RN and NSWNA member Jennifer Tuckwell, has written the following article ‘The Future of the RN’ we will be bringing you Jennifer’s three part series over the next week and a half so keep checking Nurse Uncut to read the full article.
Your thoughts and feedback are welcome in the comments section below.
The Future of the RN – part 1
As a registered nurse of many years who has witnessed what I could only describe as ‘the erosion of the nursing role’, I have a need to question the path that the current education of nurses is taking us.
From what I am witnessing, and on examination of the current education on offer, I ask ‘why’ and does it meet, evidence based best- practice? I think not.
The inadequate clinical preparation and the underlying educational directive of specialisation for the undergraduate, is one of the reasons for the inability to retain our graduates. This in turn has led to an erosion of the nursing role itself with the resultant emergence of ‘skill mix’.
The University education in its current format is not giving us a nurse who is staying in the profession – the Garling Report emphatically declares that.
This fact came to light as far back as the Battersby Report of 1990, where the factors identifying the nurses most likely to leave the profession, included the University educated nurse.
When you think that this was a mere six years after the introduction of this style of learning, one would have thought that alarm bells would have rung and a closer monitoring of this education would have ensued – apparently not.
We now have a nursing shortage approaching crisis point. We have less registered nurses now than we had in 1986.
We have an ageing workforce with 22% of our registered nurses eligible for retirement this year alone and it does not take too much imagination to see a further 22% disappearing in 2012.
The Garling Report states that by 2012 one quarter of the entire nursing workforce will have to be replaced!
In a mere 25 years we now have “skill mix” in the acute hospital setting – unheard of 25 years ago. This skill mix encompasses approximately 40% of the entire nursing workforce in the hospital – this nurse has one year or less education!
Reality is, we are not retaining our graduates.
Nursing needs to be a vibrant exciting profession, that is always “up to date” and semi-autonomous.
To accomplish change, nurses themselves need to take control of what is best for them – another recommendation from the Garling Report but known to nursing research for decades.
I would like to put forward an alternative education.
The basis of the education I am mooting, has its root in the “old” whilst mixing it with the “new” and this has been achieved most successfully by the Ambulance Service of NSW. I am advocating that we pursue this same format of education.
I would also like to see the registered nurse re-classified as Paramedic Registered Nurse and Assistant Paramedic Nurse. This re-classification for the sole purpose of instilling in the nurse just how important our role is.
We are clinicians, or we should be, and we are the very backbone and the alarm system of the health care industry. For that we need a diverse and broad based relevant clinical preparation that can be continually updated.
To become an Ambulance Officer in training to be a Paramedic (3yrs) one must first pass an interview and then a six hour examination that takes in your ability to read and write effectively, comprehend and express yourself adequately in English, pass a maths examination and an assessment of your suitability to perform your role, as well as an IQ test.
So simple, a system that has identified your ability and suitability to perform your role from day one and before you are even contemplated for a position.
The ABS in 1968, and no statistics can I find since, showed that of over 22000 nurses who started their education in NSW and the ACT, only 46% completed it.
I think not suitable played an enormous part in those statistics.
That one may enter University today, with a known, less than satisfactory English competency, undertake a full three years education at University, and then sit the remainder of the English competency test defies belief.
Your commitment to being an ambulance officer does not stop here.
For the first year of your education you will be stationed close to the vicinity of your abode, after that, you may be placed anywhere in NSW where an ambulance officer in training is deemed necessary.
Once you have been accepted you will spend the first eight weeks in the classroom setting in preparation for your placement with a Paramedic. The Paramedic is assessing you for you alertness, assessment ability, competence for the expected level of education, and communication skills. This assessment is on-going for the full three years of your education.
During this time you will be studying from prepared manuals and online courses.
You will spend, in first year, the eight weeks in class, then ten months hands-on. There are exams at regular intervals with a pass mark mandatory. A failure results in one ‘post exam’ and a second failure in a dismissal from the service.
This form of education, aside from the on-line courses, is identical to the hospital educated nurse. Pass or be dismissed – a level of knowledge and competency expected for your level of education.
The second and third year of this education incorporates another three weeks in class and then eighteen months practical with the continued supervision and assessments and exams and on-line learning.
So simple, so effective – learning “on the job”- with the added bonus of gauging if this is really the role for you.
If we cannot replicate this form of education, refine it specifically for nursing and bring nursing into line with what is needed in the 21st century, we would not be trying.
What I envisage by this, is that whilst you are gaining your knowledge base and nursing skills in hands on nursing, and getting used to shift work, – you are also studying the prepared DVD’s on respiratory disease, cardiac disease etc, with actual patients displaying the symptoms and the medications that are currently on offer for these conditions, and the nursing interventions that make this patients life comfortable and prevent complications.
This RN would be capable of reading blood results, ordering and taking blood and cannulating and initiating an IVI if necessary, the ability to read an ECG and know what drugs are applicable or may be interfering with the treatment of any abnormality seen. Ordering tests if necessary, having the ability to perform a basic physical examination, be proficient in hearing air entry to the lungs and diagnosing and reporting when there is an abnormality.
We would have compulsory annual updates of cardiac, respiratory, diabetes with the ability to upgrade your knowledge in an area of your choice, i.e. palliative, gerontology.
All of this education would be available online.
I also would advocate that along with the compulsory CPR we are taught how to intubate if necessary, and have the same drug administering rights as the Ambulance Paramedic.
These skills and knowledge base are truly not difficult. They can’t be or you wouldn’t have The College of Nursing offering a three day course for such skills as “clinical assessment”.
Australia, with a little imagination, could actually lead the world in changing the face of nursing.
What do you think of the current university-based education system? Do you feel this alternative education system may work? Tell us below!