Survey of the rural allied health workforce in New South Wales to inform recruitment and retention
Australian Journal of Rural Health
Keane, S., Smith, T., Lincoln, M., & Fisher, K.
Objective: To investigate the demographics, employment, education and factors affecting recruitment and retention of New South Wales (NSW) rural allied health professionals.
Design: This paper presents the findings from a study that explored whether the information and communication technology (ICT) skills nurses acquireWhilst universities have attempted to integrate information and communication technology into nursing curricula it is not known whether the skills developed for educational purposes are relevant or transferable to clinical contexts. university are relevant and transferable to contemporary practice environments.Descriptive study, cross-sectional survey.
Setting: Regional, rural and remote areas of NSW, Australia.
Participants: The sample includes 1879 respondents from more than 21 different allied health occupations.
Main outcomes measures: Variables included gender, age, marital status, employment sector, hours worked, community size, highest qualification, rural origin and continuing education, as well as others. Certain variables were compared for profession and gender.
Results: Women made up 70% of respondents, with a mean age of 42 years. Men were older, with more experience. Sixty per cent were of rural origin and 74% partnered, most with their partner also working. Eightyfour per cent worked in centres of 10 000 or more people. The public sector accounted for 46% of positions and the private sector 40%. Eleven per cent worked across multiple sectors and 18% were selfemployed. Two-thirds worked 35 hours or more per week, although only 49% were employed full-time. Job satisfaction was high but 56% intended leaving within 10 years, 28% to retire. Over 90% of respondents qualified in Australia and more than 80% held a degree or higher qualification. Almost half were dissatisfied with access to continuing education.
Conclusions: The NSW rural allied health workforce is strongly feminised, mature and experienced. Recruitment should target rural high school students and promote positive aspects of rural practice, such as diversity and autonomy. Retention strategies should include flexible employment options and career development opportunities.
The transferability of information and communication technology skills from university to the workplace: A qualitative descriptive study
Nurse Education Today
Bembridge, E., Levett-Jones, T., & Jeong, S.
Aim: This paper presents the findings from a study that explored whether the information and communication technology (ICT) skills nurses acquired at university are relevant and transferable to contemporary practice environments.
Background: This paper presents the findings from a study that explored whether the information and communication technology (ICT) skills nurses acquireWhilst universities have attempted to integrate information and communication technology into nursing curricula it is not known whether the skills developed for educational purposes are relevant or transferable to clinical contexts. university are relevant and transferable to contemporary practice environments.
Methods: A qualitative descriptive study was used to explore the perspectives of a small group of new graduate nurses working in a regional/semi-metropolitan healthcare facility in New South Wales, Australia. Semi-structured interviews were used and the data thematically analysed.
Findings: The themes that emerged from the study are presented in accordance with the conceptual framework and structured under the three headings of pre-transfer, transition and post-transfer. The transferability of information and communication technology skills from university to the workplace is impacted by a range of educational, individual, organisational and contextual factors.
Conclusion: Access to adequate ICT and the necessary training opportunities influences new graduates' work satisfaction and their future employment decisions. The ability to effectively use information and communication technology was viewed as essential to the provision of quality patient care.
Examining the impact of high and medium fidelity simulation experiences on nursing students’ knowledge acquisition
Nurse Education in Practice
Levett-Jones, T., Lapkin, S., Hoffman, K., Arthur, C., & Roche, J.
Aim: This paper describes a study that measured and compared knowledge acquisition in nursing students exposed to medium or high fidelity human patient simulation manikins.
Background: In Australia and internationally the use of simulated learning environments has escalated. Simulation requires a significant investment of time and money and in a period of economic rationalisation this investment must be justified. Assessment of knowledge acquisition with multiple choice questions is the most common approach used to determine the effectiveness of simulation experiences.
Method: This study was conducted in an Australian school of nursing; 84 third year nursing students participated. A quasi-experimental design was used to evaluate the effect of the level of manikin fidelity on knowledge acquisition. Data were collected at three points in time: prior to the simulation, immediately following and two weeks later.
Results: Differences in mean scores between the control (medium fidelity) and experimental (high fidelity) groups for Tests 1, 2 and 3 were calculated using independent t tests and were not statistically significant. Analysis of covariance (ANCOVA) was conducted to determine whether changes in knowledge scores occurred over time and, while an improvement in scores was observed, it was not statistically significant.
Conclusion: The results of this study raise questions about the value of investing in expensive simulation modalities when the increased costs associated with high fidelity manikins may not be justified by a concomitant increase learning outcomes. This study also suggests that multiple choice questions may not be the most appropriate measure of simulation effectiveness.
The development and psychometric testing of the Satisfaction with Simulation Experience Scale
Nurse Education Today
Levett-Jones, T., McCoy, M., Lapkin, S., Noble, D., Hoffman, K., Roche, J., Arthur, C., & Dempsey, J.
