The present program of in-service trainingfor instructors in the state-aided practical nurse programs in Massachusetts was established under the auspices of the Division of Vocational Education of the Commonwealth of Massachusetts, and it utilizes Federal, state, and local funds. Such in-service training is required by the overall state plan which was formulated for the development of practical nursing schools in 1956.
The aims of the in-eerviee education program
The objective of the in-service education program for instructors in the practical nurse program and in the health occupations is to develop effective teaching competencies. One of the aims of this objective is to ensure that the instructor has the ability to and does understand the philosophy of vocational education and the manner in which practical nursing education is a part of the vocational picture. To enable an instructor to understand the philosophy of vocational education, the educational needs of the students are used as the focal point around which teaching methods are developed. These needs of the learner are stressed in all programs of teacher training.
The other major aspect of in-service education concerns the content of the courses. In the ever-changing world of medical and nursing practice, a deep concern of the nurse educator is the responsibility to keep abreast of the newest developments or variations in nursing practice. The professional nurse-instructor must be aware of new techniques in clinical nursing, even when these techniques are not included in the current practical nurse curriculum. It must be remembered that these developments, either now or in the future, will influence the functions which the licensed practical nurse is called upon to perform. Nursing education is realistic only when it recognizes the changing aspects of the job descriptions or of the duties which nurses are called upon to perform. Therefore, the second major aspect of in-service teacher education deals with current clinical practice in nursing.
The accomplishment of these two major goals, an understanding of the role and art of practical nursing and the quality and content of the courses in practical nursing, are carried out in a variety of ways by in-service education programs conducted in the nursing schools in Massachusets.
The statement of qualification for instructors in the practical nursing programs is the foundation upon which candidates are selected before receiving approval for employment in an established program of Practical Nurse Training in a state-aided day school. In Massachusetts, fliese qualifications include registration as a professional nurse, a baccalaureate degree, and 6 years of experience in nursing, including the basic nursing education program. It is preferred that the candidate have had several years of experience in teaching nursing, and activity in a general nursing situation rather than in specialty nursing. The number of years of teaching experience required is not spelled out since we are not always able to find nurses with a teaching background. The minimum age is 24 years, and the maximum is 50 for admission to the teacher education program. The regulations are an attempt to attract well-educated nurses who have had active nursing and teaching experience.
It is the duty of the state supervisor of nursing to interview candidates for employment in the local practical nurse schools. Qualifications must be approved by the Assistant State Director of Vocational Education, upon recommendation from the state supervisor, before a candidate's name can be added to the list of qualified persons to be considered for employment by the local school committees.
At the time of the initial interview, the candidate is asked about her attitude toward the role of the practical nurse in the modern nursing team. It is an unwritten rule that the nurse must be concerned with the development of this area of nursing education and have a constructive attitude toward the growth of practical nursing. During this initial interview every candidate is informed of the general development of practical nurse education in Massachusetts, the types of sponsorship of such schools, and the organizational patterns of the vocation al programs for practical nursing. The elicting of the candidate's attitudes, and the general discussion of the need for practical nurses and good practical nurse education are the beginning of the orientation of the new teacher.
If there is sufficient time before the date of the new instructor's initial appointment, she is offered the opportunity to take the teacher-training program offered yearly, the last week of June and the first week of July in certain state colleges, by the Vocational Division of the Commonwealth's Department of Education. She then enters the new position with the assurance of knowing the methods of teaching found to be successful with the type of student she will be instructing.
If there is not sufficient time for the instructor to attend this course on a pre-service basis, the supervisor provides an orientation program for the new instructor in a series of weekly conferences.
The in-service orientation program uses three approaches to in-service orientation: (1) conferences, (2) reference reading, and (3) visitation of on-going programs. What are the major problems of the new nurse-instructors who are dealing with practical nurse education for the first time? First, lack of experience with adult students, as contrasted to the majority of professional nurse students who are essentially in the adolescent age group.
