02606917/90/0010-0058/$10.00
Nurse Education Today (1990) 10,5%62 0 Longman Group UK Ltd 1990
WORK Tradition v Project 2000 old, something new
something
John G Orr
Simple introduction of Project 2000 will not, of itself, lead to improved standards of nursing or to better retention of staff. The author believes that senior nursing staff may well revert to traditional ego-defensive stances when faced with new problem-solving learners. Implementation of Project 2000 may lead to worsening relationships, entrenchment of already hardened attitudes, increased role conflict for junior nurses, with a resultant loss of job satisfaction and increased wastage. Some conflict areas which exist in nursing are discussed. It is argued that the attitudes a learner holds towards significant others can be correlated with degrees of role conflict and that role conflict can affect job satisfaction, while loss of job satisfaction can result in wastage. Recommendations regarding action which should be taken prior to implementation of Project 2000 are outlined and conclusions drawn regarding possible outcomes.
titioners
INTRODUCTION
could
Project 2000 has been hailed as the Nursing Profession’s last chance to put its house in order. With its revolutionary approach to nurse education and practice it is being heralded by academics
and
senior
‘saviour’ of nursing. the
minds
people
of
There
reasoning,
that Project
2000
professionals
as
the
can be little doubt in logical,
intelligent
is indeed
an exciting
and ‘revolutionary’ proposal; however, is there any reason to believe that it will be any more readily
accepted
by the vast majority
of prac-
than any of its predecessors?
be argued
58
the
SOMETHING An examination year-period
it of
wastage.
OLD of published
work over a 20-
shows that the nursing
just as traditional
Indeed
implementation
Project 2000 may well lead to increased
profession
is
today as it was in the 1960’s. In
his book, Standards for Morale 1964, Professor Revans considered sickness, wastage, examination results and communications as indicators of morale. Jillian Maguire (1969), Threshold to Nursing found that the majority of nurses left voluntarily
John G. Orr MEd RMN SRN Assistant Director of Nurse Education, College of Mental Health Nursing, Purdysburn Hospital, Saintfield Road, Belfast BT8 8BH (Requests for offprints to JO) Manuscript accepted 5 July 1989
that
for ‘other reasons’
that withdrawal can be regarded by the students of the suitability for training purposes. Maguire standard loss of 30% in the first 10% in the second year and 5%
and she suggests as a judgement of the institution (1969) showed a year of training, in the third year.
NURSE EDUCATION
In 1983 the authors cerned
of Project
2000
were con-
that only 65% of those who start training
in England
and
Wales
ultimately
reach
Perhaps
Jullian
withdrawal’
Maguire’s
statement
is withdrawal
the
‘volun-
from
questioning,
tarianism
Register. tary
encourage
training
used the example
whose
attitudes
assumes
Menzies
than the comprehension
and mastery
tific facts and principles. ledge
and
the
establishing
requires
of scien-
It should include know-
development
positive
more
of
relationships
skills
in
with patients
‘why?’
of the principal
well summed
tutor
up in his
statement ‘empty vessels make the most sound. 1 have found that the most vocal students verge on the psychopathic’.
education
59
to authori-
with the question
Boorer
requires further investigation. Does the training programme fail to meet students needs? One that nursing
but revert
when faced are
TODAY
Early studies by Dalton (1969), (1960)
and Revans
Condor
(1964)
(1970),
all indicated
that conflict exists between service and education with high levels of frustration fluencing
not only students
and tension learning,
which, at least will have no adverse effects on the
having implications for patient care. It is interesting to note that the Committee
patient or the nurse.
Nursing
this kind
Further,
of learning
relationship
it is assumed
occurs
in part,
which exists between
that
by the
trained nurses
and nursing students. The student must experience a positive relationship within the context i-n which she is learning to establish patients
to nurse if she is to be able
a positive
relationship
whom she nurses.
