Clinical Supervision of Nursing Students
Clinical faculty members are essential for the success of nursing students. It is impossible to learn nursing without effective clinical experiences provided in an environment that provides support and respect for students while they learn the art and science of nursing.
Purpose of Clinical Experiences
The clinical environment is an educational environment for nursing students. While students are expected to apply the knowledge, practice the skills, and demonstrate professional attitudes consistent with professional nursing practice, it must be emphasized that clinical experience is a learning or “practice” experience for students not a “performance” experience. Clinical experiences provide the opportunity for students to:
- Apply the theoretical concepts learned in the classroom.
- Practice skills learned in the nursing laboratory in a variety of clinical situations (e.g., hygiene, medication administration, nursing interventions, etc.).
- Demonstrate skills that cannot be fully experienced in the nursing laboratory (e.g. assessment of clients with health alterations).
- Practice communication skills with clients, their families, colleagues, and other health professionals.
- Increase problem-solving and clinical decision-making skills.
- Practice clinical organization and time management skills, including determining clinical priorities for individual and multiple clients.
- Socialize professionally to the clinical nursing environments of hospital and community practice settings.
- Socialize to the profession during observational and professional activities (e.g., attendance at professional meetings, observation of community resources for client support and care, etc.)
Alternative Clinical Experiences
In many courses, alternative clinical experiences may be assigned to enhance student learning. Alternative learning experiences should not simply be a way to decrease the number off students on the nursing unit or a way to “reward” good students, but rather planned activities with specific objectives and available to all students. Alternative experiences may include observational activities (e.g., operating suite, emergency department, outpatient clinic, etc.), interaction activities (e.g., interviews of well persons, health care clients, interdisciplinary health professionals, etc.), attendance at professional conferences or meetings (e.g., FSNA, NSNA, FNA, etc.) or other instructional activities.
Alternative learning experiences should be cleared with the lead course instructor so that all students have consistent learning activities. When alternative learning activities are assigned, there should be clearly written learning objectives for the activity and a method of evaluating the student’s learning from the activity.
For clinical experiences to be effective, there must be:
- Learning objectives that are clear and concise. Learning objectives must be written in a manner that is clearly understood by all students. The lead instructor for the course should review clinical learning objectives with students and clinical faculty so that all members of the instructional team understand student requirements.
- Learning objectives that are consistent for all students in a given course regardless of clinical setting and clinical instructor. The lead instructor for the course should review clinical learning objectives with students and clinical faculty so that all members of the instructional team ate consistent in their requirements. Students in a given course talk to each other and can be confused if different clinical faculty members have different requirements for student success (# of nursing care plans, observation guidelines, written requirements, etc.).
Respect for Students as Persons
For many students, clinical experiences are frightening because of the interaction with real patients with real health problems. Students should never be reprimanded in front of patients other students, or staff members. Students should be counseled in private when their performance is unacceptable. If the clinical instructor feels that a witness is necessary when counseling a student with deficiencies, the lead course instructor or the Associate Director are preferred witnesses rather than clinical agency staff.
The FIU nursing unit is proud of the diversity of its students, staff, and faculty. Such diversity can result in misunderstanding between students and faculty in regard to student expectations. Different cultural understandings of male/female roles, teacher/student roles, and nurse/patient roles may result in behavior that is interpreted as disrespectful. All faculty members are expected to be role models of cultural competence during their interactions with students, patients, and agency staff.
Written Evaluation of Student Progress
Students should receive written evaluation of their progress at mid-semester and at the completion of the semester. Students who are deficient at mid-semester must be informed in writing of the specific deficiencies (e.g., inadequate preparation, lack of knowledge about their patient needs, absenteeism or lateness, unprofessional behavior, etc.). Failure to provide written mid-semester evaluation for students with deficiencies may require that the student receive a passing grade for the clinical course.
Clinical Supervision of Nursing Students
Students require continuous feedback regarding their performance. For students who are not meeting clinical objectives/standards, clinical faculty should counsel students promptly with a plan for remediation. For students who are meeting or exceeding clinical objectives/standards, praise for their work should also and given and opportunities for greater learning challenges discussed. Faculty should guide and nurture students to the highest ability.
