Learning in the workplace: Development of a simple language statement assessment tool that supports second-level nurse practice.

AIM: To focus learning through clarity of the enrolled nurse (EN) role (a second tier nurse position) through development of a user-friendly workplace performance assessment tool commensurate with EN standards for practice. BACKGROUND: Internationally, the nursing workforce comprises regulated and unregulated staff. In Australia, similar to other western countries, there are two tiers of regulated workforce, namely Registered Nurses (RNs) and Enrolled Nurses (ENs). Differences in RN and EN standards based on the education preparation are not always clearly differentiated in workplace practice. Roles are often seen as interchangeable: Improved clarity of both regulated and unregulated roles, when numbers of healthcare workers are burgeoning, assists performance assessment that guides further learning and safe practice. DESIGN: Two phase sequential, non-experimental design. METHODS: Phase one used focus groups (n=48), expert reference panel (n=8) and end-users (n=16) to develop simple language statements. Phase two involved field testing of the statements. FINDINGS: A 30-item, criterion-based workplace performance tool was developed. Principal component analysis of completed tools indicated work could be organised around three key areas of practice, namely, higher order thinking and problem solving, routine daily activities of care and personal and social attributes. DISCUSSION: Participants reported the statement items assisted in determining suitable activities and accompanying cues in discussing learning needs. Analysis assisted with discriminating broader elements of EN workplace performance. CONCLUSIONS: Workplace learning is important for nurses to continue to build their capacity to deliver optimum care. Assessment tools that describe professional capability in plain language statements and provide examples of supportive behavioural cues help guide on-going learning through improving the validity and thereby consistency of assessment processes. Furthermore, comprehensible and meaningful statements and cues can readily be adopted by students and educators to target learning and feedback thereby enhancing clarity of the EN role, to distinguish from other nursing roles.

Competency domains for registered nurse preceptor professional development: Evidence from a modified e-Delphi study.

AIM: To develop an evidence-based framework of nurse preceptor competency domains and competency descriptors for use in nurse preceptor professional development. BACKGROUND: Nurse preceptors are registered nurses who coach, support and assess nursing students while simultaneously caring for patients. Working as both clinician and educator requires preceptors to develop additional skills. However, preceptor preparation is often overlooked and may not be evidence based. DESIGN: A modified e-Delphi study. METHODS: A three-phase e-Delphi method informed the study that was conducted between March and September 2023. In the first preparatory phase an expert group distilled the results of a previous literature review identifying seven preceptor competency domains and more than 200 competency descriptors. Two e-Delphi rounds followed. A 70% rater agreement response threshold was chosen as appropriate in this study. The CREDES reporting framework was followed. RESULTS: In the preparatory phase, the expert group (n=6) reached consensus on six preceptor domains and 57 preceptor descriptors. In Round 1, nurse preceptors (n= 89) rated the domains and descriptors using a four-point Likert scale; from not important to very important. Six domains and 34 competency descriptors were ranked as very important'. Round 2 participants (n=30) who opted in from Round 1 indicated their 100% agreement with the Round 1 results. The results reveal that preceptors resonate intuitively with the six domains Role model, Facilitator, Leader, Evaluator, Teacher and Coach and the related descriptors. CONCLUSION: The preceptor evidence-based competency framework offers registered nurse preceptors and their employers the opportunity to focus efforts in developing a nurse preceptor workforce. The framework can be used to design preceptor professional development and offers registered nurses a self-assessment tool to identify their preceptorship skills strengths and areas for development. If implemented in these ways the framework may benefit healthcare organisations to provide quality nurse preceptorship, thus enhancing the clinical learning experiences of nursing preceptees.

Appraising differential capabilities of new graduate nurses: Development across the first nine months of employment.

