Journeying through clinical placements – An examination of six student cases
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.
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