Having an idea of what to expect before starting a placement can help students to learn
In this article…
- What to expect from placements
- What to do if there is a problem
Bill Whitehead is assistant head of subject, Healthcare Practice (nursing) at the University of Derby.
Whitehead B (2013) Getting the most out of your clinical placement. Nursing Times; 109: 37, 12-13.
This article discusses what to expect from clinical placements, what you will learn, techniques to enhance your experience, and handling a placement that is not going well.
5 key points
- Student nurses spend half of their nursing degree on placement
- Mentors must be a registered nurse with at least 12 months’ experience and a mentoring qualification
- Although students are expected to participate in direct patient care, they remain supernumerary
- Students should be encouraged to reflect as this helps to link theory learnt in university to experiences gained in practice
- Students have a responsibility to report behaviour that puts others at risk
- 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
Student nurses spend half of their degree programmes on clinical placement in order to prepare to become “knowledgeable doers” (Ousey, 2011). It is vital to get the most out of these placements, during which you will be supported and assessed by a registered nurse mentor. Although many students say they learn more on placement than in university, lecturers work hard to link theory and practice; sometimes it is not until completing a placement that students see the relevance of what they learnt at university.
What to expect
There are many methods of providing practical experience. The traditional one features “blocks” of university-based study interspersed with a series of placements in clinical settings. A variation is for students to spend two or three days a week on placement and the remainder in lectures.
A popular method of ensuring students receive the range of experiences they need while benefitting from longer relationships with the same mentor is the “hub and spoke” model (Fig 1). This involves students being based at a central “hub” placement and spending short periods on “spoke” placement areas. This exposes them to other specialties and experiences.
While some programmes include up to 300 hours of “simulated practice”, the Nursing and Midwifery Council (2010a) requires most practice learning to be undertaken in direct care of clients.
Whichever approach is used, each student will be allocated a qualified mentor. To fulfil their role in preparing students for practice, mentors need support (Whitehead, 2010); many trusts offer this through practice placement managers, link tutors, practice educators, drop-in clinics and skills labs. While all students are allocated a mentor, sadly not all mentors have access to these support structures. Mentors must be a registered nurse with at least 12 months’ experience and a mentoring qualification (NMC, 2008). The final placement mentor must be a “sign-off mentor”.
Students must be given experience of 24-hour and seven-day-a-week care, including weekend and night shifts (NMC, 2010a). This experience must be supernumerary, which means students will not be contracted by any person or body to provide nursing care (NMC, 2010a). However, they need to participate in direct care to learn so should expect to work with registered nurses and the multidisciplinary team.
Unsurprisingly, this combination of being required to undertake direct care and to also be supernumerary can be confusing for students, staff and patients. The main thing to remember is that the purpose of being on placement and delivering care is to gain practical learning experience. If you are in any doubt about your status on placement, discuss this with your mentor or university lecturer.
What should you learn?
It is impossible to learn the complete set of nursing skills you will need for your first job after qualifying (Whitehead et al, 2013), because the education and assessment you will undergo to ensure you reach the required standard is general rather than specific to a particular position. As such, the NMC and the Department of Health require all newly qualified nurses to be supported by a period of preceptorship after qualifying (NMC 2010b; 2006; DH, 2010).
Most pre-registration programmes require students to have experience of care before starting their degree, and the DH is piloting a scheme whereby students work as healthcare assistants first (Campbell, 2013). However, it is still important to participate in the fundamental care of patients during your programme.
Students must be responsible for their own learning opportunities and understand the outcomes they need to achieve on placement, discussing any queries with their mentor. You can make the most of learning opportunities in fundamental care by considering the competencies to be assessed on a placement (NMC, 2010a).
For each practice experience, consider nursing theory and human sciences (anatomy, physiology, psychology and sociology) that relate to the care provided. Nursing models, such as Roper et al’s (1980), describe human life in terms of activities of living and external influences like ageing and psychosocial factors. Several activities can be applied to patients’ needs. Maslow’s (1943) hierarchy of needs is based on the fundamental requirements of life; it is a useful tool to check you are meeting your patients’ basic needs.