Conferences. In conference the needs and aims of the older student are discussed. Because of her experience with adult patients, the nurse-instructor usually has a sound insight into the psychologic needs, the economic problems, and the home responsibilities of women in the age group 35 to 50 who may be among her future students. The understanding of the student and the barriers which her home situation may place before her success in her study and in her clinical experiences are reviewed at some length. This logically leads into a consideration of methods of encouraging scheduling of study hours in the home, the manner in which other members of the family may cooperate to free the student-mother for adequate time to concentrate on her assignments and, most important, methods which the teacher herself can use to help the student gain the maximum benefit possible from each hour in the class and clinical areas. The use of group projects centered on nursing care studies, research concerning community health activities, or new developments in clinical research in a disease such as cancer are discussed. The use of audiovisual aids, movies, slides, bulletin boards, records, etc., are emphasized. Sources of readable, free materials ' which may be taken from the classroom to the home and applied to some of the individual family problems are pointed out. The instructor is assisted to see how she can aid not only her student to efficient study but also involved family members in this effort, and indeed, use public health materials to improve family nutrition, budgeting, weight problems, social adjustments, etc.
The new nurse-instructor must also be prepared to deal with younger members in her class, many of whom may be recent graduates from high school. The art of understanding the needs of her students at different levels of education, emotional development, and responsibility in life, and the attempt to bring these individuals into a happy and fruitful class group are major challenges to the nurse-instructor. She is given an opportunity during the conferences to think through her approach to the various problems involved before her class enters the program.
Reference reading. As a follow-up to the initial information offered during the pre-employment interview concerning practical nurse education In Massachusetts, the new instructor is offered a series of reference readings to enable her to build up a general knowledge of the field. The National League for Nursing has designed a loan folder which contains many of the more important statements concerning practical nurse education. The instructor is advised to send for this folder, and the material is reviewed with her. In addition, the relatively recent "Guides for Developing Practical Curricula for the Education of Practical Nurses" from the U.S. Office of Education is used as a basic reference to help the beginning instructor to grasp the more modern concepts regarding the philosophy and scope of the practical nurse curriculum. Copies of the newer curricula of schools for practical nurse education in the vocational programs are also made available to the new instructor so that she may compare and study the approaches in the various programs.
Consultations with the executive secretary of the Board of Registration in Nursing assist the new instructor to see herself as part of the total nurse education effort in the Commonwealth. She may also confer with the registrar of the Board of Registration in Nursing, who will allow copies of the older state licensure examinations to be examined by faculty members who want to familiarize themselves with the field.
Visitation of on-going programs. During the first few months of employment, the new instructor visits selected practical nurse programs conducted with the vocational Bchools. Several organizational patterns are studied. The instructor may visit a community where health agencies are utilized for clinical experience for the students, or a community where only one hospital participates in the program. She may visit a program centered within an established vocational school building which has been renovated to provide suitable laboratory and class facilities. On the other hand, she may also visit a program which is located outside of the school plant and in an unused portion of a community health agency. The problems of channels of communication, policy decisions, etc., may vary in such settings, even though the principles of administration are the same. It is important for the instructor to realize that the program is developed according to the needs and resources of a community and that the local citizens support the pattern of growth most useful to the particular locality. The oft-stated fear of Federal control stemming from use of Federal funds is very quickly seen to be based on a fallacy when the programs are observed. Each program bears the characteristics of the community which it serves.
When the nurse-instructor enters the program as the second or third faculty member in the practical nurse department, the director of the school and the nurse co-ordinator of the program work with her to cover the information and philosophy previously described. This is done on an "on-the-job" basis, after the instructor has assumed teaching responsibilities. In the case of a nurse who is to initiate the program of practical nurse education in a new area, the supervisor is responsible for this orientation, which takes place before she holds her first class in the program. Depending on the time available, the orientation conferences may consume as many as 144 hours, or they may be limited to approximately 100 hours. The actual curriculum or course content is planned and studied in the light of the philosophies reviewed during these conferences.
The formal program of vocational teaching methods
Either before or during the first year of employment, hopefully after the instructor has had an opportunity to become aware of the problems and challenges of practical nurse education, she is required to take the 60-clockhour course in vocational teaching methods, which is offered annually during the last week of June and the first week of July at one of the state colleges. This program is a part of an on-going effort to train certain types of craft teachers. These teachers are then employed either in the vocational high school course or in approved vocational departments in public high schools.
The particular course which the nurses take is designed for teachers entering vocational education with at least a baccalaureate degree and a professional background in one of three fields: home economics, distributive education, and health occupations, e.g., nursing, dental assisting, or medical laboratory technology. The selection of groups was made after experimentation with other plans. Grouping seems to bring together a class fairly homogeneous in educational background and in dedication to their profession, while it offers diversity enough to be a fair test of the students' proficiency with certain teaching techniques.
