A modern nursing apprenticeship: back to the future?

1 March 2012

Taranaki’s radical new nursing degree sees first year students into hands-on practice from just week two of training. Nursing Review finds out more.

Nursing students at the patient bedside from week two and working shifts by their second year sounds very old school. But Diana Fergusson, head of Taranaki’s nursing school, is quick to point out the aim of the region’s new nursing programme is not to bring back the ‘good old days’ of hospital-based training.

Instead, the programme is what Taranaki DHB director of nursing Kerry-Ann Adlam calls a “nice hybrid” of the old and new.

On February 20, the first cohort of about 55 students started the radical new nursing degree developed by the Western Institute of Technology at Taranaki (WITT) nursing school in league with its clinical partners.

Fergusson said the new look curriculum arose after consultation with the local DHB, primary health care, aged care, occupational health, Maori health, and child health sectors encouraged WITT to start from scratch and create “something special for Taranaki”.

The strong message give to WITT was that its clinical partners wanted a curriculum centred on clinical practice.

Fergusson drew on the Modern Apprenticeship theory of leading US nurse education theorist Patricia Benner for the curriculum’s underpinning philosophy, along with the case-based and concept-based learning theories from Christine Tanner’s Oregon model of nurse education.

Benner’s model calls for a ‘radical transformation’ in nursing education, with a particularly strong emphasis on practical learning.

In Taranaki, this will mean that first year students will no longer be spending most of their first year in the classroom learning theory. Instead, students in week two will be allocated an acute ward at Taranaki Base Hospital, and from then on, each week will be split between learning on campus and four to six hours practical learning on the ward.

Students will return to the same ward or unit each week so they can get to know, and be known by, staff so they feel a sense of belonging to the nursing team.

“As once they’ve got that sense of belonging, the literature says that they will be able to learn and gain competency much quicker,” says Fergusson.

Adlam adds that staff will also allow students to do more, and earlier, if students are known and familiar to the nursing team.

“When you turn up to a shift and are looking after a student you don’t know the first thing about, you don’t let them do anything that really stretches them, do you?”

Allowing shiftwork from the second year onwards also means more opportunity for students to work with a consistent preceptor.

“In the past, we’ve had instances where a student nurse might have the same preceptor only twice in a six week period and that’s just crazy.”

Adlam says students will also not be expected to meet a standard just once.

“We will expect them to do whatever it is again and again and again and again, as part of their normal day-to-day practice.”

Clinical placements will be in acute general or mental health services for the first two years, with placements stretching out to a week at a time by the second year, along with case-based learning. Gone is the common practice of residential aged care being a student’s first clinical placement, with aged care placements now left until the final year when students are more skilled.

“Because aged care is so complex now and the clients are so complex,” says Fergusson.

The third year will see lengthy placements in both aged care and primary health as well as their final ten-week transition placement.

The number of courses per half-year semester will also be cut from four down to just one so there will only be six courses across the whole degree.

“That allows us to provide an integrated approach to their learning. Their nursing is going to be learned in context,” says Fergusson.

If the concept they are learning in the classroom that week is vital signs, fluid balance, or pain assessment, that is the concept they will also be taught in the ward – whether it is a surgical ward or mental health unit. Fergusson says teaching staff will be on the ward during clinical practice and they are putting check processes in place to ensure each student gets the full range of experiences required.

Fergusson spent last year developing the framework with the school’s partners and guiding it through the formal academic and Nursing Council approval processes so it was ready to kick-off in 2012.

Adlam and Fergusson are excited about their region’s new ‘modern apprenticeship’ approach to nurse education that captures some of the “old ways” – and a lot of the new theory – to help prepare students for the health system of the future.

“I think the literature that supports the framework is robust,” says Fergusson.

In addition, WITT and the DHB will also be carrying extensive and continual evaluation of the new curriculum to see how it is progressing.