Wednesday, 17 April 2019

The Importance of the Clinical Nurse Educator in Improving Patient Care

Catherine Best
Nursing Lecturer University of Bradford


Recent changes to healthcare policy such as the Five Year Forward View (NHS, 2014) the Five Year Forward View for Mental Health (Mental Health Taskforce, 2016) and the GP Forward View (RCGP & HEE, 2016) has indicated a commitment by the government to improve patient care through ensuring the provision of both experienced nurses and experienced leaders able to drive forward effective change in order to meet future need. 

Furthermore with a greater emphasis on pre-registration nurses being able to demonstrate their ability to carry out research, engage in critical enquiry, develop greater decision making skills and instil these findings into everyday practice (Willis, 2015), Clinical Nurse Educators (CNEs) will be required to develop additional skills in research, leadership and management with a considerable emphasis on improving the quality of patient care. The primary role of the CNE being to support the educational needs of nursing staff (Coates and Frazer, 2014) while having a pivotal role in ensuring the integration of theory into practice (Conway and Elwin, 2007). CNEs are part of the educational workforce and as such are required to demonstrate high level skills of reflection (Bulman et al., 2016) and in so doing support the development of student portfolios. 

Disappointingly there is limited research about the process of preparing clinicians specifically for the CNE role. Research is therefore needed to enhance understanding of clinicians’ perspectives as they develop the skills necessary to be a CNE (Cangelosi et al., 2009) with the role needing to be more fully defined (McAllister and Flynn 2016). For a nurse who is proficient in clinical practice is not necessarily adept at teaching clinical skills. Teaching is not a natural consequence of clinical expertise, but requires a skill set of its own (Cangelosi, 2009). 

Excellence in nurse education not only involves competent teaching but also requires vision, curiosity, and commitment to research for continual improvement. With the challenges faced within nursing and nurse education including nurse shortages (RCN, 2018), nursing skill mix (Aiken et al., 2016) and a lack of resources (Scott et al., 2018) CNEs have a unique contribution to make to the educating of nurses (McAllister and Flynn, 2016). 

The changing landscape of pre-registration nurse education within the UK (NMC, 2018) requires now more than ever, experienced and educated CNEs who have a clear understanding of how these challenges can be met. Significant emphasis is also placed on the importance of nurses teaching others both formerly and informally (Council of Deans of Health, 2016). This has the potential to encourage the development of both the novice and experienced nurse enabling the advancement of future nurse leaders. Such prominence on professional development puts experienced CNEs who have additional skills of mentorship, at the heart of both clinical practice and nurse education and aligns personal strengths with passion and improved performance. For quality mentors support the transition of values, skills and knowledge (Banister and Gennaro, 2012). They encourage a collaborative learning partnership, nurture strong networks within the broader multi-disciplinary team and inspire innovation (Norman and Roche, 2015).

Reflective Practice

CNEs are required to support the development of nurse practitioners who are adequately skilled and knowledgeable to critically reflect and act appropriately; the outcome of which constitutes critical knowledge as argued by Taylor (2010). The significance of reflection and the importance of embracing theories and literature to inform the reflective process is essential if nurses are to develop the skills required to support global nursing. No more is this evident than through revalidation (NMC, 2019). A process through which nurses are encouraged to celebrate their success, recognise their own imitations and act accordingly to improve outcomes, through the development of a portfolio. As Liz Allibone (cited in Spinks, 2016, p.11) argues a greater recognition therefore is needed of the role that CNEs play in promoting quality nurse education and effective patient care; it being needed now more than ever. 


The importance of nurses becoming involved in high quality research, in order to improve the provision of safe and effective care is perceived as the gold standard and requires a significant commitment from the nursing profession (Brown et al., 2009). The ability to encourage the application of research into clinical practice is therefore integral to the role of the CNE (Sayers et al., 2011). 

CNEs combine both expert knowledge and experience and are fundamental to the developing of a skilled and proficient workforce (Sayers, et al., 2011). They encourage ethical behaviours (Lewenson, et al., 2005), reciprocal sharing, learning and acquisition of knowledge and influence individual growth and transition (Thompson, et al., 2012). They have significant potential to become educational leaders (Adelman-MuIlally, et al., 2012). 


