using human capital theory to - acorn.org.au · Consider the BSc (Hons) ... •I undertook planned...

using human capital

theory to

strategisetransition to perioperative

nursing

labour market controls entry

The deep end

Sink or swim?

or synchronised swim?

Details, details

Focus of inquiry

Instrument and circulating nurse dyad

“operating room nurses”

Sub specialty:operating room nursing

The study will include

• Document analysis of curricula and other relevant perioperative written artefacts

• Gathering opinion from: • RN new graduate nurses• undergraduate nursing students (later)

• Exploring models of perioperative nursing employability independent to clinical setting

Perioperative nursing workforce in Australia

2014: 23353 nurses

747 public hospitals

612 private hospitals

1,448 operating theatres in private hospitals

Number of public operating theatres not reported

Elective admissions for surgery in 2014

Does not compute!

assigning the appropriate operating theatre

specialist nurses is a major component of improved

theatre efficiency

ACI 2014, Operating Theatre Efficiency Guidelines. A guide to the efficient management of operating theatres in New South Wales hospitals.

Patient safety

Level of perioperative nursing expertise impacts on patient outcomes and team effectiveness

Adams, Baylis & Fraser (2007)Koh, Yang, Yin, Ong, Donchin & Park (2009)Newhouse, Johantgen, Pronovist & Johnson (2010)Koh, Park, Wickens, Ong & Chia (2011) Listyowardojo, Steglich, Peuchen & Johnson (2012)McLaughlin (2012)Talsma, Anderson, Geun, Guo & Campbell (2013)Bathish, McLaughlin & Talsma (2014)Koh, Park & Wickens (2014) Sykes, Gillespie, Chaboyer & Kang (2015)

Gallagher et al. 2005, 'Virtual reality simulation for the operating room: Proficiency-based training as a paradigm shift in surgical skills training', Ann Surg, vol. 241, no. 2, pp. 364-372.

What do human capital theorists believe?

• An educated population is a productive population• Young workers more likely to undertake education• Young workers change jobs more often• People are rewarded with jobs to the degree that they possess human capital

• Unemployment inversely related to skill levels,• New generation must be given the appropriate parts of the knowledge which has already been accumulated by previous generations

• Industry demands training for an adequate supply of appropriately trained workers

What

is our

game

plan?

• New graduates increasingly recruited to the workforce

• Public system generally has more new entrants than private

• Number of new entrants to the specialty ranged from 0‐24% nationwide

• NSW Public system did not report

Details, details…

Midwifery workforce

23865Entry to practice:ATAR 90-97Bachelor of MidwiferyDouble Degree (BN, BM)BN + Graduate Diploma or Master of Midwifery (12-18 months in length)

Perioperative workforce

23353Entry to practice:ATAR 51-78Bachelor of Nursing +Employment + OJT +/-Transition programOptional:Postgraduate Certificate/Diploma90% registered nurses

Consider the BSc (Hons) Operating Department Practice

• Previously a two year diploma, now a three year degree• Leads to registration with the Health and Care Professions Council (HCPC)

• 60 per cent of the programme hours in clinical practice

• Current number of ODP registrants in UK 12,836

Consider the BSc (Hons) Operating Department Practice18 Units over 3 years:• Introduction to Working in the Peri‐Operative Environment

• Basic Anatomy and Physiology for Peri‐Operative Practice

• Fundamental Peri‐Operative Practice Skills Application of Evidence‐Based Practice

• Building Operating Department Practice Skill• Caring for Individuals in the Peri‐Operative Environment

• Concepts of Interprofessional Practice in Health and Social Care

• Contemporary Issues in Peri‐operative Practice

• Developing Operating Department Practice Skills

• Developing Surgical Skills in Peri‐operative Practice

• Developing Anaesthetic Skills in Perioperative Practice

• Emergency Care in Theatres • Leadership in Peri‐operative Practice • Peri‐operative Practice Skills for Paediatrics• Pharmacology in Peri‐operative Care • Post Anaesthesia Care Skills • Role of Enquiry in Evidence‐Based Practice• Scope of Practice for Operating Department Practitioners

Question One:

Can the operating room nursing body of knowledge and skill be differentiated into:

• firm specific (acquired following employment); and

• industry specific (acquired prior to employment)?

Question Two:

Among currently employed OR nurses, who entered the specialty in the last 5 years, and have completed or are undertaking postgraduate perioperative studies at UTAS:1. What was their experience of transition into OR nursing?2. What elements of the OR nursing body of body of knowledge and

skill do they identify as industry specific, and which do they categorise as facility specific? and;

3. Had pre‐employment education towards employability skills in OR been available to them, would they have made different choices in their nursing education?

