Dr. Slaughter-Smith is Professor of Nursing, Dr. Helms is Professor of Nursing, and Dr. Burris is Professor and Department Head, Nursing Department, Arkansas Tech University, Russellville, Arkansas.
This study was funded in part by the Arkansas Tech University Faculty Research Grant.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Jennifer Helms, PhD, RN, Professor of Nursing, Arkansas Tech University, Nursing Department, Dean Hall, Suite 224, 402 West “O” Street, Russellville, AR 72801; e-mail: email@example.com.
Because of the current nursing shortage, nursing programs are encouraged to increase enrollment to meet the needs of the community. Many nursing programs are unable to do this due to the shortage of faculty; however, some programs are instituting dual enrollment in an effort to increase the number of graduates. This means that nurses working with students not only have students more days each week, but also have students of varying skill levels throughout the week. In addition, hospitals also serve as clinical sites for students from varying education programs ranging from licensed practical nurse programs to associate degree and bachelor of science degree registered nurse programs.
In addition to the effects of the nursing shortage on education, clinical staff nurses are faced on a daily basis with dilemmas secondary to the shortage, such as increased patient care assignments and workload. Thus, it is important for nurse educators to assess staff nurse perceptions of students to provide positive rewards for both clinical nurses and nursing students. Recognizing that clinical rotations in acute care facilities are essential to the learning experiences of nursing students, the purpose of this study was to explore the benefits and limitations, from the perspective of staff nurses, of having undergraduate nursing students in the clinical arena. This study is a replication of an earlier study published by Grindel, Bateman, Patsdaughter, Babington, and Medici in 2001.
Given that nursing is a practice discipline, students are placed in clinical settings to practice with professional nurses in the care of patients. In many cases, the nurses work one on one with nursing students in conjunction with the responsibilities of patient care. Earlier studies addressing students’ perceptions of the clinical environment emphasized the importance of nurses’ attitudes toward students as making a difference in the clinical experience. Students remarked that they learned best with nurses who demonstrated a caring attitude and a willingness to teach, and who treated them as if they were part of the team (Atack, Comacu, Kenny, LaBelle, & Miller, 2000; Birx & Baldwin, 2002).
Because the majority of earlier studies focused on the student perception, Birx and Baldwin (2002) conducted a study to evaluate the clinical setting from the perspective of both the students and the staff in an effort to enhance the relationship between the students and the clinical staff and instructors. Recognizing that there was limited research on nurses’ perceptions of students, a national study was conducted to explore nurses’ perceptions of students in clinical settings. Included in the survey were adult health medical–surgical nurses and mental health nurses. Their findings indicated that both groups of nurses found students to be contributors to patient care and to the staff’s personal and professional satisfaction (Grindel et al., 2001). Yet, a later replication of the study revealed that nurses have ambivalent feelings about students in clinical settings. Nurses do not always perceive their relationship with students in a positive manner (Palmer, Cox, Callister, Johnsen, & Matsmura, 2005).
In addition, the nurses’ length of service was found to contribute to their perceptions of students’ contributions. Historically, students have been encouraged to work with seasoned nurses in an effort to learn as much as they can in the short duration of clinical time, but findings from one study suggest the opposite. Researchers compared the perceptions of students by nurses with more than 10 years of experience with those of nurses with less than 10 years of experience and found that nurses with less than 10 years of experience rated students’ contributions higher than nurses with more than 10 years of experience (Grindel, Patsdaughter, Medici, & Babington, 2003).
Because the relationship between clinical staff nurses and students directly affects the quality of the learning experience for the students, the nurses’ perceptions about students are important to assess. In an area of limited clinical facilities, increasing enrollment directly affects the nurses’ clinical environment and the students’ learning experiences. Therefore, the purpose of this study was to examine how nurses perceive student clinical rotations in an effort to enhance the relationship between service and academia.
