Learning Circle Discussion

Wednesday September 5 0900-1500hrs Facilitators: Marie Cooke

Observer: Lyn Armit

Notes from discussion following self-introductions

 Staff and new graduate support by Clinical facilitators (CF) is positive.  There are decreasing attrition rates for new graduates.  Growing recognition of the importance of work-life balance.  Students worried about their graduate year – managing family, shift work, new work environment/culture.  Acceptance that staff & students are occasionally vulnerable and not coping in their workplace.  ‘New grad’ label places too much of a focus on their inexperience. Perhaps the term ‘Graduate’ would be more appropriate.  Debriefing at uni should be used as a learning opportunity; could be used as a valuable planning tool for course convenors.  Student debriefing on clinical is helpful however it might be more useful if it was allocated at more appropriate time (before or after lunch) so they could experience the full shift, and not as frequently (perhaps twice a week)  More advice required for CFs to plan/ structure their day.

Notes from scenario (full version attached)

Paragraph 1 Scene: Am shift on a Tuesday morning in an orthopaedic (surgical) ward.

Its 0700hrs and you’ve been allocated a larger than normal patient load – heavy patients – to cover for the staff shortage. Its flu season and during handover you’ve been told that an agency nurse is due to arrive in the next half-an-hour. This is your final shift – number eight. You will have four days off when you finish this afternoon. You’re planning to work on an assignment for your coursework masters program which is due at the end of the week.

Significant workload issues Ward understaffed RN on day 8 –fatigued Heavy patients Agency nurse may require orientation to the ward and then supported during the shift Is this safe practice for the RN, the patient, the student?

1 Student awareness The student is often not aware of these conditions on the ward and the pressures at the RN

The agency’s perspective From the agency’s point of view, an agency nurse is the only solution to staff shortages.

Paragraph 2 Your NUM / team-leader approaches with a male university student from Griffith University. In front of the student she asks “Can you work with this second year student today?” You’d really rather not work with him, but you know the pressure the team is under and you don’t want to make the student feel unwelcome so you agree. As the NUM / team leader is walking away to join the medical round she tells you there is some information about the placement near the receptionists’ desk.

Consultation of Buddy RNs  Buddy RN asked in the presence of student which makes both the Buddy and the student uncomfortable. This asking process can be quite confrontational.

Expectations and evaluations  There always seems to be a gap between the expectations between uni, RN buddy and student. It is therefore important to identify goals in the beginning and re-evaluate then each day with each Buddy RN.

Student perspective re. an unwanted placement environment  Important to re-define goal’s to ‘make the most of it’  Most experiences working with an RN Buddy are useful  Keep an open mind

Dissemination of information  Depending on the agency and their processes, it may be more appropriate to forward practicum information directly to agency staff (rather than via busy educators). The best way to disseminate information is therefore via negotiation between health agency and uni.  Students can add to effective dissemination via ‘cheat sheets’  CL role can also enable this process

Rostering alternatives Clinical planning information could be disseminated in a mote timely and effective way to Buddy RNs’ rosters via coordination by educator and/or CF

Paragraph 3 You’re late getting away for morning-tea. It has been a busy morning in the ward with the medical round and some unexpected admissions. There has not been a lot that the student (Ben) has been able to do. This is Ben’s second clinical prac and his second day. He seems utterly intimidated and disoriented in the ward. He’s nice enough although when you ask him what he can and cannot do he doesn’t seem to understand the question. He looks professional and is trying to be of help but he’s really only been able to follow you and observe. You tell him you’ll allocate some time in the afternoon before handover to talk about some of the patients he observed

2 and maybe go over some care plans together. He seems genuinely grateful for your effort.