OREEM & STEEM

Operating Room Educational Environment Measure (OREEM)Surgical Theatre Educational Environmental Measure (STEEM)

• Teaching & training• Learning opportunities• Atmosphere• Workload • Supervision • Support

Modified STEEM

• I undertook planned rotation through the available specialties• I had several months of supernumerary time (time when you were additional to direct patient care numbers)

• I worked in a ‘pod’ or ‘module’ (a group of specialties) until I was proficient

• There was enough time for me to learn new skills• I felt well supported throughout my transition to the specialty• My learning needs were often not met due to clinical priorities• I was given constructive feedback on my performance

“it is an interesting job” 97.8%

“gives job security” 54%

Storen, I & Hanssen, I 2011, 'Why do nurses choose to work in the perioperative field?', AORN Journal, vol. 94, no. 6, pp. 578‐589

Summary

Systems level, strategic thinking may provide alternative means of entry to perioperative practiceThis might:Be independent of employmentHave potential to increase the perioperative nursing workforceImpact patient safety

Can we change the rules of entry?What would that look like?

Details, details …

1 ACORN 2016 Amanda Gore

The Devil is in the Details – using human capital theory to strategise transition to perioperative nursing

Amanda Gore RN, MHsc (Nsg), GDip (Nsg Ed), Cert OR Nursing

Slide 1

• Thank you all for being here today, it is a pleasure to be speaking with you all

• I’m going to talk to you today about my research which is exploring some of the conundrums surrounding entry to perioperative practice

• I guess if you are here, you have experienced some of these issues yourself

• Today I will consider the issue of ‘human capital’ in relation to operating room nursing and question whether human capital theory is a useful construct in relation to entry to perioperative nursing practice.

• This study is being undertaken in fulfilment of my PhD at the University of Tasmania

• I wanted to find out more about entry to perioperative practice because it has been a constant theme during my career.

• The operating theatre is a unique, a high-risk environment in which learning is shaped by people, case complexity and distractions. The impact of human factors on patient safety has emerged as a crucial issue. The need for a more deliberate approach to operating room education becomes an imperative as the nursing workforce undergoes threats to viability (Kiu et al 2015).

• This includes aligning education with the practice environment, and making explicit the implicit knowledge of our profession.

• I thought the best way to explore this issue would be by looking at existing curriculums, asking people who had recently entered the specialty what they thought, and then considering possible alternative means of perioperative education.


Slide 2

• Look at these bright, shining faces graduating from Uni.

• Students undertake a vocationally focused degree such as nursing for many reasons, but there is an expectation that completing this qualification will lead to employment in nursing – a return on investment of time, money and effort.

• The number of first time registrations in 2014 was:

23807

(AIHW)

• However, the Australian Nursing and Midwifery Federation estimates that 3,000 nursing graduates from 2013 have been unable to find work (ANMF, 2013).


Slide 3

• There has been an average increase of 22 % in the number of domestic students completing general courses for initial nursing registration at NSW universities (DoE, 2015).

• Why has this happened? Well for a number of reasons.

• The nursing intake has changed from a quota system to a demand driven system has resulted in nursing courses being oversubscribed and insufficient capacity to provide employment for new graduates (DoH, 2013).

• Nursing places at University are Commonwealth funded, so this represents a human capital loss for the government, the profession, and the individual.

• Labour market research for nursing by the Department of employment shows that some 70% of applicants in specialty areas were found by employers to be unsuitable to fill vacancies due to lack of skills (DoE, 2015).

• This has resulted in Registered Nurse (Perioperative) is identified as a national area of skills shortage, and appears on the Consolidated Sponsored Occupations List (temporary skilled migration, 457 visa) and the Skilled Occupations List (permanent skilled migration) by the Department of Immigration.

• In the period January 2011-May 2014, six hundred and sixty-six temporary skilled migrant visas were awarded for the category Registered Nurse (Perioperative) (HWA 2014).


Slide 4

• Just like the restricted entry sign on the OR doors, entry to the OR nursing specialty is also restricted.

• There is no prerequisite training to become a perioperative nurse.

• There is no standardised educational path for entry into the specialty.

• The only way to become an OR nurse in Australia is to gain employment as one.

• Therefore the labour market controls entry to the perioperative nursing specialty.

• Those without perioperative experience lack competitive advantage. But those will ‘experience’ have an advantage – even though we have no way of knowing how they were educated or the quality of their programs.