This descriptive study was conducted in three rural hospitals within a 30-mile radius of the university where the authors are employed. Following human subjects approval, the faculty member (C.S.-S.) explained the research study to the nurse managers at the participating hospitals. Verbal permission to conduct the study was granted from the Chief Nursing Executive at each facility.
Permission was obtained by Grindel et al. (2001) to use the 54-item survey, Nursing Students’ Contributions to Clinical Agencies (NSCCA), in this study. The NSCCA focuses on the effect of undergraduate nursing students on staff time, staff development, quality of care, staff’s personal satisfaction, and unit standards and practices. A 5-point Likert scale ranging from 0 (strongly disagree) to 4 (strongly agree) is used for 53 items. Scores range from 0 to 212 on the 53-item questionnaire. The final item is a global indicator on which the respondents rated their perceptions of students’ contributions from −5 (extremely negative) to +5 (extremely positive). The Cronbach alpha for the NSCCA was 0.95 (Grindel et al., 2001). For our study, an additional question was added to the survey instrument to elicit comments: “Reflecting back over the last few weeks/months, tell me about the experiences you have had with nursing students in the clinical setting?” (Atack et al., 2000).
In addition to the survey instrument, a modified version of the demographics questionnaire was used to accurately describe the sample population. Respondents were questioned about their age, number of years in practice, highest educational level, average daily patient care assignment, number of beds on the unit, types of nursing programs placing students on the unit, level of students, and how often students are on the unit. This additional information allowed the researchers to explore any correlations between staff perceptions and demographic data.
A convenience sample of staff nurses and nurse managers was recruited from three nearby rural hospitals that provide clinical sites for the university’s baccalaureate nursing degree students. Of the 125 surveys distributed, 84 were returned, for a response rate of 67%. Packets containing the survey were distributed to interested nurses on all units within the hospitals. A letter of explanation and encouragement to participate was included in the packet. Respondents were asked to complete the enclosed survey and return it to a designated drop box on their unit within 2 weeks. Drop boxes for completed surveys were centrally located on each unit to improve staff nurse participation.
The cover letter on the survey advised respondents that completion of the survey would serve as consent. A 4-ounce bag of Starbucks ground coffee was provided to each interested respondent. The surveys were color coded to allow the researcher to determine the specific units and area agencies represented by the surveys to enhance description of the data.
Data were analyzed using both quantitative and qualitative methods. For quantitative analysis, data were entered into SPSS version 13.0 software and analyzed using descriptive statistics. Frequencies, percentages, ranges, and means were used to describe the sample. Ranges and means were also used to quantify the amount of contact between students and staff. Pearson’s correlation coefficient was used to determine relationships. The limited number of questionnaires completed (n = 16) eliminated the possibility of meaningful inferential analysis.
The sample of 84 respondents included registered nurses (n = 67) and licensed practical nurses (n = 14). Three respondents did not provide data for their licensure level. Education levels of the registered nurses were diploma (n = 7, 10.5%), associate degree (n = 24, 38.5%), baccalaureate (n = 34, 50.7%), and master’s (n = 2, 0.3%). One fourth of registered nurse respondents were graduates of the university conducting the study. Sixty-eight were staff nurses (81%), five were nurse managers (6%), and the remaining 11 (13%) were listed as “other” (Table 1). Respondents ranged in age from 23 to 73 years (mean = 42.2 years, SD = 9.76), with clinical experience ranging from 1 to 42 years (mean = 15.8 years, SD = 10.28 years). Respondents reported that their average daily patient assignment was 5.2 patients per day (SD = 3.3 patients) and days per week working with students was 1 to 6 days (mean = 2.2 days, SD = 0.9).
Table 1: Demographics
Analysis of the data revealed that student interaction in the clinical setting was viewed positively by the majority of nurses surveyed. In response to the 11-point Likert scale statement, “Please rate the contribution of nursing students to your clinical agency” (1 = extremely negative, 11 = extremely positive), the mean was 9.31 (SD = 1.33). Items that reflect positive staff perceptions are included in Table 2.
