- Email: [email protected]
Achieving graduate outcomes in undergraduate nursing education: following the Yellow Brick Road
Nurse Education in Practice 14 (2014) 9e11
Contents lists available at SciVerse ScienceDirect
Nurse Education in Practice journal homepage: www.elsevier.com/nepr
Issues for debate
Achieving graduate outcomes in undergraduate nursing education: following the Yellow Brick Road Adele Baldwin a, *, Karyn Bentley a,1, Tanya Langtree a, 2, Jane Mills b, 3 a b
School of Nursing, Midwifery and Nutrition, James Cook University, Angus Smith Drive, Townsville, Queensland 4811, Australia School of Nursing, Midwifery and Nutrition, James Cook University, Cairns, Queensland, Australia
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 26 June 2013
Nursing practice is a dynamic and constantly changing field within healthcare, with well-documented challenges to maintaining a suitably skilled workforce to meet the needs of the community it serves. Undergraduate nursing education provides the mandatory minimum requirements for professional registration. Each nursing program has clearly stated graduate attributes, qualities that their graduates will possess on graduation. The aim of this paper is to stimulate discussion about graduate attributes for nurses, a transferrable set of specific attributes that make nursing graduates work ready. This paper focuses on identifying specific attributes, the embedding of those attributes in nursing education, particularly through role modelling, with the aim of producing a future workforce that is knowledgeable, compassionate and confident. The graduate attributes are likened to the qualities sought by the characters in ‘The Wizard of Oz’; brains, heart and courage and the learning process as the ‘Yellow Brick Road’. There is a relative lack of discussion about role modelling by nurse educators for nursing students, a potentially undervalued learning experience that we believe must be brought to the forefront of discussions pertaining to undergraduate nursing education and achieving graduate outcomes. Ó 2013 Elsevier Ltd. All rights reserved.
Keywords: Nursing education Role modelling Graduate attributes Undergraduate
Nursing Health care in Australia is languishing under the weight of increased demand for service, finite resources and funding, and challenges to the recruitment and retention of the nursing workforce. The demands placed on nurses working in any health service role are constantly evolving as the provision of health care changes, not just through increasing workload, but also in the complexity of nursing care required (McKenna and Wellard, 2004; Pelletier et al., 2005; Martin, 2013). Anecdotally, it has been estimated that one in five nurses leaves the profession within the first year after graduation, and perhaps one in three nurses leaves the profession in the first five years (Levett-Jones and FitzGerald, 2005; HWA, 2012). In addition to this high attrition rate, there has been a long standing discussion about theory-practice knowledge gaps for nursing students and new graduates, sometimes perpetuating the ‘them and
* Corresponding author. Tel.: þ61 7 47815322; fax: þ61 7 47814026. E-mail addresses: [email protected] (A. Baldwin), Karyn.bentley@ jcu.edu.au (K. Bentley), [email protected] (T. Langtree), Jane.mills@ jcu.edu.au (J. Mills). 1 Tel.: þ61 7 47815480. 2 Tel.: þ61 7 47815355. 3 Tel.: þ61 7 4042 1548. 1471-5953/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.nepr.2013.06.011
us’ attitudes of education providers and industry stakeholders (Levett-Jones & FitzGerald; Cowin and Hengstberger-Sims, 2005). As part of their strategic focus, universities are committed to providing work ready graduates able upon graduation to step up into the professional role for which they have met the educational requirements (James et al., 2004). To promote work readiness and to ensure longevity in the nursing profession, novice nurses must be equipped with the knowledge and skills to contribute to the provision of quality healthcare, the capacity to challenge current practice and the ability to facilitate change through critical thinking. As well as analysing the role of graduate attributes in nursing education, this discussion paper examines how academic staff role modelling professional behaviours contributes to meeting those attributes. Nursing education is a dynamic process aiming to produce graduates who not only fulfil professional registration requirements but who are able to actively participate in the provision of quality nursing care in a range of settings upon graduation. There is a significant body of literature related to teaching and learning in nurse education, which outlines many different strategies and initiatives to ensure that student nurses acquire requisite knowledge and skills. As nursing care has become ‘client focussed’ and ‘client centred’ whereby the outcomes are defined by the client, tertiary education is becoming more ‘learner/student focussed’ and
10
