Developing Professional Competence: Challenges for Newly Qualified Nurses

Author(s):

Karen Evans(presenting / submitting)Helen Allan(presenting)

Conference:

ECER 2014

Network:

02. Vocational Education and Training (VETNET)

Format:

Paper

Session Information

02 SES 04 B, Learning Journeys in the Health Profession

Paper Session

Time:

2014-09-03

09:00-10:30

Room:

B027 Anfiteatro

Chair:

Len Cairns

Contribution

Concepts of competence are widely debated within Europe, in the context of their relationships with VET and qualification frameworks. Integrative approaches to competence, which emphasise capacities, are contrasted with those that focus primarily on the performance of tasks. A narrow focus on task performance characterised early versions of NVQs in the UK , in which it was held that standards and qualifications could be achieved without necessarily following a prescribed curriculum or programme of education and training. There has been a gradual broadening of the learning outcomes that are associated with vocational and professional education, but the central principles continue: that (a) means and outcomes of learning can be separated and (b) many learning outcomes can be achieved through workplace and informal learning and can be validated for accreditation purposes. These principles are embedded in the Qualifications and Credit Framework (QCF).

The European Qualifications Framework competence is described in terms of responsibility and autonomy ( EC 2008: 11), emphasising proven knowledge and abilities in work or study situations. The EQF is often described as a translation device, allowing equivalences between qualifications to be explored, yet this exploration is critically dependent upon the different interpretations of the concepts of competence and qualification that are dominant in different countries. The UK approach to competence development generally critiqued as narrowly work-task oriented ( see Brockmann, Clark and Winch 2011)

In contrast with many occupational fields, UK nursing qualifications can be seen as having more in common with European frameworks than with rest of UK system. All nurses in England are to be educated to Bachelor’s (Honours) degree level, from 2013.Nursing degrees are scientifically-based, regulated and validated professionally, with 50%-50% shared learning between university and clinical placements.But competence frameworks that are more typical of UK approach have progressively been introduced, mapped across to NHS Knowledge and Skills Frameworks (KSF) for continuing professional development and potentially to EQF. Key workforce issues include increased delegation of care to healthcare assistants and a nationally perceived crisis in patient safety. 'Preceptorships’ for newly qualified nurses are one year programmes that involve building confidence and competence at the start of their careers (Dept of Health 2012). This research into the preceptorship in nurse education aims to understand better how newly qualified nurses are supported, developed and assessed in the practice situation, in their role of organising and supervising patient care. This process is often analysed in terms of the 'transfer' of knowledge and competences into the work situation. But we have approached using the lens of knowledge re-contextualisation to understand how nurses put knowledge to work in the preceptor phase.

In particular we have drawn on the framework of ‘re-contextualisation of nursing knowledge’ (Evans et al. 2010).This approach, which builds in part on van Oers (1998), provides a framework for researching programme design as re-contextualisation of curricular content and of workplace or placement support. Pedagogic re-contextualisation focuses on the approach to learning and teaching, and ‘learner re-contextualisation’ examines ‘what the learner (in this case the newly qualified nurse) makes of it all. In this paper we focus on the last of these, exploring how nurses re-contextualise what they have learned in and through other settings to allow them to organise, delegate and supervise in the practice situation. The findings are discussed in relation to the EQF definitions of competence in terms of responsibility and autonomy and proven knowledge and abilities in work or study situations, and with reference to the European debate on the extent to which approaches to professional development at the higher levels are converging or diverging in the E.U. (see Brockmann 2011).

Method

The study, based in three sites across England, aimed to investigate how newly qualified nurses (NQNs) learn to become safe and competent nurses in busy NHS wards. Mixed methods have been utilised. An ethnographic case study methodology has been adopted (Burawoy 1998). This has involved collection of participant observation data (n=54); interviews undertaken with NQNs (n=28), healthcare assistants (n=10) and ward managers (n=10) across three hospital sites in England. After meetings in which instruments were designed and agreed, data were collected in thr field by four experienced nurse researchers and a professional sociologist. Generally the mechanism involved the researcher joining the hospital shift at its start and working with ( shadowing) the agreed nurse and her or his closest co-workers, such as students or health care assistants, making field notes as appropriate. It was often possible to ‘observe’ the key features of nursing work in which we were interested from a discrete distance.The shadowing often meant going with the nurse to the ‘clinical’ room where medications might be dispensed, sitting by the ‘night station’ or ward table where computers were being accessed to retrieve or input data, or to attend a side ward where care was being carried out or managed. Where it seemed appropriate and helpful researchers chatted to patients and others to explain our purposes. Nearly all NQNs were observed on two occasions and were followed up with interviews exploring their perceptions of role and context. The extension of similar interviews to ward managers (N = 10) and support workers (N = 10) has provided a form of triangulation. We are aware of the many styles and strategies which can be applied to qualitative data to derive meaning, to theorise and to draw conclusions. Rather than claim any specific allegiances, but having worked extensively with grounded theory, phenomenological and ethnographic approaches, the researchers have shared our data and worked in teams of two or three to code and re-code it, sharing our interpretations in several face to face meetings reconciling main findings in debate. In this respect the approach has been pluralistic (Johnson et al. 2001) In a final stage we compare our conclusions about the knowledge and competences required by and developed in the practice setting by newly qualified development nurses with competence formulations that underpin the professional development of nurses in Germany ( see Kirpal 2011) and more widely in European member states (Brockmann 2011).

