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Paediatric nursing

Using final placement to prepare student nurses

There is a gap in research examining the support given to final-placement students as they become nurses. This small-scale study offers some insights

In this article…

  • Common anxieties of student nurses
  • Preparation for transition from student to qualified nurse
  • The importance of mentorship

Author

Geok-Liew Ong is paediatric practice facilitator at Barts Health Trust.

Abstract

Ong G-L (2013) Using final placement to prepare student nurses. Nursing Times; 109: 3, 12-14.

Aim This qualitative phenomenological study explored the perceptions of the support received by children’s student nurses on their final placement as they prepared for their role as staff nurses.

Method Semi-structured interviews were conducted with a purposive sample of six final-placement students. The interviews were recorded and transcribed. Thematic analysis was used to interpret the transcripts.

Findings Five themes relevant to student support were identified: preparation for transition from theory into practice; the support system; specific support for children’s nurses; students’ perceptions of transition experiences; and improvements to assist their transition process.

Conclusion Key recommendations include incorporating a transition component into the nursing programme and providing structured guidelines for mentors that focus on specific support for final-placement students.

  • This article has been double-blind peer reviewed
  • Figures and tables can be seen in the attached print-friendly PDF file of the complete article in the ‘Files’ section of this page

5 key points

  1. There is a dearth of literature on support for children’s student nurses in the transition to children’s nurse
  2. Moving from the student role to professional autonomy often leads to anxiety and stress that has been described as “transition shock”
  3. Nurse training programmes should incorporate leadership and management content
  4. Mentors need structured guidelines on specific support for students on final placements
  5. These students need support in developing decision-making, leadership and management skills, as well as skills in communication

Following the changes to the structure of nurse training from the traditional apprentice-style approach to a university-based education, many students feel unprepared to assume the role of qualified nurse.

Studies have acknowledged that support, particularly mentoring, during this transition period is essential to enable students to develop the proficiencies, competencies and skills they need, as laid down by the Nursing and Midwifery Council (2010a) (Qusey, 2009).

The NMC (2010b) recognises this, and requires all students on pre-registration nursing programmes to be supported and assessed by mentors. They must be signed off by mentors as evidence that they are fit for practice.

Background and aims

This article reports on a small-scale study of the support experienced by children’s student nurses on final placement.

I had previously received feedback from these students that indicated they experienced uncertainty and anxiety over role change. The aim of this study was to find out what specific support system would prepare them for their transition to registered children’s nurses.

Literature review

I undertook literature searches on role transition from students to staff nurses and their support systems using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid, MEDLINE, ScienceDirect, Google Scholar and the British Nursing Index. Box 1 shows the key terms used.

There is little literature relating to supporting children’s student nurses in their transition to children’s nurses and a paucity of UK studies on this topic.

Transition from student to nurse has been described as a journey of adjustment and stress, and a period of learning and socialisation (Nash et al, 2009; Qusey, 2009). The main change is the learning of leadership, management, decision-making and autonomy skills, which contrast with the supervised student role (Anderson and Kiger, 2008). The changes from the familiar student role to professional autonomy, including the accountability that goes with it, often leads to anxiety and stress that Duchscher (2008) described as “transition shock”.

Studies by Draper et al (2009) and Ross and Clifford (2002) indicated that there was a major difference between what was taught in university and the real world of nursing. They advocated providing a theoretical component to prepare students’ role transition into the workforce. Literature on adult nursing confirms that students appreciate being allowed to take the lead in planning and providing total patient care, with support (Nash et al, 2009; Chung et al, 2008; Standing, 2007).

In contrast, children’s student nurses value working alongside experienced nurses when planning and negotiating the provision of care. This shows that students perceive additional challenges in caring for sick children, particularly the potential challenges that may arise from the involvement of the child’s family (Glasper et al, 2008; Jackson, 2005).

Method

A purposive sample was made of six female participants (age range 23-30 years) completing their 12-week final placement between November 2010 and February 2011 (Schneider and Elliot, 2007).

I used a qualitative approach to ascertain how they made sense of their experiences, allowing them to express their concerns and apprehensions (Silverman, 2010). I used an inductive phenomenological approach as it enabled participants to share their perceptions and experiences from their standpoint (Holloway and Wheeler, 2002).

I used a semi-structured interview method to collect the data, which encouraged the participants to describe their experiences in their own words (Whiting, 2008). An interview guide with standardised prompts allowed the same broad themes to be explored in each interview and minimised any bias (Holloway and Wheeler, 2002). Each interview was digitally recorded and transcribed verbatim.

The University Research Committee approved the study, and all participants were assured of confidentiality and anony-mity in discussion and presentation of the findings (Holloway and Wheeler, 2002).

Results and discussion

I used Miles and Huberman’s (1994) three stages of qualitative data analysis for processing and analysing the collected data. This allowed me to inductively identify the common threads derived from the six transcripts and therefore generate themes (Silverman, 2010). Five key themes emerged and are discussed below.

Theme 1: preparation for transition

Four participants indicated that there was a lack of a theoretical component to prepare them for their transition from student to nurse.

They thought that as nurses they would: be required to take on a leadership role; have prioritisation, decision-making and time-management skills; be able to manage allocated caseloads; deal with challenging, unexpected situations; and communicate with multidisciplinary teams. However, they felt they were not provided with theoretical content on these areas. For example:

“If the university was to teach theory about role transition with practice, that would make it much better; we need to link theory into practice, especially during the final placement before becoming a staff nurse.” (Participant 2)

Other studies have highlighted the need to integrate educational aspects of student nurses’ training with the service provider (Ross and Clifford, 2002), and I have advocated the provision of the essential theoretical component together with appropriate support from mentors and others to bridge the theory-to-practice learning.

