Framework For Lifelong Learning For Nurses And Midwives - Queensland Health

1. IntentThe Framework for Lifelong Learning for Nursesand Midwives – Queensland Health (theFramework) provides a scaffold for all teachingand learning considerations that ‘value add’ toachieving a sustainable, professional, capable,person-focused nursing and midwifery (nursing/midwifery) workforce that is respected forcompetence and quality.However, it is recognised that there is oftenconsiderable variance in the nature, standardand quality of nursing/midwifery educationaccess, offerings and resources across andwithin health facilities (Fox, 2013). Therefore,the Framework has been developed to beapplicable to all nursing/midwifery contexts asan enabler to improve nursing/midwifery staffeducation and training experiences by informingstrategies, policy, practices and behaviours.As such, the Framework offers explanation aboutstandards underpinning nursing/midwiferyeducation services; key concepts associatedwith teaching and learning; strategies to supportapplication; and standards to measure theeffectiveness of educational activities.Broadly the Framework content comprises: A structured approach to clinical,professional and organisationaldevelopment opportunities for allclassifications of nurses/midwives. Explanation of learning and developmentopportunities along a continuum oflifelong learning. Specific principles, standards, andexemplars to guide health services in:–– the promotion, implementation andapplication of a culture of lifelonglearning–– applying pathways for careerdevelopment and continuum oflearning–– foundational requirements forkey programs of learning for allclassifications of nurse/midwivesparticularly new graduate (novice)nurses and midwives (Nurses andMidwives (Queensland Health andDepartment of Education and Training)Certified Agreement (EB9), 2016). Direction, planning, implementation,and evaluation strategies for workplacelearning. A guide to attainment of relevant postgraduate awards (Henderson, Fox andArmit, 2008). Explanations applicable to individuals,groups, teams of nurses/midwives, andothers that facilitate support processes,and guide a more collective overarchingprofessional approach to buildingworkforce capacity and capability therebyreducing variance in access, opportunity,expectations and standards.2. ApplicabilityIn creating an overarching resource thatcomprises a suite of standards for efficient andsuccessful development and education of thenursing/midwifery workforce, the Framework isapplicable for all nursing/midwifery groups andindividuals. These include but are not limited to: The Office of Chief Nursing and MidwiferyOfficer Queensland who networks withExecutive Directors Nursing/Midwifery(EDON/M) and Nursing/MidwiferyDirectors, Education across the State tosupport collective engagement in thedevelopment, education, and trainingof nurses/midwives within Hospital andHealth Services (HHS) by promoting:innovation; access to opportunity;resource availability; and mitigation ofvariance in standards including capabilityand capacity. The Executive Director Nursing/Midwifery(EDON/M), HHS who liaises with executivemembers, education providers, andnursing/midwifery education service leadsto: sponsor nursing/midwifery educationand scholarly pursuits; set objectivesFramework for Lifelong Learning for Nurses and Midwives5