Expected Outcomes

Within the field of nursing in England, complications in the use and interpretation of the concept of competence in the post-registration year of preceptor training are being identified in our current research, as aspects of this learning and knowledge appear to be invisible to the nurses themselves and many participants struggled to verbalise how they learnt the skills of organising and delegating care. The newly qualified nurse is immediately responsible and held accountable for delegation to others and supervises those to whom care is delegated. This delegation requires sophisticated clinical judgement , as Weydt (2010) has shown in other contexts. Yet these capabilities, crucial to role performance , are experienced as difficult by most newly qualified nurses.There is a need to rethink the assessment of nurse preparation and continuing professional development programme outcomes, to refocus on knowledgeable action-taking in the area of delegation. This involves the exercise of attuned and responsive judgement when confronted with complex tasks and often unpredictable situations. It is argued that for these requirements to be met means moving beyond dominant UK skills-based conceptualisations towards European formulations of action competences for newly qualified nurses, and a rethinking of 'transfer' in terms of knowledge recontextualisations. Building on Brockmann, the research is also highlighting further specific challenges of developing the notion of Zones of Mutual Trust (ZMTs) in continuing professional development, given the differences in post-qualification concepts, practices and support for learning in different EU member states.

References

Burawoy, M. (1998), The Extended Case Method. Sociological Theory, 16: 4–33. doi: 10.1111/0735-2751.00040 Brockmann, M. (2011). Higher Education Qualifications: Convergence and Divergence in Software Engineering and Nursing. In Brockmann, M., Clark, L. and Winch, C. 'Knowledge, Skills and Competence in the European Labour Market, Abingdon: Routledge. Brockmann, M., Clark, L. and Winch, C. (2011) 'Knowledge, Skills and Competence in the European Labour Market, Abingdon: Routledge. Cipriano, P. (2010). Overview and Summary: Delegation Dilemmas: Standards and Skills for Practice. OJIN: The Online Journal of Issues in Nursing, 15(2). Evans, K., Guile, D., Harris, J. and Allan, H. (2010) Putting Knowledge to Work: A New Approach, Nurse Education Today 30 (3), 245-251 Department of Health ( 2009) Preceptorship Framework for Newly Registered Nurses, London DoH European Communities (EC) (2008), “The European Qualification Framework”, available at: http://ec.europa.eu/education/policies/educ/eqf/eqf08_en.pdf (accessed 14 May 2009). Gillen, P., & Graffin, S. (2010). Nursing delegation in the United Kingdom. OJIN: The Online Journal of Issues in Nursing, 15(2). Johnson, M., Long, T. & White, A. (2001) Arguments for 'British Pluralism' in qualitative health research. Journal of Advanced Nursing, 33(2), 243-249. Kirpal, S. (2011) Labour-Market Flexibility and Individual Careers: A Comparative Study, Dordrecht: Springer. NMC (2010). "Essential Skills Clusters and guidance for their use (guidance G7.1.5b)." Royal College of Nursing (2011) Accountability and delgation: what you need to know. RCN, London. van Oers, B. (1998) The fallacy of decontextualisation, Mind, Culture and activity, 5(2): 143-52. Weydt, A. (2010). Developing delegation skills. OJIN: The Online Journal of Issues in Nursing, 15(2). Standing, T. S., & Anthony, M. K. (2008). Delegation: what it means to acute care nurses. Applied nursing research: ANR, 21(1), 8-14.

Author Information

Karen Evans (presenting / submitting)

Institute of Education, University of London, United Kingdom

Helen Allan (presenting)

Middlesex University, United Kingdom

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