VOL: 102, ISSUE: 13, PAGE NO: 36
Janet Wood, MSc, CertEd, BMed Sci, RGN, is professional development adviser, Sheffield Teaching Hospitals NHS Foundation Trust
There is a clear expectation for NHS trusts to invest in the professional development of nurses as a quality-improvement measure (Department of Health, 2004; 2000). CPD and clinical governance are inextricably linked because professional development is a national process that leads to quality improvement and supports the modernisation agenda.
This study explores senior staff nurses’ experiences of CPD. The purpose of the study is to ascertain whether understanding the lived experience of CPD can inform programme planning.
A lack of research evidence exploring CPD and nursing competency in general is highlighted in the nursing literature (Connelly et al, 2003; Stokes, 2000; Little, 1999). However, there is evidence that relates to this study.
Contextual research has explored the experiences of newly qualified nurses in transition from student to staff nurse. Studies carried out by Kramer (1974), Gerrish (2000), and Ross and Clifford (2002) illustrate that nurses in the transition period require support in clinical practice as they develop into accountable practitioners.
While these studies are useful they do not explore the experiences of staff nurses beyond the transition period, that is beyond six months post-registration.
Savage and Moore (2004) explored whether practice nurses who are working in general practice in the community setting understand accountability. Research by Savage and Moore (2004) reveals a poor understanding of accountability and recommends that learning resources should be developed to facilitate learning related to accountability in different contexts. They recommend the use of workshops or videos that use decision-making scenarios to explore and improve practitioners’ understanding of accountability.
A study by Benner (1984) provides a vivid and colourful description of nursing practice and illustrates implications for nurses in relation to education and practice. Benner believes the competent nurse or nurse beyond the novice stage would benefit from decision-making games and simulations that offer practice in planning and coordinating multiple complex patient care demands.
Little (1999) explored the meaning of learning as expressed by a sample of 10 intensive and coronary care nurses undertaking a post-basic course. Little identified that learning experienced by nurses in the sample group could be placed into three categories: learning as focusing on their own needs; learning as questioning; and learning as technical mastery. Little believes that learning as focusing on one’s own needs and learning as questioning to be common among nurses and identifies that learning as technical mastery is the essential theme in the study.
Connelly et al (2003) explored competencies needed by charge nurses in a US military medical centre and concluded that the most important relate to human relations. Connelly et al recommend the use of study programmes to develop competence and that these should include teaching methods such as role play, analysis of cases and debriefing in specific situations.
In an unpublished action research project on identifying and meeting the professional development needs of the new F-grade ward sister or charge nurse, Parker evaluated a professional development programme. The study group identified topics thought to enhance CPD for senior staff nurses. These were: accountability; maintaining standards; multidisciplinary interactions; handling complaints; communication; assertiveness; and portfolio-building.
Parker also listed types of learning that the sample group believed would be useful for senior staff nurses. These were: problem-solving; acting up into senior roles; work shadowing; reflection.
Learning in relation to accountability is named in two studies as necessary for the professional development of senior staff nurses. Other topics include technical mastery, human relations skills, maintaining standards, multidisciplinary interactions, complaints, communication, assertiveness and portfolio building.
The teaching methods identified as useful to facilitate learning for senior staff nurses are also varied. Predominantly the methods identified should be used away from the practice setting. These include workshops, videos, decision-making games, simulations, role play, analysis of cases, debriefing, problem-solving and reflection on action. The remaining teaching methods identified would be useful in the practice setting. These include acting up, work shadowing and reflection in action.
This study used a hermeneutic phenomenological approach. While findings are not intended to be generalisable, they are informative.
The study began once the local ethics committee had approved the research application. A purposive sample of five participants was recruited to include the widest possible variety of staff nurses at around two years post-registration. Although the study used a small sample, it is considered representative of the population being studied. However, the small sample means that findings lack external validity and conclusions should be explored with further research.
Hermeneutic phenomenology works on the basis that a driving force of human consciousness is to make sense of experience and this is uncovered through narrative (Kahn, 2000). As phenomenology relates to individual experience, data was collected at individual interviews. Participants were interviewed individually on two separate occasions. Initially they were interviewed to collect data in order to identify themes. A second interview was used to check and validate the themes identified.
While unstructured interviews are commonly used in descriptive and qualitative studies, this study involved semi-structured interviews. The researcher used open-ended questions to provide structure for the interviews. A critical reflective diary was kept throughout the study to identify and reduce bias. It is accepted that themes identified are relative to the researcher’s context of engagement and is accepted as one of the ways in which the experience is understood.
The data collected at each interview was analysed twice using different analytical styles. Data analysis allowed the researchers to shift essential themes from non-essential themes to maintain a strong emphasis and oriented relation to the phenomena.
