"Our responsibility to graduates" with New South Wales-based Clinical Educator, Dalya Holowinski

12 Dec 2023

CRANAplus Member and Riverina-based District Nurse Educator Dalya Holowinski explains the process of identifying the learning needs of the emerging workforce, the roving CNE model, and the responsibilities that established nurses have towards those just starting out.

Dalya with her goats Steph and Sam

Thanks for join­ing us, Dalya. Can you tell us about your jour­ney to becom­ing a nurse educator? 

When help­ing to start a new hos­pi­tal, I quick­ly realised that I loved edu­cat­ing. It took a while before I suc­cess­ful­ly applied for a CNE role – you’re not always going to be suc­cess­ful the first time you step out your com­fort zone.

When I did become a CNE, I sought to devel­op myself to be a bet­ter edu­ca­tor. I looked at how to be a Nurse Edu­ca­tor (NSW Health has CNE, NE 1, NE 2, and NE 3 levels).

I stud­ied a post-grad­u­ate degree through Uni­ver­si­ty of New Eng­land in train­ing and devel­op­ment. The devel­op­ment side helped me with man­ag­ing per­for­mance, which ends up in an educator’s buck­et. Dur­ing this study I was suc­cess­ful in a Nurse Edu­ca­tor role, and quick­ly devel­oped cours­es that were miss­ing, and pod­casts.

I fin­ished my study and received real­ly good results – I think this gave me the con­fi­dence to extend myself again into a NE 2 role, which put me back into crit­i­cal care.

Work­ing at a major ter­tiary hos­pi­tal again made me look at edu­ca­tion dif­fer­ent­ly.
Dur­ing my time there I pushed for change and the devel­op­ment of nurs­es through col­lab­o­ra­tive approach­es with med­ical and spe­cial­i­ty staff. I was there dur­ing COVID which trig­gered me and my fam­i­ly to say, Let’s get out of Sydney”.

The role of Dis­trict Nurse Edu­ca­tor, which is a grade 3 NE, was avail­able – again, it took a few goes, but when the role for Mur­rumbidgee Local Health Dis­trict (MHLD) came up, I was ulti­mate­ly suc­cess­ful. Then it was time to move my whole fam­i­ly, the dog and five chickens.

Con­grat­u­la­tions on your growth as an edu­ca­tor. What’s it like to nurse in the Riverina?

At MLHD, we take a car­ing and sup­port­ive direc­tion when it comes to devel­op­ing our nurs­es and mid­wives. You can nurse in two very busy hos­pi­tals and see every­thing you will see at a big metro site. At the mul­ti-pur­pose ser­vice and dis­trict hos­pi­tal sites you become a spe­cial­ist nurse in everything.

We had a great adver­tis­ing cam­paign that you may have seen which includes pic­tures of cows, lla­mas, and emus and how these ani­mals have caused injuries which you will see and treat patients for.

We have a rov­ing clin­i­cal nurse edu­ca­tor (CNE) mod­el for ear­ly career nurse sup­port and devel­op­ment, which means that at whichev­er site you work, you will always have education.

MLHD has also devel­oped a Vir­tu­al Nurse Assist Mod­el where you can call a CNE for any­thing at any time for sup­port and guid­ance through patient care, assess­ment, and treatment.

We have a young dis­trict with many young fam­i­lies. There is a lot of farm­ing, canola – it looks beau­ti­ful trav­el­ling around and see­ing emus run through the fields.

We have a huge focus on pre­serv­ing nature includ­ing our koala pop­u­la­tion at Narrandera.

Pho­to cred­it: Taras Vysh­nya – stock​.adobe​.com

It sounds like a love­ly place to work. Since head­ing rur­al, why have you decid­ed to par­tic­i­pate in the CRANAplus Nurs­ing and Mid­wifery Round­table? Do all nurs­es have a role to play in advocacy?

