Education and training

NAs participated in a 12 month traineeship program to achieve the education

qualification of an Australian Qualifications Framework level III, titled Certificate III Health Services Assistance ([IHOD], 2011a). This program was run by the hospital organisation, in conjunction with a registered training organisation. Figure 6.2 displays an overview of the traineeship program for the NA. The Certificate III traineeship model was to ensure the NA position “operated safely on the ward and that the educational component of the traineeship

153 aligned with the [organisations] policies and procedures” (PwC, 2011, p. 39). Appendix P lists the subjects that the NAs were taught at the time of this case study.

The appropriate education and training of the NA was important to their implementation in the acute hospital setting. It was reported that:

The initial training and clinical placement provided them [the NA] with the confidence required to commence work on the designated wards. Overall the classroom component of the traineeship was considered to be well delivered and gave the [NAs] a sound knowledge base (PwC, 2011, p. 39).

Despite the value of the knowledge gained from the training program the BSBC evaluation of the program reported that NA believed the traineeship was “lengthy in duration, particularly as the wage was thought to be low” (PwC, 2011, p. 39). This was agreed by the NAs who participated in this case study. They further expanded, stating that the course was repetitive and that key learning occurred in the clinical setting.

154 ([IHOD], 2011a; PwC, 2011).

Figure 6. 2 NA traineeship program overview

At the time of the study, there were no formal ongoing education programs for the NA. NAs were invited to participate in nursing in-services;61 _{however, these education} sessions were commonly not appropriate for those in the NA role, as they were aimed at the RN and EN education level. There was no defined career progression for the NA role at the time of this case study. NAs who wished to expand their scope of practice were encouraged to pursue further study, at either the Diploma of Nursing or Bachelor of Nursing level

61 _{In-services are education sessions help for nursing staff during double staffing time in the hospital}

organisation in this case.

Commencement of the NA Traineeship with a three week

intensive induction at TAFE

One week placement at a residential facility

Introduction into the ward environment and commence NA role in the acute hospital setting

NA attended TAFE one day a week for a period of 18-20 weeks dependent on the intake cohort that the NAs belonged to

Traineeship completed after 12 months to gain a Certificate III

Health Services Assistance qualification

155 ([IHOD], 2011d). Participants confirmed there were multiple NAs who pursued further training in nursing (numbers not provided). The progression of NAs into nursing careers was deemed as a “really positive outcome” (10202) by nurse leaders. They emphasised that the NA position “accesses a part of the workforce pool that probably previously wouldn’t have come into health and we need them” (10202).

It was the position of the senior managers in the organisation and the government representative that the NA position should be filled by a consistent, dedicated workforce, avoiding the transitory nature of employing a student model. Nursing leaders identified the importance of the NA becoming a member of the nursing team and promoting “consistency in the ward and not having people coming and going and getting confused about whether they’re a [NA] or a student extra” (20905). Further to this:

If your [NA] workforce is made up only of students they’re not available for various blocks …The rostering becomes diabolical and people who are coming and going quickly just don’t become part of that day-to-day regular part of the team (10202).

The DoH representative acknowledged that a blended model of NA and nursing student NAs would eventuate as NAs went on to pursue nursing training; however, felt it was essential to have a base team of NAs to provide consistency and build a sense of team. In this case study, the NA position was found to be transitory in nature, with participants reporting NA’s leaving the position or pursuing nursing careers. A blended model of NA and nursing student NAs had eventuated, as reported by managers who recalled that NAs employed by the organisation went on to pursue a nursing career with the associated education requirements.

It was argued by the ANMF that the NA role should be filled by undergraduate nursing students, as “they would have a much greater exposure to the culture, the hierarchy,

156 the work environment and consolidating their learning” (10201). The ANMF representative explained that:

One of the criticisms of the current undergraduate or nurses in their graduate year is that “they’re not work ready” … nursing culture is quite stoic and patient centred and it’s not something that university students get a great deal of exposure to during their undergraduate training (10201).

He reasoned that “they’re [the hospital organisation] not getting what they stated they wanted, which was an ongoing person who would grow into the role, they’re continually having to replace them [NAs] and train new ones” (10201); therefore, nursing students should be entitled to the benefits of working in the NA role. In response to the identified barriers for nursing students performing the NA role, the ANMF representative argued, that universities and registered training organisations would be required to adapt the delivery of nursing education, to provide a more “flexible delivery model” (10201). The concept of nursing students performing the NA role in the acute hospital setting was supported by participants from different stakeholder groups.

An effective communication strategy, staff engagement and understanding, and transparency in the introduction processes were linked by senior nurse leaders to the

perceived success of the implementation of the NA position in the hospital organisation. As part of the implementation process of the NA position, “a comprehensive ward based education program” was delivered to staff, with a “focus on the role of the [NA] within the nursing team/interdisciplinary team, scope of practice, supervision and delegation” ([IHOD], 2009a, p. 2). Nurse leaders identified “that there was a need to invest in supervision,

delegation training for registered nurses to make sure that they knew what their responsibilities were and how to do it” (10202). It was reported that as part of the

157 however, the uptake of this was deemed to be poor by nurse leaders. Beyond the initial

introduction education of the NA position, it was reported by participants that no further education or refresher education had been provided to nurses (RN/EN), at an organisation level, about the role of the NA and the role of the nurse when working with the NA. There was also no formal education packages, regarding the NA role for new staff (all nurses RN/EN) of varying experience levels employed after the implementation of the NA position) at the time of this case study. Individual ward nurse educators, who placed a high level of importance on the education of nurses (RN/EN) about the NA role, developed education packages for new and existing staff, on the wards they were responsible for.