A. Baldwin et al. / Nurse Education in Practice 14 (2014) 9e11
‘learner/student centred’ whereby the effectiveness of learning is defined by the student’s level of active engagement (Barrie, 2007). Tertiary institutions have, through consultation and research, developed descriptors of what qualities their new graduates will possess which allow educators to visualise what they are working towards. One of many recommendations from the National Graduate Attributes Project (Barrie et al.,, 2009) was to promote the establishment of alumni networks and mentoring programs to enhance students’ professional development. Professional role modelling in any setting facilitates the building of professional networks, values the knowledge and experience of past graduates who are current practitioners and enhances student understanding and confidence. It therefore seems reasonable to assume that this networking should begin at the place where learning is initiated, in the education institution. It is our assertion that these generic graduate attributes are quite often broad descriptors that provide limited guidance for the individual nurse educator, making visualising the ‘end product’ quite difficult. Being aware of what level of practice is expected as a graduate nurse provides students with the framework required to exit the course with skills commensurate with those of an entry level graduate nurse as expected by registering bodies, employers, consumers and community. This framework must also be visible to the nurse educators. Therefore there is a need for additional graduate attributes that clearly articulate the qualities nursing graduates need to enter the workplace, assimilate well and have professional longevity. Our search for understanding of graduate attributes and how to apply them to everyday teaching in an undergraduate nursing program led us on our own journey of discovery. It was on this journey that we realised that students, themselves on a journey of learning and endeavouring to establish a professional identity, are following a path where the stones are the steps of knowledge laid down for them by educators. That is, we saw similarities to Dorothy in the Wizard of Oz (Le Roy and Thorpe, 1938), following the ‘Yellow Brick Road’ seeking enlightenment. Furthermore, it is our belief that to follow this path and achieve professional competence, the nursing students must develop three essential characteristics: knowledge, compassion and professional confidence. These can be likened to the basic needs of Dorothy’s three travelling companions, the scarecrow who wanted a brain (knowledge); the tin man who wanted a heart (compassion) and the cowardly lion who sought courage (professional confidence) (Le Roy and Thorpe, 1938). The Brain e Students acquire nursing knowledge through a range of teaching and learning experiences throughout their studies. Assessment of the level and depth of nursing knowledge can be done in a formal examination setting or in a clinical setting where the student uses clinical reasoning to provide individualised holistic care. In addition, students should be provided with learning activities that promote self-assessment of the effectiveness of practice, and strategies for ongoing development and lifelong learning (James et al., 2010; McKie et al., 2012). The Heart eThe success of clinical reasoning is highly dependent upon the student’s ability to provide health care using a holistic approach to health and wellbeing. This in turn requires a degree of empathy and compassion that is empowering rather than paternalistically disempowering for the recipient of care. The Courage e To apply knowledge in a manner that supports care with a defined model and facilitates self determination for the health consumer, students must believe in their ability to be a nurse. Students must also possess enough confidence to be an active participant in the interdisciplinary health care team, to question when they are not sure, and to ask for support when needed. Students are guided to develop accountability for their
Fig. 1. Graduate attributes of nursing students.
future development and contribute to the professional development of others, becoming effective change agents for the profession and healthcare generally (McKie et al., 2012). These three elements underpin our vision of the graduate attributes of a nursing student. These are expanded upon further to more specifically define what parts go together to make the whole. To facilitate understanding of these concepts, we have constructed a model (Fig. 1) that not only identifies the characteristics, but views them in context of clinical practice. The student is at the centre of this model, which reinforces that teaching and learning approaches to achieve the desired outcomes need to be student centred. The next level surrounding the student identifies what we believe to be the three main areas of clinical practice of particular relevance to the new graduate. The nursing student and new graduate must have the ability to apply what