Reporting and performance

7.2.1 Defining the role

The ability to define the work of nurses is important and applicable to all nursing roles [24]. Role definitions provide clarity not only to the specific professional group but also importantly to peers, other professional groups within the workplace and the community. Defining what we do and informing others of our role provides clarity in expectations and pe rformance of the behaviors and characteristics we assume within a position as described by role theory in Chapter

2. Redefining nursing roles also presents challenges and opportunities underpinned by imperatives to integrate professional and educational requirements and practice competencies within role development frameworks [25].

In the Australian context, as noted in the literature review in Chapter 2, there is no consensus in terminology used for nurse educator roles. This is consistent with the vague terminology applied to nursing and midwifery roles noted in government reports and regulatory guidelines [26]. An important factor in employee performance and satisfaction is having a clearly defined role, job description and regular feedback on performance [27]. Without a clearly defined role, nurse educators may have differing notions of role parameters, as may their managers and other nurses and health professionals with whom they interact. Collaboration between nurse educators and other key stakeholders is important to determine an appropriate role definition.

The findings from the NEACH study emphasize the importance of identifying roles, responsibilities and e xpectations of nurse educators and o f developing and validating nurse educator competencies. This highlights the need for educators, employers and professional associations to work collaboratively to determine the role and scope of practice of educators. The definition posed by the researcher in Chapter 1 that ‘a nurse educator is defined as a registered nurse and professional expert whose primary responsibility is to provide education to undergraduate and postgraduate nursing students, graduate nurses and o ther occupational groups within a hospital setting’ is a broad definition embracing a range of titles for nurse educators (e.g. nurse educator, clinical nurse educator, staff development nurse) employed within hospitals across Australia assuming responsibility for educating the groups cited above. This definition may provide the starting point for further discussion within the profession to gain consensus regarding a role definition.

7.2.2 Feedback to improve role effectiveness

Performance review provides the opportunity for nurse educators to receive feedback on their performance and t o identify and negotiate performance goals and career aspirations [27]. Nurse educators require regular feedback to validate that they are performing to their full scope of practice and to acknowledge their achievements. This view was apparent when respondents ranked the item ‘uses feedback from learners, peers and your manager to improve role effectiveness’ (7.88±1.03) with the highest score in the ACONE scale. This finding demonstrates

that the nurse educator values feedback and performance review. Without this performance review and support, nurse educators are likely to disengage from their roles and workplaces or perform inadequately.

7.2.3 Clinical and performance indicators

Specifying performance indicators is increasingly necessary as ‘non-clinical roles’ — that is, roles not directly responsible for providing patient care — such as the nurse educator role, are under scrutiny to provide evidence of their contribution to patient and he alth outcomes by health managers at all levels, particularly in the current climate of fiscal restraint. This is not an unreasonable response on the part of health managers in the face of limited empirical evidence demonstrating the effectiveness of continuing professional education and significant monetary expenditure associated with these programs [28].

As nurse educators reported in the qualitative findings in Chapter 5, they are at times ‘…taken out of their role to take patient loads and pick up the slack’. When this occurs, management may well assume that nurse education and research is less important than the ability of educators to assume a clinical load. Management may also perceive that the work of an educator does not equate to a full workload. This leaves the ‘door wide open’ for managers to speculate that the nurse educator position is unnecessary or that fewer hours are required to perform the role. It is a strategy employed to meet budget targets.

Nurse Unit Managers need to ensure they have adequate staffing, but they also need to ensure that their staff receives ongoing education and support to achieve safe patient outcomes. This cannot be achieved if nurse educators are used as ‘casual’ staff that can be called upon to provide direct clinical care as and when required, while their primary responsibility of educating staff is negated.

As described in the literature review in Chapter 2, nurse educators influence patient outcomes through teaching and supervising staff, improving recognition of the deteriorating patient, and preventing and managing falls and medication errors [29]. It is important to align performance indicators to the work of nurse educators to ensure that every effort is made to optimize patient outcomes.

Only 69.6% (n=272) of study respondents reported that their role was linked to specific clinical indicators or performance outcome measures. Although some

nurse educators reported that they had clinical indicators for their role associated with falls, changes in clinical practice and medication safety, for example, it is important that nurse educators discuss and achieve consensus regarding appropriate clinical indicators, how they will be measured and, if appropriate, benchmarking these across units and facilities.

Nurse educators also indicated that they ‘monitor outcomes in relation to educational activity’ (ACONE: 6.63±1.95). It is important that nurse educators work with their peers and managers to determine appropriate performance indicators that capture their contribution and impact on nurse education, as well as identifying opportunities for performance improvement. Performance outcome measures also provide evidence to peers, managers, health organizations and the nursing profession of the contribution of nurse educators to patient outcomes and education.

7.2.4 Identifying learning needs

Nurse educators appreciate the importance of professional education and supportive work environments in influencing the delivery of safe, quality patient care [30]. Identification of learning needs, career aspirations and t he development of a pr ofessional development plan in support of continuing professional education are also important factors that support performance [31, 32]. The study findings reported in Chapter 6 show that staff whose professional development needs are identified as par t of the performance review process, perceive their contribution to the workplace to be valued and are likely to have a higher level of job satisfaction [27]. Organizations delivering safe, quality nursing care value their employees and value these processes [32].