In the UK half of the pre-registration nursing curriculum is set in the clinical setting.
VOL: 103, ISSUE: 20, PAGE NO: 26
Sharon Arkell, MA, PGDip, BSc, RN
Lisa Bayliss-Pratt, MSc, PGCE, BSc, RN, are senior lecturers in nursing, School of Health, University of Wolverhampton
Such placements are varied, taking place in the community or hospitals, and are widely acknowledged as one of the most important elements of the course.
Research has demonstrated that an effective learning environment requires good communication and collaboration between the student, mentor, ward manager, link teacher and placement facilitator (also known as practice educator or practice placement manager) (Andrews et al, 2006).
Link teachers are usually employed by the university coordinating the pre-registration programme. Their role is to provide guidance and support in the teaching and assessment of students in practice, ensuring that mentors and placement facilitators are kept up to date with changes in the programme (NMC, 2006).
Placement facilitators will have completed an approved NMC practice teacher programme or equivalent and have experience of being a mentor to students. They have responsibility for organising and coordinating learning activities within the placement environment, teaching and assessing students and supporting mentors in teaching and assessment (NMC, 2006).
They should have an excellent understanding of the placement area and the learning opportunities available and may be able to assist students in the achievement of specific learning outcomes.
Placement facilitators, in partnership with universities, have increased the number and type of placements nursing students may experience. It is now common for students to have placements in GP surgeries, prisons, social services and the voluntary and independent sectors. This means that as a student you may be away from your NHS trust and the university. It is therefore important to establish support systems by identifying whom to contact and having a clear idea of their role in terms of support.
The NMC requires that students have supernumerary status throughout the pre-registration nursing programme (NMC, 2004). This means that nursing students are additional to workforce requirements and are undertaking the placement as a learning experience and not as a member of staff. However, this does not mean that you are not required to work while on placement. You should participate in the care of patients, with appropriate supervision, to develop clinical competence to the level required of a registered nurse.
The level of supervision that nursing students require will depend on the stage of training and previous experience. This may result in some confusion for your mentor with regard to the amount and type of support and supervision required. You need to discuss this with the mentor, identifying the learning opportunities available and the level of supervision needed. Studies have shown that students who take responsibility for their own learning get more out of their placement (Chesser-Smyth, 2005).
The registered nurses with whom students work are accountable for their practice and must provide adequate supervision. However, as a student it is also your responsibility to ensure that you do not participate in any procedure for which you have not been fully prepared or are not adequately supervised (NMC, 2005).
A collaborative partnership with your mentor is essential to get the most out of your placement. Research has shown that students who regularly work with their mentor are likely to have more learning opportunities. The evidence also suggests that this will help nursing students to adapt to the clinical environment, develop intuitive practice, become professionally socialised into the role of a qualified nurse and enable them to function both independently and as part of the team. If the mentor is off sick or on leave then students should liaise with the manager so that another RN can be identified to provide support.
From your mentor’s perspective, the delivery of patient/client care is the greatest priority and sometimes, during busy times, they may not have time to support you. Students may also find they are working with HCAs to deliver care that is predominantly task-focused and feel they are not really learning or developing practice. To access learning opportunities you must try to make the most out of a difficult situation but if it persists you should discuss it with your mentor, link tutor and placement facilitator.
Holistic practice can be achieved by caring for a small group of patients while under appropriate supervision, which will help to develop confidence and competence. Undertaking care activities every day - rather than just once or twice per placement - will enable you to consolidate practice and your mentor to focus the learning time available. For example, it is less time-consuming for the mentor to supervise a student while they administer medication to four patients every day, rather than to all the patients in the placement area.
Alternatively, if you are unable to care for a group of patients and your mentor is busy you can still seek out learning opportunities. Examples include observing your mentor, reading patient records or journals relevant to the placement, talking to patients and working with other healthcare professionals.
If you do not like a placement you should not dismiss it as having no learning opportunities - all patient services offer learning opportunities. To foster a good student-mentor relationship it is important to show motivation and enthusiasm.
THE THEORY/PRACTICE GAP
The theory/practice gap is the potential mismatch between what students are taught at university and what they experience in practice. If faced with this gap it is important to challenge it appropriately and professionally to ensure the best possible care is provided or taught. You could discuss new evidence for best practice with the relevant person. There may be barriers to implementation that you had not considered or it may simply be that the individual was not aware of the evidence.
Demonstrating clinical competence is an essential part of learning to become an RN. Students’ practice while on placement is continuously assessed. This means that nursing students must consistently demonstrate their competence according to the level of knowledge expected for the particular stage of the course.
Your mentor should have undertaken mentor preparation regarding clinical assessment documentation. If for any reason the mentor is unsure of the assessment document it is important that the link teacher and/or placement facilitator is contacted to provide support.
Before discussing progress with your mentor it is good practice to assess yourself against the clinical outcomes that you are aiming to achieve. Self-assessment can help to develop critical skills and encourages you to take responsibility for your own development (Fitzpatrick, 2006). It will also enable your mentor to gain a better understanding of your perception of your progress.
If you are not performing to the required standard your mentor should identify this at the earliest opportunity, preferably no later than your midway interview, so that you can formulate an action plan and have sufficient time to address the problem areas. Your link teacher, personal tutor and placement facilitator should be informed and, if needed, should be able to offer both you and your mentor support during the interviews on your performance.
There are many potential barriers to learning opportunities and the box on the facing page offers advice on how to get the most out of a placement. Nursing students are responsible for their own learning and must take every opportunity to become competent and confident.
TIPS FOR MAXIMISING LEARNING OPPORTUNITIES
- Find out what type of placement you have been assigned to and do some background reading
- Take responsibility for your own learning
- Ensure that your mentor is made aware of any support needs you may have
- Recognise the other responsibilities your mentor has as a registered nurse
- View every day of your clinical placement as a potential learning opportunity
- Be confident in negotiating learning opportunities with your mentor
- Be motivated and enthusiastic
- Know the various personnel who are available to offer support during clinical placements
- Be aware of the potential problems that you may experience
- Understand how to make the most of placements through collaboration with your mentor
- Know the procedures for assessment
- Outline the different personnel available to support you during your placement
- Reflect on the learning opportunities that were available to you in your last placement
- Identify the barriers that you experienced in accessing different learning opportunities
- Formulate an action plan to make the most of learning opportunities available on future placements
This article has been double-blind peer-reviewed.