Scoping and redesign of the nursing and midwifery clinical facilitator learning support model in northern Queensland

‘Australia is fast approaching a dire nurse shortage’.1 Workforce strategists report a significant reason employees leave organisations is lack of training and development opportunities.2


Considering learning in the workplace is a highly valued enabler of evidence-based care provision and continual improvement,3 and the emerging minimum employee expectations of skill-building and career development opportunities,4 this project’s findings have potential transferability to invigorate nursing and midwifery (N&M) clinical learning support models.

Clinical Facilitators (CFs) are clinical nurses and midwives who provide clinical learning support for the organisation’s N&M clinical staff. CF positions (and roles) vary considerably across the organisation as they have emerged over time aligned to specific unit needs, resulting in inconsistent availability of CF clinical learning support across the organisation.

CF Loz and RN Shannon-Endo-Manometry & ph study

We took up the challenge to review and detail how current CF learning support models are delivered throughout the organisation and identify redesign opportunities. Undertaken by a project manager with experience and qualifications in clinical redesign and improvement science, incorporating N&M clinicians, CFs, educators, and managers, we undertook a journey to understand the current CF models across the organisation, systems in place, and insights of the N&M workforce. In June-September 2022, a myriad of diagnostics was undertaken, including an online survey for all N&M staff; CF self-report activity diary; focus groups and workshops; and analysis of standard secondary data such as workforce demographics.

Themes that emerged and key diagnostic data, along with root causes identified by our N&M, formed the basis of solution co-design. Our N&M generated a breadth of innovative solution ideas, which were consolidated into two overarching solutions:

  1. Create a CHHHS Clinical Facilitator (CF) model.
  2. Establish sustainable CHHHS nursing and midwifery workforce clinical learning support.
CF-Rekha and RN Sam – Medication administration advice

Considering the CF role is unique and can create tension, as the individual spans two different worlds – the clinical nurses’ practice world, and the theoretical world of academia,5 the first step to best practice for CFs is meeting role expectations. CHHHS is on track to develop a robust CF model, incorporating CF career pathways, and learning framework that is transparent and available for all CFs. CFs have an essential role in developing a safe and committed N&M workforce, with a key component- the pedagogy in facilitation. Thus, it is vital for CFs evidence-based practice to have focused training, with the theoretical underpinning of feedback for learning and assessment, and peer and mentor support so that ‘craft knowledge’ can be shared.5

Creating sustainable methods to provide N&M clinical learning support is a challenge to be embraced, and CFs, through actively advancing their sub-specialty, are well placed to provide on the ground clinical learning support and enact translation of evidence into practice.5

References
1 Victoria University online. Understanding the nursing shortage in Australia [Internet]. Melbourne VIC: Victoria University; 2022 [updated 2022 Jan 12; cited 2022 Oct 17]. Available from Understanding the nursing shortage in Australia | VU Online
2 Begley P, Dunne L. Turnover and retention report. Melbourne (AU): Australian HR Institute (AU); 2018. 22p.
3 Davis K, White S, Stephenson M. The influence of workplace culture on nurses’ learning experiences: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep. 2016 Jun;14(6):274-346. DOI: 10.11124/JBISRIR-2016-002219. PMID: 27532660.
4 Cottier M. Employee expectation gap analysis. Washington (US): Advisory Board; 2022. 2p. Report WF8154436
5 Ryan C, McAllister M. Professional development in clinical facilitation: An integrated review. Collegian [Internet]. 2021 [cited 2022 Oct 17]; 28(1):121-7. Available from DOI 10.1016/j.colegn.2020.02.007

Author:
Lisa Evans RN, GradCert(Clinical Redesign), GradCertCritCare(Emergency) is Clinical Redesign, CF-Scoping project manager, Cairns and Hinterland Hospital and Health Service in Qld

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