Reflection helps to link theory with practice and brings academic learning to life. Many examples of reflective cycles are used regularly by health professionals but one of the most common is Oelofsen’s (2012) three-stage cycle; for writing reflective assignments the following three-stage linear process (Whitehead, 2011) can be used:
- Description of the area of activity;
- Reflection upon the area of activity;
- Consequent plan to improve future professional activity.
The reflection stage should be based on further reading and thinking that illuminates the issue. Once the experiences have been considered through reflective thought or writing, or by considering the activities on placement in light of academic reading, students can discuss further with their mentor, peers or university tutor. The best way to consolidate learning is for students to reflect and learn together.
When a placement doesn’t go well
There are many reasons why a placement may not go well, including simple things like students not enjoying the specialty. This remains a valuable learning experience as it teaches them that this is not an area in which to seek work. Students should reflect on why they haven’t enjoyed a placement and discuss it with people they trust.
It can be worrying if you feel you are not performing to the expected standard. The first thing to do is discuss your concerns with your mentor. If you are setting your standards too high, your mentor may reassure you that you are within the competence range. Even if the mentor confirms your fears, they will help you formulate a plan to build up to the required standard.
Some students may feel a placement is not going well because they witness poor patient care or even mistreatment by staff, patients, carers or even their own mentor. In this case the NMC’s advice (2010b) is clear:
“Inform your mentor, tutor or lecturer immediately if you believe that you, a colleague or anyone else may be putting someone at risk of harm.”
Nursing Times’ Speak Out Safely campaign supports this and encourages employers to commit to supporting staff who raise genuine concerns. It can be tough for students to raise concerns but it is ethically correct and required by the NMC.
Routine evaluation of placements is vital to ensure the best are recognised and encouraged, and those requiring changes are noted and monitored. You will be asked to complete an evaluation form at the end of each placement to enable this and to maintain or improve quality.
If you do have problems on placement, you need not suffer alone. In the unlikely event that the first or second person you approach is unable or unwilling to help, escalate your concerns to others in the placement or university (NMC, 2010a).
Capitalise on placements by using the learning from one part of your programme to inform another. Approach every learning opportunity with a positive attitude to make the most of your placements - they are a valuable, unrepeatable opportunity.
Campbell D (2013) Nurses must spend a year on basic care. The Guardian, 26 March 2013. tinyurl.com/Guardian-HCAyear
Department of Health (2010) Preceptorship Framework for Newly Registered Nurses, Midwives and Allied Health Professionals. London: DH. tinyurl.com/DH-Preceptorship
Maslow AH (1943) A theory of human motivation. Psychological Review; 50: 4, 370-396.
Nursing and Midwifery Council (2010a) Standards for Pre-registration Nursing Education. London: NMC. tinyurl.com/NMC-PreRegEducation
Nursing and Midwifery Council (2010b) Raising and Escalating Concerns. London: NMC. tinyurl.com/NMC-Concerns
Nursing and Midwifery Council (2008) Standards to Support Learning and Assessment in Practice. London: NMC. tinyurl.com/NMC-LearningStandards
Nursing and Midwifery Council (2006) Preceptorship Guidelines. NMC Circular 21/2006. London: NMC. tinyurl.com/NMC-Preceptorship
Oelofsen N (2012) Using reflective practice in frontline nursing. Nursing Times; 108: 24, 22-24.
Ousey K (2011) The changing face of student nurse education and training programmes. Wounds UK; 7: 1, 71-75.
Roper N et al (1980) The Elements of Nursing. Edinburgh: Churchill Livingstone.
Whitehead B et al (2013) Supporting Transition from Student to Registered Nurse: A Collaborative Research Study. tinyurl.com/rcn-studenttransition
Whitehead B (2011) Bill Whitehead’s HEA Webfolio. tinyurl.com/Whitehead-Webfolio
Whitehead W (2010) An Investigation into the Effects of Clinical Facilitator Nurses on Medical Wards. PhD thesis. etheses.nottingham.ac.uk/1264