Elsevier

Nurse Education Today

Volume 35, Issue 1, January 2015, Pages 91-96
Nurse Education Today

A contemporary examination of workplace learning culture: An ethnomethodology study

https://doi.org/10.1016/j.nedt.2014.07.001Get rights and content

Summary

Background

Creating and maintaining a sustainable workforce is currently an international concern. Extensive literature suggest that students and staff need to be ‘engaged’, that is they need to interact with the health team if they are to maximise learning opportunities. Despite many studies since the 1970s into what creates a ‘good’ learning environment, ongoing issues continue to challenge healthcare organisations and educators. A ‘good’ learning environment has been an intangible element for many professions as learning is hindered by the complexity of practice and by limitations on practitioners' time available to assist and guide novices.

Objectives

This study sought to explore the nature of the learning interactions and experiences in clinical nursing practice that enhance a ‘good’ workplace learning culture for both nursing students and qualified nurses.

Design

An ethnomethodology study.

Setting

A range of clinical settings in Victoria and Queensland, Australia.

Participants

Students and registered nurses (n = 95).

Methods

Fieldwork observations were carried out on student nurses and registered nurses, followed by an individual interview with each participant. An iterative approach to analysis was undertaken; field notes of observations were reviewed, interviews transcribed verbatim and entered into NVivo10. Major themes were then extracted.

Results

Three central themes: learning by doing, navigating through communication, and ‘entrustability’, emerged providing insights into common practices potentially enhancing or detracting from learning in the workplace.

Conclusions

Students' and registered nurses' learning is constrained by a myriad of interactions and embedded workplace practices, which can either enhance the individual's opportunities for learning or detract from the richness of affordances that healthcare workplace settings have to offer. Until the culture/or routine practices of the healthcare workplace are challenged, the trust and meaningful communication essential to learning in practice, will be achievable only serendipitously.

Introduction

In the face of an increasing ageing population with associated demand for health services and continuing predicted shortfalls in healthcare worker supply (Health Workforce Australia, 2012, O'Brien and Gostin, 2011) creating and maintaining a sustainable workforce is currently an international concern. As part of this process there is, in particular, an increased need to improve the workplace learning experiences for students that will enable them to be competent, and generate confidence in their own capabilities (O'Brien and Gostin, 2011). In addition, existing staff teams need to create ‘learning in practice’ (Billett and Newton, 2010) as an everyday activity to ensure they remain abreast of rapid developments in health care practice and to ensure that this knowledge is imparted to students.

Extensive literature in this area reports that students and staff need to be ‘engaged’ in the health care community, i.e. they need to interact with the health team if they are to maximise learning opportunities (Egan and Jaye, 2009, Eraut, 2011, Newton et al., 2009b). Support from a range of members of the health care team in guiding students' practice through the provision of opportunities for learning is therefore vital (Newton, 2011). However, despite many studies since the 1970s (Fretwell, 1980, Ogier, 1981) into what constitutes a good learning environment, ongoing issues continue to challenge healthcare organisations' and educators' capacity for learning (Siggins Miller Consultants, 2012). A ‘good’ learning environment has been an elusive element for many professions as learning is obstructed by the complexity of practice and by the limitations on practitioners' time available to support and guide novices (Benner et al., 2010, Henderson et al., 2010, O'Brien and Gostin, 2011, Rodger et al., 2008).

Within the context of nursing, the majority of learning support provided to students in the clinical areas today is through working alongside a registered nurse who is the student's assigned preceptor, buddy or mentor. While the nomenclature of these roles varies across organisations and countries, essentially the preceptor, buddy, or mentor is instrumental in identifying appropriate learning opportunities for students and graduates and assisting their assimilation into the team (Henderson and Eaton, 2013, Ockerby et al., 2009).

Section snippets

Background

Ideally workplaces should encourage and motivate learning that leads to personal and professional growth. However, if learning is to occur in the workplace several factors have been identified as important. These include progressive leadership, co-operative teams, work clarity, realistic workload, mechanisms to acknowledge staff, and participation in decision-making (Schalk et al., 2010).

These contextual factors have been clearly established as necessary elements for staff and students to

Aim

This study aimed to understand factors in the workplace that may contribute to or inhibit a culture of learning in nursing. This was the first phase of a two year project on workplace learning.

Method

The fieldwork was framed in underlying principles of ethnomethodology to examine the everyday, taken for granted, practices of nurses and nursing students, and the impact of these practices on the learning culture of the workplace (Henderson, 2005, Holstein and Gubrium, 2005). Rather than an extensive

Results

The central findings from analysis of the fieldwork observations and interviews revealed three dominant themes: learning by doing, navigating through communication, and ‘entrustability’, and are described in detail below.

Discussion

These findings clearly identified that the well-established practices of learning by doing, unstructured communication, and students seeking to be trusted (Hauer et al., 2014), continue to dominate practices during student clinical placements.

Student interviews highlighted that in order to learn, they needed to find a way of negotiating the system to learn about practice. This is an important aspect in the student formulating their identity as a nurse and learning to negotiate their place in

Limitations

From the perspective of qualitative research, the sample size is substantial though this does not imply that the results are generalizable. This study occurred in the context of open clinical interactions; observations did not include observing or feedback of strategic meetings therefore particular approaches to learning adopted by the specific units were not considered (e.g. formal regular meetings to encourage feedback; open free flow forums to raise issues). Throughout the duration of the

Conclusions

Despite the key recognition that the professional preparation of nurses is paramount for the sustainability of healthcare workforces, nationally and internationally, due to the predicted shortfalls of healthcare workers in the coming decade; a major encumbrance that perpetuates is the quality of the workplace learning experience. Until the culture/or routine practices of the healthcare workplace are challenged, the trust and meaningful communication essential to learning in practice, will be

Acknowledgment

This research was supported under Australian Research Council's Discovery Projects funding scheme, project number DP12010421. The authors wish to acknowledge the support of the students and nurses who participated in this project along with the participating healthcare and tertiary organisations. We also acknowledge Christine Ossenberg for her contribution to data collection and Katherine Cook who assisted with participant recruitment.

References (34)

  • T. Egan et al.

    Communities of clinical practice: the social organisation of clinical learning

    Health

    (2009)
  • M. Eraut

    Informal learning in the workplace: evidence on the real value of work-based learning (WBL)

    Dev. Learn. Organ.

    (2011)
  • T. Fenwick

    Matters of Knowing and Doing: Sociomaterial Approached to Understanding Practice

  • J.E. Fretwell

    An enquiry into the ward learning environment

    Nurs. Times Occas. Pap.

    (1980)
  • J. Hattie

    Visible Learning: a Synthesis of Over 800 Meta-analyses Relating to Achievement

    (2013)
  • K.E. Hauer et al.

    Understanding trust as an essential element of trainee supervision and learning in the workplace

    Adv Health Sci Educ

    (2014)
  • Health Workforce Australia
  • Cited by (0)

    1

    Tel.: + 61 3 9902 4570, + 61 413 684411 (mobile); fax: + 61 3 9905 4837.

    2

    Tel.: + 61 7 3176 5115; fax: + 61 7 3240 7356.

    3

    Tel.: + 61 414538663 (mobile); fax: + 61 3 9905 4837.

    View full text