An engaging chapter in a new book for nursing students by Federation University Associate Dean of Teaching Quality and Student Retention and senior lecturer in Nursing, Dr Karen Missen, provides practical advice for nursing students about how to prepare for and make the most of clinical placements.

Dr Missen says working in the health field while undertaking the nursing degree can enhance a student’s readiness for work, especially if they are employed as a Student in Nursing (SIN), Assistant in Nursing (AIN) or an Enrolled Nurse (EN), or even a ward clerk or receptionist.

However, she warns against doing a student clinical placement in your place of work - because, “there is a risk that the nursing student will end up working within the scope of their employment rather than the scope of a nursing student role.”

Unexpected challenges

The chapter ‘Becoming Practice Ready’ arms students with knowledge of key challenges and how to address them:

• Time pressures – student nurses are expected to take on a range of shifts, including evening, overnight and weekends, which can be challenging for mature students with family responsibilities.
   
• Financial pressures – because its not advisable and often not possible, to continue with other paid work while on placement.
   

Dr Missen frankly addresses ethical and emotional challenges student nurses can face in clinical settings.

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or emotional abuse of patients, breaches of patient safety, privacy and dignity, the provision of substandard or outdated care, and clinical errors.

When they try to raise concerns about these they may encounter hostility or resistance. In worst case scenarios, student nurses experience bullying and incivility.

“A study by Budden et al. (2017) revealed that 50% of nursing student respondents experienced bullying and harassment behaviours while undertaking clinical placements, and that the main perpetrators were registered nurses.”

Exciting opportunities

Despite all the possible challenges, Dr Missen writes that clinical placements can be incredibly rewarding and pivotal for final year students:

“One of the most exciting things about the final stages of nursing study is that you will get the opportunity to be more actively and independently involved in patients’ care.”

“Being exposed to real patients, performing skills under scrutiny and in unfamiliar situations, can make clinical placements both intimidating and stressful for nursing students…Regardless of how many placements you have already completed, the increasing duration and significance of placements as you progress through your program makes adequate preparation even more important.”

Dr Missen writes that in their final placement, student nurses need to practise initiating patient care and, if possible, managing a full patient load.

She advises them to make the most of the chance to demonstrate their ability to prioritise care and take on more responsibility.

Another bonus is the opportunity to develop professional relationships and networks with potential postgraduation employers and co-workers: “The clinical placement environment provides students with the opportunity to foster relationships with nurses who may be potential referees for graduate year applications.”

Dr Missen’s key points of advice for graduating student nurses:

• Be professional and maintain safety: Dress according to the specified uniform. Be punctual – arrive early on the first day and at least 15 minutes prior to the commencement of all shifts. This allows time to introduce yourself to staff, find handover and review your learning goals for the day. Notify appropriate staff (healthcare and education provider) in a timely manner when unable to attend a shift or placement, and report injuries and near misses immediately.
   
• Maintain standards and scope of practice: Follow appropriate clinical procedures and protocols under the supervision of a registered nurse and work only to the level of practice commensurate with your nursing program.
   
• Be self-directed: Meet with your preceptor on your first day of placement and go through your learning objectives. Identify your strengths and limitations and set goals each week to work on both enhancing and developing your capabilities.
   
• Acknowledge limitations: Intellectual honesty is critical to safe practice. Acknowledge when you do not know something – be honest with yourself and others. Ask questions, seek help and support. This is an important habit for practice readiness and something healthcare staff will expect you to do.
   
• Seek regular feedback: Feedback is an essential component of learning. Actively request feedback from staff you are working with. Be aware that feedback can be formal or informal, so be sure to monitor verbal and nonverbal communications.
   
• Access resources: Read local policies, procedures and guidelines. These might include infection prevention and control, dress code, manual handling, equality and diversity, electronic devices and the use of social media. Organise resources specifically designed for quick access to medication information, calculation formulas and other essential reference material pertinent to your learning.
   
• Engage proactively in learning and developing: Seek and engage in a diverse range of experiences aimed at meeting your learning goals and developing your capability as a registered nurse. 
   
• Learn about diagnoses and procedures pertinent to your patients.
   
• Practice procedures even if you have done them before. If you need more practice on a specific procedure – ask for more.
   
• Reflect on what you have learnt at the end of each shift to reinforce learning. Keep a de-identified record of these reflections for your portfolio.

From the chapter ‘Becoming Practice Ready’ by Dr Karen Missen in Transition to Nursing Practice from student to professional published by Oxford University Press.

Dr Missen worked as a registered nurse in both metropolitan and regional health care settings since the early 1990s; she has post graduate qualifications in intensive care and nursing education, and has been a nursing academic for over 14 years. Her PhD examined the practice readiness of newly graduated registered nurses.