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DISCUSSION QUESTION - AJAN Volume 25 Issue 4 Do you consider a structured graduate transition program assists in keeping new graduates in the nursing workforce? How should such a program be structured? RESPONSES As a 3rd year student, I look forward to participating in a structured program. It is one thing to say that as students, we need more clinical prac time to learn nursing skills, but with no partnership between the hospitals and the universities, it is very hard to gain good quality learning experiences. The uni simply finds us a placement and as long as we have our allocated hours signed off, they don't care what we have done. There is no one there to say 'hey, we have something interesting happening in the next ward - come and have a go'. Instead, we are left to our own devices with hopefully a nurse who might let us at least do a pill round. A structered program run by the hospital takes some of the anxiety out of graduate nursing as until we have a permanent position within a ward, we are going to need support systems in place. You cannot possibly know all there is to know after three years at uni. Having experienced structured transition program after I graduated in NSW in the early days of univeristy training, it was seen as an extremely valued component of moving into the work force. One of the problems in recent years is that the running of these programs has moved from being beneficial to both the new starter and the organisation to trying to cater for every wish/whim that new grads may have. There needs to be clearly defined rules for participating on the program, otherwise offer the grad the ability to move to "supported" permanent employment within a ward/unit/service. As a recent graduate nurse I find effective and timely peer support during the transition to full time nursing work extremely beneficial. This highlights the need for skilled preceptors and clinical nurse educators in the area. Yes I do and I believe there needs to be a greater emphasis on integrating the schemes with Community nursing and aged care nusrsing not jsut focusing them on acute care. A great deal of nurses learn a lot through these schemes and they would be more rounded with this included within the schemes. As a former NUM, and manager of an education department I feel strongly that a well-structured trasition program does assist in retaining graduates. However in our current nursing climate it is difficult to achieve a programs which fully meet the needs of new graduates. Preceptors have no recognition for their advanced role, nor do they have adequate supernumerary time to connect and engage with preceptees. There just aren't enough "numbers" it seems for hospitals in particular to justify "pulling someone off the floor" to support our future workforce, which is very dissapointing. The other issue particularly in rural health is that there are often too few members of the education team who are spread far too thinly to provide support, a point which many hospitals (not all) seem to not understand. I agree with the authors of this article that the current system of trasition program needs to be reviewed! Programs need to better meet the needs of gradutes as beginning practitioners who require a higher degree of support. The supernumerary period for graduate must be increased with a greater focus on skills consolidation, and preceptors should be given adequate recognition for their role and adequate "non-clinical" time to connect with their precptees. More funding needs to be put towards graduate support nurse roles, with a realistic EFT per graduate. While governments are promising to increase nursing degree places, there is no thougth to the vital issue of providingmore funding to cope with the demands this places on what is an alredy stretched workforce of nursing educators. Ideally final year students should also be given the opportunity to begin the transition phase into their chosen hospital. Gradautes should also be given the option of entering into a second year of supported practice post their graduate, as is curently on offer in some organisations. Most importantly the nursing culture of treating graduates as a liability because "they dont know anything" needs to stop. Perhaps the reason why graduates dont feel confident and safe to practice is beacause this is what they are told to believe? I am a newly graduated RN and I am currently completing a graduate program in Queensland. I definatly think that having a graduate program is a good way to keep newly graduated nurses in the workforce. I think is offers a lot of support to us and allows us to see many different aspects of nursing. I feel that in my uni degree I did not have enough clinical placements and the graduate program has helped me to become more comfortable as a nurse. I think that having 4 month rotations is very good because you get more experience in the area. It would be good if everyone could do a placement in a medical setting, a surgical setting and a setting of their own choice. I know it would be difficult to always place them in a setting of their choice but if they had preferences then that would help with that. I feel that a graduate program is a great way to make new nurses feel more welcome and comfortable in the nursing environment. No I don't think they need to continue producing assignments as a post graduate, whenthey have already completed three years of study as an undergraduate. Their pays are started at the bottom rate, and this becomes a fourth year of intensive learning. I found that the graduates expressed dissatisfaction. The learning should be made more fun and out of curiosity. Facilitation can be encouraged and the graduates need to be oriented to all areas of nursing practice so they can make an informed decision as to where they wish to want to specialise in their own time. DISCUSSION QUESTION 2 - AJAN Volume 25 Issue 3 Do you think the use of sterile water injections to relieve lower back pain during labour is an appropriate form of pain relief? RESPONSES I think that the water injections are an appropriate form of pain relief during labour. I only wish they were available to me during my labour! I think they could be a HUGELY popular way to decrease the use of other forms of pain relief. DISCUSSION QUESTION 1 - AJAN Volume 25 Issue 3 Should adolescents have the right to know their diagnosis and participate in decisions about their treatment even when their parents object? RESPONSES I believe that adolescents should have the right to know about their diseases and treatment options, in just the same way as the elderly. They should also have a say in decision-making. This adolescent is 15 years old. He is old enough to start being responsible for his