A state of un-readiness

There were many aspects of the Fiji School of Nursing (FSN) that were not ready to receive and implement the new curriculum. They included the teachers, the clinicians, the resources required to support a curriculum change, the curriculum document and its assessment tools, and the relevant policies required to guide the new programme. The un-readiness of the teachers

The curriculum was implemented on the 18th September 2004 despite the initial refusal and opposition of the teachers at the FSN. Earlier on, the teachers had requested the deferment of the implementation of the curriculum from September 2004 to February 2005 to allow them time to prepare themselves and also to phase- out one of the two classes following the older curriculum. The teachers expressed their frustration at being ordered to implement a curriculum which in their view was incomplete; in addition to work overload and the non-availability of resources. The nature and description of the incomplete curriculum is discussed later in this chapter. At the time of implementation in September 2004, the year two and year three students of the older curriculum were into the middle of their academic year. There

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were no new staff recruited and the teachers who taught the older curriculum were also expected to teach in the new class and write up the course contents, assessments, course guidelines and develop their own tests and examinations for both classes. Teachers were also expected to continue with the clinical supervision of the students of the older curriculum in their various placement areas.

The Ministry of Health and the Nurses, Midwives and Nurse Practitioners’ Board of Fiji (NMNP Board) nevertheless stood firm on its decision to implement the curriculum, citing staff shortage as the reason behind its decision (JCU01). The nature of the administration of the FSN by the MOH does not allow autonomy in terms of decisions affecting the conduct of business at the school.

I know that when we come up with ideas and innovations and we bring them across to the head of the institution (FSN), sometimes those ideas are just shunned. I think that the institution itself has no authority. That’s my personal opinion; whether we have any power to control the running of the organisation or not. Because at most times when we need to decide on issues that concern the school, even the slightest decision has to be taken back to the Director of Nursing at the MOH headquarters. (FSN 04, p.9) The order was that this change needs to take place and we had to move. But we were not ready. We asked a few times to give us time to prepare but NO; it had to be implemented. Management was adamant that it had to commence (I don’t know whether it was the school management or from head quarters). They did not consider our plight! All of us (or most of us) were also teaching the other programme. But how could we work when we had nothing? (FSN 06, p.14)

Most of the planned refurbishment for the school library and the internet facilities were not available for the students for the whole of the first year of the curriculum (GR 03) and most of the teaching aids and printing had to be met by teachers paying from their own pockets.

An incomplete curriculum document

The teachers lamented at the state of the new curriculum when first implemented in 2004. Whilst all the teachers pointed to the lack of objectives and contents of the various subjects across the four strands, a JCU consultant explained that:

The curriculum was written in such a way that would encourage the development of the teachers in writing a curriculum. The JCU team developed all the materials for use in the first year of implementation. We

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then gave them less material to work with in the second year and the third year we provided a ‘bare’ curriculum. (JCU 01, p.2)

A participant refuted this claim stating that the first year curriculum was not complete when implemented in 2004 and the teachers had to produce their own materials from nothing:

I had never worked so hard in my life to prepare my lessons, my tutorials, my study guides and so forth. At times I would not leave this building until 2am in the morning. In addition, there was no assessment tools developed for the teachers to use in the first year of implementation! (FSN 06, p.3)

The JCU curriculum consultant later clarified the project team required the teachers to complete writing of the subject content as the course progressed from year one to year three (JCU 01). The teachers were oblivious to the ideals espoused by the JCU team and were not aware of the intentions of the project team. This curriculum strategy appeared to have been understood by the Principal of the FSN but was never communicated to the teachers by the JCU consultants or the Principal and the leaders at the MOH (FSN 08). The incompleteness of the curriculum was also testified by a senior academic when she stated:

If the curriculum was complete when we implemented it, it would have been much easier. But we came across a lot of difficulties because the curriculum was incomplete and there wasn’t enough material to refer to. (FSN 02, p.1)

My understanding of the new curriculum was that it’s just a ‘reviewed’ curriculum but after I saw it, all strands were very different and had deviated completely from what the curriculum was before the review (older curriculum). (FSN 02, p.2)

We were not familiar with terms used. We were told what the expectations of a competency curriculum were…we contributed ‘as we were told’; but where we were heading to, we did not know. (FSA 1, p.1)

They started to give us the themes and the hours to cover the themes; but when we looked at them (themes) they were in the form of very broad objectives. Some faculty members were really lost and did not know what was going on. FSA 03, p.6)

In this curriculum, you are discovering to teach as you go through it and it’s so unfair to the students and the teachers. It was a half developed curriculum and we were forced to teach it. To be short of staff, trying to write up the curriculum and at the same time trying to teach it and looking back to see if it’s the real thing, this is all of it or we were just teaching half of it. (FSN 02, p.11)

