Doctoral researcher Jennifer Roberts is asking for nurse educators to take part in an anonymous survey about their preparedness and experiences of working with Māori nursing students in nursing schools.
Roberts is head of EIT’s School of Nursing, which has a high percentage of its nursing student population identifying as Māori – about a third in its Hawke’s Bay campus and about half in Gisborne.
“It’s an important study body for us in our region and we take that responsibility seriously given the national emphasis on growing the Māori nursing workforce.”
In 2015 the HWNZ Nursing Workforce Governance Group set a date of 2028 for the Māori nursing workforce to match the percentage of Māori in the population with the goal of helping improve access to quality health care for Māori. (Currently nurses identifying as Māori make up about six per cent of the nursing workforce, while Māori are 15 per cent of the New Zealand population.)
Roberts said she initially considered looking at what were the barriers and enablers for Māori nursing students’ success for her doctoral research topic. A literature search discovered that a lot of work had been done in that area but where there was a gap in knowledge was how nurses educators and nursing schools worked with Māori nursing students.
So she decided to flip the question around and focus on how nursing education practice in nursing schools and institutes may be contributing or inhibiting Māori student success. “And success is more than just achieving the qualification, it is about having a positive experience through learning as well,” said Roberts.
She said little was known about nursing educators’ preparedness for working with Māori students or their experiences in doing so.
“As (nursing) lecturers I think we all understand the importance of cultural safety in nursing practice,” said Roberts. But she wondered how that translated into how teachers themselves taught and interacted with student nurses. “Are we (ourselves) culturally safe in the classroom?”.
Roberts said if you look at the population of nurse educators, most were Pakeha like herself. “I think so many of us are well intentioned, but we maybe don’t have the tools…” said Roberts. “We want to do a good job, but are we?” She stressed it was “not a witch-hunt in any way” and instead her research’s aim was to help figure out how best to equip the nurse educator workforce to deal with cultural aspects of education.
Roberts said helpful work had been done by Ngā Manukura o Āpōpō – a workforce project to foster the professional development of Māori nurses and midwives that has included publishing performance scorecards of nursing schools. Informal work had also been done by NETS (Nursing Education in the Tertiary Sector) looking at what systems nursing schools had in place for supporting Māori students. Roberts’ work was to focus on the preparation and experience of nurse educators
She is inviting nurses currently working in undergraduate nursing education as nursing lecturers, nursing programme co-ordinators or undergraduate nursing programme managers to take part in an online survey and/or interviews.
Her research questions include:
Nurse educators who wish to take part in the anonymous questionnaire can click here or email Jennifer Roberts to find out more.
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Your initial personal statement – what drew you to the profession of nursing and what you can offer and contribute.
(Rachel Phillips and Lorelle Bobsien, graduate programme coordinators at Auckland DHB.)
(Sandra McLean-Cooper, nurse consultant education and development at Nelson-Marlborough DHB.)
(Steph White, NETP coordinator for Capital & Coast DHB.)
( Sally Houliston, nurse consultant workforce for Hawke’s Bay DHB.)
(Rachel Phillips and Lorelle Bobsien, graduate programme coordinators at Auckland DHB.)
(Sandra McLean-Cooper, nurse consultant education and development at Nelson-Marlborough DHB.)
(Steph White, NETP coordinator for Capital & Coast DHB.)
( Sally Houliston, nurse consultant workforce for Hawke’s Bay DHB.)
The CV template on the ACE Nursing website is recommended as a good guideline for what a CV should include.
If you are applying for a Nurse Entry to Practice (NETP) or New Entry to Specialist Practice (NESP) graduate training programme through the ACE process, the documents to be submitted as part of the online application include:
Full details of the ACE application process and the CV template and other resources are available at https://nursing.acenz.net.nz.
]]>As a third-year nursing student, I had the pleasure of completing my elective placement in the Hokianga, working on the ward alongside a supportive group of health professionals. This placement is unique as the ward nurses are also responsible for running the emergency room if a status one or two patient arrives.
On my second day of placement, a lady in diabetic ketoacidosis (DKA), presented to the emergency room. She was brought in by her family and was unconscious. The nurses and doctors arranging her treatment plan asked me to assist in her care and I took up the opportunity.
