Utilising the Canterbury Dedicated Education Unit Model of Teaching and Learning to Support Graduate Nurses

Abstract

IntroductionThe transition period from undergraduate student nurse to the graduate registered nurse (GRN) role can be a stressful time for many (Tsai et al., 2014). This challenging and demanding transition can lead to dissatisfaction with nursing, high personal stress levels and intention to leave the profession (Jamieson, Kirk, & Andrew, 2012). High turnover rates for new graduates is costly both to the graduates and the employer. To mitigate these concerns, historically the preceptorship model of clinical teaching and learning (CTL) has been used globally to support GRNs (Hyrkas & Shoemaker, 2007). This article presents the findings from the pilot of an alternative model of CTL, the Canterbury Dedicated Education Unit (CDEU), used to support New Zealand GRNs enrolled in a Nurse Entry to Practice Programme (NETP) in an inpatient unit. In this context the GRNs were students who had graduated from New Zealand Bachelor of Nursing programmes within the last six months and who had passed the Nursing Council of New Zealand state exams to become registered nurses. The GRNs were in their first year of practice and were employed as registered nurses by a District Health Board and concurrently enrolled into a NETP. Nurse Entry to Practice Programmes are "structured entry programmes [13 months duration] ... for nurses wishing to work in hospitals, primary care, or aged and residential care" (Ministry of Health, 2014, para 1).The preceptorship model of CTL, that was in place to support GRNs, was becoming more difficult to manage in this unit due to a number of issues, including larger numbers of part time staff and a lack of trained and consistently available preceptors. In addition, preceptor fatigue was occurring due to increasing demands on the limited pool of trained preceptors being repeatedly allocated to support increasing numbers of GRNs allocated to this unit, coupled with the need to provide on-going support to undergraduate nursing students and new staff (Charge Nurse Manager, personal communication, 20 August 2013). For the past six years, this area had been successfully using the CDEU model of CTL to support undergraduate nursing students. The unit decided to pilot the CDEU model to support GRNs to ascertain if this model could address the areas of concern noted above.Literature reviewThe preceptorship model of clinical teaching and learningThe preceptorship model of CTL is based on a 1:1 nurse/ student ratio, with students mirroring the shifts of their preceptor for the entire length of their clinical placement (Billay & Myrick, 2008; Maginnis & Croxon, 2007; New Zealand Nurse Educators Preceptorship Subgroup, 2010; Sharples & Elcock, 2011). In this model, a high level of commitment is required from the preceptor, as they are often allocated a student for long periods of time. The preceptorship model has been successfully implemented worldwide (Hyrkas & Shoemaker, 2007), however, concerns have been voiced about a range of issues, including preceptor fatigue, minimal preceptor knowledge about the undergraduate curriculum and the need to replace preceptors on annual leave, thus diminishing student/preceptor continuity (Barker & Pittman, 2010; Edgecombe, Wotton, Gonda, & Mason, 1999; Jamieson et al., 2008). As a result, several other CTL models have been developed. Examples of these models include dedicated education units, team preceptorship (Beecroft, Hernandez, & Reid, 2008), collaborative learning units (Callaghan et al., 2009) and team leader models (Russell, Hobson, & Watts, 2010).Nonetheless, the preceptorship model is used widely throughout New Zealand to support both undergraduate nursing students as well as new staff, such as GRNs enrolled into NETP (New Zealand Nurse Educators Preceptorship Subgroup, 2010). These programmes, which are offered throughout all New Zealand DHBs, have proven to be a successful way to "support the confidence and competence" of graduates as well as contributing positively to the recruitment and retention of these nurses (Haggerty, McEldowney, Wilson, & Holloway, 2009, p. …