I am a registered nurse of twenty years of experience. After graduated from my three-year training in a nursing school, I had been worked in an intensive care unit (ICU) and a pulmonary unit of a public hospital. Now I am working in a non-government organization serving the mentally disabled. No matter which specialty I am working in or how senior I am, I found learning being crucial for professional competence, job satisfaction and personal growth. In this paper, I would like to reflect critically on my experience of learning in nursing with reference to relevant learning theories.
Learning in workplace
At the time when I started to work as a registered nurse in a new workplace after graduation from nursing school there was no structured orientation program like nowadays. As an enthusiastic beginner with an imminent need, my motivation to learn was very high. I clutched every opportunity to observe how other colleagues perform, to ask questions proactively and to study references from ward manuals and books by myself. In addition, the colleagues were willing to teach and finally I was able to meet the requirement of my new role quickly and smoothly.
With about a year of experience, I started attending formal in-service training courses. I was assigned to attend trainings of the specialty I was working with and some core management skills. Nevertheless, I got little satisfaction but I did not know the reasons at that time until I was studying my bachelor’s degree program and was promoted to Nursing Officer later on. As a new Nursing Officer I had to deal with a lot of problems which I had not come across before but some issues were the topics that I was studying at that time. I then tried to apply the knowledge and theories into practice. Not only could the knowledge solve my problems, but also the application of theories had enhanced my learning. I realized that putting theories into practice make the learning and working effective and interesting and vice versa. I felt the sense of satisfaction of learning by then.
Advanced academic learning
I started to pursue a master’s degree program last September. My motivation for advanced academic learning is both extrinsic and intrinsic. The academic requirement for professional nurse is increasing now and I need to upgrade myself so as to be synchronized with the pace of professional development. Academic study has made me more knowledgeable, more critical and more assertive. Moreover, the qualification enhanced my self-confidence directly. The program is actually imposing great pressure on me that I need to struggle for a balanced life between work, family and study. In order to up keep my motivation in learning, I tried hard to make the study more interesting and pragmatic by integrating theories into practice, sharing and discussing with colleagues as much as possible.
My learning experience in the workplace when I was newly qualified was a kind of social learning which Atkinson, Atkinson, Smith, Bern, and Hilgard (1990) described as learning by watching the behaviors and the consequences of others. Social learning is a human instinct and we learn by it consciously or unconsciously. When I was a newly qualified nurse, the need to learn was immediate. I consciously went into the learning process of attention, retention, reproduction, and also motivation. If the displayed behavior was perceived favorable to me, my motivation was particularly high. It was because of my active participation and my self-directed learning, I had a good learning outcome at that stage. Quinn (2001) believed that the quality of the model influence the result of learning. I am always aware of my behavior when I become a senior nurse, need to act as a preceptor or a mentor and especially when I have become the ward-in-charge which Fretwell and Melia (as cited in Hand, 2006) found to have an exceptional strong influence on colleagues in their studies. The reinforcement of the displayed behaviors has influence on individual’s motivation to reproduce the behavior. To ensure a favorable learning outcome, I intentionally give positive reinforcement for favorable behavior and negative reinforcement for unfavorable behavior. I value social learning because it is much safer than trial and error in clinical practice and it is a natural way to learn.
Reflection and critical reflection
From time to time, malpractices happen in every workplace. It is important for persistent reflections to improve nursing qualities. Reflection being described by Raelin (2002) is the practice of standing back to examine the meanings of things happen around us. Reflection helps to identify malpractice and makes improvement accordingly. By reflection, nurses identify areas for improvement and improve their “quality” as models. Besides, reflection makes us more receptive to the alternatives of reasoning and behaving (Raelin,2001). There is critical reflection which is a deeper and broader type of reflection and is a collective action to enhance organizational learning and change (Gray, 2007). Furthermore, it encourages learning at a more profound and transformative level (Mezirow, 1990). Now I have established the habit of periodical reflection and I am striving to achieve appropriate critical reflection. Critical reflection involves questioning long-established believes and attitudes but may lead to resentment of the staffs. It has to be carried out skillfully at appropriate time. I discovered that the practice of critical reflection would be more receptive if it is done immediately after a critical incidence.
A part of my learning journey had contradicted to andragogy. Knowles (1990) recognized that adults learn best when they are self-directed and assume responsibility for their learning. He also expounded the following six assumptions of andragogy: 1. Adults need to know the reason to learn.
2. Adults have a self-concept of being responsible for their own decisions and need to have a self-directed learning. 3. Adults come to learn with rich experiences which are the foundation and resources for learning. 4. Adults are more ready to learn if there is a need to learn. 5. Adults’ orientation to learn is problem-centered.
6. Adults are responsive to external motivators and respond better to internal motivators.
When going to formal professional trainings, I was assigned to attend some management workshops and lectures when I had only two or three years of experience. At that stage my job duty and responsibility did not include management and I was not interested in it either. So I did not know why I had to learn management. The knowledge I had learnt could not be applied into practice. Actually I was not ready to learn management at that time. It was not self-directed. I am sure that these learning would have been more fruitful if they were arranged when I needed to assist in ward management or if I had at that time a long term perspective of seeing the need to take up a management role one day. Then when I attended the ICU courses, many of the course contents could not be practiced in my hospital which was a rehabilitation hospital that the ICU was small and did not provide care as “intensive” as other large acute hospitals.
A point I had to admit is that my attitude of learning at that time was passive and dependent. After attending a course or a lecture, I could actually discuss with the ward in-charge and give new ideas but I had not done so. My learning at that stage had several points contradicted to andragogy and was the reason why I did not feel satisfied with all that learning.
Having got such experience, now when I do training and development plan for my staffs, I usually discuss with them about their needs and preferences. If they need to take some mandatory sessions as required by the hospital, I must make sure they know the reasons. When I coach or mentor new staffs or clinical placement students in my workplace, I would emphasis why they need to learn those things I showed to them. After my colleagues attending a course or a lecture, I usually ask them what they have learnt and encourage them to put theory into practice.
Honey and Mumford (as cited in Penger and Tekavcic, 2009) categorized learning styles into four types as pragmatist, activist, reflector and theorist. My learning style can be described as pragmatist or activist. I enjoy trying new ways and test their practicability in work. I appreciate
knowledge and theories that can be put into practice and solve problems. I understand that the characteristics of a reflector being favorable to listen, think and evaluate thoroughly and the characteristics of a theorist loves to see things globally are as valuable as other styles. Now I am trying to further develop my learning style because as remarked by Astin, Closs and Hughes (2006), no one learning style is regarded as the best and it is beneficial to use all four learning styles. From my point of view, different learning style is advantageous to different focus or context of learning. If the focus of learning is to acquire a hands-on skill, activist and pragmatist are more advantageous. If the focus of learning is to understand a phenomenon or a theory, reflector and theorist are more advantageous. Therefore, developing learning styles beyond our dominant types can strengthen our ability to learn.
This article reviews my learning experience in nursing. Starting with informal learning in workplace, then proceeding to formal in-service education and academic learning, I was being highly pragmatic and my orientation to learn can be explained by andragogy. I value social learning, reflection and critical reflection. My experience has impacted on my style of mentoring and coaching in clinical practice. I am striving to further develop myself to think more proactively and globally which is essential for on-going learning.
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