In this episode of the Care to Learn Podcast Erin Wakefield, an experienced Perioperative Clinical Nurse Educator, speaks about simulation-based education, transition shock, successful preceptorship programs and much more...

Podcast Transcript

Wayne: From Ausmed Education, hello and welcome to episode four of the Care to Learn Podcast series. I’m Wayne Woff and each month we sit down with interesting and influential professionals working within healthcare and education.

In this episode we’ll be talking to Erin Wakefield, a Perioperative Clinical Nurse Educator who is working in the public sector in Melbourne. Erin has a true passion for empowering nurses through education and is a strong advocate for graduate nurses in the perioperative setting.

In today’s episode we’ll discuss the value of simulation-based education and its huge benefit in the perioperative environment. Erin also speaks about the research on transition shock and how nurse educators can support graduate nurses to have a successful transition to professional practice.

So, let’s get into it.

Wayne: Erin, great to have you here for our Care to Learn Podcast today. Traditionally we start these podcasts by giving our guests an opportunity to tell our audience a little bit about their professional journey, their background, and how you became a Clinical Nurse Educator, the role that you’re in at the moment.

Erin: Thank you I’m thrilled to be here. I started out as a theatre nurse 20 years ago now. Initially I chose a graduate year that would give me the most time in theatre, and after that I went off to the ward for a couple of years to consolidate my skills.

Like so many of us do as a young 20-something nurse, I then left Melbourne to travel. I first went up to Alice Springs Hospital where I worked for 2 years, and absolutely loved it. But then I was ready to go off and do a little bit more trauma, so I ended up at the Townsville Hospital in far-north Queensland.

After that, I was very lucky to be accepted by the Australian Red Cross for placement overseas. So, after quite a long process I ended up in Northern Kenya working with the Sudanese war-wounded. I was one of the theatre managers there.

When I came back to Melbourne I went back into theatre. I spent a couple of years as a general surgery ANUM and worked in both public and private over the time of having my children.

Eventually a position came up as an educator, and that’s where I am today! I’ve been in my role for four years now and I’m very passionate about nurse education and empowerment through education.

Wayne: Fantastic! You recently wrote an article on Leading a Culture of Educational Change through Simulation. We’d like you to speak a little bit about the value of simulation-based education, and to also reflect on whether the outcomes vary from other modalities when using simulation-based education?

Erin: The term simulation is a massive umbrella term to define a whole lot of different educational interventions. It can be anything from using a cannulation arm to practice cannulation, to an online program. For example, Monash Health have done First2Act which enables the practice of managing deteriorating patients in real time.

However, what I’m doing in the theatre environment is more commonly known as fully-immersive simulation-based education. What this means is that I set up a story to involve both the perianaesthetic and perioperative nurses in a life-threatening emergency. So, for example, it might be a difficult airway leading to a can’t intubate can’t oxygenate event. And then down at the perioperative side it may be a post-partum haemorrhage. So, you can imagine that we’re doing this in the theatre and it’s very very life-like.

Simulation is so much more efficient and effective than the traditional didactic teaching simply because it encompasses the principles of adults learning. Learners – we’re talking about experienced nurses as well as novices – are engaged; it’s relevant, it’s interesting.

Often, I’ll ask the staff: ‘in-service time is coming up, would you like an in-service on anaphylaxis, or would you like to read a little bit about it and then let’s do one?’

Primarily, simulation is for the practice not only of the technical skills, but also for the non-technical skills that you really need in a crisis.

I’m sure a lot of people have heard of the Elaine Bromiley case, but I’ll just re-cap in case they haven’t: Elaine Bromiley was a fit and healthy mother and in 2005 she was admitted in the UK for an elective ENT surgery. When she was induced, her airway became difficult and was lost.

In hindsight, what happened was a can’t intubate, can’t oxygenate scenario. However, because of the lack of teamwork, lack of leadership, communication and so forth, Elaine died. Not only was there task-fixation by the doctors and nurses, no one stood up to say ‘hey, let’s look at the big picture’.

Elaine’s husband was a pilot and over the last 15 or so years he has completely changed the way non-technical skills are taught worldwide. He’s really brought it to the fore of medical education. So, when I saw the YouTube video that Martin Bromiely had created it really really resonated with me. If emergency situations are practiced for in other industries, like his own aviation, nuclear, military and so forth, why on earth don’t we practice for them in theatre? Emergencies do happen.

Wayne: So, it would be fair to say that you’re a huge advocate for simulation-based education? And the feedback from your learners over the journey has been extremely positive, I take it?

Erin: Very much so. It’s taken time to change the culture and really embrace simulation as a learning tool. What I’ve found in my experience is that people who have been quite reluctant to embrace it have had a bad experience previously. Often this is the feeling of having been perceived to have been reprimanded in public.

So, it’s super important to create a really safe learning environment. It takes time to set it up well. No one’s going to put themselves out there to have a go and possibly do something wrong if they feel they’re being judged.

So, what I always share with staff, novices and experienced staff alike, is called the Harvard rule of simulation: I know you know what you’re doing, let’s just have a practice and see how we go.

Wayne: You’ve also done extensive research on transition to practice and transition shock that graduate nurses may experience when they enter the workforce. Could you speak a little about the challenges of meeting the needs of new graduates as an educator?