There
with
is evidence
suggest that these ‘positive relationships’ always initiated or maintained. Thomas
and Pine1 (1970)
teaching
and 67% believed that insufficient was allocated
to their training. only
14%
to
are not
found that students
believed they had insufficient
questioned
the
by sisters
teaching
time
Of the students
thought
sisters
spent
enough time teaching. LeLean (1973) suggests that some ward sisters spend as little as 2% of
was not stimulating,
contact minimal,
the
amount
which sister has with student while
Reid
(1983)
nurses
quantifies
of is
sister/
student teaching time to be as little as 5 minutes per week. Perhaps, through nursing experience, sisters
develop
the
attitude
students is an unimportant According to Thomas
that
teaching
aspect of their role. and Pine1 students
communi-
student
which is appreciated
or one who in an emer-
gency only’ (Committee
of Nursing
1972
107D). While the Briggs
Committee
report
Para was
published in 1972, it still rings true today. Perhaps the traditionalism of nursing is resistant to all major change? I have tried to show that there is a link between students
negative
attitudes
to nursing
and role
conflict and that role conflict leads to further negative attitudes which may have a mushrooming
effect
velopment
that
on
basic training
but exhausting;
by a knowledgeable
uses initiative
all.
claims
claimed
mittee also stated that ‘some sisters are threatened
hospital.
(1976)
report)
cations were poor, questions not welcomed, and there was little time for real care. The Com-
their time with students and in 80% of the student days - no communication with sister at Long
(Briggs
in-
but also
and
spread
throughout
an entire
1 believe that there is an almost inevit-
able progression
from
the foundation
and de-
of negative attitudes to ever widening
conflict to loss of all job satisfaction ally wastage. The belief
regarding
loss of job
and eventusatisfaction
continues to be shared by many others in the 1980’s. West and Rushton (1986) found that levels of frustration, reactions
latent
were significantly
hostility higher
and angry among
the
believe that clinical teachers and tutors are out of touch with the reality of nursing, technical
student nurses than among a large sample of graduate engineers. They further claim that
advances and advances in other methods of treatment. While this study by Thomas and Pine1
learners were likely to feel that their efforts to work efficiently as possible were blocked by
is limited it does highlight
some areas of conflict.
other people.
It can be legitimately
claimed that
David Boorer (197 1) argues that there is a very real and deep seated insecurity among nurses in
both earlier and recent research indicates that learners do not experience their working en-
senior
vironment
posts;
he shows
that
many
appear
to
as warm and supportive.
West and
60
NURSE EDUCATION
Rushton (1986) MOST learners
TODAY
have shown in their study that were dissatisfied with the job
security and many were dissatisfied
with super-
vision, lack of respect and low pay. West and Rushton learners
in their
having no freedom perception
(1986) suggests that 45% of
study perceived
to act independently
role as and this
was associated with lower satisfaction
at work and greater freedom
their
frustration.
is suggested
This
lack of
to be an important
stress for the student
cause of
nurse.
A high level of stress may be a cause of low job satisfaction. shown that played
Darcy where
by senior
identificable cinating
staff
to learners,
loss in job
study
and job (1988)
(1988), Waite (1987) have negative attitudes are disthere
satisfaction.
of organisational
satisfaction
in nursing,
is an
In a fas-
commitment Wakefield
et al
have shown that where there is a conflict
between
the needs of the organisation
professional
development
needs
to the high turnover
I would suggest that the problem must be attacked at various levels. I have argued elsewhere
for promotion
Appointments
among
hos-
pital based nurses in the USA.
Bendall’s
nursing today,
in the and
as being
1950/1960’s
nursing
bound profession
dissatisfiers
must
are important (197 1) claimed
factors
‘a nurse’s attitudes
be found attitudes
in patient to patients
in
those who teach from those
Then
the only way forward
providing
a
situation
immersed
in
develops
where
practice
and
the the
her educational role. to prepare for Project the same tasks I identified
In order believe
is to be
teacher
is
practitioner 2000, I still in 1984 lie
ahead:a)
Educating percieve
b) c) d)
‘traditional’ their
role
tutors
as solely
who class-
room orientated; Determining areas of responsibility; Overcoming staff;
resistance
Motivating
ward
of
sisters
service to
seek
Developing the clinical nursing officer; Overcoming
emotional
g)
quickly,
to patients
care.