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The description of an incomplete curriculum by the teachers fitted the type and form in which the FSN curriculum was presented. The new curriculum only presented the subject prescriptions, which in some cases were incomplete. While it presented a list of possible topics to be covered in each subject, many other subjects across the four strands presented a minimal list of topics to be considered. The lack of curriculum awareness in the FSN teachers contributed to their lack of understanding of the rationale proposed by the JCU consultants. While the JCU consultants expected the local teachers to produce the content and write up the tutorial scenarios with the assessment tools as an important curriculum development activity, the teachers saw it as an incomplete document. The absence of the clinical assessment forms and evaluation tools further compounded the incompleteness of the curriculum document. The lack of objectives and the contents of the curriculum courses forced the teachers to write up the content and fill in whatever was required for a subject. The relevance and the quality of such material was secondary and for many subject areas such as Primary Health Care, therefore reverting to the content of the previous curriculum was inevitable and logical (FSN02).

The teachers were used to teaching from the previous Diploma of Nursing curriculum, which used a ‘teacher-proof’ approach to curriculum change (Macdonald, 2003). This curriculum detailed the whole course from course prescriptions, to course contents, assessment strategies to clinical learning tools and methods leaving the teacher very little to do with the subject except to teach it. The previous curriculum was compared to the new curriculum through its user-friendly presentation that anyone could pick up the document and teach from it. In the words of a senior academic at the school:

We are nurses; trained to be nurses and not teachers. We were brought straight from the clinical areas of practice to the school of nursing to teach! We know nothing about developing the curriculum and writing its content. (FSA 03, p.3)

Knowledge gaps

Teachers that were interviewed identified the gaps that existed across subjects in most strands. From the outset the NMNP Board of Fiji, in accepting the revised curriculum

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and its accompanying review report, noted the gaps in the content and requested immediate redress from the curriculum consultants (ADN02). These gaps included blood transfusion and blood safety, nursing standards, family planning and holistic and spiritual care (NMNP Board, 2003). At the implementation of the curriculum and for the subsequent three years, the gaps first noted by the NMNP Board have not been addressed. The first graduates from the new curriculum identified many areas that were not covered during their three years of education, some of which were earlier identified by the NMNP Board before the curriculum implementation.

When we first graduated and entered the service, we worked as interns in the general and special units. We did not know many things…like drugs, protocols for drug administration, blood transfusions and blood safety, the emergency management of anaphylactic shock and a reaction to blood transfusions. (GR 01, p.8)

Other areas not covered in their curriculum included primary health care nursing and community health nursing knowledge (GR 03; GR 02). Apart from the many omissions, graduates also identified a number of procedures that were not taught. These included the underwater-seal drain, drug imprest system, and injection techniques for giving immunisation. The incomplete state of the curriculum created a lot of anxiety for the teaching staff as they struggled to understand the curriculum approach and to write up the curriculum content. A teacher described the level of stress and mental strain the incomplete curriculum and its expectation brought upon their health:

You know when I try to re-call what happened, again and again, I just thank God that I am still sane because when I think of those hours I used to be in my room trying to do the work; ugh! It was just terrible and I know it was affecting my health. I remember I lost a lot of weight! (FSN 04, p.4)

Similarly, another teacher described her experience with the incomplete curriculum: We had to read and read. We sacrificed a lot of; our health, our families. We

had so much to prepare in terms of teaching aids, guides and reading resources, materials apart from teaching the other classes of the old curriculum. I have never worked so hard before to prepare for tutorials, my lessons, guides and so forth. Sometimes I would never leave this building until 1 am or 2 am in the mornings. My husband would yell at me on the phone and sometimes I would just sleep here! You know other tutors too slept here. One night, a husband (policeman) came knocking here because his wife did not come home. She was found sleeping on the floor in her office. She was just too tired to go home! (FSN 06, p.13).

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Teachers struggled to understand the new approach used in the curriculum to produce their course content and other requirements of the curriculum. Some teachers did not realise the new curriculum also needed to have a new set of assessment tools to guide the students’ clinical learning. According to a senior academic staff member, the teachers took matters into their own hands when they decided to use their Christmas family excursion in a local resort to develop their clinical assessment forms (FSN 06). The outcome of this two-day workshop was a three-year assessment logbook for the new curriculum. This three-year logbook formed the basis of all subsequent assessment forms that were being written at the FSN.

