Editorial: Work-based learning - a change in culture

Abstract

Whilst the notion of work-based learning in nursing has always been acknowledged and accepted, it is only relatively recently that strategies have been devised which seek to use experiences and occurrences in practice as overt learning opportunities. Perhaps some of this move can be attributed to the growth of reflective practice and clinical supervision over the past 20 years; but perhaps, more pragmatically, we need to look to the development of competence frameworks to assess fitness for practice in a variety of roles, and the need for practitioners to be relating theory to practice and demonstrating outcomes such as change in practice and practice development. A key driver though, for the increasing recognition of the clinical environment as a source and venue for learning, is the financial pressures arising from service reconfiguration in response to the global financial climate and the pressures on the registered nursing workforce. Certainly, across the UK, the reality is that many managers cannot release staff to attend taught programmes and are looking for alternative learning opportunities to enable staff to continue to demonstrate professional development that benefits both the service and the patient. This issue draws together a range of papers, demonstrating that the notion of work-based learning is a dynamic concept and can be enacted in many ways. What appears to be significant though is that the initiatives presented have been developed as responses to local need, and are therefore culturally specific. This is also a move away from cohort learning approaches, which are based on providing all engaged in the learning with a similar, taught, knowledge and skills base, through a notion of equity of content. What the work-based approach is grounded in however, is equality in outcome, enabling different content and processes of learning to be utilised in achieving a prescribed outcome. Our first paper by Williams reviews the current literature exploring work-based learning as a concept. She suggests that part of the challenge is a wholesale cultural change from perceiving learning as something that transpires in a classroom to that which can happen in the workplace. She suggests that nurse managers need to develop learning cultures in the workplace, where skilled facilitation is available to encourage critical reflection and to effect change in practice. Clearly, for the majority of practitioners, their everyday reality is grounded in practice – the notion of work-based learning locates their learning within this environment, enabling them to learn from challenges and problems that occur for them, and enables them to find solutions through the learning process. The theory of work-based learning is all very well, but how can it be implemented in practice? Our next four papers present a range of ways in which this challenge has been met. What draws them together is that each individualised approach has resulted in the development of solutions for the particular sets of circumstances pertaining, yet all are presenting work-based learning solutions that start to tackle the cultural shift needed towards how nurses learn and develop in the practice environment. Boomer and McCormack show how the deliberate strategy of developing the culture and content of care alongside the development of the individual has resulted in two overriding outcomes. Firstly, there are process outcomes which demonstrate growth in the participants as leaders who contribute to the cultural shift. Secondly, they have found general outcomes which demonstrate practice change. They suggest that cultural and personal change need to be addressed together, as they are interdependent – and indeed, we have decades of evidence that shows that just educating the individual out-with the clinical environment does not result in practice change that could be anticipated. Learning within the workplace needs to be a team and environmental commitment, with the true notion of the learning organisation exhibited. Jasper et al. also address the importance of cultural change within the working environment in discussing the challenges of designing a professional development programme for ward managers that arose from a Ministerial task force enquiry into standards of care in Wales. The resultant programme is essentially located with the learning needs of the individual ward manager at its heart. Once learning needs against the competencies have been identified the ward manager (or those aspiring to become managers) is facilitated to construct their own programme from a range of available learning opportunities, which will enable them to demonstrate achievement of all the competencies outlined. Hence, the ward manager’s learning needs within their own specific and particular role are put at the centre of the programme, rather than the ‘one size fits all’ approach of much professional development. The result of the pilot project, however, suggests that until there is cultural change towards work-base learning, and support for this instead of classroom-base approaches, there is likely to be a shift away from the principles which guide the framework for the programme towards the centrality of formally taught components as opposed to the work-place generated learning envisaged. In the next paper, Thurgate presents a solution to the education and development of training a supportive workforce to provide knowledgeable care under the supervision of trained practitioners. Again, the solution presented incorporates large elements of work-based learning appropriate to the role designation and focus of the support worker. The NHS in the UK is currently reviewing the skill mix of registered to unregistered practitioners, and is proposing a cost-effective solution as a reduction in the former and growth in the latter. Thurgate suggests that all practitioners’ understanding of the role boundaries is critical in enabling the delegation of work if these new roles are to succeed. She suggests that issues of supervision in training, mentorship, supernumerary