In the context of providing high quality patient-centred care, health systems are demanding that frontline staff, including nurses are flexible, skillful workers who maintain a level of currency and competency. As nurses’ scope of practice continues to evolve with increasing accountability and autonomy, a renewed emphasis on continuing education (CE) and workplace learning is needed. However, research suggests that nurses’ work environments generate high responsibility, excessive stress with immense workloads and often limited support or time for reflection (Holland et al., 2012). These straining conditions are leading to higher turnover rates (15% in Australia) (Roche et al., 2014) and with projected shortages of 110,000 nurses by 2025, retention is critical (Twigg and McCullough, 2013). Workplace learning research recommends a culture of learning to enhance staff retention and job satisfaction (Govranos and Newton, 2014). How can a balance be achieved to ensure nurses are adequately supported from a training perspective while continuing to perform in an increasingly busy workplace environment?
A 2013 study conducted at a major teaching hospital in Melbourne provides some context on how nurses perceive CE and what they see as CE in their ward environment.
Nurses yearned for changes to facilitate lifelong learning and cultivate a learning culture. Nurses are particularly motivated by in-service training but this currently consists of face-to-face training, which can be difficult to achieve with nursing populations split across shifts and locations.
Registered nurses prefer their education to take place within their workplace as the learning environment impacts their professional development. Their learning is influenced by clarity around their role, the quality of their supervision and opportunities for education. These, along with organisational and management support for their learning, impact their motivation, empowerment and learning culture.
This points towards a training method that can be utilised in-service but is centred around the nurse – dovetailing with his or her work patterns and locations. Face-to-face training available around the clock in diverse locations is impractical, but high quality online training, which can be accessed at times and locations convenient to the nurse, could be the answer.
Respondents said lifelong learning was important to:
- “Keep up to date with my career”
- “Improving standards”
- “Providing excellent care”
The emphasis that the nurses place on the quality of training (“standards”, “excellence”) is important to acknowledge, and indicates that training must not simply be training for training’s sake – it must be competency based, with an improvement in competency demonstrable through an assessment.
One’s responsibility towards one’s own professional development is similarly important. Vadah, one of the respondents, sees identifying a training need and self-directed learning as important ingredients in taking ownership of one’s learning, “People [should be] responsible for their own learning rather than being spoon fed, and that's a big problem, is there's a lot of people that don't feel they need to be educated”.
Finally, the ward “culture of busyness” limits the time available for nurses to pursue their education. The culture is ingrained in nurses from their student days, so it is a hard cultural element to change. The culture is also understandable from a managerial point-of-view: hospitals are businesses, and accountable to stakeholders and funders. While leaders and educators may want to achieve perfect professional development for their staff, the organisational focus must be on its core business of treating patients. Training must fit into that overall structure – so a training solution which is available at the nursing station, in the break room or beside the patient is ideal.
The training challenge, therefore, is to find a training tool that is available throughout the day and night, in various locations; identifies training needs, allows self-directed, competency based adult learning and fits into a nurse’s working environment.
Elsevier’s Clinical Skills, brings competency assessment and training to the ward and the bedside – rather than taking nurses away for training – and ClinicalKey® for Nursing provides the necessary content to support evidence-based nursing practice and continuing education.