they have learnt in theory to their nursing practice; perform and interpret patients’ conditions and provide the appropriate nursing care through sound clinical reasoning and ongoing skill acquisition and development; and to provide nursing care that is based on reliable evidence gathered through robust research within the overarching policy framework of the institution. The outer ring of the model describes the qualities that the nursing student/new graduate must acquire to fulfil the nursing role, aligning with the application to practice in the middle ring to achieve a well rounded nursing graduate. To achieve the desired graduate outcomes of a registered nurse who is courageous, compassionate, competent, confident, contemporary, communicative, robust, resilient, resolute, reliable, resourceful and reflective, it is important to incorporate teaching methods that enhance the development of the professional brain, heart and courage in a curriculum in order to provide appropriate opportunities. The future nursing workforce must have brains; current knowledge that can be demonstrated and applied in the clinical setting. They must have heart; the capacity to apply knowledge in a manner that honours the individual and promotes independence. Finally, they must have courage; to implement their existing knowledge, to
A. Baldwin et al. / Nurse Education in Practice 14 (2014) 9e11
challenge current practice and to drive future change in healthcare (Madsen et al., 2009). Acquisition of the qualities in the outer ring is not easily measured, and the teaching of these qualities maybe even more difficult to quantify. These qualities, when present in the experienced clinician are not visible as individual traits in the professional repertoire, but are more likely to be viewed as a whole. However, students can pick up on these qualities very quickly and will often seek to emulate those nurses they aspire to be like (Perry, 2008). This role modelling in clinical practice has been the subject of previous research where it has been identified as being an essential part of nursing students’ clinical experiences, facilitating professional identity development and professional socialisation (LevettJones and Lathlean, 2007, 2008, 2009; Donaldson and Carter, 2005; Girard, 2006; Perry, 2008). As part of their clinical placement experiences, it is expected that nursing students will adopt behaviours they observe in the clinical area, but the power of role modelling in the non-clinical education setting is less well documented. Teaching staff in the university setting are themselves experienced clinicians, so it is reasonable to assume that students observe and imitate demonstrated role modelled behaviours either related to specific skills they have been taught, or to the manner in which the teaching staff go about their professional duties. Wolf et al. (2004) investigate what attributes nursing students identified in those they perceive to be good teachers. One of the strengths these authors found was that a good teacher demonstrated professionalism, and subsequently was thought, by the students, to be a good role model. It is this student perception that requires further investigation to bring a previously undervalued teaching tool to the fore. Conclusion For nursing students, the issue is not about achieving a fantasy existence in a world like Oz, it is about finding those attributes within themselves. Thus, the acquisition of the qualities we identified as essential for graduate nurses will result from embedding them within our teaching practices. The existing literature discusses role modelling for clinical skills and clinical practice in the context of the clinical setting with much less reference to the impact of role modelling by nurse educators in the tertiary or nonclinical setting on nursing students. While role modelling in clinical areas remains an integral part of learning, and should remain highly visible as part of the professional development of nursing students, role modelling in formal education settings requires similar exposure. It is this area which requires much further investigation and discussion to identify the covert learning which may well turn out to be more powerful than previously thought. Maybe the wizard is there after all.
11
