The U.S. Department of Labor (2007) has reported a projected national need for 1 million RNs between 2006 and 2016. To meet this projected nursing shortage crisis, nursing education programs have focused on increasing enrollment in nursing colleges and universities. As nursing programs push to expand their enrollment numbers, they are faced with serious resource issues (American Association of Colleges of Nursing, 2005; Yordy, 2006).
Currently, many barriers to increasing enrollment in nursing programs exist. One barrier is shortage of qualified faculty. Faculty salaries in academia cannot compete with the service sector. Increased competition for clinical site placement from competing nursing and multidisciplinary programs, especially inpatient sites, also creates a barrier for increasing nursing student enrollment (Cloutier, Shandro, & Hrycak, 2004; Northeast Ohio Nursing Initiative, 2004; Oermann, 2004; Yordy, 2006). A final barrier to increasing enrollment is budgetary restraints, as many states are decreasing higher education funding (Northeast Ohio Nursing Initiative, 2004; Yordy, 2006).
Increased enrollment into the baccalaureate nursing program at Youngstown State University has become a double-edged sword. The favorable aspect is a significant increase in the number of undergraduate students entering the bachelor of science in nursing program. However, finding appropriate clinical sites for nursing students in the maternal-women’s health nursing course has become increasingly more difficult. As with any area of specialty, mother-baby units comprise a small population of the hospital census.
Clinical experiences reinforce didactic learning for student nurses and are a critical component of nursing educational programs. Experience and preparation received during clinical rotations influence students’ abilities to assume clinical roles upon graduation (Henderson, Heel, & Twenty-man, 2007). Traditionally, clinical learning opportunities for students have been in hospital settings in maternity nursing units (Lewin, 2007). Currently, maternity nursing faculty are faced with several challenges, including the changing health care environment, clinical site competition, and declining birth rates. These challenges may limit learning opportunities, especially in rural areas and community hospitals, where a limited number of births may occur.
Faculty at Youngstown State University have implemented innovative strategies to meet these challenges and to promote appropriate clinical learning experiences for students enrolled in a maternal-women’s health nursing course. Traditional inpatient clinical experience included rotations in labor and delivery units, mother-baby units, and special care nurseries, reinforcing educational content in these areas.
Although these clinical experiences are located in the hospital, a wealth of community experiences for maternal-women’s health nursing students exists. A variety of clinical opportunities were provided to assist students with integration and development of maternity and women’s health nursing skills. Clinical opportunities included both inpatient and community experiences.
Although patients were seen in the hospital during the stages of childbearing, other aspects of maternity care and women’s health had been overlooked. The maternal-women’s health nursing course is wellness focused. Therefore, students needed to experience the care of women in a more holistic approach compared with nursing care in the hospital setting.
Collaboration with inpatient and community health care agencies is vital in designing experiences to meet nursing students’ learning needs. Nurses in health care agencies work with students while providing nursing care in the community setting. Students receive many benefits as they can gain new skills and knowledge from experienced nurses, and they are able to apply theory to practice (Allen, Smith, & Lorentzon, 2008; Brown, 2004).
Clinical faculty visited and assessed potential community clinical sites that would meet the maternal-women’s health nursing course learning objectives. Collaborative communication with agency nurses is essential. Faculty members selected specific sites that would meet clinical experiences and placement needs for students. Responsibilities of faculty were to develop rotation schedules; promote collaborative relationships; clarify roles; and identify agency policies, procedures, and agency culture. Contracts between the agency or clinical setting and the department of nursing were developed (Brammer, 2008; Kelly, 2007).
Current clinical skills and expectations were reviewed with community health care agency nurses to promote understanding of student performance and expectations within the community agency setting. Nursing faculty acted as facilitators in assisting the community nurses with selection of activities for student participation (Brammer, 2008; Lewin, 2007). This process is dependent on assessment of individual student needs, competencies, and skills. When not present in the agency or clinical site, clinical faculty members were available to nurses and students via pagers, cell phones, and e-mail.
Open communication and collaboration were encouraged between faculty, nurses, and students throughout the term. Students evaluated experiences through journal writing assignments. Students were able to relate and reflect on their clinical experiences within the agency or clinical site. Journal writing helps facilitate students’ critical thinking abilities and promotes self-directed learning (Bradbury-Jones, Sambrook, & Irvine, 2007; Ibarreta & McLeod, 2004; Tornoe, 2007).
