Clinical education in prelicensure nursing programs: findings from a national survey.

OVER THE PAST FIVE YEARS, the NLN has given serious attention to identifying current approaches to clinical education in nursing, proposing alternatives, and studying the impact of teaching innovations. Building on the work of previous initiatives, including the Clinical Nursing Education Task Group, the Blue Ribbon Panel for Priorities in Nursing Education Research, and the Think Tank on Clinical Education in Nursing, the NLN commissioned a national survey to examine the barriers and challenges faculty face in optimizing students' clinical learning. The survey asked about strategies used to address these barriers and challenges, the effectiveness of these strategies, and the teaching practices faculty employ most frequently in clinical settings. For this survey, challenges were defined as "those course, context, professional, or personal aspects over which you, as a faculty member, exert some degree of control or influence or those aspects of your teaching practice that are influenced by the particular course, context, or setting in which you teach and over which you, as a faculty member, exert some degree of control or influence. " Barriers were defined as "those institutional, state, or federal guidelines/policies, as well as structural, programmatic, administrative, or procedural aspects of your program/ school that influence students' clinical learning and over which you personally may have little or no control. " (A monograph with the full report will be available from the NLN in September.) The Survey NLN members were alerted to the survey, available for completion on the NLN website, via announcements at NLN events, in NLN Member Updates, and in Faculty Development Bulletins. Members were also notified via email blast, and the invitation to participate was posted on three listservs related to nursing education. In each case, respondents were asked to circulate the survey URL to other faculty they knew to be teaching in clinical settings, whether or not these persons were members of the NLN. The survey included both multiple-choice and open-ended items. Data were compiled by the NLN and, after approval from the Indiana University Institutional Review Board, converted into SPSS files for transfer to the Indiana University School of Nursing for analysis. Findings A total of 2,386 faculty, from 50 states and all types of programs (associate 40 percent, diploma 9 percent, baccalaureate 51 percent), completed this survey. Respondents represented a wide range of institutions (Table). On average, they had been involved in prelicensure education 12.3 years (range 1 to 45 years). Fifty percent had been teaching in clinical settings more than 10 years. BARRIERS TO OPTIMIZING STUDENTS' CLINICAL LEARNING Respondents were provided a list of 17 possible barriers to optimizing students' clinical learning and asked to select and rank order the five most important barriers they faced. The following barriers were identified most frequently as among the five most important barriers. * Lack of quality clinical sites * Lack of qualified faculty * Size of clinical groups (ratio of faculty to students) * Restrictions on the numbers of students or limitations to students' experiences imposed by clinical agencies * The time-consuming nature of students' learning multiple agency systems (including technology) For each barrier ranked among their top five, respondents were provided a list of possible strategies that could be used to address the barrier. They selected up to three strategies they used most often to address each of their top barriers and rated the effectiveness of each strategy on a four-point scale; scores ranged from 1 (not at all effective) to 4 (very effective). Notably, although a variety of strategies were employed to address each of these important barriers, none of the strategies respondents identified were deemed very effective. …