Nursing degree students’ clinical placement experiences in Australia: A survey design

AimThis study aimed to evaluate Australian nursing students’ views of placements at seven tertiary education institutions with the use of the Placement Evaluation Tool (PET).BackgroundClinical placements are a core element of healthcare education programs around the world (Chuan and Barnett, 2012) with undergraduate nursing students required to complete a prescribed number of hours as part of their degree. The quality of nursing clinical placements varies with a range of positive and negative learning experiences.DesignA survey design was used with a contemporary survey tool– the Placement Evaluation Tool (PET). Using Qualtrics software (Qualtrics, 2005) the on-line survey was distributed to approximately 6265 undergraduate nursing students at six Australian universities and one Technical and Further Education (TAFE) college where Bachelor of Nursing degree students were enrolled. Three Australian States were covered. Sites were selected where a project team member was employed.MethodsA total of 1263 nursing students completed the Placement Evaluation Tool (PET) − 19 items (rated 1–5), one global rating (rated 1–10) − following placement in three Australian States (July 2019−February 2020). Most - 618 (48.9%) completed a placement in acute care with placements positively rated overall.ResultsThe total PET mean score was 78.3% with 29.8% being ‘extremely satisfied’ (10 out of 10 – Item 20). However, 11.0% were dissatisfied with global ratings of four or less, whilst ratings between States differed significantly (p = <0.001). One third of respondents answered a free text statement relating to placement experiences, with significantly more comments from older students (p = <0.001) and from those with ratings in the lower range (p = <0.001). Three core themes emerged: 1. Staff Attitudes to Students, 2. Environment and 3. Lifestyle.ConclusionsWhilst students’ clinical experiences in Australia tend to be positive a minority reported exposure to negative staff attitudes, in unsafe environments, with lifestyle detriments. Further work is required to understand and enhance student experiences.     

Developing the future rural nursing workforce: report on a nursing roundtable

BackgroundThere are ongoing health workforce shortages in rural Australia with nurses a major component of the provision of health care. Training for nursing students in rural areas is one strategy to overcome this.AimTo explore possibilities for nursing student rural clinical placements, with a view to increase the length of placements and strengthen the future rural nursing workforce.MethodsA Nursing Roundtable was held in regional Western Australia (WA) with representatives from five Western Australian universities, tertiary providers and service clinical stakeholders. Participants attended site visits to local facilities which included primary, community and hospital-based facilities.FindingsMajor issues identified included short length of nursing placements; inflexibility of bookings via centralised placement databases; financial and family responsibilities inhibiting students taking up placements; quality of on-site supervision; and the availability of graduate programs after qualifying. Participants agreed longer student clinical placements reduced workload for academic and clinical staff allowing students to settle and be industry ready.DiscussionThere was a strengthening of goodwill and willingness of university and clinical stakeholders to work collaboratively to lengthen student placements and consider placements in non-traditional settings to expand student understanding of career possibilities, rural and Indigenous communities, and the underpinning determinants of health.ConclusionBack-to-back practicums or potential to share placements between different organisations were recognised as opportunities for further development. Efforts to increase placement length, broaden experiences and overcome financial barriers need to be addressed. Production of a marketing video to include job potential post-graduating was suggested to attract students.     

Accommodating and supporting students with disability in the context of nursing clinical placements: A collaborative action research