Various community sites used and students’ perspectives regarding their experiences are described.
Community Sites and Student Perspectives
Incorporating women’s health into the classroom required the need to include clinical experiences to reflect this content. Faculty determined strategies to help students integrate relevant theoretical concepts of maternal-women’s health nursing by placing students in more community sites. Students responded well and had positive comments regarding their community clinical learning experiences. After each clinical encounter, students wrote a journal entry reflecting on their experiences. Most entries positively regarded the community agencies. Excerpts from student journals, with permission, verify the learning potential of multiple in-patient and community clinical sites for students (Kelly, 2007; Tornoe, 2007).
Women’s Health Clinic
Students were assigned to various women’s health clinics to gain knowledge regarding prenatal, post-natal, and gynecologic care. Students assisted nursing personnel while implementing nursing care. In addition, students selected one pregnant woman to follow throughout her clinic appointment. Students learned about the patient’s perception of care she received at the clinic and were able to identify nursing leadership roles. Students provided health teaching and were able to identify how economic, cultural, social, and legal issues affect their patients’ health care needs.
Some students described this site as a good learning experience because it provided an opportunity to observe different roles and responsibilities of the nurses, compared with nurses in the hospital setting. Students noted the different needs of a diverse population in the health clinic setting. They gained knowledge regarding the immense health care needs of pregnant women in each trimester. Students were able to apply many theoretical concepts learned in the classroom and gained practical skills such as finding fetal heart rates and measuring fundal heights. They reported the nurses and doctors were great role models who displayed professionalism, knowledge, and dedication to their patients—qualities students try to attain in nursing. Students were impressed with the detailed education patients received. They reported that this experience would help them provide comprehensive education to this patient population in the future.
Welcome Home Visits
The Welcome Home program is offered through the local county health department. Students traveled with a nurse to various homes of new mothers who had recently delivered and were able to identify health needs of new mothers and their newborns. They also implemented effective communication and interpersonal skills by providing health teaching.
Students reported that this experience was very different from experiences in other community agencies because the clinical site was in a private home rather than in a traditional health care setting. They learned about various public health programs that are available to new mothers and their newborns. Students were able to compare the needs of mothers immediately after birth with the needs of mothers 1 to 2 weeks postpartum. Some students recognized family problems in providing adequate care for the newborn. Patient education was identified as a significant component of this clinical experience.
Perinatology High-Risk Office Settings
The objective for this experience was aimed at implementing health-focused, community-based nursing for women experiencing complicated phases of the reproductive process. Students were able to assist with procedures such as nonstress tests and obtaining vital signs, testing urine for protein and glucose, and locating fetal heart rates. This valuable clinical site expanded students’ knowledge of high-risk problems that may be experienced during pregnancy. Students observed procedures such as three-dimensional and four-dimensional sonograms and amniocenteses. Students were able to use therapeutic communication skills when talking to women and their families who were anxious regarding the status of their pregnancies.
This was the most popular of community experiences. Students reported learning a great deal from the doctors and nurses at the high-risk clinic. They observed patients with high-risk conditions that they had read about in their textbooks. Students applied theoretical concepts to the clinical setting. After discussing the course of pregnancy and its complications with a couple, one student stated that she had gained an in-depth understanding of their situation and hoped that she had provided them with some comfort. Another student described how she worked with a family from a different culture at this clinical site. She was excited to have addressed a culturally sensitive situation in this population.
Prenatal Childbirth Education
Health teaching is a major part of nursing care in maternity and women’s health. Students are expected to meet the educational needs of each family member while enrolled in the maternal-women’s health course. Attending childbirth classes reinforced this aspect of nursing. While attending these classes, students gained knowledge regarding information presented to future mothers and their coaches.
Many students found that the prenatal childbirth education program reinforced the content learned in class. Students reported learning how to educate pregnant couples. It was helpful to experience this phase of childbearing to help students understand the parents’ viewpoint and concerns regarding labor and delivery. As one student stated:
You get to see a different aspect of things in these classes. It’s not like being on the floor…. You get to see the “before.”
Students were impressed with the detailed information taught in these classes.
