Miao-Qing ZHUANG, Hong-Fang CHEN,Huan-Ze LISchool of Nursing, Shaanxi University of Chinese Medicine,Xianyang, Shaanxi, China; Department of Nursing, Shaanxi Traditional Chinese Medicine Hospital, Xi’an, Shaanxi, China

ABSTRACT

Objective: The objective is to understand the current situation of clinical practice training for nursing master’s degree postgraduates, and discuss the necessity of implementing the “dual specialty” training mode for nursing master’s degree postgraduates in China.

Methods: Phenomenological research method was used to conduct semi-structured in-depth interviews with 10 nursing master’s degree graduates, and the data were analyzed by Colaizzi 7-step analysis method.

Results: Four topics were extracted: The objective of clinical practice training for nursing master degree postgraduates was not specific;the cultivation direction is not refined; the ability of clinical practice is weak; the research direction is not consistent with the required position.

Conclusion: Implementing special double training mode can solve nursing professional master degree postgraduate education lacking the ability to service the needs of society, graduate students and the existing problems of specialist nurse training and the cultivation of “heavy science, light clinical practice” status quo and the effective way of guiding graduate students career planning, so the implementation of special“double” training mode is necessary.

Keywords: Dual specialty, graduate student, master’s degree, nurse specialist, nursing education, nursing talents

INTRODUCTION

With the gradual development of China’s medical cause,the Ministry of Education approved the establishment of a master of nursing specialist (MNS) in 2010 and defined the training objective of MNS education,[1]that is, to cultivate high-level, application-oriented, and specialized nursing professionals. This major measure has gradually narrowed the gap between Chinese higher nursing education and international nursing education.[2]Aiming at the practical and professional nursing science, the implementation of specialized nurse-oriented MNS education is an important measure to train senior nursing professionals. At present,specialized nursing talents in China mainly include MNS postgraduates and specialized nurses. They are highly consistent in training objectives, training modes, and other aspects, both of which take occupation or post as the starting point and endpoint.[3-5]MNS education is based on training senior nursing professionals, while specialized nurse training is based on training expert clinical nurses.[6]The training of specialized nurses will be integrated into the MNS clinical practice training stage to realize the parallel training namely“dual specialty” training, so as to promote the development of specialized nursing; it is also a step of our country’s nursing education and international nursing education.[7]In this research, we adopts a semi-structured in-depth interview method, starting from the own experience of MNS graduate students in our school, to understand the present status of the MNS graduate students in clinical practice, discuss the necessity of the implementation of the special “double”training mode for MNS graduate students in China, and put forward corresponding countermeasures and the suggestions for perfecting the MNS education in our country at the present stage and providing direction and reference basis for building the special “double” training mode conforming to China’s national conditions.

METHODS

Research object

From August to September 2019, MNS postgraduates of a Chinese medicine university in Shaanxi province were selected as interviewees by the method of objective sampling. The determination of sample size is based on the repetition of the data of interviewees and the absence of new themes in data analysis.[8]Inclusion criteria were (1) pass the national unified entrance examination for graduate students;(2) graduate student in MNS; (3) clinical rotation time ≥6 months; and (4) they were willing to participate in the study.

Research methods

Under the guidance of phenomenological research methods,semi-structured in-depth interviews were conducted on the research objects. Revise a specific interview outline according to the literature review, expert guidance, and preinterview: (1) Do you think the training orientation of MNS graduate students in China is reasonable and the specific training mode is reasonable? Please talk about your views from the specific training details (the setting of core courses, the main form, and content of clinical practice, the difference like work compared with undergraduate students,etc.); (2) During the clinical practice, how do you feel about refining the professional direction to critical illness, blood purification, venous therapy, wound stoma, hospice care,diabetes, Peripherally Inserted Central Catheter (PICC), and rehabilitation according to the research direction? (3) What do you think of integrating nurse specialist courses (including theoretical courses and practical courses) into the clinical practice stage of MNS graduate students? (4) What are your career plans and expectations (about position, development space, and professional expectation)? (5) What problems do you think exist in current MNS education?

According to the principle of the convenience of interviewees,the interview time and place were agreed to select conference rooms of each department (no third person was present,only researchers and interviewees), and the time was about 20–35 min. The whole interview was recorded with a recording pen. Before each test, the recording effect was tested to ensure that the recording materials were clear and authentic. After the interview, the original materials such as the recording materials and relevant written records were completely sealed by the researcher himself.

