Developing a postgraduate professional education framework for emergency nursing: a co-design approach

In Australia, the health industry and the tertiary sector provide post-registration courses for emergency nurses [1]. These range from practical, competency-based shorter modules to specialty programs to longer courses that are mixed theory and practice, postgraduate degrees. Irrespective of whether a course is delivered by a hospital or a university, education providers have a common goal. That is, to promote students’ higher-level learning, arming them with the knowledge and skills to work from a strong evidence base [2]. To serve this end, the Australian Qualifications Framework (AQF) Council operates as an advisory body to regulate all postgraduate offerings across Australia. Despite said aims, the significant but separate energies invested by industry and universities in postgraduate course design and delivery often results in the unnecessary duplication of content and resources [3]. Notwithstanding the global demand for postgraduate courses, evidenced for example by 1700 United States universities offering Masters-level programs [4] and many institutions in the United Kingdom offering Graduate Certificate and Doctoral Preparation courses [5], there are critical gaps in postgraduate offerings [3] in Australia. Courses offered by higher education providers (HEP) are based on industry need and are developed and delivered with significant industry input [6]. For example, in the Australian context postgraduate courses are overseen by course advisory committees with membership comprising of academics, key industry and professional organisation stakeholders [7]. However, these advisory committees are often implemented ‘after the fact’ – when university stakeholders have already undertaken most of the course design and often delivered it.

This study was a collaboration of academics and educators, clinicians, postgraduate emergency nursing students, administrators and nursing regulators. The co-designed partnership offered a new way to design learning based on a culture of shared decisions, relevance and agility, created and agreed from the outset. This enabled a range of stakeholders to contribute and have their needs heard [8, 9]. Other approaches, such as a Delphi method, would not have given us the rich engagement and ongoing feedback that we were able to achieve through the lens of the co-design approach [8].

The number of participants able to attend all or part of each workshop was influenced by clinical demands at the time and ranged from nine (Workshop 3), to 16 (Workshop 2) and 21 (Workshop 1).

The data formed eight categories that fell within two main themes. These two themes are summarised in the two matrices presented in Tables 1 and 2. Matrix 1 [or theme 1] (Table 1) harmonises the first two categories: the mandatory factors that shape postgraduate nursing curricula in Australia and the need for a unifying model of nursing practice across educational contexts. Matrix 2 [theme 2] (Table 2) systematically articulates the remaining six categories. These cover the principles and processes that should be thought-out when developing and delivering emergency nursing curricula. These include good practice principles of professional learning; types of professional learning; stakeholder terms of engagement; scaffolding of teaching and learning; harnessing the diverse contexts of learning; and assuring course quality. The data were also drawn on to develop an interim framework (Fig. 2). The categorised data were also provided to participants for review and feedback.

The two matrices aligned the postgraduate emergency nursing education goals and curriculum development processes of the local health care service industry, national health care regulators and national higher education bodies, as well as the professional learning and credentialing needs of students and their employers. A robust thread running through both themes was the importance of work-integrated learning to prepare postgraduate students for practice. The culmination was mutual agreement of an operational framework to optimise learning of emergency nursing based on an academic-industry-student collaborative approach (Fig. 2) as well as the creation of a graduate certificate in emergency nursing curriculum exemplar. This led to establishment of principles to guide future curriculum development, implementation and evaluation.

Five guiding principles (Fig. 1) of curriculum development, implementation and evaluation were then established to inform the processes subsequently used in the study. Beneficial in the establishment, maintenance and development of a co-curricular distributed leadership partnership, the principles demarcate and represent the evolutionary steps involved in moving through design and creation phases to achieving capability with tangible outcomes and future direction. Emerging from curriculum development milestones and processes undertaken during the workshop series, the principles articulate the architecture of collaborative, linear and iterative scaffolded processes through which participants can transition while designing and constructing sustainable and suitable curricula. As such, a key outcome of Workshop 3 was the finalisation of a clinical-academic integration strategy and framework construction. This resulted out of a consortium approach of distributed leadership and jointly-determined, fully-articulated, fit-for-purpose roles for industry, university and student roles – the third principle.

However, to achieve capability, it was determined that respectful relationships between industry and academe must be maintained, and that affiliations that embedded joint mentoring and capacity building processes must be established. This would ensure a viable longer-term teaching and learning community of practice. To ensure robust development and delivery, successful postgraduate curriculum transformation also relies on health service provider engagement in appropriately-resourced academic activity. These were the final two guiding principles, delineated with the intention of providing future recommendations. The adoption of five guiding principles potentially supports the sustainable implementation of co-curricular partnerships.

Matrix 2 (Table 2) captures expectations of the various stakeholders with respect to learning and teaching quality and enhancing student employability. The participants considered it essential that all stakeholders understand and articulate the good practice principles of nursing curriculum development and delivery before they determine teaching and learning processes. Participant summaries generated through workshops are represented in Table 2 and Figs. 1 and 2.

