May 04, 2020, By: Joanne Petersen
Take away messages
- Supporting student nurse practice is an element of professional standards, and an ethical consideration for all nurses.
- The author offers easy tips and practical pearls that enhance the nurse preceptor/student nurse learning experience.
- Creating the right environment in any practice setting, from rural nursing to urban acute care, can ensure student nurse success in final practicums.
What’s your initial response when you think of a student nurse doing a practicum on your ward? Do you shy away from working with the student, or do you embrace the opportunity to grow the nurse of tomorrow?
The Canadian Nurses Association Code of Ethics for Registered Nurses (CNA, 2017) has an appendix addressing ethical considerations in relationship to nursing students, and two statements that speak clearly to nurse–student interactions:
Nurses treat each other, colleagues, students and other health-care providers in a respectful manner, recognizing power differentials among formal leaders, colleagues and students. They work with others to honour dignity and resolve differences in a constructive manner (p. 41).
Nurses share their knowledge and provide feedback, mentorship and guidance for the professional development of nursing students, novice nurses, other nurses and other health-care providers (p. 41).
It’s pretty clear: we all have an ethical responsibility to nursing students.
At the provincial level, the regulatory bodies set the practice standards for the profession. These broad, principle-based statements also address what is expected of RNs in every practice setting in terms of supporting student nurses. In Saskatchewan, where I practise as a point-of-care RN, the Saskatchewan Registered Nurses Association document “Registered Nurse Practice Standards” (SRNA, 2019) states:
- #4 Service to the Public: The RN demonstrates leadership in quality and ethical nursing practice, delivery of health care services and establishing professional relationships. The RN upholds this standard by: #48 Acting as a formal and/or informal mentor to RNs, nursing students and colleagues to enhance and support professional growth.
… we all have an ethical responsibility to nursing students.
So I bet you can guess that I am an RN who embraces “supporting and enhancing” the professional growth of nursing students.
Precepting nursing students
Over the course of my 31 years in clinical practice, I have grown professionally and evolved my competencies as a preceptor to nursing students. Over the past 5 years, in a rural integrated facility, I have precepted fourth-year nursing students every year. I believe every nurse has something to offer a student.
When my own daughter was a student nurse in the Saskatchewan Collaborative Bachelor of Science Nursing program offered by the University of Regina and Saskatchewan Polytechnic, I took the opportunity to attend a learning session hosted by the program for RNs who were interested in precepting nursing students. The learning was invaluable in my role as a preceptor, and really boosted my confidence in having a student nurse tagged up with me for 6 weeks. No clinical instructor was on site but was available via phone or email.
Each student is unique in terms of their personality, learning style, previous experience, and goals, but there are many commonalities. Every student is a little (or a lot) nervous at the start. They are adjusting to a brand-new workspace, totally new faces, and a preceptor in place of a clinical instructor. And they are all wanting to put their education into practice.
I’ve found it helpful to meet with the student before she or he ever set foot in the facility. Meeting up for coffee a day or two before enables me to give them a rundown of what to expect that first day, answer their questions, and find out what their learning plan is. I also set out my expectations upfront to head off any problems. Punctuality is very important to me; to me, that means arriving at least 10 minutes ahead of report, not one minute.
Well before this first meeting I will have provided the student with my shift work schedule so that they can plan the 6 weeks well in advance. Almost all of the students I see are not from our rural area; most have found temporary accommodations for the practicum, and they want to know what days they can plan on going back home.
Many nurses assume they cannot precept students if they work part-time. In my experience, it works marvellously when two part-time RNs team up to jointly precept a student. The student gets some flexibility in scheduling shifts, and can choose which shifts between the two nurses work best for them. They also get the added benefit of learning from two different nurses.
Challenges and opportunities
Just as each student is unique, each nurse is unique in how they organize their workload, their style, perspectives, experience, and insights. This leads to a very rich experience for the student.
Often these final practicums for the fourth-year students are their first exposure to working the night shift and the challenges it brings. I find nursing students are keen to learn the self-care strategies that seasoned shift workers use to make the night shift manageable, and so I offer my student the flexibility to do night shifts with another RN to afford them a different perspective.