Aim/objectiveTo examine issues and challenges encountered by university and clinical milieus in addressing the needs of students with disability during their clinical placements; and to identify existing or potential accommodation and support measures to address the challenges encountered.BackgroundThe influx of students with learning disabilities, attention deficit disorder [with or without hyperactivity], mental health disorders or on the autism spectrum has caused an increase in the number of students with disabilities of more than 900% in universities in the past decade. This increase is causing added pressures to both the academic services providing student assistance and the personnel responsible for these students’ clinical placements. While several studies have focused on measures designed to accommodate students with disabilities during their theoretical courses, only a small number worldwide have focused on student accommodation and support in the context of clinical placements. In the current paper, strategies highlighted in these studies were grouped under three categories: prior, during and post clinical placements.DesignCollaborative action research conducted amidst three learning communities.MethodsThe larger study included learning communities from three disciplines: education, social work and nursing. Three tools helped guide the discussions: 1) brainstorming and classification tool; 2) contribution and feasibility tool; and 3) carrousel tool. The current study focusses solely on the findings from the five meetings of the nursing learning community (n = 14 participants).ResultsSix categories of challenges were documented: 1) Poor writing skills; 2) Difficulty adapting to clinical milieus; 3) Difficulty linking theory with practice and setting priorities; 4) Difficulty managing specific and situational needs; 5) Issues with interpersonal skills and overall attitude; and 6) Challenges pertaining to students’ professional responsibility to disclose their condition. Several accommodation and support measures were identified for each set of challenges and were also grouped under three categories: prior, during and post clinical placements.ConclusionsOur study revealed that the issues identified could in fact be faced by any students, albeit their impact and complexity increased considerably when dealing with students with disability. It brought to light that the implementation of some of the measures identified will require changes to the structure of nursing programs. It also highlighted the ever-growing complexity of the clinical instructor role and the fact that clinical instructors do not always feel adequately prepared to support students with disability.     

“It's not their fault”: Clinical facilitators' experiences supporting English as second language students

BackgroundInternational nursing students in Australia are faced with additional stress and challenges during clinical placements due to language and cultural differences. These factors can significantly impact their learning experience and personal wellbeing.AimThis study aimed to explore the clinical facilitators’ perspectives of the experiences of international nursing students and the potential strategies for improving their learning experiences during clinical placements.MethodsAn exploratory qualitative study was designed. Semistructured interviews with 14 participants were conducted and analysed using thematic analysis.FindingsThe findings were categorised into two categories. (1) Clinical facilitators’ perspectives on the international nursing students’ experiences during the clinical placements, and (2) Clinical facilitators’ perspectives on strategies for improving the learning experience of international nursing students. Category 1 consisted of three themes: (i) Reduce self-confidence when communicating in English, (ii) Lowered perceived self-efficacy, and (iii) Looking for a sense of belonging. Category 2 consisted of five themes: (i) Nurture a supportive environment, (ii) Use validating and understanding communications, (iii) Promote acceptance of the cultural and language diversities, (iv) Use strength-based approaches, and (v) Create opportunities for transcultural socialisation.DiscussionClinical facilitators are well-positioned to support international nursing students to achieve positive learning experiences during clinical placements. More support from the university and hospital may be needed to enable clinical facilitators to effectively implement the identified potential strategies.ConclusionThe study findings provided the background for future research to upskill clinical facilitators and support them to facilitate positive experiences for international nursing students during clinical placements.     

Clinical placements in general practice: Relationships between practice nurses and tertiary institutions

As a practice-based discipline a key component of undergraduate nurse education is clinical practice experience. The quality of clinical experiences has a significant impact on the students' ability to function competently post graduation. The relationship between higher education institutions (HEIs) and health service placement providers impacts upon the quality of clinical placements. In Australia, the growth of primary care nursing and the shortage of acute clinical places has prompted HEIs to explore the placement of students in general practice. Given the increasing attention being paid to non-traditional clinical placements, it is timely to explore how universities are establishing relationships and models of clinical placement. This paper uses qualitative research methods to explore the perspectives of 12 Australian general practice nurses who have experience in facilitating undergraduate clinical placements about the relationships between HEIs and nurses. Findings are presented in the following three themes: (1) Appropriate preparation for placement: They don't know what primary health really means, (2) Seeking greater consultation in the organisation of clinical placements: they’ve got to do it one way for everyone, and (3) Uncertainty and lack of support: I had no contact with the university. Clinical placements in general practice can be an innovative strategy providing non-traditional, yet high quality, teaching and learning experiences for undergraduate nursing students. To optimise the quality of these placements, however, it is essential that HEIs provide appropriate support to the practice nurses mentoring these students.     

