Friday, 26 July 2019: 3:50 PM
Purpose:
Nursing faculty recognize that students experience stress as part of their professional education. If student stress is allowed to escalate, students are more prone to make mistakes, lose confidence in their ability to perform assigned tasks, and potentially fail (Wallace, Bourke, Tormoehlen, & Poe-Greskamp, 2015). Stress in nursing students may also cause feelings of self-deprecation and low self-esteem, and may later affect nursing students’ lives and journeys as professional nurses (Junious, Malecha, Tart, & Young, 2010; Wallace et al., 2015).
The clinical environment may cause students to experience high levels of stress due to the rigorous academic and emotional demands placed on them when they begin to take responsibility for client care (Moscaritolo, 2009). Clinical nursing faculty are responsible for the education of students and for creating a satisfactory learning environment in order to effectively assist students in clinical practice. However, these faculty members may not be fully aware of the extent of student stress and the impact it has on students’ lives and learning (Chernomas & Shapiro, 2013).
The purpose of this study was to describe and understand clinical nursing faculty perceptions of undergraduate baccalaureate nursing student stress in the clinical environment. Clinical nursing faculty have a critical role to recognize sources of student stress and demands on nursing students, and understand its significance for educational and professional success. Faculty often see their role as preparing students for the realities of real-life nursing, including stress and sadness, yet they may be unaware of the vulnerability students feel in the unfamiliar territory of the clinical environment and the amount of support and interpretation students need in order to be successful.
In addition, clinical nursing faculty were frequently identified by nursing students as major sources of nursing student clinical stress (Arieli, 2013; Bagcivan, Cinar, Tosun, & Korkmaz, 2015; Chen & Hung, 2014; Chernomas & Shapiro, 2013; O’Mara, McDonald, Gillespie, Brown, & Miles, 2014; Pulido-Martos, Augusto-Landa, & Lopez-Zafra, 2011; Wallace et al., 2015). Faculty need to understand how their interactions with students can help or hinder the learning process. Despite an increasing body of research on stress and student perceptions of stress, nursing faculty perceptions of nursing student stress have been relatively unexplored. There was no published research, located to date, specific to clinical nursing faculty perceptions of nursing student clinical stress.
Methods:
A qualitative descriptive design was used to provide a rich description of clinical nursing faculty perceptions of undergraduate baccalaureate nursing student clinical stress. A purposive sample of 14 clinical nursing faculty with at least 4 semesters of clinical nursing faculty experience from accredited, generic baccalaureate nursing programs in the Northeast region of the United States participated in open-ended interviews using a semi-structured format. The 14 clinical nursing faculty interviews took place between August 2017 and October 2017, and were digitally recorded and transcribed. Before and after each interview, field notes, observations, and reflections were detailed to document the surroundings and non-verbal expressions of the participants. Furthermore, a reflective journal was kept by the researcher throughout this study. Sample size adequacy was justified when saturation of data was achieved, and qualitative content and thematic analysis were used to sort the descriptive data to generate themes.
Results:
The four themes that surfaced from the interview data were: feeling overwhelmed when encountering the unknown, which included the sub-themes of facing self-doubt and experiencing insecurity in nursing actions; struggling with personal life factors, enduring uncivil clinical interactions, and contending with nursing faculty interactions. Feeling overwhelmed when encountering the unknown illustrated the strong emotional effect that participants believed students perceived when they were exposed to unknown clinical conditions. Participants conveyed that new clinical encounters tended to emotionally overpower the nursing students and acknowledged this “shock” as a considerable contributor to nursing student clinical stress.
The data in the sub-theme facing self-doubt illustrated the uncertainty and unsureness that clinical nursing faculty participants perceived nursing students experienced when exposed to new and changing clinical situations in the clinical environment. The sub-theme experiencing insecurity in nursing actions illustrated the participants’ perception of nursing student uncertainty and hesitancy in their nursing actions. Furthermore, faculty participants perceived that the absence of clinical faculty supervision in the clinical environment contributed to this insecurity in nursing students when performing clinical nursing actions. Many participants relayed exemplars of their inability to closely monitor and adequately assist their students in the clinical setting due to the disproportionate student-to-faculty ratio and the vast amount of responsibilities they have in this complex clinical environment.
Participants described the theme struggling with personal life factors as stressors derived from individual life events and aspects outside of the clinical environment as affecting the student emotionally and contributing to nursing student clinical stress. The theme enduring uncivil clinical interactions represented the sometimes difficult, discourteous, and rude behaviors and communication that nursing students were confronted with in the clinical environment. Difficult communication with staff nurses was most frequently perceived by clinical nursing faculty participants as causing nursing student clinical stress. Most of the participants identified that many staff nurses stated they did not want to work with nursing students, and described situations in which students were “belittled” by staff nurses. Terms such as mean, horrible, rude, and nasty were used by these participants to describe nurses’ attitudes and behaviors towards students in the clinical environment.