Table 2: Positive Perceptions With Which Staff Nurses Most Likely Agree
The most frequently rated negative staff nurse perception was that problem students can be frustrating. Other negative perceptions included lack of assertiveness with important therapies, confusion and noise added to the unit when students are present, and lack of appreciation for the support of staff nurses (Table 3).
Table 3: Negative Perceptions With Which Staff Were Most Likely to Agree
Themes in Qualitative Data
Respondents were provided with an opportunity to share additional thoughts about working with students by answering a final question, “Reflecting back over the last few weeks/months, tell me about the experiences you have had with nursing students in the clinical setting.” One quarter of the page was left blank under this question to allow respondents to share their thoughts about their experiences with students. Three key themes were identified in the responses: (1) Eager to Learn, (2) Willing to Help, and (3) Serving Their Time.
Eager to Learn. Respondents noted in the following comments that students display an eagerness to learn:
- All the students that I worked with in labor and delivery and the postpartum unit were very eager to learn and practice skills. The more comfortable they were throughout their rotation, the more fun they were. All showed great critical thinking skills.
- I have found the students to be energetic and willing to participate in patient care. They are eager to learn about the patients and their needs.
- Most of the students are eager to participate and willing to try anything. Almost all will readily jump at the opportunity to do something new.
Willing to Help. Some comments referred to the willingness of students to help out in the unit:
- The majority of students have been very willing to help with all they are allowed. The students trigger/challenge me to be better informed about [medications] and treatments. I have enjoyed my experience with the nursing students.
- A student was here for several days completing her preceptorship. She was an amazing help. She fed babies, changed diapers, admitted newborns. She wasn’t completely confident, but she was doing great and had appropriate questions and offered ideas as well. We could see that she was genuinely interested.
- Nursing students are always very helpful in our [intensive care unit] setting because we give total care: vital signs, baths, [morning] care, feeding and intake/output. The students are very helpful in doing these activities, which allows more time for the [intensive care unit] nurses to focus on patient care with the students present.
Serving Their Time. Respondents also identified challenges of working with students who are not actively engaged while working with staff:
- Not all students are created equally (obviously). Several show that they are just there to do their time—these are the ones that you really have to watch and instead of decreasing nursing workload, it doubles it.
- We have had a few that were just ‘serving their time.’
- Students who want to learn and experience things—I love to help—but if they say “I’ve already done that,” that tells me they think once is enough and they don’t need any more teaching.
- Occasionally we have one [who] wants to sit at the desk and not do much.
- Some have been assertive to learn. These students have been well accepted by staff. Other students prefer to sit at the desk every chance possible. The staff soon decide to not waste effort on these students.
The findings from this study indicate that staff nurses have generally positive feelings about working with students, although several nurses expressed some of the common frustrations of working with students in the qualitative responses. Of the top 10 items that reflect positive perceptions of staff nurses, seven reflected personal or professional benefits for the staff working with students. The focus of the remaining three items was the care received by patients and their families.
These findings are consistent with findings of the study by Grindel et al. (2001). In that study, of the top nine positive perceptions agreed on by adult health/medical–surgical and mental health/psychiatric nurses, six of the perceptions reflected personal and professional satisfaction gained by nursing staff. They included five of the same positive perceptions found in our study: (1) allows for opportunities for mentoring, (2) allows nurse to participate in student development, (3) enhances the clinical setting as a learning environment, (4) stimulates staff intellectually, and (5) allows for reciprocal learning.
The assistance provided by students in daily patient care assignments was noted as a positive aspect of working with students. Some nurses view this assistance as beneficial to the overall care of patients on the unit. Furthermore, staff nurses recognized the eagerness displayed by some students to actively engage in the learning process and participate in the care of patients. Students need to realize that staff nurses can perceive when a student is genuinely interested in learning and that they will respond to the student accordingly. Although staff perceptions were generally positive, the nurses also expressed some of the challenges of working with nonassertive students. For some students, this nonassertive demeanor may be due to lack of confidence, fear of failure, shy personality, or laziness. Regardless of the cause, staff nurses view these students as unmotivated and a waste of their teaching effort. Students must be informed that their level of enthusiasm and willingness to engage in the learning process while in the clinical setting has implications for the response of staff nurses to them.
