Accepted Manuscript

The value of a learning needs analysis to establish educational priorities in a newclinical workforce

Adrienne Hudson, Elayne Ellis-Cohen, Shari Davies, Desley Horn, Alison Dale,Lorelle Malyon, Rachel Edwards, Jane Harnischfeger, Glenda Radel, RebeccaBundy, Jacqueline Jauncey-Cooke

PII: S1471-5953(17)30825-9

DOI: 10.1016/j.nepr.2017.11.016

Reference: YNEPR 2341

To appear in: Nurse Education in Practice

Received Date: 1 August 2016

Revised Date: 15 November 2017

Accepted Date: 23 November 2017

Please cite this article as: Hudson, A., Ellis-Cohen, E., Davies, S., Horn, D., Dale, A., Malyon, L.,Edwards, R., Harnischfeger, J., Radel, G., Bundy, R., Jauncey-Cooke, J., The value of a learning needsanalysis to establish educational priorities in a new clinical workforce, Nurse Education in Practice(2017), doi: 10.1016/j.nepr.2017.11.016.

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THE VALUE OF A LEARNING NEEDS ANALYSIS TO ESTABLISH EDUCATIONAL PRIORITIES IN A NEW

CLINICAL WORKFORCE.

Adrienne Hudson a,b

Elayne Ellis-Cohen a

Shari Davies a

Desley Horn a

Alison Dale a

Lorelle Malyon a

Rachel Edwards a

Jane Harnischfeger a

Glenda Radel a

Rebecca Bundya

Jacqueline Jauncey-Cooke* a,b

a. Lady Cilento Children’s Hospital. Children’s Health Queensland, PO Box 3474, South Brisbane,

Queensland, Australia.

b. School of Nursing, Midwifery & Social Work, The University of Queensland, St Lucia, Queensland,

Australia.

*Corresponding author: Jacqueline Jauncey-Cooke

Postal: CCHR, Level 5. PO Box 3474, South Brisbane, 4101, Queensland, Australia

Phone: +61 7 30697517

Email: Jacqueline.jauncey-cooke@health.qld.gov.au

Abstract word count: 167

Body word count: 4,494

Acknowledgements

We would like to acknowledge the support of Ms Wendy Fennah throughout the LNA and

subsequent manuscript process. We would also like to thank the nurses of LCCH for contributing to

our survey and all the work they do to improve outcomes in children.

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Abstract 1

A learning needs analysis was undertaken in a newly formed workforce. The goal of the learning 2

needs analysis was to establish both the skill set and educational needs in the nursing workforce 3

prior to moving to a new purpose built facility. The results would then enable nurse educators to 4

develop, plan and deliver appropriate educational strategies. Staff (73%) completed an online 5

survey; the results were collated and analysed. The results of the learning needs analysis suggested 6

an experienced workforce that had great capacity to care for children across a wide spectrum of 7

acute clinical needs. Interestingly the results of the learning needs analysis conflicted with the 8

clinical reality. To investigate possible reasons for this difference we conducted a focus group 9

session with nurse educators. The focus group findings highlighted the significance of change and 10

how that impacted on the clinical capacity of experienced staff. We concluded that the results of the 11

learning needs analysis were representative however they needed careful interpretation in the 12

context of substantial change. 13

Highlights 14

• Learning needs analyses provide information on clinical skill sets and deficits 15

• Substantial change impacts significantly on nursing capacity 16

• Reduced capacity is a temporary aberration 17

18

Keywords 19

Learning needs analysis; workforce development; nursing education; impact of change 20

Funding 21

This research did not receive any funding from agencies in the public, commercial, or not-for-profit 22

sectors. 23

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Introduction 24

In order to transition two separate workforces from different organisations into one new workforce, 25

nurse educators decided to use a Learning Needs Analysis (LNA) to help them plan and prepare 26

orientation and ongoing educational programs. A LNA is a valid and reliable tool that nurse 27

educators can use to assess strengths and deficits across their workforce (Dyson et al, 2009). Playing 28

an important role within the continuous professional development paradigm, a LNA provides 29

information that can be used to develop, plan and implement educational strategies that meet the 30

overall needs of the organisation (While et al, 2007). It can also be used to ensure that individual or 31

cohorted learning needs are understood and ideally catered for. A LNA has been used successfully 32

across different healthcare disciplines and settings (Dent et al, 2008; Gould et al, 2004). However a 33

