Melbourne Graduate School of Education - Theses

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    Clinical congruence : where graduate nurse clinical reality meets organisational clinical requirements
    Pisani, Heather ( 2004)
    In the mid 1980s, education associated with the requirement for registration as a Nurse in the State of Victoria moved from a hospital-based system into the university setting. This move brought with it many and varied requirements for change within the health care setting. The students of nursing were now no longer a part of the workforce, they were transient visitors in the patient care setting with very specific clinical requirements to be met; and they were there for less time! This research project is not about whether this change in preparation should have occurred. It is well accepted amongst the profession that this was necessary to raise the status of the nursing professional. We now have registered nurses with a primary degree in nursing or health science. The question here however, is what clinical capacities do the newly graduates and registered nurses have when they enter the clinical workforce, and what clinical capacities are required by the health care institutions that are employing them. Have these institutions an accurate and realistic knowledge of the clinical capacities of the newly graduated registered nurses they employ? This research concentrated on the self-perceived and reported clinical capacities of newly graduated registered nurses as they entered the clinical environment and the clinical capacities required by the clinical areas that employed them. Clinical congruence was then measured between these two sources. The findings demonstrated that in a supported environment, where graduates can expect and receive clinical support and mentorship, clinical congruence:is likely to be achieved. However, in an environment where clinical skills are required to be undertaken at an unsupervised level, there were a significant number of distinct clinical skills for which the graduates report unpreparedness. Graduates and Nurse Managers alike agreed that increased clinical experience during the undergraduate preparation time is optimal, but the universities indicated that the fiscal and chronological constraints of a three-year degree program, in an environment where there is a cost incurred for the clinical experience, is difficult to achieve. This research demonstrates, in a tangible way, the need for a supported Graduate Transition Program to facilitate the consolidation and / or achievement of clinical competency for the graduates as they enter the workforce. This support will assist in ensuring the maintenance of a dynamic nursing workforce into the 21st century to meet the needs of the Victorian community at a time when it is most vulnerable during the period of ill health.
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    The graduate nursing program : an exercise in reality orientation for the beginning practitioner in transition
    Pisani, Heather ( 1995)
    Graduate Nurse Education, so long taken for granted, has of recent times been trust into the clinical spotlight. This, from the clinician practitioners, as much as anyone, has come about from the changed focus of undergraduate preparation. Whilst completing baccalaureate preparation in a University has had perceived positive results from a professional perspective it has arguably resulted in graduates demonstrating different attributes to their predecessors. No longer bureaucratically encultured, and with limited exposure to the clinical setting, the requirements of the contemporary graduate program is vastly different to its historical counterpart. Whilst the academics argue the role and place of the "Graduate Year Program" this dissertation seeks to illuminate the requirements of such a program from the unique perspective of the graduate clinician participants. That a program is a requirements is taken as granted, and arguments into the role and place of these programs are presented. The abundant literature related to the experience is discussed, in a focussed sense, within the constructs of its Australian application and in particular the Victorian precepts. The sense of "de ja vue" experienced whilst reviewing the Kramer and Benner experience arguably illuminates the discussion. The Phenomenological approach to the research task, utilising the notion of grounded theory facilitates the story of the Graduates as they experience the first three months of clinical practice in a major metropolitan hospital. An attempt is made to return to the academic agenda the notion of the "Graduate Internship" with recognition of the differing emotions that this notion evokes. The experience is further validated by canvassing the Nurse Unit Manager perceptions of the process. The findings demonstrate the importance of a clinically based transition program, one that this author believes is best offered as a component of a service based practice year. The components of a practice based year are demonstrated as best being advocated by the clinician participants of the program. The validity of their insight into their requirements are born out in this dissertation. What is important is their continued exposure to the rigours of clinical practice. This, to best translate their theoretical preparation into a capacity to meet clinical service needs. Whether these objectives have been successfully achieved will be judged by the readers of this work. Make no mistake, however, that this is an important topic and requires of the profession critical reflection and revision of the impact of the critical first few months of clinical experience for the neophyte practitioner. This is a testament to their own experiences. Experiences that they have agreed to share with us. Listen to the lesson they give, and learn for the future, the future of the Nursing Profession.