• Not only do new graduates lack employability skills for the specialty, it is less likely that they will even consider this specialty through lack of exposure in their qualifying education.

• The net result is that should an RN new graduate be employed in an operating theatre, it is with the knowledge that they will not be immediately productive in their role.


Slide 6

• The current response of many employers is to offer an extended orientation, what is commonly known as a ‘transition program’ (Senate Affairs Committee, 2002).

• Transition programs in turn are impacted by workplace constraints

• The perioperative nursing shortage, retirements and reduced working hours in turn affect the experience quotient in a unit which can impact on workplace learning.

• New entrants are at risk if learning how without learning why until much later.

• I see a wide variety of knowledge in the UTAS Grad Cert students, and it makes me wonder what can we reasonably expect as assumed knowledge in nurses with one or more years of practice?

• After all the Grad Cert is not an introductory course. In saying that, every year there are people wanting to do the course who have no prior experience, so they can work in the specialty.


Slide 8

• Transition programs described in the literature from Australia include:

Allanson & Fullbrook ( 2010)

• Preceptors are expected to facilitate the transition from education into practice while maintaining a full clinical and without receiving additional time or compensation as trainers.

• This situation for preceptors has the potential impact on outcomes should the needs of patients, team, new graduate and the preceptor are inadequately met.

• Depending on the context it can take 12 months or more to achieve autonomous practice (Stobinski, 2008).

• Reports in the Australian literature are limited - 5 days of didactic followed by preceptorship and OJT (Allanson & Fullbrook). Based on the SESIAHS Foundations program, which was described by Rabach & Sutherland-Fraser in (2009) edition of Perioperative nursing and Introductory text.

• We on the front line accept this as the status quo. Is this because we are all working individually very hard on this issues, and so focused that the opportunities of professional collectivity are not possible?

• What might be a central unifying force? Is it ACORN? Is it the Government? Is it US?

• At the recent AORN conference, the sessions I attended on entry to practice had a common theme – CONSORTIUMS and COLLABORATION.


Slide 9

• Instrument and circulating nurses are largest group in perioperative nursing, this will be the focus of the study. This provides a narrowing of focus and is more manageable given the discrete skills sets.

• This study is being conducted in order to better understand issues that shape current practices in perioperative education and entry into the specialty.

• The aim of this research is to generate evidence that will inform the design of human capital interventions that support the perioperative labour workforce through education of potential employees.

• A major distinction regarding human capital relates to the transferability of human capital across organisations, determining who is willing to bear the cost of education, and whether it should occur prior to or following employment (Becker 2009).

• To that end this study aims to identify the operating room nursing knowledge and skills that are general, which could be acquired prior to employment via education.

• The study further aims to explore the inequity in bargaining power of new graduate RNs in the perioperative workforce that arises from industry control of entry to practice.

• Nurses recently transitioned into this specialty will be consulted about the circumstances of their entry to the perioperative nursing workforce.


Slide 11

The following are not new concepts:

• Demand for perioperative staff increasing • Average age of perioperative nurse 48 • 50% due to retire/reduce hours in next 5-15 years • Shortage of skilled perioperative nurses • Oversupply of RN new graduates • Capacity of the ORs to absorb large numbers of learners is not certain

• Due to the lead time and expense of training a perioperative nurse, it could be quicker and cheaper to recruit an overseas qualified nurse experienced in perioperative nursing. In the period January 2010- May 2014 a total of 666 temporary 457 Visas were awarded for the 254423 Registered Nurse (Perioperative) category (HWA Report on Immigration, 2014).

• A report by Health Workforce Australia (2014) noted that when an occupation is on the Skilled Occupation List international nurses can apply for a permanent visa through the skilled independent pathway which removes the need for sponsorship associated with the 457 Visa.

• The numbers of permanent skilled migrants with perioperative experience are not available. New Zealand, using the same classification, stipulates that the applicant must have 5 years experience in specialty, but in Australia only Queensland specifies experience.


Slide 12

• This information is not centrally reported, and difficult to uncover. It makes it difficult to estimate the size of the impact of new graduates in the perioperative setting. Shouldn’t we know this information?

• In New South Wales, the focus of this study, there are over 270 operating theatres in 99 public hospitals (ACI, 2014).

• In comparison, Victoria has approximately 237 operating theatres in use daily (DHHS, 2015).

• Queensland has a total 236 operating rooms in 43 hospitals (QLD Health, 2015). There the trail goes cold.


Slide 13

• 2 million admission for elective surgery in 2014.

