The analysis of the data led to the development of the Theory of Economising Learning: How nurses maintain competence with limited resources. After graduation, to secure the professional learning they required, nurses needed to contribute personal resources including time, money, technology, the site of learning and prior knowledge. Nurses indicated that these resources were limited and consequently, they needed to get the best possible learning outcomes in exchange. They had to be constantly mindful that the outcomes they received justified the expenditure, hence, economising learning. The availability of these resources is different and at some level, finite for each nurse. Following is the exposition of the Theory of Economising Learning, describing the process by which nurses maintain their professional competence with finite resources.
The Theory of Economising Learning describes five stages of a necessarily continuous process as the nurse continually learns throughout their working life. The theory is represented in Fig. 1.
The process starts and finishes with defining curriculum as the nurses described their awareness of the need for learning as being directly influenced by what they viewed as the knowledge needed to maintain competence in their work. Their personal curricula will ultimately be altered as their knowledge increases and new knowledge deficits are identified.
Curricula in the education sector are based on what knowledge it is expected a learner will have at graduation, adequately equipping them to undertake the occupation for which they are educated. Nurses work across many different specialties and although they will require some common knowledge and skills, what the individual identifies as important to their personally identified curriculum will differ markedly. The personal curriculum is largely influenced by what is happening in a particular ward area, as one participant stated:
I’m prompted to go to education by common themes emerging on the ward, for example renal and chest pain.
A personal curriculum evolves over time as a person becomes aware of a knowledge deficit; as one participant stated when discussing the challenges for new staff:
You don’t know what you don’t know.
Compared to a nurse with extensive experience, a new graduate will have only a basic understanding of what is involved in working in a specific area, and this is generally expected and accepted. As a consequence, the next step in the process of economising learning is gaining awareness.
Nurses described becoming aware of the need to learn in order to advance their careers. In order to advance, nurses will often become aware of their need to complete more formal learning, such as acquiring a postgraduate qualification. This has been called “stepping” as nurses are stepping up to higher positions or changing career direction as a result of further learning. Examples of this would include a nurse completing postgraduate qualifications to become a Midwife or completing leadership qualifications to become a manager.
Nurses also described gaining awareness of the need for further learning when their current level of knowledge compromises their competency. This can occur when they have insufficient knowledge to address a particular situation which arises in the workplace. This has been described in the theory as “falling short” and requires the nurse to take immediate action to maintain the safety of the patient. Rather than falling short, a nurse can also be prompted to identify a knowledge deficit or aspire to broaden their curriculum to achieve a particular end.
The research uncovered that the workplace significantly influenced whether or not a nurse identified the need for learning. When those in a work area have high expectations of knowledge and the acquisition of knowledge was modelled by senior staff, the participants identified that there were increased expectations around gaining knowledge. Participants also identified that the expectations of their colleagues influenced their own expectations around their knowledge.
Participants who were in senior positions identified that their colleagues expected that they would have a high level of knowledge and this motivated them to keep learning. These nurses were often consulted by less-experienced staff and therefore needed the knowledge to be able to adequately fulfil this role. The extent of this was dependant on their formal role within the group. This idea is reflected in this note from an interview:
Learns so she has information for staff, motivated by what staff need to know and to stay current.
The degree to which the nurses had expectations of themselves was another variable to be considered. Some participants described having higher expectation of themselves than others. While some nurses stated they needed sufficient knowledge to react to and understand any situation and claimed the aspiration to continuously improve their knowledge, others identified needing only the knowledge to do their job.
Learning opportunities flow into the nurse’s awareness at a variable rate, depending on the particular workplace and the opportunities that the nurse is aware of both within and outside of the organisation. Participants described how the flow of opportunities ebbed and flowed; sometimes not enough and at other times, too many. Obviously, insufficient opportunities make it more difficult for the nurse to access learning. By way of contrast, participants stated that if they were made aware of too many opportunities or asked to undertake too much learning, they became reluctant to engage with the opportunities to improve their knowledge that they would ordinarily value. As the learning opportunities come into the nurse’s awareness, the nurse compares them to their personal curriculum and determines whether or not they will engage with the learning opportunities.
