The impact of previous general experience and of working alongside specialist practitioners in the community setting before undertaking the course were considered determining aspects in ongoing student achievement. These particular personal determinants gave rise to both positive and negative positions regarding their impact. Some practice teachers felt that previous experience within their chosen discipline ensured that students had greater insight into the specialist role and had therefore given due consideration to the pros and cons of undertaking the programme of preparation:
“…had insight into management of caseloads… not coming to do this course on a whim; they’ve got full understanding of what’s involved. That they’ve been preparing for it, really”.
4th interview
A theory posited by Knowles in the 1970s and 80s in relation to nurse education was that of andragogy, or adult learning (Knowles, 1980), qualities of which were identified as independence, autonomy in learning and learning guided by previously gained experience; inferred by the above quote.
The particular PT making this comment, continued later in the interview to suggest that this prior experience also enabled the SP student to recognise the role transition – their ability to utilise prior learning and experience to advance their personal development to specialist, higher level practice:
“…they suddenly realised by asking the right questions and delving that little bit deeper...they were getting lots of different perspectives and the situation they were in, that would have been completely overlooked.” 4th interview
Another PT conveyed her discomfort related to students who had had limited exposure to care delivery in other settings prior to accessing SP programmes; considering that this could result in inappropriate responses or ineptitude in some situations:
“…it does worry me that the exposure isn’t enough to acute care…That people may be faced with situations that they don’t feel equipped to deal with in the community setting, because they’ve not had that exposure in secondary care…it sits difficult…with me there”.
1st interview
This comment conveys to me the importance of a rigorous selection process involving input from PTs, to recruit students onto the programmes who have a range of experience to equip them to adapt to situations encountered in community care settings. Careful selection would clearly support the PTs in their practice assessment of SP students, as without this experience, greater input and investment would be required from the PT to ensure higher level practice within the specialism is achieved.
It is also probable that these PTs could be basing the requirements of SP students on their own experience, however as identified by Eraut
(1998), when entering a new job the individual has to understand the context and people to become fully competent. It therefore follows that acceptance into that professional community is necessary to recognise and develop existing levels of competence and utilise previous experience.
This PT’s concern relates more to general levels of experience – the well-roundedness of nursing experience of the SP student that assists in the development of confidence and enables transferability of existing knowledge and skills. Issues related to confidence levels will be discussed further later in this chapter.
Boran (2009) suggests that a general feeling by the student of being deskilled can also ensue once out in the practice placement, due to the student entering a new, unfamiliar learning environment. This view was supported through the interviews, as moving into a new community of practice (Smith, 2003, 2009), the student’s expertise within their previous role may not be fully recognised or valued by the PT and wider team in the new practice setting, which could negatively impact on their confidence levels and impair skills transfer. As articulated by one PT:
“Bearing in mind, the student when they start – if they feel demotivated, they feel deskilled and that itself causes problems…”
5th interview
It was interesting to discover that other PTs considered that previous experience, if within the same discipline being studied, could be a barrier to learning new ways of working; resulting in the student being constrained by their previous understanding of the role, and unable to consider things from a broader or different perspective:
“…sometimes there’s an attitude, ‘well, I’ve been doing this for years’ and that’s hard to
longer than I have, for example….Theory and practice as well, and this being entrenched. The idea that ‘I’ve been a school nurse for years and years, and I know what I’m doing’. That inability to think wider.”
3rd interview
Three particular terms can be extrapolated from the above and other transcribed PT interviews to exemplify the requirement for a broader perspective as an essential element in developing higher levels of practice:
“…went into the depths…” Interview 2
“…delving that little bit deeper…” Interview 4 “…to think wider…” Interview 3
The PT in interview seven also echoed the importance of these qualities:
“She picked it up much more quickly and was much wider, deeper thinking.”
7th Interview
Subsequently, some of the above opinions were borne out by one focus group member who had previously been a PT:
“Sometimes some of the experienced community staff nurses come in with...feeling that they know it all already – you know, and not find it very easy to learn to become a student”.
Focus group 2
Also therefore, the way PTs view and respond to the past experience of the student could affect the student’s ability to challenge their own assumptions and perspectives on aspects of practice. The PT should be receptive to and draw upon information from the student regarding their level and type of previous experience, in order to build on this starting point. Lauder et al (1999), in an examination of
knowledge and skills transfer within nursing from one clinical environment to anther, stresses the importance of the practice supervisor in facilitating this transfer. If existing knowledge is not identified, the potential of the learning environment could be limited and lead to PTs and the practice team validating existing practice rather than challenging and extending it, which links to the reference on page 39 regarding the zone of proximal development of the student and reaching and extending their potential for development (Vygotsky, 1978), which I will return to later in relation to communities of practice.
These quotes also allude to the PT at times feeling somewhat frustrated by or requiring greater confidence in the role of practice assessor – another area that I will return to later in this chapter.