came around to check on me later in the morning…. See, we had practised the care of a patient with tracheotomy in the simulation labs back at university the week before – something just wasn’t right. My Clinical Facilitator and I went and checked the hospital policies and procedures together… it was a book in those days, (but you would check the intranet now)! We discovered the policy concurred with my hunch that dilators should be present at the bedside at all times… so with my Clinical Facilitator, we tracked down a pair of the dilators required at the Central Sterilising department… and took them back to tape to the the bed unit wall… I reported in the handover that the safety equipment was now located at the bed unit (the Nursing Unit Manager thanked me for my diligence) I went home from that shift feeling very happy that even if they were not ever required (and it was not clinically likely in this case), I had made sure that my patient was safe!
The next morning… off my patient went for his shower… and while he was in the shower I made up his bed beautifully, refreshed his water jug, and tided-up his bed unit. I checked that the oxygen tubing was intact and the suction was working…. and the dilators were still safely taped to the wall. I was very eager to be a fine nurse… All was sparkling clean, fresh and ready for his return. As he sat on the edge of his bed… he coughed – and enormous cough…. his tracheotomy tube dislodged… fell out completely…. I could not believe my eyes… we were located in an alcove at the end of the ward… I buzzed three times for others to come and take over … (my plan in the event of an emergency was to assume a notetaker role… and being so eager to learn all I could… I would take very good notes!). Nurses came from everywhere… arriving in the room and know one knew what to do… so, I found myself applying the dilators to the patients tracheotomy to maintain his airway, while a code was called. The Junior Medical Officer appeared… and had never inserted a tracheotomy tube before…. so there I was, after practising the procedure over and over again in the simulation lab at university… guiding a bunch of senior health professionals in the procedure! My flashbulb memory persists years later… The NUM wrote a lovely commendation, and offered me a graduate position for the following year (you could do that then!). (I didn’t take her up on that offer… as it turned out… the cardiac intensive care unit offered me a spot and I took that instead). But, that was my first lesson in speaking up respectfully, being brave, being prepared and being safe.… with real life and death consequences in the balance. So… some tips from my prac to yours…
- Be brave! Yes, you will see and do things you never imagined – even on student prac! Each day will make you stronger.
- Be prepared… be ready to try new things… have a go (under appropriate supervision).
- Say yes! And, respect no!
- Mind your manners! Be quick to introduce yourself, don’t stand back and wait for introductions. Hello – my name is… I am from… I am here to help you with… Thank your patients and nursing teachers for guiding you and supporting you as you learn.
- Talk it thorough… what you’re doing, why you’re doing, how you’re doing, where you have been, and where you’re going, and … who you are doing with, and to… talk about your feelings, your thoughts and your actions as they relate to your developing practice with a trusted and confidential nursing mentor.
- Be kind to your student peers, mentors, teachers and of course – patients and their families.
- Be safe… do safety checks where and when ever you can – check the safety of equipment, processes, bed unit and environment. Every time you do a safety check you reinforce your learning and you train yourself to deliver quality care while keeping your patients and colleagues safe.
- Read all the policies and procedures you can… knowing the organizational structure helps you to navigate your way through the health care maze… and helps you to guide others towards the assistance they need too.
- Ask questions… don’t be put off by the unofficial-student-code-of-conduct that says ‘don’t ask questions so we can get out of here quicker’! Rather engage, immerse, ask, read, and listen.
- Turn-up, show-up, put-in… make yourself useful. Be ready to play an active role in the health care team, be prepared to help-out and chip-in. Onlookers need not apply.
To prepare for you own nursing practicum… you can learn more if you read Chapter One (by me and some of my past nursing students) The Australian healthcare context, Clinical Nursing Skills: An Australian Perspective. Cambridge University Press, Pages 11-19… here’s the link:
Or – ask your nursing school library for a copy.
If this has been useful to you – remember to share it with others too!
Looking back – what advice would you give your first year self… hear are some of the things I would have liked to have known more about!