An appropriate flow of learning opportunities enables nurses to not only become aware of possibilities for learning, but allows them easier access to those opportunities. These opportunities can come in many different forms, including articles for informal self-directed learning, structured opportunities within the organisation, online resources or courses, or outside face-to-face workshops. The use of technology is invaluable in both facilitating learning opportunities for staff and in making staff aware of those opportunities. Technology facilitates access to repositories for learning materials, where a nurse is able to use a single access point to learning but is able to target the specific learning opportunities that are relevant to them. Using technology to facilitate access to a repository stops nurses being bombarded by information being displayed around the wards but still allows them quick access to opportunities. Nurses are also motivated to learn from people they trust and are more likely to access those learning opportunities recommended to them.
If the learning opportunities are not made available to the nurse through the education flow within the organisation, they must seek out learning opportunities themselves. In the theory, this is called “seeking” as it is an activity that takes time and resources from the nurse. It takes time for the nurse to seek out the opportunities and insight to discern if the learning is appropriate for their needs.
Before and while a nurse is engaged in learning, they must balance their motivation for learning against the personal resources it takes to engage with that learning. This is where organisations are able to make an impact: By reducing the resources a nurse needs to input into learning or by increasing the nurse’s motivation through raising expectations and optimising education flow. Nurses stated they were more likely to engage in learning if the organisation contributed to the cost and provided them with time out of work to participate.
The nurses balanced their motivation to learn against the personal resources they had to contribute to that learning to determine how and if they would engage. The nurses also used various strategies to reduce the impact on their personal lives through moderating the amount of personal resources they needed to contribute.
Engagement with learning only occurs when a person identifies the need for learning and then allocates the required resources to undertake that learning. The value in the learning must therefore outweigh the cost of the personal resources needed to engage with it. The nurse’s perceived knowledge deficit contributed to the shape of the personal curriculum and provided the motivation for learning. The greater the deficit, the more pressure they felt to bridge that gap through learning. The nurse evaluated each learning opportunity to determine if it addressed the deficit in knowledge. The availability of personal recourses was balanced against the motivational factors informed by personal beliefs, the environment, extent of the knowledge deficit, expectations of self and others, and the need to move into a different position. Finding the time for learning was described as being difficult for the nurses as usually this time came from their often busy personal lives.
When highly motivated, nurses show incredible ingenuity for finding ways to include learning in their lives. Digital technologies are often employed to save a nurse time with learning while also maintaining the quality of that learning. The use of digital technologies depended on their availability, the nurse’s access to the internet and their knowledge and comfort with using technology. As a result, each individual used the technologies differently and to varying degrees to economise the resources needed to acquire knowledge.
Nurses often use mobile applications (“apps”) on their mobile phones or tablets in the workplace to enable them to access information quickly. While it was often just to check knowledge rather than to gain new knowledge, this behaviour enabled the nurse to ensure they were using best practice. They used their mobile devices to quickly check medication uses, side effects and dosages that otherwise would require them to access the information at the nurses’ station which was not time efficient and at times, not possible. Some nurses divulged that they would like to use their mobile device for this purpose, however, mobile devices were not allowed to be used within the ward. This raises safety concerns as nurses may be dispensing medications without having the knowledge they need to ensure safe use. Some new graduate nurses used apps recommended to them by the nurse educator which they found valuable. Recommending apps to staff also gave the educator some input into the information the staff were obtaining which ensured the quality of the learning.
The flexibility of digital learning enabled the nurses to target the information that is relevant to them. To increase their efficiency, the nurses sought out the knowledge they needed to learn and compared it to their current knowledge levels. Experienced nurses were more likely to undertake online learning as they are able to “skim over” what they already knew and concentrate on what they did not know. As indicated in this fieldnote:
Would rather learn online as she’s sick of bad presenters and feels she has sometimes more knowledge. Can learn what she wants to learn and complete in her own time, without wasting a day of her leisure time.
This was not the case with all experienced nurses and appeared to be dependent on the availability of their personal resource of time.
Nurses often learned while multitasking. For example, nurses would listen to learning materials that had previously been downloaded to a mobile device. Podcasts can be listened to while exercising or doing household chores. Nurses multitasked when waiting for appointments or waiting to pick up children from activities.
Similar to multitasking is catching time where the nurse takes advantage of a short period of time to concentrate on learning. It differs in that only learning happens during that period. Catching time is often at the expense of personal time, but is woven into their lives in such a way as to minimise the impact on their personal lives. The time used when catching time is usually when their families are engaged in other activities. Examples of this are when children are at after school activities or most frequently, when they are sleeping, either late at night or early in the morning. Time can also be “caught” at work during periods when they are not so busy and at the change of shift. Both multitasking and catching time require that learning is able to be undertaken in small pockets of time perhaps building to a larger piece of learning.
