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Help for New Nurses

Why Your Nursing Clinicals May Have Been Counterproductive.

June 8, 2013

In an article on the issue of nursing students being treated harshly in the clinical setting, one of the problems that the authors discuss is the fact that undue stress is being placed on the students. This has the effect of thwarting their learning experience by putting a strain on student-staff relationships which are an integral part of a student’s clinical experience (Levett-Jones 2009). The results of this harsh or uncivil treatment were listed as poor self-confidence, a breakdown in communication in which medication errors are prone to occur, and an overall environment that is not conducive to learning.

According to the article, a survey was performed by nursing students who experienced the clinical requirements but had not yet received their licensure. Questions focused on specific experiences of incivility as well as positive experiences, and what can be done to address incivility in the clinical setting.

Harsh experiences were described as exclusionary (a feeling of being in the way), rude (speaking condescendingly), and dismissive (Ignoring the students all together). Nursing students reported positive experiences when the floor nurses included them in their reports and patient care. The more the students were treated as part of the team, the better and more enriched the experience.

Concerning how to address the issue, the students surveyed suggested preparing students before attending the clinical by warning them that not all nurses will welcome their help. The most voted suggestion to solve the problem is by not acting the same way in their future experiences with student nurses.

The authors, in discussing their findings, stated that the students’ difficulty obtaining a report was in violation of the standardized approach set forth by the joint commission in which nursing students are to be made aware of their patients’ status.

Another issue discussed that must be dealt with is the lack of awareness as to the ability of the student nurses. This may then require the floor nurses to play a guessing game. This could be avoided by having the instructor meet with the nurses to inform them of what they can and can’t do. And finally, the students must be taught when to ask questions and what proper behavior is when observing.

The authors end the article by noting that more research is needed on a broader scale to provide more solidified results. The phrase “nurses eat their young”, was confirmed to a certain extent by this study. The need for more research was noted in order to determine what differences, if any, exist between genders, units, age, and level of the student in the nursing program.

An aspect of this article which I would like to focus on is the issue of instructors not preparing their students properly during preparation and the clinical sessions. I can relate to being unprepared in clinicals and being treated in an uncivilized manner because of it. I painfully remember being thrown into clinical without the foggiest idea of what to do. Neither the floor nurses nor the instructor had a clue what my level of competency was. On my first clinical after being assigned my patient, I asked my instructor what I was expected to do and nearly got kicked out of the program for not reading her mind. The lack of preparation and guidance between my instructor, floor nurses, and myself was at a level that I would now call negligence.

In a study assessing the preparatory process of nursing students, students were interviewed and asked about their experience in the clinical setting. The students universally criticized the mentoring system for giving too little attention to skill performance, leaving the new graduates feeling anxious about their ability to perform key nursing skills (Calman 2002).

According to an article in The Journal of Clinical Nursing, the problem stems from the fact that, as of yet, there is no standardized method of training nursing students in the clinical setting (Jokelainen 2011). As further noted by Calman, “Students’ views suggest that they had little confidence in methods of clinical competence assessment and there is evidence that there is a lack of consistency in the training of student assessors in the clinical areas” (Calman 2002).

A study was performed to systemize the nursing clinical mentoring system. The authors gathered research literature and came up with two common goals in mentoring nursing students. The first is to facilitate student learning. This involves supporting a learning environment. An example would be to personalize each student’s list of goals to achieve. The second common goal found in most of the scholarly literature is the strengthening of the students’ professionalism. This goal can be obtained by having the student interact in a professional manner when communicating with his/her colleagues.

In conclusion, the clinical counterpart to the lectures can be a very traumatic experience to the new graduate. In correlation to this, new nurses are entering the job arena doubting their abilities to perform. Incivility, lack of proper supervision, and no standardized method of clinical teaching all attribute to a less than optimal clinical education. As discussed in the article, instructors must encourage questions, communicate with the staff nurses, and prepare students to deal with the stressful experience. In addition, student goals must be standardized as well as methods of supervision.

Although the research showed that in most cases students do not fail out of clinical, the real goal is to gain the experience necessary to enter the job market with a certain level of familiarity with the responsibilities that are required. And until we fix the system, clinicals may mainly be teaching fear and resentment.

References

Anthony, M., & Yastik, J. (2011). Nursing students’ experiences with incivility in clinical education. Journal of Nursing Education, 50(3), 140-doi:http://dx.doi.org/10.3928/01484834-20110131-04

Calman, L., Watson, R., Norman, I., Redfern, S., & Murrells, T. (2002). Assessing practice of student nurses: methods, preparation of assessors and student views. Journal Of Advanced Nursing, 38(5), 516.
Jokelainen, M., Turunen, H., Tossavainen, K., Jamookeeah, D., & Coco, K. (2011). A systematic review of mentoring nursing students in clinical placements. Journal Of Clinical Nursing, 20(19/20), 2854-2867. doi:10.1111/j.1365-2702.2010.03571.x

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