Post Registration Nurse Education in the CAWT Region

Post Registration Nurse Education in the CAWT Region

Centre for Nursing Research

University of Ulster

Submitted by:

Assumpta Ryan

Kader Parahoo

Marian Cooper

January 2001

List of Contents

Page No.

Chapter 1 – Introduction

1.1Background1

1.2Continuing Education frameworks in the United Kingdom2

1.3Continuing Education Frameworks in the Republic of Ireland3

1.4Rationale for the present study3

1.5Research Objectives5

1.6Potential Benefits of the Study5

Chapter 2 – Methodology

2.1 Stage 1- Perceptions of nurses of their educational needs and other relevant 8

areas.6

2.1.1Questionnaire Objectives6

2.1.2Instrument Formulation6

2.1.3Sample and Sampling7

2.1.4Analysis7

2.1.5Ethical Issues7

2.2Stage 2 – Focus Group Interviews with Senior Nurse Managers

2.2.1Focus Group Discussions8

2.2.2Participants9

2.2.3Analysis9

2.2.4Ethical Issues 9

2.3Structured Interviews with Education Providers9

2.3.1Structured Interviews10

2.3.2Interview Schedule 10

2.3.3Analysis102.3.4 Presentation of Findings 10

Chapter 3 – Training Needs Analysis Questionnaires12

3.1Response Rate12

3.2Profile of Respondents12

3.3Qualifications12

3.4Length of Service13

3.5In-service and post-registration attendance rates13

3.6Frequently attended in-service courses14

3.7Frequently attended post-registration programmes15

3.8Courses currently undertook16

3.9Factors influencing decisions to attend and not to attend additional health related training and education. 17

3.10Personal Obstacles influencing additional health related training and education attendance. 17

3.11Support19

3.12Attitudes to in-service training and post-registration education.20

3.13Future Intentions21

Chapter 4 – Focus Group Interviews24

4.1Response Rate24

4.2Profile of Respondents24

4.3Current Provision25

4.4Current Educational Needs26

4.5How are the educational needs of nurses assessed?27

4.6Preparing for the future29

4.7Senior Nurse Managers views on CAWT31

Chapter 5 – Semi-Structured Interviews33

5.1Research Questions33

5.2Results of Interviews with Educational Providers33

5.3Leadership and Management37

5.4Assessing the demands for in-service training and post-registration

education39

5.5Uptake of Courses41

5.6Delivery of Courses42

5.7Education provider’s views on CAWT43

Chapter 6 – Summary and Recommendations45

6.1Summary of Key Points45

6.2Recommendations47

References

Appendices

List of Tables

Page No

3.1Job Title12

3.2Qualifications13

3.3Length of Service13

3.4In-service attendance rates over the past 2 years13

3.5Post-registration attendance rates over the past two years14

3.6Frequently attended in-service courses14

3.7 Diplomas completed over the past two years16

3.8 Degrees completed over the past two years16

3.9 Personal obstacles influencing additional health related education

and training attendance18

4.1 The sample distribution of Focus Group participants24

4.2 Job Titles of Focus Group Interviewees24

4.3 The extent to which current educational frameworks address a

number of educational issues.25

4.4Top-Ten in-service needs.27

4.5Needs Assessment strategies employed by Sperrin Lakeland

Trust, Cavan General Hospital and Sligo General Hospital.29

5.1Current level of provision of clinical courses offered by the four

providers and their duration34

5.2Current level of provision of leadership and management courses

offered by they four providers and their duration37

5.3Current level of provision of education courses offered by the four

providers and their duration.38

List of Appendices

Appendix 1 – Clinical, Leadership and Educational courses audited

Appendix 2 – Training Needs Analysis Questionnaires

Appendix 3 – Cover Letter

Appendix 4 – Focus Group Questionnaires

Appendix 5 – Interview Schedule for Semi- Structured Interviews

Chapter 1

Introduction

1.1 Background

The CAWT (Co-operation And Working Together) initiative originated in July 1992 with the formulation of a cross border project between the North Eastern and North Western Health Boards in the Republic of Ireland and the Southern and Western Health and Social Services Boards in Northern Ireland. Aimed at improving the health and social well being of its resident populations the project provided a framework for groups and individuals to come together on a range of common issues relevant to their service areas.