The role of the CNE is expanding, and with it the need for CNEs to recognise the unique contribution they make to the mentoring of nurses, including themselves. For as Weidman (2013) purports research has indicated that those who fail to receive effective mentorship have a more challenging time developing their role as CNEs than those who do. 

CNEs must also be encouraged to become self-determined life-long learners a process known as heutagogy (Bhoyrub, 2010), for CNEs must be able to work in environments that are dynamic and require the utilisation of a plethora of skills, including teaching, assessment, effective communication and audit. Further commitment is needed to ensure that CNEs have a defined skill set that enables them to transition to this role with the least possible anxieties. In so doing, as with any nursing role, ultimately, we are assigning the theory practice gap, extensively researched within the nursing literature, to the annals of nursing history. 


Adelman-Mullally, T. Mulder, C.M. McCarter-Spalding, D.E. Hagler, D.A. Gaberson, K.B. Hanner, M.B. Oermann, M.H. Speakman, E.T. Yoder-Wise, P.S. and Young, P.K. (2013) The clinical nurse educator as leader. Nurse Education in Practice, 13 (1) January, pp. 29-34. 

Aiken, L.H. Sloane, D. Griffiths, P. Rafferty A. Bruyneel, L. McHugh, M. Maier, C.B. Moren-Casbas, T. Ball, E. Ausserhofer, D. and Sermeus, W. For the RN4CAST Consortium. Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety Online First, published on 15 November 2016 as 10.1136/bmjqs-2016-005567 

Allibone, L. (2016) cited in Spinks, J. (2016) Call for support and standardising of clinical nurse educator’s role. Nursing Standard, September 30 (3) pp. 11 

Banister, G. and Gennaro, S. (2012) Mentorship and best practices for mentorship. In: Ives Erickson, J. Jones, D. Ditomassi, M. (Eds.) Fostering nurse-led care professional practice for the bedside from Massachusetts General Hospital. Indianapolis, Sigma Theta Tau International, pp. 197-215 

Bhoyrub, J. Hurley, J. Neilson, G.R. Ramsay, M. and Smith M. (2010) Heutagogy: An alternative practice based learning approach. Nurse Education in Practice November 10 (6):322-6. doi: 10.1016/j.nepr.2010.05.001. 

Brown, G.T. Wicline, M.A. Ecoff, L. and Glaser, D. (2009) Nursing practice, knowledge, attitudes and perceived barriers to evidence-based practice at an academic medical center. Journal of Advanced Nursing, 65 (2) February, pp. 371-381 

Bulman, C. Forde-Johnson, C. Griffiths, A. Hallworth, S. Kerry, A. Khan, S. and Sharp, P. (2016). The development of peer reflective supervision amongst nurse educator colleagues: An action research project. Nurse Education Today, 45, pp. 148-155.

Cangelosi, P.R. Crocker, S. and Sorrel, J.M. (2009) Expert to novice: Clinicians learning new roles as clinical nurse educators. Nursing Education Perspectives, 30 (6) November pp. 367-71 

Coates, K. and Fraser, K (2014) A case for collaborative networks for clinical nurse educators. Nurse Education Today 34 pp. 6-10 

Conway, J. and Elwin, C. (2007) Mistaken, misshapen and mythical images of nurse education: creating a shared identity for clinical nurse educator practice. Nurse Education in Practice, 7 (3) May, pp. 87-94. 

Council of Deans (2016) Educating the Future Nurse - a paper for discussion. London: Council of Deans 

Lewenson, S.B. Truglio-Londrigan, M. and Singleton, J. (2005) Practice What You Teach: A Case Study of Ethical Conduct in the Academic Setting. Journal of Professional Nursing, 21 (2) March - April, pp. 89-96 

McAllister, M. and Flynn, T (2016) The Capabilities of Nurse Educators (CONE) questionnaire: Development and evaluation. Nurse Education Today, April pp. 39:122 

National Health Service (2014) Five Year Forward View. London: NHS. 

Norman, K. and Roche, K. (2015). Mentors: supporting learning to improve patient care. British Journal of Healthcare Assistants, 9 (3) pp. 132–137. 

Nursing and Midwifery Council (2019) Revalidation. London: NMC. 