Erin: I can. I’ll start by sharing with you a definition of what transition shock is. I had the pleasure of hearing Judy Boychuk-Duschner speak at the Australasian Nurse Educators Conference in Auckland. She was amazing, I was absolutely mesmerised by what she had to say simply from the selfish point of view that she was giving a name to what it was that I went through 20 years ago. As a grad going straight from university into the operating theatre, I had absolutely no idea: I worried about patients when I went home; I worried I was going to cause a harm; I didn’t know how to integrate into the team, let alone knowing how to scrub and scout for example.

She, through her research, was able to put a name to what I’d experienced myself, which was transition shock. The honeymoon stage comes first. This is where the grads are really excited to be on the ward or in theatre; everything’s rosy; they’re on supernumerary time; they’re pretty happy to have a job and all is well. However, as time goes along and the realities of nursing work set in they tend to withdraw, sick leave often goes up, and there’s a bit of unhappiness.

So what Judy shared in her research was how to overcome this shock stage and enable young graduate nurses to go on successfully to transition.

Wayne: We might move next to the concept of preceptorship and where this fits in. Could you talk a little bit about the value of preceptorship and how to best set up a successful preceptorship program?

Erin: Preceptors are the backbone of the successful transition of graduates, particularly in the perioperative environment.

As you know, all registered nurses are mandated to not only take part in their own education, but also to assist in the education of others. Despite that, it takes a really special person to be a preceptor.

The team I work with in theatre are all highly skilled theatre nurses who are so passionate about their role and they want to share that knowledge and empower graduate nurses to be the best they can be.

Setting up a program to support them is something I feel very strongly about because they’re at the coal face every day with our learners. So, once a month I try and have a preceptor meeting with our team. It often involves food, catered by me. But, the crux of the matter is we can come together and talk about how the grads are going, organise or alter their individualised learning plans, and it also gives the preceptors a chance to learn something new. For example, Blooms Taxonomy or it might even be just an update from the GNP. There’s so much out there in regard to adult education that can help our preceptors to be the best that they can be.

Wayne: I just wanted to pick up a couple of terms that you used earlier and get your insights about the balance in the education space between the technical and the non-technical skillset that nurses need within your setting. Obviously, there’s a range of clinical, technical skills that they need to be good at, but there’s also non-technical skills that might be more interpersonal communication, negotiation et cetera. Do both of those areas get attention when it comes to education?

Erin: Definitely, in particular with our graduate nurses who are coming straight from university. Learning the technical skills is often times not a problem, but to transition successfully, what I’ve found in my own experience is that graduates need an insight early on into the subtleties of the theatre culture. For example, closing the door quietly so the whole theatre team doesn’t turn and stare at you. Or how to communicate assertively if it’s required and so forth.

Wayne: And that leads us into an area that I know you’re very interested in and that’s the ability to have a space where feedback can be given. And sometimes that feedback will be not that positive, will be room for improvement. What comments would you make from an educational point of view when it comes to the ability of educators to provide that type of feedback?

Erin: Sadly, as an educator I often have to give negative feedback. Although, I need to share with you that Jenny Rudolph has written a fantastic article titled There’s no such thing as “non-judgemental” de-briefing. It’s a little old now but it’s still perfectly relevant.

She’s created a technique called the advocacy inquiry model. Originally, I looked into it because I was keen to make my theatre simulation debriefs the best that they could be. But now I use it in everyday interactions. It enables me to give negative feedback to the learner in a way that maintains their dignity.

Wayne: And in terms of how people respond to that? You’ve found that in slightly changing your approach, potentially, with this model that that has improved the way that information is received?

Erin: Definitely. I think we can safely say that the feedback sandwich is out of date. Advocacy-inquiry is the way to go.

Wayne: That moves us on to our second-last topic: the best strategies for engaging reluctant learners. It’s a subject that is often in the minds of educators, no matter what the clinical setting. But what are your tips for educating and engaging people who could be characterised as reluctant learners.

Erin: As an educator the first thing I do is a learning needs analysis or a gap analysis. I have a really good chat with them to find out why it is that they’re feeling reluctant. Often times it’s just fear about coming in to theatre. Perhaps they saw something on TV that terrified them, or maybe they’ve had a bad experience themselves or a loved one has had a bad experience previously. So, after a good chat and really digging down to find what the cause is, generally we can work around it.

Wayne: Terrific. We’ll do our set of closing questions which we traditionally have on the Care to Learn Podcast, the first of those: what’s one thing you’ve learnt in the past month that has stuck with you?

Erin: I’m a student myself and I recently completed my first exam in about 15 years and I have to say it was such an eye opener, but my pearl of wisdom today would be: your best is good enough.

Wayne: Our second question: what’s your favourite personal learning tip?

Erin: That would have to definitely be: please look up the advocacy-inquiry method by Jenny Rudolph, I can’t overstate it enough. It’s fantastic. You can give any feedback at all and still maintain the dignity of your learner.

Wayne: I can hear the keyboards tapping already! And our third and final question: what’s the best advice you’ve ever received about CPD or continuous learning?

Erin: This is a great question. I recently had cause to assist a registered nurse to collate her CPD. So, my best piece of advice would be to document as you go along. There are so many proformas out there to meet the legislated requirements, but it’s the reflective process involved in filling out the proforma that will also help you with your clinical practice.

Wayne: Thank you for your time today, Erin, it’s been fantastic to have you on this episode of our Care to Learn podcast. Thank you very much.

Erin: Thank you for having me.