Reality vs. the ideal  During busy shifts it is quite a suitable strategy for the buddy RN to ask the student to follow and observe.  The RN Buddy can verbally articulate the 'what and why' of their practice and decision-making process.  This strategy id dependant on the year level of the student – more suitable for a third year student than a first year.  Acknowledges the individual work habits of RN buddies

Student anxiety Anxiety might be perceived as disinterest. Nervousness is natural for student and they’re sensitive to ‘reluctant’ RN Buddies. Important to welcome students

Scope of practice  Students often not aware of scope of practice  Possible solutions: o Lists o Uni reiteration via a pre-brief session o Greater involvement by CF

Paragraph 4 You’re late getting away for morning-tea. It has been a busy morning in the ward with the medical round and some unexpected admissions. There has not been a lot that the student (Ben) has been able to do. This is Ben’s second clinical prac and his second day. He seems utterly intimidated and disoriented in the ward. He’s nice enough although when you ask him what he can and cannot do he doesn’t seem to understand the question. He looks professional and is trying to be of help but he’s really only been able to follow you and observe. You tell him you’ll allocate some time in the afternoon before handover to talk about some of the patients he observed and maybe go over some care plans together. He seems genuinely grateful for your effort.

Debriefing  Debriefing sessions disrupts the day for Ben and his Buddy RN.  Ben looses his opportunity to translate and apply the contexts he witnessed throughout the day.  Hi also missed the handover, which is a great learning opportunity to learn the ‘language’  The Buddy RN looses the acknowledgement from the student that she deserves as well as an opportunity to participate in Ben’s learning.  The opportunity for mutual acknowledgement /evaluation between buddy RN and student has been lost.

Workload issues  CFs have a heavy work load (funding for 1 CF to 8 students)  Educators have a heavy work load.\  Perhaps the logical focus should always be on the relationship between the student and the Buddy RN

3 Post lunch session Reference back to the previously identified suggestions for change (in PowerPoint presentation – attached)

Communication  More detailed information required for stakeholders involved in clinical o Information needs to get to the RN buddy. o Perhaps CF has a greater role in preparing staff prior to the placement, including information re. student’s scope of practice, contacts, possible rostering strategies.  Necessary to have central person for effective dissemination o Some concerns about this point. o Sometimes the information stops at the central person due to workload issues. o If information could be sent to the CF, they could take a greater role in information dissemination. o Different health agencies have different process, so direct contact / negotiation between uni and agency is necessary.  Greater links with ANMC National Competency Standards for RNs in the workplace o Clearer communication of link between ANMC National Competency Standards and the CAT with all stakeholders. o This may lead to increased familiarity with the Competency Standards  Closer networking and liaison

Workload and Practice  Greater notification and preparation for RN staff o Longer timeframe for notification of staff that students are coming  Use of cheat sheets (carried by students?) for RN staff to enable them to quickly understand student’s scope and core skills to be practices o Practice refresher prior to placement: . A pre-brief at uni . Revisit normal assessment values  Re-examination of university placement and health agency rostering models o Online resources such as repository of documents, references, discussion board– web access for all stakeholders.

Preparation and Level of Support  Greater notification and preparation for RN staff o Greater communication /evaluation between Buddy RN and student should be structured and acknowledged o This process doesn’t take time not is it resource intensive  Personalisation of information o Individual reflection and communication skills need to be nurtured  Greater liaison with Clinical Facilitator o Debriefing sessions should be less frequent and scheduled appropriately (such as pre or post lunch) so students can work through into the end of the shift and complete the progress notes and participate in handover.  Formal recognition via career advancement for role in clinical education  Closer reciprocal ties with the university

4 o It’s time to start confronting some of our assumptions about learning, interpretation and sharing or information.

The challenge: Marie’s idea • Looking into students having a journal/communication tool that they use from year one to their final placement. Included in this communication tool would be a cheat sheet (scope of practice, clinical tasks, theoretical objectives and other tasks to be achieved each day to be practiced) • This would be something that would refer that confronts the problems associated with students working with different RN Buddies each shift, the lack of formal feedback, the lack of preparation for RN buddies. • Involvement: course convenors, student representatives and RN Buddies • Meetings, mock-up version pre-trial. • People’s time, printing • Pilot Trial for 2008 clinical with simple evaluation or students and RN Buddies.

Other ideas: • Short video vignette via digital camera. Intro to ward. Send to uni to be posted on course website • Rostering for clinical placement – two to three days to work with the same student. Liaise with NUM, educator. • A simple dot-point guide for RN buddies: “The ten dos of working with a student” • Guide for Clinical facilitators: What, when, where and how of effective clinical supervision, de-briefing • Student to student: Dos for students re clinical prac – email consultation and communication of all the students who have been involved in the LCs. Communication with each other via the course site. Represent student body on other projects.

From little things big things grow!