Where is the professionalism?
Some participants viewed nursing as a profession. Others strongly questioned the right to call nursing a profession. When asked why nursing was a profession, participants found it difficult to qualify and express what nursing did to qualify it as a profession. Those questioning nursing as a profession believed that the struggle to retain a professional image could be attributed to the failure of nurses to embrace the ongoing educational requirements expected of a professional.
There are not enough people who are career focused. There are too many who are just coming to work, doing their job and going home. They’re blue-collar workers and that’s their attitude. There’s nothing wrong with that, but don’t call yourself a professional nurse if that’s going to be your attitude to your working life and your career. … at some point, you have to be engaged in your profession. There are too many people here
[who think] that it’s a job. It’s just a job. … but I despair that we’re all classed as registered nurses and registered professionals because we’re not. So, I find it really frustrating. (Kaylah)
The disappointment was unmistakeable in Kaylah; both her voice and body language gave support to her words. Kaylah was sad that colleagues and other nurses, who for various reasons, refused to engage in the professional role of the nurse as she viewed it.
Failing grade
The NMBA’s approach to CPD as a professional requirement is not viewed as successful among participants. Participants have been highly critical of the CPD undertaken by many nurses, after witnessing the damage that the current approach has had on the nursing profession.
The disappointment of participants was evident in both voice and body language revealing a disheartening and tiredness at attempts to instigate change
themselves. These feelings are exacerbated by nurses observing little or no change since the implementation of mandatory CPD in 2010.
I don’t think it’s changed a lot to be honest. I think people are just skating through and hoping that they don’t get audited. There’s a lot of people, a lot of girls here that have young families that wouldn’t be doing the hours to be honest, particularly if they’re on nightshift. There’s no way, no way in the world they’d be getting
the hours which is disappointing. (Alysha)
The disappointment towards nurses failing to engage in learning contributes to negative perceptions amongst participants. This cumulative approach adds to the fatigue experienced in those nurses that see the value in CPD.
All about image
Criticisms toward the NMBA model of CPD were identified in the data. One such criticism surrounded the protection of the image of the nurse. Participants’ beliefs about the motivations of the NMBA mandatory CPD were telling.
Protecting the profession, them rather than us. (Trish)
Such scepticism about the NMBA motives questions if the image of nursing is more important than the betterment of the profession to the regulatory body.
I can’t even think of what it’s called. But this training to do with aggressive people is just mumbo jumbo. It doesn’t make any sense. It doesn’t seem relevant. I’ve got no idea why we’re doing
it. It’s them [employing organisation] covering themselves I think.
I don’t know. But it’s CPD. (Trish)
Trish’s experience of training that she called ‘mumbo jumbo’ creates questions for the mandated model of CPD, especially when she is then prepared and permitted to count this as mandated CPD. The NMBA mandates that nurses engage in CPD to demonstrate that nursing meets its professional requirement of education.
Participants strongly criticised the adopted model. Trish criticised the type of training that can be counted as CPD, Kaylah felt a minimum of twenty hours per year was too restrained. This was supported with commentary about the ease with which twenty hours could be achieved, with a few days at a conference and/or a few articles researched.
One of the things I find with the registration bodies is their requirement to do twenty hours per year, which I just go ‘well that’s laughable!’ Twenty hours is seriously easy and also part of me goes I’m insulted that as a professional I have to prove that I’m doing twenty hours … But I do understand that. That is the way of the world and that within any profession you’re going to have that group and you’re going to have people who are engaged. So, you have to come to some sort of arrangement, so I understand that.
(Kaylah)
Whilst accepting that the NMBA has to set a standard, other criticisms arose. The standard set by the NMBA has been challenged by some, like Kaylah, believing that the model contributes to harming the profession. These views are expressed in the next section.
We’re being dumbed down as a profession
A criticism of participants is that the NMBA, as the peak professional body, has not succeeded in demonstrating the strengths of the nursing profession. A contributory factor is the critique around recording CPD, as expected by the NMBA. Words such as ‘ridiculous’, ‘pointless’ and a ‘dumbed down’ approach to learning were frequently observed in the transcripts of participants.
Concerns exists about the level of professionalism and the broad scope of what the NMBA considers acceptable CPD has been criticised.
I think nursing, nursing talks about being a profession but we’re not. We’re not. We have a long way to go and part of that is you have a Board that says it’s okay to put down hand hygiene as thirty-minute CPD. That standard is so incredibly low that it is not
doing anything to progress the profession. I don’t know, except to say that if they really got strict about it then they’d have to deregister half the bloody nurses. (Kaylah)
The NMBA model of CPD has blurred the lines between continuing education and mandatory employer training and competencies. The majority of participants in this research were not comfortable and opposed the blurring of lines and what is seen as opening Pandora’s box.
I don’t think mandatory training should be continuing education because to me continuing education is about improving what skills you’ve got, expanding knowledge. Not just ticking boxes, and a lot of mandatory training is ticking boxes. So the hospital can go to accreditation agencies and say all our staff have attended their fire training, all our staff does. So, if that goes through and it gets counted in training, but to me its continuing professional development is actually – if your profession is nursing, what have you done to improve your scope of nursing practice? (Jessie)
The declaration of participants as representatives of the nursing profession was clear. CPD needed to be of a professional standard, not to fit the employer, but to fit the needs of the individual and the profession.
That to me is demeaning nursing. So, if I look at other professions, alright, I’m sure they wouldn’t have to do those demeaning things and they wouldn’t be included in their PD, their CPD hours.
(Jamie)
CPD evidence and the Board
Many participants were concerned at the lack of evidence to support nursing as a profession, in particular, ongoing education.
I think we should have the drive to do it [nursing] ourselves. But I
at it, it will only be the odd one that is audited. If you are only doing it because you get audited, well yeah. (Leah)
The desire from within nursing for a stronger stand was widespread with many participants echoing Leah’s thoughts. There was a broad level of support for the NMBA to revise the current model, placing a greater emphasis on the evidence of CPD provided by nurses.
Professional behaviour toward CPD is lacking
Amongst nurses that embraced CPD there was bewilderment as to why colleagues did not see the value associated with the development of new knowledge. As professionals, participants understood that nursing is measured by more than its bedside manner, with examination of its contribution to evidence and associated improvements in patient outcomes significant factors.
The participants, such as Alysha, believed colleagues lacked professional behaviours about education.
Before people would wander off and do bits of pieces [work] and
handover. If you had a busy patient you would say, ‘we need to
care for the patient’ or ‘we won’t go to that [in-service] today’. But
now you don’t get a choice, you go to that education session
because it’s starting to be that important. (Alysha)
By employers and management forcing nurses to engage in CPD the absence of professional responsibility remains. Nurses should be seeking educational opportunities not being told to go. A unanimous view across participants was that CPD requires more than the annual ticking of a box instigated by the NMBA, with the current poorly conducted random audit.
All about attitude
One of the areas of criticism surrounded the reluctance across individuals and groups of nurses to embrace change and evolve their practice. Kaylah shared an experience that occurred after returning from CPD that offered new insight and understanding into the provision of care for various conditions.
I had people go ‘what’s wrong with it the way it is?’ I kind of go I can’t believe that attitude of ‘why change?’, when it’s just about engaging in new ideas. (Kaylah)
The disinterest in change has impacted on those that engage in CPD, creating barriers that deter nurses from sharing knowledge and embracing the advancement of a profession. As Kaylah showed, nurses who disseminate new knowledge are simply asking colleagues to engage in a discussion as professionals.