Nurse managers have a responsibility to facilitate staff learning and development.
In the process of learning, skills and competence complement knowledge and understanding to improve performance and effective practice.
One of the defining characteristics of professional practice is active learning – a continuum of developing knowledge and understanding, and of building skill through solving problems.
It’s not enough to be conversant with practical techniques, current procedures and protocols – to build a confident and competent framework for professional practice, nurses must learn from their own and others’ experiences.
The value of ongoing professional education in the development of high-quality nursing is being increasingly recognised.
Studies show that professional development for nursing practitioners results in improved care delivery.
Organisations that encourage learning provide nurses with opportunities to:
- Review, critique and question their day-to-day practice;
- Learn from highly skilled colleagues;
- Continue professional development;
- Implement new ideas; and
- Take ownership of their professional contributions.
Creating Learning Opportunities
Levi Strauss, one of the most successful businesses in the world, spends four out of every five dollars on ‘knowing’, rather than on ‘doing’.
However, when the United Kingdom Nursing and Midwifery Council introduced a mandatory requirement for nurses to spend five days every three years on professional updating (NMC 1993), there was a concern whether this could be afforded!
Rather than viewing education as a funding problem, it should be valued for its contribution to improving skills and competences.
Theory and practice are inseparable. When nurses practice they use, test and build theory; and, when they study theory, they examine it for its applicability to practice.
In offering learning opportunities, nurse managers play a key role in enhancing the relationship between theory and practice.
In planning and developing services, managers should take into account the training needs of staff.
The most effective development of staff occurs when the training and learning activity meets personal and professional needs as well as the requirements of the organisation (Gould et al. 2003).
There are a number of tools and approaches that can be used to assess training needs – Training Needs Analysis (TNA) – but essentially it is a systematic assessment of the practitioner’s needs in the context of the role he or she is undertaking.
Further Reading: Training Needs Analysis (TNA) The Key to Effective Nursing Education
Gould et al. (2003) undertook a review of TNA techniques in nursing and concluded: ‘As targets become increasingly common…there will be a concomitant need to ensure that staff training is relevant, provides value for money and is sufficiently responsive to meet the rapidly changing needs of the workforce. TNA will be an important tool in helping to identify this need’.
TNA supports ‘role-based education’ – the development of skill and knowledge through education programs applied to the work role.
As such, role-based training is an important tool for a manager to consider in their educational remit.
Learning Sets – How to Learn from One Another
Another learning devise is the use of action-learning sets.
These are formal learning groups in which each participant learns from one another.
The learning agenda is agreed upon by the group and each member is allocated time, which can be used in a variety of ways, depending on the issues and challenges that he or she wishes to contribute.
Learning sets can achieve the following outcomes:
- Make progress towards the solution of a real problem;
- Determine how to approach an ill-defined problem to which no one knows the answer (or even an appropriate course of action); and
- Create an environment in which practitioners learn with, and from, each other in the pursuit of their common tasks.
Learning sets often operate best when immediate colleagues are not in the same group. Establish sets in which colleagues from different settings learn from one another.
Indeed, a core principle is that the manager also participates in learning that challenges and reflects his or her own practice.
Using Skills Escalators – The Skills Inventories
The concept of a ‘skill escalator’ underpins strategies in the UK to develop their health workforce.
The concept is usually linked with notions of lifelong learning whereby staff members are encouraged to participate in renewing and extending their skills.
A policy to establish skills-escalator programs in healthcare services is underpinned by the notion that: ‘…all staff are encouraged through a strategy of lifelong learning to constantly renew and extend their skills and knowledge, enabling them to move up the escalator’ (DoH, UK 2007).
The principle is that clinical practitioners in all disciplines and at all levels are supported with a framework that focuses on the necessary skills to do the job required. This might include ‘customer care’ skills for an admissions nurse or doctor, or computer skills for clinicians working in services with electronic patient records.
Managers are responsible for providing the framework for skills development: commencing with the provision of on-the-job vocational training, progressing to formal professional programs and extending to ongoing professional development.
The notion is that learners can step on or off the skills escalator at any time and receive recognition for the level they have achieved.
A skills inventory is a technique for establishing an agreement (between a manager, a practitioner and an educator) on the skills that are central to the role of the practitioner.
The intention is that all parties then support the development of skills in the practice environment of the practitioner, enabling the skills escalator to be accessed appropriately as part of a longer-term plan.
Formal Programs – What Courses Offer
Formal courses and programs have previously been one of the most common approaches to the development of staff learning.
Formal courses of study offer an opportunity to learn with others – often supported by a significant library and other resources of learning materials – and are often assessed and accredited by educational institutions, such as universities or professional bodies.
