IWORK The nurse teacher’s role in the practice setting

In the light of the education reforms brought about by the implementation of Project 2000 it is essential that nurse teachers critically appraise their role and function. In particular, they need to give careful consideration to their role in relation to the practice setting. Whilst the English National Board (1989) indicate that nurse teachers should retain their clinical competence and be able to teach in both classroom and practice settings, little has been written in respect of the implications of this directive. This paper considers the issue of clinical competence and explore some of the different dimensions of the nurse teacher’s role in the practice setting, in respect of teaching, providing educational support and facilitating good practice. Finally, some of the issues relating to the successful fulfilment of this role are identified for consideration.

INTRODUCTION

Project 2000 (UKCC 1986) represents a major reform of nurse education and brings with it new challenges for nurse educators. In proposing the case for a ‘knowledgeable doer’, it identifies the need for a practitioner who possesses a sound knowledge base and who is able to apply effectively this knowledge to practice. However, achieving this outcome may prove problematic to nurse educators. The Project 2000 report acknowledges that one of the major dilemmas of the current system of nurse education concerns the gap that exists between the theory taught in the classroom and the practice encountered in clinical settings. The reasons behind the theory- practice gap are complex and it is not the intention of this paper to provide a detailed

Kate Gerrish MSc B Nurs RGN RNT Principal Lecturer in Nursing, School of Human and Health Sciences, The Polytechnic, Huddersfield HDl 3DH, UK (Requests for offprints to KG) Manuscript accepted 14 January 1992

analysis. Kather, I would like to refer briefly to one of the contributing factors identified by Project 2000, namely, the situation which has arisen within nurse education of two grades of nurse teacher; the nurse tutor whose primary responsibility concerns teaching the theory of nursing in the classroom setting and the clinical teacher who teaches in the practice setting. The effect of this division in teaching responsibility has served to widen, rather than reduce, the gap between theory and practice (Robinson 1986).

In attempting to remedy this situation the United Kingdom Central Council (LJKCC) has led a move to establish one grade of nurse teacher, whom they describe as a teacher/prac- titioner, accordingly:

Nurses, midwives or health visitors who retain their clinical competence and facilitate the development of the practitioner teacher, student teacher and student; has an initial teacher qualification; is responsible for teaching, assessing and supervising; makes formative and summative assessments of student progress. (ENB 1989)

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CLINICAL COMPETENCE

The English National Board’s definition (ENB 1989) indicates that nurse teachers will be required to retain their clinical competence, a requirement which has major implications for both existing and future teachers. Whilst the term clinical competence is one that is familiar, there appears to be no general consensus of opinion as to what it means in relation to nurse teachers. I would therefore like to put forward one interpretation and suggest three dimensions to clinical competence.

First, clinical competence implies a prac- titioner who has the ability to practice as a first level nurse. To this end, the competencies specified in Rule 18 (UKCC 1983) provide some guidance as to the level of ability required. However, although nurse teachers should be capable of functioning as a first level nurse, this does not imply that they possess all the highly complex specialists skills required of registered nurses in a particular clinical area, or that they have necessarily retained the array of advanced

clinical and management skills that they exer- cised in their last clinical post.

Secondly, the nurse teacher should possess an in-depth advanced knowledge of nursing and be able to apply this knowledge in such a way as to improve professional practice. The ENB’s report of the Teacher Preparation Project (1990) indicates that an advanced knowledge base can best be achieved by securing an all graduate teaching profession. Accordingly, they have set 1995 as the deadline for achieving this aim. It is recognised that some teachers may elect to establish their academic credibility in the discipline of nursing and others may choose to pursue one of the relevant disciplines which inform practice. However, regardless of aca- demic background, it is essential that teachers are able to apply theory to practice and this may not necessarily be concomitant with graduate status.

Finally, the nurse teacher needs to be in touch with the realities of practice. They need to be aware of the current contexts within which care is delivered and factors which influence the delivery of that care, both at the macro and the micro level. For example, they need to be know- ledgeable about the broad implications for prac- tice of the NHS reforms brought about by the White Paper ‘Working for Patients’ (DOH 1989). However, they also need to be aware of the impact on practice at the point of delivery of care of specific initiatives such as resource manage- ment, skill mix, and quality assurance schemes.

The importance of clinical competence to the nurse teacher should not be underestimated. It is only by retaining clinical competence that the nurse teacher can be perceived as clinically credible by both clinical staff and students. Clinical credibility is fundamental to the nurse teacher successfully occupying any kind of effective teaching role in the practice setting.

TEACHING IN THE PRACTICE SElTING

In looking back over the past three decades it is interesting to note that nurse teachers seldom teach in the practice setting (Jones 1985, Reid

1985) and appear to have abdicated this aspect of

their role, in the first instance to the clinical

teacher and more recently, to clinical staff (Robinson 1986). With the demise of the clinical

teacher and increasing demands being placed on clinical staff to fulfil a multi-faceted role, it is

important that nurse teachers re-examine their

teaching role in respect of the practice settting.

