Finding time for quality clinical education on an acute care cardiothoracic ward
Elizabeth Matters MACN
Ongoing continuous professional development (CPD) activities for clinical nursing staff are widely regarded as an essential component of quality assurance and risk mitigation, and are a mandated part of the annual requirements to maintain professional registration as a registered or enrolled nurse (Nursing and Midwifery Board of Australia, 2010). CPD is acknowledged in the literature as a key tool in ensuring successful clinical outcomes for patients and positive workplace cultural growth for nursing staff and health care organisations on a number of levels.
On a personal level, nurses who engage in CPD activities exhibit increased job satisfaction, efficacy, confidence and accountability as practitioners, and are less likely to experience burnout resulting in a departure from the profession (Pool, Poell & Cate, 2013; McCormack & Slater 2006; Nsemo et al, 2013).
On an organisational level, CPD programs have been shown to establish and maintain high care standards, promote positive behavioural change and assure safety of clinical care (McCormack & Slater, 2006; Katsikitis et al, 2013; Clarke, Kelleher & Fairbrother, 2010). Furthermore, a well administered CPD program can contribute to the successful attraction and retention of high quality nursing staff and can ultimately add to the financial viability of the organisation (Johnson et al, 2011).
Despite these advantages, the challenge of finding time in the acute care clinical setting for educational activities remains difficult to combat. Many nurses work under considerable time, financial and workload pressures, and will not engage in educational activities in addition to their patient responsibilities unless they are provided with ongoing support to do so (Katsikitis et al, 2013).
Therefore, it is essential that CPD opportunities are provided in an organisational environment that is conducive to learning and development, and which offers educational opportunities in a series of diverse formats (McCormack & Slater, 2006; Katsikitis et al, 2013). In addition, the educational offerings must be tailored to the interests of the target audience (Katsikitis et al, 2013).
As a new clinical nurse educator, trying to establish a program which would engage a group of motivated but very busy cardiac nurses, I found that there were few places to turn for practical ideas on how to bring education into an acute care ward where there was very little time to spare. The result was that we developed our program from scratch in a way which made educational activities a relevant and significant part of our daily working lives while still allowing us to deliver high quality patient care.
It is my hope that by sharing our experiences, other nurse educators looking for ideas will be able to bring some new educational initiatives into their own workplace and see the benefits for themselves.
The chief aim of our program was to reinvigorate staff enthusiasm for education and to emphasise that engagement with quality assurance and professional development has a direct effect on the success of the unit and their own job satisfaction. The program was commenced with a focus on the individual learning needs and career aspirations of the staff. In pursuit of a fresh approach to educational engagement, we launched a range of new initiatives.
- Professional Development Planning Sessions. These sessions were held in January with each staff member in order to review their professional development progress and set personal goals for the next 12 months. Where possible, these goals were formulated to tie in with the unit’s quality assurance objectives. Personalised Professional Development Plans were constructed following the sessions and distributed to each nurse so they could chart their own progress throughout the year. Copies of the plans were also given to the Nursing Unit Manager so that they could be integrated into each staff member’s performance appraisal.
- Implementation of a mix of group and private learning sessions. The frequency of group learning (in-service) sessions was increased to five per week (once daily on weekdays during the shift overlap between the morning and afternoon shifts) with the same topics repeated several times so that more staff could attend and benefit from the knowledge. Two educational themes were allocated to each month and the learning sessions were planned to link in with these themes. In addition, the educator worked with each staff member individually to achieve their learning goals in the course of their work by acting opportunistically to provide short informal teaching sessions.
- Increased focus on involving staff in positive role modelling. Senior staff were asked to act as advocates for various elements of clinical care. Representatives of the team attended hospital wide meetings on their area of special interest and reported back to the rest of the department.
- Provision of written resources. An education folder was developed for those staff who worked weekends or night duty. The folder contained handouts pertaining to all the topics covered in the in-service sessions for those who could not attend in order to emphasise that education was accessible to all staff members regardless of shift patterns.