Critical action research applied in clinical placement development in aged care facilities

XIAO LD, KELTON M and PATERSON J. Nursing Inquiry 2012; 19 : 322–333
Critical action research applied in clinical placement development in aged care facilities The aim of this study was to develop quality clinical placements in residential aged care facilities for undergraduate nursing students undertaking their nursing practicum topics. The proportion of people aged over 65 years is expected to increase steadily from 13% in 2006 to 26% of the total population in Australia in 2051. However, when demand is increasing for a nursing workforce competent in the care of older people, studies have shown that nursing students generally lack interest in working with older people. The lack of exposure of nursing students to quality clinical placements is one of the key factors contributing to this situation. Critical action research built on a partnership between an Australian university and five aged care organisations was utilised. A theoretical framework informed by Habermas’ communicative action theory was utilised to guide the action research. Multiple research activities were used to support collaborative critical reflection and inform actions throughout the action research. Clinical placements in eight residential aged care facilities were developed to support 179 nursing students across three year‐levels to complete their practicum topics. Findings were presented in three categories described as structures developed to govern clinical placement, learning and teaching in residential aged care facilities.     

Confidence,interest and intentions of final-year nursing students regarding employment in general practice

BackgroundRising health care burden has increased demand for general practice nurses. Exploring final-year nursing students’ perceived levels of confidence, interest and intention to work in this area can inform preparation and recruitment of new graduates into this workforce.AimTo explore final-year nursing students’ confidence, interest and intention to work in general practice.MethodsFinal-year nursing students from five universities situated in New South Wales, Australia were surveyed between March and June 2019. The survey comprised investigator-developed questions and validated tools adapted for use in general practice.FindingsOf the 355 included responses, 34.1% respondents had a clinical placement in general practice. Work experience was a significant predictor of confidence in working as a Registered or General Practice Nurse. Being enrolled as an international student, general practice placement experience and high confidence to work in general practice were significant predictors of interest and intention to work in this setting. Analysis showed a strong positive relationship between interest and intention to work in general practice, and a small but positive relationship between confidence and intention to work in general practice.DiscussionDespite generally positive views around their confidence, interest and intention to work in general practice, some respondents indicated uncertainties around these, and the usefulness of their undergraduate preparation towards PHC employment. This may be attributable to the inconsistent exposure to general practice nursing within Australian undergraduate nursing programs.ConclusionIncreasing students’ theoretical and clinical exposure to general practice enhances confidence and interest to pursue a career in this setting.     

‘Anyone can have a mental illness’: A qualitative inquiry of pre‐registration nursing students’ experiences of traditional mental health clinical placements

Nurses play a crucial role in mental healthcare provision. Like many countries, Australian nursing students are educated in comprehensive pre‐registration programmes which include mental health clinical placements. Placements play a vital role in students’ education, providing the opportunity to engage with consumers and develop mental health nursing knowledge and skills. There is limited knowledge of student perspectives on traditional placements in contemporary recovery‐oriented mental health services. This interpretive qualitative inquiry aimed to explore nursing students’ experience of traditional mental health clinical placement and how it influenced their practice and their understandings of recovery from mental illness. Data were collected from focus groups with n = 31 nursing students in a large metropolitan public mental health service. Thematic analysis resulted in three themes of experience: humanizing people with mental illness; learning about recovery; and shifting perspectives on mental health nursing. Through a positive placement experience where they felt supported and included by staff, students came to see consumers as people rather than diagnoses, developed greater understanding of mental health nursing work and were more likely to consider mental health nursing as a career choice. Peer‐support workers were an important influence on students’ understandings of recovery and have a key role to play in educating students on placement. Students need to be prepared and supported by university and clinical staff to deal with vicarious trauma that may occur on placement. Mental health placements play a crucial role in attracting students into the field, and it is imperative they remain part of comprehensive pre‐registration education.     

Consultation to review clinical placement processes: A quality assurance project

AimWorking in partnership is a key goal for nursing and community health practice. This case study reports the quality assurance process employed to enhance the process of allocating clinical places for postgraduate Maternal and Child Health nurses in Victoria, Australia.BackgroundThe review of the clinical placement process occurred because councils (placement providers) reported being overwhelmed with inquiries and applications for places, time-line issues and some confusion about processes. This situation was further compounded as these clinical placements were provided by Councils at no cost to universities or students.DesignThe Quality Assurance consultation process was guided by an action research approach and systematically explored the experience of municipalities hosting students.MethodThis involved five discrete phases: Online survey 1, Focus group, Draft consultation report, Online survey 2 and Distribution of Maternal and Child Health clinical placement process packages. Feedback was reported regarding what was working well, challenges with existing student placements and suggested strategies to improve the student placement process.ResultsCollaboration led to improvements in the clinical placement process and produced key resources for stakeholders. An unexpected outcome of the process was the development of a List of Expectations and Responsibilities for all stakeholders.ConclusionThe councils providing MCH clinical experience are highly valued by the universities and their students as clinical placement is provided voluntarily as a contribution to the MCH profession. All parties indicated it was very beneficial to collaborate to optimise this process.     

