Elsevier

Nurse Education Today

Volume 32, Issue 5, July 2012, Pages 485-489
Nurse Education Today

Expanding the clinical placement capacity of rural hospitals in Australia: Displacing Peta to place Paul?

https://doi.org/10.1016/j.nedt.2011.08.013Get rights and content

Summary

In order to identify opportunities to build capacity for clinical placements, we mapped and described the organisation of student placements at three hospitals, each with multiple education providers, in rural Victoria, Australia. Using a cross-sectional, mixed method design, data were collected by survey, interviews and discussion with student placement coordinators representing 16 clinical health disciplines.

Teaching and supporting students was regarded as an important part of the service each hospital provided and a useful staff recruitment strategy. There were peaks and troughs in student load over the year, though this was less marked for medicine and dentistry than for nursing and allied health disciplines. Whilst placements were managed largely on a discipline basis, each hospital had taken steps to communicate information about student placements across disciplines and to identify opportunities for interprofessional education (IPE).

Placement capacity could be increased by sharing placement data within hospitals, smoothing the utilisation patterns across the year, capitalising on opportunities for IPE when there is concurrent placement of students from different disciplines, and through better employment of underutilised clinical areas.

Introduction

Reflecting conditions in many other countries, there is a shortage of health care professionals in both rural and metropolitan areas of Australia. Increasing the supply of graduates is critical to resolving this crisis and to meet the public's need and expectation for safe, timely and accessible health services. In response, universities have been encouraged to accept greater numbers of students into health professional courses (Eley et al., 2008) and as a consequence, pressure has been placed on clinicians and health services to accept additional students for practical experience (Eley and Baker, 2007). The impetus to boost graduate numbers has also increased competition between both universities and health disciplines to access sufficient, quality placements for students (Department of Human Services, 2007). There can often be independent requests from different universities (or disciplines) to the hospital to place students in the same clinical area at the same time. However, accepting new students who displace others can cause conflict and result in little gain in placement capacity.

The ability of clinical agencies to accommodate students is constrained by a multitude of organisational, regulatory and educational requirements, including the availability and preparedness of clinicians to teach and mentor students (Barnett et al., 2008, Darcy Associates Consulting, 2009). There is a risk that the cumulative pressure on clinical facilities to accept more students could exacerbate the supervisory impost on clinical staff and their potential for burnout (Cowin and Jacobsson, 2003, Gupta et al., 2009). In the context of escalating staff workloads and diluted skill mix, some clinical agencies have questioned their commitment to clinical education with students regarded as a ‘burden’ (Jackson and Daly, 2009).

The clinical competence of new graduates and their need to receive sufficient clinical exposure during their training has received significant attention (Hilton and Pollard, 2005, Mallik and Hunt, 2007). Apprehension about the adequacy of clinical preparation has generated criticism that graduates are not ‘workplace ready’ or ‘fit for practice’ (Heath, 2002). Quality placements contribute to the development of clinical competence and improve recruitment and retention (Henderson et al., 2007). Barriers which limit the clinical preparation of health care students, such as insufficient clinical placements and competition between students from different disciplines for learning opportunities in the same clinical area or from the same group of patients, are likely to compound this problem (Wottan and Gonda, 2004, Lekkas et al., 2007). Fresh approaches to clinical education are needed if the number of students is to be increased without compromising student learning or patient care (Hall, 2006). Simulation, the clinical learning environment (CLE) and interprofessional education (IPE) have emerged as key topics for discussion in health professional education (D'Amour and Oandasan, 2005, Eley et al., 2008, Pike and O'Donnell, 2009, Steven et al., 2007).

The clinical environment should optimise students' experience of quality care, expose them to a culture of evidence based practice and incorporate interprofessional collaboration as the basis for patient care (UK Department of Health, 2001). Collaboration, teamwork and IPE feature prominently as priorities for health care reform though cannot occur without recourse to appropriate training (Cook, 2005, McCaughey and Traynor, 2010, Stone, 2007).

Whilst there has been only limited uptake of IPE in undergraduate curricula or clinical placements in Australia (Thistlethwaite, 2007) major initiatives have recently been implemented to better plan, coordinate and facilitate clinical placements at State and National level (Health Workforce Australia, 2010). Importantly, steps also need to be taken at a local, contextual level to prioritise demands, facilitate appropriate experiences for students and help build capacity.

Across Australia, the initial preparation of health care professionals occurs in universities where courses may vary in length depending on the discipline. However, most are structured and taught on a semester basis and new intakes of students typically occur at the start of the calendar year.

Each hospital may have links with any number of universities with whom they negotiate the placement of students for practical (clinical) experience. Unlike the practices in many other countries, it is not uncommon for hospitals to receive requests to provide placements for students from many different universities and colleges, especially in nursing and the allied health disciplines. This practice adds a complexity to the management and organisation of placements as each university has individual contractual requirements, quality assurance processes, governance arrangements, policies and procedures for dealing with students as well as different sets of learning outcomes specified for each placement. The clinical placement coordinators located at each hospital for each discipline, face complex challenges in accommodating multiple requests and in balancing competing expectations (Barnett et al., 2010).

These problems may be amplified in rural hospitals, as many health curricula require students to undertake a placement experience in a rural setting. In some disciplines, such placements have been mandated as a way to expose metropolitan based students to rural and remote settings with a view that they may seek employment opportunities in these, or similar areas, some time following graduation. This would then help address the maldistribution of health professionals and contribute to improving health outcomes in these areas (Australian Institute of Health and Welfare, 2008). Many rural hospitals also experience greater staff shortages and often employ a higher proportion of part-time staff. Both factors can make the placement of increased number of students difficult.

Within this context, this project aimed to: map and describe how student placements were organised and managed at three rural hospitals and to identify opportunities that could build capacity for clinical placements and interprofessional learning (IPL).

Section snippets

Methods

The project team identified 19 hospitals in Victoria for potential participation on the basis that each facility accepted students for clinical placements in a range of health disciplines from two or more universities. A letter of invitation was sent to Chief Executive Officers and three facilities were recruited on the basis that each was able to complete the project within the prescribed timeframe. Approval was received from relevant ethics committees prior to data collection.

At each site,

Results

The number of students on placement with each hospital was a function of a number of factors including: the size of the organisation, the range of services offered and staff profile. At each site, most disciplines had developed their own repository for student placement data though each hospital had initiated mechanisms that encouraged this information to be collated centrally. Table 1 shows the student placement characteristics of each hospital.

In the largest facility (Hospital A), a total of

Discussion

Whilst the three rural hospitals included in this study were not atypical of those found in more densely populated regions of rural and regional Australia, extrapolation of these findings to other contexts is cautionary. Each health care facility has its own unique history, services and relationship with its community and education provider/s. Notwithstanding this limitation, the data suggests that within hospitals, acute care bed numbers can reasonably inform estimates of placement capacity.

In

Conclusion

In the push to increase placement numbers and in an environment of increased competition for placements, the potential for saturating clinical venues with students, compromising the quality of their learning and overloading clinical staff are well-recognised challenges (Smith et al., 2010). As reported elsewhere (Magnusson et al., 2007) regular site-specific consultation and negotiation as well as regional, state-wide and national planning is critical to minimise these adverse impacts. With

Acknowledgements

The research team thanks participants, their hospitals and the Victorian Government Department of Health for funding this research. We also thank Katherine Collins for editorial work on the manuscript.

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