Practice-informed nursing: The future of transformative nursing education and research in a technological context
Three significant factors will impact on the future of nursing education and research in Australia
- Entrenchment of a culture of patient safety among practice-ready graduates while offering transformative educational experiences to nursing students and building resilient communities. Rural and regional communities, Indigenous people, and international inclusiveness and connectivity will be particularly important.
- Entrepreneurial nursing academics will be pivotal in developing innovative ways to fund practice and research projects; deliver quality-learning programs; and produce a strategic mix of research outputs. This is critical because of cuts to funding across the higher education sector and increasing competition for research grants.
- Capitalising on E Health – using the term broadly to cover not only storing, retrieving, maintaining and sharing patient records safely and effectively, but also electronic health service delivery assisted by communications technologies, such as web-conferencing, internet-based interventions, and the use of apps and social media. And there’s also E Health in academia – the way that the technologies are revolutionising the teaching, learning and research environment for nursing. Nursing academics’ expertise in E Health technologies will undoubtedly need to expand in the future.
transformative practice informed patient safety
The health industry expects universities to produce nursing graduates who are practice-ready and proficient in delivering quality health care where patients are safe, health risk is reduced, and deterioration is detected and responded to quickly. The graduates must be prepared for the high acuity of workplaces in the health sector, and must possess the indispensable attribute of resilience. Industry also expects graduates to be skilled in collaborative teamwork and capable of leadership and supervision early in their careers (Australian Commission on Safety and Quality in Health Care, 2010; Australian Institute of Health and Welfare, 2014; NSW Health, 2013).
A new era in the nursing discipline is dawning where transformative models of service and care are prioritised. The transformative process surpasses the traditions of ‘evidence-based practice’ and ‘life-long learning’, which frequently uses ‘time-spent’ as a metric to determine learning outcome.
Instead, future nursing needs contemporary continuous transformative learning, and practice-informed research using continuous models that are more flexible and nimble, in order to enhance capacity to adapt to rapid changes. Preparing students to be practice-ready has become increasingly challenging within the traditional three-year degree program, where specialty themes compete for inclusion. There is a need for innovative and entrepreneurial practice-informed teaching and learning to invigorate future curriculums, in conjunction with a balanced approach to practice-informed research agendas.
Postgraduate courseware will need to align with, and adapt to, market forces. In Australia, this includes addressing the changes announced by government to create Primary Health Networks and Health Care Homes, and ensuring the supply of qualified nurses to fill posts in these national centres (for example, Credentialed Mental Health Nurses). Advocating for appropriate reimbursement of specialist nurses will be a critical driver of postgraduate education (Australian College of Mental Health Nurses, 2013).
nurse entrepreneurialism in higher education
Funding for the higher education sector has been dwindling in recent years leading to major budgetary challenges, particularly for regional universities. Popular, high-enrolment courses like Bachelor of Nursing will continue to be important and strategic contributors to the overall university budgets.
International university ranking analysts suggest that “strongly motivated academics can offset to some degree limited funding” (Williams, Leahy, de Rassenfosse, & Jensen, 2016). Actively seeking collaborations will be vital to ensuring research funding success at the highest level, and so will serious attention to grantsmanship.
Nursing curriculum, with its expensive practicums, will undergo closer fiscal scrutiny in the future. So will other teaching related expenditure, with imperatives to maintain industry accreditation, to provide quality educational experiences for students, to have genuine consumer participation in curriculum design, and to incorporate digital and simulated pedagogies while managing cost effectiveness.
A particular challenge for nursing is to improve the impact of nursing research generally. Co-investigative nurse membership of collaborative interdisciplinary research teams has been important. A newer challenge is to move towards a position of excellence in nurse-led health research. New opportunity exists to do this, with the Australian Research Council looking to widen the definition of measurable impact to include category 2 and 3 grants, and with impact metrics increasingly linked to Google open access outputs, and international linkages including co-authorship (Williams et al., 2016).