The study generated data that identified the following key themes:
- The experience of CPD is about being opportunistic;
- The experience of CPD is about keeping up to date with advances in nursing practice;
- The experience of CPD is about undertaking experiential learning;
- The experience of CPD is about meeting the demands of current roles.
CPD is about being opportunistic
In this study being opportunistic relates to the participants’ experiences of courses and study days. During the interviews, all participants described being motivated to attend courses and study days. During the first interviews it was apparent that there were plenty of opportunities for participants to do so. Three confirmed that a structured learning programme provided as part of the preceptorship period during the first six months of employment had a beneficial impact on CPD.
During the second interviews all participants agreed that their experience of CPD included taking the opportunities available. Two participants stated that their experiences demonstrated that personal time management and clinical area workload could influence whether opportunities were taken.
CPD is about keeping up to date
The participants’ experiences of CPD relate to keeping up to date with advances in nursing practice. During the first interviews participants told their stories of attendance at mandatory study sessions such as cardiopulmonary resuscitation ‘to keep me up to date’. One participant said her experience of attending courses and study days had been relevant to her practice. Another described CPD as a means of advancing her competence and development and learning technical skills.
During the second interviews participants agreed that their experience of CPD related to keeping up to date with the latest advances in nursing practice. One added that her experience had included significant learning after her pre-registration programme ‘because things are changing all the time’.
CPD is about experiential learning
CPD is about experiential learning or learning that takes place in the practice setting. Participants told stories of learning through experience and the value of doing clinical courses that require clinical competency assessment. They also talked about reflection in action. Two participants described a new situation and a problem that had made them think and learn while acting. They considered this to be part of CPD.
During the second interviews participants agreed that their experience of CPD had been about experiential learning.
CPD is about meeting role demands
Participants described their experiences of CPD in terms of meeting the demands placed on them in their roles as senior staff nurses. They also described developing into confident members of the multidisciplinary team. This illustrates that learning human relations skills was a component of the lived experience of CPD among senior staff nurses in the sample group.
The evidence illustrates that CPD helped participants cope with the stress they experienced in relation to nursing practice. One participant explained how CPD had helped her gain competence and confidence.
During the second interviews participants agreed that their experiences of CPD had been about meeting the demands of their current role.
Evidence in this study illustrates that CPD is about keeping up to date with advances in nursing practice. Participants recounted that they had the opportunity to attend study days and courses. NHS trusts that provide an opportunity for nurses to attend courses and study days nurture a workforce that is fit for practice, fit for purpose and enhances the quality of care delivery.
However, leaving the clinical area to attend courses and study days separates the process of learning from the act of engaging with patients in the practice setting. Indeed, Pugsley and Clayton (2003) found that nursing students were more positive when learning was promoted with experiential learning techniques rather than the traditional lecture-style courses.
In this study participants identified that their experience of CPD was related to experiential learning. It is clear there is a culture in which attending courses and study days is valued and equal value should be placed on learning in the practice setting.
Participants in this study were motivated to take CPD opportunities and this supports them in meeting the demands placed on them in their current roles. Kramer (1974), Gerrish (2000), and Ross and Clifford (2002) identified the need for support in the practice setting for newly qualified nurses.
Evidence in this study illustrates that the need for support extends beyond the transition period. Support can be offered with clinical supervision. Clinical supervision is a supportive mechanism that supports lifelong learning. Reflective practice is central to clinical supervision and Griffiths (2004) writes that reflection is an important component of experiential learning.
Participants’ experiences illustrate that engaging with CPD reduced the stress they experienced while they developed from a novice to become a competent member of the multidisciplinary team. This study illustrates that undertaking CPD has helped participants to develop confidence and competence as well as capability and job satisfaction. This is significant since Chang et al (2005) illustrate that role stress is one of the main reasons nurses leave the profession.
Exploring the lived experiences of senior staff nurses has provided information that is useful for professional development programme planning. Senior staff nurses in the sample studied were motivated to engage in a range of CPD opportunities in the form of study days and courses as well as experiential learning.
While attending courses and study days is useful, this study illustrates the value of experiential learning for senior staff nurses. Therefore teaching methods that are useful in the practice setting, such as acting up, work shadowing and reflection in action should be considered when planning programmes of study for senior staff nurses. In addition, types of learning that are practice-focused will be useful. These include learning sets and scenario and decision-making games.
CPD has enabled senior staff nurses in the study sample to stay up to date when it comes to the latest advances in nursing practice and meeting the demands of their role. Evidence in this study illustrates that engaging with CPD can help to reduce work-related stress among senior staff nurses.
Providing CPD opportunities can promote confidence and competence as well as helping to develop a workforce that is both ‘fit for practice’ and ‘fit for purpose’. Due to this being a small study further research is required.
This article has been double-blind peer-reviewed.
For related articles on this subject and links to relevant websites see www.nursingtimes.net