Are nurses recognised,prepared and supported to teach nursing students: Mixed methods study

BackgroundThe requirement for clinical teaching and supervision of undergraduate nursing students is a continual high volume, high impact essential requirement of registered nursing staff. Nurses are integral in facilitating the learning of nursing students in the practice environment to deliver quality safe care. However nurses engaged in teaching and supervising nursing students have unique challenges.ObjectiveTo understand how well recognised, prepared, and supported nurses perceive they are to teach and supervise undergraduate nursing students in the practice environment?MethodsNurses from 12 different wards of two hospitals were invited to participate in the study. A sequential mixed methods approach comprising hard-copy questionnaires, completed by 59 nurses, and six focus groups. Four feedback sessions verified findings.ResultsA low level of recognition and support for the amount of time available to nurses to teach and supervise was reported from both survey and focus group data. Four themes emerged from focus groups. Nurses recognised their role to teach and supervise students; The role in teaching and supervision was not recognised at a system level; Nurses could be more prepared to teach and supervise students; and Nurses required more support for their role in teaching and supervising students. A major challenge was the low level of support nurses perceived from the education sector in preparing students for placements. The nurses reported a disconnection of components of the student placement system, which was difficult to negotiate when undertaking this teaching and supervision role.ConclusionThe complex practice environment, where nursing student numbers are increasing and nurses have to navigate an often disconnected student placement system, requires a rethink of the precentorship or buddy one-to-one model of clinical placement. Addressing these challenges will be an essential step in protecting the interests of the public, nurses and nursing profession.     

Nursing students' lived experience of a clinical placement in prison healthcare: A systematic review

AimA systematic review of the literature to explore nursing students’ lived experience of a clinical placement in a healthcare setting in a prison, to identify how and if their needs were met to enable an optimal learning environmentBackgroundThere is an increasing demand for clinical placements to support undergraduate/prelicense nurse education, especially within primary and community healthcare settings. A clinical placement in a prison has the potential to provide multiple learning opportunities for nursing students due to the unique requirements of prisoners. However, there remains a need to understand nursing students’ experiences of a clinical placement in a prison.MethodsThe updated PRISMA guidelines for reporting systematic reviews guided the development of this study. Inclusion and exclusion criteria informed the search strategy of recognised MeSH terms and Boolean operators, which were applied to search CINAHL complete, APA Psycinfo, MEDLINE, Google Scholar and Grey Open. Manual searching of the reference lists of all identified studies was completed. Standardised critical appraisal instruments were applied to each included study. Data extraction and analysis was completed by adhering to the thematic analysis process described by Thomas and Harden.ResultsThe electronic database and reference list search identified 81 studies published between January 2000 and December 2021 in the English language, which was reduced to the inclusion of five studies. Following screening, studies were completed in USA (n = 2), Australia (n = 1), Canada (n = 1) and UK (n = 1). A total of 228 nursing students had completed a clinical placement in prison. Four themes were identified: 1) pre-placement anxiety; 2) a sense of safety; 3) impact on negative stereotypes; and 4) an opportunity for learningConclusionThe voluntary and opt-in nature of clinical placements in prison may have created some bias in the results. However, standardised preparation and orientation of nursing students prior to commencing a clinical placement in prison is essential. Nursing students require structured support to understand their anxieties, the rules and regulations of security and how to interact with prisoners prior to entering a prison. Clinical placements within prison provide nursing students with an opportunity to challenge negative attitudes towards diverse and marginalised populations, develop clinical practice, knowledge and become socialised into the profession. However, the experience, knowledge and willingness of Registered Nurses to support nursing students is essential, to enable and empower their learning within this non-traditional clinical placement.Tweetable abstractOn completion of a placement in prison healthcare nursing students identified pre-placement anxiety, a sense of safety, impact on negative stereotypes and an opportunity for learning, however, the need for preparation, orientation and realistic understanding of safety remains.     