Nurse researchers will need to be grant-ready and this includes building track record in grant success, and generating publications from their research. Concurrently, nursing scholars will need to develop industry and research linkages (including international higher degree research student intakes), together with the technological skills to generate outputs in digital domains.
safe and effective e health innovations
State and Federal governments are turning their service delivery focus and funding streams toward E Health services to meet growing expectations across the Australian consumer population (Australian Bureau of Statistics, 2013; Australian Commission on Safety and Quality in Health Care, 2015). For example: digital gateways for triaging and accessing health care service provision (Department of Health, 2015), managing patient health records, and delivering, monitoring and evaluating health interventions (Christenson & Petrie, 2013; Department of Health, 2016; Department of Health, 2015; E Mental health strategy for Australia, 2012; Keast, 2016).
E Health skills will need to be recognised as a core competence in future nursing curriculums (Australian Commission on Safety and Quality in Health Care, 2015). The rise of E Health presents opportunities for nursing with improved digital pedagogy learning design systems to produce nursing graduates who are practice-ready for the new and evolving practice domain of safe E Health. This has particular relevance for including and servicing rural and regional communities.
The nursing academy in Australia is trending against the odds. Nationally, enrolments are high, outputs and impact are strengthening despite dwindling higher education budgets for the discipline. Nursing academics will continue to drive the Australian nursing discipline into the future as they transform their focus towards practice-informed teaching and learning, practice-informed research integrated with international connectivity, and stronger collaborative relationships with the health sector and wider society.
- Australian Bureau of Statistics. (2013). Internet Activity, Australia, December 2012. (8153.0). Canberra: Australian Bureau of Statistics. Retrieved from http://www.abs.gov.au/
- Australian College of Mental Health Nurses. (2013). A Survey of Credentialed Mental Health Nurses working in the Mental Health Nursing Incentive Program.
- Australian Commission on Safety and Quality in Health Care. (2015). Australian Commission on Safety and Quality in Health Care Annual Report 2014/15. Retrieved from http://www.safetyandquality.gov.au/
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- Best, O. (2015). The cultural safety journey: An Australian nursing context. In O. Best & B. Fredericks (Eds.), Yardjuligin: Aboriginal and Torres Strait Islander Nursing and Midwifery Care (pp. 51-73). Port Melbourne: Cambridge University Press.
- Christenson, H., & Petrie, K. (2013). Information technology as the key to accelerating advances in mental health care. Australian and New Zealand Journal of Psychiatry, 47(2), 114-116.
- Department of Health. (2015). Australian Government Response to Contributing Lives, Thriving Communities – Review of Mental Health Programmes and Services. Canberra: Australian Government Retrieved from http://www.health.gov.au/
- Department of Health. (2016). Health Budget 2016–17. Retrieved from http://www.health.gov.au/
- Department of Health. (2015). e-Health. Retrieved from http://www.ehealth.gov.au/
- E-mental health strategy for Australia. (2012). Canberra: Commonwealth of Australia Retrieved from http://www.health.gov.au/
- Godbold, N., & McCaffery, K. (2015). Improving care by listening: care communication and shared decsion-making Communicating quality and safety in health care (pp. 164-175). Port Melbourne: Cambridge University Press.
- Keast, K. (2016). How technology will advance nursing practice. Retrieved from http://healthtimes.com.au/
- Little, F., O’Brien, A., Gray, M., Wilson R. L., & Finn, A. (2015). Scoping novel rural mental health clinical placements for undergraduate nursing and social work students in Northern NSW. Final Report: 20th November 2015. Retrieved from Hunter & Central Coast Interdisciplinary Clinical Training Network:
- NSW Health. (2013). Policy Directive: Recognition and Management of Patients who are Clinically Deteriorating. (PD2013_049). Sydney: NSW Ministry of Health.
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- Williams, R., Leahy, A., de Rassenfosse, G., & Jensen, P. (2016). U21 Ranking of National Higher Education Systems 2016. Retrieved from http://www.universitas21.com/
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