Nursing older people--a role for new graduates? New graduate nurses learn vital nursing skills through spending time working in elderly care wards.

In 1998, the Ministerial Taskforce on Nursing recommended that the Clinical Training Agency work with nursing organisations to develop a national framework for the first-year of clinical practice for new graduate nurses. (1)

The first year of clinical practice has long been identified, both in New Zealand and internationally, as a key aspect of the development of professional nursing practice and the ongoing retention of nurses in the hearth workforce. The taskforce recognised that new professionals required support to make the transition from an educational context to a professional practice context. The programme the taskforce recommended included a minimum of two and a maximum of three rotations in two scopes of practice.

Including rotations into elderly care wards is an ideal opportunity to prepare our fledgling nurses to be able to nurse order people, within the wider hearth field. Recent research from the United Kingdom has identified that, within the hospital setting, around that of patients at anyone time are order and, given the growing size of the order population, this figure rooks likely to rise. (2) Hence the care of order patients will form an increasingly important part of the jurisdiction of hearth care professionals, particularly nurses. On average, over half of patients in Rotorua Hospital's medical unit are aged 70 and over. There is no doubt that order people are increasingly the highest users of our health services.

Yet how do new graduate nurses perceive a rotation to an elderly care ward? Lakes District Health Board (DHB) has been running a one-year new graduate programme for over five years, with around 30 graduates taken in this year. Each nurse spends six months in two different speciality areas, such as orthopaedics, surgical, medical or elderly care/rehabilitation. For many, requesting a placement in an elderly care ward will be seen as taking positive first steps to a rewarding career in this speciality. Others may not view their rotation in such a positive light, yet Ministry of Hearth feedback on three pilot new graduate programmes found that those new graduate nurses who had at feast one placement in a clinical area that was not one of their initial preferences, thought the experience gained in those areas was stiff useful to them. (3)

One of the comments made by a new graduate nurse at Lakes DHB regarding a placement on an elderly care ward was that she would "de-skill" that all the technical knowledge gained from a first rotation in an acute unit would be lost. Traditionally, nursing has been regarded as one of the professions that engage in a series of practices and behaviours that focus on ritual and control. (4) In fact, nursing order people has become one of the most pioneering, courageous and innovative areas of practice. Yet nurses have had to fight for the recognition of their skills and what they have to offer the profession, along with the rives and health of order people. Nurses working with order people have developed superb assessment skills, are open to the realities and challenges of practice, flexible and responsive to need, and creative in finding new ways of working to develop practice and services within their working environment.

Technical skills are only one aspect of being a nurse. Being able to set up an intravenous infusion pump to deliver antibiotics is a skill air nurses can be taught. User manuals, policies, protocols and guidelines ensure best practice and safe delivery of the medication, yet what policies and protocols guide us to say the fight thing to the 85-year-otd, who, despite intensive rehabilitation, cannot safety return to their two-storied home? What policies and protocols tell us when to step in and intervene and when to let independence have an opportunity to prevail? And what policies and protocols teach us to care? Nursing in a rehabilitation ward with order patients enables our new graduate nurses to develop their "people" skirts, through talking, interacting, and carrying out hands-on nursing care. Nurses gain an immense sense of achievement seeing the patient who has had a stroke get dressed independently or regain their balance or mobility. The skills developed in this setting writ become the building blocks of their practice, for relating to people is the basis of care.

Older people do not easily fit into the medical paradigm. A single diagnosis is rarely possible, as disease manifestations are likely to be multiple and complicated by the effects of the aging process. Nurses working with older people face dairy challenges with complex issues such as poly-pharmacy, wound care and the constant concern that elderly patients can so rapidly deteriorate from being medically well to being acutely unwell.

Working with older people is an opportunity for nurses to act as witnesses to wonderful life stories and experiences, to gain invaluable clinical experiences and to work in an environment where the nurse tries to give the patient as many opportunities as possible to exercise freedom of choice and to make informed decisions. The importance of skirted, caring nursing practice can never be underestimated in the care of older people. As a new graduate nurse, are you up to the challenge?

References

(1) Ministerial Taskforce on Nursing (1998) Report of the Ministerial Task force on Nursing: Releasing the potiential of nursing. Wellington: Ministry of Health. Available on website www.moh.govt.nz.

(2) McKinlay, A. (2003) Student nurses' attitude towards working with older patients. Journal of Advanced Nursing; 43: 3, 298-309.

(3) Ministry of Health (2004) New graduate first year of clinical practice nursing programme: evaluation report. Wellington: Ministry of Health. (also available via www.moh.govt.nz)

(4) McCormack, B. (1999) The contribution of expert gerontological nursing. Nursing Standard; 13: 25, 42-45.

Gillianne Meek, RN, BSc (Nursing), Dip Hearth Studies, DipMgmt, is acting associate director of nursing--medical and diagnostics services at Lakes DHB. She is a member of NZNO's gerontology section committee.