Student nurses in the United Kingdom spend approximately half of their nursing education programme in the practical setting, learning to nurse. This practical setting is commonly referred to as the Clinical Learning Environment (CLE). High quality placement experiences are essential in supporting the development of knowledge, skills, values and attitudes required of a Registered Nurse. However, the literature suggests that many students describe their clinical placements as being punctuated by negative experiences. Given the importance of learning in practice for the profession, and the pervasive negative reports from students, this study investigates the critical question of how student nurses experience learning within the CLE. A qualitative methodological approach was taken, with interviews and focus groups conducted with forty-six student nurses. The focus of the discussions was to specifically elicit the students’ experiences of learning in this environment. Theories of situated learning (Lave and Wenger, 1991) and power (Lukes, 1974) were used to support the analysis. Analysis of the data highlighted three key themes: i) Educational realities associated with the CLE; ii); the influence of Mentorship iii) Power and powerlessness. It was found that care delivery requirements are consistently prioritised above the learning needs of students; coined ‘the clinical imperative’ in this thesis. Given the extent of clinical pressures, mentors are relatively powerless to advocate for students’ learning needs. Under such circumstances, students have a propensity to take up non-supernumerary ‘worker’, rather than peripheral ‘learner’ roles, often ‘supervised’ by Healthcare Assistants. The students described their learning experiences as typified by patterns of inadequate supervision and ubiquitous poor practice. Student powerlessness within the hierarchical structure, compounded by risk of failure or poor treatment, creates student vulnerability. Such vulnerability means that students are often willing to exchange learning for work, to reduce risks and ingratiate themselves with mentors. Positive mentoring relationships may ameliorate the pressures inflicted by the conditions of the CLE. Conversely, negative mentoring experiences may exacerbate the risks associated with learning in this environment. Despite such challenges, students are still required to demonstrate their increasing competence, which can become problematic if they have not been afforded appropriate learning opportunities. Analysis of the data reveals that students frequently experience mentors (and others) utilising their power to coerce. Students often feel unable to challenge (either compromised learning experiences or poor practice) because they fear reprisals. The influence of power can lead to the suppression of students in the CLE, and in the worst cases may lead to attrition. This thesis demonstrates that students experience significant challenges to learning within the CLE, challenges which are poorly understood. Greater understanding of how student nurses experience learning within the CLE can inform those responsible for nurse education how to improve and optimise learning in this challenging environment.
|Date of Award
|1 Jun 2020
|John Owens (Supervisor) & Alan Cribb (Supervisor)