Theme 2: support systems

All participants acknowledged that they received adequate support for their role transition experiences and spent protected time with their sign-off mentors and co‑mentors.

They also said the support from mentors and senior nurses was there to prepare them with the necessary knowledge, skills and confidence for independent practice as nurses (Draper et al, 2009). For example:

“My sign-off mentor would sit down and discuss what my role would be as [a] responsible staff nurse, how I would increase my knowledge and everything like that leading to my staff nurse role.” (Participant 4)

All participants also agreed that they received a range of support from a dedicated paediatric practice facilitator (PF), which contributed towards their learning experience and professional development (McNamara, 2007).

Theme 3: specific support for children’s nurses

Four participants indicated the need for support with their communication skills when dealing with patients and the multidisciplinary team.

Although a number of support needs are fundamental to student nurses in all fields (Ross and Clifford, 2002), support in communicating and dealing with sick children and their families seems particularly important for children’s nurses (Jackson, 2005), as clear communication is paramount when working in a multidisciplinary team, and when using a family-centred care approach (Glasper et al, 2008). For example:

I need support with communication with the family and giving the information in a way they understand and not using many technical terms.” (Participant 5)

Participants also needed specific support in dealing with challenging situations, and with adolescents and their families. Caring for adolescents required specialist nursing skills and understanding. Participants felt supported when they were able to receive feedback and support from senior nurses and mentors, and also their PF. Feedback formed part of their learning process and helped with their professional development. For example:

“My mentor did give me feedback, which I thought was the best thing because you can only improve; that is how I learnt and reflected on this.” (Participant 2)

Four participants felt that they would benefit from support in the job application process before their final placements.

All participants said they received this support from their placement mentors and senior nurses; the PFs supported them by letting them practise their interview techniques.

This finding is valuable as this aspect was not reported in any other studies. This type of support would be beneficial for future students - improving their job prospects and reducing their anxiety.

Theme 4: positive and negative perceptions

The participants were looking forward to the positive aspects of their new roles when qualified. These included the ability to care for patients independently, carrying out certain tasks and taking on the autonomous nurse role (Ross and Clifford, 2002).

They acknowledged that the support given was relevant to their transition to be children’s nurses. Five participants were especially looking forward to securing a job and earning money.

There were a few negative views of the transition experience. These related to mentorship in their final placements, a lack of standardised structure for the transitional experience and students’ anxiety and stress for their expected new role when qualified (Nash et al, 2009).

Students used words such as “scary” and “anxieties”, which denoted their emotion and levels of stress as part of their negative transition experience, which has been described by Duchscher (2008). The anxiety of taking on the new role and the higher expectations placed on them when qualified seems to be similar for final-placement students, as expressed by newly qualified nurses (Gidman et al, 2011; Ross and Clifford, 2002).

Only one participant felt that initially there was a lack of opportunity to practise her impending new role. This could be related to a lack of mentoring skills (Hodge, 2009), and poor understanding of what transition students need (Nash et al, 2009). There is a need to provide structured guidelines for mentors on what students are allowed to do and should be expected to learn during their final placements (Gidman et al, 2011; Ross and Clifford, 2002).

Theme 5: suggestions for improvement of students’ transition process

The last theme focuses on participants’ suggestions on how to improve their experiences.

These include providing theoretical components, such as leadership and management sessions, workshops to develop interview skills and structure for mentors during their final placement experience. Most participants said they could learn from simulation sessions, in which they practise their skills in a set-up environment that replicates real-life scenarios.

Limitations of the study

This is a small sample from one inner-city higher education institution (HEI), which may limit generalisation of the findings; further in-depth study is therefore required (Schneider and Elliot, 2007).

Recommendations and implications

This small study has identified some key recommendations and future implications for education, practice and research.

In terms of education, the HEI should incorporate specific leadership and management content into the transition component of the programme and more simulation practice in the nursing programme.

For practice, placement providers need to ensure there are structured guidelines for mentors focused on specific support that is relevant for final-placement students. This should include support for decision-making skills, leadership and management roles, as well as communication skills.

Finally, a more in-depth research study would be beneficial. A larger sample from children’s and other fields of student nurses focused on this transition period would give greater insight.

Conclusion

This qualitative phenomenological study emphasises the need to give children’s student nurses a relevant theoretical component for their transition role, and to provide an appropriate and specific support system.

It has also highlighted the valuable role of mentors who themselves need support to carry out their role (Gidman et al, 2011). However, there is a need to address the lack of a mentoring structure to support students’ role transition and what constitutes support to satisfy their transitional needs.

The findings are relevant to my role as a paediatric PF, which is to support mentors and sign-off mentors, and assist with students’ learning experience as stated in NMC (2010a; 2010b) standards. The findings can be used to improve future support systems for final-placement students and to enhance their transition experiences so they are fit for practice (Qusey, 2009).

The ultimate aim is to improve the quality of care provided for sick children and their families. Moreover, this study focused on a gap in research, examining final-placement students’ transition and their support system before becoming nurses.

Box 1 Keywords and terms

● Support student nurses
● Transition to RN
● Children’s student nurse
● Mentorship
● “Sign-off” mentor
● Final placement
● Competency
● Fitness for practice
● NMC document
● Nursing education

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