LNA may not capture the effect organisational change has on the capacity of a workforce. This paper 34

will describe the value of using a LNA to establish educational priorities and will also explore how 35

this sits within a substantial organisational change like merging separate workforces from different 36

organisations into one workforce in a new healthcare facility. 37

Background 38

Following a review of paediatric services in Queensland, Australia, the principle recommendations 39

was to centralise tertiary paediatric services (Mellis Report, 2006, Jauncey-Cooke, Franklin 2010). 40

This review was the catalyst to merge two existing children’s hospitals into one single facility. The 41

rationale for the merge was to improve outcomes for children and their families, avoid duplication of 42

services and reduce disjointed service provision for many Queensland families. The establishment of 43

one hospital would enable the provision of optimal paediatric tertiary care in one facility, built in a 44

central location (Jauncey-Cooke, Franklin 2010). 45

A targeted and protected recruitment process was used to establish the workforce for the new 46

facility. This process ensured that the majority of staff employed were sourced from either of the 47

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existing hospitals, and subsequently had paediatric experience. Despite this, the merging of the two 48

paediatric tertiary facilities into one larger organisation posed a number of challenges for the Nurse 49

Educators. These challenges included: 50

• A substantial and sudden increase in the number of clinical staff; 51

• An influx of ‘new’ staff requiring orientation ; 52

• Some staff were appointed to speciality areas outside their prior experience; 53

• Determining the knowledge and skills required for nursing staff working in clinical units with 54

altered patient cohorts and acuity levels than those they had previously worked in. 55

To address these challenges the Nurse Educators developed a framework of service transition that 56

included a LNA as its cornerstone. The LNA would identify the existing knowledge and skill set of the 57

nursing staff and identify educational needs. This would then inform a prioritised service transition 58

towards the new facility. 59

Merging two existing children’s hospitals into one single facility required a substantial organisational 60

change. This change includes geographical, cultural, interpersonal and practice adaptations. When 61

faced with substantial change it is essential to consider change management theories in order to 62

facilitate the change. Change management describes the process of implementing and facilitating 63

change as a dynamic process. It is acknowledged that change creates uncertainty and can be 64

emotionally challenging (Bowers, 2011). In the context of the nursing workforce, it is important to 65

consider what affect the substantial organisational change might have on the clinical skills and 66

education requirements of the clinical staff. The work of Patricia Benner (1982, 2001) who describes 67

the transition of nurses from novice through to expert and the work of Dreyfus & Dreyfus’ Model of 68

Skill Acquisition (1986) should be considered. Both allude to the effect that a change of environment 69

and speciality can have on nursing staff. 70

Study Aim 71

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The primary aim of this project was to conduct a LNA and identify the existing knowledge and skill 72

set in two workforces prior to merging. 73

Secondary aims of the project were to explore the LNA results in the context of substantial 74

organisational change 75

Method 76

A review of the literature including Medline, Cinahl, and Embase databases did not reveal any 77

existing tools that could be readily adapted for the purpose of identifying existing skills and 78

education needs of the of the workforce in this context. Therefore the Nurse Educators developed a 79

tool using Lasater’s Clinical Judgement domains of Beginning, Developing, Accomplished and 80

Exemplary to develop the generic document (Lasater, 2007; Staniland et al, 2011). In order to 81

simplify the terminology and facilitate user engagement the decision was made to modify the 82

terminology from Lasater’s domains to no experience, minimal confidence, confident, very confident. 83

The Nurse Educators met with key stakeholders from each specialty within the organisation. The aim 84

of the key stakeholder consultation was two-fold; to identify a core set of skills and knowledge 85

across paediatric nursing and then identify specific skills and knowledge for each speciality. 86

