Enhancing the employability of newly qualified nurses

Nurses are the largest segment of staff in any healthcare setting. Nurses play a vital and major role in taking care of the medical needs of patients. While the field of medicine has come a long way, nursing education has not advanced accordingly. The India Nursing Counsel (INC) has been the same, structurally and functionally, since the Indian Nursing Act of 1947 came into force. The act has not been reviewed or revised significantly for 69 years now, while, unarguably, the state of healthcare has drastically changed.

The Federation of Indian Chambers of Commerce & Industry (FICCI) task force has developed an integrated framework which is essential for strengthening nursing as a sector in India. They have a roadmap of recommendations for strengthening the nursing sector. Some of the most relevant and related to nursing education are:

1. Skill/competency outcome based nursing curriculum
2. Competency based skill testing for licensing

As with other professional education streams in the country, nursing education is also facing challenges. The principles of quality, patient safety, communication skills, multidisciplinary working and exposure to technology are not part of the curriculum across.

There is lack of focus on soft skills such as communication and leadership. There is an overt need for upgradation of curriculum, outcome-based training, specialised trainings, standardised exams and licensing procedures and the uniform availability of nursing education across the country.

The question then arises, is its really that important to take the nursing education, related curriculum and training seriously?

William Shakespeare’s play Hamlet has the famous phrase “To be or not to be”. It can mean any number of things depending on the meaning you ascribe to the English verb “to be.” It can mean: “to act or not to act,”, “to confront or to let be.”

The Nursing Principal of the Somaiya College of Nursing, Avani Oak was crystal clear in confronting this challenge and to ACT by taking a step in the right direction.

Like any good education institute, the principal and management were clear in going beyond the syllabus and skilling their students to become better nurses of tomorrow and increase their ability to get better employment.

They tied up with a company called TAAS which uses the philosophy of Focused Integrated Talent (FIT) to understand, customise and measure the talents and competencies of a nursing job position.

FIT is a patented design thinking approach to understand challenges, root causes, solutions and execution by taking all the stakeholders into the equation. From patients to nurses to doctors.

We interviewed patients and families about their experiences with medical care. These sessions “added the value of walking in a patient’s shoes, an emotional value that complemented the interviews. Patients wanted a regular flow of information to help them better understand what was happening, and they wanted to know that their care providers were communicating with one another. Coordinated and clear communication, they said, would do much to relieve their heightened anxiety and fear.

Nursing college heads were interviewed to understand their challenges with educating and training nurses based on the expectations of the healthcare community.

As a final outcome nurse competencies were identified to provide the services expected of a nurse by the healthcare system. The competencies were mapped to measurable constructs and an evaluation was created.
Students of the final year were evaluated and diagnosed.

The report broke down individual and team competency into low, medium and high.

Data analysis

This section deals with the analysis of the gaps in the attributes and competencies.

Analysis of the gaps among the attributes of nurses.
It is clear from Figure 1 that the gap in the attribute of high and average

score of the nurse is maximum for accountability, emotional intelligence, decision making and patient focus. The gap is minimal in quality focus area, collaboration and adaptability.

Figure 2

Analysis of the average competency score among the nurses

It is evident from the above figure that the gap in the competencies of high and average score is minimal for interpersonal relationship, time management, decision making and tension. But the overall score for handling tension is very low and requires immediate attention.

Majority of the competencies of the nurses were average for hygiene, self control, customer service, team player, social warmth, safety and maturity.

Efforts need to be done for improving the competency in flexibility, system driven and sensitivity.
To conclude, it is seen that the education provided has gaps. The education needs to take remedial measures to empower the nurses to develop attributes like accountability, emotional intelligence, decision making and patient focus. The competencies that require attention are: flexibility, system driven and sensitivity and handling stress and tensions.

Limitations of the study:
1. The results could be different if student is assessed in real patient scenario.
2. The data gathered cannot be completely reliable due to subjectivity issues, language constraints and personal barriers.

Recommendations
Major steps are required to enable the nurses to handle stress. The curriculum will need to impart actual practical oriented training that could empower the nurses to learn quality patient care. Soft skill training to develop empathy and become patient focused needs to be ingrained. Critical thinking ability through use of scenarios, assignments for analysing reports, exposure to intensive care areas for developing advanced thinking, etc. will minimise the gaps and improve the overall FIT score of the institute. Accountability could be improved by initiating handing and taking over right from first year, making students responsible for the care of patient and taking steps and actions against non-accountable actions.

In the final analysis nurses have a very demanding career, and each day brings a new challenge for them. They care selflessly for patients and their families. They are the backbone of the healthcare system, working tirelessly round the clock, at the bedside of each patient. They are alert and responsive, and monitor, plan and coordinate all patient care activities — all this in a complex and fast changing environment of healthcare, which demands progressively higher technical competencies, as well s increasing service expectations from patients. They also form the largest volume of the healthcare workforce.

The educational institutes owe it to the society and the future nurses to be given the guidance, training and appropriate skilling to make them successful.

Reference: Some data & feedback taken from “Paradigm Shift for a better Future” FCCI, August 2016