Conflict of interest The authors declare no conflict of interest. References Barrie, S., 2007. A conceptual framework for the teaching and learning of generic graduate attributes. Studies in Higher Education 32 (4), 439e458. http:// dx.doi.org/10.1080/03075070701476100. Barrie, S., Hughes, C., Smith, S., 2009. Report: The National Graduate Attributes Project: Integration and Assessment of Graduate Attributes in Curriculum. Australian Learning and Teaching Council, Department of Education, Employment and Workplace Relations. Cowin, L., Hengstberger-Sims, C., 2005. New graduate nurse self-concept and retention: a longitudinal survey. International Journal of Nursing Studies 43, 59e70. http://dx.doi.org/10.1016/j.ijnurstu.2005.03.004. Donaldson, J., Carter, D., 2005. The value of role modelling: perceptions of undergraduate and diploma nursing (adult) students. Nurse Education in Practice 5, 353e359. http://dx.doi.org/10.1016/j.nepr.2005.05.006. Girard, N., 2006. Like it or not, you are a role model. AORN Journal 84 (1), 13e15. Health Workforce Australia (HWA), 2012. Health Workforce 2025 e Doctors, Nurses and Midwives, vol. 1. HWA, Adelaide, Australia. James, I., Andershed, B., Gustavsson, B., Ternestedt, B., 2010. Knowledge constructions in nursing practice: understanding and integrating different forms of knowledge. Qualitative Health Research 20 (11), 1500e1518. http://dx.doi.org/ 10.1177/1049732310374042. James, B., Lefoe, G., Hadi, M., 2004. Working ‘through’ graduate attributes: a bottom up approach. In: Sheehy, F., Stauble, B. (Eds.), Transforming Knowledge into Wisdom: Holistic Approaches to Teaching and Learning. HERDSA Conference, pp. 174e184. Levett-Jones, T., FitzGerald, M., 2005. A review of graduate nurse transition programs in Australia. Australian Journal of Advanced Nursing 23 (2), 40e45. http://www.ajan.com.au/Vol23/Vol23.2-6.pdf. Levett- Jones, T., Lathlean, J., 2007. Belongingness: a montage of nursing students’ stories of their clinical placement experiences. Contemporary Nurse 24 (2), 162e174. Levett-Jones, T., Lathlean, J., 2008. Belongingness: a prerequisite for nursing students’ clinical learning. Nurse Education in Practice 8, 103e111. http:// dx.doi.org/10.1016/j.nepr.2007.04.003. Levett-Jones, T., Lathlean, J., 2009. ‘Don’t rock the boat’: nursing students’ experiences of conformity and compliance. Nurse Education Today 29, 342e349. http://dx.doi.org/10.1016/j.nedt.2008.10.009. Le Roy, M., Thorpe, R., 1938. The Wizard of Oz [Motion Picture]. Metro-GoldwynMayer, United States. Madsen, W., McAllister, M., Godden, J., Greenhill, J., Reed, R., 2009. Nursing’s orphans: how the system of nursing education in Australia is undermining professional identity. Contemporary Nurse 21 (1e2), 9e18. Martin, P., 2013. The mid Staffordshire NHS Foundation trust inquiry: The Robert Francis Report 33, 181e182. McKenna, L., Wellard, S., 2004. Discursive influences on clinical teaching in Australian undergraduate nursing programs. Nurse Education Today 24, 229e235. McKie, A., Baguley, F., Guthrie, C., Jackson, C., Kirkpatrick, P., Laing, A., O’Brien, S., Taylor, R., Wimpenny, P., 2012. Exploring clinical wisdom in nursing education. Nursing Ethics 19 (2), 252e267. Pelletier, D., Donoghue, J., Duffield, C., 2005. Understanding the nursing workforce: a longitudinal study of Australian nurses six years after graduate study. Australian Journal of Advanced Nursing 23 (1), 37e43. Perry, R., 2008. Role modelling excellence in clinical nursing practice. Nurse Education in Practice 9, 36e44. http://dx.doi.org/10.1016/j.nepr.2008.05.001. Wolf, Z., Beitz, J., Wieland, D., 2004. Strengths and weaknesses of faculty teaching performance reported by undergraduate and graduate nursing students: a descriptive study. Journal of Professional Nursing 20 (2), 118e128.
Contents lists available at SciVerse ScienceDirect
Nurse Education in Practice journal homepage: www.elsevier.com/nepr
Issues for debate
Achieving graduate outcomes in undergraduate nursing education: following the Yellow Brick Road Adele Baldwin a, *, Karyn Bentley a,1, Tanya Langtree a, 2, Jane Mills b, 3 a b
School of Nursing, Midwifery and Nutrition, James Cook University, Angus Smith Drive, Townsville, Queensland 4811, Australia School of Nursing, Midwifery and Nutrition, James Cook University, Cairns, Queensland, Australia
a r t i c l e i n f o
a b s t r a c t
Article history: Accepted 26 June 2013
Nursing practice is a dynamic and constantly changing field within healthcare, with well-documented challenges to maintaining a suitably skilled workforce to meet the needs of the community it serves. Undergraduate nursing education provides the mandatory minimum requirements for professional registration. Each nursing program has clearly stated graduate attributes, qualities that their graduates will possess on graduation. The aim of this paper is to stimulate discussion about graduate attributes for nurses, a transferrable set of specific attributes that make nursing graduates work ready. This paper focuses on identifying specific attributes, the embedding of those attributes in nursing education, particularly through role modelling, with the aim of producing a future workforce that is knowledgeable, compassionate and confident. The graduate attributes are likened to the qualities sought by the characters in ‘The Wizard of Oz’; brains, heart and courage and the learning process as the ‘Yellow Brick Road’. There is a relative lack of discussion about role modelling by nurse educators for nursing students, a potentially undervalued learning experience that we believe must be brought to the forefront of discussions pertaining to undergraduate nursing education and achieving graduate outcomes. Ó 2013 Elsevier Ltd. All rights reserved.