The first 30 hours of the course is conducted by a teacher-trainer who is a member of a team which serves the vocational division. It is his responsibility to present the philosophy and objectives of vocational education, its history and development in Massachusetts, and the major Federal and state laws which have provided financial support and enabled the growth of this area of education. He also describes the overall areas of education such as agriculture, home economics, trade and industry, technical education, distributive education, practical nurse education, adult homemaking education, and supervisory training whick the total program offers in the Commonwealth. During the past 2 years, increasing emphasis has been placed also on the role of vocational education in the re-training of unemployed adults under the Manpower Training and Development Act.
Following this general information about vocational education, the teacher is instructed in the handling of forms for recording attendance and ratings in skills which is required by the programs. During the latter part of this first week, the students begin to discuss the basis upon which their lesson plans are constructed and the job analysis in which skills are isolated and on which teaching plans arebased. Theconstruction of a lesson plan follows, with emphasis on organization to present information which must be learned, information which is related to the kernel of the lesson, and information which is interesting but not essential for the grasp of the concept or the gaining of a new skill. This, then, is the target upon which the lesson plan is built Then follows information on methods of involving students in the learning process.
During the second week particular emphasis is placed on the preparation of a model lesson plan and the demonstration of practice lessons. The class is sectioned into groups containing representatives of the various fields. The nurses have the opportunity to present demonstration lessons to members of other professions. The acquisition of simple skills by lay persons stresses the strengths and weaknesses in the presentation of the lessons. In turn the nurses act as students for the teachers of home economics and distributive education. In this type of cooperation greater understanding is fostered among the groups participating in the effort of vocational education. Students are asked to evaluate the usefulness of the program and how they plan to alter their teaching. Followup activities consist of visits by the supervisors to the classes throughout the state. The local directors also cooperate in assisting the teachers to best use the teaching techniques developed. The use of audio-visual aids, including instruction by closed circuit television, is stressed in some fields.
Professional improvement conferences
Every teacher within the state-aided vocational program is required to maintain complete command of his or her specific trade or profession in order to keep abreast of changes within the particular field. To provide an opportunity to meet this requirement, an annual Professional Improvement Conference is held during the last week of June at a state college. Instructors who fail to attend this program must offer a substitute plan of professional improvement which meets the approval of the local director and the state supervisor in charge of a particular field in the Division of Vocational Education. Every third year the instructor is required to undertake actual work experience in his field, or to take courses related to his major responsibilities in the school for at least 30 clock hours.
At the yearly professional improvement conference, instructors are offered an opportunity to remain in residence rather than to commute. Therefore, they have many informal occasions when conversation with other instructors from various schools in the state can shed light on common problems. Conferences are presented for different groups of teachers and the topics range from the latest content in a certain field of work to courses in the psychology of learning, the use of audio-visual aids, leadership and conference leadership methods, and evaluation of student growth.
On-going in-service education
Faculty meetings are conducted at intervals throughout the year in the local schools, and nurses are invited to sit in with the faculty. In this way they learn the problems and progress of the school as a whole and become identified with the total progress which is being made on both the high school and posthigh-school levels. At one school, the nearest State College offers extension courses during the winter months, and faculty members are encouraged to take such courses.
Informal ratings for teachers are held in most schools. Although the seniority basis is commonly used as a basis for yearly increments in salaries, at least one of the newer schools evaluates teacher proficiency and established increments on the basis of the growth and ability shown during the year. The evaluation of teacher activity is still far from well defined, but it is definitely beginning to acquire clarity. The evaluation is done by the local director and serves as a method of in-service education within the school.
Throughout the year the supervisors visit as many programs as possible and make an effort to confer with instructors after sitting in at least one of the classes with her. In this way the state supervisor attempts to assist the local instructor and to be aware of the caliber of instruction being offered. In larger school systems local supervisors may visit classes in the course of the year.
Instructors in the practical nurse programs, like other vocational instructors, are expected to belong to the Massachusetts Vocational Association and to attend regional and state-wide meetings on overall problems of vocational education. In addition, the nurses belong to their own alumnae groups.
The total program of in-service education may be summed up as a cooperative endeavor involving state and local efforts. An interested attitude on the part of the instructor, who is expected to take advantage of the various channels through which she can improve her work and be aware of professional progress in her field, is the foundation of the success of this program.