Contextualising capability : how capability is identified and recognised in registered nurses undertaking the postgraduate certificate in neonatal intensive care

This thesis explores Capability in Registered Nurses undertaking a Postgraduate Certificate in Neonatal Intensive Care (PG Cert NIC) in Australia. It contextualises Capability of the PG Cert NIC student and identifies how expert neonatal nurses recognise Capability in Neonatal Intensive Care clinical practice. In the 1990s, nursing regulatory authorities embraced the clinical competence framework to ensure that nurses graduating from higher education institutions (HEI) had achieved the minimum standards for safe clinical practice. In order to measure achievement of these minimum standards, assessment of clinical practice was simplified. Essentially reduced to a tick box of tasks or skills (competencies) to achieve proficiency, and assessing performance of such competencies in the workplace. As a means of evaluating nurses in practice, this is problematic. The literature suggests competency-based evaluation tools present a reductionist approach and being simplistic and prescriptive, are limited to assessing the acquisition of knowledge and skills, and fail to empower people to reach their full potential. Contemporary discourse in higher education proposes 21st Century Graduates will be entering a dynamic workforce that requires more that minimum performance standards and a skill set beyond competency. The nursing profession has long recognised that good clinical practice is more than just meeting minimum performance standards. A broader concept that of Capability, includes competence but is more forward looking, recognising potential. Although there is some research into Capability in nursing, there is nothing specific to nurses in Neonatal Intensive Care. This research clarifies Capability in the neonatal context and identifies how Capability is recognised in students undertaking the PG Cert NIC in Australia. The study took place between March 2013 and January 2017. It used grounded theory (GT) with a mixed method approach to explore the concept of Capability within the context of the PG Cert NIC. It mapped, in three stages, the developing concept of Capability in the PG Cert NIC student, to clarify what is actually being appraised. Stage 1 of this study used Nominal Group Technique (NGT) to obtain a consensus among the neonatal nurse educators in Australia on the discipline specific Graduate Attributes for neonatal nurses. Stage 2 used eDelphi, to achieve a consensus from a panel of expert Neonatal Intensive Care nurses, on the Capability Requisites for students enrolled in the PG Cert NIC. Stage 3 used semi-structured interviews with expert practicing neonatal nurses, to determine the evidence the PG Cert NIC student presents which is taken to indicate Capability in clinical practice. Prior to this study, Capability in the PG Cert NIC nurse had not been explored. A clear finding from this research confirmed that Capability in the PG Cert NIC nursing students includes and moves beyond competence. It established that the mentors of students undertaking the PG Cert NIC, appraise Capability in clinical practice, and interpret Capability through verbal and non-verbal communication cues taken from the PG Cert NIC student. This research has resulted in the development of nationally agreed Graduate Attributes for the Postgraduate Certificate in Neonatal Intensive Care (PG Cert NIC) in Australia. It has provided a clear definition of the Capable Neonatal Nurse and culminated in a PG Cert NIC Capability Framework, and a visual representation of Capability through the development of the PG Cert NIC Capability Wheel. These outcomes will assist the neonatal clinician to nurture capability in practice, as well as support neonatal education in the development of a Capability curriculum for PG Cert NIC. The development of a theoretical concept of Capability in students of PG Cert NIC will go some way towards making it amenable to assessment in the future.