Keywords: Nursing education Role modelling Graduate attributes Undergraduate
Nursing Health care in Australia is languishing under the weight of increased demand for service, finite resources and funding, and challenges to the recruitment and retention of the nursing workforce. The demands placed on nurses working in any health service role are constantly evolving as the provision of health care changes, not just through increasing workload, but also in the complexity of nursing care required (McKenna and Wellard, 2004; Pelletier et al., 2005; Martin, 2013). Anecdotally, it has been estimated that one in five nurses leaves the profession within the first year after graduation, and perhaps one in three nurses leaves the profession in the first five years (Levett-Jones and FitzGerald, 2005; HWA, 2012). In addition to this high attrition rate, there has been a long standing discussion about theory-practice knowledge gaps for nursing students and new graduates, sometimes perpetuating the ‘them and
* Corresponding author. Tel.: þ61 7 47815322; fax: þ61 7 47814026. E-mail addresses: [email protected] (A. Baldwin), Karyn.bentley@ jcu.edu.au (K. Bentley), [email protected] (T. Langtree), Jane.mills@ jcu.edu.au (J. Mills). 1 Tel.: þ61 7 47815480. 2 Tel.: þ61 7 47815355. 3 Tel.: þ61 7 4042 1548. 1471-5953/$ e see front matter Ó 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.nepr.2013.06.011
us’ attitudes of education providers and industry stakeholders (Levett-Jones & FitzGerald; Cowin and Hengstberger-Sims, 2005). As part of their strategic focus, universities are committed to providing work ready graduates able upon graduation to step up into the professional role for which they have met the educational requirements (James et al., 2004). To promote work readiness and to ensure longevity in the nursing profession, novice nurses must be equipped with the knowledge and skills to contribute to the provision of quality healthcare, the capacity to challenge current practice and the ability to facilitate change through critical thinking. As well as analysing the role of graduate attributes in nursing education, this discussion paper examines how academic staff role modelling professional behaviours contributes to meeting those attributes. Nursing education is a dynamic process aiming to produce graduates who not only fulfil professional registration requirements but who are able to actively participate in the provision of quality nursing care in a range of settings upon graduation. There is a significant body of literature related to teaching and learning in nurse education, which outlines many different strategies and initiatives to ensure that student nurses acquire requisite knowledge and skills. As nursing care has become ‘client focussed’ and ‘client centred’ whereby the outcomes are defined by the client, tertiary education is becoming more ‘learner/student focussed’ and
10
A. Baldwin et al. / Nurse Education in Practice 14 (2014) 9e11
‘learner/student centred’ whereby the effectiveness of learning is defined by the student’s level of active engagement (Barrie, 2007). Tertiary institutions have, through consultation and research, developed descriptors of what qualities their new graduates will possess which allow educators to visualise what they are working towards. One of many recommendations from the National Graduate Attributes Project (Barrie et al.,, 2009) was to promote the establishment of alumni networks and mentoring programs to enhance students’ professional development. Professional role modelling in any setting facilitates the building of professional networks, values the knowledge and experience of past graduates who are current practitioners and enhances student understanding and confidence. It therefore seems reasonable to assume that this networking should begin at the place where learning is initiated, in the education institution. It is our assertion that these generic graduate attributes are quite often broad descriptors that provide limited guidance for the individual nurse educator, making visualising the ‘end product’ quite difficult. Being aware of what level of practice is expected as a graduate nurse provides students with the framework required to exit the course with skills commensurate with those of an entry level graduate nurse as expected by registering bodies, employers, consumers and community. This framework must also be visible to the nurse educators. Therefore there is a need for additional graduate attributes that clearly articulate the qualities nursing graduates need to enter the workplace, assimilate well and have professional longevity. Our search for understanding of graduate attributes and how to apply them to everyday teaching in an undergraduate nursing program led us on our own journey of discovery. It was on this journey that we realised that students, themselves on a journey of learning and endeavouring to establish a professional identity, are following a path where the stones are the steps of knowledge laid down for them by educators. That is, we saw similarities to Dorothy in the Wizard of Oz (Le Roy and Thorpe, 1938), following the ‘Yellow Brick Road’ seeking enlightenment. Furthermore, it is our belief that to follow this path and achieve professional competence, the nursing students must develop three essential characteristics: knowledge, compassion and professional confidence. These can be likened to the basic needs of Dorothy’s three travelling companions, the scarecrow who wanted a brain (knowledge); the tin man who wanted a heart (compassion) and the cowardly lion who sought courage (professional confidence) (Le Roy and Thorpe, 1938). The Brain e Students acquire nursing knowledge through a range of teaching and learning experiences throughout their studies. Assessment of the level and depth of nursing knowledge can be done in a formal examination setting or in a clinical setting where the student uses clinical reasoning to provide individualised holistic care. In addition, students should be provided with learning activities that promote self-assessment of the effectiveness of practice, and strategies for ongoing development and lifelong learning (James et al., 2010; McKie et al., 2012). The Heart eThe success of clinical reasoning is highly dependent upon the student’s ability to provide health care using a holistic approach to health and wellbeing. This in turn requires a degree of empathy and compassion that is empowering rather than paternalistically disempowering for the recipient of care. The Courage e To apply knowledge in a manner that supports care with a defined model and facilitates self determination for the health consumer, students must believe in their ability to be a nurse. Students must also possess enough confidence to be an active participant in the interdisciplinary health care team, to question when they are not sure, and to ask for support when needed. Students are guided to develop accountability for their
Fig. 1. Graduate attributes of nursing students.
