How educators can do more for nurses entering practice
By Megan Keszler
August 8, 2022
As I say to my students: the more work you put in now, the easier your transition to independent practice will be.
Nursing is a tough job these days. Sometimes I worry that we are not doing enough in clinical education to prepare our students for the realities of bedside nursing in a pandemic and post-pandemic world. To drive the success of my students well into their first two years of registered nursing practice, I keep this end goal in mind even in their very first hospital clinical placement. Steinaker and Bell’s (1979) taxonomy levels of learning most closely approximate how I envision my clinical placements should run to advance the learner’s experience and knowledge. Landers, O’Mahony, and McCarthy (2020) provide a summary of how this taxonomy and others could work in clinical education. Their approach could prove adaptable to the post-pandemic world of nursing practice, with students moving fluidly through the levels of learning depending on their clinical practice area.
As an example of how I make this taxonomy operational in clinical placements, I do not hide the realities of acute care nursing from students. They are exposed to everything that happens on the unit, from the perspective of both the staff and the patients. I assign them challenging cases from the beginning, according to their clinical level, and always have them reach just beyond what they think they are capable of. The key to this is supported practice: I will be physically present to support them. If students become underchallenged at any point, it’s time to increase their learning: another patient, more acuity, more complexity. Giving them easy assignments may make my life and their lives easier now, but it does nothing to advance their growth and does not prepare them for the realities that await them after graduation, making them more vulnerable to struggling in their final preceptorship and beyond.
I also want to prepare them for the mental and emotional realities of nursing. The pandemic has changed how we nurse at the bedside, and we, as a profession, are grappling with what this means not only for us but also for future generations. By working challenging cases, students not only develop resilience, but we also work together to develop coping strategies early. They develop competence and confidence earlier. At the end of every clinical day, I also meet with my students, without exception. These post conferences are kept to 30 minutes or less to facilitate maximum time on the unit practising. Good debriefings for challenging cases are warranted; I try to send no student home worrying about what happened that day. They should feel good about their clinical experience and about nursing; it should not be a negative experience for them. Students report anecdotally that the debriefing is valuable and that it encourages their reflective practice.
If students become underchallenged at any point, it’s time to increase their learning.
In tough situations, students also report noticing the teamwork atmosphere more and realizing that they will never be alone in stressful situations. They begin to see their education as less competitive and more collaborative. The collaborative approach to clinical group practice results in students looking out for each other to develop that desired teamwork quality of nurturing and supporting each other’s practice. Often a student will call to tell me about finding a catheterization for a peer who lacked the opportunity to perform one. The calling student is just as excited as the student who will now have the opportunity to practise that skill. These students will often keep in touch with each other, which helps them develop peer support well into the new graduate practice phase and beyond.
Furthermore, former students report that the clinical approach closely approximates actual acute care practice and helped them transition by knowing what to expect. For example, I remember one former student who entered my clinical setting having been underexposed to nursing practice. She started her placement extremely anxious, but went on to work as an undergraduate nurse immediately afterward. She reported that her supervisors told her she was one of the best-prepared undergraduate nurses they had ever had.
A colleague on the unit recently took a clinical educator role and said to me, “I never realized how much work it is. I’m just doing this two days a week, and I couldn’t stop thinking of how you do this full time.” I replied, “If it’s hard work, that’s how you know you’re doing it right.” That’s genuinely how I feel as a clinical educator working with students as I am generally very busy supporting their practice in real time. Working hard as a student similarly means that you’re on the right track to a successful transition to registered nursing practice.
Landers, M. G., O’Mahony, M., & McCarthy, B. (2020). A theoretical framework to underpin clinical learning for undergraduate nursing students. Nursing Science Quarterly, 33(2), 159-164. doi:10.1177/0894318419898167
Steinaker, N., & Bell, M. R. (1979). The experiential taxonomy: A new approach to teaching and learning. New York: Academic Press.
Megan Keszler, BN, RN, CNCC(c), is a sessional instructor for the Faculty of Nursing, University of Calgary, and a bedside nurse in internal medicine and cardiology with Alberta Health Services.