Nurses who wished to continue their education through M-level study had to have the approval of the hospital management to facilitate their study time. For those who were not granted hospital management approval, the hospital was not obliged to accommodate the demands associated with studying for a Master‟s degree. These nurses
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were required to adapt their study to their work time without being given time-out or study days. It was hard for the majority of M-level participants to do so, especially that the part time option of study is not offered in the Jordanian universities.
Nurse managers were asked why some hospitals sponsor nurses for M-level education. A variety of reasons for doing so were noted. These include improving the status of the hospital, encouraging nurses to remain in practice, improving nursing care, and undertaking research:
“the hospital got only this number of Master‟s degree nurses. When we attend conferences you find papers and research from all hospitals except ours. We want as well to cancel the concept that if you have a Master‟s degree you have to be in a position. Secondly, we want to improve the level of nursing care in the hospital. I worked in a committee with the Royal Medical Services; they have what they call professional ladder. In America there are nurses who don‟t like to be managers or to be nurse-in-charge so they developed certain positions that enabled these nurses to work with the patients. We thought why don‟t we have Master‟s level nurses in all the wards? They can do research, scientific days and so on.” (Deputy Director of Nursing 1)
Where sponsorship was available, this entailed paying the fees and shuffling shifts around and facilitating working hours to cope with study demands. This way of accommodating nurses who were undertaking Master‟s degrees created problems for all nurses and for management. Coordinating nurses‟ working time with their study time caused difficulties for managers:
“We sponsored six nurses, but we suffered a lot because they wanted everything from the hospital. They wanted time; they wanted the practice credit hours to be counted from their working hours. Here we don‟t have the luxury to allocate them study days. With the shortage we have it is not possible to give six nurses study days, and the policy here does not allow us to do so.” (Director of Nursing 1)
A nurse supervisor in the ICU expressed her frustration by saying:
“I have problems putting schedules together, so I need to make considerations to their duty and their university; for example, one of them asked for three days off in the week; this is a very big problem for me; we have 14 staff for seven patients (ICU); we have holidays; it is a headache.” (Nurse Supervisor 2)
Allowing nurses to undertake a Master‟s degree was sometimes described as „a burden‟. M-level nurses put additional pressure on the hospital by requesting support and time to undertake academic work. One Director of Nursing expressed frustration that these nurses did not, he felt, take into consideration the needs of their hospital. There was
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also a fear that Master‟s degrees might lead nurses out of practice. This attrition, it was felt, might influence managers‟ support for Master‟s education. It is, therefore, common practice in Jordan for sponsored nurses to be tied with a binding contract that obliges them to work at least double the period they spend studying, in their sponsoring hospitals or to pay back the financial costs of their studies. Nevertheless, when M-level nurses graduate, they tend to pay and leave:
“That‟s why allowing the nurse to study for a Master‟s has become a burden on the hospital because you have to arrange his rota, his holidays. Everything has to be arranged the way he wants it and not the way that suits the hospital then when he graduates he will leave; that‟s the tragedy.” (Director of Nursing 2)
“The concept in Jordan if you have Master‟s you have to go and teach in the university, as soon as the nurse graduates he will resign, no one stays in the hospital.” (Deputy
Director 1)
An M-level nurse explained the situation in her hospital:
“The nurses who were sponsored by the hospital might get a managerial post. In return, they have to work for the hospital (compulsory) for three or four years. For example, a colleague of mine is waiting to complete this mandatory service and leave the hospital.”