Opportunities for Remediation
Students who demonstrate deficient or unsafe practice must be provided with opportunities during the clinical experience for remediation and demonstration for improvement. Students may be referred to the nursing laboratory, the FIU Learning Center, the course lead instructor, or the Associate Director for remediation or guidance for improvement. When making such referrals there must be verbal or written communication between the clinical instructor and the person for whom the student is referred.
Components of Clinical Experiences
Student Assignments. Student assignments may be made the evening before clinical or two hours before the starting time of clinical depending upon the agency and nursing unit. Faculty may make assignments the evening before for nursing units where client turnover is not frequent, such as long term care facilities, or general nursing units. For student experiences on nursing units with rapid turnover, such as intensive care units, assignments may be made two hours prior to the start time of the clinical activity. Assignments must be made allowing sufficient time for student preparation prior to the beginning of the clinical time.
Client/patient assignments may be made by the clinical instructor, by the students, or by the instructor and students together. Assignments should be made based on student learning needs; thus clinical instructors must know what prior experiences students had and what experiences they need. Having the theory class schedule assists the instructor in assigning appropriate clients/patients to enhance learning. For example, if students are studying the respiratory system in Pathophysiology, respiratory drugs in Pharmacology, and nursing care of clients with respiratory problems in Adult Nursing, then the clinical assignment should include clients with respiratory problems. If a students has not had an opportunity to perform a specific nursing procedure on a “live” client, the instructor might assign a client who requires that procedure.
The number of clients assigned may vary with the type of clients and the ability of the student. First semester nursing students may be assigned one client at the beginning of clinical experiences and assigned two or more clients as they become more confident and skilled. In some environments such as an intensive care unit, the student may be assigned one client. It is also effective to assign two students to provide care to one or more clients together. This can reinforce the concept of collaboration in client care.
Pre-Conference. During pre-conference, planning of client care continues. This is an opportunity for students to ask questions about their assigned clients and for the instructor to assess students’ preparation. It also provides students with an opportunity to organize their day and establish priorities of care. If student are expected to participate in change of shift report, pre-conference should finish so that students are on time for the report.
Clinical Practice. After pre-conference and report, students may start assessing their clients and providing care in collaboration with the registered nurse responsible for the client. While the instructor is responsible for the care given by all students, the instructor may spend the most time with students who require intense instruction or guidance. For this reason, not all students may administer medications every clinical day, especially when beginning students are developing proficiency and confidence in this skill. Similarly, for students who are demonstrating a nursing procedure for the first time on a “live” client, the instructor must be available to guide the student in successful performance of the skill. I t goes without saying that students must be informed prior to the clinical experience that they will be performing these procedures so they can prepare adequately.
Opportunities for leadership and practice of delegation skills are also important. One strategy for providing these experiences is to assign one or two student the team leader role with other students being members of their team. In this way, the “team leader” interacts with the “team members” under the guidance of the instructor to ensure that client needs are met.
Clinical instructors must be active participants in nursing students’ learning. They must be readily available to students for guidance, answers, and support throughout the clinical day. If students are off the primary nursing unit for observational experiences, the clinical instructor should make telephone contact to insure that the student is achieving the objectives of the observational experience.
Post-Conference. Post conference is a time to analyze and synthesize the events of the clinical day. It is essential to summarize the day’s experiences and set goals for future clinical days.
There are many strategies for creating a successful post conference. Often, post conference is used to process student feelings about some critical event of the day, such as the death of a client, a succesesful cardiorepsiratory resuscitation, a client’s diagnosis of a terminal condition, or a client’s hostile or belligerent behavior. Post conference may also be used for students to present their client/patient using a “nursing rounds” model. All students can then participate in discussion about the care provided and alternatives to that care. Such discussion can be used to challenge students to defend the care they planned. Sometimes, post conference may be used for specialized heath professionals, such as the infection control nurse, social worker, or respiratory therapist or chaplain to discuss their role in client care.
Post conference should always be done in an environment where client confidentiality is maintained. The activities of post conference can help students synthesize the events of the clinical day through critical analysis of their client care.