It is essential that nurse managers be clear about the outcomes expected from a given course of study, and that measurable results are available to assess the investment made in staff.
A nurse manager must be sure that the program is likely to meet the needs of the organisation and the individual, both professionally and intellectually.
It is useful to identify the results that might be expected from what is often a high-cost investment.
The following table provides a checklist of questions that can be asked in assessing the merits of a proposed course.
|Aims and characteristics of course
||Is this the right course for my staff?
||What new things will staff members learn?
||What new things will staff members be able to do as a result of this course?
|Improve confidence and responsibility
||How will personal behaviour change?
||Where does study take place? Is this education at the point of need?
||What resources and facilities will be available to my staff?
||How long will the course take to complete?
|Level of course
||Does this build on existing skills?
|Credentialing for course
||What qualification or professional recognition will the course give? How will this add to the credentialing of the workforce?
|Skill mix covered by course
||How will the course contribute to the nursing skill mix in our setting?
|Strategic and operational aspects of the course
||Does this course enable the service to meet its goals, care for new patients, and offer better services to patients?
Mentoring and Coaching
Mentoring and coaching relationships are not only useful in achieving work goals but also provide an important support for nurses’ development.
Nurse managers can arrange for a nurse an appropriate mentor or coach and share their thoughts on how to use that mentor or coach.
Part of managing people is to encourage and at times to coach – focusing on how the individual can contribute to the team’s performance.
However, mentoring is more likely to focus on individual needs, and may be separate from the management process. The mentoring process involves coaching, advising, career guidance and counselling.
As an educator, the nurse manager is a role model.
If the manager is committed to his or her own personal development and education, colleagues are more likely to be enthusiastic about education.
Nurses transmit a lot of their knowledge and skill through stories of their own experiences. The manager can, in effect, become a powerful ‘co-author’ in helping staff members shape their practice through learning from one author’s stories.
Making time to share experiences, discussing challenging, issues and explore strategies that have or have not worked is one approach. These discussions can be powerful mediators of culture, role expectations and performance.
On-the-Job Training and Teaching in Clinical Settings
Nurse managers and educators frequently talk about the importance of practice-based learning, but they often fail to exploit the real opportunities it provides.
This is partly because most clinical settings are focused on ‘getting the work done’. The systematic planning of care becomes yet another task – thus losing the value of systematic planning as a vehicle for team learning.
The challenges that must be overcome in developing effective learning in the clinical setting are:
- Using theory to explain practice;
- Allowing space and time for teaching;
- Involving the patient in the teaching session in a meaningful way;
- Taking risks; and
- Enabling nurses to learn from all members of the team (including unqualified staff and those from other disciplines).
Reducing the Clinical-Academic Divide
Though nurses have argued for many years over ways to reduce the perceived divide between theory and practice, there remains an inaccurate perception that education is dislocated from practice.
Part of the problem relates to the routine and rhythm of two worlds that use different languages, have different priorities and even have different functional years.
Unlike other professions, nursing continues to criticise its intellectual status and to relegate its education as being ‘out of touch’ with the real world.
Effective ways in which this divide can be reduced involve working partnerships between healthcare providers and healthcare educators, such as:
- Supporting students in practice-based learning;
- Whole-systems planning for education and practice; and
- Joint appointments and new careers.
Supporting Students in Practice-based Learning
The curriculum leading to professional qualification should respect and reflect contemporary developments in practice.
Students must be fit to practice at the time of qualification and fit for a specific purpose in a specific setting fairly quickly after qualification.
Professional education must therefore reflect contemporary practice, and clinical managers have a part to play in enabling students make connections between theory and practice when they are caring for patients in real settings.
Some managers exploit technology to support learning in the clinical workplace. Initiatives include online discussion with nurses in other centres, rapid access to nursing literature, online learning support at the nursing station and the use of workforce-demand assessment tools in the clinical setting.
Academics and managers need to establish effective partnerships to: identify what is needed from practice learning and establish an inventory of key skills to be acquired.
In this way, the limited experience available is maximised and students are properly prepared to work in real settings with patients and clients.
Whole-systems Activity for Education and Practice
The managerial concept of ‘whole-systems theory’ has recently been applied to the provision of education.
Applying this theory to education involves bringing together all of the stakeholders in education – including patients, nurses, managers, funders, teachers, students and agencies.
All of the processes, connections and people involved in education are then ‘mapped’, including policy drivers, new protocols, individual needs and professional frameworks.
The connections, gaps, nodal points and key players are identified.