The LNA consisted of approximately 50 questions. The first section explored demographic details, 87

preceptoring experience, and currency with both legislated and organisational mandatory training 88

and core paediatric nursing skills. The second section required staff to self-assess their confidence 89

levels in regards to clinical knowledge and skills within the specialty they would be assigned to. 90

Figure 1 provides an example of a skill set that was used for staff who would be working in a 91

respiratory clinical specialty. 92

Insert Figure 1 93

Figure 1 - Example of respiratory skill set 94

95

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The questions were embedded into an online survey server (Survey Monkey ™) with a link emailed 96

to all nurses who had secured a position in the new facility. The results of the LNA were exported 97

from Survey Monkey ™ into a Microsoft Excel spread sheet. The data was cleaned, duplicates 98

removed and all data de-identified. Staff cohorts were grouped by speciality and clinical areas and 99

then assessed in entirety. Demographics were presented as percentages, mean or median 100

(depending on distribution) with confidence intervals. Confidence level option for skills questions 101

were collapsed into two groups; those that lacked confidence with this skill and may require support 102

(no experience or minimal confidence) and those that were confident (confident or very confident). 103

These are presented as descriptive and frequency statistics. 104

As part of the framework of service transition evaluation a focus group was conducted with Nurse 105

Educators. The aim of the focus group was to explore the results of the LNA in the context of wider 106

organisational change. The session was facilitated by a Nurse Researcher and recorded using a 107

digital voice recorder (Olympus DS-7000). The session was then transcribed verbatim and 108

anonymised. A thematic analysis was performed to identify themes from the data. 109

Ethical consideration 110

Ethical approval for this project was granted through the Children’s Health Queensland Human 111

Research Ethics Committee (HREC/14/QRCH/351). 112

Results 113

LNA results 114

The LNA was conducted in August 2014 with a response rate of 73.41% (624/850). Whilst 3.95% of 115

these survey responses were incomplete, any data that was complete was included in the analysis. 116

Where staff completed the survey more than once, only the most complete record was retained. If 117

they were equally completed the data from the first version was included in the analysis. 118

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Demographics: There was an even representation of respondents from both hospitals (54/46%). 119

The majority of respondents (77%) had more than 5 years’ paediatric nursing experience (Figure 2). 120

Eight per cent of respondents had less than 2 years’ paediatric nursing experience. Thirty three 121

respondents had post graduate qualifications (Figure 3). Level of post graduate qualifications varied 122

from Graduate Certificate through to Doctorate of Philosophy. Twenty-two per cent of respondents 123

stated that they had other relevant qualifications such as Midwifery, Nurse Immuniser, and 124

Certificate IV in Workplace Training and Assessment. Of all respondents, 69% had completed a 125

preceptorship course. 126

127

Insert Figure 2 128

Figure 2 - summary of respondents’ years of paediatric nursing experience 129

130

Insert Figure 3 131

Figure 3 - Percentage of respondents who have completed postgraduate qualifications 132

133

Completion of legislated and requisite mandatory training: Currency with legislated and required 134

training by respondents was calculated. Results ranged from 21% for Family Centred Care through to 135

Medication Safety at 69% (Figure 4). 136

Insert Figure 4 137

Figure 4 - percentage of respondents who have completed legislated and requisite training 138

Confidence in clinical assessment skills: Staff were asked to self-assess their level of confidence in 139

performing the following clinical assessments (Figure 5): neurological assessment; cardiovascular 140

assessment; respiratory assessment and primary/secondary surveys. The options provided were: Nil 141

experience with this; Minimal confidence-supervision/guidance required; Confident-independent 142

with this; Very confident – able to teach this. Respondents were largely confident across all skills; 143

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neurological (86%), cardiovascular (74%), respiratory (75%) and primary/secondary survey (75%) 144