Boorer
are both influ-
to her and by her attitudes
Overcoming from
role of the reactions
resistence
a profession
to change
which
tional and conservative
in
staff; is tradi-
in outlook.
hide-
enced by the attitudes of staff (both senior and junior)
of
mistake to separate
are still prevalent
is still a traditional,
as the nurses’
an acceptance
senior service/teaching
with the same vicious circle of
of events
particularly
would confirm
that more
who practice.
D
role conflict, negative attitude development, loss of job satisfaction and wastage. Ways to break this chain
of Joint
I believe
higher qualifications;
‘NURSING, A HIDEBOUND PROFESSION’ identified
of the concept 1984).
claim that it has been a fundamental
e)
Problems
(Orr
joint appointees
and the
of the nurse,
organisational requirements takes precedence. They claim that this conflict is most important in contributing
THE WAY FORWARD
to them -
It must be recognised of a new Preparations (Project
2000)
that simple introduction for Practice
Curriculum
will not in itself remove/reduce
role conflict nor increase job satisfaction.
In fact,
such changes may actually increase role conflict by forcing traditionalists into a defensive authoritarian stance when faced with the new research/problem solving orientated student nurse. it is important therefore that we accept an individual
and collective
responsibility
to ‘Sell’
attitudes between staff and attitudes of staff to patients are, in reality, indivisible’.
the Project at every available opportunity allowing even the most traditionalist nurse the opportunity to discuss and participate in decisions
If Boorer is right, then one could assume that morale will be low were high degrees of conflict exist.
about how change should develop. It is clear too that Colleges of Nursing need to incorporate comprehensive programmes of
NURSE EDUCATION
stress management itate
the
among
into their curricula
development
a!1 nurses.
outlined
Interdisciplinary
by Bergman
misunderstanding,
and facil-
of interpersonal
skills
training,
as
(197 1) may help remove conflicts
and
negative
atti-
tudes between the various hospital disciplines. common
basic
course
for
doctors,
A
interdisciplinary one
would reinforce training by many psychologists who state that
way of changing
attitudes
is by proper
education. Committees should be set up to ensure a free flow of communications in the nurse
hierarchy.
Prevalent
identified
and potential
removed
by interchange
disciplines.
attitudes
or existing personnel
appointed
in a counselling/liasion
strengthen
ties between
There
should be shared
informal
dialogue
should
be
role conflicts
of dialogue
Professional
among
should
be
capacity
to
service and education. facilities available for
between
disciplines.
Social
clubs should be formed
at all hospital complexes
to assist in cementing
positive
informal
setting.
continuing
education
for all nurses fessional
Perhaps
attitudes
in an
most important
of all,
should be made available
to ensure
self-respect
maintenance
and prevent
of pro-
regression
authoritarian stances when ‘threatened’ questions of a ‘degree’ nurse. Shenton provision tinuing existing
and
Hamm
of appropriate education employees
(1988)
claim
opportunities
that
the
for conof changes
and developments, and to feel confident their present professional role. However, employers
to
by the
for all staff is vital to enable to keep abreast
pay only lip-service
about many
to the provision of
continuing education, and many do not make the opportunities which do exist sufficiently well known to their staff. The continuing education budget is often the first expenditure to be cut by cost saving employers,
but this is an expensive
false economy. As part of a continuing education proit is vital to introduce/develop a gramme, meaningful Staff Development and Performance review schedules in order to accurately identify Service
staff needs. programmes
Where should
61
that staff feel
that their voices are being heard. I believe that implementation
of these recom-
mendations should lead to diminished role conflict, more positive attitudes and increased job satisfaction.
