Academic-Practice Partnerships (APPs) are generally defined as strategic inter-organisational relationships aiming to advance mutual interests in practice, education, innovation, and research [1, 2]. In the context of nursing education, APPs began to develop in the 20th century when nursing education transitioned from hospital-based formation to academic institutes. It is argued that this separation has led to a profound chasm between the theoretical and applied practice of nursing [3], potentially causing a lack of shared vision and missed opportunities in cases where APPs lack structure or formality. When this happens, it is likely to impede student learning outcomes and the experience of pre-registration nursing placements [3, 4].
Recent literature reviews on residential aged care facilities (RACFs) such as long-term care facilities, nursing homes, care homes and assisted living facilities, which offer skilled nursing practice placements emphasise the importance of understanding the nature of these APPs and their impact on student placement outcomes [5–7]. APPs are recognised as useful tools to reduce discrepancies in the provision of care and subsequently the associated healthcare costs [8]. Formalising APPs can also facilitate the implementation of potential improvements identified through ongoing research [2, 6].
In the context of nursing education, APPs with RACFs present unique contextual challenges, such as the extent of collaboration between different RACFs and approved educational institutions (AEIs), and the impact of organisational culture on collaboration and learning within specific institutions [9, 10]. In comparison with hospital placements, RACFs often have fewer qualified staff and are increasingly relying on agency workers, which may result in additional pressures on staff nurses to supervise students or place more responsibilities on students to identify and benefit from the available learning opportunities [11, 12]. However, McCloskey et al [5], argue that the challenges faced by staff nurses in RACFs could also be mitigated through greater collaboration with universities. Strong partnerships are crucial for AEIs and practice partners, such as RACFs, to consolidate resources and create a conducive learning environment that promotes optimal patient care, supports nurses, and provides students with positive clinical experiences [16].
In the United Kingdom (UK), nursing students are required to complete clinical placements in diverse healthcare settings to meet the NMC proficiency standards; This diverse exposure not only enriches their experiences but also contributes to nurturing a future nursing workforce with a deep understanding of the diverse needs of patients across different ages[14]. Placements within RACFs provide future nurses with the opportunity to develop a deeper understanding of the elderly patient population who have a higher prevalence of chronic illnesses, multi-morbidity, and decreased capacity for self-care [15–17]. However, gerontology is often shown to be the least preferred career choice among nurses and one of the least preferred placement choices for nursing students [7]. Nursing in RACFs is often associated with negative stereotypes, including being perceived as uninteresting, offering limited career progression, and having poor staffing levels [6]. Similarly, a significant proportion of students perceived RACF placements as unattractive, repetitive, unskilled, unchallenging, and boring 4,19]. Consequently, students may feel that RACF placements limit their professional growth and put them at a disadvantage compared to their peers in fast-paced acute care environments [11].
The negative perception of aged care has been attributed to multiple factors, including a negative portrayal of RACF in the media and ongoing negative stereotypes perpetuated within the AEIs that predominantly focus on acute care in hospitals within the nursing education curriculum [20, 21], in addition, there is a misperception that RACF placements are only suited for teaching students basic nursing care [6]. Husebø et al. [6] argued that significant learning, which nurtures the formation of desirable nursing knowledge and attitudes, is possible within RACF; However, potential challenges including poor coordination between some AEIs and RACFs can hinder the full potential of RACF placements in being effective learning environments for pre-registration nursing students [6, 5]. Suboptimal student experiences during some RACF placements can further perpetuate negative attitudes towards aged care. This highlights the importance of fostering collaboration between AEIs) and RACFs while also cultivating a more comprehensive understanding of the distinct roles of pre-registration students and nursing educators in recognising and utilising the teaching and learning opportunities during placements in RACFs. These efforts are ultimately instrumental in empowering students to achieve the proficiency standards established by the NMC [14].
While challenges may arise during RACF placements), it is essential to emphasise that students acquire valuable skills and develop their capacity for providing compassionate, person-centred care [21]. RACF placements can enable nursing students to establish a solid foundation that significantly influences their nursing careers and can empower graduates who are better able to advocate for patient autonomy and dignity [6, 21]. There is a recognition that some RACF facilities provide good experiences to students which help change negative attitudes [11]. Therefore, it is important to understand both the factors facilitating positive placements and the barriers to fostering collaboration among the different stakeholders involved in ensuring a positive learning environment. There is a need to ensure that staff feel supported in their supervisory roles within RACFs which could help safeguard against a shortage of experienced and passionate nurses working in RACFs [13]. By reviewing the literature, it would become possible to implement measures which can positively influence RACF placements.
Research objective
This scoping review aims to identify the facilitators and barriers in sustaining the APPs between AEIs and RACFs in the context of pre-registration nursing students’ placements.