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Editorial Is postgraduate education a luxury or necessity for professional nurses: A trans-Tasman perspective Louise D Hickman, Judy Mannix* and Stephen Neville+ Faculty of Health University of Technology, Sydney, NSW, Australia; *School of Nursing & Midwifery, University of Western Sydney, Penrith, NSW, Australia; +School of Nursing, Massey University, Auckland, New Zealand
ever before has there been such a need for nursing expertise to be at the forefront of health care provision. Global populations are more complex than ever before, with an ageing of the population bringing with it an increase in chronic and complex health and social care needs. There continues to be disparities in service usage and outcomes for many individuals and their families in our diverse communities. Nurses are integral to the provision of health care services to individuals and communities, and are the health professional group who have most contact with consumers of health services. As the largest health professional group, nurses are in a premier position to provide comprehensive health care to consumers that is evidence-based, seamless and person-centred. Within the western world health care is an expensive commodity, largely due to technological advances in health care delivery. In addition, the provision of health care occurs in an environment of diminishing fiscal and human resources. Attempts at containing health care costs are identified in a recent report recommending that tertiary educated registered nurses be replaced with less educated, unregulated personnel to provide personal care for patients in hospitals (Duckett, Breadon, & Farmer, 2014). Care delivery model changes like this delegates what has historically been deemed the work of registered nurses to untrained caregivers in order to free up registered nurses to perform more complex tasks, for example, administer light sedation for procedures, undertaking endoscopies and prescribing, all tasks that traditionally were roles undertaken by medical officers. The care provided by untrained personnel does not occur in a vacuum and requires oversight by registered nurses. This adds to the complexity of the registered nurse role and 2
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requires advanced clinical skills including management and leadership skills. Postgraduate education is the platform for the development of evidence-based advanced clinical and leadership skills. It is therefore essential that postgraduate nursing education is both encouraged and available, especially considering that nurses are one of the few health professional groups whose undergraduate, pre-registration education is restricted to a 3-year degree. Unlike allied health colleagues and doctors, nurses do not experience the benefits of a 4- to 6-year undergraduate degree as preparation for initial practice in their chosen discipline. To argue that nurses do not need as comprehensive an education as other health professionals is nonsensical, considering the 24/7 role registered nurses undertake. Currently, not all new graduates are able to secure employment at the end of their nursing degree but in the not too distant past the reverse was reality; there had not been enough nurses to fill vacancies. Compounding this was the difficulty in retaining registered nurses long-term in the workforce. Even in the current climate it can be difficult retaining new graduates beyond their first few years of practice. One of the keys to increasing retention rates is to have a nursing workforce that is better equipped and educated to survive and thrive in an increasingly complex health care environment. It is clear from economic and workforce planning perspectives that undergraduate nursing courses are unlikely to increase in length anytime soon so it is imperative that opportunities exist for nurses to access postgraduate courses. Postgraduate education in nursing provides the basis for registered nurses to extend their knowledge and expertise within chosen areas of healthcare. In addition, these postgraduate qualifications empower nurses to lead
Internal use and practice at advanced levels within their scope and areas of practice. Ultimately advanced nursing practice roles must positively impact on the health and wellbeing of consumers of health services. An example from New Zealand is the development of registered nurse prescribing roles where nurses after undertaking a postgraduate programme of study and subsequent approval from their regulatory body are able to prescribe a designated set of pharmacopoeia, within a defined area of practice. The postgraduate education underpinning this nursing practice role requires a nurse to undertake courses in physiology and pathophysiology, advanced assessment and clinical decision-making, clinical pharmacology and a prescribing practicum. Consequently, these registered nurses are able to provide a timely and comprehensive health care service to individuals and communities that have the potential, if community based for example, to decrease admissions to acute care environments. Fortunately, New Zealand nurses have the opportunity to have their clinically focussed postgraduate education funded by government, which is not the case elsewhere. To undertake advanced nursing practice roles, such as the example outlined above, the nursing workforce needs to be not only appropriately educated but also adequately resourced to positively impact on health outcomes, as well as to be fiscally prudent within a financially strained health care system. Advanced nursing practice roles mean nurses are able to work to the upper end of their scope of practice. While pre-registration nurse education delivered through tertiary education providers is widespread and accessible across the developed world, in Australia the opportunity to access postgraduate education is not in the same position. Unlike undergraduate nurse education most postgraduate courses are not subsidised, meaning that registered nurses need to complete
courses as full-fee paying students, a situation that can create financial stress for nurses who usually have other financial responsibilities and pressures associated with day-to-day living. Now more than ever industry and universities need to support nurses to complete postgraduate nursing education. There are some areas within the postgraduate nursing environment where there is little requirement by industry to advance knowledge and skills. Sadly, some of these areas, such as primary health care, mental health and aged related residential care are seen as priority areas by health experts. In the current climate, nurses at all levels require a range of skills and enhanced resilience to enable them to navigate the complexities of their environment and patient needs. There are funding differences between New Zealand and Australia that impact on the accessibility of postgraduate education for nurses. However, both countries need a highly skilled nursing workforce; not only clinical skills but also management and leadership skills. Consequently postgraduate qualifications in nursing should be available and accessible to all nurses post-registration. Postgraduate education provides nurses with critical thinking, knowledge translation, leadership capacity, interprofessional communication and advanced clinical skills. Not only does the current health care environment throw up challenges, it also provides opportunities. After all, nurses are frequently ranked as the most trusted professional group by the public. We need to honour the public’s trust in us by ensuring the nursing workforce has the capacity to provide quality care and services built from a strong evidence-base, gained through quality education. Reference
Duckett, S., Breadon, P., & Farmer, J. (2014). Unlocking skills in hospitals: Better jobs, more care. Carlton, VIC: Grattan Institute.
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