nurses,
physiotherapists, etc., could then branch out into their own specific areas. Bergman’s call for statements
meet these needs as it is important
TODAY
appropriate, be developed
Into
References Bendall E 1965 ‘Wastage, sickness and allocation. A survey of student nurses’. Nursing Times, 4 June: 760-763 Bergman R 197 1 International Nursing Review 18, 3 Boorer D 1971 The study of attitudes - a vital problem for all nurses. Nursing Times, 67, 26 August 1967: 1045-1047 Commitee of Nursing 1972 Report of the Committee on Nursing. Chairman: A. Briggs. Her Majesty’s Stationery Office Conder P 1970 Tension: the needs of service & education. Nursing Times, 26 February: 274-276 Dalton B M 1969 ‘Withdrawal from training of RNMS student nurses’. Nursing Times, 7 August 1969, Occasional Papers, 125-128 and Nursing Times, 14 August 1969, Occasional Papers: 129- 132 D’Arcy P 1988 Time to mature. Nursing Times, 3 1 August 1984, 35: 43-44 Fox D et al 1965 Satisfying & stressful situations. Columbia University Press Hale C 1986 Measuring iob satisfaction. Nursing Times 82 April, pp. 43-46 vd Heyman R, Shaw M P & Harding J 1984 ‘A longitudinal study of changing attitudes to work among nursing trainees in two British general hospitals’. Journal of Advance Nursing 9, 6:-297-305 . Hvland M E. Millar 1 & Parker S 1988 How hosnital ‘ward members t&at learner nurses. Journal 01 Advance Nusing 13,4: 472-477 LeLean S 1973 Ready to report, nurse. Royal College of Nursing, London Long P 1976 Student nurse assessment. Nursing Times, 72.2: 522-555 Maguire J 1969 Threshold to nursing. Bell Publications, London Menzies I E P 1960 ‘The functioning of social systems as a defence against anxiety’. Tavistock Institute of Human Relations Merton R K 1957 Social therapy and social structure. New York Free Press Orr J 1984 Joint appointments - the way forward. Nurse Education Today 4,6: 132-134 United Kingdom Central Council for Nursing, Midwifery and Health Visiting 1986 Project 2000 - a new preparation for practice.-United Kingdom Central Council for Nursing, Midwiferv and Health Visiting. Reid N.G. 1985 ‘The effective training of nurses: manpower implications’. International Journal of Nursing Studies 22, 2: 89-98 Reid N.G. 1985 B Wards in Chancery (Nurse Training in the Clinical area). RCN London Reid N.G. 1983 Aspects of Nursing Training in
62
NURSE EDUCATION
TODAY
Northern Ireland. New University of Ulster, Coleraine Revans R W 1964 Standards for Morale: Cause and effect in Hospitals. Nuffield Provincial Hospitals Trust, Oxford H.P. Shenton H & Hamm C 1988 How to retain nurses. Professional nurse 3,9: 360, 362 Thomas E & Pine1 C 1970 Ward teaching, what nurses think. Nursing Times 66, 9: 286287
Waite R 1987 Waste not, want not. Nursing Times 83. 27: 25-7 Wakefield S et al 1988 Differences in work outcomes. Job satisfaction, organisational commitment and turnover among hospital nursing departent employees. Wo;ld Journal of Nt&sing Research United States of America. No. (11 98-105 West M & Rushton R 1986 The drop out factor. Nursing Times 3 1 December: 293 1.
