Pressure on primary health care student placements

1 July 2012

Increasing interest from nursing students in primary health careers is putting pressure on clinical placements in primary health, a research project has found.

A number of recommendations to improve the availability and consistency of clinical placements was made by the research team following its survey of New Zealand nursing schools.

Karen Betony, lead researcher for the project and Nurse Maude community nurse educator, said in the past nursing students didn’t see community or primary health care as their first career choice. But now, in a trend being felt internationally, more institutions were reporting students requesting primary health settings for their final elective placements.

“That puts additional pressure on institutions to find places to accommodate them.”

Fourteen of the sixteen nursing schools returned the research questionnaire, which gathered baseline information on the range of primary health and community settings used for clinical placements, innovations or barriers to schools providing quality placements, and how their degree’s primary health content was taught.

Betony said one issue highlighted by the survey was that the Nursing Council stipulates students should gain experience in “primary health care and community settings” but did not make clear how wide or narrow those settings could be.

“It means that there are potential teams out there that aren’t being used, either because the tertiary institution doesn’t feel they are appropriate or the teams themselves don’t see themselves as appropriate or offering anything of value, which is a real shame.”

Some respondents identified community mental health teams, correctional services, defence force, and residential schools as primary health and community placements, and several included aged care facilities.

Uncertainty over whether any non-hospital based placement met the Nursing Council requirement had prompted a recommendation by the study for the Nursing Council to clarify its expectations of a “primary health care and community” clinical placement.

Further recommendations were made to establish regional approaches to clinical placement, to prevent "poaching" and manage placements more efficiently, and to review funding of placements to prevent barriers to primary health placements for nurses.

Betony said issues were raised by schools about placing students in general practices, with some GPs concerned about the interruption to their practice nurses’ workload and the increased pressure on the practice. Some schools also reported to researchers about medical centres being given priority to GP trainees and the issue of wanting money for placing students was also more of an issue in these centres.

Taking an inter-professional team approach to student learning, for example, getting feedback on a student’s patient interactions from an observing occupational therapist or physiotherapist, was also recommended.

Betony said there was also potential in placing students in community services like the Salvation Army, although they didn’t traditionally employ registered nurses.

“They are providing the epitome of primary health care as they are working close to where the patient lives, works, and plays.”

She said while such a placement may mean the student was not doing clinical cares, like wound dressing, they would be gaining clinical skills experience in guidance, advice, and health promotion and could be assessed by an RN working with the service.

Betony, who works for Christchurch’s Nurse Maude Association, said recommendations from the research project, which was carried out in league with the Christchurch Polytechnic Institute of Technology and New Zealand Institute of Community Health Care, had been sent out widely to places including the Nursing Council, Health Workforce New Zealand, Ministry of Health, and nursing organisations.