Becoming a Nurse Aide: An Investigation of an Existing Workplace Curriculum in a Nursing Home

Although nurse aides take on a high share of care activities in nursing homes, almost nothing is known about how they develop the knowledge and skills to do so. This study attempts to close this research gap by answering the following research questions: (1) How do novice aides learn and develop and how is their learning trajectory structured? (2) What are the potential and problems of these informal training schemes? (3) How can the enacted training schemes be improved to assure effective and efficient learning and development of novice aides? In total, 19 nurses were interviewed to answer these questions. The analysis revealed that novice aides learn almost exclusively through observation and imitation as well as explanations of more experienced nurses. The typical learning trajectory of aides is structured such that they start to care for residents described as simple and progressively proceed to take care of more difficult ones. Such a trajectory allows nurses to construct hierarchically ordered knowledge in a meaningful way, minimises consequences of potential errors, and attempts to avoid discouragement that leads to early dropout and turnover. Strong learning potential has been found in more formalised discussion opportunities where collective experience with residents is discussed. Problems in acquiring the required knowledge and skills arise especially when instructing nurses believe that the prior experience of novices is sufficient for the work at hand, as well as when work practices require competences that are highly opaque. Suggestions of how to avoid pitfalls and how to foster existing learning potential are given.