I have realised that we need to speak up more for equi­table access to health and health­care edu­ca­tion. As part of the Round­table, we can influ­ence some great col­lab­o­ra­tion and the devel­op­ment of nurs­es, mid­wives, and allied health in rur­al and remote.

All nurs­es need to remind them­selves of their why’ and their com­mit­ment to mak­ing our lives bet­ter through bet­ter patient expe­ri­ences in healthcare.

As a Nurse Edu­ca­tor, how do you iden­ti­fy the workforce’s learn­ing needs?

Inci­dents, seri­ous adverse event reviews (SAERs), learn­ing needs analy­sis, speak­ing with staff, vis­it­ing sites, patient and fam­i­ly feed­back, and some­time gov­ern­ment rec­om­men­da­tions. Even glob­al meet­ings like Inter­na­tion­al Coun­cil of Nurs­es, or con­fer­ences too.

At the 2022 CRANAplus Con­fer­ence, you pre­sent­ed on this rov­ing CNE mod­el. How suc­cess­ful has this been?

There has been a sig­nif­i­cant increase in train­ing par­tic­i­pa­tion. Our new grad­u­ate num­bers have increased, and we have been able to do that through pro­vid­ing an edu­ca­tor to come out and work with them.

We’ve got 33 sites, and the rov­ing mod­el con­tributes to con­nec­tion and col­lab­o­ra­tion between them.

Pho­to cred­it: Taras Vysh­nya – stock​.adobe​.com

Speak­ing on a nation­al lev­el now, what solu­tions do you think could bring about a larg­er, bet­ter pre­pared workforce?

The pro­mo­tion of nurs­ing as a pos­i­tive job. We need to remove the neg­a­tive media and remind our­selves about the good things we can do. It’s a real­ly good job to have, real­ly stable.

We’ve got mul­ti­ple path­ways, we can become Nurse Prac­ti­tion­ers. We can achieve so much in nurs­ing.
A rethink of the fund­ing mod­el from the Aus­tralian Gov­ern­ment would be great. Doc­tors are not the solu­tion to a lot of work­force sup­ply and nurs­es and mid­wives need to be able to work at the top of their scope.

Our uni­ver­si­ties could do more to pro­duce work-ready grad­u­ates and to instil an under-stand­ing of the role and its respon­si­bil­i­ties. We need a four-year degree, nurse and mid­wife intern­ships where we are super­nu­mer­ary, and to be giv­en Train­ing Edu­ca­tion Study Leave (TESL) as in the med­ical field, so we can
afford to con­tin­ue our education.

As an edu­ca­tor, what are your thoughts on learn­ing on the job, ver­sus bring­ing your skills with you to the role?

Well, that’s a curly one, as right now our junior work­force does not always enter the work­force with ful­ly-fledged skills in nurs­ing but will look at things dif­fer­ent­ly and want express’ pathways.

Of course, you have to learn on the job. It’s hard to teach expe­ri­ence, and you can’t be an expert after six months.

But we’ve got to coun­ter­bal­ance that – we need peo­ple to be per­form­ing at the top of their scope ear­li­er. This has been weigh­ing on my thoughts as an edu­ca­tor late­ly, and I don’t have the answer. Except to say that we can edu­cate you to be the best in what­ev­er you decide to do, just as long as you stay in nurs­ing and mid­wifery.

What else can nurs­es do to sup­port under­grad­u­ates and recent graduates?

Nurs­es need to nur­ture all our work­force, includ­ing our col­leagues in allied health and med­ical. We need to work and train togeth­er. There are great ini­tia­tives like at John Hop­kins Hos­pi­tal where all the nurs­es, phys­ios and doc­tors attend the same ori­en­ta­tion – how amaz­ing would that be?

All nurs­es have a respon­si­bil­i­ty to encour­age oth­ers to be nurs­es, and no mat­ter what our day entails, we need to remem­ber our why’ and how this will bring about a bet­ter patient experience.

Inter­est­ed in join­ing a clin­i­cian round­table? View cur­rent oppor­tu­ni­ties here.