future development and contribute to the professional development of others, becoming effective change agents for the profession and healthcare generally (McKie et al., 2012). These three elements underpin our vision of the graduate attributes of a nursing student. These are expanded upon further to more specifically define what parts go together to make the whole. To facilitate understanding of these concepts, we have constructed a model (Fig. 1) that not only identifies the characteristics, but views them in context of clinical practice. The student is at the centre of this model, which reinforces that teaching and learning approaches to achieve the desired outcomes need to be student centred. The next level surrounding the student identifies what we believe to be the three main areas of clinical practice of particular relevance to the new graduate. The nursing student and new graduate must have the ability to apply what they have learnt in theory to their nursing practice; perform and interpret patients’ conditions and provide the appropriate nursing care through sound clinical reasoning and ongoing skill acquisition and development; and to provide nursing care that is based on reliable evidence gathered through robust research within the overarching policy framework of the institution. The outer ring of the model describes the qualities that the nursing student/new graduate must acquire to fulfil the nursing role, aligning with the application to practice in the middle ring to achieve a well rounded nursing graduate. To achieve the desired graduate outcomes of a registered nurse who is courageous, compassionate, competent, confident, contemporary, communicative, robust, resilient, resolute, reliable, resourceful and reflective, it is important to incorporate teaching methods that enhance the development of the professional brain, heart and courage in a curriculum in order to provide appropriate opportunities. The future nursing workforce must have brains; current knowledge that can be demonstrated and applied in the clinical setting. They must have heart; the capacity to apply knowledge in a manner that honours the individual and promotes independence. Finally, they must have courage; to implement their existing knowledge, to
A. Baldwin et al. / Nurse Education in Practice 14 (2014) 9e11
challenge current practice and to drive future change in healthcare (Madsen et al., 2009). Acquisition of the qualities in the outer ring is not easily measured, and the teaching of these qualities maybe even more difficult to quantify. These qualities, when present in the experienced clinician are not visible as individual traits in the professional repertoire, but are more likely to be viewed as a whole. However, students can pick up on these qualities very quickly and will often seek to emulate those nurses they aspire to be like (Perry, 2008). This role modelling in clinical practice has been the subject of previous research where it has been identified as being an essential part of nursing students’ clinical experiences, facilitating professional identity development and professional socialisation (LevettJones and Lathlean, 2007, 2008, 2009; Donaldson and Carter, 2005; Girard, 2006; Perry, 2008). As part of their clinical placement experiences, it is expected that nursing students will adopt behaviours they observe in the clinical area, but the power of role modelling in the non-clinical education setting is less well documented. Teaching staff in the university setting are themselves experienced clinicians, so it is reasonable to assume that students observe and imitate demonstrated role modelled behaviours either related to specific skills they have been taught, or to the manner in which the teaching staff go about their professional duties. Wolf et al. (2004) investigate what attributes nursing students identified in those they perceive to be good teachers. One of the strengths these authors found was that a good teacher demonstrated professionalism, and subsequently was thought, by the students, to be a good role model. It is this student perception that requires further investigation to bring a previously undervalued teaching tool to the fore. Conclusion For nursing students, the issue is not about achieving a fantasy existence in a world like Oz, it is about finding those attributes within themselves. Thus, the acquisition of the qualities we identified as essential for graduate nurses will result from embedding them within our teaching practices. The existing literature discusses role modelling for clinical skills and clinical practice in the context of the clinical setting with much less reference to the impact of role modelling by nurse educators in the tertiary or nonclinical setting on nursing students. While role modelling in clinical areas remains an integral part of learning, and should remain highly visible as part of the professional development of nursing students, role modelling in formal education settings requires similar exposure. It is this area which requires much further investigation and discussion to identify the covert learning which may well turn out to be more powerful than previously thought. Maybe the wizard is there after all.