The teachers’ view of the curriculum document was that it should be written up and completed in all areas including the assessment forms and strategies. The rationale for curriculum ownership and empowerment used by the JCU whereby the teachers were expected to produce their own curriculum content and produce assessment tools was either unacceptable to, or misunderstood by the teachers.

Subject mapping

The process of curriculum mapping or subject alignment required each teacher to record or document her/his own teaching and then compare and examine with the other teachers for gaps and overlaps, redundancies and new learning (Udelhofen, 2005). Four years after the initial implementation of the 2004 curriculum, subjects taught across the strands continue to be mal-aligned leading to repetitions of themes and topics, as well as creating gaps and overlaps in knowledge and nursing procedures. Implementation of the curriculum was not easy, as the majority of the teachers did not fully understand the nature of the curriculum and its incomplete state created more confusion.

That is why when they (teachers) started to panic when the JCU consultants kept coming at us to implement it; most of them were not actually doing any work because they did not understand anything. They could not read the document; it made no sense to them. (FSA 03, p.3)

The former head of the FSN was fully aware of the difficulty faced by the teachers when she stated that the teachers were frustrated with the change, but fell short of

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explaining the absence of curriculum leadership and guidance for the staff during this critical period of their development:

I found that they (teachers) were quite frustrated along the way. I don’t blame them. Maybe because they lacked the relevant educational knowledge. They did not understand how I looked at things; I wanted them to learn and to be involved from the beginning. They really struggled. That’s why we had a lot of frustrations, a lot of talks and finger pointing. (FSN 08, p3-4)

The rationale for providing an incomplete curriculum was known to the head of the institution but was never made known to the teachers; who were expected to carry out most of the curriculum work during the implementation period. However, the teachers interpreted this non-disclosure of the rationale for curriculum development as an absence of leadership and guidance on the part of their leaders when they needed it most (FSN 04).

We wanted to give these children (students) our best. I don’t know what else to say to that when management cannot consider your request. It’s like being thrown into the deep and they did not care. And you know, that’s exactly what she told us “this curriculum is like being thrown into the water; you have to either swim or sink” I don’t know if she knew what she was saying! (FSN 06, p.17)

The state of un-readiness of the school to implement an incomplete curriculum influenced the teachers’ opposition to the Ministry of Health’s implementation plans in 2004. When the teachers were made to implement the curriculum in 2004 there was no time to design and plan classes, to develop the content of the curriculum and to document and map the curriculum. Teachers interviewed for this research likened the process of implementation to ‘building a ship and sailing it at the same time’ (that is, writing the curriculum and teaching it at the same time), leaving them no time to make plans or review their subjects.

While it appeared that the MOH wanted the curriculum implemented in September 2004, knowing full well that it needed to be written up, the Acting Director of Nursing had this to say on interview:

You know they say that they were building their ship and sailing it at the same time. For each year, I believe the school had to write up the content and guides for the curriculum and then also write the assessments for each

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year. It is not easy and I take my hat off for the staff of both schools for developing and teaching the curriculum at the same time. (ADN 02, p3)

The nursing division at the MOH was therefore fully aware of the difficulties that the teachers were going through, but allowed it to continue. The impact of such expectations and workload on the teachers was enormous, as described by one participant.

I was teaching Management to around 200 students from the older curriculum; where you know, you do everything. We teach, we mark assignments, set assessments and examinations and mark them. We counsel and supervise clinical practice. At the same time in (September) I received my package to do my Master’s programme with JCU by distance. I didn’t touch my books until December. And I led the Nursing Practice strand in the new curriculum and we had 198 students. I don’t know if any other institution had done this to continue to write a curriculum and at the same time you are implementing it. I am amazed and I thank God we are still ‘sane’ after all that!! (FSN 04, p.3)

One of the participants at the time of implementation described the difficulties of the teachers implementing their subjects:

Teachers had difficulties identifying the linkages, continuity or the conceptual relationship of subjects taught within a semester. There were topics in PPD that needed to be linked to PHC strand and we tried to make sure that other strands do not repeat subjects already taught. Subjects such as Management, which is taught in PPD needed to be linked to PHC within the management of a nursing station, health centre or rural hospital. (FSN 01, p.4)

In fact a former Principal of the school knew the teachers struggled because they lacked the necessary and relevant educational preparation to undertake the curriculum development and implementation responsibility, but she fell short of providing reasons for the lack of guidance and why they were not provided. Principals, according to Fullan (2007), are the gatekeepers of change in their institutions and their actions may promote or inhibit change. The role of the Principal in a curriculum change will be discussed in-depth in Chapter 8 of this thesis.

Catching up, overlaps and missing links have been key features of the implemented curriculum (FSN 04; FSN 05; FSN 03; FSN 06). The problem of unrelated topics across