Educational silos in nursing education: a critical review of practical nurse education in Canada.

Changes to practical nurse education (with expanded scopes of practice) align with the increasing need for nurses and assistive personnel in global acute care contexts. A case in point is this critical exploration of Canadian practical nursing literature, undertaken to reveal predominating discourses and relationships to nursing disciplinary knowledge. The objectives of this poststructural critical review were to identify dominant discourses in practical nurse education literature and to analyze these discourses to uncover underlying beliefs, constructed truths, assumptions, ambiguities and sources of knowledge within the discursive landscape. Predominant themes in the discourses surrounding practical nurse education included conversations about the nurse shortage, expanded roles, collaboration, evidence-based practice, role confusion, cost/efficiency, the history of practical nurse education and employer interests. The complex relationships between practical nursing and the disciplinary landscape of nursing are revealed in the analysis of discourses related to the purpose(s) of practical nurse education, curricula/educational programming, relationships between RN and PN education and the role of nursing knowledge. Power dynamics related to employer needs and interests, as well as educational silos and the nature of women's work, are also revealed within the intersection of various discourses.

Labouring to nurse: the work of rural nurses who provide maternity care.

INTRODUCTION: This research takes up the standpoint of nurses who provide maternity care to women and families in six different communities of one geographically isolated area of British Columbia, Canada. This first report (phase one of the study) focuses on describing the complexities of rural nursing work and identifies some possibilities for change that would better support nurses in their work. METHODS: This study was guided by institutional ethnography and included both observations of nursing work and interviews with expert informants about nurses' work of providing maternity care in rural communities and geographically isolated small towns. Nurses were asked to describe their work in as much detail as possible, and chronological accounts were constructed. Analysis focused on painting a complex picture of the work of rural nurses and identifying traces of social organization for further investigation. RESULTS: Overall, the work of nurses who provide maternity care was characterized as broad in scope, as requiring complex knowledge and skills, with a significant amount of professional responsibility in an environment with limited resources. Rural nursing work was also grounded in nurses knowing their community. An adequate number of skilled nurses was consistently identified by all participants as essential for the safe provision of maternity care. Since opportunities to learn the skills needed to provide maternity care were difficult to obtain in small rural settings, nurses also identified affordable and accessible continuing professional education as the most important strategy for recruiting and retaining rural nurses. CONCLUSIONS: Phase one of this study has confirmed the complex and contextual nature of rural nursing work. Phase two, which is currently underway, is exploring the institutional discourses, structures and work processes that obscure this complexity and regulate, rather than support, rural nurses' work of providing maternity care.