Through funding obtained from the Special Support Programme for Peace and Reconciliation in 1999, CAWT was provided with the opportunity to investigate the possibility of sustainable co-operative working arrangements and the further sharing of resources across the catchment areas of Sperrin Lakeland Trust, Sligo General Hospital and Cavan General Hospital. This, it is assumed would go a long way in actively supporting the border areas in an attempt to break down the barriers created by borders that have inhibited economic and social development over centuries (CAWT, 2000).

Various workshops were organised to map out potential projects and as a result a Nurse Training and Education subgroup was established. The group proposed the establishment of a Joint In-service Education Programme for qualified nurses. In-service education was selected as a key issue for development as it is not only important from a CAWT perspective but a fundamental requirement for the professional development of nursing in general. The present study, therefore, aims to promote integration of nursing on both sides of the border, through an in-service education programme that will incorporate clinical practice, education and research to enhance the health and well being of the CAWT community.

1.2 Continuing Education Frameworks in the United Kingdom

Over the past few years post-registration education and training has been subjected to substantial change and development. The formulation of a Post-Registration Education and Practice Project (PREPP, UKCC, 1990) for example, has led to significant changes in the areas of post-registration education and training with the responsibility now being placed on the practitioners themselves. For example, as part of this package nurses must complete a minimum of five days in-service study activity or equivalent; maintain a personal professional profile of learning activity and undertake a Return to Practice Programme from the 1 April 2000 if they do not undertake a minimum of 750 hours/ 100 working days in the five year period leading to a renewal of registration (NBNI, 2000).

CATS (Credit Accumulation and Transfer Schemes) have also been introduced which now gives nurses, midwives, and allied professionals, with diploma level qualifications, the opportunity to ‘top-up’ to degree level through relatively short programmes of study. Similarly, the introduction of APELS (Accreditation of Prior Experiential Learning Schemes) now permits staff with the professional experience to ‘trade-in’ their experience to obtain academic credit.

The recently published NHS plan (NBNI, 2000), while primarily concerning England, has also served to create major changes within the area of education and learning. Its key initiatives include:

• The drive towards high quality and excellence, and systems being put in place to achieve these
• The emphasis on evidence-based healthcare and clinical effectiveness, and establishment of research and development strategies and agencies to monitor and facilitate this emphasis
• The establishment of clear lines of clinical accountability through introduction of clinical governance
• The recognition of the vital contribution of the staff within the health services and the commitment to education and training, and more specifically to a lifelong learning orientation.

1.3 Continuing Education in the Republic of Ireland

Continuing Education is defined by An Bord Altranais as ‘a life long professional development process which takes place after the completion of the pre-registration nurse education programme. It consists of planned learning experiences which, are designed to augment the knowledge, skills, and attitudes of registered nurses for the enhancement of nursing, practice, patient/client care, education, administration and research’ (The Commission on Nursing 1998, p.100). This is the definition of continuing education that was formally adopted by the Commission of Nursing in 1998. The Commission saw the need to develop and strengthen the availability of professional development for all nurses and midwives and suggested that it might be helpful to consider professional development under the following three headings (Commission on Nursing, 1998):

In-service – which would consist of education on occupational health issues and work orientation programmes.

Continuing Education – which would consist of education on developments in nursing and the treatment of patient groups; and

Specialist Training – which would consist of dedicated educational programmes and experience supporting a nurse seeking to practice at advanced level.

As a result of these educational developments the responsibility of Education for Specialist and Advanced Practice was appointed to the National Council for the Professional Development of Nursing and Midwifery. The Council, which held is first meeting in January 2000, was established in the hope that it would approve courses to ensure accessibility, a geographic spread in the provision of specialist courses, as well as maximise the use of educational resources. It is also hoped that the Council will develop ‘a comprehensive database in relation to the provision of specialist post-registration nursing and midwifery education and also determine the appropriate level of qualification and experience for entry into speciality practice’ (An Bord Altranais, 2000, p 22).

