Elsevier

Nurse Education Today

Volume 29, Issue 6, August 2009, Pages 630-634
Nurse Education Today

Journeying through clinical placements – An examination of six student cases

https://doi.org/10.1016/j.nedt.2009.01.009Get rights and content

Summary

Introduction

How student nurses are permitted to participate in healthcare settings during placements is central to their skill development, formation of occupational identity and retention in nursing. Novices’ participation and learning was mapped through their clinical experiences from student to graduate, as part of a multi-method longitudinal study examining nurses’ workplace learning.

Methods

Twenty-nine second and third year nursing students participated in a series of interviews over a two year period. Six students, representing a cross-section of a student cohort form the basis of this case study. Interviews were transcribed verbatim and thematically coded.

Results

Four themes encapsulating the participants’ journeys through clinical situations were identified; (a) creating learning opportunities, (b) gaining independence, (c) becoming part of the team and (d) generational differences. The themes reflect the development of novice nurses and the nuances of the workplace as a learning environment.

Discussion

The cases highlight the importance of supportive placements that comprise openness with opportunities, tolerance of inter-generational differences and invitations to become part of the nursing team. The challenge for nurse educators is how to best prepare students for the complexities of the social, cultural and political arena of clinical practice.

Introduction

Australian pre-registration nurse education was transferred from hospitals to universities in the 1980s. Students nurses’ clinical practice is now gained through clinical placements sequenced throughout their undergraduate degree. Yet, learning the specific and changing requirements of nursing work is most likely shaped by how these students are permitted and elect to participate in work activities and interaction (Billett, 2006). Workplace factors, such as cliques, hierarchies and affiliations serve to regulate the “distributions of activities, interactions and judgments about the individual” (Billett, 2006, p. 41) and in ways not always aligned to effective working or learning. The focus of this paper is drawn from student interviews that were undertaken as part of a funded three year longitudinal project examining workplace learning in nursing.

Section snippets

Literature review

Workplaces have distinct practices because of their culture, norms, history and workforce composition, thereby requiring particular ways of working, even across the same occupation (Billett, 2003) that need to be learnt. Learning and knowledge can be understood from two perspectives: the individual and the social (Eraut, 2004). The individual perspective assists in understanding how people learn and what they contribute to the construction of knowledge. The social perspective emphasises the

Sample

Twenty-nine Bachelor of Nursing (BN) students from two campuses of an Australian University, who completed all their clinical placements at one healthcare organisation, accepted invitations to participate in this project. Of these, six students comprising a representative cross-section of second and third year students, metropolitan and regional university campus and life experiences prior to nursing were selected for a detailed analysis of their experiences. The students range in age from 19

Theme 1: creating learning opportunities

This theme articulates the importance of invitational qualities of the ward and the clinical staff in enabling students and graduates to develop their knowledge and practical skills. In their first interviews, students’ emphasised the influence of ward staff in providing appropriate and challenging learning opportunities, as illustrated by Ellie’s quote: “If a nurse is sticking in a nasogastric [tube] or if they’re taking out the PICC…think ‘oh, I’ve got a student, let’s let them do it’ ”.

In

Discussion

The themes creating learning opportunities, gaining independence and becoming part of the team reflect a journey which it would seem has changed little over the course of decades of nurse education. In some clinical situations potential future nurses were exposed to workplace experiences that emphasised students as being irrelevant and undesirable. The lack of open invitations for the next generation of nurses does little to support their development of nursing competence and identity. Despite

Conclusions

Healthcare workplaces are complex learning environments for student nurses to negotiate. This complexity is accentuated by inter-generational student cohorts and workforce. Educators need to be cognisant of the underpinning issues of inter-generational diversity and its impact on students’ learning in relation to socialisation and acceptance within the workplace. The challenge for healthcare organisations is how to manage the current tensions within the workplace to generate attitudinal change

Acknowledgments

The authors acknowledge the support provided by the Australian Research Council who funded this research project and to the contributions of the nurses and student nurses in the project.

References (22)

  • E. Chang et al.

    Role stress and role ambiguity in new nursing graduates in Australia

    Nursing and Health Sciences

    (2003)
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