Throughputs
Rebuilding the Bridge: Challenges Faced by Academia and Practice for Meaningful Student Nurse Clinical Experiences
July 19, 2024 — Pamela Pascarelli, DNP, RN, NPD-BC, CCRN
Denise Menonna Quinn, DNP, RN, NPD-BC, AOCNS, BMTCN
Leaders in academia and practice settings share a common goal of assisting nursing students to feel confident and competent, as well as to possess the skills to care for multiple patients—yet accomplishing this remains a continual challenge. Ko & Kim (2022) identified that nursing students experience emotional shock when placed in the clinical setting and express feelings of “fear of becoming a nurse” ( p.1). A contributing factor to this highlighted in the clinical setting is a lack of opportunities which leads to a subsequent lack of competency and confidence in clinical skills. The fundamental skills that students commonly struggle with include IV insertion, indwelling urinary catheter insertion, medication administration, care of central venous access devices, and use of IV infusion pumps.
In the nursing world, “transition to practice” and “bridging the gap between theory and practice” are frequently used to describe the progression from academia into practice and the disconnect many new nurses experience when comparing their didactic knowledge and the actual practice setting. These topics have been areas of focus for decades as they relate to nursing professional development (NPD) in both the hospital and in academic settings. This article discusses strategies to address common challenges in both the academic and practice setting for nursing students. Improving challenges is work toward narrowing the gap and rebuilding the bridge. This article addresses common challenges related to nursing students' proficiency in clinical nursing skills as well as the opportunities available for them to practice skills.
Teamwork is a foundational aspect of providing high-quality care to patients. Integral parts of teamwork include the nurse-to-patient ratio as well as faculty-to-student nurse ratio. Currently, the number of faculty is an area that has created significant discussion. According to Munday (2023), faculty shortages have increased to 8.8%, and for the past year the highest number of vacancies were located in western part of the U.S. Nursing schools struggle to hire full-time faculty with the appropriate educational background for the compensation that is available.
However, many schools are diligently marketing to increase student enrollment across all academic divisions to potentially offer higher salaries for the full-time professors. Bakewell-Sachs, Trautman, & Rosseter, (2022) acknowledge that new paradigms and increased incentives among academic educators and practice leaders need to be examined and instituted to decrease the shortage and ultimately impact patient care in a positive manner by having more confident new graduates enter the workforce.
The faculty shortage also impacts the size of clinical groups. When the faculty member has a large or maximum size clinical group, it limits their ability to have dedicated 1:1 time with the student and limits the number of skills they can successfully perform with each one. Additionally, many organizations across the nation are hiring increased numbers of newly graduated nurses in the clinical setting. The increased number of nurses on orientation who require skills validation limits the opportunity for students to perform skills during their clinical time due to overcrowding or lack of enough skills for everyone to demonstrate on the units.
Medication administration is essential for nursing practice. Due to state and organizational regulations and requirements, nursing students may not be allowed to administer certain types of medications. One study reviewed 1,904 nursing students’ medication errors that were documented and the common errors identified were the following: wrong dose form, omission of medication, and wrong time (Triantafyllou, Gamvrouli, & Myrianthefs, 2023), Therefore, some clinical sites limit the types of medications and routes of administration that students may administer. Examples include IV push, IV administration through central line catheters, or administration of controlled substances. So, the dilemma becomes, how can the nursing student be proficient in medication administration?
Identifying and raising awareness of the current barriers, challenges, and safety concerns between academia and practice is aimed to create increased dialogue between the stakeholders on both side of the bridge to develop environments that are conducive to providing the highest quality resources and care—to ultimately provide high quality patient care. Table 1 depicts the challenges acknowledged by academia and practice for nursing students to perform clinical skills as well as strategies for success.
