It is impossible to address the contribution of the nurse educator without considering contextual issues such as workloads, infrastructure support, interactions, access to staff, and support for education activities. Socially constructed role boundaries have implications for nurse educator role identity and ultimately their success and views of effectiveness. Additionally, the nurse educator’s desire to collaborate with colleagues and to have the role and education services accepted could be viewed as a mechanism to obtain connectedness thereby aligning the professional identity of the role with organisational and work unit expectations.
The ability to achieve a learner-centred approach to learning was influenced by the work environment, the organisation, political imperatives such as funding and
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the nurse educator’s knowledge and skills and expectations of others. Engaging large numbers of staff while addressing organisational obligations in an environment that was not always conducive to learning was problematic for nurse educators. A line manager pointed out that:
It is difficult for the nurse educators to have an individual approach to engaging the learner when they have to constantly respond to organisational training needs and have so many staff to support. Sometimes it has to be the same approach for all. IDI LM 1 (15). L 236.
These experiences are supported by other research undertaken in different contexts which refers to the nurse educator as a go between who attempts to fit learning and training around clinical schedules and imperatives (Bellack, 2005; Daly, Speedy & Jackson, 2000; Gibson, 1998; Goleman, 1998; Levitt-Jones, 2005; Robinson et al., 2006; Siler & Kleiner, 2001; Young & Patterson, 2007). They also point to the educator-manager relationship and the expectation that the former will adapt to the needs of the latter. As such and as these authors argue, it is often easier for the nurse educator to approach the learner as a passive consumer rather than facilitate learning.
The educator’s use of passive strategies was at times the only alternative to convey knowledge of an important practice change given clinical priorities. As noted, nurse educator engagement in work units and access to staff to facilitate learning varied between work units and was dependent on the nurse educator negotiating workloads to accommodate the priorities and needs of others. However and as perceived, lack of engagement and visibility in work units was a central criticism of the nurse educator role and created difficulties for role identity and acceptance. Additionally, as the nurse educator was seen to set the direction for educator activities but full complexity of the role was not readily understood the nature and extent of their workload were not acknowledged. This further complicated the ability of the nurse educator to manage impressions of the role.
Judgments about workloads were contextual. For example, the impression was that while nurse educators were busy, the nurse unit manager role was busier. Nurse educators were not tied to work units in coordinating patient-focused activities and a plethora of staff. Nurse unit managers and clinical nurses thus saw
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nurse educators as ‘flitting’ in and out of work units at ‘whim’. Two nurses outlined their views:
Part of the problem I see is, that both the nurse educator and nurse unit manager are both base NO4s. One of the areas I think is a problem is what is believed to be a difference of workloads. IDI LM 1 (13). L 168. We’re spreading nurse educators too thin. We’re asking one nurse educator, like everything in health care, to do a role for four or five wards. But nurse educators don’t have a budget, or staff and don’t have to manage 30 patients a day coming and going. IDI CN 1 (1). L 164/ 244.
Nonetheless, nurse educators, line managers and clinical nurses all agreed that nurse educator workloads were increasing and that the role was too diverse. At times this was attributed to the knowledge, skills and capacity of the individual. Yet there was acknowledgement of broader issues such as constant change, large numbers of inexperienced staff and advancing technology. Other studies have also identified similar factors impacting on the ability of clinical educators to achieve effective role outcomes (Davis et al., 2005; Hardy & Hardy, 1988; Ramage, 2004). Nurse educators were expected to juggle multiple realities to realise expectations and minimise potential work difficulties with little regard for the personal or professional impost. However, where responsibilities continued to expand, nurse educators were stretched and often only able to focus on basics such as mandatory and requisite skills. The following nurses explained that:
In regional roles they are often expected to be everything to everyone and cover diverse area in which they may not have expertise. Sometimes I think there is too much diversity and they are asked to do too much. IDI LM 1 (10). L 39.
I feel like our educator has enough work you know for two full time jobs. IDI CN 1 (10). L 108.
I think the nurse educator role is just expanding and expanding as much as the poor person can do it you know. I think we need clinical facilitators. There is too much to do the role properly. You run all day and it is stressful. IDI NE 1 (10). L 392.
Line managers did acknowledge that increasing workloads and lack of professional growth and isolation impacted on the nurse educator’s ability to develop in the role and meet expectations. These factors potentially limited the educator focus to operational activities of workplace learning. Two line managers noted their experiences:
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Educators do feel isolated. Some need a lot of direction and at the moment with restructure everybody’s firing things at her. I think the role is too big for one person to do it is a huge job. IDI LM 1 (9). L 188 / 218.
When their workload becomes too high they say, ‘you know well my workload is too high’ and they get absorbed in doing some of the operational things. I think a lot of the operational stuff is self-propelled sometimes. In some cases it may be because they don’t have the knowledge and skills. I think there is a lot of threat perceived. IDI LM 1 (12). L 76 / 84 / 148.
The combination of diverse and expanding nurse educator work combined with the expectation of being a general resource diluted the responsibilities and attributes of the position. Indeed, nurse educator participants expressed frustration at being considered a ‘jack of all trades’, or a ‘stop gap’. Two nurses put their views on nurse educators as a generic resource:
They expect the nurse educator to know everything and to be there and to deliver whatever they want and need. Sometimes that mismatch between what people think what they want and what they actually need impacts on how staff view the nurse educator. IDI NE 1 (2). L 273 / 279. I would have to say that the nurse educator role is very broad and in some respects the nurse educator role is expected to be everything to everybody. IDI CN 1 (7). L 232.
Nurse educator interactions with others (and particularly nurse unit managers) were seen by participants as impacting on how they dealt with or responded to workplace difficulties. Nonetheless, often nurse educators were perceived as motivated, assertive and generally capable. The following nurse stated that:
Unless nurse educators have a certain level of assertiveness and personal power it would be very easy to be pulled from pillar to post by different people. I think sometimes if in doubt give it to the nurse educator and sometimes that can make the role very broken. The nurse educator is not treated very well. IDI CN 1 (7). L 236.
The changing nature of work, workplace demands and work practices influenced workplace learning; however, determining the extent and impact of such work difficulties was challenging. DeMarco (2002) contends that nurses keep silent to avoid conflict and to maintain the status quo in the workplace. Yet this acquiescence reinforced the nurse educator as a ‘safety net’ rather than as a leader
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who supports workplace practice and champions change and education activities. These conflicting views often located the nurse educator at odds with the nurse unit manager and others over work unit priorities and nurse educator value. The nurse educator was positioned as the other, who was a peripheral work unit resource, legitimately able to construct an identity (albeit continually varying) in the unit and guide learning and development, but without line responsibility for patient outcomes. Potentially this ambiguous identity in the workplace negatively influenced the nurse educator’s ability to negotiate social relationships and perceptions of role value. Consequently it was the nurse educator who modified behaviour and actions in an attempt to meet expectations to engender effective workplace learning and acceptance in work units and the organisation.