CLINICAL ROTATIONS for nursing students provide learning experiences that both challenge us and teach essential skills we'll use when taking care of future patients. To gain the most during this time, nursing students must follow an experienced nurse who's supportive and open to teaching. Yet no system is currently in place to ensure that a student will be partnered with a nurse who wants to teach. Because of this, many students feel uncomfortable and incompetent after a day in clinical.
In this article, I propose a simple strategy to ensure that students and RNs are paired appropriately. My proposal is based on the negative experiences I, and fellow nursing students, encountered by being paired with preceptors who were closed off to teaching. Through interdisciplinary research on the successes of preceptorship in the healthcare industry and the great impact it can have on education, I developed this intervention in hopes of providing a better clinical environment that fosters optimal learning.
Qualities of a positive experience
Research has indicated that “the development of a positive working relationship between a nurse preceptor and student involves developing a mutual rapport.”1 For this to happen, a student must be paired with a nurse who's willing to take the time to demonstrate and explain procedures in a mutually respectful relationship.
Another research study indicated that with more preceptor interaction, students perceive a higher degree of competence in their nursing skills. Ninety-six percent of the students in this study rated relationships with their preceptors as important to very important.2
Barriers to education
Working with a nurse who isn't open to teaching undermines a student's confidence. One student I interviewed said, “I was in clinical following a nurse who didn't speak one word to me. I tried being proactive by asking what I could do to help. But she cut me off, saying that I needed to stay out of her way so she could work.”
Nurses have responsibilities to patients, so finding time to teach can be hard. In units with high-acuity patients such as the ICU, nurses may feel uncomfortable working with inexperienced students who might put their patients at risk for harm.
Some nurses have negative impressions of students. One of the RNs I interviewed stated: “Our charge nurse can't stand them and neither can I. They give me more work to do, and I get blamed for things I didn't do!” She proclaimed this after sharing stories of nursing students who'd leave patients' rooms without making sure the call bell was within reach or who had a negative attitude about being corrected.
Despite some negativity, many of the experienced staff members I spoke with were completely open to having a student accompany them during clinical rotations. One nurse said, “Personally, I enjoy teaching students, interns, and new graduates. They may be working on my unit one day, so I want them to learn the correct way of doing things.”
Nurses shouldn't feel obligated to teach because it can take away from patient care. Working with a busy nurse who isn't open to teaching can dampen a student's enthusiasm and undermine self-confidence.
Let's say, for example, that a nurse has six patients. Not having time to explain procedures, the nurse brusquely tells the student to empty a Jackson-Pratt drain. The student has never emptied a drain before but doesn't want to upset the nurse, so he or she attempts the procedure anyway. Because the student empties the drain incorrectly, wound drainage contaminates the patient's wound. This illustrates the importance of using a systematic approach when pairing students with nurses.
Surveying experienced nurses
Research has shown that students unanimously agree leadership is important in nurse preceptors and that the qualities of an effective nurse preceptor and those of a clinical leader are synonymous.3
So what can we do to ensure every clinical experience is safe and effective? My proposal is to implement a survey experienced RNs can complete to determine if they possess the required leadership abilities and, more importantly, if they wish to have a student follow them during clinical rotations. This quick survey would only need to be submitted once during the course of the nurse's career within a particular facility. The results can then be compiled into a list that would permanently remain on each unit. The charge nurse could use the list as a guide when pairing students with RNs on the unit. If a nurse no longer wishes to be a preceptor, he or she can simply inform a supervisor of this decision.
I created a sample survey and 20 nurses on an ICU filled it out. (See Nurse preceptor questionnaire.) Thirteen nurses requested a student, so the charge nurse put each of the four students on that unit with one of these nurses. During postconference, every single nursing student was overjoyed. They all expressed appreciation for the nurses because they took the time to teach them procedures they'd only read about in textbooks. The students were able to leave with more confidence, knowing they could independently perform the interventions. Likewise, the nurses were elated to know that they'd contributed to the students' education.
Better clinical rotations
This survey can be a starting point for a new system for precepting nursing students. Other suggestions from the survey include developing a workshop for nurses who want to teach in a clinical setting. The workshop would provide a systematic approach that could be used to communicate the same learning objectives for each student to master during the course of his or her clinical. This would provide consistency in education and build the teaching RNs' confidence. Research indicates that enabling the participants to gain knowledge, skills, confidence, and positive attitudes toward precepting students through learning empowers the RN in this role and enhances adult teaching and learning abilities.4
By implementing these practices in your healthcare facility, you can help improve the learning outcomes of future nurses, increase nurse satisfaction, and improve patient safety.
1. Stevenson K, Randle J, Grayling I. Inter-group conflict in health care: UK students' experiences of bullying and the need for organizational solutions. OJIN
2. Kim KH. Clinical competence among senior nursing students after their preceptorship experiences. J Prof Nurs
3. Zilembo M, Monterosso L. Nursing students' perceptions of desirable leadership qualities in nurse preceptors: a descriptive study. Contemp Nurse
4. Smedley AM. Becoming and being a preceptor: a phenonmenological study. J Contin Educ Nurs