Aim: This paper reports the development and psychometric testing of the Satisfaction with Simulation Experience Scale, an instrument designed to measure and compare differences in satisfaction levels between nursing students exposed to medium and high fidelity human patient simulation manikins.
Background: Student satisfaction is important to engaged and meaningful learning and it facilitates active and purposeful participation in simulation experiences. There are suggestions that student satisfaction may have some correlation with performance. Few studies have explored in a rigorous way the impact of manikin fidelity on nursing students' satisfaction with simulation experiences.
Method: The items for the Satisfaction with Simulation Experience Scale were identified following a critical review of the literature. Content validly was established by use of an expert panel. During 2009 and 2010 the instrument was tested with second year (n=268) and third year nursing students (n=76) from one Australian university. Exploratory factor analysis with varimax rotation was used to determine construct validity and Cronbach's coefficient alpha determined the scale's internal consistency reliability. Differences in satisfaction levels between groups were analysed using an independent t test. Responses to an open ended question were categorised using thematic content analysis.
Results: The scale demonstrated satisfactory internal consistency (alpha 0.77). Exploratory factor analysis yielded a three-component structure termed Debriefing and Reflection, Clinical Reasoning, and Clinical Learning; each subscale demonstrated high internal consistency: 0.94; 0.86; 0.85 respectively. Mean satisfaction scores were high for each group. However, statistically significant differences were not apparent between second or third year students exposed to medium and high fidelity manikins. Content analysis identified 13 main categories including supplementing versus replacing clinical placements and the need for increased exposure to simulation sessions.
Conclusion: The results of this study indicate that simulation is highly valued by students, irrespective of the level of fidelity. This raises questions about the value of investing in expensive simulation modalities. The Satisfaction with Simulation Experience Scale was reliable and valid for this cohort. Further research in different contexts would be valuable in extending upon this work.
Implementing a clinical competency assessment model that promotes critical reflection and ensures nursing graduates' readiness for professional practice
Nurse Education in Practice
Levett-Jones, T., Arthur, C., Gersbach, G., & Roche, J.
Aim: This paper describes the design, implementation and evaluation of the Structured Observation and Assessment of Practice (SOAP), a model used to assess third year undergraduate nursing students’ clinical competence.
Background: Competence is a complex concept that is difficult to define and measure. The assessment of nursing students’ clinical competence has confronted universities with problems of validity, reliability, subjectivity and bias for many years. This presents particular problems in nursing as patient outcomes may be compromised by incompetent practice. Too often assessments of nursing students’ competence comprise brief assessments of psychomotor skills, vague global assessment of generic skills/attributes or assessments undertaken in simulated laboratory settings rather than the real world of practice.
Methods: The Structured Observation and Assessment of Practice (SOAP), is a full day holistic practicedriven clinical competence assessment approach that motivates nursing students’ learning, promotes critical reflection and confirms graduates’ readiness for professional practice. This model was introduced in 2004 and since then 1031 students have been assessed. Quantitative and qualitative data has been collected via an anonymous online evaluation
Results: Survey results have been statistically analysed using The Statistical Package for the Social Sciences (SPSS) (Version 13) with exploratory factor analysis employed to ascertain construct validity. This paper will report on the four components that showed acceptable factor loadings and that together accounted for 77.65 per cent of the variance: perceived learning outcomes, consistency with general clinical performance, quality of assessors, and anxiety/stress impact.
Conclusion: The results of the SOAP approach supports the premise that quality clinical assessment requires nursing students’ exposure to complex challenges undertaken in authentic clinical contexts, observed by registered nurses who are trained as assessors and have a strong educational and clinical background.
The evolution of the nephrology educators' network.
Journal of Renal Care
Sinclair, P., & Levett-Jones, T.
Nephrology nurse educators face many challenges related to professional development and resource sharing. In Australia and New Zealand, as well as other countries where the ‘tyranny of distance’ is a feature, access, equity and lack of educational support due to the geographical isolation of many nephrology units, present particular challenges. This paper reports the findings from a case study of 51 nephrology nurse educators in Australia. Using an exploratory descriptive approach, the study aimed to identify current issues facing nephrology nurse educators and determine the feasibility of developing an online community of practice to support them in their role. An outcome of the study was the establishment of The Nephrology Educators’ Network. This network seeks to enhance peer support, collegiality, critical companionship, collaboration, knowledge sharing and the benchmarking of practices for those involved in nephrology nurse education. In this paper, we describe and reflect on some of the outcomes and challenges faced in developing this network.
Proof of concept: Developing a peer reviewed, evidence-based, interactive e-learning program
Journal of Renal Care
Sinclair, P.M., Schoch, M., Black, K., & Woods, M.