Task groups work on key areas of discontinuity and problem areas are readily identified.
Perhaps a most important aspect is the sense of joint ownership of educational development that emerges.
Joint Appointments and New Careers
Joint appointments play a role in uniting theory and practice.
Some joint appointments have been highly successful in this respect; although the challenge of meeting competing demands is sometimes too difficult and the dual role becomes unsustainable.
The developing role of the nurse manager has education and practice as core and embedded sub-roles.
Some of the most effective joint appointments in nurse management occur at a senior level where the nurse manager can influence systems that effect joint working – rather than working at an individual level within the organisation.
In these senior management roles, the nurse leads, directs and establishes a framework for clinical practice. Central to these newer roles is a responsibility to embed education and enquiry within the clinical environment.
Joint working also means that educators need to be part of the practice environment.
Guidelines developed in the UK recommend the establishment of clinical deans to support clinical academic careers by forging new partnerships between service institutions and educational institutions (CDH 1999).
Other mechanisms include the development of ‘clinical sabbatical’ programs, in which academic staff return to practice for significant periods to renew practice skill; and agreements that allow clinical practitioners to contribute to formal on-campus programs in return for full-campus rights.
Such agreements enable practitioners to gain access to mentorship and support for their clinical and educational role in the workplace.
Education is everybody’s business and the nurse manager has an important role to play as an educator, facilitator and developer.
If nurses are to practice effectively, the manager’s role is crucial in building an environment that encourages and promotes learning.
Ensuring that learning becomes part of the ‘day job’ is a management function that can make a measurable and real difference to the patient’s experience of healthcare.
The Richards report (1977) suggests that:
…responsibility within clinical governance places an obligation on service providers…[the] proper management and provision of initial and continuing education will be part of this obligation such that patient safety is assured, standards are maintained and accountability for teaching and learning is identified.
All professionally qualified practitioners need the appropriate academic as well as practice that underpins their roles and have the time and funding for their continuing development.
Nurse managers should have clear expectations of their nursing staff and support the continuing development required to facilitate the practice expected.
The UK Council of Deans (2007) published a position statement that outlines the expectations of education and articulates the skills and understandings that nursing staff need:
- Be evidence aware;
- Be politically aware;
- Be ethically and culturally sensitive;
- Be ambassadors, role models and facilitators/teachers for the next generation of professionals;
- Understand and work inter-professionally – build teams and alliances within and across organisational and professional boundaries;
- Possess skills in facilitating, mentoring and assessing student learning, together with high-level transferable skills; and
- Incorporate the patient/client voice.
The challenge for the nurse manager as educator is creating a vibrant culture that develops, respects and rewards these skills.
As one student wrote ‘…I don’t know how I did it, but I tried things I never thought I could do – you gave me the confidence to have a go. I shall never forget that the fantastic things I have achieved are in part due to you – you believed I could and made it possible. I can’t wait to try these things out in practice.’
This chapter was originally published in Nurse Managers: Guide to Practice 2nd Edition. To obtain a copy of the book, please click here.
CDH, see Council of Deans and Heads of UK University Faculties for Nursing, Midwifery and Health Visiting.
Council of Deans and Heads of UK University Faculties for Nursing, Midwifery and Health Visiting 1999, ‘Developing a Clinical Academic Career for Nurses and Midwives: A Consultation Paper’, July 1999.
DoH, see Department of Health (UK)
Department of Health, UK, ‘Introduction to Skills Escalator’ (accessed 8 Feb 2007), www.dh.gov.uk/en/Policyandguidance/Humanresourceandtraining/Modelcareer/D.
Frost, S. 2008 ‘Nurse Managers as Educators’, in Crowther, A. (ed.) Nurse Managers: A Guide to Practice 2nd Edition, Melbourne: Ausmed Publications, pp 227-40.
Gould, G., Kelly, D., White, I. & Chidgey, J. 2004, ‘Training Needs Analysis: A Literature Review and Reappraisal’, International Journal of Nursing Studies, 41(5), pp 471-86.
NMC, see Nursing and Midwifery Council (UK).
Nursing and Midwifery Council (UK) 1993, ‘The Future of Professional Practice and Education. Final Draft Report’, published as Paper One, CC/93/12, London UKCC
Richards, R. 1997, ‘Clinical Academic Careers: Report of an Independent Task Force Chaired by Sir Rex Richards’, Committee of Vice-Chancellors and Principals of the Universities of the UK, London.
UK Council of Deans Summer 2007, ‘Strategic Position Statement 3: The Role of the Faculty in Nursing, Midwifery and Allied Health Professional Education’, www.councilofdeans.org.uk.