BACKGROUND: Effective transition to practice for new graduate nurses (NGNs) is of national and international concern. Development of NGNs expands well beyond higher education studies and relies heavily on support during their first year of employment. Little is known of the differential development of NGNs, namely the trajectory of developing capability. AIM: This study differentiates NGN development during their first year of employment through appraisal of universal domains of nursing practice relevant to the international community. METHODS: Using a quantitative evaluation design NGN performance was appraised at 1-, 3-, and 9-months from February 2020 to November 2021, using a 23-item appraisal tool and accompanying behavioural cues organised around four universal domains of practice: professional values and behaviours; comprehensive nursing practice; organisational capabilities; personal growth and development; and a fifth domain specific to Australia, that is, legislative requirements. Workplace performance was appraised by clinical supervisors and numerically rated according to intensity of coaching required to meet requisite standards of practice. RESULTS: The shift in rating scores of intensity of coaching required, over three time periods across four key universal domains, were statistically significant (p < .001). These findings which indicate the intensity of required coaching for maintenance of standards reduced over the time period suggest advancing NGN capability. The domain representing professional values consistently rated the highest. The domain denoting legislative requirements largely flattened after three months. CONCLUSION: These findings corroborate the significant development of NGN capability during the first nine months of employment, especially during the initial three months. Furthermore, they provide empirical evidence that NGNs are most adept at demonstrating professional values; a recognised capability developed through employment during pre-registration studies. Discriminant data is of value to inform both targeted development of individual NGNs and when collated, the education needs of cohorts.

Measuring changes in nursing students' workplace performance following feedback encounters: A quasi-experimental study.

BACKGROUND: Work-integrated learning and performance is intimately linked with assessment and feedback; however, empirical evidence concerning the impact of feedback on student performance in workplace settings is limited. A novel practice-based feedback intervention-the REMARK (nuRse fEedback iMplementAtion frameworRK) program-was developed and implemented. Sustainable feedback processes that involve both learners and learning partners can ultimately maximise learning outcomes, optimise self-regulation, and impact performance. OBJECTIVES: To determine the impact of implementing an educational intervention based on best practice principles of feedback on undergraduate nursing student performance during clinical placements in acute healthcare settings. METHODS: A non-equivalent, quasi-experimental design was used. A pre- and post-assessment strategy for both control and intervention groups was employed. The REMARK program was based on known attributes of effective feedback critiqued in the literature that foster interactions between a learner and learning partner and, hence, support dialogic feedback. RESULTS: Clinical assessment data of 214 final-year nursing students collected at three time points were analysed. Using multivariate modelling, the results indicated that students participating in the REMARK programme (intervention group) had statistically higher performance scores than students in the control group when time and placement setting were controlled. CONCLUSIONS: This research provides evidence that engagement with an intervention based on attributes of effective feedback improves nursing students' workplace performance during clinical placement. To achieve the greatest advantage, incorporating strategies that encourage students to adopt an active role in feedback conversations that relate to the student's learning goals are recommended.

The contribution of paid employment for students during their pre-registration nursing studies: An integrative review.

OBJECTIVE: This integrative review of the literature explores potential associations between paid employment during students' pre-registration study period and development of workplace capabilities. The capacity to demonstrate attainment of standards of practice upon registration as a nurse is essential for the delivery of safe, quality care. The increasing shift, internationally, to higher education, concerns have been raised about limited time in practice settings and consequently nurses' capability upon employment. Extensive research has been conducted into student clinical placement models and graduates transition programs, but employment during students' pre-registration study has received little consideration. DESIGN: An integrative approach of peer reviewed articles. DATA SOURCES: A systematic search of the literature published between 1996 and 2021 across five electronic data bases; including Cumulative Index to Nursing and Allied Health Literature, Scopus, Medline, American Psychological Association and Education Resource Information Centre was conducted. REVIEW METHODS: Data was analysed according to the Whittemore and Knafl (2005) framework to maintain a methodical and meticulous approach. RESULTS: Fourteen studies differentiated graduates employed during their studies. Employment contributed to developing capabilities across four domains, namely, personal growth and development, comprehensive nursing practice, organisational capability and professional values and behaviours upon employment. CONCLUSION: Employment during pre-registration studies is associated with developing workplace capabilities. Opportunities to develop the capability of graduates should focus on the possibility of 'learning' during employment rather than merely a recruitment strategy.

The use of factor analysis and abductive inference to explore students' and practitioners' perspectives of feedback: divergent or congruent understanding?

BACKGROUND: The importance of feedback in workplace-based settings cannot be underestimated. Approaches that evaluate feedback reflect either the sender's or receiver's viewpoint in isolation of each other. This study investigated prevailing student and practitioner views of feedback resulting from development and testing of a survey about feedback. METHOD: This study used a cross-sectional design, incorporating use of expert consultation and factor analysis of surveys. Fifty-two items based on identified attributes for effective feedback from current research were developed and reviewed through expert consultation. Surveys developed from the items were completed by students (n = 209) and practitioners (n = 145). The juxtaposition of items based on students' and practitioners' responses to the surveys were examined through use of exploratory factor analysis. RESULTS: Separate student and practitioner surveys resulted. Each survey contained 23 items that clustered into factors. The item statements were different across practitioner and student groups Only nine items were shared across factors identified for both groups. The resulting factors represented different notions of feedback-namely, practitioners had a process-oriented focus in comparison with students' outcome focus. CONCLUSION: While students and practitioners view feedback differently this does not necessarily mean they are incongruous.