Sexually Transmitted Infection Clinic
Understanding of sexually transmitted infections is an important aspect of nursing in maternity and women’s health. The local health department sexually transmitted infection (STI) clinic provided students with learning opportunities that focused on STI epidemiology, transmission modes, risk factors, prevention strategies, communication, privacy, and ethical issues. Students provided health education to individuals and families faced with these disorders. This clinical experience reinforced classroom content, ethical dilemmas, and privacy issues that many individuals and families encounter.
Students reported this experience to be a “real eye opener.” They were astonished at the substantial number of clients who sought care for STIs. One student reported she had expected to see only younger clients and was amazed to see middle-aged clients as well. Students related they were surprised to see clients from diverse economic, educational, and social backgrounds. As one student stated:
Those with STIs look the same as I do. The old myth about those with STIs being dirty has gone out the window. I now realize that no matter who you are or what your background is, you can still end up with an STI. This can happen to the best of people.
Students were impressed with the protection of patient confidentiality and privacy and how this protection encouraged clients to follow through with treatment. Students observed the importance of good interviewing and nonjudgmental questioning techniques to make clients feel comfortable and promote compliance.
Students gained knowledge regarding STIs, and confidentiality and ethical issues. They gained skills in interviewing techniques and specimen collection. Students noted this clinical experience added to their knowledge base by reinforcing didactic content. The experience helped students use a leadership role and develop interpersonal skills.
Hadassah Check It Out Program
Under the direction of a nursing faculty member, students were able to assist with presenting the Hadassah Check It Out Program in local school settings. The program is designed to teach adolescent girls about self-breast examination and general healthy habits. Students presented a prepared script about breast cancer risk, epidemiology, and diagnostic early detection methods. Students introduced speakers (cancer survivors) and demonstrated how to identify breast lumps using rubber breast models. Students also assisted with administration of a pretest and post-test. This experience helped reinforce students’ knowledge and skills of women’s health.
Students were able to gain skill in patient education regarding teaching adolescent girls how to identify breast lumps using rubber breast models. Students gained skills reinforcing the importance of self-breast examination and knowledge about diagnostic tests and techniques for early breast cancer detection.
Advanced Nursing Practice Settings
Clinical experiences included accompanying nurses in advanced practice roles. Pregnancy and well-women’s health care were reinforced by observing a nurse midwife and lactation counselor. Students were able to understand the role of advanced nurse practitioners within the obstetrical arena. Clinical experience with the lactation counselor focused on breast-feeding techniques, eduction for lactating mothers, and the importance of providing ongoing support and follow-up for successful lactation.
Students were excited about this learning experience and opportunity to observe roles of the nurse midwife and lactation counselor in action. Many students were unaware of opportunities for nurses to practice in these advanced roles. Students were impressed with the knowledge of these advance practitioners and their varied roles, as well as the passion, autonomy, responsibility, and accountability they assumed in their practice roles. Students gained knowledge about pregnancy, childbirth, and lactation and were able to integrate this knowledge with theoretical concepts. They gained knowledge regarding specialized advanced practice roles and preparation required for these roles.
Nurse Midwife. Experiences with the nurse midwife allowed students to gain skill in interviewing techniques, fundal height measurement, and obtaining fetal heart rates. Students observed women in different stages of pregnancy, ranging from 12 weeks to 38 weeks. Some students observed nurse midwife deliveries and noted differences between nurse midwife and physician delivery techniques.
Lactation Counselor. Students reported that clinical experiences with the lactation counselor enabled them to identify benefits of breastfeeding for both mother and infant and the importance of meeting the needs of the lactating mother and family. They also noted the important benefits that breastfeeding provides for babies with complications due to prematurity. Students reported they gained much knowledge and skill and were able to educate patients regarding breast-feeding techniques, equipment, milk storage, maternal diet requirements, jaundice, and support.
Students were able to observe the lactation counselor using leadership roles of coordinator, collaborator, client advocate, and change agent while caring for childbearing families and women. One student described the nurse lactation counselor as the “best proponent of patient advocacy” she had ever seen.
These clinical site placements provided nursing students with valuable experiences and helped solve issues of clinical site competition. Students were able to apply, analyze, and synthesize didactic content and develop new skills in maternity and women’s health nursing. Students developed an understanding of real-life roles advanced practice nurses assume in their maternity and women’s health practice. Multiple inpatient and community clinical sites provide a wealth of learning opportunities and potential for students enrolled in maternity and women’s health nursing courses.
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