• 300,00 for emergency surgery

• (AIHW – Admitted patients)

• Majority of elective surgery admissions occurred in private hospitals (67%); 50% of admissions in public hospitals

• Each patient cared for by a minimum of 4 perioperative nurses, in some cases more

• Demand for surgical procedures increasing

• Increasing surgical specialisation

• Older, sicker, more complex patients

• Increased use of minimally invasive procedures

• New technologies requiring different skills and different learning curves


Slide 14

• Let’s look at the nursing workforce.

• 17 % of the acute care workforce are perioperative nurses.

• Does the reality of the workforce match the educational preparation of nurses?

• Can we “future proof” nurse education?

• Can an undergraduate degree be all things to all nurses?


Slide 15

• Perioperative nursing has a distinct and separate knowledge base and skill set

that has to be acquired after graduation from initial qualifying education.

1. A nursing specialty

2. A distinctive practice with has some overlap with nursing, or

3. A distinctive practice with no overlap with nursing

• Yet over half of all acute care admissions are for surgery.

• To me it does not add up.

• How do you feel?


Slide 17

The interface between undergraduate education and employment in perioperative nursing could manifest in patient safety issues, particularly if the number of new grads/novices rises and skews the overall expertise quotient in a facility.

Lower expertise linked to:

Complications

turnover time

procedural duration

total operating room process time interpersonal frustrations

mental task loading

infection…

…clinical mistakes

Is this an optimal learning environment?

Some of the same process variables that are measured in theatre efficiency initiatives are impacted by nursing expertise.

Surgical education is grounded in the Halstead tradition of apprenticeship and graduated responsibility and perioperative nursing has followed that to a degree.

But in the near future will we have enough ‘masters’ to teach our apprentices?

And given what we are beginning to know about expertise and teamwork, is it safe for patients for nurses to learn this way?

Given the extended time it takes for a perioperative nurse to reach full productivity, is it the best use of the health care dollar?


Slide 18

• The Human Capital in just this room is enormous.

• Human capital theory is the most influential economic theory of western

education and set the framework of government policies since the early 1960s.

• Education is an inherent good.

• Education is an investment that produces benefits in the future in the form the

marketable skills of workers.

• Human capital will be valued in the market because it increases firms’ profits

• Human capital is valued by workers because it generates income through

employment.

• Human capital includes not only formal education, but also experience and

on-the-job training

• This perspective is important in understanding investment incentives

• Investments are made in human capital with the expectation that there will be

a return on investment

• Expenses include:

• Out of pocket or direct costs

• Foregone earnings

• Opportunity costs

• Psychic losses – stress of studying


Slide 19

• Human Capital Theory (Becker 1962, 2009) has the potential to provide important insights about the relationship between nurse education and employability in OR nursing.

• Human Capital Theory suggests that if OR nursing-specific human capital is increased through education then the individual nurse will benefit through being more immediately employable.


Slide 20

• Human Capital Theory makes a series of predictions about investment in and

timing of training.

• Younger people are more likely to undertake education and training. But, they

are a more mobile part of the workforce.

• Crucial distinction is also made between general and specific human capital

(Becker 1962)

• You always own your human capital, and you take it with you when you leave.

• The employer loses their investment when you leave their firm.


Slide 22

What workforce planning is there for perioperative nursing.

I’ve read a lot of publications from the now defunct HWA – doesn’t that tell you something!; and in those where they were calculating future demand for nurses, perioperative nursing was intentionally omitted, as it did not follow the same patterns as other specialties. I read this as the team working on this did not have an understanding of the issue.

Do you find that hard to believe that no entity has overall responsibility for workforce planning for perioperative nurses?

This data is not centrally recorded or tracked.

The Perioperative Workforce in Australia was an excellent data rich national survey on our workforce.

However, it is now 10 years old - this is the most recently available data.

New entrants were defined in the survey as:

Those who have been employed in your perioperative department over the last 12 months and have not previously been employed in the perioperative workforce anywhere (novices)

Could there be a means of documenting this – APHRA? ACORN?


Slide 24

• Midwifery workforce compared to Perioperative workforce.

• As a point of contrast, let’s look at professional corollary.

• Why is midwifery workforce tracked, considered separately, separately

registration, and now, direct entry? Why is the ATAR so high and nursing’s

low in comparison?

• Apparently decreased by 12962 since 2011 mainly through retirement.

• 50% of the overall program on clinical placements in order for the course to be

accredited

• In common – no pay incentive for completing specialisations

• Interestingly – Ana/Recovery specialty but not for Operating room

(perioperative covers?)


Slide 25

Consider the BSc (Hons) Operating Department Practice

This program is offered at about 20 Universities in the UK.