(Figure 5). 145

Insert Figure 5 146

Figure 5 - self rated confidence with assessment skills 147

148

Confidence in managing clinical deterioration: Staff were asked to self-report their confidence in 149

managing clinical deterioration. Across all categories the percentage of staff that were confident in 150

managing a range of deterioration scenarios was high (>75%). 151

Staff movement between clinical areas: Staff were asked to indicate which clinical area they were 152

working in at the time of completing the LNA and where they would be working in the new hospital. 153

The majority of staff were recruited to the same or similar clinical unit. Survey results indicated that 154

of the 21 identified clinical units in the new hospital, 14 had >75% of staff with prior experience in 155

that clinical field, or a similar field. There were four wards that had a lower percentage of staff who 156

had previously worked in the clinical speciality; however this was reflective of either a new service or 157

a new combination of services being housed within one clinical unit. 158

Focus group findings 159

Seven Nurse Educators participated in a focus group discussion following the opening of the new 160

hospital. Given that one of the primary aims of the LNA was to identify the existing knowledge and 161

skill set of the nursing staff and identify education opportunities the focus group was asked to 162

explore the results within the broader context of the substantial organisation change that occurred. 163

The themes generated from the discussion were: staff who completed the LNA were not necessarily 164

the same staff who were working at the bedside when the new hospital opened; every detail and 165

process in the facility was new to the staff; and anticipating change. These themes will be explored 166

in the following section of this paper. 167

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Staff who completed the LNA were not necessarily the same staff who were working at the 168

bedside when the new hospital opened 169

The LNA was conducted in August 2014 approximately three months before the move to the new 170

hospital. The focus group participants described that the LNA was a “moment in time” that captured 171

a group of staff prior to the move. They went on to describe the actual workforce that presented in 172

the days, week and months after moving into the hospital had been “diluted” and no longer 173

represented the same staff that completed the LNA. 174

In order to meet the new model of service delivery, new services were being introduced in the 175

facility that had not existed in the previous organisations. Likewise, some of the established services 176

were expanding and required increased numbers of staff. In order to meet the demand for greater 177

numbers of staff, nurses with predominantly adult backgrounds in the relevant clinical areas were 178

recruited. Recruitment of staff from interstate and overseas also contributed to the further 179

‘dilution” of the workforce and the numbers of staff whom completed the original LNA. 180

There were many opportunities for the existing staff to apply for more advanced roles. At the time 181

of completing the LNA the staff were very clinically confident and competent clinicians in their 182

existing roles which reflected the positive LNA results in terms of skill set. Securing advanced roles is 183

a natural career progression; however it takes time for the clinicians to develop the extended skills 184

that come with a new advanced role. A clinician who is functioning as an expert (“very confident”) in 185

one role may revert back to functioning as a novice (“minimal confidence”) in a new role, particularly 186

if it is a more advanced role. This cohort of staff created challenges for both the staff and the 187

educators : 188

“….and there was also that group of people that might have been a Grade 189

5* at [either hospital] but all of a sudden they were a Grade 6* at [the new 190

facility] so they are// not only are they at a new facility but they are in a 191

new role and I guess if you didn’t know that they were new to that position 192

you would have an expectation that they are a Grade 6, they are my support 193

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and they are just learning their own role and some of the NUMs [Nurse Unit 194

Managers] were inexperienced in those roles as well.” 195

*Grade 5 is the equivalent to a Registered Nurse and a Grade 6 is equivalent to a 196

Clinical Nurse Specialist 197

These factors contributed to challenges for the Educators when they moved into the new hospital. 198

Despite completing the initial LNA several months before moving, staffing movement in and out of 199

the organisation and within roles meant that those who had completed the LNA were not 200

necessarily the staff that the Educators were working with in the coming months. This made it very 201

difficult for the Educators to plan education programs specific to the needs of the wards they were 202

covering. 203

Every detail and process in the facility was new to the staff: 204

The new hospital is a state of the art facility with brand new equipment, technology and processes. 205

