Document an account of existing knowledge of the role, scope of practice

and performance standards of nurse educators in acute care settings in Australia.

As roles within the Australian health care system are being reviewed [2], this study was timely in identifying imperatives for reviewing the nurse educator role. Prior to this study, the Australian nursing literature was limited in knowledge of the nurse educator role in acute care hospitals, their scope of practice and

performance standards [1]. As identified in the literature review in Chapter 2, the role of nurse educators in acute care hospitals in Australia is distinct from nurse academics, who mainly work in universities [1, 3]. The complex clinical environments do not always value and appreciate the nurse educator role.

The study sample was consistent with the demographics of the ageing registered nurse population in Australia [4]. Role expectations, beliefs and attributes need to be defined for specific roles (as described in Chapter 3) [5]. Role expectation may be defined as attributes that other staff and the organization believe an individual assumes in their job [5]. However, the use of multiple titles for the role of educator, such as nur se educator, clinical nurse educator, and c linical nurse consultant, for example, (as described in Chapters 5 and 6 ) arguably result in confusion regarding role expectations and r esponsibilities in the workplace, nursing and the broader health workforce.

Role ambiguity was found to be a feature of the nurse educator roles in acute care hospitals, further reinforcing confusion in nomenclature, expectations and as a consequence, work plan. Role ambiguity has al so increased as m ultiple nursing roles, including the registered nurse, assume responsibility for education in the workplace, rather than the responsibility for education falling to nurse educators alone [1, 3]. Role ambiguity potentially leads to role stress, overload and dissatisfaction as do cumented in the study findings and m ay be linked to educators feeling the role is devalued in the workplace.

Meaning is the main idea behind symbolic interactionism, whereby human behavior and interactions are considered through both symbols and their meanings [6]. As hum ans, we do not simply respond to events we encounter; rather our previous experiences allow us to consider and give meaning to events. Our actions in response to an event occur as a consequence of the meaning the event holds for us. This meaning can be applied to the study findings demonstrating some educators believed they were valued in the workplace although more educators reported that their role was insufficiently acknowledged. The concept of feeling devalued was perceived to be at the level of government, workplace executive and among managers, nurse managers and nurse colleagues.

Within the study data, at the government level, devaluing was perceived by participants to be reflected in lower salaries making the role less attractive and not valuing the education some have attained in order to work as an educator.

Respondents to the survey commented that devaluing is linked to workplaces where education is seemingly not valued at the executive level, where nurse educator positions are seen to be expendable, where budget restraints are imposed and w here positions such as nur se managers responsible for education and nurse educator positions are not filled when they become vacant. As the study described, the trickling down effect of devaluing also occurred among nursing peers where the contribution of nurse educators was seemingly invisible, notably through recognition from nursing awards and scholarships.

Nurse education in the acute care hospital requires skilled educators capable of understanding and contributing to patient care outcomes by conducting contemporary evidence-based education and developing and contributing to policy and practice that supports a saf e workplace and po sitive patient outcomes [7]. However, the low numbers of nurse educators holding a post graduate qualification in education (22%) or a clinical qualification at a master’s level (22%) reflects both a de creased emphasis on the importance of education from the perspective of both the individual and organization.

In tandem with other nursing research [8-10] in this study, the quality of the work environment is an important factor in employee satisfaction and in turn effective nurse education and patient outcomes. The Professional Practice Environment (PPE)scale [11] used in this study was demonstrated to be a valid and reliable tool for assessing the work environment among nurse educators in both private and public hospitals.

As described in the model of nurse educator satisfaction in Chapter 6, Fig. 6.5, nurse educators who have a job description, meet regularly with their manager and who have spent a number of years performing in their role are more likely to be satisfied with their professional practice environment than nurse educators without this structure. Work motivation, control over nurse education practice, engaging in collaborative solutions to problem solving and cultural sensitivity were also identified as i mportant elements of the work environment contributing to satisfaction. These findings may inform the development of integrated professional practice environments where professional practice and workplace satisfaction of nurse educators are optimized influencing safe, quality patient care.

Additionally, the results described in Chapter 5 showed that nurse education requires appropriate staffing levels (skill mix of educators and dedicated staffing hours for education), as well as organizational commitment in support of lifelong learning. This includes recognition that clinical education and continuing professional education are intrinsic components of core business supporting patient safety in healthcare environments. The findings of this study highlight the need for career pathways and building nurse educator capacity to support specialty sustainability [10].