Optimizing Prelicensure Students' Learning in Clinical Settings:Addressing the Lack of Clinical Sites

Abstract

IN 2009, THE NLN COMMISSIONED A NATIONAL SURVEY TO EXAMINE CLINICAL EDUCATION IN PRELICENSURE RN PROGRAMS (Ironside & McNelis, 2010). Respondents were asked to identify the organizational and structural barriers and pedagogical challenges they faced in optimizing students' clinical learning. For each of the top five barriers and challenges they chose, respondents were asked to identify strategies they used, along with their perceptions of the effectiveness of those strategies. The most frequently identified barrier was of quality clinical that can accommodate the number of students in my group and/or provide experiences relative to the learning objectives of my course. Indeed, for more than half of the 2,386 respondents, this barrier was ranked among the top five barriers they faced. The three most frequent strategies faculty employed to address the lack of quality clinical were: * Providing clinical rotations on evenings, nights, weekends, and/or holidays * Substituting simulation activities for clinical hours * Providing more observational experiences for students during clinical time. Despite their prevalence, faculty perceived these strategies to be only somewhat effective in addressing this barrier. To learn more about efforts to address this barrier, respondents' free-text comments, offered at the end of each section of the survey, were analyzed. These comments highlighted efforts to find more quality clinical and to use alternative (typically referred to as non-acute-care sites). Finding More Quality Clinical Sites Faculty respondents frequently described finding more quality clinical sites as a strategy they used in response to limitations imposed by clinical agencies on the number of students per setting or unit (and the types of care students could provide); to limited numbers of available preceptors; or to losing a clinical site to another school. The challenge of securing appropriate clinical will likely continue to intensify as schools respond to the need for more nurses in the workforce by enrolling more students. In many cases, respondents also described growing competition among schools as they vied for limited clinical and the hostility this competition created. Finding quality clinical often resulted in increased travel time for both faculty and students, particularly for those in rural areas. In addition, as with many other strategies respondents identified throughout the survey, efforts to find more quality clinical often created other problems, such as increasing administrative time for faculty; scheduling difficulties for faculty and students; limiting the time available for faculty to provide adequate guidance and supervision to students; and consuming precious clinical time with multiple site orientations. As one respondent stated: [The lack of quality clinical sites] has forced us to recruit more and scatter smaller number of students across them ... huge increase in administrative time and orientation hassles! Finding quality clinical not only touches on the number of sites, but also on the working environment in existing sites. Several respondents expressed concern about the burden students place on staff nurses who must try to provide quality patient care while simultaneously precepting nursing students and/or new staff hires. A number of quotations reflect this concern: * So many schools use the floors, the staff are overburdened with student presence and can become resistant to working with students. As a result, students have had negative experiences during clinical. * Agencies are over-studented and often burnt out. Also [students are] competing for space with [the unit's] orientees. * Students are falling over each other in the hospitals. I think it is sometimes overwhelming for the patients to deal with. …