and performance targets; build andfoster partnerships/relationships; acceptjurisdiction for standards, workforcecapacity/capability, and risk mitigation. Nursing/Midwifery Directors or AssistantNursing/Midwifery Directors - Educationwho assume accountability for: educationand professional vision; expert strategicand operational education leadership inapplying the Framework intent; fosteringtranslation of knowledge to practiceand scholarly endeavours; effectivelycollaborating with the EDON/M, Directorsof Nursing/Midwifery, Nursing/MidwiferyDirectors, Assistant Nursing/MidwiferyDirectors, interprofessional colleagues,internal and external partners (e.g. HigherEducation Sector [HES]) to lead, andevaluate education initiatives to achieveexpected outcomes. Directors of Nursing/Midwifery, Nursing/Midwifery Directors, and AssistantNursing/Midwifery Directors who ensurethe Framework is applied effectively tosupport: resource allocation; teaching andlearning strategies; evaluation of serviceand workforce needs in attainment of asustainable, professional, capable personfocused nursing/midwifery workforcevalued for competence and quality. Nursing/Midwifery Educators who: reflectand regularly undertake self-assessmentof role contribution and developmentneeds to inform, and foster collaborationwith others in the application ofFramework tenets in determiningeducational activities; facilitate translationof knowledge to practice; and buildcapacity and capability to address clinical,professional and organisational learningneeds (AHPRA, 2014; Fox, 2013).ÌÌ This role is integral in promotingapplication of the Framework tenetsacross the continuum of lifelonglearning. Clinical Nurse/Midwife - ClinicalFacilitators (Coaches) who role model,and use their expert clinical knowledgeand skills in supporting and workingcollaboratively with Nurse/MidwiferyEducators and others to apply the6tenets of the Framework by undertakingdevelopment, education and training froman operational perspective within specificclinical contexts. Line Managers who: collaboratewith Nurse/Midwifery Educators tosupport application of the tenets ofthe Framework; identify and evaluateworkforce development needs, andmonitor standards in liaison withNurse/Midwifery Educators and others;operationalise relevant educationalresources and support strategies. Clinical Nurse/Midwifery Consultants who:demonstrate and promote excellence inclinical and professional standards whenworking with others to apply the tenets ofthe Framework to practice. Nursing/Midwifery staff (all classifications)apply the tenets of the Framework toidentify development gaps, shapeexpectations, reflect and formulate owndevelopment requirements in line withrole and classification expectations.ÌÌ It is also the responsibility of eachindividual (all classifications) togenerate and nurture a postiveworkforce culture that promotes, andsupports reflection, inquiry, lifelonglearning, workforce capacity/capability,professionalism, compliance withrelevant standards, and developmentof the capacity and capability of others.ÌÌ A nurse/midwife who is responsiblefor development/education outcomes,standards and nursing/midwifery staffperformance (e.g. Nursing/MidwiferyDirectors, Nurse/Midwifery UnitManagers, Nurse/Midwifery Educators,Clinical Nurse/Midwife – ClinicalFacilitators) demonstrates soundawareness of, and ability to apply thetenets of the Framework in order to:effectively generate dialogue; upholda common language/nomenclatureand expectations to foster support andengagement in lifelong learning; andestablishment of best practice, andworkforce outcomes.Framework for Lifelong Learning for Nurses and Midwives

ÌÌ Newly graduated nurse/midwives areprovided:–– additional learning support andaccess to programs of learning thataccelerate their transition into theworkplace and consolidate learningsto enable achievement of expectedstandards, and the provision of selfsufficient, safe competent care.–– opportunity for supervision andsupport by experienced nurses/midwives who offer objectivefeedback regarding performance,and facilitate confidence andcompetence in achieving relevantstandards of practice; and assist byaccelerating a pathway to clinicalspecialisation (i.e. nursingprofession). It is the responsibility of each nurse/midwife (all classifications) to share theirknowledge and practice in a professionalmanner (as per the Nursing and MidwiferyBoard of Australia (NMBA) Codes ofConduct (Principle 5) (NMBA, 2018a andb) when supporting, directing, teaching,supervising and assessing nursing/midwifery students, new graduates andother nursing/midwifery colleagues toachieve best practice care.broadly accepted approach to industrybased nursing/midwifery workforcedevelopment, education and trainingacross Queensland.3. GlossaryTo clarify terms used within the Frameworkpertinent to nursing/midwifery, education andto promote collective use and appreciation ofconsistent terminology a Glossary is providedas Appendix 1. This Glossary is important giventhat many terms, in particular those relatedto workplace and continuing professionaldevelopment are often used interchangeably.Without clarification of terminology, confusionand impact on achievement of shared language,appreciation of requirements, and application ofthe Framework tenets and educational outcomesmay be compromised (Quinn and Hughes,2013). The Framework can be used to provideothers with a clear description of thenature, scope, standards, outcomesand reporting processes applied in thedevelopment (including ContinuingProfessional Development), education,and training of nurses/midwives within aHHS/facility/directorate/service. This facilitates:–– resource allocation (fiscal, human andphysical)–– effective application of the BusinessPlanning Framework (BPF) (OCNMO,2016)–– demonstration of outcomes aligned toprofessional and other standards–– internal and external benchmarking–– collective use of language and aFramework for Lifelong Learning for Nurses and Midwives7

