A stock-take of existing aged care clinical placements for undergraduate nursing students in Australia

A stock-take of existing aged care clinical placements for undergraduate nursing students in Australia

[Executive summary]: In 2006, the Centre for Rural and Remote Area Health (a research centre of the University of Southern Queensland and the University of Queensland) was funded by the Australian Government Department of Health and Ageing to undertake a study examining the experiences of universities in relation to aged care clinical placements for undergraduate nursing students. The study involved collecting and analysing quantitative and qualitative data from 32 heads of schools of nursing and midwifery on an Australia-wide basis.

The research was driven by concerns about the recruitment and retention of aged care nurses. The aim was to review the different means by which undergraduate nursing students undertake aged care clinical placements in Australia. The research found a paucity of literature specifically focusing on clinical experiences in aged care for undergraduate nursing students. However, the prevailing view is that aged care is not a favourite career option for many student nurses (Happell, 1999; McKinlay & Cowan, 2003; Nielsen, 1999).

Method

The research employed a cross-sectional, descriptive design to provide a baseline upon which future data on aged care clinical placements could be compared. All Australian universities with a Faculty, Department or School of Nursing were invited to participate.

Results

Universities held similar understandings and expectations as to what is meant by the term ‘aged care clinical placements’. This usually incorporated some notion of placements that involve care of patients/clients over the age of 65 and/or in a setting where students come into contact with an older person. The health services used for aged care clinical placements were primarily private and public residential aged care facilities or hospital rehabilitation units located in areas convenient to the university.

The number of students placed in health services that offered aged care per semester varied widely. The universities that had the largest numbers of students placed on a per-facility basis were those in close proximity to, and had forged close links with, health services that provided opportunities for aged care clinical placements.

The most common reasons given for the refusal of placement from health services was competition from other universities or competition from other academic years of the same university. However the majority of universities reported they were “always” or “very often” able to place students for aged care clinical placements. Around half of the universities were required to pay for aged care clinical placements, the method of payment most commonly used being the health service invoicing the university.

The selection process most commonly applied when choosing health services for aged care clinical placements was based on whether or not the facility had received accreditation. As we point out in this report, this may not be a particularly valid or satisfactory basis for selection.

The educational activities and experiences offered by health services were quite varied with those related to dementia care and palliative care being the most common.

Universities primarily ran orientation sessions involving both staff and students as a means of preparing staff to support and supervise students. Universities most commonly utilised the services of a registered nurse employed by the health service to supervise students while they were on clinical placement. This was generally in combination with an adequately trained clinical facilitator employed by the university.

Academic staff involved in supporting and supervising students during clinical placement usually had a mix of both academic and clinical aged care experience. However it was not always possible to achieve this mix. It was not uncommon to use generalist nurses with tertiary qualifications or experienced aged care nurses with no tertiary qualifications.

Aged care clinical placements were commonly undertaken in the first and third years of academic study. Universities typically reduced the number of third-year students placed per health service to ensure that students received adequate attention from the supervisory staff.

Universities made concerted attempts to ensure that placements were tailored to meet the clinical needs of students but this was not always possible due to the competition for places from other universities. Universities claimed that their students were prepared for undertaking aged care clinical placements primarily through the academic course-work undertaken.

Recommendations

• Aged care clinical placements need to be spread more evenly across health services and universities need to expand their definition to include other sites that offer aged care specific services.
• There needs to be a commitment to underwrite the financial costs for student travel and accommodation so as to be able to access rural and remote health services. This may also help to ease skill shortages in rural areas.
• Universities need to have better internal co-ordination of aged care clinical placements to eliminate conflict between first and third year placements.
• A more coordinated approach to placements should be negotiated between competing universities to ensure all students have equal access to an aged care placement.
• The development of more formal agreements between universities and health services should be able to ease the pressure on competing universities.
• The financial aspects of aged care clinical placements should be standardised to make this an attractive placement for the universities.
• There is a need for the development of a clinical audit tool to be used across universities to assess health service suitability for an aged care clinical placement. This will ensure that students will undergo similar standards of aged care clinical experience.
• More support is needed so that health services are better able to support their staff in taking on students for aged care clinical placement.
• Incentives should be offered to specialist aged care nurses to participate in further training to enable them to be good educators either in academia or in the workplace.
• There is a need for more emphasis on university staff to have aged care qualifications and relevant experience.
• University curricula should include specific aged care content to better prepare students in the complexity of caring for older people. This educational content should be consistent across all universities.
• Supervision of students on aged care clinical placements should be provided by suitably qualified educators.
• Supervisors of students on aged care clinical placements should ensure that the focus does not remain just on acquiring basic nursing skills, but should also focus on acquiring aged care specific skills.
• There needs to be more promotion of aged care as a fulfilling and challenging career choice.

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