Nurse Education Today (1990) 10,5%62 0 Longman Group UK Ltd 1990
WORK Tradition v Project 2000 old, something new
something
John G Orr
Simple introduction of Project 2000 will not, of itself, lead to improved standards of nursing or to better retention of staff. The author believes that senior nursing staff may well revert to traditional ego-defensive stances when faced with new problem-solving learners. Implementation of Project 2000 may lead to worsening relationships, entrenchment of already hardened attitudes, increased role conflict for junior nurses, with a resultant loss of job satisfaction and increased wastage. Some conflict areas which exist in nursing are discussed. It is argued that the attitudes a learner holds towards significant others can be correlated with degrees of role conflict and that role conflict can affect job satisfaction, while loss of job satisfaction can result in wastage. Recommendations regarding action which should be taken prior to implementation of Project 2000 are outlined and conclusions drawn regarding possible outcomes.
titioners
INTRODUCTION
could
Project 2000 has been hailed as the Nursing Profession’s last chance to put its house in order. With its revolutionary approach to nurse education and practice it is being heralded by academics
and
senior
‘saviour’ of nursing. the
minds
people
of
There
reasoning,
that Project
2000
professionals
as
the
can be little doubt in logical,
intelligent
is indeed
an exciting
and ‘revolutionary’ proposal; however, is there any reason to believe that it will be any more readily
accepted
by the vast majority
of prac-
than any of its predecessors?
be argued
58
the
SOMETHING An examination year-period
it of
wastage.
OLD of published
work over a 20-
shows that the nursing
just as traditional
Indeed
implementation
Project 2000 may well lead to increased
profession
is
today as it was in the 1960’s. In
his book, Standards for Morale 1964, Professor Revans considered sickness, wastage, examination results and communications as indicators of morale. Jillian Maguire (1969), Threshold to Nursing found that the majority of nurses left voluntarily
John G. Orr MEd RMN SRN Assistant Director of Nurse Education, College of Mental Health Nursing, Purdysburn Hospital, Saintfield Road, Belfast BT8 8BH (Requests for offprints to JO) Manuscript accepted 5 July 1989
that
for ‘other reasons’
that withdrawal can be regarded by the students of the suitability for training purposes. Maguire standard loss of 30% in the first 10% in the second year and 5%
and she suggests as a judgement of the institution (1969) showed a year of training, in the third year.
NURSE EDUCATION
In 1983 the authors cerned
of Project
2000
were con-
that only 65% of those who start training
in England
and
Wales
ultimately
reach
Perhaps
Jullian
withdrawal’
Maguire’s
statement
is withdrawal
the
‘volun-
from
questioning,
tarianism
Register. tary
encourage
training
used the example
whose
attitudes
assumes
Menzies
than the comprehension
and mastery
tific facts and principles. ledge
and
the
establishing
requires
of scien-
It should include know-
development
positive
more
of
relationships
skills
in
with patients
‘why?’
of the principal
well summed
tutor
up in his
statement ‘empty vessels make the most sound. 1 have found that the most vocal students verge on the psychopathic’.
education
59
to authori-
with the question
Boorer
requires further investigation. Does the training programme fail to meet students needs? One that nursing
but revert
when faced are
TODAY
Early studies by Dalton (1969), (1960)
and Revans
Condor
(1964)
(1970),
all indicated
that conflict exists between service and education with high levels of frustration fluencing
not only students
and tension learning,
which, at least will have no adverse effects on the
having implications for patient care. It is interesting to note that the Committee
patient or the nurse.
Nursing
this kind
Further,
of learning
relationship
it is assumed
occurs
in part,
which exists between
that
by the
trained nurses
and nursing students. The student must experience a positive relationship within the context i-n which she is learning to establish patients
to nurse if she is to be able
a positive
relationship
whom she nurses.
There
with
is evidence
suggest that these ‘positive relationships’ always initiated or maintained. Thomas
and Pine1 (1970)
teaching
and 67% believed that insufficient was allocated
to their training. only
14%
to
are not
found that students
believed they had insufficient
questioned
the
by sisters
teaching
time
Of the students
thought
sisters
spent
enough time teaching. LeLean (1973) suggests that some ward sisters spend as little as 2% of
was not stimulating,
contact minimal,
the
amount
which sister has with student while
Reid
(1983)
nurses
quantifies
of is
sister/
student teaching time to be as little as 5 minutes per week. Perhaps, through nursing experience, sisters
develop
the
attitude
students is an unimportant According to Thomas
that
teaching
aspect of their role. and Pine1 students
communi-
student
which is appreciated
or one who in an emer-
gency only’ (Committee
of Nursing
1972
107D). While the Briggs
Committee
report
Para was
published in 1972, it still rings true today. Perhaps the traditionalism of nursing is resistant to all major change? I have tried to show that there is a link between students
negative
attitudes
to nursing
and role
conflict and that role conflict leads to further negative attitudes which may have a mushrooming
effect
velopment
that
on
basic training
but exhausting;
by a knowledgeable
uses initiative
all.