status and effective support whilst undertaking work-based learning are challenges that need to be addressed if this approach is to succeed. Shekleton’s paper presents how the challenge to develop upcoming leaders in a membership organisation was met. This resulted in a 3 day ‘boot camp’ for the State President Elect personnel to enable them to start to develop the leadership skills needed for their next role. The American Association of Nurse Anaesthetists recognised that their presidents elect were all facing the ‘same challenges: a fast-paced, rapidly changing environment characterised by the need for good communication and teamwork and the ability to organise workgroups and plan for the efficient and optimal use of resources’. Although the response to this challenge was an intensive ‘boot camp’ type programme, it essentially related to the skills need for the work-place role. Apart from the cultural element recognised within these papers, they all also allude to the need for good support for learning in the workplace, whether this be through facilitation, mentoring or role modelling. Our next five papers present perspectives on support within clinical environments. Severinsson and Sand draw attention to the fact that in order for students to receive good and effective clinical supervision there needs to be a commitment for managers and staff nurses to engage in on-going professional development. The key to effecting this as a cultural norm appears to lie in a transformative leadership style which is value-driven, and which can facilitate and enhance the supervision and development of student nurses as a result. Holmlund et al. provide evidence of the value of group supervision in supporting students' personal and professional development, While and Winstanley present the results of a research study exploring the implementation fo clinical supervision in Queensland, Australia. They, too, draw attention to the significance of overcoming the prevailing culture and facilitating change. Indeed, clinical supervision was seen as ‘tour de force’ for cultural change, but was polarised as an opportunity by many, but a threat by some participants. The authors conclude that a ‘single, cohesive and explicit management position needs to be adopted’ drawing attention to the key role of the manager in enabling and spearheading changes in practice. Omansky draws attention to the ‘considerable stress and responsibility associated with preceptoring or mentoring’ student nurses. Her findings suggest considerable role ambiguity, conflict and overload is experienced by nurses attempting to support students in the practice environment. She calls for a formalisation of the role, to increase its professional standing and reduce the stress generated within it. This, of course, is nothing new to the nursing profession, where there has always been recognition of the implicit role of teaching learners yet this does not seem to be regarded as a key component of the role despite its inclusion in job and role descriptions. Yet, a central feature of a profession is a commitment to lifelong learning, and to some extent the enactment of that in perpetuating the profession through development and teaching of those in fledgling positions. Perhaps the perception of the educational function of nurses as an added extra, rather than a central component of being a nurse, is reflective of increasing workloads and demands on registered practitioners, and lack of recognition within workload when this function is taken on. Finally, the last paper in this series addresses the issue of the formal recognition of prior learning within the notion of continuing professional development. Accreditation of prior learning, whether certificated or experiential, has been a feature of many countries’ broadening perspectives on professional development for many years. However, as Jooste and Jasper point out, whilst the principles for recognising prior learning may be similar, account needs to be taken of the cultural circumstances within which nursing occurs in creating a strategy for assessing and accrediting that learning. The circumstances pertaining to the nursing workforce in South Africa in the post-apartheid era are explored. A framework arising from nurse managers’ contributions is presented as a way of enabling senior nurses in managerial positions to gain credit for experiential learning and admission to post-graduate programmes that will enable them to gain University qualifications that they would otherwise be unable to access. Although the previous papers address the cultural and supportive aspects of work-based learning overtly, the remaining papers in the issue also have implications for the ways in which we use the practice environments as opportunities for professional learning. All the papers draw attention to the significance of the work environment for the culture of nursing, and in particular, how managerial empowerment and style impact on the way nursing care is delivered. These papers, drawn from a range of countries, draw attention to the common challenges facing nursing managers in today’s world. Many of these challenges are within the sphere of influence of the nurse manager, and therefore carry a responsibility for perceiving a need for change and initiating a response that will resolve the issues. Despite the global challenges facing healthcare delivery today, there will always be people requiring the skills and dedication that professional nursing care offers. It behoves us all, as managers, to build positive, learning working environmental cultures that respect those professionals and enables them to gain high levels of job satisfaction and reward in their work. Work-based learning is a strategy for increasing professional self-esteem, whist serving the needs of the employing organisation in terms of providing safe, effective and evidence-based care. The nurse manager’s role is to facilitate that culture; to ensure their environments recognise their role in offering learning opportunities wherever and whenever they occur.

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