4. Assumptions The HHS/facility/directorate/servicevalues a sustainable, competent,compassionate, innovative, professionaland capable person-centred nursing/midwifery workforce that is encouraged toparticipate in ongoing self-reflection andcontinuous learning. Person-centred care, quality improvement,translation of knowledge into practice, andrepeated demonstration of competenceunderpins all education/training andnursing/midwifery developmentalactivities. All nursing/midwifery education/traininginitiatives, activities and resourcesreflect minimum standards of registeringauthorities, professional bodies,legislation and HHS/facility/ directorate/service (e.g. policies, procedures). The principles of Performance andDevelopment Planning (PDP) underpinnegotiation of teaching and learningand support processes required by eachnurse/midwife. The application of a career pathwayenables the current and emergingworkforce to plan a development journeywhich facilitates acquisition of requisiteknowledge and skills for role expectations. The workplace environment supports aculture that fosters the development ofnursing/ midwifery staff, and lifelonglearning that meets clinical, professionaland organisational needs. The context of the workplace setting isfundamental to realistic and meaningfulengagement within the healthcare team;achievement of clinical skills, knowledge,and interprofessional socialisation thatcultivates productive and competentcontribution to health consumer outcomesand the health care system.8 Teaching and learning principles, andsupport processes are applied flexibly toaccommodate variance in learning needs,styles and competence from a novicepractitioner to the more experiencedprofessional colleague. Novice practitioners are provided withcontext specific learning pathways,foundational resources, and additionalsupport processes to foster effectivetransition to professional practice andengagement in lifelong learning. Each nurse/midwife assumes personalaccountability and responsibilityfor professional engagement, theirlifelong learning pathway and effectiveutilisation of learning opportunities, andworkplace offerings (e.g. Orientation,Transition Support Processes, ContinuingProfessional Development, SuccessionManagement). A shared perspective of nomenclature,foundational requirements, principles andstandards minimises variance betweenHHS/facility/directorate/service offeringsand promotes equity and access fornursing/midwifery staff. All organisational activities benefit fromworkplace learning that is viewed asfundamental in striving for professionalexcellence, standards, evidence basedpractice and optimal outcomes. Training and education are valued, andviewed as fundamental to developingcapability and striving for excellence.Similarly, industry employed Nurse/Midwifery Educators are valued andrespected for their engagement andcontribution in developing and supportingnurses/midwives in continuousimprovement, translation of evidence intopractice and lifelong learning.Framework for Lifelong Learning for Nurses and Midwives

5. Nursing and Midwifery Scope of Practice andProfessionalismThe scope of practice of the professions is thefull spectrum of roles, functions, responsibilities,activities and decision-making capacity thatthe individual nurse/midwife is educated,competent and authorised to perform (NMBA,2007). The overall scope of practice depicts anevolving and dynamic range of responsibilities,that reflects the ‘outer limits’ or boundariesfor the professions and all of the roles andactivities of practice (NMBA, 2007; CRNNS,2015). Therefore, it forms the foundation fromwhich governments determine legislation,governing bodies prepare standards of practice,educational institutions prepare curricula, andemployers prepare role descriptions (Nelsonet al., 2014). Moreover, the scope of practiceof each individual nurse/midwife is influencedby the context in which they practice, therequirements of the employer and the needs ofhealth care consumers and families (Nelson etal., 2014). As such, particularly in the nursingprofession an individual’s scope of practicewill vary according to the activities, functions,responsibilities and accountabilities for whichthey are educated, authorised and competentto perform. Although midwives are consideredalready competent to scope of practice atgraduation organisational and other barriersmay exist that influence scope application (ICM,2013; NMBA, 2018d). Consequently, the scopeof an individual nurse/midwife’s practice maybe narrower than the scope of the nursing/midwifery professions (NMBA, 2007; Nelson etal., 2014).However, in nursing and midwifery, a number ofgenerally recognised descriptors or attributeshave been noted in international literature(Mark, Salyer and Wan, 2003; RNAO, 2007).These include: knowledge based on evidence;a spirit of inquiry; intellectual and individualresponsibility/accountability (relevant torole authorisation); autonomy (Nurses andMidwives [Queensland Health] Award – State2015, [Reprinted 2017]); specialisation; innovation and vision; collegiality andcollaboration; and a well-developed groupconsciousness (ethics and values) (Mark, Salyerand Wan, 2003; RNAO, 2007). Achievementof professional tenets and optimal scopeof nursing/midwifery practice requires theindividual to: be familiar with the legislation andprofessional body requirements; demonstrateprofessional standards; and put into actionthe values and attributes of the professionand organisation when providing care andcollaborating with consumers, nurse/midwiferycolleagues, interprofessional health care teammembers and others (e.g. external providers,HES) (CRNNS, 2015; OCNMO, 2013a and b).Hence, achievement of optimal scope of practicerequires a complex interplay of professionalattributes, experience, learning, scientificknowledge and critical thinking by the individualnurse/midwife to perform at the highest level ofcompetence (knowledge, skills and judgment)and confidence, and thereby make the utmostcontribution to outcomes (CRNNS, 2015;OCNMO, 2013 and b).There is little consensus in the literatureregarding the meaning of professionalism(Mark, Salyer and Wan, 2003; RNAO, 2007).Framework for Lifelong Learning for Nurses and Midwives9