Data analysis and quality control

The transcription and processing of materials and on-site observation records were completed within 24 h after the end of the interview. The interview records of the research subjects were coded according to A1-A10 and an independent document was established for each respondent. With the help of NVivo11 software, the Colaizzi 7 analysis method was used to analyze the data. This research adopts the researcher Martin method, interview to interview objects together by two researchers, including 1 record after interview and transcription, the text information through interview WeChat returns to verify the object, after the interview object recognition, two researchers investigated the same information for continuous and repeated reading and analysis, coding, the results compared with raw data continuously, forming the final theme.

Ethic considerations

Before the interview, contact the interviewee, introduce the purpose, method and content of the research, explain the importance of recording and relevant written records to the interviewee, and promise to keep the interview information confidential and conduct the interview after obtaining consent.

RESULTS

Topic 1: Master of nursing specialist postgraduate training objectives are not speci fic

The training goal of MNS postgraduates is to cultivate high-level, applied and specialized nursing professionals who can independently solve common problems in the field of nursing and have strong research and teaching ability. This goal puts forward clear requirements for the cultivation of MNS postgraduates, but the goal is too broad, without precise positioning of the cultivation goal of refinement direction,which is consistent with the results of other studies.[9,10]A2: “I think the training orientation of MNS postgraduates is very reasonable, but the content is not specific enough, so I suggest to develop directional and specific training objectives according to the special characteristics of each field.” A8:“At present, there is no specialized subject training target.Clinical teachers generally adopt the ‘experience-based’teaching mode, which lacks pertinence. The previous generalist education model is no longer suitable for the cultivation of interdisciplinary nursing talents.”

Topic 2: The direction of master of nursing specialist cultivation is not re fined

With the development of specialization of medicine,nursing education is bound to develop into specialization.Therefore, the cultivation of high-level specialized nursing talents is an irresistible trend.[11]Domestic MNS cultivation direction is extensive but not precise, involving a wide range of knowledge but lack of depth, unable to truly reflect the specialization. Comparatively speaking, foreign MNS education is more finely divided, and the research direction is its characteristic professional field, which has the educational resources to cultivate this direction. Therefore, to adapt to the needs of medical development, MNS postgraduate generalist education can be appropriately refined and specialty reform implemented. A4: “I think the current training direction of postgraduate education is relatively broad, which can be further refined. For example, clinical nursing can be divided into surgical nursing, internal medicine nursing, maternal and child nursing, etc., Surgical nursing specialty can be divided into stoma nursing direction, digestive tract tumor nursing direction, and critical care direction, etc., Gynecology and obstetrics nursing can be divided into the professional direction of midwifery and gynecological oncology nursing direction. As far as I know, there are 19 specialized nursing training directions in Hunan province, such as emergency nursing, rehabilitation, pediatric nursing, s, and so on. Every MNS graduate student can choose specialized training that is in line with his or her research direction.”

Topic 3: Pay attention to scienti fic research ability but ignore clinical practice ability

The ultimate goal of MNS education is to cultivate high-level nursing professionals, and clinical practice ability is the core competence of front-line nurses.[12-15]The “dual specialty”training model requires a combination of scientific research training and clinical practice based on clinical practice training. However, during the interview, we learned that MNS education pays more attention to scientific research ability and neglects the cultivation of clinical practice ability.The phenomenon of “emphasizing scientific research,neglecting clinical practice” runs counter to the original intention of setting UP MNS education. A1: “There are many research projects under my supervisor, which requires the participation of MNS graduate students. Therefore, I will join my supervisor’s research team to follow-up on the research projects after the end of the 1styear of theoretical courses. As a result, the training time for clinical competence is relatively reduced, leading to weak clinical practice ability.” A5: “During the 3-year master’s degree, it is required to publish the core thesis, write the graduation thesis, and defend the thesis. In the 1styear, I was relatively weak in scientific research, so in the second two years of clinical practice, I mainly focused on the writing of papers but neglected the learning of clinical skills.”