Clinicians were not only dealing with a new geographical environment, they were also using 206

equipment that was new to them, working alongside new colleagues and for some staff they were 207

unfamiliar with the processes and infrastructure enabling them to provide routine clinical care. 208

When any clinician is taken out of their familiar environment they revert back to being a novice 209

practitioner for a period of time where they take longer to process and double check things (Dreyfus 210

& Dreyfus, 1996) : 211

“…you absolutely cannot underestimate the impact that this has, it’s not 212

only the new environment, it’s not only the new teams, it’s not only the new 213

equipment it’s the frustration factor of not being able to do things that you 214

were previously very all over, all over. That you could very simply take on 215

board, co-ordinating and managing certain things to then that frustration of 216

that not being easy any longer ………..” 217

The participants described these frustrations as impacting on the clinician’s confidence. Where a 218

clinician many have previously described themselves as being confident with particular skills, when 219

taken out of the familiar environment with new equipment, processes and technologies they are 220

unlikely to continue to described themselves as functioning confidently in these circumstances. 221

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Participants cited that clinicians “felt they should be more efficient than what they were” despite 222

working in circumstances beyond their control. 223

Merging workforces and moving to a new facility meant that established relationships were often 224

lost. Having these established relationships contributed substantially to an effective, efficient and 225

confident workforce : 226

“… in a healthcare environment that’s how things operate it’s very often 227

that creates a sustained relationship that allows for that, just going the 228

extra mile for people, you know while you’re on your way down there…oh 229

yeah alright. Taking on those smoothing over the corners type of roles 230

occurs very much with that relationship stuff and I think because we then 231

came in our new environment where we had new people and new teams 232

and new everything and some of that smoothing over the corners didn’t 233

work as effectively” 234

The merging of two completely different organisations with their own distinct cultures, processes 235

and technologies was quite unique to other moves within healthcare into a brand new facility. It is 236

not unusual to hear of an organisation building a new facility and the staff move into the new 237

facility. In those circumstances, despite being in a new environment most of the staff already know 238

each other and the infrastructure including familiarity with paperwork and how to call support 239

services for example. In this situation, two existing hospitals merged into the one organisation in a 240

new facility where none of the processes were familiar and staff were working alongside colleagues 241

they had never met before.. In this situation, this change impacted every aspect of the clinicians 242

daily work routine : 243

“….. normally if you’re new to a ward, even if there’s a couple of you 244

starting it doesn’t take you long to integrate. But everyone was new, in this 245

new environment and a bit wary and a bit stressed and a bit scared so 246

building that relationship has taken much longer” 247

The move itself and all of the associated complexities has been a stressful time for all of the staff 248

involved. The participants felt that everyone underestimated the impact this stress would have on 249

the individuals, teams and organisation as whole. Despite a tremendous amount of preparatory 250

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work being completed in anticipation of the physical move and the change in service provision, the 251

participants acknowledged that no one could have anticipated the impact this massive change could 252

have had on the clinicians and their ability to provide clinical services : 253

“….. while our intentions were very good we underestimated a lot of other 254

factors that impacted on stress levels, we all know that we don’t function 255

well under stress so while it was a good idea at the time we underestimated 256

a lot of other variables that impacted on their ability to function effectively 257

and efficiently and at the level that they expected themselves let alone what 258

we expected”. 259

Anticipating change: 260

The participants discussed that LNAs conducted prior to moving to a new facility should include an 261

exploration of how people manage change. Rather than being purely clinical skills focused, the 262

participants felt in hindsight that exploring people’s experience of change and how they manage it 263

would be very beneficial to planning the support required for a move like this : 264