Indeed, it is suggested that a teaching presence in the practice setting is fundamental to the

successful development of the Project 2000 prac-

titioner. It has already been acknowledged that

students undertaking Project 2000 programmes will be required to assimilate a body of know-

ledge relevant to nursing and be able to apply this knowledge to practice. However, the nature

of both nursing knowledge and nursing practice present the student with particular difficulties.

In the first instance neither nursing theory nor nursing practice can be viewed as ‘wholes’. The

student nurse studies knowledge derived from nursing, the biological, behavioural and social

sciences, ethics and research, and is then

required to synthesise the knowledge from these different disciplines to form a coherent whole. practice is similarly fragmented in that the

student is subject to different experiences in each practice setting. Furthermore, practice is

classified in different ways:

I. age - e.g. care of the elderly; 2. medical

treatment - e.g. surgery; 3. disease - e.g. oncology; 4. system - e.g. renal.

Again the student is faced with the prospect of attempting to make sense of the total experience by developing a concept of nursing practice.

The student is then required to apply the assimilated theory to the assimilated practice.

This is a particularly difficult task unless it is ensured that the theory taught has direct re-

levance to the practice experienced. To some extent this can be achieved by ensuring that the nurse teacher is clinically credible in the areas that they teach. However, it can further be enhanced by the nurse teacher occupying an active teaching role in the practice, as well as the classroom setting. In support of this stance, it is unrealistic to expect that clinical staff in a par-

ticular setting have the breadth and depth of

nursing knowledge, or the insight into the range

of practice settings, to help the student make the necessary links with past learning experiences

and see the relevance to future learning. B? contrast, the nurse teacher is uniqueIF positioned to assist the student in this task.

However, although it is suggested that the nurse

teacher occupies a unique position in respect of facilitating the integration of theory with prac-

tice, it does not imply that any less importance should be attributed to the teaching role of‘ clinical staff, who remain the clinical experts in a

particular field. Rather, the respective teaching roles of the nurse teacher and clinical stafi’

should be seen as complementary to each other.

In order to assist the student to integrate theory with practice it is important that the

teacher adopts a creative approach, utilising an

array of different teaching methods and drawing upon the rich source of learning oppor-

tunities present in the practice setting. The strategies used in the past may no longer be

applicable and the teacher needs to evaluate carefully new initiatives.

EDUCATIONAL SUPPORT

Since the research of the early 1980s (Fretwell 1982; Marson 1982; Logier 1981; Orton 1981)

identified some of the difficulties clinical staff have in fulfilling an effective education1 role,

various measures have been introduced in an attempt to remedy the situation. For example,

the ward sister development programme (Lath- lean & Farnish 1984) and the establishment of the ENB course number 998 entitled ‘Teaching

and assessing in clinical practice’ have both sought to equip clinical staff with appropriate

teaching skills. Furthermore, a variety of ‘clinical link’ schemes have been established whereby a nurse teacher liaises with a specific clinical area to provide support to clinical staff in respect of fultXing the educational aspects of their role and providing a means whereby they can be updated on developments in nurse education. Such initiatives are particularly important in the

230 NURSE EDUCATION TODAY

light of the current education reforms. However, the introduction of Project 2000 also raises a number of new issues that need to be taken into account by nurse teachers in fulfilling this supportive role.

One of the most significant changes which has direct implications for clinical staff relates to the introduction of supernumerary status for student nurses. Student nurses will no longer be required to make a major service contribution for the majority of their training, but rather, will undertake practice placements for specific learn- ing purposes. This shift in emphasis from ‘worker’ to ‘learner’ requires a significant re- orientation on the part of clinical staff. From recent observations in colleges of nursing where Project 2000 programmes are in progress there appears to be some confusion over the term ‘supernumerary’ and an indication that clinical staff require particular support in assisting students establish a balance between obser- vation, selective participation in care and developing clinical competence.

that nurse teachers remain sensitive to the increased pressures clinical staff may find them-

selves working under with the introduction of the NHS reforms (DOH 1989) and the conflict- ing demands they experience in balancing their clinical and managerial roles with their edu- cational one. This may well become more acute with the re-assessment of skill mix and a likely reduction in the number of qualified prac- titioners in a particular care setting. The edu- cation support offered by nurse teachers may then need to evolve to meet these new situations.

FACILITATING GOOD PRACTICE

Furthermore, the introduction of Project 2000 has resulted in students assuming increased responsibility and autonomy for their own learning. This places additional emphasis on the role of clinical staff in assisting students identify and utilise appropriate learning oppor- tunities presented in the practice setting. The focus of the Project 2000 curriculum on a model of health requires a further re-orientation on the part of clinical staff if they are to assist students fulfil their learning needs.