- Creation of a departmental education newsletter. The monthly newsletter contained a description of the educational goals for the following month, the previous month’s audit results and details of upcoming educational study days. It also included a column in which pertinent nursing updates and care standards were articulated. This newsletter was sent to each staff member via email.
- Set up of a permanent education display. The education display, located in the tea room, included the previous month’s audit results with strategies for improvement, the education calendar, copies of the current newsletter, nursing care updates and descriptions of the educational content of each of the upcoming group learning sessions. The display also included the departmental ‘skills bank’ in which nurses who possessed a particular skill or clinical background were acknowledged. The skills bank acted as both a public statement of an individual nurse’s expertise and also as a resource for nurses who were seeking advice or support from their colleagues in a particular area.
- Establishment of a quality roundtable. This monthly forum gave staff the opportunity to bring issues or problems which they were encountering in the provision of clinical care to a democratic discussion in which solutions were developed as a team. Various topics were discussed throughout the year including reports on new findings from conferences and clinical issues which needed attention.
- Promotion of a ‘Skill of the Week’. Each week, a small practical skill (injection technique, IDC insertion etc.) was highlighted for attention in order to ensure that staff remained confident and competent in their full skill set. The skill was chosen to complement the learning themes for the month. The ‘Skill of the Week’ was identified each week on the education board and staff who were unfamiliar with the skill were able to request an individual learning session with the educator during their shift.
- Establishment of reflection sessions. An open forum was held at the conclusion of the year to allow staff to give their feedback on the program and to make suggestions for the following year. These sessions allowed the staff to express personal interests and goals which were taken into consideration when educational planning took place.
- Acknowledgment of achievement. Each staff member received a Certificate and Record of Participation summarising their participation in CPD activities throughout the year, as well as a list of all the competencies which they had achieved.
Like all new ideas, it took a while for the staff to integrate the new educational offerings into their workday routine but, once they did, they came to appreciate the benefits. An average of 90% of the participating staff completed their CPD registration requirements directly through engagement with the program and did not have to use their personal time to fulfil these obligations. Attendance at education sessions rose dramatically and it became popular to attend on a regular basis.
An increase in participation itself had a positive effect on the quality of the education offerings. Thanks to the guarantee of regular ward in-service times and satisfactory attendance, we were able to offer education on a wide range of topics taught by medical, nursing and allied health internal and external guest speakers.
Each year, we delivered education on an average of 64 distinct medical and nursing topics. Each nurse attended, on average, 26 sessions a year. The reputation of the program grew within the hospital with many staff from other departments attending education sessions on the unit.
Our staff showed appreciation for the range of professional development opportunities available to them in the workplace and also took up educational offerings outside the
hospital with the financial support of the organisation. They believed that the morale on the ward had improved and volunteered that they felt positive and supported. In short, they felt that there was a promising and exciting future for them in this facility which would support their career aspirations and professional goals.
While the project proved extremely successful in creating a workplace culture where learning and education was valued by management and bedside staff alike, it involved a lot of effort and personal commitment on the part of the educator. We found that it took time, creativity and tenacity to create the initial buy-in to make such a program successful and, at times, it was easy to feel that the task was too big to be achieved.
I believe in retrospect that, when staff feel that their participation and involvement in professional development is a source of pride and an important aspect of their working life, they will seek out opportunities to involve themselves in learning despite the other demands on their time and energy.
In the future, it is my hope that clinical workplace education can be given more prominence and support across the nursing spectrum and that the clinical educators of Australia can find more opportunities to share their ideas and innovations with each other. There is so much potential just waiting to be explored and developed!
Acknowledgments: With thanks to the staff on Level One and the executives at North Shore Private Hospital for supporting this initiative.
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Katsikitis, M., McAllister, M., Sharman, R., Raith, L., Faithfull-Byrne, A., Priaulx, R., 2013, ‘Continuing professional development in nursing in Australia: current awareness, practice and future directions’, Contemporary Nurse, 45(1): 33-45
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Nsemo, A., John, M., Etift, R., Mgbeka, M. & Ogira, E., 2013, ‘Clinical nurses’ perception of continuing professional education as a tool for quality service in public hospitals
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