“Because you have got that 70% of nurses that have greater than 5 years’ 265

experience. I’m used to knowing exactly what I know. It would be interesting 266

to have done a learning needs analysis, I know that when you created it, it 267

was very much knowledge, content based but it would’ve been interesting if 268

we could’ve asked questions on how you manage difference, how you 269

manage change, I mean not that you want to ask that question because it 270

all sounds too airy fairy fluffy but then if you actually got respondents that 271

said you know these guys don’t manage change well that should have been 272

a bigger component because as you have found it seems that everyone on 273

paper knows what they are doing.” 274

Many of the clinicians had been working for their respective organisations for many years (20 -30 in 275

some cases). Whilst this provides an organisation with a wealth of experience and a stable 276

workforce, the focus group participants hypothesised that these clinicians may not have had much 277

experience adapting to change and this may have had an impact on adapting to the new facility and 278

associated changes : 279

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“…….so maybe in a sense we had too much experience. Do you know what I 280

mean? Sometimes the less experience, what you don’t know doesn’t scare 281

you as much” 282

Although newer clinicians may not come with the depth and breadth of clinical experience that can 283

be gained from working for an organisation for many years, these clinicians may be more adaptable 284

to change. Clinicians who are used to moving throughout clinical specialities and organisations 285

(student nurses or casual pool staff for example) may in fact have developed mechanisms that assist 286

them to adapt to the change and function effectively and confidently more quickly than established 287

clinicians : 288

“……..I think we are a bit wiser now and maybe we would re-word the way 289

we ask some things or maybe we would give better explanations about 290

what we were trying to get out of the questions and maybe we would ask 291

some more cultural, stress type, coping things” 292

Discussion 293

The LNA was a useful tool to identify the self-rated confidence with clinical skills of the nursing staff 294

prior to the merge of two existing organisations into one new facility. The survey identified cohorts 295

within the workforce who could perform specialised clinical skills relevant to the speciality area they 296

would be working in and those with skillsets that could be utilised throughout the transition like 297

mentoring and preceptorship for example. The LNA also identified skill gaps and highlighted 298

educational priorities at both an individual and a group level which contributed to the planning and 299

development of proposed educational strategies. As discussed within the focus groups however, the 300

staff who completed the LNA were not necessarily the same staff who were working at the new 301

facility in the days, week and months after opening which made it challenging to tailor the 302

educational strategy prior to the move. Within nursing it is quite normal for workforce numbers to 303

fluctuate continuously due to things like the broad range of ages of nurses working in hospitals, high 304

rates of maternity leave in a predominantly female workforce and staff moving on to new 305

opportunities which gives rise to the need for a temporary workforce. To combat this it might be 306

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useful to complete the LNA on a regular basis (possibly annually) as opposed to a one off activity and 307

administer it to all staff when they are employed within the organisation to capture the current 308

workforce. 309

This focus group discussions highlighted that many staff who were not acting in their “usual” roles 310

either because they were new to both organisations and setting up a new service or through 311

promotion. Likewise, with the opening of the brand new facility and the associated changes all of the 312

staff were essentially working in an unfamiliar environment which reverts them back to a novice like 313

state impacting their ability to function effectively and efficiently. Benner proposes that nurses pass 314

through five levels of proficiency: novice; advanced beginner; competent; proficient and expert. 315

These levels of proficiency are based on the Dreyfus Model of Skill Acquisition (Benner, 1982, 2001; 316

Dreyfus & Dreyfus, 1986). The Dreyfus model postulates that as professionals transition through the 317

model of skill acquisition they move from one of rigid adherence to taught rules and procedures 318

(explicit knowledge) through to a more intuitive mode of operation that relies on implicit knowledge 319

(knowledge based on experience, familiarity and repetition). There is an acknowledgement that 320

despite having many years’ experience, if an expert nurse is put in an unfamiliar environment or 321

situation they will revert back to working in a novice like state (heavily reliant on explicit knowledge) 322

until they become more familiar with the environment and processes (Benner, 1982; Dreyfus & 323

Dreyfus,1986; Hudson, 2014). Granted, the restoring function of a former expert clinician is faster 324

than moving through the novice to expert model as a beginning practitioner. Nonetheless it can be a 325

frustrating and challenging time for the clinician. The restoration was perhaps not as quick due to 326

the multitude and magnitude of the changes that the staff faced within the new facility, new 327

equipment, new processes and new colleagues. 328

As discussed, change creates uncertainty and can be emotionally challenging (Dowers, 2011). 329