At first I thought to myself, “This is extremely different from reading it in a case study or book.” I also felt quite out of my depth. But after speaking with the charge nurse, I felt very confident that I could carry out the designated assessments. My role included taking 15-minute observations and blood sugar level readings and transcribing these onto the board, preparing saline flushes, gathering equipment for catheter insertion and IV fluids and, most importantly, speaking with the patient’s family.
I think this patient had been in DKA for a long time before she was brought to the hospital. I also think the family didn’t understand what was happening to the patient or how serious this condition can be.
The patient was not responding to the treatment provided and needed to be transferred to a bigger hospital – a two-hour ambulance ride away. I felt a helicopter transfer might have been more beneficial because of the risks a long ambulance journey might pose to the patient, but fortunately she arrived safely.
On reflection, the positive learning experiences from this emergency were that the DKA protocol was being followed, everyone worked as a team, and decisions were made as a team. There was a designated leader right from the beginning, which helped to facilitate the patient’s care and everyone had a specific role.
If a similar situation arose, I would again take the opportunity to participate. What I might do differently is ensure that the family understood what was occurring right from the beginning, and explain to them more about the seriousness of DKA.
I believe that as students we should embrace such opportunities during clinical placements, as these can provide perfect learning situations and environments to enhance our teamwork skills, even though they take us out of our comfort zones. Remember, we are supported throughout our clinical placements so we can practise safely within our scope and can begin to build a professional foundation for when we too are registered nurses.
]]>This is not an uncommon scenario for a postoperative patient on a surgical ward. However, for me this was a new experience. No longer was I the eager third-year student trying to lend a helping hand wherever possible. This time, I was the patient.
When I reflect on all I have learnt so far about being a nurse and providing care, I think my experience as a patient taught me one of my most invaluable lessons. As I lay there on the floor that day, I could truly understand how vulnerable it can feel to be a patient.
My experience reminded me of the time I was involved in the care of Rachel* a healthcare assistant of 20 years. Rachel really struggled with the concept of being the patient. She cried as she explained to me that she had always been the one to provide care, and was struggling to accept help. She hated the fact that she could no longer go to the toilet without some assistance. She felt extremely vulnerable.
From day one of our nursing education we are taught that patient-centredness forms the foundation of care. We are taught that in order to provide the best care possible we need to form partnerships with our patients – partnerships based on empowerment and active participation.
When I was a patient, it was important to me that I was informed of my own treatment plan. So when my nurse promptly explained why I had fainted and what they were going to do about it, I felt understood and empowered.
To Rachel, being an active participant meant doing as much of the care as possible for herself. It was therefore our responsibility, as providers of care, to enable and support her independence. It was important that we recognised what mattered to Rachel.
I now better understand the significance of the nurse-patient partnership and how empowering it is to be an active participant in your own care. I consider learning this lesson to be the silver lining of my patient experience, and I hope it will enable me to provide more empathetic, individualised care.
*Not her real name
]]>Five years ago three of Ashleigh’s schoolmates at Maniototo Area School took their own lives within eight months of each other leaving her not knowing what to do with herself.
“It was a hideous time. I was 13, and trying to comprehend why someone would make that decision. I was angry and sad all at the same time.”
When government funding became available for an anti-bullying campaign Ashleight and student leaders from five other Central Otago schools grabbed the opportunity and founded ‘Sticks n Stones’. Under the scheme student ambassadors are trained and given the skills to help other young people, especially with online issues, or helping them find the right support network.
“There was such a generation gap between advice versus how youths were living their lives online.”
The group also plays an advocacy role as Ashleight points out a lot of decisions are made about youth without consulting youth.
“A lot of decisions are being made about youth without consulting them. She said the group was now being approached for its views on policies like the ‘Harmful Digital Communications Bill’.
The London trip is not Ashleigh’s first time on the national and international stage as she has spoken at a Dublin conference on bullying. As a Queen’s Young Leader she is one of 60 young people selected for the awards programme from around the Commonwealth. The programme offers a year-long package of training, mentoring and networking offered through Cambridge University including a one week residential programme at Cambridge and receiving their award personally from the Queen at a ceremony on June 29.
