A contemporary examination of workplace learning culture: An ethnomethodology study
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.
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