Change management frameworks can help guide individuals and organisations through change with 330

collaboration and good communication being vital components (Mitchell, 2013). In this project 331

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however, it was acknowledged that the large numbers of staff who frequently worked shift working 332

patters and an under-estimation of the magnitude of change made it challenging to effectively 333

communicate and collaborate. 334

Limitations and future recommendations: 335

There were several limitations to this project including: resource restrictions; the constantly 336

changing workforce; delay in analysing results and refining the LNA tool. Staff tasked with 337

undertaking this framework of service transition continued their usual operational capacity which 338

gave them limited time to develop, refine and conduct the LNA. Resource restrictions also meant 339

that a broader collaborative approach towards service development and benchmarking was limited 340

(Howarth, Holland, Lunt & Cosgrove 2006). Had sufficient capacity been available then a more 341

formalised benchmarking operation should be undertaken to establish a more comprehensive 342

evaluation of current services and education and training requirement against evidence based 343

domain benchmarks (Howarth, Holland, Lunt & Cosgrove 2006). 344

345

As highlighted throughout this paper the fluctuating and changing workforce leading up to and after 346

the merge of the two existing organisation into the new facility was a challenge. The LNA was 347

conducted three months prior to moving into the new facility and many of the staff who completed 348

it had either moved outside of the organisation or were working in different positions. Although the 349

organisation does not anticipate such a monumental move again in the near future, it would be 350

more useful to conduct the LNA with the newly established workforce and then repeat it on a 351

regular basis (perhaps every 12-18 months). Likewise, it would be useful to ask any new starter 352

within the organisation to complete the LNA to contribute to the individual and group education 353

planning. 354

355

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Despite the LNA being conducted three months before the opening of the new facility there was no 356

capacity for the data to be analysed and distributed to the Nurse Educators until after the move into 357

the new facility. Personnel in the Learning and Workforce Development team were employed by 358

two different organisations, most of whom were heavily involved in move processes, logistics, 359

orientation and induction. Workloads involved in preparation for move and maintaining “business 360

as usual” were significant and many competing priorities existed. In the future, the authors would 361

suggest that the analysis of the LNA would need to take place in a more timely fashion to be of 362

benefit in planning the yearly educational strategy. 363

364

The LNA was comprised of approximately 50 questions and took participants approximately 30-45 365

minutes to complete. This may have led to fatigue in the participants and may have affected how 366

they answered some of the questions. As previously described, the Nurse Educators were very time 367

poor and did not have an opportunity to pilot or refine the LNA. In the future the authors would 368

suggest reducing the number of questions contained in the LNA, piloting and refining prior to 369

sending the LNA out across the organisation. 370

371

The accuracy of using a self-assessment model can also be questioned. Given the resources and time 372

available, the Educators decided to use a self-assessment approach, however there are 373

acknowledged limitations of using this model with the potential for overestimation (Davis, et al 374

2006). In the future the authors would suggest reviewing this model and refining during the 375

suggested pilot of the tool. 376

377

The authors would suggest including questions around experience with change and stress if other 378

healthcare organisations were considering using an LNA prior to moving into a new facility. 379

Although we have acknowledged that merging two hospitals into one new facility is a relatively rare 380

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event, a focus on these questions would still be relevant to organisations who are moving onto a 381

new facility. 382

383

Conclusion 384

A LNA was a useful tool in identifying both strengths and deficits within a newly created workforce 385

and Nurse Educators were able to use the results to provide focus to planned education 386

programmes. The participants identified that the LNA was a useful tool in the newly established 387

workforce and is something they would like to see repeated on a regular basis to inform education 388

strategies. The participants did however highlight the magnitude of change for the nursing staff 389

merging from two separate existing organisations onto a new facility was far bigger than anticipated. 390