1.4 Rationale for the present study

The importance and relevance of continuing professional education to nurses has been repeatedly illustrated throughout the literature (Hutton, 1987; Waddell, 1991; Nolan and Owens, 1993; Waddell, 1993). Nolan and Owens (1993) for example, who undertook an evaluative study of the Welsh National Board’s Framework for Continuing Education reported that the framework produced practitioners who indicated that they were more knowledgeable, confident and assertive which enhanced their contribution to clinical care. A meta-analysis conducted by Waddell (1993) adds further support to these claims and serves to highlight how continuing professional education (CPE) can have a positive effect on nursing practice.

However, despite the amount of research conducted on the effects of continuing professional education (Nolan et al, 1995; Waddell, 1993) and the recent developments aimed at providing flexible continuing education programmes, nurses are still deciding not to undergo additional programmes of study due to a number of obstacles, which are making it increasingly difficult (Mac Gregor and Dewar, 1997). Difficulty in obtaining study leave, lack of support from managers, difficulty obtaining funding, low staffing levels, and the late advertisement of courses (Studdy and Hunt, 1980; Lathlean, 1987; Rogers and Lawrence, 1987; Lindsay, 1990; Chapman, 1992; Shepherd, 1995; Bariball and While, 1996) have frequently been reported as major obstacles blocking access to additional nurse related training and education. Mac Gregor and Dewar (1997) also indicate that staff generally want courses that are more flexible than those currently available preferring short part-time courses that would permit them to retain their jobs and use their own off-duty time as study time. A plethora of studies also report personal obstacles such as domestic responsibilities (Lindsay, 1990; Larcombe and Maggs, 1991) and a lack of individual motivation as greatly hindering CPE involvement.

As the research clearly demonstrates, nurses have a number of educational needs. The consistency of certain factors therefore raises the need for these issues to be considered when planning the provision of in-service and post-registration education. Shepherd (1994, p.68) maintains that ‘training needs analysis is an essential part in the development of continuing education programmes and their implementation into practice’. He added that individuals know best what their educational needs are and can even identify the solutions. Bearing this in mind, completing a quality needs assessment cannot assure, but almost certainly can assist in, the development of appropriate cost-effective educational offerings.

A similar view is also shared by Farley and Fay (1988, p.15), who assert that ‘training needs analysis result in educational programmes that are effective and contribute substantially to the growth of the health care profession’. The primary aims of the present study are therefore to assess the current educational needs and existing education provisions across the CAWT region, which includes Sperrin Lakeland Trust, Sligo General Hospital and Cavan General Hospital, in an attempt to provide a baseline measurement of current in-service provision to identify gaps and barriers in present in-service deliver. It is hoped that this will then provide a framework against which an effective joint in-service structure can be devised so as to identify and create long term, sustainable development, of shared services and co-operative working arrangements in the border area under investigation (CAWT, 2000).

1.5 Research Objectives

In consideration of the primary aims of this study the research objectives are as follows:

1. To conduct a needs assessment to determine the educational needs of qualified nurses in the CAWT region comprising Sperrin Lakeland Trust, Sligo General Hospital and Cavan General Hospital.
2. To investigate post-registration education provision in the CAWT region in the following areas (Appendix 1)
3. Clinical issues
4. Leadership issues
5. Education
6. To highlight priority areas and make recommendations on the structure and content of a Joint In-service Education Programme for nurses on both sides of the border.

1.6 Potential benefits of the study

It is proposed that the present study will lead to a number of potential benefits.

• The sharing of experiences in the context of the cross border culture. There will be a geographical advantage that will be tailored to the local area, which will be underpinned by cultural understanding.
• The development of nursing skills in an attempt to address the specific needs of the CAWT community.
• The further evolvement of services in the move to ensure that the CAWT community become self-sufficient in the provision of the health care.
• The development of teaching staff skills.

Chapter 2

Methodology

The objectives of the present study dictated that data were collected in three stages employing three methods of data collection.