In the UK, operating department practitioner as a registered, regulated health care practitioners – not technicians.

Health and Care Professions Council (HCPC) regulate the following professions: arts therapists, biomedical scientists, chiropodists / podiatrists, clinical scientists, dietitians, hearing aid dispensers, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, practitioner psychologists, prosthetists / orthotists, radiographers, social workers in England and speech and language therapists.


Slide 26

Health and Care Professions Council (HCPC) regulate the following professions: arts therapists, biomedical scientists, chiropodists / podiatrists, clinical scientists, dietitians, hearing aid dispensers, occupational therapists, operating department practitioners, orthoptists, paramedics, physiotherapists, practitioner psychologists, prosthetists / orthotists, radiographers, social workers in England and speech and language therapists.

All of these professions have at least one professional title that is protected by law, including those shown above. This means, for example, that anyone using the titles 'physiotherapist' or 'dietitian' must be registered with us.


Slide 27

Can the operating room nursing body of knowledge and skill be differentiated into:

• firm specific (acquired following employment); and

• industry specific (acquired prior to employment)?

There are few normative standards of perioperative education which outline the content and length of initial training required to perform productively in the operating room.

There is no evidence indicating which, if any, elements of OR nursing-specific human capital can be acquired independent of employment.

What is clear is the need for a distinct human capital intervention crafted to suit the unique needs of the OR nursing specialty, better aligning the graduate RN skillset to perioperative workforce needs.


Slide 30

Question 2

Among currently employed OR nurses, who entered the specialty in the last 5 years, and have completed or are undertaking postgraduate perioperative studies at UTAS:

1. What was their experience of transition into OR nursing?

2. What elements of the OR nursing body of body of knowledge and skill do they identify as industry specific, and which do they categorise as facility specific? and;

3. Had pre-employment education towards employability skills in OR been available to them, would they have made different choices in their nursing education?

In Part Two, participants will be asked to complete a questionnaire delivered through a secure web based platform. The data will be analysed in order to:

Establish practice pattern profiles of entry to perioperative nursing in the facilities in which they transitioned to practice

Gain insight into opinions about the knowledge and skills they perceive to promote employability in the OR

Whether they believe pre-employment education could offer new graduate RNs competitive advantage in entering the perioperative workplace; and,

Had this been available to them, would they have made different choices in their own nursing education?


Slide 31

Many questionnaires assessing educational environment, as perceived by the participants, have been developed.

The educational environment is defined as the "ethos" or "climate" that affects all aspects of learning within an educational setting.

The Operating Room Educational Environment Measure (OREEM), is a 40-item educational environment inventory, with five subscales-namely, learners' perceptions of the atmosphere, learners’ perceptions of learning, learners’ social self-perceptions, learners’ perceptions of teachers and learners’ academic self-perceptions.

The Surgical Theatre Educational Environmental Measure (STEEM) is a shorter version of OREEM with 15 items. The STEEM has been shown to be a reliable and practical tool for measuring the operating theatre educational environment in medical students.


Slide 32

This study adopts and modifies items from the full STEEM to construct a 7-item, operating room nurse focused, Likert-type scale questionnaire. Two questions have subscales:

a. Choosing the specialty

b. Education structure

c. Clinical structure

d. Scope of new graduate practice

e. Other factors

And,

a. Acquiring perioperative nursing knowledge

b. Choices in nursing education and specialty entry

In addition, 5 questions preceding the modified STEEM were included which asked about gender, age, state where entry to practice occurred, sector in which they entered practice, State or Territory, number of Operating Rooms, and how long it was before they felt they had fully transitioned into the specialty. This questionnaire will be distributed to RNs who have completed or are completing a Graduate Certificate in Perioperative Nursing via distance education at UTAS using a secure online platform.


Slide 34

By looking at that larger pattern and the way the pieces fit together we can gain increased understanding.

Today I have presented a range of contextual information that impacts on perioperative entry to practice and which shapes the approach to my research.

System-level strategic thinking and cross disciplinary perspectives may present other possibilities in entry to practice.

By consulting the individuals affected by entry to practice and who are the ones choosing to make investments in their human capital, many valuable insights could be gained.

We should consider whether we need an agreed standard of perioperative nursing entry to practice.

Human capital theory suggests that the individual, not the employer, would be willing to undertake this type of learning to secure a foothold in our specialty.

using human capital theory to - acorn.org.au · Consider the BSc (Hons) ... •I undertook planned...

Documents

Transcript of using human capital theory to - acorn.org.au · Consider the BSc (Hons) ... •I undertook planned...