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«Understanding the needs of all the stakeholders: Issues of training and preparation for health work students and their clinical educators LOUISE ...»

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Understanding the needs of all the stakeholders: Issues

of training and preparation for health work students and

their clinical educators



Southern Cross University, Lismore, Australia

Work-integrated learning (WIL) is vital for preparing health-work students for practice. WIL activities have multiple

stakeholders, each with their own set of expectations and requirements, both explicit and implicit. Negotiations to

provide these learning experiences for students happen at many levels and those at the coalface are often unaware of the different expectations of the various stakeholders. By developing their ability to consider multiple stakeholder perspectives, health students and their clinical educators are in a strong position to maximize the benefits, limit the disadvantages, and increase the satisfaction of the multiple stakeholders. Social awareness, communication skills and relationship development and maintenance hold the key to building capacity to manage the WIL experiences more skillfully, leading to better outcomes for all. This discussion paper examines an example from the field that drew attention to the need for a better understanding of the needs of all stakeholders. (Asia-Pacific Journal of Cooperative Education, 2016, 17(2), 93-100) Keywords: Multiple stakeholders, work-based literacy, WIL, clinical placement, expectations, agency The work-integrated learning (WIL) activities, including practice, clinical experiences or placements, and fieldwork are a vital component of preparing healthcare students for practice. These learning experience placements are an important part of their preparation prior to taking up positions in the health workforce after graduation. They are a requirement for accreditation for nurses and allied health workers. Clinical placements provide students with opportunities to integrate theory with practice, to develop clinical competence, strengthen confidence and build on their skillsets (Rodger et al., 2008). As clinical placements hold an important position in the health education of nurses and allied health disciplines, much effort is expended ensuring that students are prepared for their placements (Nagarajan & McAllister, 2015). Professional development is available for clinical educators and those who aspire to fulfil these roles. Unfortunately, a number of issues of unmet expectations for both students and hosting facilities are consistently identified in the literature (Nielsen, Noone, Voss, & Mathews, 2013; Nielsen, Sommer, Larsen, & Bjork, 2013) and these have a negative effect on the partnerships.

Employers have expectations over and above graduates’ abilities to demonstrate the skills and knowledge they have acquired and their knowledge of the models and theories that underpin their learning. Employers often comment that graduates are ill-equipped to demonstrate agency; intentional motivation to work towards strategic goals (Fortune, Ryan, & Adamson, 2013). Moreover, some graduates are seen as unprepared for the realities of employment, and unable to cope with the pressures of the work environment (Adamson, Hunt, Harris, & Hummel, 1998). For these reasons, it is necessary to provide learning experiences that help students develop social astuteness, interpersonal influence, networking ability and apparent sincerity (Ferris et al., 2007). Harvey, Harris, Harris, & Wheeler, (2007) argue that politically skilled individuals are better able to manage interprofessional relationships due to their skills in interpreting social information and responding to the information with situationally appropriate behaviors. This ability to understand social Corresponding author: Louise Horstmanshof, Louise.Horstmanshof@scu.edu.au HORSTMANSHOF, MOORE: Understanding the needs of all the stakeholders: Issues of training and preparation interactions at work helps workers respond to situations effectively, minimizing disruption and maximizing benefit.

Prior to attending any placement, apart from the institutional guidelines, procedures and policies, students are provided with detailed information about the competencies that they are expected to demonstrate and how these will be assessed. In addition, each placement has its own set of rules and requirements and such information is typically provided in a variety of ways, from hard copy handouts to online interactive websites. Despite the effort put into preparing students for WIL placements, many students remain unprepared for the experiences. Clinical educators often remark that the students have not familiarized themselves with the materials before arriving at the placement (Levett-Jones, Fahy, Parsons, & Mitchell, 2006).

In health disciplines, the success of any WIL placement is measured on numerous parameters that include the satisfaction of multiple stakeholders: students; the facility; the clinical educators; the patients/clients and their carers; insurance companies; university faculty and accrediting bodies, to name a few. WIL placements results from consideration of the strategic objectives of various organizations and this makes it crucial not only to identify all the salient stakeholders, but to manage robust relationships with them so their objectives can be managed optimally (Assudani & Kloppenborg, 2010). Moreover, Freeman (2010) argues that instead of viewing stakeholders as disparate in their interests, to manage stakeholders well, they should be seen as “bound together by the jointness of their interests” (p.7). In other words, it is important to understand how professional relationships with stakeholders work. It is, therefore, vital to consider what the student undertaking the WIL placement brings to the relationships that already exist. Clearly this is a complex issue.

Mitchell, Agle, and Wood (1997) provide some guidance for defining who and what really counts in stakeholder recognition. They categorize stakeholders according to their possession of one, two or all of the following attributes.

