My Thoughts on Clinical Experience
(AKA "How faculty and students fit together")

I believe that nursing students are learners in a unique setting. Somehow, learning and experimentation must be blended with safe practice. I once had a colleague who talked about the ability to make "safe mistakes", and thought she was a little loose on the mind. Today, I must agree with her. As long as the client is safe, can the student be allowed to make mistakes? How far does an instructor let a student go? I believe we can learn from our errors. If a student makes an error while preparing a medication, I may let the student go, to see if the student will identify the problem. Until the student is at the bedside ready to give the medication, any errors are "safe mistakes". We must, however, remember that the client's safety and well-being are the most important activity in the clinical setting. Student learning will always take a second seat to client safety.

My role in clinical varies with the need. I am at times a cheerleader, a guide, a disciplinarian, a quiz master, or a coach. Since each student's learning experience is a personal adventure, each student learns from a variety of opportunities provided during the semester. In essence, I am there to facilitate the student's individual learning experience. It is hoped that the clinical environment will support student growth. Students have shared experiences. We must learn from each other because each student's experience is unique. It is important to consider what information is important for a new graduate to have to practice safely. Sometimes a student wants experiences that are better left to another time. Sometimes it is not possible for each student to have the same type of experiences; therefore, it is up to me to get the maximum experience for each student out of the limited time provided.

Nursing is a practice based discipline and, like everything else, practice does perfect the ability to perform not only tasks, but thinking and problem-solving, as well. Class provides the framework for the student to function in the clinical arena; the textbook becomes "plan A", a guide to what is perceived as the "best" option available.

Clinical practice, on the other hand, provides the unique problems, chaos and changing values that can not be provided in the textbook - real life. Our clinical experiences combine the tasks, problem-solving, critical thinking, and professional values in one place and provide the opportunity and challenge to apply the knowledge gained from the text book. The clinical setting begs us to ask questions about what is right for our patients. We need to question if what we believe is right for our patient can merge with what is proposed in the text.

According to Piaget, we use our current knowledge to try to solve the problem at hand. Each new experience becomes part of our "bag of tricks" (knowledge), from which we can draw to resolve future unknown dilemmas. Putting a syringe with no needle in the trash is a "safe" mistake; no harm occurs (unless you count the drug addict who finds it in the trash). There are even times when we need to make mistakes to realize the impact our lack of knowledge has. The important thing is to correct them and prevent them in the future. We need to incorporate that new experience into our "lived experiences" to use when faced with a dilemma in the future.

Skills needed include teamwork and collaboration, therefore, students are encouraged to work with staff and each other. Part of being a successful practitioner means knowing where to find the information when needed.

Ah, true! However each one of you has been given the essential skills, knowledge and attitudes to practice safely in your previous courses and some of your skills come from life. Part of my job is to insure that you use that knowledge and skill to continue learning and providing quality care to your patient.

The student alone knows what gaps in knowledge he or she has, and is responsible for seeking out opportunities to learn. My job is to facilitate your learning towards meeting your goal of graduation, while insuring a safe environment for the clients and staff. I want to help you succeed, but you are ultimately responsible for keeping me informed of your learning needs.

Because learning is a personal adventure, the student provides the learning from the opportunities provided during the semester. It is expected that students will come prepared to meet the clinical focus for the week. For example, if the focus is on oxygenation, then it is expected that a student will come to clinical prepared to discuss arterial blood gases, oxygen therapy, respiratory assessments and respiratory medications such as bronchodilators. Journaling provides students with the opportunity to tell me how they met the clinical objectives for the week. What did they gain from the clinical experience? The evaluation provides the student with a forum to indicate how the objectives of the course are being met. The journal, in combination with the evaluation tool and observations, demonstrates to me that a student has met the objectives for the week.

Nursing is not static. It is an ever changing profession with demands for adaptability and critical thinking. As such it requires a strong knowledge and skills base. Each week students demonstrate to me their ability to apply the knowledge gained to clinical situations. One error is a mistake and noted as such. A second similar occurrence tells me the student may not have learned from the previous experience. The problem would again be mentioned, however, now I need to be concerned; is there a pattern developing? A third occurrence indicates to me that there is a pattern and action must be taken. This is formative evaluation and occurs each week. Formative evaluation provides a basis for my decision-making when I consider how the student is progressing towards the end goal. If necessary, a warning will be given or probation instituted.

A verbal meeting will occur with each student approximately at the mid-point of the semester. Students will also be asked to evaluate individual performance during the semester. In the event of negative performance, a meeting will be held immediately with the student. The final evaluation should have no surprises for the student.

Summative evaluation occurs at the end of the semester and reflects the observations made during formative evaluation. The final evaluation should reflect the footsteps the student took along the way to successfully meeting the course objectives.