Flexible rostering in nursing student clinical placements: A qualitative study of student and staff perceptions of the impact on learning and student experience

AimTo explore whether a flexible rostering system for nursing students during their clinical placements enhanced their experience and contributed to a positive learning environment.BackgroundIn England, attrition from nursing programmes is an enduring issue, often related to student experience of clinical placements. Students juggle caring responsibilities, academic assessment and additional part-time jobs to mitigate financial hardship, while they are undertaking the clinical placement aspect of their courses. Flexible or self-rostering is a system that has been implemented with qualified practitioners in several NHS organisations and may present a solution to the need for flexibility in clinical placements for students.DesignThis was a qualitative pre-and post-intervention study.MethodA flexible rostering system was co-produced with nursing and midwifery students and subsequently implemented in four in-patient areas in an inner-city NHS healthcare organisation between November 2019 and February 2020. Qualitative interview data were collected from participating students and NHS staff from participating clinical areas, before and after implementation between October 2019 and February 2020.ResultsThree focus groups and one interview were undertaken pre-intervention, involving 13 students. Seven students and seven staff participated in a focus group or interviews post implementation. Findings indicated that the flexible rostering system gave students control over their work-life balance and enabled them to feel empowered in their clinical areas, less anxious and more focused on their development. Clinical staff reported unexpected benefits in terms of student attitude and attendance, allowing them to focus on teaching rather than dealing with concerns or changing the rota. Some staff felt there were challenges with implementation, which both students and staff agreed could be addressed by developing rostering guidelines.ConclusionThe findings indicate that wider implementation of the flexible rostering system should be recommended to capitalise on the personal and contextual benefits.     

Validating the Nurse Professional Competence Scale with Australian baccalaureate nursing students

BackgroundProfessional competence is necessary to enhance patients’ quality of care and safety, however not much is known about nursing students’ perceptions of their professional competence at the point of graduation, particularly in the Australian context.AimTo validate the Nurse Professional Competence (NPC) Scale in the Australian context and explore graduating nursing students’ perceptions of their own competence and their suggestions to improve their learning experience.MethodA cross-sectional survey incorporating the NPC Scale was conducted with nursing students at the point of graduation at one large Australian University.ResultsFifty-six graduating nursing students completed the NPC Scale. Scale reliability measured via Cronbach’s alpha was 0.96. Almost 80% of students felt confident with their nursing skills and felt that the nursing program had prepared them for a graduate position as a registered nurse. Students reported their highest competence was in Value-based Nursing Care (m = 89.4) and Documentation & Administration of Nursing Care (m = 86.7), and the lowest were Development, Leadership & Organisation of Nursing Care (m = 80.9) and Care Pedagogy (m = 83.0). Students’ most common suggestion to improve the learning experience was to provide additional clinical workplace experience.DiscussionThe NPC Scale demonstrated excellent reliability in the Australian context. The areas that scored highest and lowest on the NPC were congruent with findings using this instrument in other countries.ConclusionFurther validation of the NPC Scale should include a larger sample that includes both graduating nursing students from multiple universities as well as registered nurses and incorporates confirmatory factor analysis.     

Preceptors’ perceptions of supporting nursing students in prison health services: A qualitative study

BackgroundOur university commenced clinical placements for third-year nursing students in Prison Health Services (PHS) in 2014. Registered nurse preceptors employed in these services facilitated students’ experiential workplace learning, assessed their competence and assisted them to meet course objectives in this challenging environment. To date, no studies have examined preceptors’ experiences of supporting students in the prison health setting.AimThe study aim was to investigate preceptors’ perceptions of supporting nursing students undertaking clinical placements in PHS, in order to inform development of resources and processes.MethodsQualitative data were collected via a focus group and interviews with preceptors (n = 6) working in metropolitan PHS. Data underwent thematic analysis.FindingsParticipants valued the opportunity to support student learning, finding students contributed to the workplace by bringing in new ideas, and conducting beneficial projects. However, preceptors requested better rostering and workload management by their employer. They also wished for more detailed information from the university regarding student orientation and preparation to support student learning. They felt that the employer-provided preceptorship training did not fulfil their needs.DiscussionPreceptors in PHS settings shared many of the support needs of those in other settings, although some challenges were more specific to the setting.ConclusionThis paper makes recommendations on how preceptors in PHS can be better supported to fulfil the role.     