]]>Amanda (pseudonym) was only 14 years old when she came into my care. Although it wasn’t really my care but the care of the nurse I was following around for the day, like a shadow. I was only a small and helpless nursing student, tripping over my feet trying to keep up with the busyness of a fully qualified and competent registered nurse. At least that’s how she saw me. I saw myself as someone who was well educated, with practical skills to boot. Perhaps a bit shell-shocked and out of my comfort zone, but otherwise completely capable.
Because of her injuries, Amanda needed a tetanus injection, an idea she strongly opposed. As I approached her, needle in hand, she winced, then cried, screamed, swore and pushed me away. It was at that point that my nurse took command of the situation. She took the needle from my hand, administered the injection and briskly left the room, apologising for interrupting my learning experience.
Through my nursing career, I will remember this event. Not because of what I watched the nurse do, but because of what I did not do.
My knowledge and capabilities made me responsible for my own inaction.
On reflection I wonder, faced with this situation again, would I have done anything differently? Would I have spoken up? Would I follow the principles of patient-centred care we are taught?
In a hospital environment, people perceive students in very different ways. Perhaps the most common image is a young, immature student, inexperienced and hesitant.
However, my time as a student nurse has taught me something that others may find surprising: we are valuable.
As students, we learn best practice, research key topics, study pathophysiology, familiarise ourselves with legislation and codes and perhaps most importantly, we are a fresh set of eyes.
However, we also have a responsibility to speak up, ask questions, be confident and to critically analyse our nursing practice and that of the registered nurses who are our role models.
Throughout my nursing degree, I am learning to find the balance between being a learner and a critic of professional practice.
*Abbreviated version of Reflection: missing the moment
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Upon entering the nurses’ station, I learnt a death had occurred in that room and the butterfly picture signified this. I questioned the tikanga and kawa (protocols) surrounding patient deaths and asked if I could take part in the blessing of that room as I had a compelling urge to participate. As a ‘Te Ōhanga Mataora Paetahi’ nursing student from Te Whare Wānanga o Awanuiārangi, the principles of kawa whakaruruhau (cultural safety) are promoted as part of my nursing practice.
I met with the priest on her arrival to the ward. Following whakawhanaungatanga, she retrieved a notebook from the nurse’s station in which she recorded details of her duty and placed an identification sticker of the deceased underneath. We entered the room and I closed the curtains behind me. She filled a cup with water and began to karakia over it.
The priest acknowledged the deceased before making her way around the room performing karakia and sprinkling water. I remained behind her during this stage with my hands clasped in front of me and my head slightly bowed. A sense of ‘presence’ surrounded me and my wairua (spirit) and hinengaro (mind) were fully engaged.
Once the entire room was blessed she began to recite the Lord’s Prayer in Māori. At this stage I moved up beside her instinctively and joined in the karakia. Following this process, the tapu had been lifted and a state of noa was imposed upon the room and ourselves. We exited the room and shared whakawhanaungatanga once again before returning to work.
Upon reflection, this clinical experience highlighted both the importance of tikanga Māori and kawa whakaruruhau following the release of a tūpāpaku and personally for me the importance of identifying and applying knowledge of cultural safety within my nursing practice.
It allowed me to pay tribute to and provided (without me even knowing at the time) closure and acceptance of the passing of someone with significant mana who offered manaaki and tautoko throughout my studies – someone I knew and respected. I would encourage students to embrace cultural practices throughout their placements.
Fresh eyes steeped in best practice and the latest research can provide a critical commentary on the old ways of working and on organisational structures that can act as barriers to person-centred, evidence-based care. Students are often accused of being idealistic and not understanding what nursing is like in the real world; however, aligning what they may see in clinical practice with what they have been taught is often a very real dilemma for nursing students.
Pedler, Burgoyne, and Boydell (2010) describe leadership as being an activity which generates socially useful outcomes. Students are also able to start practising leadership in this way. Rather than complaining about their experiences and walking away, students are challenged to investigate and critically analyse issues they come across in the clinical environment so as to help inform and add value to their nursing practice.
Students are taught the need to be assertive, the need to challenge what they consider to be poor practice and to share what they know to be the best. This can be rather daunting for student nurses on clinical practice – as traditionally they have had little influence in the clinical settings they visit. Therefore students must become as competent in these areas as all others during their undergraduate studies.