The impact of this substantial organisational change which included a new physical environment, 391

new processes, new culture and working with people you may not have worked with before meant 392

that the results of the LNA could and should not be considered in isolation. In the future, an LNA 393

should be done including aspects of the respondent’s ability to adapt to change and incorporate 394

aspects of change management into the education strategy. 395

References 396

Benner, P. (1982). From Novice to Expert. American Journal of Nursing. 82(3). 402-407. 397

Benner, P. (2001). From novice to expert: Excellence and power in clinical nursing practice. New 398

Jersey, Prentice Hall Health. 399

Bowers B. (2011). Managing change by empowering staff. Nursing Times. 107(32/33). 19-21. 400

Davis, D., Mazmanian, P., Fordis, M., Van Harrison, R., Thorpe, K., Perrier, L. (2006). Accuracy of 401

physician Self-assessment compared with observed measures of competence. Journal of the 402

American Medical Association. 296(9). 1094-1102. 403

Dent, A., Asadpour, A., Weiland, T., Paltridge, D. (2008). Australasian emergency physicians: A 404

learning and educational needs analysis. Part one: Background and methodology. Emergency 405

Medicine Australasia. 20. 51-57. 406

Dreyfus, H. L., & Dreyfus, S.E. (1996). The relationship of theory and practice in the acquisition of 407

skill. Benner, P., Tanner, C.A. and Chelsea, C (eds). Expertise in nursing practice. New York: Springer. 408

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Dyson, L., Hedgecock, B., Tomkins, S., Cooke, G. (2009). Learning needs assessment for registered 409

nurses in two large acute care hospitals in Urban New Zealand. Nurse Education Today. 29. 821-828. 410

Gould, D., Kelly, D., White, I., Chidgey, J. (2004). Training needs analysis: A literature review and 411

reappraisal. 41. 471-486. 412

Howarth M, Holland K, Hardiker N. (2006). Shaping the Future for Primary Care Education & Trianing 413

Project. Best Practice in Education and Training Strategies for Integrated Health and Social Care: A 414

Benchmarking Tool. Vol 7. North West Universities Association. 415

http://usir.salford.ac.uk/17623/1/wp3_toolkit.pdf. 416

Hudson, A.P. (2014). Exploring the experiences of nurses who care for children who have Acute Life 417

Threatening Events (ALTE) in hospital, Doctorate of Philosophy, Aston University, (p131). 418

Jauncey-Cooke J., Franklin D. (2010). Creating a new cardiac service: the Brisbane experience. 419

Australian Journal of Advanced Nursing. 28(2). 74-80. 420

Lasater, K. (2007) Clinical Judgment Development: Using Simulation to Create and Assessment 421

Rubric. Journal of Nursing Education. 43(11). 496-503. 422

Mitchell G. (2013). Selecting the best theory to implement planned change. Nursing Management. 423

20(1). 32-37. 424

Review of Paediatric Cardiac Services in Queensland, 2006. Chair: Professor Craig Mellis. 425

www.health.qld.gov.au 426

Staniland, K., Rosen, L., Wild, J. (2011). Staff support in continuing professional development. 427

Nursing Management. 18(1). 33-37. 428

While, A., Ullman, R., Forbes, A. (2007). Development and validation of a learning needs assessment 429

scale: a continuing professional education tool for multiple sclerosis specialist nurses. Journal of 430

Clinical Nursing. 16, (6). 1099-1108. 431

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Figure 1

Skill Sets

No

experience

Minimal

confidence Confident

Very

confident

Respiratory

Care of child with nasal prong / face mask

oxygen

Care of child on high flow oxygen

Care of child with nasopharyngeal airway

Oximetry

Suctioning of upper airway

Nasopharyngeal aspiration

Insertion of an oropharyngeal airway

Insertion of a nasopharyngeal airway

Management of intercostal catheters

Tracheostomy care - acute

Tracheostomy care - established

High flow oxygen therapy

Management of non-invasive ventilation

(CPAP, BiPAP)

Management of respiratory medication

delivery devices

Interpretation of blood gas results

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Figure 2

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Figure 3

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Figure 4

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Figure 5