The value of clinical placements in nursing training

Clinical placements are an essential part of nursing training, giving students hands-on experience in dealing with patients and enabling them to put what they have learned in the classroom into practice. They generally begin during the first or second semesters of study. They are a required element of every course, whether an associate or bachelor’s degree. The American Association of Nurse Practitioners (AANP) and the American Nurses Credentialing Center (ANCC) require training nurses to undertake hundreds of clinical hours covering a wide range of medical situations.

Nursing school is often divided into three main components: in-class learning, simulation labs, and clinical rotations. All are important ways for students to develop their skills and knowledge, but clinicals are often regarded as offering the most beneficial learning opportunities. Clinical rotations can vary in length and where they are based – some can be around a month long, while others may be more short-term. They usually take place in acute care, long-term care, mental health facilities, and community settings and are designed to allow students to experience a wide range of specialties.

It is important to recognize the importance of learning and understanding how theory and practice work hand in hand, particularly in a role such as nursing, which requires both academic and clinical knowledge on top of nurturing soft skills such as excellent communication, confident decision-making, and learning to work under pressure. Nursing theory describes, explains, and predicts everyday experiences, and this helps guide nurses in their assessments, interventions, and evaluations when at work and provides criteria by which the quality of care can be measured. They are described as sets of concepts that are interrelated, models, and propositions that are gained via both deductive and inductive reasoning based on certain assumptions. They are used for assessing patient conditions and identifying their needs.

Theory also has a role within clinicals, helping to shape the way nursing is done, whatever the clinical situation, providing basic commitments, orientation, and attitudes in a practical way. Therefore, in nursing clinicals, theories are used to help students respond to the needs of clinical situations, giving specific ways of implementing nursing practice.

What to expect from nursing clinicals

The number of nurses assigned to a clinical instructor will vary depending on the size of the program, and they will be a student’s main support system throughout the rotation. In many cases, they will be on-site for most of the nurse’s clinical time, so they can effectively monitor and supervise progress and answer any questions. The instructor will assign various tasks and will also be looking at practical skills in order to assess grades. Students could also be expected to shadow a working nurse to learn from them and help with their patients.

Clinical shifts are normally scheduled for between eight and twelve hours to give students the experience of full-time nursing and understand different patient needs at varying hours of the day.

Students will not be expected to provide complete patient care during their first few clinical rotations, but as their confidence and skill set grow, they will be expected to take on more responsibility. By the end of the final rotation, students will be able to care for many patients on their own with minimal supervision. While students may not have patients they are in charge of primarily, they will be assigned patients they are in charge of and the primary caregiver for. Caring for these patients will involve following nurses’ orders, administering medications, assisting in ADLs, and assisting with procedures.

Clinical placements are designed to cover a range of specialties to help students work out what areas they wish to explore during their careers. Examples of placements include:

  • Pediatrics
  • Community health
  • Psychiatric care
  • Medical-surgical unit
  • Long-term care and geriatrics
  • Critical care and emergency
  • Operating rooms and recovery
  • Labor and delivery

Clinical homework often consists of care plans, which are a way for student nurses to connect the patients they see with the nursing process itself. The five parts of a care plan are assessment, nursing diagnosis, plan, intervention, and evaluation. Depending on the program, participants will be required to complete a certain number of care plans.

Before they start, many students ask whether they have to find their clinical rotations. Preceptors and clinical sites have to be properly vetted to make sure the experience will prepare them to reach the proper outcomes required by their nursing program. Quality nursing programs will provide clinical placement services, allowing students to focus on their studies and guaranteeing the rotations provided will meet the requirements of the curriculum.

Each school will give students a list of guidelines on what to wear, but generally, they all have a mandated uniform which includes:

  • A pair of special-order scrubs in the school’s color
  • A badge from the nursing program
  • A badge from the healthcare system
  • Closed-toed shoes
  • Other useful items are a pen, a nursing report sheet, a penlight, and a stethoscope

The importance of clinicals

The Commission on Collegiate Nursing Education (CCNE) defines clinical nursing experiences as ‘planned learning activities that help students to understand, perform, and refine their professional competencies’.

Not only do nursing clinicals provide experience in a variety of environments, but they also allow students to explore different specialties in different areas.

As well as gaining essential hands-on practical experience, clinicals are a useful way of building connections for the future when thinking about gaining regular employment or career development. Making a good impression during this time can help with future work opportunities.

During clinicals, nursing students can get a close-up view of the daily tasks of a registered nurse, working alongside them and having the opportunity to ask questions and learn from what they do. Plus, students will be expected to undertake basic nursing procedures, not only learning techniques, but also building confidence at the same time.

They also help students understand what specialties best suit their personality and long-term goals. Learning how to manage time, adjust priorities, and work in a sometimes hectic and stressful environment is a useful way to dip a toe in the water of day-to-day nursing before stepping back and assessing what has been gained from this experience and what more a student needs to do to improve their skills and knowledge.

Grading and assessment

The grading system for clinicals will vary depending on the school, but each must adhere to national guidelines set by accreditation bodies. In most cases, the following criteria will be used:

  • Attendance – many nursing schools require students to have completed a specific number of hours to prove they are competent in certain areas.
  • Being prepared – this includes elements such as wearing the correct clothing and studying patient care plans in advance.
  • Participation – assessors look at how nurses successfully demonstrate practical skills such as taking vital signs and charting.
  • Homework and care planning – this involves creating patient care plans for most clinical rotations, which aim to enhance understanding of nursing processes such as diagnosis, planning, intervention, and evaluation while at the same time providing a framework for best care practices.