Impact of a work-based feedback intervention on student performance during clinical placements in acute-care healthcare settings: a quasi-experimental protocol for the REMARK programme.

INTRODUCTION: Current perspectives present feedback as a dynamic, dialogic process. It is widely accepted that feedback can have an impact on workplace performance, however, how dialogic feedback is enacted with the learner in authentic healthcare settings is less apparent. This paper seeks to describe the design and development of an implementation study to promote the learner voice in the feedback process and improve feedback encounters between learners and learning partners in healthcare settings. METHODS AND ANALYSIS: A quasi-experimental study design will be used to evaluate whether implementation of a work-based intervention to improve feedback impacts student performance during clinical placements in healthcare settings. Student performance will be measured at three time points: baseline (pre), mid-placement (post-test 1) and end-placement (post-test 2) in keeping with standard assessment processes of the participating university. The intervention is underpinned by Normalisation Process Theory and involves a layered design that targets learners and learning partners using best-practice education strategies. Data regarding participants' engagement with feedback during clinical placements and participants' level of adoption of the intervention will be collected at the completion of the clinical placement period. ETHICS AND DISSEMINATION: This study has ethics approval from both Griffith University and Metro South Health Human Research and Ethics committees. Dissemination of results will be local, national and international through forums, seminars, conferences and publications.

What attributes guide best practice for effective feedback? A scoping review.

There has been an observed increase in literature concerning feedback within the last decade, with the importance of feedback well documented. Current discourse promotes feedback as an interactive, dialogic process between the learner and the learning partner. While much has been written about effective feedback, less is known about key elements that support dialogic feedback. It is therefore important to investigate what is known about the elements that guide best practice for effective feedback. A scoping review of the extant literature following Arksey and O'Malley's methodology was conducted. A search of literature published in English identified sixty-one publications eligible for this review. Publications were representative of the international literature from both empirical and non-empirical sources. Feedback elements were extracted from the included publications and categorised into 11 core attributes. The attributes identified feedback as: being a process; criteria-based; requiring multiple forms and sources of data/evidence; needs to be desired by the recipient (i.e. invited and welcomed); timely; responsive to the learner (i.e. tailored to developmental needs/learning preferences of the learner); frequent; future-focussed; reciprocal (i.e. two-way); involves skilful interaction; and is multidimensional (i.e. engages the learner in more than one way). Despite the rhetoric on feedback as a 'dialogic process', a gap remains in our understanding around what is required to engage the learner as an equal partner in the feedback process. Further research exploring the impact of specific aspects of the feedback process on practice is required.

Validation of the Australian Nursing Standards Assessment Tool (ANSAT): A pilot study.

BACKGROUND: Workplace-based learning and assessment are essential elements of all nursing education programs. There is, however, limited evidence of validity and reliability available regarding assessment instruments, based on the professional competency standards for nursing in Australia. OBJECTIVE: The aims of this project were to advance the assessment properties of a new instrument, the Australian Nursing Standards Assessment Tool (ANSAT) and investigate the acceptability of this instrument when applied to the evaluation of the professional competence of nursing students in authentic practice settings. METHODS: A validation study of ANSAT was conducted by 23 clinical assessors from two universities, completing 220 instruments for second and third year undergraduate nursing students undertaking clinical placement in an authentic practice setting. 'Think Aloud' interviews and a post-test survey provided additional data to determine the validity and acceptability of the ANSAT. The pilot study occurred in parallel with completion of existing university assessment instruments. RESULTS: Principal components analysis extracted one factor: professional practice competence. Comparison of total instrument scores between year levels demonstrated a significant difference in each of the clinical domains (p=0.000), suggesting that the instrument is sensitive to differing levels of performance across different year levels. The ANSAT demonstrated high internal consistency with a Cronbach's alpha coefficient of 0.976. Post-test evaluation completed by assessors demonstrated high usability and acceptability for use in common practice settings. DISCUSSION: Results of the pilot study provided preliminary support for the ANSAT instrument. It is recommended that testing of the instrument be undertaken on a larger cohort to ensure the generalisability of the findings to other nursing populations. CONCLUSION: There is a need for valid and reliable instruments that assess the performance of nursing in the authentic practice setting. With the addition of supportive behavioural cues, the ANSAT enables clarity, consistency and collaboration in workplace-based assessment.

