A positive evaluation of the implementation of the NA into the acute hospital setting was expressed by senior nurse leaders. Key factors described by the hospital organisation as having contributed to the successful integration of the NA position were support, education and an effective steering committee (the expanded description of these key factors is provided in Appendix O). The BSBC evaluation59 of the NA pilot program concurred with the internal hospital organisation’s evaluation of the implementation of the NA program.
59The BSBC evaluation report, conducted by PriceWaterhouse Coopers, on behalf of the Department of Health
144 Strong executive support and leadership, a comprehensive communication strategy, training and education, and systems and processes that were guided by a project officer and a steering committee were linked, in the BSBC evaluation report, to the perceived effectiveness of the NA position in the acute hospital setting. The implementation of the NA position was overseen by a steering committee and supported by a project officer.
The steering committee consisted of key management and education personnel. This steering committee:
Met at regular intervals to ensure that the purpose of the role wasn’t lost and was continued in practice, but also any teething problems or
misunderstandings that came out of the role could be discussed openly as a prophylactic type of context rather than reactive (20901).
A project manager was involved in the oversight of the implementation of the NA position. The project manager “oversaw the project and so was responsible for establishing the role into the health service, so that included everything from development of policy to …
educational programs consultation with the nursing teams” (20906). In addition, the hospital organisation “implemented a clinical support nurse role which was dedicated to the [NA] role” (20906). This support role “was actually even more important than we even first had thought it would be” (20906).
The clinical support nurse role “was there to provide support and assistance and direct supervision to the [NAs] and help them achieve their competencies as part of their
traineeship” (20906). The support nurse also played an important role in the integration of the NA into the nursing team and nursing culture. Support for the NAs was important, as “health care environments are stressful to work in and they’re unusual places to work in and you’re confronted with lots of things that you don’t normally get confronted with out in normal society” (20906). Further, as noted in Section 6.6, the hospital ward environment was “very
145 adversarial” (20906) at the time of the NA introduction. Thus, the clinical support nurse role “became very important in supporting that group of staff [NAs] but also the role was
incredibly important in supporting the registered nurses as well” (20906).
The NA role was new to the Victorian acute hospital setting, and nurses “needed to change their practice and the way they work to actually take advantage of the role” (20906). The clinical support nurse provided nurses with support for the appropriate delegation and supervision of the NA in their daily practice. The close interaction that the clinical support nurse had with nurses (RN/EN) on the wards, and with the NA group, enabled her to identify any issues arising “very early, feeding it back to the steering committee rapidly … getting on top of it very soon, so that role was absolutely pivotal” (20906). At the end of their
traineeship support for the NA group was handed over to the wards where they worked. Due to this, part of the clinical support nurses role “was creating independence and … making sure they [NAs] were part of the ward they weren’t something special or something a side … they use wards resources and education” (20906).
The effective integration of the NA into the ward environment and nursing team was an integral part of the NA model. It was argued that continued support for the NA position past their traineeship would impair this integration process and the NAs would become “different and special” (20906) with a long-term “negative impact” (20906). NAs continued to turn to the clinical support nurse past the completion of their traineeship, rather than solely relying on ward resources. Despite the identified, pivotal nature of the clinical support nurse role, the value of allocating resources to the central support of the NA role beyond the implementation of the NA position was also questioned by nurse leaders.
At the time of writing up this case study (2017), the clinical support nurse role had been decommissioned due to funding and questions of the perceived necessity of the position,
146 “because the role isn’t new anymore we’re not sure that we need a particular person to
facilitate their progress” (20901). Assessment and coordination of the NA traineeship was to be passed to the nursing educators on each ward. In this case study, it was revealed that further clarity was required regarding the level of support nurse educators were to provide NA during training and after completion of training (see Section 9.4.2). Further clarity about the education of nursing staff about the NA position and their responsibilities was also required. The BSBC evaluation stated:
The importance of communication with future new staff, who may not be aware of the role of the [NA], was also raised as a key consideration to ensure that they understood the role and the duties performed by [NAs] (PwC, 2011, p. 43).
In contradiction to the assertion that the NA no longer needed a support person, one nurse leader argued that “you need someone to coordinate the program … the amount of paperwork that is involved just in running the course is quite significant and you have to go through and assess them all” (20904). A review of the data collected confirmed the importance of
appropriate support for the NA and nurses (RN/EN) during the implementation of the NA model and integration of the position into the acute hospital setting.
Six years after the implementation of the NA role at the hospital organisation and one year after data collection for this case study, the DoH released an implementation guide for the NA position into the acute hospital setting (DHHS Vic, 2015). This document was aimed at health services intending to implement the NA role into their hospital setting. It discussed:
the description of the NA position assessing the need for the NA position governance issues
147 guiding principles of change60
communication strategies
supervision and delegation strategies role clarity
recruitment
education and training
the evaluation of the NA program in the acute hospital setting.
This document was released after the implementation of this the NA position into other health services in Victoria.
6.8 Part of the nursing team: Structures of supervision and workload allocation