health, particularly in this day and age of increasing youth independence. This cancer has the possibility of impacting on his quality of life for a significant portion of his life should it not respond well to treatment. Therefore he will eventually become reponsible for it's management in the long term regardless of parental interference. I am a strict atheist so I am bias when it comes to religion enroaching upon health issues and belive it should have no place when concering minors, the best available treatment for conditions should be used in all instances unless the minor does not want that treatment and is deemed to be mentally capable of making such a decision. Once a consenting adult, I am of the belief that you can chose how to live you life as you see fit. Yes, they have the right to know about what is going to happen to them and what choices there are. Some adolescents I know are more on the ball than some of the adults I know and this frame of mind should reflect how they are treated in hospital. One wonders if the parents have not come to terms themselves with the boy's illness when they do not wish to discuss the illness, the treatment and the effects. Does religion play a role here in beliefs in regards to the frozen sperm. It is sad to think the parents are unable to discuss with the boy the illness, treatment and outcomes, because the boy unless he has a mental disability to understand he is becoming progressively unwell or the effects of medication he is going to suspect something is seriously wrong and this may affect him psychologically and delay his healing process. Adolescents have the right to know what is wrong with them. They need to be adequately supported through the process of understanding their illness and the treatment options. Whilst there can be a complex of individual and family dynamics to navigate, treatment and care providers have a responsibility to maintain open lines of communication between all significant decision makers, including the adolescent themselves. Sensitivity and open, honest communication are the key. Difficult as that can be in some circumstances! In short, "Yes". In Australia, we can give weight to the Gillick principle (British, but endorsed by the High Court of Australia in 1992). Therefore, if the adolescent is capable of understanding the situation, the proposed treatment and the possible outcomes, they should be given the right to accept or decline treatment. A typical 15yo should probably be INVOLVED in making their own treatment decisions, although they would probably need guidance and counselling in terms of some of the more serious long term effects/outcomes. Notwithstanding, each case must be assessed on its merits. Response to discussion question: It is the nurse's duty to inform a patient about their illness/condition and how it can be treated regardless of age, sex, race or physical condition. Why do 18 year olds have this privilage of gaining this information without their parents' consent while a 17 year old may have to fight their parents for this right? If an adolescent wishes to know their treatment options, it is the nurse's duty of care to inform them in an appropriate manner. It is a human desire to want to live healthily. Parents may feel they know what is best for their child, but may not know how their adolescent feels about the situation unless the adolescent is included in such important decisions about their health. Such exclusion from these important decisions may lead to resentment towards the parents, particularly if a certain treatment would have saved emotional strain on the adolescent's behalf (very important during such emotional and hormonal turbulance) but the parents refused both the treatment and the adolescent's opinion. I and many others my age would certainly attest to this. I think it depends on the situation surrounding the teenagers care. Also the capacity to which the teen understands the illness needs to be taken into account. A case conference between parents rabbi social work and the Oncology nurses and doctors may assist in understanding of each other's points of view. Nurses can be put in a difficult position if gentle clear communications are not commenced early. There is potential for nurses to be 'made an example of' if there is no clear procedure on the ward so everyone has the same approach to care. It does depend on the maturity of the person, recently we had a 16 year old diagnosed with ALL and she was involved in all the discussions but we soon found out that she was a very young 16 year old, so these are the issues that need to be found out. her mother was not helpful with a previous history of mental illness and a cancer diagnosis herself. Being a younger person in the health care industry I believe that adolescents should have the right to know their diagnosis and be a participating member in the decisions about their treatment. Everyone has a right to know what is wrong with them and how it is going to be treated. You cant leave them out of the loop. I believe a teenager should be consulted at all times regarding their care as they are the people who have to live with the decision made, for the rest of their lives. Being young myself, with the amount of resources out there the patient is able to make an informed choice. No one has the right to choose how a person is treated medically or otherwise uninformed. Having read this case study my gut instinct is to tell the patient of his condition. If you remove this from a medical setting, you would not get behind the wheel of a car without first being taught how to drive. You do not solve a maths equation without first being shown the formula. You cannot beat cancer if you don't know you have it, and don't understand why one day you feel relatively okay but then after some undisclosed medicine you feel 10 times worse and start losing your hair. Not telling this child of his condition plays with his sense of self and identity. How can he sit in a ward amongst other cancer patients receive the same treatment as them but deny he has cancer. The people who are going through the same treatment as him are able to provide support where those who haven't can't. This support will be hampered by his denial that he has cancer. I think the patient has a right to know the full extent of his condition, and all the treatment methods so he can make an informed decision. If he chooses to go along with the doctrines of his faith so be it, but he may in fact want treatment, either way he should have all the information. They should be allowed to be involved, they after all are the ones who will have the treatment, and it may help them accept their condition and treatment if they feel more in control of what is happening.
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