Commentary on McGowan B (2006) ‘Who do they think they are? Undergraduate perceptions of the definition of supernumerary status and how it works in practice’. Journal of Clinical Nursing 15, 1099–1105
Director of Nursing, Faculty of Health and Social Care, The Open University, Walton Hall, Milton Keynes, MK7 6AL, UK. Telephone: +44 (0) 1908 858871; E-mail: email@example.com
McGowan's paper (2006) is on a subject which remains topical in contemporary nurse education – the thorny issue of the supernumerary status of students of nursing. Ever since the move of nurse education from the NHS to the higher education (HE) sector in England in the mid-1990s, this has been a recurring theme. The status of students shifted from that of predominantly worker to learner and with it a raft of measures to attempt to safeguard this new status. Supernumerary status was one such measure, one that has been defined and enacted in a diversity of ways. McGowan's study attempted to shed light on this issue and explored how students defined supernumerary; how it was implemented in practice and the effects it had on the students.
However, rather than clarifying some of the issues, I felt in places McGowan's paper perpetuated some of the past and current confused thinking. For example, despite acknowledging that the literature identifies challenges with respect to how supernumerary is defined, his definition of supernumerary (a process by which essential practical nursing skills are developed in a supportive learning environment facilitated by an experienced member of nursing staff) does nothing to clarify the position. Where did this definition come from and what are some of the issues he alludes to in the literature on definition? In a definition of supernumerary I would expect to see some reference to protection of time for students to engage in learning in the practice setting. This learning, of course, is both the practical learning ‘on-the-job’ as well as the theoretical learning ‘in a book’. The challenge facing good mentors and supporters of students in practice is to engage in a raft of activities that facilitate both types of learning and which ‘marry’ the two components of knowledge for nursing practice. For me, students need to have time protected in the practice setting to enable this facilitation of learning to take place. McGowan's definition did not explicitly allude to this; further discussion and debate is required as, I suggest, consensus has yet to be reached.
From a methodological perspective, we must also remember that this was a relatively small study of 10 focus groups (n=60) using second year undergraduate students in one university in England. Their experience of and attitudes towards the concept of supernumerary might not be the same for other nursing students, for example, diplomates and for students in other countries.
That said the study illustrated some key issues about contemporary student–nurse experience. Many of these are not new, have been around for a long time and are, therefore, proving to be resilient. It is about time we wrestled with some of these issues and moved nurse education firmly into the 21st century. The issues I have identified are students’ understanding of the concept of supernumerary status, the pivotal role of the charge nurse, mentoring and finally, what we mean by ‘learning on the job’. I will briefly examine each of these in turn.
What do we mean by supernumerary?
A key theme to emerge from McGowan's study was students’ understanding that being supernumerary was about being ‘extra and not counted in the numbers’. One student said ‘It is going in to learn on placement and not being counted in as staff. You are there to watch and observe. You are there as an extra’. I agree with the student in one regard – not being counted as staff on the duty roster. However, I strongly disagree with the conflation that this also equates to merely watching and observing. For me this is a fundamental misunderstanding, one that needs to be dealt with swiftly. Being an observer is not what being supernumerary is about. Supernumerary status is about giving learning – not service – primacy in the student experience. Students need to understand that this involves a role as an active participant.
The charge nurse role
The role of the charge nurse first explored by Fretwell (1980), Orton (1981), Ogier (1982) and Runciman (1983) was identified, yet again, to be crucial in setting the learning culture on the ward. All these studies identified the ward sister as the lynch pin to the learning environment, what she/he needs to do and ‘the kind of person the sister needs to be in order to facilitate learning’ (Runciman 1983, p. 116). In particular these studies demonstrated that ‘there is a great deal more to teaching than didactic instruction or telling. It seems that, in addition to considerable commitment to and active involvement in teaching, a sister needs high-level interpersonal skills and awareness of her own behaviour and attitudes in order to be an effective teacher and to create a good climate for learning’ (Runciman 1983, p. 116). Why therefore do we appear to be no further on in 2006?
Mentoring is at the hub of the student experience – it matters so much. When we get it right it works well and really makes a difference. When we get it wrong it can have a truly devastating and profound effect. It is about time we got it right. The transfer of nurse education into HE in England in the mid-1990s did much harm with respect to mentorship. Prior to this transfer, student nurses learned according to the apprenticeship model and most qualified staff in clinical areas assumed a responsibility for teaching students. Following their shift in status from worker to learner post-transfer, I suggest that qualified staff abrogated their mentoring responsibilities, relying on the HE sector to provide this. No one appeared to be responsible for supporting learning in the practice setting. It is still taking time to recover from this and to instil in staff that everyone is responsible for the students’ experience. Let us do this now – recruitment and retention rest on us getting this right. No matter how many students we get in through the door, they will not stay if their experience is poor.
Learning on the job
Mentors are supposed to facilitate learning on the job. But what do we mean by learning on the job? It can mean giving time to study ‘on the ward’ or wherever the practice placement might be. But, more valuably, it means much more than that. It means being able to take theoretical learning and to relate it/re-create it into professional experience/learning. Students need to be taught the principles of how to learn on the job and mentors how to facilitate it.
So what next?
- •Clarity about what we mean by supernumerary. The Nursing and Midwifery Council could take a lead here;
- •More appropriate investment in charge nurse development – invest, invest in clinical leadership;
- •Develop better mentorship training.
Wherever it is that we are working, at whatever level, we all have a responsibility to support students’ learning.