Educating and developing students as leaders is a central purpose of the Bachelor of Nursing programme at the University of Auckland where I teach. To this end we have developed an assignment for second year students in which they are expected to demonstrate an informed perspective of their clinical experience that is underpinned by relevant literature, evidence, policies or guidelines. The assignment is solution focused, they are required to seek out evidence about issues identified and to provide practice recommendations. The work is presented in the form of a journal article that students will be encouraged to submit to publications like Nursing Review.
While developing the assignment, I approached Nursing Review to see whether they were interested in developing a section specifically for nursing students to present critical reflections and other items relevant to student nurse life. Our students were surveyed and found to be overwhelmingly positive about their desire to read and contribute to such a section. Although similar platforms exist internationally, the new Nursing Review section will be the first of its kind in New Zealand.
Using a solution-focused, analytical approach, students will develop a wider understanding of what they see and experience in the clinical environment. Finding a voice, albeit in print or online, demonstrates leadership by informing the community as a whole. This process will contribute to the development of pre-registration students who can challenge practice issues in a reasoned way.
Ultimately it provides the scaffold to developing new graduate nurses who are leaders in nursing practice, simultaneously contributing to new initiatives which will showcase a student nurse perspective of the clinical practice environment.
Reference: Pedler M, Burgoyne J, & Boydell T (2010). A Manager’s Guide to Leadership. McGraw-Hill Education (UK).
AUTHOR: Cathleen Aspinall is a professional teaching fellow at the University of Auckland school of nursing.
]]>When I think about my time as a student nurse, there is one experience that sticks out above all others. That day I realised being a student didn’t mean that I was without responsibility. Amanda (pseudonym) was only 14 years old when she came into my care at the emergency department. Although it wasn’t really my care but the care of the nurse I was assigned to for the day, or so I thought at the time.
Amanda had been stabbed, three times. Because of her injuries, she needed a tetanus injection, an idea she strongly opposed. As I approached her, needle in hand, she winced, then cried, screamed, swore and pushed me away. It was at that point that my nurse took command of the situation. She took the needle from my hand, administered the injection and briskly left the room, apologising for interrupting my learning experience.
I have to say at this point, looking back on the event, it seems quite wrong. But in the moment it can be too easy to get caught up, and to convince yourself that the nurse knows best and that there are no other options.
As nursing students, we are taught to reflect. We discuss and write about our learning experiences – good and bad – and we are encouraged to continually improve our practice.
When I reflect on what happened with Amanda, I often return to the concept of autonomy. Autonomy is the code of ethics’ principle that outlines how every individual has the right to make their own decisions about any aspect of care they will receive1. In New Zealand, each individual also has the right to respectful treatment, dignity, independence and informed choice2. With this in mind, Amanda’s hospital experience was poor. She was not in control of the care that she was receiving and her independence and choice were neglected at times.
In hindsight, I recognise that I was just as responsible for this outcome as the nurse I was working with. I had many opportunities to improve the situation, but I took none of them. At the time I was simply happy to follow the nurse, and do as she saw fit. I can now see though – what I had somehow forgotten in the moment – that treating her with respect was not a luxury but a right. Amanda deserved the right to refuse, as well as our empathy and kindness. Reflection has allowed me to identify this as my area for improvement. I will continue to learn and challenge myself so that in these situations I am capable of identifying when things are not going well, and push myself to speak up, to be the patient’s advocate.
As students, we are continually learning, like everyone else in this profession, and as a result, we can get things wrong. But, for the majority of the time, we are highly capable. As students we learn best practice, research key topics, study pathophysiology, familiarise ourselves with principles, legislation and codes, and perhaps most importantly, we are a fresh set of eyes. We have evidence-based practical skills that have been taught to us by some of the best in the field. We gain a holistic perspective on nursing through our exposure to different areas, and it is all fresh in our minds. We are an asset to the health care team.
I believe that sometimes there is a misconception that students have to watch rather than participate; that we don’t know what we’re doing and can’t be trusted on our own. As students we are placed in the clinical environment primarily to learn, but that doesn’t mean we cannot contribute or be helpful in more ways than one.
Indeed, I propose that registered nurses and students can all learn from each other. If this was more openly acknowledged by students and staff, the student nursing experience would exponentially improve and the clinical area would truly be a learning environment.
So how can we move forward as students and nurses – in the most constructive way possible – to create learning environments that benefit the patient?