2.1 Stage 1 Perceptions of nurses of their educational needs and of relevant issues

Stage 1 involved conducting a questionnaire survey in order to determine the educational needs of qualified nurses in the CAWT region and to establish their views on in-service training and post-registration education provision. Because of the primary objectives of the study, it was decided that the questionnaire should be written in a semi-structured format containing both closed and open-ended questions so as to obtain both descriptive and analytical data. The questionnaire, while containing a few questions chiefly concerned with demographic data, was mainly concerned with eliciting perceptions of educational needs and future educational intentions of nurses in the CAWT region.

2.1.1 Questionnaire Objectives

1. To assess if, and how many nurses in selected clinical areas are currently engaged in post-registration education and in-service training programmes.
2. To identify those factors influencing participation in continuing education programmes.
3. To identify areas in which these selected nurses require further education and training.
4. To examine the nurses’ attitudes to post-registration education and training.

2.1.2 Instrument Formulation

The research team assisted by an advisory group, chosen because of their expertise and insights into the educational needs of nurses, developed this instrument (Appendix 2). Topics were generated by the relevant literature concerning the educational needs of qualified nurses; chiefly Shepherd’s (1995) training needs analysis, which was used to identify a post-registration education framework for an amalgamated school of nursing in England. Distinctions were made between in-service and post-registration education using Chapman’s (1992) definitions.

In-service: Study days, lectures and conferences, which tend to be informal and arranged locally.

Post-registration: specifiable courses that end with the issue of a certificate or qualification, for example degrees and diplomas.

The instrument was pilot tested by a small sample of 16 nurses of equal numbers from Northern Ireland and the Republic of Ireland respectively. As a result of the pilot study, some questions were rephrased to enhance clarity but there were no major changes to the instrument.

2.1.3 Sample and Sampling

Opportunistic sampling techniques were employed during this particular research stage. A number of wards, namely Medical Care, Surgical Care, Intensive Care and Elderly Care, across The Erne Hospital, Tyrone County Hospital, Sligo General Hospital and Cavan General Hospital were selected and the entire population surveyed (n = 564). A nurse manager or administrator in each hospital distributed the questionnaires and a return envelope to each of the four wards. A sealed box was provided for each ward for the return of questionnaires. Reminders were sent to each of the four sites in an attempt to maximise the response rate.

2.1.4 Analysis

Due to the structure of the questionnaire used in this study, two data analysis methods were employed. Responses to demographic questions were analysed using the statistical package SPSS. The approach taken to analyse the open-ended questions was thematic with key issues and themes being extracted.

2.1.5 Ethical Issues

The research team were presented with no major ethical considerations throughout this research stage. All questionnaires remained anonymous and the issue of confidentiality was addressed by providing envelopes for completed questionnaires. A cover letter (Appendix 3) accompanied each questionnaire and this was used to inform participants about the purpose of the study and their right to refuse to participate if they so wished.

2.2 Stage 2 Focus Group Interviews with Senior Nurse Managers

Stage 2 of the project utilised Focus Group Interviews to elicit the views of senior nurse managers on post-registration and in-service education and training provision from a CAWT perspective. By virtue of their position within the chosen organisations these nurses were in a strong position to determine the educational requirements necessary to ensure the delivery of quality care to a diverse client group.

2.2.1 Focus Group Discussions

Focus groups are well suited for a full range of qualitative studies and can be defined ‘as a qualitative research technique using discussion among a small group of people (usually 4-12) in a comfortable non-threatening environment to obtain perceptions about a particular problem, area of interest, or topic of study’ (Lederman, 1990, p.121). According to McDaniel and Bach (1994), this technique therefore provides insight and data that are not accessible without the stimulus of the group discussion. In addition participants in this setting have an opportunity to validate information given by agreeing or disagreeing with statements made by others. This validation process in turn ‘helps the researcher to identify the essential themes in the data’ (White, 1998, p. 148).

In this study the interviewers were interested in obtaining information on 4 main areas:

• The benefits to be gained from cross border collaboration
• The obstacles that must be overcome to ensure the success of the proposed CAWT in-service initiative
• The extent to which current in-service provision will provide for future educational needs
• The steps that must be taken in an attempt to address these future needs

The validity and reliability of the focus group interviews were further enhanced by, asking the participants to complete a short questionnaire (Appendix 4).

2.2.2 Participants