Leadership in clinical education — Embedding learning in everyday practice
Article Outline
Workplace learning integrates theory with its application to the workplace. It is essential to foster safe beginning level practice and continuous career development for nurses. Learning in “real” practice situations is invaluable for nurses prior to registration, upon graduation, and furthermore in their development of specialist skills. These learning experiences in the clinical context provide students and staff the opportunity to apply working knowledge that makes sense of theory. Such experiences contribute to nurses' practices becoming meaningful therefore such knowledge is more likely to be retained and applied in subsequent clinical situations. This process for students and new graduates of applying knowledge in clinical settings is largely influenced through leadership. Leadership is instrumental in shaping the nature of the interactions with staff and the clinical experiences that become available (Kelly and Ahern, 2009).
There are many different roles that support this learning and teaching in the clinical setting. Clinical educators, facilitators, mentors, preceptors and clinical guides are all skilled clinicians who have a recognised education role within the practice context. Depending on the local arrangements these positions can contribute to teaching of students, new graduates or novice staff through creating and recognising learning opportunities. When possible, relief from direct patient care responsibilities provides time for those interactions that further enhance learning, for example, questioning, encouraging reflection, and offering feedback. Teaching in the clinical practice situation can be in the form of direct role-modelling or demonstrating, engaging with the learner to identify their learning needs, assessment of skills and/or providing feedback. Many of these skills can be readily adopted by all clinicians to promote learning in the clinical setting. For many practice based professions, including nursing, this role of the clinician to teach at the bedside has now been formally acknowledged.
In Australia and Canada, this role is clearly specified in their competency statements of a registered nurse. In Australia, the ANMC Competency standards clearly include that the registered nurses has a responsibility to teach [refer Section 4.3](Australian Nursing and Midwifery Council (ANMC), 2005). This teaching responsibility of the nurse who provides direct patient care should be fostered and supported and, in turn, augments those roles with designated education responsibilities. It is this symbiotic nature of clinical education positions and nursing staff who deliver direct clinical care that warrants further discussion, as a mutually beneficial relationship can be immensely powerful in establishing clinical learning environments.
In the first instance consideration needs to be given to how to support the teaching responsibilities of the nurses who provide direct care to the client. As identified in the literature the nurse at the bedside is instrumental in creating, shaping and influencing student learning (Brammer, 2006). These nurses need to be assisted to develop behaviours that are not onerous, yet encourage engagement by learners such as sharing background information about situations, demonstrating, verbalising decision-making processes, exploring with students their thoughts and providing feedback to students when time permits. These behaviours are influential in effectively guiding and facilitating the learning of students, graduates and staff not familiar with a specific clinical context.
These positive behaviours important in facilitating learning opportunities for a range of staff need to be encouraged and fostered. Clinicians with education responsibilities such as preceptor, clinical guide, and mentor contribute to student learning through engaging with students to afford learning opportunities. Designated supernumerary education positions can further assist through coaching nurses who provide direct care at the bedside, thus the whole team develops behaviours that facilitate the learning of students, graduates and new staff.
Such practices when embedded in clinical contexts lead to the creation of learning environments. In clinical learning environments the activities of the community of nurses contribute to learning and the progressive career development of staff. While recognised education staff maybe responsible for assessment and formal feedback to students or new graduates everyone can facilitate behaviours that inspire learning. Ideally, the nurse at the bedside will be influenced by the peer group that values behaviours commensurate with learning.
Furthermore, leadership is a vital component of the creation of learning environments. Ward/unit managers or “shift” team leaders have been recognised as the “gate-keepers” for establishing a milieu that welcomes learners and assists staff to develop behaviours that facilitate learning in the clinical area (Andrews et al., 2006). These local leaders are therefore instrumental in shaping the motivation of teams to support learning.
Through exhibiting effective leadership behaviours such as open communication and sharing knowledge and ideas, leaders and senior staff members can influence other staff to interact in a positive manner that fosters learning. Learning becomes embedded within everyday clinical practices through these layers of supportive leadership. This is in contrast to many clinical areas where teaching is delegated to a single nurse or couple of nurses who show an interest in teaching and therefore are constantly called upon to “take a student” or “help the new graduate”. In these circumstances a large proportion of the team fail to engage in facilitating learning and therefore unable to actively play a role in an emerging learning environment.
Articulating specific leadership activities that can be adopted by staff at the various levels in the organisation is crucial for the continuing development of learning organisations. A recent collaboration between academia and industry has described a range of activities that staff at all levels can engage to nurture learning. These include — innovative supervision arrangements between the nurse unit managers and the university clinical co-ordinators around placement models, preparation of both staff and students for the clinical practicum around appropriate behaviours that facilitate learning, and a booklet for staff and students to use during the clinical practicum to assist in communication (Creedy and Henderson, 2009).
An approach where staff are recognised, and accordingly developed as learners along a continuum of knowledge and skill progression is more important than ever before because of the increasing complexity of health care. If leadership supports staff to value their own contribution and share their knowledge and expertise with each other then the practices of the nursing staff are more likely to be responsive and therefore better able to meet the demands of the health care system.
References
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PII: S0260-6917(10)00015-8
doi:10.1016/j.nedt.2010.01.003
Crown Copyright © 2010. Published by Elsevier Inc. All rights reserved.