Topic 4: The research direction does not match the required position

Among the 10 MNS graduate students interviewed, all the 6 MNS research students expressed their willingness to accept clinical nursing work. However, due to the broad training direction of MNS, the hospital could not provide corresponding jobs, so that it finally gave up the clinical work. Therefore, in the clinical practice stage of MNS, the cultivation of specialized nurses should be integrated. A9:“Nurses are not only limited to clinical work, but also can develop in many aspects, such as PICC, emergency care,wound stoma, etc., and implement multi-card on duty.” A7:“My current research direction is traditional Chinese medicine encephalopathy. If encephalopathy related nurse specialist training, such as rehabilitation, can be arranged in the specialized training stage of clinical practice, I am very willing to engage in clinical rehabilitation work in the future.” A10:“I’m between clinical and school, so I’ll try it for half a year,and if it’s appropriate, I’ll go into clinical work.” A6: “I hope I can be engaged in specialized nursing in clinical practice in the future. Combined with the scientific research knowledge I have learned, I can guide clinical nurses.”

DISCUSSION

The necessity of implementing the training mode of“double majors” The inevitable choice to make up for people’s need for health services

China’s development of MNS education time is short and small scale, compared with developed countries there are obvious defects. Some MNS graduate students have a deviation in their cognition of career positioning.[16,17]They pay more attention to cultivating scientific research ability while ignoring clinical ability. Therefore, the concept of “emphasizing scientific research while neglecting clinical ability” still dominates,and they are unwilling to engage in clinical work in the future. However, with the change of disease spectrum and the continuous improvement of people’s demand for health services, the cultivation of high-level nursing professionals will become an inevitable trend. Therefore, it is necessary to change the current single training mode and realize dual speciality training by integrating nurse specialist training into the stage of MNS education, so as to achieve the goal of simultaneous improvement of scientific research ability and clinical practical skills. This makes MNS graduate students obtain a qualification for position of a specialized field once they graduate, ultimately increasing the output of senior specialized nursing talents and meeting the hospital and the social demands for nursing professionals.

An effective way to solve the existing problems in master of nursing specialist education and nurse specialist training

The implementation of the dual specialty training mode is an effective way to solve the existing problems in MNS education and nurse specialist training. First of all, in the context of the present situation in China, the cultivation of a senior nursing talent needs at least 7–8 years (including 4 years for nursing undergraduate education, 3 years for graduate education in MNS and 3–6 months for specialist nurse training), however,such long training cycle is difficult to meet the needs of today’s society for senior nursing talents. Therefore, it is necessary to implement dual specialty and integrate nurse specialist training into the MNS training stage to shorten the training time of senior nursing professionals to 7 years.Second, the clinical practice time of MNS graduate students is usually 18–24 months.[18]To maximize the effect of the internship and effectively consider the career development of students, it is also necessary to integrate the training of specialized nurses into the clinical practice stage of MNS.Furthermore, in terms of the economy, training an excellent senior nursing specialist requires a large amount of human,material, and financial support. If similar training is arranged at the same stage, the waste of educational resources, funds,and personal time will be avoided to a certain extent. In the practice effect, the training effect is optimized. Thus, it is concluded that the implementation of the “dual specialty”training mode shortens the training time, adjusts the training cycle, and accelerates the output of senior nursing talents.

Effective measures to improve the status quo of master of nursing specialist graduate students’ emphasis on scienti fic research and light on clinical practice

MNS education aims to cultivate senior nursing professionals,and clinical practice ability is the internationally recognized core ability of MNS training.[15,19-21]MNS postgraduates engaged in clinical nursing work must have strong clinical practice ability to meet the needs of future career development. However, given the current social situation,scientific research achievements are needed to evaluate whether MNS graduate students are excellent, whether they can find a satisfactory job after graduation, and whether they can be promoted to professional title smoothly. From the perspective of the long-term development of the hospital,having a strong scientific research ability will help promote the smooth development of clinical front-line nursing work.During the interview, we learned that MNS postgraduates spend most of their clinical practice on the cultivation of their scientific research ability. Furthermore, China’s MNS education is at the stage of “crossing the river by feeling the stones,”lacking a perfect MNS education system and neglecting the cultivation of clinical practice ability. The above reasons will lead to the phenomenon of “attaching more importance to scientific research than to clinical practice” in the clinical practice training stage of MNS postgraduates. However,the implementation of the “dual specialty” training mode increases the training of specialized nurses in the clinical practice stage, which effectively guarantees sufficient clinical practice and scientific research time based on completing the master’s course study, to achieve the effect of paying equal attention to both scientific research and practice. Thus, we can draw a conclusion that the cultivation mode of dual specialty is an effective measure to improve the status quo of “emphasizing scientific research while neglecting clinical practice” in training MNS postgraduates.