This study was conducted in three rural hospitals where the nurses’ education levels varied widely. Eighty percent of respondents were RNs from a variety of educational backgrounds, 17% were licensed practical nurses, and the remaining 3% did not answer this demographic question. Only 16 questionnaires had all questions and demographic information answered. Furthermore, one quarter of the registered nurse respondents were graduates of the university conducting the study, which may have resulted in biased findings. Missing data and demographic information, lack of generalizability of the findings to hospitals other than those in rural settings, and the potential for bias by the staff nurses who were graduates of the researching university were noted by the researchers as limitations of the study.
The purpose of this study was to explore the benefits and limitations of having undergraduate nursing students in the clinical arena, from the perspectives of the staff nurses. The results of the study provide nursing faculty with insight into staff nurses’ perceptions of students, which highlight the advantages and challenges of time spent with students. Nursing faculty need to provide clear instructions to students about the expectations of the faculty, the staff nurses, and patient care unit management regarding the level of care students are expected to provide. Consequences of failing to engage in the learning process should be delineated for students. Students’ expectations should also be clarified with nursing staff so the expectations are reasonable and within the students’ abilities and level of performance. Students need to be informed that their presence in the unit is viewed as intellectually stimulating and beneficial to patient care. Sharing this perspective of staff nurses might inspire students to more accountable in the care of patients and their investment in the learning process.
- Atack, L., Comacu, M., Kenny, R., LaBelle, N. & Miller, D. (2000). Student and staff relationships in a clinical practice model: Impact on learning. Journal of Nursing Education, 39, 387–392.
- Birx, E. & Baldwin, S. (2002). Nurturing staff-student relationships. Journal of Nursing Education, 41, 86–88.
- Grindel, C., Bateman, A.L., Patsdaughter, C.A., Babington, L.M. & Medici, G. (2001). Student contributions to clinical agencies: A comparison of adult health and psychiatric staff nurses’ perceptions. NLN Nursing & Health Care Perspectives, 22, 197–202.
- Grindel, C.G., Patsdaughter, C.A., Medici, G. & Babington, L.M. (2003). Adult-health/medical-surgical nurses’ perceptions of students’ contributions to clinical agencies. Medsurg Nursing, 12, 117–123.
- Palmer, S.P., Cox, A.H., Callister, L.C., Johnsen, V. & Matsmura, G. (2005). Nursing education and service collaboration: Making a difference in the clinical learning environment. The Journal of Continuing Education in Nursing, 36, 271–276.
|Level of licensure|
| RN||67 (77.1)|
| LPN||14 (16.7)|
| No response||3 (0.03)|
|Level of RN education|
| Diploma||7 (10.5)|
| Associate||24 (38.5)|
| Baccalaureate||34 (50.7)|
| Master’s||2 (0.03)|
| Staff nurse||68 (81)|
| Nurse manager||5 (6)|
| Other||11 (13)|
Positive Perceptions With Which Staff Nurses Most Likely Agree
|Allows opportunities for mentoring||98|
|Allows nurse to participate in student development||95|
|Students interact with patients and families||93|
|Enhances clinical setting as learning environment||88|
|Becomes a source for recruitment||86|
|Stimulates staff intellectually||82|
|Allows for reciprocal learning||81|
|Expose staff to different perspectives||79|
|Students offer a secondary source for assessment data||76|
|Provide individual support and care for patients||74|
Negative Perceptions With Which Staff Were Most Likely to Agree
|Problem students can be frustrating||77|
|Students are less assertive with important patient therapies||44|
|Adds to the confusion and noise of the unit||37|
|Do not appreciate the support of the staff nurses||12|