Clinical Placements and Student Support

During their individual programmes of study the student nurses and midwives spend a minimum of 50% of their time in a variety of placements. From the students’ viewpoint the nature and length of individual placements was of importance to their progression through the programme and to meeting their learning needs:

It’s good now the placements are longer…because we used to only have four to five weeks placements and by the time you got used to the place, you were leaving, so now they’re longer so you get confident and you’re more like a member of the team and you ask things and go off and do things and stuff. (Student nurse Case study C)

I think it would be quite good if we stayed in placements longer but still had the same number of placements, you seem to kind of get to know a ward and then you’re having to move on again and you’re still learning on that ward… (Student nurse Case study F)

Some students undertaking a four-year programme had less clinical experience in their final year and felt that, although the fourth year itself had enhanced their learning in the wider sense, the way in which the programme was structured meant they only had a three- month final placement in the whole 12 months:

(Re fourth Year)… I mean clinical wise it doesn’t really do anything….. what fourth year does to be honest for us well it has for me certainly is you’ve got a bigger understanding of the NHS as a whole as a business in depth and it brings in the management side as well which I don’t know that I would have been able to you know put in to practice initially … (Student nurse Case study J)

(Re placement in fourth year)… the same 12 weeks. So we were kind of anxious about going out because you’ve not experienced the clinical environment unless you kind of work on the bank or something but even then you’re there as an auxiliary…And you feel a bit rusty that’s what I feel like… and you feel that expectations of nurses out there of fourth year students are so high that when you explain to people you feel like oh my god what if I do something stupid because I’ve not been on placement for a year –even the simplest of things. (Student nurse Case study J)

The number of students on placement at any one time affects the learning experience, but it was evidence from the comments that many of the mentors invested a great deal of time in ensuring that whenever possible, this was not compromised:

(Re: How many students do you have on placement?)…Significant amount, it is constant….the placements are roughly between five and eight weeks … this is always a challenge. University always asks us if we can take more and we try and get the staff a wee break so they don’t have a student with them all the time, it is relief for staff but also for the patients in the community because you are constantly asking if you can bring a student and sometimes the patients need a wee break as well from the students so when you are visiting people in their own home you have to be obviously selective at times. (Lead community nurse Case study C)

Where we work I feel we really let the students down, we work in a 27 bedded unit and just now we have eight students who are semester three and four and have got two management students who are semester six so that is ten students. Just now I have got two students and a management student shared with another nurse so trying to facilitate them all with a mentor is very difficult. We have actually devised a

programme that because there are so many students they all get to go into an assessment multi-disciplinary team meeting once and go on a ward round, half a ward round each and try and get them to do that twice. (Mentor Case study E)

In midwifery there may be less of an issue as to student numbers at any given time, but as can be seen in the following extract, there were a different set of issues to deal with:

Midwifery is varied, we have students right from the start through to management and various stages, the early semester ones they go out with the team midwives that’s for normal experience, really concentrating on communication that kind of thing and then later on they come into where I am working at the moment is the maternity suite and they in there I think it is semester seven and they are actually, what they are looking for is compromised pregnancy and that’s what their speciality is at that stage and they also spend time in the birthing suite and the experience is varied in terms of management…we do try and allocate at least one mentor to a student, well definitely one but do try and get an associate mentor but that is not always possible because of shift, you know, because we are expected to have the mentor on and try and get the mentor on and get at least most of the shifts on at the same time with the mentor but sometimes that is really difficult to do, so that is probably one of the biggest challenges that we find is actually making sure of that…and we do sometimes get, recently we had a complaint you know feedback from the student saying that they hardly spent time with the mentor so we tried to work on that and sometimes we do it better than others but that depends on actually what staff we have because we don’t have a lot of staff in the ward. (Midwifery mentor Case study E)

It is interesting to note that in a study by Last and Fullbrook (2003) the quality of placements as well as the poor support received from some mentors and tutors, together with not being supernumerary and not being valued, were contributing factors to students leaving nursing and midwifery. They could not, however, generalise their findings to other settings due to the size of the study and local factors. They are possible indicators to be considered in HEIs with high attrition rates. Placement experiences also formed the basis of a study by Andrews et al (2005), in which it was concluded that ‘in particular the absence or presence of a supportive and positive learning environment, are seminal for many students in shaping their first destination employment decisions’ and also that ‘experiences of one ward can impact upon the perception of the entire institution and consequently the decision to apply for work there’. One very innovative placement organised at the University of the West of Scotland (Paisley) was a partnership with a charity known as Across (Purdie et al 2008). This entailed a well-organised and executed two-week placement for six third-

year student nurses, taking seriously ill and disabled people to Lourdes and back. The reported outcome of this for the students was that the placement appeared to boost their confidence in care delivery to a group of very dependent people. Support for the students was also clearly evident and students were placed in teams where the support staff included a lead nurse who had attended a mentorship programme.