workforce
“ Moving from the academic realm into the everyday reality can throw up many real world challenges .
From theory to practice
Getting students ready to work on the ward .
By Karen Missen
Nursing has changed enormously since I started my nursing training as one of the last cohort of solely hospital trained nurses in the late 1980s . Although we transitioned to a degree qualified profession more than 30 years ago , there are still debates about whether nursing training is better now and whether nursing students are really ready to practise in the clinical setting when they graduate . Having come through hospital-based training and now overseeing the education of nursing students at university , I can see both sides .
One thing is sure , nursing students today study nursing and science subjects in depth in a way that was not possible in the hospital-based training system I went through . The use of simulation and various online programs in current nursing programs allows nursing students to practice their skills and critical thinking before they try them out with real patients .
Clinical placements are still a crucial part of nursing training , every student must do five clinical placements in actual health care settings like hospitals , aged care facilities and mental health hospitals over their three-year degree .
Quality clinical experiences that give student nurses direct experience of managing patient care are vital , especially for final year students .
A challenging impact of the stress placed on hospitals by the COVID-19 pandemic was that we found it harder to organise quality clinical placements for final year students . A lot of placements were cancelled because they were considered to be in ‘ COVID hot zones ’ such as emergency departments , critical care units and potential COVID wards in both metropolitan and regional hospitals .
With the vaccine roll out and hopefully a return to more manageable healthcare environments , this year we are placing our nursing students in a range of acute care settings where they have contact with patients with a variety of care needs .
I believe a nursing student ’ s final clinical placement is the most exciting time as they get given more responsibility for patient care . But placements can also be intimidating and stressful – being exposed to and impacting on real patients , being required to demonstrate skills under scrutiny and in unfamiliar situations , can be nerve wracking .
I ’ ve seen many student nurses struggle with the realities of managing their lives while on a placement . Like working nurses , they are expected to take on a range of shifts , including evening , overnight and weekends , which can be challenging for students with family responsibilities .
Many students can face financial pressures , because it ’ s not advisable and often not possible to continue with other paid work while on a three to six-week clinical placement , twice a year .
Moving from the theoretical and academic realm into the everyday reality can throw up many real world challenges .
Whilst many health care settings have high standards of care and follow strict procedures , student nurses can witness poor nursing practice , including : physical or emotional abuse of patients ; breaches of patient safety , privacy and dignity ; the provision of substandard or outdated care ; and clinical errors .
Unfortunately , there is evidence that when students try to raise concerns about poor or abusive practice with their preceptors they may encounter hostility or resistance . In worst case scenarios , student nurses experience bullying and incivility .
A study published in 2017 revealed that half the nursing student respondents experienced bullying and harassment behaviours while undertaking clinical placements , and that the main perpetrators were registered nurses [ Budden et al 2017 ]. I find this very shocking , and all the more reason to support the high standards of university-based training to try and reduce this behaviour .
Another challenge graduating students face is stiff competition for nursing jobs , with 8000 student nurses expected to graduate every year .
Currently there are not enough graduate positions available . Figures released by Graduate Careers Australia ( GCA ) continue to reveal a steady decline over the past decade in the number of nursing graduates who manage to find full-time jobs in their chosen profession .
Given this reality I always stress to students to really make the most of their final placement . This is the time to practice initiating patient care and to manage a full patient load . It ’ s their chance to show their ability to prioritise care and to take on more responsibility .
I encourage students to use their placements to develop professional relationships and networks with potential post-graduation employers and co-workers : they may become valuable referees in the search for a nursing position . ■
Dr Karen Missen is the Associate Dean of Teaching Quality and Student Retention in the Federation University School of Nursing , and a senior lecturer in Nursing . nursingreview . com . au | 25