Monday, October 09, 2006

meaningful support in the quest for professional development

I’ve been making a concerted effort to work with every graduate in the last few weeks. This allows me to observe their practice and provide feedback – something they don’t seem to get a lot of.

Each graduate is allocated a preceptor on the ward for their whole placement, but the reality of heavy workloads and differing rosters pushes observation and feedback to the side. The grads head into their room and get to work, and the preceptors do the same in their room.

Nobody really knows how the graduates are working, or whether their practices are excellent, fair or poor because there is no time to observe them in the nitty-gritty of care provision. Charts, nursing notes, patient comments and the questions they ask provide some insight into their practice, but it isn’t the same as observing how they work for a whole shift.

So at the risk of feeling a heel, I attach myself to a graduate for a day, follow them around and watch what they do. I pay particular attention to infection control measures, medication management, documentation, knowledge and application of knowledge, communication, time management and provision of care.

That’s a fair bit to take in, and when I’m also trying to keep up with the patients’ conditions and needs it all becomes a little overwhelming. This is compounded if a graduate is struggling – I become very frustrated when I identify needed interventions that the graduates do not recognise or do not consider a priority. Often it is easier to intervene myself rather than talk them through the assessment, prioritisation and intervention required. Best case scenario when I step in is that they view me as a role model worth observing and learning from. Worst case scenario, the graduate feels undermined and demoralised when I hijack their plans for the day. It’s a tricky one – sometimes the day is very busy, and talking it through just takes too long. The patient needs action NOW so I take the speedy option and takeover their care for a moment or two.

Recently one graduate in particular found my intervention unhelpful. I had arranged to work with them for the day, and turned up after the shift had commenced. Things steadily became worse as the day progressed – time management was almost non-existent and the graduate missed IV medications, failed to complete fluid balance charts, omitted important observations and didn’t document care in a timely manner.

I stepped in and did quite a bit of the work and made suggestions to the graduate. At the end of the day they were disappointed with their performance as well as feeling that I had invaded their working space. If my role is all about support then for them to feel so demoralised, I mustn’t have provided much!

It was a revealing moment. This tactic didn’t work with this graduate. Sometimes it does work (and is absolutely necessary for the patient's wellbeing), but in this situation it was all wrong. This grad needed me to stand back, leave them to work their own way, intervene only when absolutely vital, and provide feedback on everything they did. We discussed this at the end of the day. I have since worked with this person again, and we had a much better day! They worked, I observed and they appreciated the feedback I provided.

One aspect of support is observing practice, making assessments and intervening appropriately. That means evaluating the intervention a graduate requires: What is their learning style? What support would they like me to give? How can I assist them in providing a high standard of care? Do they even need assistance, or should I simply stand back, observe and give feedback on their practice?

Lesson to learn – always ask the graduate what they want to gain from my presence! It might not match what I want to offer, but this is about them and meeting their needs. My task is to listen, identify their needs and tailer my intervention to their unique requirements. Then I will be providing worthwhile support that can help them develop professionally.


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