Unsafe student clinical performance calls for a systematic approach

Patient safety is the responsibility of both the system and the individual practitioner. Unsafe incidents are a very real possibility when nursing students are preparing for their profession. The curriculum committee of the Nursing Education Program of Saskatchewan (NEPS) identified the need for a unified and consistent process related to students who demonstrate unsafe clinical performance. Many clinical teachers experience difficulty in identifying and making decisions related to students' unsafe performance. The authors describe the development of a systematic approach that was adopted by NEPS in June 2005 and is being used across all program years and sites. The approach provides students with a fair and just process and reflects the responsibility of the educational program to prepare graduates who will provide safe, competent care.     

Classifying specialist student practice: debates and dilemmas

At present, the practice elements of the Specialist Community Practitioner Awards within the BSc (Hons) in the Community Health degree course at Manchester Metropolitan University do not directly contribute to degree classification. Student evaluation and external examiner concerns about the heavy assessment load motivated the course team to consider classifying practice at 20 Level III credits which would replace 20 theory credits. The process of developing a credible assessment tool for specialist practice was long and hard but the course team is now in a position to undertake an exploratory study of the assessment and classification of practice. This paper provides an overview of the discussion and debates that took place in the years before the study began. A future paper will provide detail of the study and will include practice educators, students and managers views on the structure, process and outcomes of marking specialist student practice in community settings.     

Policies and procedures for scheduling student nurses

A smoothly operating system for student clinical affiliations can save staff time and positively influence recruitment and retention. To ensure a systematic approach to scheduling students, the author shares her approach, policies, and procedures.     

Evidence-based policy and procedures: an algorithm for success

Evidence-based practice is defined as the use of current best evidence by clinicians when making patient care decisions. Barriers to an evidence-based practice are well identified in the literature and significantly impact the use of research findings in practice. A key feature of a practice environment that supports and promotes the use of best evidence is requiring clinical practice policies and procedures to be evidence-based. The authors describe the structure and process developed to facilitate evidence-based policies and the outcomes of the initiative.     

Federal CAT policy: politics and practice

The critical care nurse encounters a patient in a setting that is charged with overt physiologic needs that are addressed by an array of healthcare providers in a setting dominated by covert political dynamics. Understanding these dynamics can empower critical care nurses to create a voice of agency to advocate disciplinary nursing concerns. Policy skills enable nurses to participate in meaningful ways in the policy process. As conventional and complementary practitioners interact, critical care nurses are likely to confront difficult issues. Insight into the processes that shape the federal CAT agenda allows nurse educators, researchers, and clinicians to anticipate likely effects on their own domains of practice. The ability of nursing as a professional discipline to engage in appropriate political and policy activity concerning CAT policy is enhanced by understanding the complex nature of that discourse.     

Parent-nursing student communication practice: role-play and learning outcomes

Parents accompanying their child's hospitalization can experience stress associated with the child's illness, treatments, and major alterations in family life. Nurses often serve as the primary communicator and cultural broker because of their constant presence at the child's bedside. Nursing students may not have essential parent-nurse communication competencies. In an innovative method of teaching nursing students about communicating with parents, 64 undergraduate nursing students participated in a parent-led postconference with a nursing instructor. The parents provided background and led role-play activities and debriefing sessions with students. Feedback provided by students before and after the parent session included requests for additional parents' experiences, appreciation and exceeded expectations of hands-on experience, recognized value of information provided, and the recommendation that all students attend. We demonstrate that empathy is a teachable skill, nursing students are apprehensive about communicating with parents, and nursing students do not understand how much families rely on nurses.     

Assessing practice of student nurses: methods,preparation of assessors and student views

AIMS: To describe the methods of measuring progress in achieving competence of preregistration nursing and midwifery students used by institutions of higher and further education in Scotland and to describe the philosophy and approaches to competence assessment in each institution. BACKGROUND: Institutions of higher and further education in Scotland operate a variety of schemes to assess the clinical practice of student nurses. These are based on different philosophies and practices and this raises the question of which are valid and reliable. METHODS: All institutions in Scotland providing validated Diploma of Higher Education programmes for preregistration nursing and midwifery participated in this study. Data were collected by postal questionnaire, review of programme documentation and supplemented with interviews with key stakeholders. The directors of the 13 programmes (seven nursing and six midwifery programmes) were surveyed and also 12 group interviews with students (six nursing and six midwifery student groups) from seven institutions. Students from all four branches were represented and 72 students (36 nurses and 36 midwives) were interviewed. RESULTS: Four key findings were identified and related to competence assessment methods, preparation of practice assessors, consequences of failure to meet expected level of outcome and students' views. CONCLUSIONS: There has been a change in theoretical frameworks of assessment instruments used since the 1992 programmes commenced and only a limited number of approaches to clinical assessment are used in Scotland. Students' views suggested that they had little confidence in methods of clinical competence assessment and there was no formal validity and reliability testing within institutions. A lack of consistency in the training of student assessors in the clinical areas was identified. Some of these issues may be resolved with the development of a national instrument for competence assessment.     

Fitness to practise for student nurses: principles, standards and procedures

Since 2009, all schools of nursing have been required to establish a fitness to practise committee to consider any pre-registration student health or character issues (Nursing and Midwifery Council, 2008). In 2009, fitness to practice standards were published (NMC, 2009a). This article outlines how fitness to practise procedures apply to nursing and midwifery students in the U.K. and explains the key differences between how they are applied to trainees and to registered nurses.     

Preoperative fluid restrictions: hospital policy and clinical practice

This study examined the practice of preoperative fluid restrictions and the influence of the hospital 'nil by mouth' policy on clinical practice. Structured interviews were used to assess the knowledge of nurses and anaesthetists relating to current hospital policy, their attitudes to fluid fasting and the constituents of clear fluids. The interval between the last intake of fluid and the induction of anaesthesia was measured in 90 adult patients to determine actual periods of fasting. It was found that most patients on the same operating list commenced fasting simultaneously with little or no attempt made to individualize the timing which contributed to prolonged periods without fluids, ranging from 3 hours 30 minutes to 17 hours and 45 minutes. Only 30% of nurses were aware of the hospital policy compared with 75% of anaesthetists. The evidence from this study demonstrated that the hospital policy was not reflected in clinical practice which continued to be based on tradition.