The most important finding arising from this study was the overwhelming desire for industry to be involved in all aspects of university postgraduate emergency course development and for universities to likewise be involved in courses developed and delivered by industry (Fig. 2). Traditionally stakeholder involvement in course advisory committees provides a controlled environment for engagement, yet in this project, co-design enabled a more equal playing field of all stakeholder contributions. The emphasis all participants placed on mutual involvement was significant, but deliberations indicated that currently, it is not well-operationalised. This is despite the fact that tertiary education in Australia is regulated by the Tertiary Education Quality Standards Agency (TEQSA) [16] stipulate that universities engage regularly with course advisory committees comprising industry stakeholders to ensure the relevance and currency of their curricula. Similarly, health services often seek university advice to ensure the congruence of their professional development offerings with AQF Level 8 courses to provide a postgraduate articulation pathway for their emergency nursing students. Graduate Transition Programs offered in Queensland, Australia are good examples. These hospital-based programs deliver an entry to specialty program to newly-graduated/employed registered nurses, which can often be credited towards university study [7]. However, discussions during workshops clearly indicated that while both universities and hospitals do seek input from the other, this tends to occur when courses are already conceptualised and largely developed. In contrast, Henderson and Creedy [17] argue that the best student learning experiences occur when clinical content, context and teaching approaches are negotiated from the beginning of course development.

Consistent with the literature [18‐21] the data indicated that it was important to have a range of professional learning experiences and related assessment methodologies (e.g., industry case studies, simulation, industry mentoring, industry placements) within curricula and adapted to context. Work-integrated learning and assessment for a rural emergency nurse, for example, might be made most relevant if metropolitan placements, or video-conferenced simulations, are embedded. As presented in Matrix 1, the educational value of learning-in-place warrants explicit acknowledgment within university postgraduate nursing curricula [12]; however, workplaces should also understand both what students bring to work-integrated learning placements and what they need from the workplace to maximise their learning [22].

The risk of universities providing sub-standard learning experiences for nurses without deep industry engagement was also highlighted in this study. This is corroborated by Australian research in the higher degree context, which clearly demonstrated the ill-preparedness of graduate and postgraduate students for the ‘world of work’ [20, 23]. Substantial evidence from multiple practice disciplines further indicates that deep learning can only occur if industry and disciplinary bodies are explicitly engaged in university course development and delivery [6]. Mutually determined work-integrated learning approaches appear to be the best way to enable authentic learning environments [6, 20, 24]. Hence, Matrix 2 is anchored in principles such as ensuring industry referencing throughout course development and delivery; initiating and sustaining collegial relationships; properly resourcing industry involvement in curricula; fully understanding the students’ learning needs by involving them in course development; and ensuring that curriculum currency is maintained.

The five guiding principles created from this study are starting points for those looking to co-design and implement a postgraduate curriculum in partnership. Our experiences of industry and academe working respectfully and collectively culminated in shared outcomes grounded in these principles. Further, the value that all participants placed on integrating workplace-based learning into university courses targeting domain-specific and advanced practice nurses [11], as well as nurse practitioners [13], warrants consideration. Sociocultural theories of workplace learning propose that optimal learning outcomes are the result of students’ active participation in clinical activities during their study, coupled with their ‘real-life’ learning interactions with the complex and dynamic clinical work environment [18, 22, 25]. Hence, alignment of the industry-academic agenda through well-designed work-integrated learning and assessment experiences increases the relevance of postgraduate courses in emergency nursing (Table 2).

The co-designed Graduate Certificate of Emergency Nursing exemplar developed during this study encompasses the requirements of industry and aims to provide students with quality learning and useable course outcomes. It embraces the imperatives and mutual goals of both industry and universities, while harmonising diverse pedagogical approaches. Devised as a means of strengthening industry-university collaboration, it serves to bridge the current gap between practical capabilities and theoretical scaffolding of learning (reflective of AQF compliance), while meeting the regulatory requirements of the Nursing and Midwifery Board of Australia [10, 11].

This study has highlighted the potential of an industry-academic agenda increasing the relevance of postgraduate specialist courses in health, reinforcing the connection between industry and higher education to promote postgraduate learning and employability. Figure 2 provides a unique future blueprint for employability skills to build more collaborative partnerships between employers, industry, higher education and professional bodies in health. In the future, we hope to test the Framework formally, along with its emergency nursing exemplar. The aim is to ensure the transparency of the Framework, promote sustainability of the embedded principles, develop and operationalise joint governance processes and support continuing development of such educational partnerships.

We acknowledge the lack of generalisability of this study’s findings, namely that the findings are context-specific to health services and universities involved. However, given the depth of participants’ background, from clinical care to professional organisation and academic representatives, we suggest that our framework is considered, it can be adapted to other postgraduate nursing contexts.

This study presented a joint exploration of strategies to design nursing curricula, with the objective of producing work-ready postgraduates who benefit from a thoughtful blend of clinical and university learning experiences. We also illuminated the role of local hospitals and universities in preparing registered nurses for specialist employment and explored how to embed these ideas within curricula using the exemplar of postgraduate emergency nursing. Consensus from the workshops indicates that in the ideal scenario, the framework could be used widely by local health services and universities to guide their joint development of courses, where work-integrated university-level teaching and learning are embedded. The strategies and exemplars developed in this study offer guidance for any professional education provider. The framework exemplifies a spirit of consultation and collaboration, valuing student voice that could usefully guide future joint curriculum development and delivery in other postgraduate nursing specialities.