Editorial

Abstract

As a practice discipline, nursing has a long and well-established history of teaching and learning that occurs in the clinical environment (Mannix, Faga, Beale, & Jackson, 2006). For many years, the workplace, as a site of clinical learning, was taken-for-granted and viewed as unproblematic. Nurse education was largely based in the health sector, and it was simply accepted that placing learners into the clinical environment meant they would have opportunities to learn, and that appropriate learning would occur (Jackson, 2009; Mannix et al., 2006). However, the major changes to nurse education that occurred late last century meant that many nurse education programs were no longer wholly conducted in the health sector. These changes have been the catalyst for educational providers to re-visit workplace learning, to consider the value of workplace learning, its place in contemporary nurse education and to consider possible alternatives to workplace learning.Recently there has been increasing concern about threats to the supply of adequate quality clinical learning opportunities to meet the demands of the undergraduate education sector (Cross, 2009; Mannix, Wilkes, & Luck, 2009). The pressure on the acute and community sectors for clinical places has meant that alternative sites and models of clinical learning have been sought. In the Australian context, venues such as residential care facilities which may have previously been overlooked and not viewed as optimal sites of workplace learning are now relied on to ensure that undergraduate students are able to gain adequate workplace learning opportunities. This situation is mirrored in the UK where, despite one hand of the UK National Health Service (NHS) funding nursing education; the other hand is thrown up in horror at the prospect of the need for more clinical placements. Imaginative solutions have to be found and like the Australian situation, these will likely include the private sector nursing homes and a significant move to including more primary care placements and, indeed, emphasising primary care in newly validated nursing programmes (Nursing and Midwifery Council, 2010). This could be viewed as being progressive, or as a virtue being formed out of necessity.The use of mannikens is common place and these are becoming increasingly sophisticated and more lifelike compared with the inanimate, inflexible and, frankly, pointless 'dolls' that we encountered in our training days (Watson & Thompson, 2009). The increasing sophistication of these mannekins is remarkable and, undoubtedly, they have an important role to play in specific, clinically clear situations such as physical assessment, acute cardiac and respiratory care; intensive and critical care and a range of emergency and clinical skill situations. However, with less time being spent with patients and more with - seemingly - animate mannekins, the potential effect on nurses' caring and interpersonal skills needs to be considered. After all, an anaphylactic reaction can be simulated using a mannekin; counselling the partner of someone who has just died suddenly, unexpectedly and in huge distress as a result of an anaphylactic reaction cannot. Mannekins help prepare people for success and the minimisation of failure - both worthwhile, but clinical practice is not like that.Therefore, while there are undoubted benefits associated with simulation technologies as an adjunct to support learning (Cooper et al., 2010), these technologies cannot replace the learning that occurs in the workplace. Furthermore, controlled clinical experiences such as those provided by simulation cannot prepare students for the socialisation and interpersonal aspects of working in busy clinical environments in the same way that authentic workplace learning can do. Research has shown that within the clinical environment, students can be presented with opportunities to negotiate some of these problematic aspects of practice that await them in their future careers as registered nurses (Jackson et al. …