Finally, Project 2000 seeks to develop reflec- tive practitioners (Schon 1987) who will be able to engage in continual evaluation of their clinical practice, critically analysing and further developing it. This requires an effective system of tutorial and mentor support and presents a strong case for the nurse teacher not only to offer tutorial provision in the practice setting but also to support mentors develop skills in facilitat- ing reflective practice.

In addition to the two aspects of the teacher’s role in the practice setting already mentioned, it is suggested that nurse teachers have an increas- ingly important part to play in facilitating good practice. In order to teach effectively, nurse teachers need to be aware of current develop- ments in clinical practice. They should, there- fore, be in a position to provide a valuable resource to clinical colleagues in respect of new initiatives and their effect on the practice setting, and subsequently on the learning experiences of students. In addition, it is important that nurse teachers are active in promoting research mindedness amongst practitioners and students alike. To this end, they need to foster a critical, questioning approach to practice, assisting clinical staff to develop the ability to appraise critically research findings, assess their applica- bility to practice and finally facilitate the implementation of valid research findings.

It is acknowledged that a number of the afore- mentioned issues are particularly focused on the introduction of Project 2000 and, once estab- lished, it can be argued that clinical staff may well require less support. However, it is important

In this respect, it is important that nurse teachers consider their role as agents of change. In the light of the developments in nurse edu- cation arising from the implementation of Pro- ject 2000, together with other developments affecting nursing practice, it is imperative that nurse teachers are active in the practice setting, promoting, facilitating, supporting and evaluat- ing change. Such an approach may well be new to clinical staff who have traditionally seen the nurse teacher’s role primarily in respect of

student nurses. However, it is contended that by

the nurse teacher maximising this aspect of their

role the quality of the learning environment can

be enhanced.

THE WAY FORWARD

From the preceding discussion it can be seen that within the context of Project 2000 the nurse

teacher occupies an important role in the prac- tice setting, both in respect of students and clinical staff. It is important that, having identi-

fied these aspects of the nurse teacher’s role, consideration is given to how its development

can best be facilitated. In the first instance it

requires commitment on the part of individual

teachers. History indicates that it will not be easy

to balance conflicting demands between the classroom and the practice settings, particularly

since the theoretical content of Project 2000 courses is greater than preceding programmes. However, unless nurse teachers themselves ack- nowledge the importance of this aspect of their

role then the success of Project 2000 may be put in jeopardy. In addition, senior nurse edu-

cationalists must be committed to the develop-

ment of the nurse teacher’s role in the practice setting and until this is included within edu- cational policy it is unlikely to succeed.

Secondly, in order to ensure the success of this

role, collaboration is required between nurse

educationalists and clinical staff. This should occur at the level of the teacher/ward staff and between senior nurse educationalists and nurse managers so that they are aware of their

respective roles and the contribution each can make to the quality of the clinical learning environment. Collegiate relationships need to be

established whereby individuals respect each other’s expertise in different areas of practice

and are therefore able to contribute from a position of strength.

Nurse teachers must also be adequately pre- pared for this aspect of their role. It is important that courses concerned with initial teacher preparation take on board the implications of

the nurse teacher adopting a higher profile in

the practice setting and provide the student

teacher with the necessary knowledge, skills and opportunities to develop this aspect of their role. A large proportion of the current courses focus

on developing classroom teaching skills to the neglect of those that may be more applicable in

the practice setting - an issue that requires

urgent attention. Furthermore, student teachers need to be provided with the opportunity to

develop expertise in a particular specialism, either a prof’essional specialism such as child

care, or a subject specialism such as health promotion. They then need to be given the

opportunity to explore and develop these specialisms within the context of practice,

thereby developing clinical competence. Finally

teachers need to be equipped with an array of

skills which will enable them not only to respond

positively to the changes affecting their own practice, but also enable them to effectively

support and facilitate change affecting others. The development of a more practice ori-

entated focus on teaching is something that may be new to a number of experienced, existing,

qualified teachers and forms an important part of ongoing staff development. It is crucial that

they are given the necessary help and encouragement to re-establish their clinical

competence and consider creative ways of

developing their role in the practice setting. Developments of this nature may well prove

threatening, and it is important thar the nurse teacher is adequately supported both by senior

nurse educationalists and by peers. Oppor- tunities should be available for identifying needs for personal and professional development and planning a course of action to establish this role.

However, it is crucial that in order to ensure the future development of the role of the nurse

teacher in the practice setting, these initiatives

are introduced gradually with adequate prepar- ation and support of all those involved, and are subject to careful evaluation. Unless this is the case, the mistakes of the past may well reoccur. It behoves the profession not to dismiss the import- ance of an educational presence in the practice setting, for without it the success of Project 2000 may be brought into question.

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