Staying connected via social media, emails, reading journals and online groups allow nurses to undertake small amounts of learning frequently without the need to specifically search for the learning opportunity. The nurses consistently sift and sort this information and place the learning into their lives through the behaviours of multitasking, catching time and targeting.
Education flow is most available to nurses who are connected through their digital devices, using these to access learning. Nurses who are digitally connected use social media in their everyday lives. They are also nurses who stay up-to-date with their specialty by attending conferences and being members of groups related to that specialty. The more connected of these nurses have a good knowledge of what is available online and influence other nurses regarding what learning is needed in a work area. Examples were given by nurses of being made aware of learning opportunities through emails sent by other staff (often the educator or facilitator) or being part of a closed Facebook group where learning opportunities or bites of information relevant to their workplace were posted. Through staying connected, the nurse is able to undertake small amounts of learning frequently, thereby allowing them to integrate learning into their lives. As one nurse commented.
I don’t have time to look for it so if it comes to me that’s great … I send the emails from work to home and will access it in other places while I am waiting.
The above comment also demonstrates nurses sifting and sorting the information they received. The nurses in this research sifted the information by relating it to their personal curriculum and deciding whether or not they will undertake the learning. They then sorted the information to decide how and when they would engage with it. If it was of particular interest to them, they engaged with it immediately or they saved it for a later time. They also sorted the material to decide how they could best interact with the material and either sent it to their home computer, saved it to a mobile device, or printed the material as some preferred to have a hard copy. Making the material available digitally allowed the nurses to have choices in the way they interacted with the learning.
When balancing, a nurse sometimes needed to compromise their definition of competence. Compromising occurs when the nurse’s motivation for learning is outweighed by the personal resources they need to contribute. When compromising, the nurse will not engage with a learning opportunity, therefore, balancing and engaging are dependent on each other.
Nurses engage with learning in one of three ways: 1) Learning on the run occurs when the nurse is engaged with work and the knowledge is needed and is immediately applied; 2) Pre-emptive learning, in advance of when it is needed, where the nurse has included the learning in their personal curriculum and may be in response to a previous knowledge deficit; and 3) credentialed learning that involves a formalised curriculum and results in a qualification. Learning on the run, pre-emptive learning, and credentialed learning are undertaken within the overall context of the workplace.
After the nurse has undertaken the process of economising learning, they will have a altered view of their learning needs and they will modify their personal curriculum accordingly. The process will then start again with the nurse’s knowledge increasing continually and the personal curriculum being altered and refined. As discussed, the process is influenced by the workplace and occurs within the context of an organisation.
The organisation significantly influences the nurses’ opportunities and engagement with learning. If the organisation has a culture of knowledge being valued and an expectation that nurses will use best practice, nurses indicated they would be more likely to undertake learning. Nurses also felt more inclined to use their personal resources if the organisation contributed to their learning, as one nurse explained:
It helps when work is supportive of education. There was pressure in another hospital I worked at to do everything in your own time. Here you are encouraged more and the atmosphere is different in the hierarchy. When people apply to go to education, they usually get it and it makes you more enthusiastic to also do some in your own time.
Access to resources within the workplace reduces the need for nurses to use their personal resources for learning. Resources include senior nurses as mentors, computers available in work areas, and time during work to undertake learning. Nurses valued senior nurses visiting them regularly during the shift and discussing patients as this education was based on the needs of their patients. One hospital had numerous computers available for staff on the ward. This meant that staff had access to them at all times, allowing them to check on things they were unsure of and to engage with learning in any downtime.
The amount of mandatory learning that a nurse needs to complete, impacts on the amount of personal resources the nurse has to allocate to learning to address knowledge deficits. Some workplaces allocated time for nurses to complete their mandatory training either by relieving them from patient care or allowing them to catch time. As this comment indicated:
I do my internet education at work. Since there has been eLearning, I am up to date with mandatory education.
If nurses received too much information about learning opportunities, it made it difficult for them to determine what was important and what was not, and they became desensitised to the requests of the organisation. Therefore, there needs to be consideration given as to how learning opportunities are communicated to staff. As this nurse stated:
Online learning is saturated here. It should be refined to only professional development, not to invade. Staff need to feel like they’re getting something rather than something being asked of them.