11
Conflict of interest The authors declare no conflict of interest. References Barrie, S., 2007. A conceptual framework for the teaching and learning of generic graduate attributes. Studies in Higher Education 32 (4), 439e458. http:// dx.doi.org/10.1080/03075070701476100. Barrie, S., Hughes, C., Smith, S., 2009. Report: The National Graduate Attributes Project: Integration and Assessment of Graduate Attributes in Curriculum. Australian Learning and Teaching Council, Department of Education, Employment and Workplace Relations. Cowin, L., Hengstberger-Sims, C., 2005. New graduate nurse self-concept and retention: a longitudinal survey. International Journal of Nursing Studies 43, 59e70. http://dx.doi.org/10.1016/j.ijnurstu.2005.03.004. Donaldson, J., Carter, D., 2005. The value of role modelling: perceptions of undergraduate and diploma nursing (adult) students. Nurse Education in Practice 5, 353e359. http://dx.doi.org/10.1016/j.nepr.2005.05.006. Girard, N., 2006. Like it or not, you are a role model. AORN Journal 84 (1), 13e15. Health Workforce Australia (HWA), 2012. Health Workforce 2025 e Doctors, Nurses and Midwives, vol. 1. HWA, Adelaide, Australia. James, I., Andershed, B., Gustavsson, B., Ternestedt, B., 2010. Knowledge constructions in nursing practice: understanding and integrating different forms of knowledge. Qualitative Health Research 20 (11), 1500e1518. http://dx.doi.org/ 10.1177/1049732310374042. James, B., Lefoe, G., Hadi, M., 2004. Working ‘through’ graduate attributes: a bottom up approach. In: Sheehy, F., Stauble, B. (Eds.), Transforming Knowledge into Wisdom: Holistic Approaches to Teaching and Learning. HERDSA Conference, pp. 174e184. Levett-Jones, T., FitzGerald, M., 2005. A review of graduate nurse transition programs in Australia. Australian Journal of Advanced Nursing 23 (2), 40e45. http://www.ajan.com.au/Vol23/Vol23.2-6.pdf. Levett- Jones, T., Lathlean, J., 2007. Belongingness: a montage of nursing students’ stories of their clinical placement experiences. Contemporary Nurse 24 (2), 162e174. Levett-Jones, T., Lathlean, J., 2008. Belongingness: a prerequisite for nursing students’ clinical learning. Nurse Education in Practice 8, 103e111. http:// dx.doi.org/10.1016/j.nepr.2007.04.003. Levett-Jones, T., Lathlean, J., 2009. ‘Don’t rock the boat’: nursing students’ experiences of conformity and compliance. Nurse Education Today 29, 342e349. http://dx.doi.org/10.1016/j.nedt.2008.10.009. Le Roy, M., Thorpe, R., 1938. The Wizard of Oz [Motion Picture]. Metro-GoldwynMayer, United States. Madsen, W., McAllister, M., Godden, J., Greenhill, J., Reed, R., 2009. Nursing’s orphans: how the system of nursing education in Australia is undermining professional identity. Contemporary Nurse 21 (1e2), 9e18. Martin, P., 2013. The mid Staffordshire NHS Foundation trust inquiry: The Robert Francis Report 33, 181e182. McKenna, L., Wellard, S., 2004. Discursive influences on clinical teaching in Australian undergraduate nursing programs. Nurse Education Today 24, 229e235. McKie, A., Baguley, F., Guthrie, C., Jackson, C., Kirkpatrick, P., Laing, A., O’Brien, S., Taylor, R., Wimpenny, P., 2012. Exploring clinical wisdom in nursing education. Nursing Ethics 19 (2), 252e267. Pelletier, D., Donoghue, J., Duffield, C., 2005. Understanding the nursing workforce: a longitudinal study of Australian nurses six years after graduate study. Australian Journal of Advanced Nursing 23 (1), 37e43. Perry, R., 2008. Role modelling excellence in clinical nursing practice. Nurse Education in Practice 9, 36e44. http://dx.doi.org/10.1016/j.nepr.2008.05.001. Wolf, Z., Beitz, J., Wieland, D., 2004. Strengths and weaknesses of faculty teaching performance reported by undergraduate and graduate nursing students: a descriptive study. Journal of Professional Nursing 20 (2), 118e128.