While clinicals are subjective experiences, it is uncommon to fail them as there is generally a great deal of support and interaction with instructors. However, there are a few circumstances under which someone can fail, and these could be causing harm to a patient, administering medications without the presence of a clinical instructor or licensed registered nurse, not adhering to clinical guidelines, and potentially causing harm to a patient.

Challenges

Nursing clinicals are vital parts of the learning experience and can be exciting, but they are not without their challenges.

For instance, hospital settings can be very fast-moving and stressful environments, especially if you are not used to working within them. While most of the people students will be dealing with will be supportive and helpful, the nature of the job means that they may be focused on dealing with immediate issues and helping patients day-to-day rather than simply guiding student nurses. It is important to remember that everyone in that environment was once in the same position.

A report published in the National Library of Medicine in 2020 stated that clinical education is one of the fundamental domains in developing the nursing profession, providing the opportunity for students to transform conceptual knowledge into skills that can be applied to patient care. Their clinical experience is a major factor in determining the quality of their overall education and has a significant impact on their learning outcomes. It found that studies show most students consider working in clinical centers stressful, which affects the learning process and its outcomes. Therefore, an environment that works to appreciate, welcome, guide, and alert students when they begin working there may help to reduce their anxiety. Ensuring students receive the best support possible is a vital factor in making the most of their learning experience and assisting their progress in a positive way.

Things to consider include the fact that, unlike the theory element of a course, the clinical learning environment is not so structured. Students within clinical settings are often exposed to challenging patients and emergency situations. All of the things they experience may cause stress and anxiety and can influence their choice of future careers. Therefore, it is important to have high-quality and effective guidance and management to ensure the students can advance their competencies and increase their confidence for the future.

Making the most of clinicals

Ideas to help maximize a student’s experience of clinicals include:

  • Take notes – carry a notepad when making rounds to write down questions or observations to help with any assessments.
  • Ask questions – it is important to clarify the information given, whether as situations arise or at the end of the shift.
  • Be ready to work immediately – clinicals offer immediate opportunities for experiencing the benefits of hands-on education, so it is a good idea to be open to helping practically where possible.
  • Learn through practice – the best way to master non-academic nursing skills is to learn by doing.
  • Be prepared – it is a good idea to read and refresh all knowledge of the clinical subject before it begins, which not only helps the student but also shows instructors that a student is serious about learning.

Important interpersonal nursing skills

Throughout the training, nurses will learn both academically and practically the skills and knowledge they need. The more practical or clinical experience they have, the more confidence they will gain as they ease into their new career path. Confidence is crucial, and although it may come with experience, the knowledge that a student has made the most of the learning opportunities on offer, including clinicals, will help.

Understanding how to maintain a holistic understanding of course content and how to use that knowledge to put it into practice and make informed decisions is a very important skill for new nurses. Thinking critically is also a key nursing skill, as is honing and developing the ability to make quick decisions in high-stress situations.

Whatever role a nurse is in, patients are at the core. So, a good bedside manner is an important tool in a nurse’s armory, and on top of clinical treatment, it has the biggest impact on the experience of a patient and their family. The ability to make useful human connections and create an environment where patients and their families feel safe, informed, and cared for cannot be underestimated.

The word leadership does not mean a nurse is in a specific leadership role, but the job involves working with patients and their families who require updates and guidance, and this means a nurse is in a position of leadership. It is important, therefore, to be self and situationally aware, be at ease in managing projects, conflicts, and emergencies, and have good time management skills.

Getting the first qualification to become a nurse is just the beginning of a commitment to lifelong learning, changing within organizations, and developing soft skills. There are very few industries that move at a faster rate than medicine and patient care, so understanding there is always more to learn is vital. This can be done by undertaking self-development courses, more clinical training, and understanding what is going on in the world of healthcare, whether via specific medicine and health-related reading or more general publications, magazines, and websites.

Good interpersonal skills are essential, such as working well with colleagues, communicating, and collaborating effectively to maximize good patient care. These skills can be read about but are more likely to develop during hands-on experience. Being open to advice and questioning, when necessary, is also key to evaluating and assessing the best way to proceed with a patient’s care.

Getting the right qualification

Doing an online nursing degree is a useful option for many people, and clinicals are still a very important part of the learning process. There are similarities between clinical hours for nursing schools offering in-person and online study – these include the kind of patient care and professional skills students must demonstrate. In some cases, online nursing programs will assist the student in finding nursing clinical hours, which is the case at Rockhurst University.

Having confidence in the quality and relevance of clinicals in nursing school is vital for any nurse. Rockhurst University offers complementary clinical placement services where students are matched with a clinical placement coordinator who can help find preceptors and clinical sites within the right regions. On top of this, students are notified of their placements before each rotation in their program and receive support until they complete all of their clinical requirements.

For candidates who already have a bachelor’s degree in another field, Rockhurst University offers a hybrid Accelerated BSN which includes a full-time program enabling students to become a skilled nurse in 16 months, 100 percent online course work, and a 10 day on campus residency with instruction at the university’s simulation lab.

Once the right qualifications have been achieved, the job prospects for registered nurses are positive. According to the Bureau of Labor Statistics, the employment of registered nurses is projected to increase by 6 percent between 2021 and 2031, with approximately 203,200 job openings projected each year over that decade.

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