Te Puawai - July 2005

Editorial

Dr Jenny Carryer

An editorial in the recent edition of Kai Tiaki (June, 2005) gives much pause for thought. In the editorial College member Cathy Andrew notes that Nurse Educators in the Tertiary Sector (NETS) last year conducted an informal survey which established that applicants to nursing programmes were declining in quality and number except in both the Auckland region and in University based programmes.

Cathy also noted that attrition rates are increasing, students must work part time while studying, there is a significant rise in the number of international students, especially from China, and the age of applicants is increasing. Overall she signals a decline in the popularity of nursing as a career suggesting there is anecdotal evidence that “nursing has been losing out to career options such as business, marketing, tourism and hospitality, that give entry to the perceived ‘glamorous’ global world of commerce”.

A diminishing supply of nurses balanced against an increasing demand is a worry indeed. A loss of nursing workforce would have very serious implications for patient safety and for community health in general. There is now just so much evidence of the consequences of an inadequate level of registered nurse staffing or a diminished skill mix and of the costly and miserable escalation of adverse events and patient complications.

I suppose the key question is: what can we as a profession, in New Zealand at least, do about this issue? We must never be beyond rigorous critique and investigation of our own standards and practices; everything we do must always be open to scrutiny and honest evaluation. There is a strong drive to make nursing education the best it can be because we need to make a nursing degree, and subsequent career in nursing, an attractive option in order to ensure that there will always be enough high quality registered nurses to meet population needs. Clearly the student population in 2005 is not the same as it was twenty years ago. Social and economic factors have created different pressures and different demands.

Let’s consider for a moment that nursing decides to proactively address the challenge of maintaining high quality nursing education against the many constraining factors which may make it difficult. How will we go about addressing such concerns? How will we challenge the educational institute leaders in the lesser resourced polytechnics who have a vested interest in our programmes? And how will we address the irony of some university power brokers who are still not sure that nursing, unlike all other health professional groups, actually has a place in the University setting?

I would like to propose a checklist for nursing education as a starting platform. My vision is that students of nursing take for granted the following conditions. That they:

• Enter the programme only when it is reasonably sure that they can be successful, personally and academically.
• Are taught by nurse educators who are all actively engaged in at least one aspect of the policy, politics, scholarship, research or practice of nursing.
• Are taught by educators who always teach with the bigger picture in mind and have an attitude of energetic and rigorous scholarship.
• Are taught in an environment of openness, respect, honesty and mutual respect.
• Are never oppressed in such a way that they either leave nursing or continue on to replicate that oppression on future colleagues and students.
• Are taught topics other than nursing (sociology, psychology, biosciences, etc) by experts in that field who have appropriate post graduate qualifications in the relevant area.
• Regularly interact with expert clinicians who role model life long learning.
• Learn that nothing is sacred and everything is up for examination and challenge.
• Are NEVER told that what they witnessed in practice was indeed unacceptable but when they get out there they will have an opportunity to do it better. Sound familiar?
• Have real clinical experiences which go beyond “show and tell” and give them opportunities to test their developing skills and in the presence of registered nurse role models.
• Learn to test their sense of professionalism against a strong socio-political awareness of what it means to be a health professional in this century.
• Understand biculturalism implicitly and use it as a foundation for developing care that is acceptable to all cultural groups.
• Have the opportunity to develop a strong sense of partnership with consumer groups and understand that it is their needs which shape our professional direction.
• Learn to take for granted their own authority on health related topics and their absolute freedom, indeed responsibility, to speak about such things to multiple sources of media.
• Leave the programme with a thirst for education, a commitment to life long learning and a clear sense of their own professional responsibilities and rights.

Such a recipe when further developed and debated might act as a testing ground against which our programmes could be evaluated; perhaps they are the basis for asking ourselves some questions. Are we able to meet all of these goals at the same time in 20 different locations around the country? Can we provide this without staff who are actively engaged in the wider practices of the discipline? How do we best use our limited resources and how do we meet the challenges around ensuring excellent clinical placements and postgraduate practicums for all of our students at all levels? One particularly troubling issue at the moment is the prescribing practicum for Nurse Practitioner trainees who are meeting a number of frustrating obstacles.

I was not personally impressed by the report of the KPMG review of undergraduate nursing education commissioned following a specific recommendation of the Ministerial Taskforce on Nursing. The document seemed somewhat ethereal and abstract and I suppose the lack of any subsequent response or action from it bears testament to its irrelevance. The thought of review might make us uncomfortable and uneasy but declining enrolments, increasing attrition and workforce issues signal a need for thought at least. Review is made doubly difficult when of course there are a great many programmes doing a fine job and for whom review would be an unwelcome burden of time and energy. Whatever our views it seems to me that we need a safe space to debate them and the courage to debate them without acrimony or fear or personal involvement. We need to role model the very rigour and critique which characterises degree based education and is a feature of professional responsibility and accountability.

Some have suggested a national forum of industry, students, consumers and educators to set out a strategic plan for the future needs and models of registered nurse preparation. The ground around us moves very quickly and even postgraduate education needs constant thought to ensure we are giving graduates the best possible opportunities.

In spite of our problems and concerns, New Zealand nursing is possibly at the most wonderful place it has ever been in history. We have lots of exciting, challenging, political, developmental, educational and service fronts to be working on; contrary to many of our overseas colleagues’ situations we have entry to practice at bachelors degree level and we have substantial postgraduate programmes. Increasingly nurses are taking up further study and finding how it changes their views and practice; more and more nurses understand the power of scholarship; nursing service is beginning to get back on its feet after 15 plus years of decimation and many nurses are now appropriately remunerated. In another few years Nurse Practitioners are going to be able to transform primary health care and many other areas and significantly contribute to nursing service leadership.

It would be a shame to be failing to attract students into the profession at the very time when we need them most and have begun to achieve something tangible to offer them in terms of clinical career progression and appropriate remuneration.

Professor Jenny Carryer
RN, PhD, FCNA(NZ),
Executive Director