Internal motivation to guide master of nursing specialist graduate students in career development planning

At present, the employment competition is quite fierce,and MNS graduate students must have certain competitive advantages, and make long-term plans for their future career development, to adapt to the competitive intensity of today’s social jobs. After 3 years of systematic training, MNS postgraduates have greatly improved their scientific research ability, evidence-based thinking ability, and critical thinking ability, making them have more obvious advantages after entering into clinical work compared with undergraduates.In the process of implementing the “dual specialty” training mode, MNS graduate students are required to choose the specialized direction consistent with the research direction for training in the clinical practice stage, which is conducive to them to have a certain tendency of specialty for their career development and provide internal motivation for their future career development. Meanwhile, it is necessary to change the current situation of “emphasis on training, light on application” and guide MNS graduate students to make correct nursing career planning, which is in turn to provide a guarantee for hospital high-level nursing talent reserve.

Suggestions and countermeasures Start the “dual specialty” training mode as early as possible

As we know, the implementation of the “dual specialty”training mode is very necessary for MNS postgraduates,hospitals, and society. Therefore, it is necessary to coordinate and cooperate effectively among specialized nurse training bases, hospitals, and other aspects to develop a set of feasible plans and start the “dual specialty” training mode as soon as possible. In addition, MNS postgraduates can discuss with their supervisors to determine the direction of nurse specialist training after admission, so that they can reasonably choose the research direction and subject direction in the future, plan the postgraduate study stage and avoid the inconsistency of the three directions.

To properly bridge the differences between master of nursing specialist education and nurse specialist training

Postgraduate education in MNS is higher academic education,while nurse specialist training is vocational qualification education. Both of them are to cultivate high-level, applied,and specialized nursing professionals with strong specialty and high nursing level. Although they are different in educational forms, they are essentially closely related.Hence, it is necessary to conduct in-depth analysis of them from the aspects of training target, training methods, access conditions, training contents, and evaluation indexes, to explore their similarities and differences between them and seek common ground while reserving differences, thus forming a “dual specialty” training model that meets not only the training of specialized nurses but also MNS education.

Strengthen the communication and cooperation among the government, medical institutions, and colleges

Although there are similarities between MNS education and specialist nurse training, they belong to two different management systems, namely the education system and the health system. Therefore, the government, institutions of higher learning, and medical institutions should strengthen their communication and cooperation, to realize the organic combination of efficient and high-quality education resources and clinical nursing resources, and to construct the “double-major” training mode in which resources are integrated and shared. At the same time, the manager of the training base for specialized nurses should realize the importance of specialized nursing, constantly explore and innovate in the work of specialized nursing, as well as introduce new ideas, new technologies, and new services.

CONCLUSION

To sum up, the results of this study show the current situation of clinical training in MNS education in the primary stage and discuss the necessity of implementing the “dual specialty”training mode for MNS postgraduates in China, to provide a basis for the formation of the “dual specialty” training mode in line with the characteristics of nursing development in China. The “dual specialty” training mode is an inevitable trend of the development of nursing academic education and vocational education,[22]which is in line with China’s demand for high-level, professional, and practical training of nursing talents. It can fundamentally improve the clinical ability of MNS graduate students and the educational level of specialized nurses in China, which will realize the win-win situation of MNS graduate education and specialized nurse training modes. However, the “dual specialty” training mode is still in the embryonic stage of nursing education reform, so it is necessary to improve the MNS education and training system step by step through active reform, drawing lessons from the innovation of other professional training modes abroad and at home, and from various aspects such as enrollment plan, curriculum setting, clinical practice, and assessment.

Financial support and sponsorship

This work was sponsored by a Scientific research project of Shaanxi Administration of Traditional Chinese Medicine(No. 2019-ZZ-ZC010).

Con flicts of interest

There are no conflicts of interest.