(M-level nurse 1)
In addition, for nurses enrolled in a Master‟s programme to be able to attend their classes in the morning, some of them had to work night shifts, which in turn affected their performance in practice, reinforcing an undesirable image of M-level nurses and fuelling dissatisfaction with their role in hospitals. The academic challenges and demands on M- level nurse students caused some nurse managers to criticise their commitment to practice:
“they want to take night shift so they can be at the university in the morning; they need the money to continue their education; few of them tried to educate us or tell us something new about what they learnt----they are very exhausted; the university asks them many things, research, papers, exams, so many things. They don‟t have time to waste in the unit.” (Nurse Supervisor 2)
Nurses are usually recruited into a Master‟s programme on the hope that their newly acquired knowledge and skills that would enable them to improve practice. However, their inability to commit themselves to their nursing work while studying is of a particular concern because these are experienced nurses who have been demonstrated to perform well in practice:
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“We select them [for Master‟s degree] based on years of experience, and performance evaluation.” (Director of Nursing 2)
Some nurse managers expressed concern about those nurses who were studying in fields in which they had no clinical experience. One charge nurse, for example, questioned how a nurse would benefit from studying critical care when he had only worked in the delivery room. As a result, nurse managers were unsure of the usefulness
of such nurses to practice after completion of their Master‟s. M-level nurses‟ credibility
was therefore considered to be dependent on their experience in the speciality area, not their degrees. Prior knowledge of, and practice experience in, the speciality was considered necessary for service improvement. A Master‟s degree was seen as an asset, but not as the most important element:
“there are those who are sponsored by the hospital; we have someone in delivery room. How can she use her knowledge in critical care in delivery room; the other is in operation room; another is in surgical floor; one of them is in postpartum department. What can they do there?” (Charge Nurse 1)
Nurse managers, therefore, argued that nurses who wished to pursue higher education should do so in their own area of speciality. They further argued that such individuals should be selected for their experience and clinical performance. In short, nurse mangers want experienced practitioners to go out from a particular practice area and come back to it; they are not interested in the generic outcomes. It seems that they do not consider that M-level education equipped nurses with sufficient transferable skills to make them a valuable asset in other practice areas. This also suggests that, because of the predominance of critical care courses, nurses not working in that specialty area do not have many prospects for study and their potential educational development is limited. This view shows that there is a tension between what educationalists expect, which is the generic value of M-level education and what nurse managers want.
An M-level nurse noted that one of her M-level colleagues had been sponsored by the hospital after working for twenty years in the operating theatre. This colleague had been promoted (after gaining a Master‟s degree) to a nurse supervisor in the ICU. Her narrative suggests that experience in the operating theatre was not relevant to the ICU. However, the sponsoring hospital may have considered that significant experience in any
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field of practice, when allied with a Master‟s qualification, entitled this nurse to a managerial post:
“those nurses who were sponsored by the hospital they might get a managerial post. In return they have to work for the hospital (compulsory) for three or four years. A colleague of mine is waiting to complete this mandatory service and leave the hospital. He has been transferred from the operation room after working there for twenty years and was appointed as a supervisor for the ICU. He is not familiar with the ICU work and procedures, not even the basics. The only good thing that came out of having the degree is the promotion and the increment in his salary.” (M-level nurse 1)
This narrative may give an indication that hospitals are not deploying M-level nurses appropriately, and that hospital settings are not prepared to cope with the M-level graduates‟ qualifications. It also indicates that hospitals are not willing to tailor specific posts for them in terms of assigning them new roles that recognise specialist skills. This may also suggest a lack of communication between the educational institutions and employers of nurses, further reflecting the tension between generic and specific outcomes as discussed earlier in this section:
“The practice settings are not equipped to use their (M-level nurses) advanced skills and knowledge.” (Staff Nurse 2)
Challenges such as lack of funding, restricted availability of study leave, and difficulties in replacing staff on study leave, have been reported in the broader literature (Beeston et al., 1998; Gosling, 1999; Nolan et al., 1995; Read et al., 2000). Nurse managers‟ concerns are also echoed in Joyce and Cowman‟s (2007) comment that education is expensive and time consuming in terms of financial, personal, and work commitments, and requires careful consideration from nurses and employers. The authors point out that one of the challenges is to convince nurse managers that professional development is vital for developing practice. They also draw attention to the need for policy makers and funders to consider the importance of planning strategically for continuing professional development to keep nurses in the profession.
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