… nursing students are keen to learn the self-care strategies that seasoned shift workers use …
Besides the actual work of nursing and caring for our patients, there are other learning opportunities we might not think about when we have a student nurse. I’ve immersed the students in my own professional development. One student went with me to an Advanced Cardiac Life Support recertification training day and got to see me in the student role, being tested in a mega code scenario.
Another student attended the provincial nursing regulatory body council meeting with me in my capacity as president and watched me chair a meeting.
Every student who has spent time with me has been introduced to how I complete my mandatory continuing competence documents for the regulatory body as part of annual licensure. I also introduce the student to any employer-driven online training modules that support our practice. I’ve used the online employer module on best practices in transfusion management as a refresher prior to the student assisting with a blood transfusion or administration of IVIG. It really boosts their confidence and instills in them an appreciation for career-long learning.
It is of utmost importance in my practice that students clearly identify themselves as a student nurse to our patients and colleagues, and that we get the patient’s permission to allow the student nurse to be involved in their care. This has had an added benefit for me as a preceptor to be able to go back later to talk with the patient about the experience and gain valuable feedback for my student, either verbally or in writing, on the final evaluation, which I provide to the student and the clinical instructor.
Patients have shared with me that they appreciated all the explanations I provided to the student as we performed a particular procedure, and it helped them understand exactly what we were doing. I’ve had feedback from patients on a student’s posture, body language, and tone of voice that has been invaluable to the student as an improvement strategy. I also seek feedback on student performance from other staff, the special care aides and LPNs we work alongside, other RNs, and the doctors with whom we interact daily.
A key piece of learning that I do with every student nurse is the expectation that at the end of every shift the student must share with me, informally, three things they learned that day. It’s how we end every shift together.
On the first day, it might be simply where the staff fridge is to put their lunch, or the names of three co-workers. As the practicum progresses, the students’ minds seem to blossom. One did a full neurological assessment on a stroke-alert patient we were transferring to tertiary care. That student learned the value of a thorough and well-documented nursing assessment. Another student learned the importance of the choice of words we use with patients and families in having tender conversations about death and dying.
One of the biggest challenges … is when to quit hovering and watching over the student’s shoulder and give them the independence and responsibility they will need …
Interprofessional communication and collaboration are often not identified by students as part of their learning plan. Their focus is usually on specific tasks, like IV insertion and bladder catheterization. My role as their preceptor is to facilitate elevating their learning as opportunities present themselves.
We had a locum physician providing weekend coverage. I knew from past experience that this person did a full ward round on every patient Saturday mornings. So, on Friday afternoon I suggested to the student that this would be a great chance to expand their comfort zone by rounding with the physician the next day.
We prepared by ensuring that the student was familiar with all the patients and their history. We discussed what communication tool the student would use to present the patient’s story, and how to engage the patient and their family in the rounding. The student also had to discuss any patient issues with the nurse assigned to the patient that day.
On Saturday morning, my role was to explain to the locum physician what we had planned and to seek her collaboration in this learning for the student. In the end, what the student thought was going to be her toughest assignment turned into an affirming leadership and communication exercise that she ranked as one of her top three most valuable learnings in the entire practicum.
Independence and responsibility
One of the biggest challenges for a preceptor in a 6-week practicum is when to quit hovering and watching over the student’s shoulder and give them the independence and responsibility they will need as they transition from student to new nurse. I’ve found that some students are ready but don’t feel they are—they need a gentle nudge or challenge to gain confidence. Others take the initiative and declare they are ready to go solo. Each student situation requires solid communication between the preceptor and student to ensure that patient safety is the top priority.
It is a privilege to be able to precept students in a 12-bed rural hospital, to give them a wide depth and breadth of experiences that only a rural setting can provide within the closeness and comradery of a tight-knit health care team. When those student nurses tell you they are considering applying for a position on staff, and then weeks later call to tell you that they passed their NCLEX-RN, it is truly a proud moment.
And when you later find yourselves working side by side as co-workers, it’s even better yet!
Canadian Nurses Association (CNA). (2017). Code of ethics for registered nurses.
Saskatchewan Registered Nurses Association. (2019). Registered nurse practice standards.
Joanne Petersen is a diploma nursing graduate of Kelsey Institute of Applied Arts & Science in Saskatoon, Saskatchewan, class of 1989. She is a proud point-of-care RN at the Assiniboia Union Hospital in southern Saskatchewan. Joanne is passionate about professionalism in nursing and leading from where you stand.