claims
claimed
mittee also stated that ‘some sisters are threatened
hospital.
(1976)
report)
cations were poor, questions not welcomed, and there was little time for real care. The Com-
their time with students and in 80% of the student days - no communication with sister at Long
(Briggs
in-
but also
and
spread
throughout
an entire
1 believe that there is an almost inevit-
able progression
from
the foundation
and de-
of negative attitudes to ever widening
conflict to loss of all job satisfaction ally wastage. The belief
regarding
loss of job
and eventusatisfaction
continues to be shared by many others in the 1980’s. West and Rushton (1986) found that levels of frustration, reactions
latent
were significantly
hostility higher
and angry among
the
believe that clinical teachers and tutors are out of touch with the reality of nursing, technical
student nurses than among a large sample of graduate engineers. They further claim that
advances and advances in other methods of treatment. While this study by Thomas and Pine1
learners were likely to feel that their efforts to work efficiently as possible were blocked by
is limited it does highlight
some areas of conflict.
other people.
It can be legitimately
claimed that
David Boorer (197 1) argues that there is a very real and deep seated insecurity among nurses in
both earlier and recent research indicates that learners do not experience their working en-
senior
vironment
posts;
he shows
that
many
appear
to
as warm and supportive.
West and
60
NURSE EDUCATION
Rushton (1986) MOST learners
TODAY
have shown in their study that were dissatisfied with the job
security and many were dissatisfied
with super-
vision, lack of respect and low pay. West and Rushton learners
in their
having no freedom perception
(1986) suggests that 45% of
study perceived
to act independently
role as and this
was associated with lower satisfaction
at work and greater freedom
their
frustration.
is suggested
This
lack of
to be an important
stress for the student
cause of
nurse.
A high level of stress may be a cause of low job satisfaction. shown that played
Darcy where
by senior
identificable cinating
staff
to learners,
loss in job
study
and job (1988)
(1988), Waite (1987) have negative attitudes are disthere
satisfaction.
of organisational
satisfaction
in nursing,
is an
In a fas-
commitment Wakefield
et al
have shown that where there is a conflict
between
the needs of the organisation
professional
development
needs
to the high turnover
I would suggest that the problem must be attacked at various levels. I have argued elsewhere
for promotion
Appointments
among
hos-
pital based nurses in the USA.
Bendall’s
nursing today,
in the and
as being
1950/1960’s
nursing
bound profession
dissatisfiers
must
are important (197 1) claimed
factors
‘a nurse’s attitudes
be found attitudes
in patient to patients
in
those who teach from those
Then
the only way forward
providing
a
situation
immersed
in
develops
where
practice
and
the the
her educational role. to prepare for Project the same tasks I identified
In order believe
is to be
teacher
is
practitioner 2000, I still in 1984 lie
ahead:a)
Educating percieve
b) c) d)
‘traditional’ their
role
tutors
as solely
who class-
room orientated; Determining areas of responsibility; Overcoming staff;
resistance
Motivating
ward
of
sisters
service to
seek
Developing the clinical nursing officer; Overcoming
emotional
g)
quickly,
to patients
care.
Boorer
are both influ-
to her and by her attitudes
Overcoming from
role of the reactions
resistence
a profession
to change
which
tional and conservative
in
staff; is tradi-
in outlook.
hide-
enced by the attitudes of staff (both senior and junior)
of
mistake to separate
are still prevalent
is still a traditional,
as the nurses’
an acceptance
senior service/teaching
with the same vicious circle of
of events
particularly
would confirm
that more
who practice.
