Pupil enrolled nurses at their second year level at the hospital under study endured the challenges contributed by lack of clinical support. Therefore, it is mandatory upon nurse educators, managers and researchers to take note of the gaps identified and intervene so that the pupil nurses are fully supported to optimise their full potential in order for them to develop into proficient practitioners upon completion. Based on the findings of this study, the researcher propose the following recommendations for clinical learning environment, and the nursing education institution, as they work collaboratively, and for further research.
5.4.1 Recommendations for the nursing education
The researcher proposed the following recommendations for the nursing education: Pupil nurses are placed in the clinical learning environment in order to integrate theory and practice to become skilled, knowledgeable and proficient providers of high quality nursing care. According to SANC (1992:9), the main aim of nursing education is to develop the student capacity for critical, analytic, creative thinking and interpretation of data as well as making independent judgement. The students should be provided with the learning opportunities that ensure the broad spectrum of the curriculum. In order to achieve the above-mentioned goal as described by SANC, the following is recommended:
• There should be a close collaboration between the stakeholders at the NEI and the hospital in the form of communication and resources to improve and maximise their clinical placement. The NEI management to negotiate with the hospital management for more guided practical days to allow time for the nursing skill practice and assessment whereby students do not conflict with the ward routine.
• Constant evaluation of perceptions of nurse pupil nurses about the learning environment should be conducted in order to examine and clarify their values so as to improve and maximise their clinical placement (Chan 2002:74).
• Meetings and in-service training should be facilitated to focus the attention to registered nurses, preceptors, mentors and clinical facilitators on student learning needs as well as post reflective feedback.
• Nurse educators should be visible in clinical units.
• The nurse educators may reduce theory practice gap by incorporating methods such as simulations to align classroom teaching with the current realities of high occupancies, and shortage of staff.
• There should be incorporation of problem-based activities such as, reflective journals and learning portfolios for enhancement of critical thinking.
• The NEI should facilitate timeous recruitment and appointment of dedicated nurse educators to meet tutor-student ratio. The nurse educators should reach out directly where students are allocated, be sensitive to their needs, accompany
them, organise, structure and plan assessments, and keep accurate records of clinical teaching.
• The frequency of engagement of the preceptors in the role of facilitation and education needs further consideration.
According to NES (2011:2) clinical preceptors were recommended to ensure minimal level of clinical teaching and support students during their clinical practice for role taking. It is further stated that the NEI is responsible for developing a positive practice environment.
5.4.2 Recommendations for the nursing management
Bruce et al (2013:36) state that the main responsibility of the registered nurse in the unit is to ensure that the patient receives the highest quality care, and in instances whereby the students are unable to perform such tasks, they have a moral duty to ensure that they are being taught, supervised, and mentored.
• Registered nurses should be reminded of their role to teach students, when they are allocated in the units.
• The functional perspective part of the role theory states that senior personnel from a profession has to orientate and induct new members on the role expectations and also supervise them on performance and mastery of the new skills. The nursing manager of the clinical area should continuously commit to support student nurses as well as the nursing staff in performing their duties through:
o Identifying the mentors.
o All those expected to mentor, especially registered nurses, must receive in-service education.
o Ensuring that mentors are available and placed on the same shift as the nurse pupil nurses for effective supervision to takes place.
o Clarification of the roles of mentors in the unit.
o Student mentorship should be enhanced in both clinical practice and NEI to develop student nurses professionally and personally.
o There should be adequate resources such as enrichment programmes for mentors so as to have improve mentoring.
o The unit registered nurse should be familiar with the objectives of
o The student nurse to utilise teachable moments to integrate theory into practice.
o Organising and providing adequate resources for nursing staff to execute their duties, by evaluating the unit occupancy levels and making sure that there is adequate and correct staff mixes to supervise and mentor students.
o Facilitating in service training and focus on issues such as communication patterns, respect, attitudes and interpersonal relationships to improve quality of relationships amongst registered nurses, mentors, and nurse pupil nurses.
o Establishment of student forums such as meetings to address their learning needs and challenges in the clinical learning environment and intervene accordingly to promote a conducive learning environment.
5.4.3 Recommendations for the nursing research
The nursing researcher recommends that future research be conducted and focused on:
• Conduct bigger studies that will involve all private hospital groups in Limpopo Province on nurse pupil nurses in order to explore their perceptions on support during clinical placement.
• Include other categories of nurse pupil nurses in the studies such as pupil nurses on bridging course leading to registration as a registered nurse. SANC (R683, 1989, as amended) to explore their perceptions on support during clinical placement.
• Conduct studies on roles of nurse educators, mentors, unit managers and registered nurses on clinical support for nurse pupil nurses.