Table 1 - Challenges for Nursing Student Skill Opportunities in the Clinical Setting as Experienced by Authors
Academic Setting Challenges
|
Practice Setting Challenges
|
Strategies for Success
|
- Academic faculty shortage
|
- Monitoring competency of clinical faculty
|
- Creative incentives to recruit nursing faculty
- Encourage nurses to pursue advanced degrees and consider clinical faculty positions
- Collaborate with clinical settings for joint appointments
- Competency validation of clinical faculty
|
- Limitations on student skill opportunities
(may be site specific)
|
- Limitations on student skill opportunities (state and site specific)
- Policy and procedures at clinical site
- Concern for hospital acquired infections
- Central line care and management
- Foley catheter insertion
- Medication administration
- Narcotic/controlled substance administration
- IV push medications
- Administration of medications through a central line catheter
- IV insertion
|
- Increased dialogue with all involved related to concerns for student experiences and patient safety/quality
- Collaborate to change policy and procedures
- Utilize NPD practitioners in the clinical setting
|
- Faculty:Student ratio
|
- Nurse:Patient ratios (number of new nurses on orientation who need skills)
|
- Incentives for faculty
- Joint appointments
- Night shift opportunities
|
- Maximum size clinical groups
|
- Increased student observation experiences due to maximum size clinical groups
|
- Collaboration with all involved for alternate hands-on clinical experiences
- Designed space for nursing students to learn at clinical sites
- Designated education units
|
- Variations in equipment
|
- Variations in equipment
|
- Collaboration with equipment and pharmaceutical companies
- Collaborative grant writing to obtain like equipment
- Collaboration with academia and practice for like equipment
|
- Documentation in electronic medical record
|
- Documentation in electronic medical record
|
- Collaborate with all involved
- Collaboration with EHR companies
- Active playground environments
|
|
References:
- Bakewell-Sachs, S., Trautman, D., & Rosseter, R. (2022). Addressing the nurse faculty shortage. AmericanNurse. https://www.myamericannurse.com/addressing-the-nurse-faculty-shortage-2/
- Jafarian-Amiri, S., Zabihi, A., & Qalehsari, M. (2020). The challenges of supporting nursing students in clinical education. Journal of Education and Health Promotion, (9).
- Ko, Y-J & Kim, S-Y. ( 2022). Transition Shock Experience of Nursing Students in Clinical Practice: A Phenomenological Approach. Healthcare, (10), 613.
- Munday, R. ( 2023). The states with the largest nursing faculty shortage. https://nursejournal.org/articles/states-with-the-largest-nursing-faculty-shortage/
- Triantafyllou, C. Gamvrouli, M. & Myrianthefs P. ( 2023). Frequency of nursing student medications errors: A systematic review. Med RX IV. https://www.medrxiv.org/content/10.1101/2023.02.26.23286460v1#:~:text=A%20total%20of%201%2C904%20nursing,student%20medication%20errors%20is%20high.
Pamela Pascarelli, DNP, RN, NPD-BC, CCRN
Manager, Department of Clinical Education, Hackensack University Medical Center
Pamela Pascarelli graduated from William Paterson University with a BSN. She later obtained an MSN as a clinical nurse specialist with a focus on critical care nursing from Rutgers University and subsequently her DNP from William Paterson University, all in New Jersey.
She is the manager of the clinical education department at Hackensack University Medical Center where she has worked for over 30 years. Dr. Pascarelli has held many roles in the department ranging from ancillary education, critical care nursing educator, and supervisor. She also maintains academic and clinical faculty positions at colleges and universities in New Jersey.
Denise Menonna Quinn, DNP, RN, NPD-BC, AOCNS, BMTCN
Education Specialist, Hackensack University Medical Center
Denise Menonna Quinn began her nursing career as a graduate of Holy Name Hospital School of Nursing in New Jersey. She later obtained her BSN from St. Peter's University, her master’s degree in clinical nursing from Seton Hall University, and her DNP degree from William Paterson University, all in New Jersey.
Dr. Menonna Quinn currently works as an academic and clinical instructor at Colleges and Universities in northern New Jersey as well as an education specialist at Hackensack University Medical Center. She has dedicated her more than 30-year clinical career to the care of oncology patients in a wide variety of roles including staff nurse, clinical specialist, breast cancer nurse coordinator, education specialist, and insurance nurse navigator.