(1) The stakeholder’s power to influence the institution(s) (2) The legitimacy of the stakeholder’s relationship with the institution(s) (3) The urgency of the stakeholder’s claim on the institution(s) Experience shows that in the case of successful and ongoing WIL placements, the needs of and benefits to all stakeholders have been established, either purposefully, or serendipitously. Further, responsibility for the maintenance of the relationships is typically shared across the placement communities. These relationships are dynamic and the needs and objectives of the parties are likely to shift or change. Additionally, these relationships are likely to have a life cycle with several stages in which the different priorities exert their influence and demand for attention. The need for vigilant, careful management of these relationships is a constant one. It is vital for both students and clinical educators to realize that although for them, the placement may be a short-term, one-off situation, it has been forged through many discussions, promises, compromises and agreements. Such agreements create relationships that need to be nurtured and maintained, so that the relationship continues and the source of placements is sustained to mutual benefit – most particularly, to the benefit of future students.

It is important that the clinical educators and host organizations identify and understand students’ expectations as this affects the students’ overall satisfaction with the WIL placement experiences. Yet, while it is acknowledged that ensuring a close congruence Asia-Pacific Journal of Cooperative Education, 2016, 17(2), 93-100 94 HORSTMANSHOF, MOORE: Understanding the needs of all the stakeholders: Issues of training and preparation between their expectations and actual experiences is important (Belanger, Mount, & Wilson, 2002), students expectations are not always clearly expressed, or even known, at the commencement of a placement. At times the expectations may even be unrealistic or contradictory. It is, therefore, important where possible to identify and manage students’ expectations as an ongoing process (Bordia, 2006). However, it is equally important when preparing students for placement to help them understand the existence of the other stakeholders at any WIL placement. It is not expected that, at the start of a WIL placement, students will have an understanding all the competing needs and expectations of stakeholders in any one situation. In fact, Cooper, Orrell, and Bowden (2003) recommend an ongoing reciprocal approach of communicating and listening; gather information through communication and reflect on its meaning and implications. Engaging in brainstorming sessions, or using situation analysis tools or mindmaps, before and continuously throughout the placement as students and clinical educators gather additional information can assist them to gauge the extent of the various stakeholders’ interests. Doing so provides clinical educators with an opportunity to guide students to come to regard the WIL experience as “an integral part of generative social practice”(Lave & Wenger, 1991, p. 35) that focuses on the “importance of participation” (Fleming, 2015, p. 110). In this way students are encouraged to develop a different awareness - moving away from a focus on their individual learning objectives.

Nagaranjan and McAllister (2015) recommend Billett’s (2009) theoretical framework to integrate practice experiences in the curriculum for Allied Health students. In this framework the integration of learning experiences in both academic and practice settings is outlined with suggestions at three phases: before, during and after the WIL experience.

Important in this framework is the notion of supporting students to develop into agentic learners. Human agency is defined as the ability “to influence intentionally one’s functioning and life circumstance” (Bandura, 2006, p. 164). Furthermore, Richards, Sweet, and Billett (2013) remind us that it is not only the students’ readiness for learning that is at issue, but also “their intentionality (i.e., personal purpose), effort and direction of their engagement processes” (p. 251) that ensures that they engage with the learning that is offered.

Nonetheless, it is unreasonable to expect students or clinical educators to fully understand the complexities of the relationships and interests that exist in the workplaces they enter to spend relatively short periods of time. However, this does not mean that they should ignore their existence. While they may be forgiven for failing to fully understand these relationships, they may not be forgiven for ignoring their existence and we need to bring this into the design of our learning and teaching about WIL. The need for understanding and acknowledging the elements of this complex WIL experiential learning landscape is illustrated through an examination of the following example from the field.


Students from two disciplines were provided placements in a primary health care setting with older adults. They were afforded the opportunity to interact with adults in residential care, and with adults living independently; managing their own health in the villages attached to the residential care facilities. The facility had previously provided placements for nurses in the residential care facility as part of an ongoing agreement, but had not provided placements for either the clinical exercise physiology (CEP) or occupational therapy (OT) students before. In OT terms, these were emerging placements, with opportunities to Asia-Pacific Journal of Cooperative Education, 2016, 17(2), 93-100 95 HORSTMANSHOF, MOORE: Understanding the needs of all the stakeholders: Issues of training and preparation introduce new primary healthcare services and demonstrate their benefits to the placement partners and the participants. Role-emerging placements are ones where the discipline role has not as yet been established as a service (Dancza et al., 2013). Table 1 below provides information on the number of students by discipline and duration and nature of placement TABLE 1: Duration and nature of student placements by discipline

–  –  –

The two emerging placements differed in both the number of students on placement and also the nature and timing of the placements. The CEP students varied in number on any one day from one to eight and their placements were spread across three separate sessions, with ten students provided with placement opportunities over the period. The clinical supervision of these students was shared by two registered clinical exercise physiologists who also work in private practice. These were masters students completing placements for accreditation with Exercise Sports Science Association (ESSA).

The OT students were in their final placement before graduation, at the end of a four year undergraduate degree. Their programs stipulated a placement of ten (10) weeks in a block of time. They were supervised by a registered OT who also worked in private practice. Due to the length and intensity of this placement, the project leader worked with the residential care facility and the managers of the independent living village to scope two projects that would be of benefit to both the students and the placement sites. Both projects had the potential to showcase the students’ abilities and the benefits of the discipline to the facility, while providing real world, meaningful experience for the students. New graduates often find that their new qualifications are not regarded as highly in the marketplace as is experience, or the combination of experience and qualification.

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