Nursing and Midwifery Council (2018) Future nurse: Standards of proficiency for registered nurses. London: NMC 

Royal College of General Practitioners and Health Education England (2016) GP Forward View. London: NHS 

Royal College of Nursing (2018) Staffing for Safe and Effective Care. London: RCN 

Sayers, J. DiGiacomo, M. and Davidson, P. (2011) The nurse educator role in the acute care setting in Australia: important but poorly described. Australian Journal of Advanced Nursing, 28 (4) June-August, pp. 44 - 52 

Mental Health Taskforce (2016) The Five Year Forward View. London: The Mental Health Taskforce. 

Scott, P.A. Harvey, C. Felzmann, H. Suhonen, R. Habermann, M. Halvorsen, K. Christiansen, K. Toffoli, L. and Papastavrou, E. (2018) Resource allocation and rationing in nursing care: A discussion paper. Nursing Ethics [Online], pp 1-12. Available from: <> [Accessed 11th March 2019] 

Taylor, B. (2010) Reflective Practice for Healthcare Professionals. 3rd ed. Berkshire: Open University Press 

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Willis, G.P. (2015) Raising the Bar Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants. London: HEE.

Monday, 15 April 2019

What influences HIV PrEP practices among nurses?

by Wasantha Jayawardene MD, PhD

A noticeable gap in the clinical care literature is the lack of representation of advanced practice nurses in studies examining delivery of HIV pre‐exposure prophylaxis: emtricitabine/tenofovir once‐daily pill, along with sexual risk reduction education. A recent article entitled ‘HIV pre‐exposure prophylaxis uptake by advanced practice nurses: interplay of agency, community, and attitudinal factors’ by Jayawardene et al and published in JAN reports that HIV prevention practices among nurses with prescriptive authority is determined by interaction of multiple factors: characteristics of healthcare agency, features of community being served, and attitudes of nurses toward evidence-based practices overall. However, nurses’ characteristics, such as age, race, experience, political and religious affiliations played a negligible role.

Authors analyzed responses from randomly‐selected advanced practice nurses who completed an online survey, consisted of several validated self‐rating measures. Community characteristics had direct effects on organizational behavior of healthcare agency and HIV prevention practices, such as pre-exposure prophylaxis. While the healthcare agency had a large effect on HIV prevention practices, it also impacted nurses’ motivation to adopt evidence‐based practices overall. Meantime, community also had indirect effects, through healthcare agency, on HIV prevention practices and motivation to adopt evidence‐based practices. Therefore, when planning a HIV pre-exposure prophylaxis intervention, advancing inputs from healthcare professionals, organizational leadership, and community members is crucial to success. 


Saturday, 6 April 2019

Are nursing students fit to work?

Roger Watson, Editor-in-Chief

Nursing is increasingly about keeping people healthy through health promotion, and not just about treating illness. Part of being healthy is being fit and there have long been concerns about the fitness of nurses with high levels of stress, smoking and obesity. If nurses are going to be encouraged to be fit then it should begin with nursing students and this study from Australia by Pugh et al. (2019) and published in JAN aimed to: 'describe the exercise, physical fitness and musculoskeletal health of nursing students.'

The study included  over 100 students and gave them a fitness test and asked them about exercise and musculoskeletal injuries. Most claimed to exercise regularly but were below recommended levels of exercise. Back pain was the most common injury and approximately 40% were obese, with some in danger of obesity related health conditions.

The authors concluded: ' Although the proportion of overweight or obese undergraduate nursing students in our study was below that of Australian adults, almost 40% of the students would be overweight or obese on entering the nursing workforce. Coupled with data highlighting a propensity for inadequate weekly exercise, below par fitness and a high prevalence of musculoskeletal trouble in the low back and neck, it is imperative that university schools of nursing and subsequent employers consider the potential implications for nurses’ health and long-term working capacity.'

You can listen to this as a podcast.

Pugh, J. D., Cormack, K. , Gelder, L. , Williams, A. M., Twigg, D. E. and Blazevich, A. J. (2019), Exercise, fitness and musculoskeletal health of undergraduate nursing students: A cross‐sectional study. J Adv Nurs. doi:10.1111/jan.13990