Knowledge and skill acquisition related to vascular access are traditionally individual institutional educational initiatives. Australia currently has no national evidence based education programme for renal nurses. A survey of Australian and New Zealand Nephrology. Educators’ conducted in 2009, identified the need for more effective and consistent delivery of clinical education for nurses using innovative, web-based approaches supporting the tenets of e-learning methodologies. This paper discusses the development, implementation and proposed evaluation of a peer reviewed Australasian e-learning programme on buttonhole cannulation. It will further highlight the benefits of inter-organisational partnerships and how these partnerships can facilitate positive change in teaching and learning practices. This project has unique characteristics that collectively provide value, distinction and innovation to nurses, patients and renal departments. As the e-learning programme was founded on a platform of evidence-based practice it is therefore easily transferable to an international context.
The evaluation of an online orientation to rural mental health practice in Australia
Journal of Psychiatric and Mental Health Nursing
Robinson, T., Hills, D., & Kelly, B.
The aim of this study was to develop and evaluate an online, interprofessional education programme for clinicians commencing work in rural mental health services in New South Wales, Australia. Twenty-eight participants, including nurses, psychologists, social workers and occupational therapists, completed a 24-week education programme (Introduction to Rural Mental Health Practice programme) that orientated clinicians to working in rural settings. The online programme included an orientation to online learning and clinical skills such as risk assessment, therapeutic communication and de-escalation skills applied in rural settings. Twenty-four participants provided pre- and post-evaluation responses that were matched and analysed using paired t-tests to identify any significant differences in mean scores across the domains of interest. Fifty per cent (n= 13) of participants had a background in nursing and 49% were allied health clinicians (psychologists, social workers and occupational therapists). Statistically significant improvements (P < 0.05) were detected in participant confidence in responding to common mental health problems, knowledge about the role of different services in rural mental health care, perceived safety of work and perceived self-efficacy in dealing with challenging or aggressive behaviours. The Introduction to Rural Mental Health Practice programme was successful in orienting clinicians to rural mental health but the small sample size highlights the need to evaluate the programme with a larger cohort of rural clinicians. The attrition at the early stages of the study highlights significant challenges in the retention of rural clinicians in online education programmes. Factors that promoted participation and retention included the provision of study leave and orientation to the online environment
Self-reported competency and continuing education needs of limited licence remote X-ray operators in New South Wales, Australia
Remonte and Rural Health
Smith, T., & Fisher, K.
Introduction: In rural and remote parts of New South Wales (NSW) Australia, GPs and registered nurses who have completed a short course in basic radiography perform X-ray examinations when or where a radiographer is not available. This is a form of âskills transferâ. They are licensed under the NSW Radiation Control Act 1990 to perform a limited range of examination types, providing a valuable service that prevents rural and remote residents from having to travel to access services. The aim of this survey was to gather background information about the NSW remote X-ray operators and investigate their self-perceived need for continuing education.
Method: A questionnaire was mailed to all 131 remote X-ray operators in NSW, with reminder letters sent 6 weeks later. The questionnaire consisted of 30 close-ended and 3 open-ended questions. Among the questions, respondents were asked to rate their self-perceived competency in 12 examinations covered by their licence, and to indicate how well they understood and how challenging they found certain aspects of radiographic practice.
Results: Seventy-four percent of the respondents were nurses, 24% GPs and there were 2 physiotherapists, with an overall response rate of 63%. The majority (80%) performed radiography in towns of 3000 people or less. Together with other remote operator colleagues, 58% said that they performed an average of 2 to 10 examinations per week. Most thought their radiography was âGood but not excellentâ (48%) or âSatisfactory most of the timeâ (41%). For 2 of the examinations (ankle and wrist) more than 90% of the respondents felt competent. For another 6 examinations less than 80% felt competent. Only 23% felt they could perform a chest X-ray on a premature baby. The most challenging aspects for respondents were dealing with paediatric and difficult patients; and the highest level of understanding was in âRadiation protectionâ. Nineteen percent âNeverâ did continuing education in radiography and radiology and 35% âRarelyâ did so. The GPs did more continuing education than others, and 80% felt a need for continuing education in this field. Approximately half (51%) said they had âregularâ contact with a radiographer and 32% âsometimesâ had contact. Seventy percent said this was âExtremelyâ helpful. Approximately one-third (34%) received feedback about their radiography âRegularlyâ, most (44%) from a local radiographer. Preferred methods of continuing education were: face-to-face training; working alongside a radiographer; reviewing or auditing of their radiographs; and distance or online education. The support needed to undertake radiography continuing education was: time off from regular duties, transport and accommodation, and the support of management.
Conclusions: The survey results strongly suggest a need for continuing education in radiography and radiology for NSW remote X-ray operators. The GP respondents appeared to have different needs from the nurses and physiotherapists. Recognising their special circumstances and the isolation under which they work, ongoing educational support, as well as the opportunity to benchmark their practice against more mainstream services, should be embedded in the system. There is an opportunity to develop a best practice model for supporting and re-credentialing limited X-ray licence holders and to create a national benchmark. A well planned strategy may have relevance in other practice settings where skills transfer may be practised now or in the future.