Expanding the clinical placement capacity of rural hospitals in Australia: Displacing Peta to place Paul?
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.
References (34)
- et al.
Building capacity for the clinical placement of nursing students
Collegian
(2008) - et al.
The evaluation of a successful collaborative education model to expand student clinical placements
Nurse Education in Practice
(2010) Developing inter-professional learning: tactics, teamwork and talk
Nurse Education Today
(2009)Designing quality course management systems that foster intra-professional education
Nurse Education Today
(2006)- et al.
Addressing Australia's nursing shortage: is the gap widening between workforce recommendations and the workplace?
Collegian
(2003) Developing clinical placements in times of scarcity
Nurse Education Today
(2006)- et al.
Enhancing the effectiveness of the teaching and learning of core clinical skills
Nurse Education in Practice
(2005) - et al.
No model of clinical education for physiotherapy students is superior to another: a systematic review
Australian Journal of Physiotherapy
(2007) - et al.
New role to support practice learning — can they facilitate expansion of placement capacity?
Nurse Education Today
(2007) - et al.
The role of simulation in nurse education
Nurse Education Today
(2010)
The perennial struggle to find clinical placement opportunities: a Canadian national survey
Nurse Education Today
Rural, Regional and Remote Health: Indicators Of Health Status and Determinants Of Health. Rural Health Series No. 9. AIHW cat. no. phe 97
Models of interprofessional learning in Canada
Journal of Interprofessional Care
Interprofessionality as the field of interprofessional practice and interprofessional education: an emerging concept
Journal of Interprofessional Care
Best Practice Clinical Learning
Clinical Placements in Victoria: Establishing a Statewide Approach
Will Australian rural clinical schools be an effective workforce strategy? Early indications of their positive effect on intern choice and rural career interest
The Medical Journal of Australia
Cited by (20)
Consultation to review clinical placement processes: A quality assurance project
2022, Nurse Education in PracticeCitation Excerpt :Often, MCH workplaces are constrained by declining numbers of nurses and high workloads (Kruske and Grant, 2012) and increasing complexity of clientele (Department of Health and Human Services, 2016). These issues potentially lead to restricted capacity for supervision and mentoring of students (Barnett et al., 2012; Bourgeois et al., 2011). Similarly, nurses may have a limited understanding of the university curriculum (Peters et al., 2013) and be reluctant to take on the preceptor role, perceiving themselves as ill-prepared, unsupported and lacking confidence (Sorrentino, 2013).
Several strategies for clinical partners and universities are perceived to enhance physiotherapy student engagement in non-metropolitan clinical placements: a mixed-methods study
2017, Journal of PhysiotherapyCitation Excerpt :This is particularly important given the unmet healthcare needs of communities in non-metropolitan areas.1 There is evidence to suggest that students who have had positive clinical placements in these areas will be more likely to seek employment in non-metropolitan areas on graduation.2–12 As the demand for physiotherapy clinical placements across Australia increases, there is an urgent need to utilise all geographical areas and provide students with positive learning experiences outside of metropolitan areas.13
Quality clinical placements: The perspectives of undergraduate nursing students and their supervising nurses
2016, Nurse Education TodayThe experiences of student nurses on placements with practice nurses: A pilot study
2016, Nurse Education in PracticeCitation Excerpt :The importance of high-quality practice learning opportunities is well-documented nationally and internationally in the UK (e.g., Quality Assurance Agency, 2001), in Canada (e.g., Reimer Kirkham et al., 2007, Smith et al., 2010) and in New Zealand (e.g., Betony and Yarwood, 2013). However, globally the issue of capacity with regard to practice placements for student nurses is also becoming more acute as student numbers increase and number of practice areas for placement learning decreases (Edwards et al., 2004; Hall, 2006; Reimer Kirkham et al., 2007; Barnett et al., 2011). In addition to the decreased availability of traditional hospital-based placements, there are major policy changes taking place globally to move healthcare provision into the community.
New ways of seeing: Nursing students' experiences of a pilot service learning program in Australia
2016, Nurse Education in PracticeCitation Excerpt :First and foremost, ‘learning outsider the box’ relieves pressure on traditional clinical settings where rising numbers of students require placement. Traditional clinical placement sites are increasingly viewed as overburdened, competitive and constrained environments that have the potential to compromise student learning and staff wellbeing (Barnett et al., 2012; Hall, 2006; Smith et al., 2010). A pressing need for alternate and innovative placement sites is widely acknowledged and internationally, the use of innovative placement sites appears to be increasing (Hall, 2006; Smith et al., 2010; Smith et al., 2013; Stallwood and Groh, 2011).
Clinical placements in general practice: Relationships between practice nurses and tertiary institutions
2013, Nurse Education in PracticeCitation Excerpt :As universities have increased the number of undergraduate nurses to address issues of nursing workforce shortage, there is growing competition for finite placements in the clinical setting (Andre and Barnes, 2010; Bourgeois et al., 2011; Courtney-Pratt et al., 2012). The availability of clinical placements is constrained by a combination of organisational, regulatory and educational requirements, as well as the capacity of health services to supervise and mentor undergraduate nurses (Barnett et al., 2011; Bourgeois et al., 2011). In the contemporary clinical environment of high workloads and diluted skill mix, there has been a decreased capacity to provide placements (Barnett et al., 2011).