Recruitment and selection of students

Representatives of the hospitals or institutions who employed the nurses nominated

potential applicants for student openings in the APN programme. Candidates were selected from a pool of what all participants described as expert clinical nurses – the ‘cream of the crop’ as designated by their employers. Highly skilled nurses caught the attention of nursing managers, directors of medical services and consultants who were interested in supporting them for advanced education. Criteria for candidates for the APN programme included the following:

 Initial RN (registered nurse) diploma level education;  Advanced diploma in a clinical specialty;

 ‘off shore’ bachelor’s degree;

 Minimum of three years clinical experience in an identified specialty.

All prospective students were reviewed by National University of Singapore regarding their eligibility for university admission. At the time of completion of data collection in 2011, APN student cohorts did not include self-selected students nor were there any options for part time study. In order to fill the slots for the first cohort of students the Programme Manager utilised the authority associated with the manager’s position to convince Directors of Nursing, Assistant Directors Nursing, and Directors of Medical Services to select top clinical nurses with strong clinical practice backgrounds as appropriate candidates to enter the programme. Initially Directors of Nursing were uncertain about the course and reluctant to identify applicants for the programme. Findings indicated they did not really understand the role themselves even though they had to select students for the first cohort. All nursing managers interviewed indicated that they were unclear about the APN role and uncertain re expectations of the outcome of the academic programme. This led them to take on the role as trail blazers themselves in order to provide support for the APN students who were pioneers for role development. The following quote by an Assistant Director of Nursing exemplifies this challenge:

‘All of us [nursing managers] took it step by step. The first step was to nominate people for the programme so there were numbers representing each hospital. After that we needed to send about three [potential students] to get the class started so that the total number is sufficient to form a batch to start the programme. We looked at who were our best nurses ... at that point we didn’t know who was going to enter.

We saw the curriculum … it described this thing [the APN]. In reality how is it going to be done? We still have no idea. We read a lot of literature on the APN role, on nurse practitioners but local context wise even the clinicians, actually most of us were lost as to how is it going to happen’ [Participant 10NL]

The nurses recruited for entrance into the programme in the initial stages were unclear themselves as to the intent and focus of the course they had been selected for. A participant from the first student cohort provided these comments:

‘Basically the first batch of nurses that went there [National University of Singapore] weren’t told that they were to be an APN. We were informed … that we were going to advanced education. We were nominated by the hospital. Halfway through the course we were told this course was going to be adult health as an APN. I was very trusting and to me I think there is no harm in learning more things’ [Participant 20NL] However, the same participant challenged the necessity of a formal academic programme for advanced nursing and suggested that the course was in reality simply legitimising functions nurses were already able to perform. This viewpoint is illustrated with this quote:

‘[The role] is good in that nurses are given the expanded role, even higher

education. In a sense they may not be fully utilised in this role because in the past we did a lot in the expanded role. Not because we were trained. We learned on the job. We were given autonomy by the physician to do the role. … now everything is based on paper qualification and competency’ [Participant 20NL]

At the completion of data collection in 2011 nursing managers and medical consultants were gaining confidence in the educational programme and were acquiring some clarity as to the position of the APN in the Singaporean healthcare workforce. Although awareness of the emphasis of the course was improving, students remained unclear as to their future role upon completion of the programme. All participants indicated that lack of role clarity and uncertainty regarding the programme outcome contributed to ongoing difficulty in student recruitment in the initial stages. In addition, there was concern about ‘creaming off’ the ’top’ clinical nurses. Nursing management indicated that retrospectively nominating top clinical senior nurses from hospital settings may not be the best choice of candidates in terms of the calibre of nurses needed for an APN role. They also indicated that selecting their ‘best’ nurses negatively impacted the balance and priorities of the total nursing workforce for an institution.

Findings indicated that discussion and some disagreement arose as to who should

participate in student selection. Representatives of healthcare institutions that employed the nurses indicated they were familiar with the candidates and their aptitude for academic education. They were reluctant to share responsibility with representatives of the university nursing department in interviewing and screening applicants for the programme. Key stakeholders and university representatives saw this as negatively impacting recruitment. There was little change in the recruitment process at the time of completion of data

collection in 2011; however, the recruitment processes were under discussion by employers and academic nursing leaders. The next subsection presents student data from the time of enrolment in the programme to the point in time when they reached the position of a licensed APN.