The impact of covid-19 on psychosocial well-being and learning for australian nursing and midwifery undergraduate students: a cross-sectional survey

AimTo explore the impact of COVID-19 on psychosocial well-being and learning for nursing and midwifery undergraduate students in an Australian university.BackgroundThe World Health Organization has reported a substantial psychological impact of COVID-19 on healthcare professionals to date. Evidence is lacking, however, regarding university nursing and midwifery students of the pandemic and its impact on their educational preparation and/or clinical placement during the COVID-19 pandemic.DesignCross-sectional survey of nursing and midwifery undergraduate students enrolled in the Bachelor of Nursing suite of courses from the study institution in August- September 2020.MethodsA cross-sectional self-administered anonymous online survey was distributed to current nursing and midwifery undergraduate students. The survey included three open-ended questions; responses were thematically analysed.ResultsOf 2907 students invited, 637 (22%) responded with 288 of the respondents (45%) providing a response to at least one of the three open-ended questions. Three major themes associated with the impact of the pandemic on psychosocial well-being and learning were identified: psychosocial impact of the pandemic, adjustment to new modes of teaching and learning, and concerns about course progression and career. These themes were underpinned by lack of motivation to study, feeling isolated, and experiencing stress and anxiety that impacted on students’ well-being and their ability to learn and study.ConclusionsStudents were appreciative of different and flexible teaching modes that allowed them to balance their study, family, and employment responsibilities. Support from academic staff and clinical facilitators/mentors combined with clear and timely communication of risk management related to personal protective equipment (PPE) in a healthcare facility, were reported to reduce students’ stress and anxiety. Ways to support and maintain motivation among undergraduate nursing and midwifery students are needed.     

Promoting patient safety using electronic medical records in nursing/midwifery undergraduate curricula: Discussion paper

This discussion paper highlights the importance of Australian nursing and midwifery students’ lack of exposure to electronic medical records during their undergraduate programs. There is pressure on universities offering nursing and midwifery programs to provide students with opportunities to learn to use patient electronic medical records. This will provide authentic rehearsal with the digital technology prior to clinical placements and increase graduate work readiness.Informed by contemporary literature, we describe the benefits of implementing electronic medical records (eMR) in health organisations and identify the challenges and barriers to implementing and integrating the education of electronic records into undergraduate nursing and midwifery programs. Undergraduate students who had not experienced eMR as part of on-campus learning felt unprepared and lacked confidence when commencing clinical practice. Some international nursing and midwifery programs have found that student’s skills improve in decision-making and documenting patient observations when eMR is integrated into their university education program. Successful integration of an eMR program should consider academic/teaching staff skills and confidence in technology use, initial and ongoing costs and technical support required to deliver the program.In conclusion, Australian universities need to embed eMR learning experiences into the nursing and midwifery undergraduate curricula to increase students work-readiness with a focus on patient safety.     

Mental health stigma and undergraduate nursing students: A self-determination theory perspective

BackgroundClinical placements are essential in preparing students for professional practice. Given the serious negative impact of stigma on people with lived experiences of mental illness, it is essential to explore whether the educational setting of a clinical placement can influence mental health stigma.AimsUsing a Self-Determination Theory lens, this study aimed to examine whether the educational setting of a clinical placemen influences the stigma of undergraduate nursing students toward people with lived experiences of mental illness.DesignQuasi-experimental; pre-test post-test.MethodsNinety-nine undergraduate students enrolled in an accredited nursing program within Australia completed two surveys pre- and post-clinical placement. The surveys measured the educational setting (learning climate) and mental health stigma (social distance).FindingsStudents who partook in an Autonomy-Supportive mental health clinical placement reported a significant decrease in stigma from pre-to-post placement, whereas the Balanced/Neutral group reported a significant increase in stigma from pre-to-post-placement.DiscussionThe findings of this research have considerable implications for nursing facilitators and preceptors. Those that support autonomy amongst future nursing professionals are more likely to positively influence students’ mental health stigma. Those who do not promote an autonomy-supportive setting may actually worsen mental health stigma.ConclusionThe educational setting in which a clinical placement occurs can influence nursing students’ mental health stigma.