By Anthony Tuckett
What will become known as the Schwartz Report into Nurse Education reviews the educational preparation of nurses in Australia and factors that influence why an individual would make nursing as career choice.
Steven Schwartz’s Educating the Nurse of the Future has 17 years of nurse education experiences to call upon; provides 26 recommendations across 77 pages and invites nurse educators and higher education providers to evaluate our responses to it in four years.
Professor Schwartz points to challenges that have changed since the last review, in 2002.
Population ageing: is underscored as impacting nurse education today and into the future, accordingly determining curriculum content. This is a no brainer. What nurse educators and other healthcare professional educators must do is move older people nursing from being “a thing” and make it “the thing.” This means more than tacking it onto the front-end of an enrolled nurse or bachelor of nursing programme as an introduction to activities of daily living (“basic nursing cares”).
The review also asks us to reflect on the rise of the unregulated carer, especially in aged-care. This ties to a general concern with the wavering English language and numeracy proficiency of graduates. None in the nursing education community will argue against Schwartz’s call to have assistants in nursing regulated. We all agree. And the Royal Commission into Aged Care Quality and Standards will certainly recommend AINs be better educated and regulated. Those who will balk at this impost will be the aged care business operators scratching to keep costs down…better educated, regulated workers cost more!
Unsurprisingly, mental health and well-being is picked out as necessarily determining nursing curriculum content. Professor Schwartz calls for equipping a nursing workforce capable of helping people with psychological problems. Who would argue?
ENoF proposes an evidence-based rationale for prescribing adequate clinical placement hours and makes a prima facie case for increasing hours in Australia (suggesting 1000 hours). This would need to be evidence-based, but whatever the size of an increase, the question will be how to fund it and where to find more placements. As the report points out, clinical placements are already shabby and not fit-for-purpose, for want of proper sites. Whilst the report also demands only assigning accredited placement facilities for clinical placements, this would increase their scarcity and costs. It is not something the Australian Health Practitioner Regulation Agency and the Australian Nursing and Midwifery Accreditation Council could pull-off in a four-year review period.
All will agree with Professor Schwartz that nursing students on regional placements should have their travel and accommodation costs covered. There is an argument that this should not be limited to regional outreach, inner-city placement poverty is emerging as a very real undergraduate concern, with very real financial, plus emotional, burdens. Subsidies are needed for clinical placements, regardless of the nurse undergraduate’s placement postcode.
Not everyone will agree with the report’s recommendation for more focus on outcomes or a standard list of core skills, to be tabulated and ticked-off by the undergraduate nurse as evidence of work readiness.
In some quarters, this professional practice record-book has its origins in the darkness of a bygone era when nurses were trained in the hospitals.
Challenges to introducing it would include reaching a consensus on what would be on the list, and how prescriptive it would be. In keeping with a focus on assessment and readiness for practice, a return to the universal examination –what used to be called The State Exam – where graduates sit an independently administered test, is proposed.
Regardless of what the professions thinks about this proposal, logic dictates it is a fair and reasonable proposition, given the Nursing and Midwifery Board of Australia is exploring testing internationally prepared professional nurses seeking registration here.
There is also some merit in extending the bachelor of nursing to 3.5, or even four years (a 3.5 year precedent exists). An additional year could be research training leading to doctoral studies (see Recommendation 25) or a paid internship. Higher education providers with extended programmes and those with overtly designed and publicised articulation pathways between the EN to BN have obviously influenced the report (for example, Curtin University). This makes sense for student retention, offering exit points – and exit points that allow undergraduates to earn a living.
The report does not say it so overtly, but nesting a cluster of VET providers within the Academy would be a win-win for the HEPs, the diversification of the student and academic profile, and the nursing workforce.
Inter-professional Education is cited as a cornerstone for educating the nurse leaders Professor Schwartz generously identifies as necessary professionals overseeing multi-disciplinary teams. However, the report does suggest while there is some talking the talk, there is little walking the walk among nurse education higher education providers. Beyond the few HEPs trying, who would argue?
There is opportunity and scale to innovate here, and the report’s call for work on digital, online delivery is one solution upon which we can capitalise.
The report speaks to the need for innovation and scholarship of learning and teaching around online delivery and the use of simulation.
Alongside these there is also a call for a curriculum that addresses the rapid emergence of health informatics and digital health technologies. The report flags real opportunities here – the melding of best available digital and interactive synchronous teaching and group building technologies to also deliver new content in a recommended expanded degree. It is true though, if we hold to the technological imperative, the wicked problems are costs, accessibility for those on the fringes and reliability of networks.
Professor Schwartz scores a “distinction”. While there is much to prize, be pleased and proud about in nurse education in Australia, his report is equally positive.
Dr Anthony Tuckett teaches and researches in the University of Queensland’s School of Nursing, Midwifery and Social Work