'What matters to graduates': An evaluation of a structured clinical support program for newly graduated nurses.

Effective guidance in practice is necessary for safe practice of clinicians upon entering the workforce. The transition period is recognised as a time of significant stress as newly graduated nurses (novices) endeavour to consolidate their nursing knowledge and gain mastery in a new working environment. This study explored novices perception of a structured clinical support program designed to assist their assimilation and development of good practice in the real world. Surveys and focus groups were conducted twelve months after novices commenced employment in a large tertiary hospital in South-East Queensland, Australia. Survey results from 78 novices (43% response rate), and feedback from a subsequent focus group of the respondents, indicated that the program which provided interactive content days and supervised experience in an environment conducive to learning was successful in transitioning novices. Novices placed considerable importance on largely intangible aspects of the interactive days, such as emotional support and collegiality which contributed to their confidence. These intangible elements of programs are often not measured and therefore their value not visible to those responsible for continuous education. Of particular significance was that novices indicated their thoughts about practice were given limited consideration. This is an important factor for future retention.

Achieving success in intervention studies: an analysis of variable staff engagement across three midwifery settings.

AIMS AND OBJECTIVES: To critically analyse the success of staff's behaviour changes in the practice setting. Facilitators were employed to initiate and facilitate a four-step process (optimism, overcoming obstacles, oversight and reinforcing outcomes) that fostered development of behaviours consistent with learning in everyday practice. BACKGROUND: Many studies seek to engage staff in workplace behaviour improvement. The success of such studies is highly variable. Little is known about the work of the facilitator in ensuring success. Understanding the contextual factors that contribute to effective facilitation of workplace improvement is essential to ensure best use of resources. DESIGN: Mixed methods METHODS: Facilitators employed a four-step process - optimism, overcoming obstacles, oversight and reinforcing outcomes - to stage behaviour change implementation. The analysis of staff engagement in behaviour changes was assessed through weekly observation of workplaces, informal discussions with staff and facilitator diaries. The impact of behaviour change was informed through pre- and postsurveys on staff's perception across three midwifery sites. Surveys measured (1) midwives' perception of support for their role in facilitating learning (Support Instrument for Nurses Facilitating the Learning of Others) and (2) development of a learning culture in midwifery practice settings (Clinical Learning Organisational Culture Survey). Midwives across three sites completed the presurvey (n = 216) and postsurvey (n = 90). RESULTS: Impact varied according to the degree that facilitators were able to progress teams through four stages necessary for change (OOORO). Statistically significant results were apparent in two subscales important for supporting staff, namely teamwork and acknowledgement; in the two areas, facilitators worked through 'obstacles' and coached staff in performing the desired behaviours and rewarded them for their success. Elements of the learning culture also statistically improved in one site. CONCLUSIONS: Findings suggest behaviour change success is dependent on facilitators to systematically engage staff through all four stages of implementation. RELEVANCE TO CLINICAL PRACTICE: It is important that investment is made to commitment and resources to all four stages before embarking on change processes.

Impact of engaging middle management in practice interventions on staff support and learning culture: a quasi-experimental design.

AIM: This study evaluated the impact of different levels of engaging middle management in ward based strategies implemented by a project educator. BACKGROUND: The challenge for learning in practice is to develop effective teams where experienced staff engage and foster learning with students and other novice staff. DESIGN: A quasi-experimental pre- and post- intervention four group design was conducted from November 2009 to May 2010 across four general surgical and four general medical inpatient matched units in two settings in South East Queensland, Australia. METHOD: Staff survey data was used to compare control and intervention groups (one actively engaging nurse managers) before and after 'practice learning' interventions. The survey comprised demographic data and data from two validated scales (support instrument for nurses facilitating learning and clinical learning organisational culture). RESULTS: Number of surveys returned pre- and post-intervention was 336 from 713 (47%). There were significant differences across many subscales pertaining to staff perception of support in the intervention groups, with only one change in the control group. The number of significant different subscales in the learning culture was also greater when middle management supported the intervention. IMPLICATIONS FOR NURSING MANAGEMENT: Middle management should work closely with facilitators to assist embedding practice interventions.