D
role conflict, negative attitude development, loss of job satisfaction and wastage. Ways to break this chain
of Joint
I believe
higher qualifications;
‘NURSING, A HIDEBOUND PROFESSION’ identified
of the concept 1984).
claim that it has been a fundamental
e)
Problems
(Orr
joint appointees
and the
of the nurse,
organisational requirements takes precedence. They claim that this conflict is most important in contributing
THE WAY FORWARD
to them -
It must be recognised of a new Preparations (Project
2000)
that simple introduction for Practice
Curriculum
will not in itself remove/reduce
role conflict nor increase job satisfaction.
In fact,
such changes may actually increase role conflict by forcing traditionalists into a defensive authoritarian stance when faced with the new research/problem solving orientated student nurse. it is important therefore that we accept an individual
and collective
responsibility
to ‘Sell’
attitudes between staff and attitudes of staff to patients are, in reality, indivisible’.
the Project at every available opportunity allowing even the most traditionalist nurse the opportunity to discuss and participate in decisions
If Boorer is right, then one could assume that morale will be low were high degrees of conflict exist.
about how change should develop. It is clear too that Colleges of Nursing need to incorporate comprehensive programmes of
NURSE EDUCATION
stress management itate
the
among
into their curricula
development
a!1 nurses.
outlined
Interdisciplinary
by Bergman
misunderstanding,
and facil-
of interpersonal
skills
training,
as
(197 1) may help remove conflicts
and
negative
atti-
tudes between the various hospital disciplines. common
basic
course
for
doctors,
A
interdisciplinary one
would reinforce training by many psychologists who state that
way of changing
attitudes
is by proper
education. Committees should be set up to ensure a free flow of communications in the nurse
hierarchy.
Prevalent
identified
and potential
removed
by interchange
disciplines.
attitudes
or existing personnel
appointed
in a counselling/liasion
strengthen
ties between
There
should be shared
informal
dialogue
should
be
role conflicts
of dialogue
Professional
among
should
be
capacity
to
service and education. facilities available for
between
disciplines.
Social
clubs should be formed
at all hospital complexes
to assist in cementing
positive
informal
setting.
continuing
education
for all nurses fessional
Perhaps
attitudes
in an
most important
of all,
should be made available
to ensure
self-respect
maintenance
and prevent
of pro-
regression
authoritarian stances when ‘threatened’ questions of a ‘degree’ nurse. Shenton provision tinuing existing
and
Hamm
of appropriate education employees
(1988)
claim
opportunities
that
the
for conof changes
and developments, and to feel confident their present professional role. However, employers
to
by the
for all staff is vital to enable to keep abreast
pay only lip-service
about many
to the provision of
continuing education, and many do not make the opportunities which do exist sufficiently well known to their staff. The continuing education budget is often the first expenditure to be cut by cost saving employers,
but this is an expensive
false economy. As part of a continuing education proit is vital to introduce/develop a gramme, meaningful Staff Development and Performance review schedules in order to accurately identify Service
staff needs. programmes
Where should
61
that staff feel
that their voices are being heard. I believe that implementation
of these recom-
mendations should lead to diminished role conflict, more positive attitudes and increased job satisfaction.
nurses,
physiotherapists, etc., could then branch out into their own specific areas. Bergman’s call for statements
meet these needs as it is important
TODAY
appropriate, be developed
Into
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NURSE EDUCATION
TODAY
Northern Ireland. New University of Ulster, Coleraine Revans R W 1964 Standards for Morale: Cause and effect in Hospitals. Nuffield Provincial Hospitals Trust, Oxford H.P. Shenton H & Hamm C 1988 How to retain nurses. Professional nurse 3,9: 360, 362 Thomas E & Pine1 C 1970 Ward teaching, what nurses think. Nursing Times 66, 9: 286287
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