Students are always learning and we would be foolish to act as if we know everything, indeed misplaced confidence is dangerous.
With a career choice like nursing, you can’t just “fake it ‘till you make it”, when you are dealing with the health and lives of individuals. So my advice to myself and other students like me, is that there are no stupid questions. None. We have a responsibility to speak up, ask questions, be confident and to critically analyse our nursing practice and that of the professionals around us. Throughout my nursing degree I am learning to find the balance between being a learner and a critic of professional practice.
The same advice could be shared with the registered nurses we are learning from; there are no stupid questions. Don’t be afraid to ask us what we are capable of, what we’ve done before, what we want to try and what we need to learn. When the lines of communication are opened, we can create a professional relationship that will be beneficial for both parties. When you are aware of our strengths and weaknesses, we can be your ally and asset.
Over my time as a student nurse, I have experienced misconceptions of my abilities, many of them contradictory, based on the uniform I wear. I have been faced with challenging situations that have shaped and advanced my practice. Through my experiences, I have come to the conclusion that the student nurse can be an asset to any health care team. We are well-researched, and keen to put our theoretical knowledge into action. But there is also a responsibility that lies with the student, to speak up, reflect and, above all, to learn.
*Full Version of Reflection on being both a learner and a critical observer
The survey found that on average 73.3 per cent (996) of the November graduates were working as nurses by March 31* – a nearly identical rate to last year’s NETS survey. Of these 813 reported working in government-subsidised NETP (nursing entry to practice) and NESP (mental health) programmes, a further 174 were nursing in non-NETP jobs in the private sector (mostly in aged care but also primary health) and nine were nursing overseas.
Nearly 250 of the new graduates responding to the survey (246 or 18% of the November cohort) reported they were still hunting for a nursing position at March 31, a further 37 reported they were not seeking a nursing position and 80 (nearly 6%) didn’t take part in the survey.
The annual NETS survey also included a breakdown of the graduate employment rates for the 16 schools that also reflect the number of NETP placements offered through the schools’ local district health boards. Only eight of the degree programmes had all of their November graduates respond to the survey – other programmes were missing data from between a couple to up to 23 students – which also affected the findings.
Graduate employment rates reported by survey respondents in the Northern region were 87.8% for NorthTec, 64.4% for AUT, 55.6% for the University of Auckland, 77.8% for Manukau Institute of Technology (83.3% for its BN Pacific programme), 91.3% for Massey University’s Albany programme and 75% for Unitec.
In the middle of the North Island the reported job rates were 67.3% for Waikato’s WINTEC, 76% for Toi Ohomai Institute of Technology (formerly Waiairiki), 92.7% for Taranaki’s WITT, 65.9% at UCOL, 87.1% for Massey’s Manawatu programme and 67.3% for EIT. In Wellington the job rates were 66.3% for Massey’s Wellington programme and 59.4% for Whitireia (42% for its BN Pacific).
The South Island once again had one of the highest employment rates with 77.8% at NMIT, 94.5% at Ara Institute of Canterbury (formerly CPIT), 83.8% at Otago Polytechnic and 77.3% at Southland’s SIT.
The NETs survey indicated that once again that the most common area to get work was in medical or surgical wards followed by aged care/continuing care elderly, primary health (including practice nursing) and acute mental health. The most common sector for graduates to find work in non-mentored NETP programmes was aged care/continuing care elderly – with 87 graduates employed in non-NETP places compared to 34 who gained places in aged care NETP programmes. This is a nearly identical trend to last year with the nurses union NZNO stating last year that number of new graduates being employed by rest homes with no guaranteed mentoring was an ‘ongoing concern’.
The next most common area in non-NETP programmes was primary health with 41 finding non-NETP places compared to 51 employed in NETP places.
*The NETS March 31 data differs from the March 1 job statistics released by the ACE new graduate placement programme as NETS surveys only November graduates and because it captures graduates who find jobs outside of the NETP and NESP offered through ACE, including jobs overseas. The ACE March 1 statistics indicated 1274 of the 1455 graduates graduates who applied through ACE for NETP or NESP positions were November graduates. In total 853 (60%) of all ACE applicants (which also included July 2016 and November 2015 graduates) were reported as being successful in finding NETP or NESP places by March 1.
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