6. Nursing and Midwifery Education ContextRealisation of the assumptions, andprofessional and individual scope of practiceoptimisation considerations underpin theeffective application of the Framework andachievement of expected nursing/midwiferyeducation outcomes in the workplace. Therefore,comprehensive appreciation of the scope ofopportunities to engage, the types of activitiesnurses/midwives undertake, and the extent andnature of support, supervision, and guidanceprovided become fundamental to evaluatinghow individuals learn and apply principlesto workplace practices (Fox, 2013). As such,Fox (2013) identified that Nurse/MidwiferyEducators play a key role in the ongoingdevelopment of nurses/midwives in obtainingrequisite knowledge and skills for providingcare and managing within complex healthcareenvironments. Nurse/Midwifery Educatorsenhance partnerships, facilitate translationof knowledge to practice, support practicestandards to build a sustainable, professional,and capable workforce by adjusting focus toaddress learning, and education needs withinthe context of practice (Fox, 2013).Application of the tenets of the Frameworkare reliant on a shared governance approach.Therefore, depending on specific circumstances,Nurse/Midwifery Educators and others (e.g.Clinical Nurse/ Midwife – Clinical Facilitators,Clinical Coach) with an education emphasiswill focus on one or a combination of thetenets of the Framework to enable workplacedevelopment opportunities for nurses/midwivesto assist achievement of practice standards andoptimal outcomes. Accordingly, Nurse/MidwiferyEducators support a culture of learning in theworkplace; function as custodians of standards;act as a resource ‘safety net’ and advocate forthe achievement of best practice (Fox, 2013).Therefore, a core responsibility of the Nurse/Midwifery Educator role is to support selfdirected lifelong learning in partnership withother colleagues to contribute to the continuingdevelopment of the individual and theprofession (Fox, 2013).10The responsibility of the individual is to engagein active lifelong learning as continuous,collaborative, self-directed learning applicableto one’s profession as well as all aspects oflife. Learners should be self-directed and takeresponsibility for setting goals, identifyingresources for learning, and reflecting on andevaluating their learning. By integrating workand learning, the individual acquires, engagesand applies knowledge within the authenticcontext of work to achieve desired outcomes(Fischer, 2014).It is also acknowledged that to achieve optimumutilisation of the nursing/midwifery workforcethere needs to be acceptance that care is notjust a collection of tasks. As such, the context ofcare, consumer and population health needs,workforce knowledge, skills and mechanismsin place to progress the individual’s capacityto meet work place expectations must beconsidered in relation to professional principles,codes of practice, standards and obligations(NMBA, 2018a andb; Besner et al., 2005;CRNNS, 2005; White et al., 2008). Moreover,nursing and midwifery practice is not restrictedto the provision of direct clinical care, but ratherextends to any role where a nurse/midwifeuses their skills and knowledge to inform andoptimise practice to meet role expectations.Therefore, in working towards achieving suitableclinical, professional and organisationaloutcomes, it is contended that the employerhas a responsibility to provide a learningenvironment that assists staff to effectivelymanage change, supports career development,facilitates remedial education, and promotesself-directed learning (Billet, 2016; Fox, 2013;Schoonbeck and Henderson, 2011). Thesignificance of ongoing learning and individualdevelopment to maintain work practice currencyand professional competence is furtherreinforced by health professional registrationmandatory requirements in Australia (AHPRA,2014), governance, and systems. In applyingthe tenets of the Framework, HHS/facility/directorate/service structures, governanceand philosophy need to be incorporated inall educational support activities to fosterFramework for Lifelong Learning for Nurses and Midwives

consistency in direction, and optimise bestpractice, and other intended outcomes.Additionally, documents that underpin fiscal andworkforce objectives, strategic direction, andeducation, training and research fundamentalrequirements have been used to inform theFramework. These include (but are not limitedto): Queensland Health (QH) Health andWellbeing Strategic Framework 2017 to2026 (Queensland Health, 2017a) Department of Health (DoH) Strategic Plan2016 – 2020 (Queensland Health, 2014) Hospital and Health Service Strategic Plan(as rele

2 Framework for Lifelong Learning for Nurses and Midwives Overarching Caveats The terms 'person-centred' and 'consumer' have been used throughout the 'Framework for Lifelong Learning for Nurses and Midwives - Queensland Health (2018)', Nursing/Midwifery Career Pathways and other supporting resources to reflect the care philosophy within both the