The data in the theme contending with nursing faculty interactions identified dealing with and managing nursing faculty interactions as a significant student clinical stressor. Participants perceived nursing faculty interactions were manifested in a wide variety of ways, including individual faculty expectations, instructional and evaluative discrepancies, and verbal and non-verbal communication. Data depicted the insecurity, apprehension, and increased susceptibility to stress that nursing students can face when clinical nursing faculty behavior creates an unpredictable and unstructured learning environment within the already chaotic clinical setting.
Conclusion:
Particular components worthy of attention in the current study were the terms and descriptions that were used by participants when communicating the negative clinical interactions between students, and both nursing staff and clinical faculty. Participants used powerful terms such as “mean”, “horrible”, and “nasty” when describing clinical interactions with staff nurses that contributed to nursing student clinical stress. In contrast, less severe terms such as “inappropriate” and “difficult” were used by participants to describe negative interactions with clinical nursing faculty in the clinical environment. This finding may indicate a lack of recognition and acknowledgment by participants that particular faculty behaviors may produce excessive student stress.
Study participants overwhelmingly communicated that clinical nursing faculty contribute to nursing student clinical stress; however, less than half of the participants acknowledged that they in their clinical nursing faculty role contributed to this stress. The remaining participants maintained that they have seen or heard anecdotal stories of other clinical faculty demonstrating behaviors that contributed to nursing student clinical stress, but they did not contribute to this stress. This finding in the current study is in striking contrast to the abundance of current literature on what nursing students perceive as stressful in the clinical environment. Therefore, there may be disparate perceptions of student clinical stress between nursing students as discussed in the current literature and clinical nursing faculty participants in the current study, as related to the impact of nursing faculty behaviors and actions on nursing student clinical stress.
Transitions Theory is presented as a theoretical framework supporting the findings of this study, as the undergraduate baccalaureate nursing student transitions into the clinical environment. The application of the four themes and related sub-themes described in this study to Transitions Theory assists in further understanding clinical nursing faculty perceptions of undergraduate baccalaureate nursing student clinical stress.
Implications of this study from the perspective of nursing science and research offer a view of nursing student clinical stress from the clinical nursing faculty educating undergraduate baccalaureate nursing students in the clinical environment to advance the science of nursing education. In nursing practice, study findings may aid in the identification of strategies to decrease undergraduate baccalaureate nursing student clinical stress, thus being transferable to new graduate nurses, nursing preceptors working with new graduate nurses, and the onboarding of new nurses.
Implications for nursing education include providing faculty a clearer understanding of the stress phenomenon, so they may better educate a student and evaluate a student’s progress in the clinical environment to decrease nursing student clinical stress. Additionally, assisting clinical faculty to understand how their interpersonal interactions with students can help or hinder the learning process may aid faculty to create new instructional strategies or modify existing techniques with students in the clinical environment to reduce student stress, improve nursing education practices, and ultimately promote more effective clinical learning.
Nursing faculty recognize that students experience stress as part of their professional education. If student stress is allowed to escalate, students are more prone to make mistakes, lose confidence in their ability to perform assigned tasks, and potentially fail (Wallace, Bourke, Tormoehlen, & Poe-Greskamp, 2015). Stress in nursing students may also cause feelings of self-deprecation and low self-esteem, and may later affect nursing students’ lives and journeys as professional nurses (Junious, Malecha, Tart, & Young, 2010; Wallace et al., 2015).
The clinical environment may cause students to experience high levels of stress due to the rigorous academic and emotional demands placed on them when they begin to take responsibility for client care (Moscaritolo, 2009). Clinical nursing faculty are responsible for the education of students and for creating a satisfactory learning environment in order to effectively assist students in clinical practice. However, these faculty members may not be fully aware of the extent of student stress and the impact it has on students’ lives and learning (Chernomas & Shapiro, 2013).
The purpose of this study was to describe and understand clinical nursing faculty perceptions of undergraduate baccalaureate nursing student stress in the clinical environment. Clinical nursing faculty have a critical role to recognize sources of student stress and demands on nursing students, and understand its significance for educational and professional success. Faculty often see their role as preparing students for the realities of real-life nursing, including stress and sadness, yet they may be unaware of the vulnerability students feel in the unfamiliar territory of the clinical environment and the amount of support and interpretation students need in order to be successful.
In addition, clinical nursing faculty were frequently identified by nursing students as major sources of nursing student clinical stress (Arieli, 2013; Bagcivan, Cinar, Tosun, & Korkmaz, 2015; Chen & Hung, 2014; Chernomas & Shapiro, 2013; O’Mara, McDonald, Gillespie, Brown, & Miles, 2014; Pulido-Martos, Augusto-Landa, & Lopez-Zafra, 2011; Wallace et al., 2015). Faculty need to understand how their interactions with students can help or hinder the learning process. Despite an increasing body of research on stress and student perceptions of stress, nursing faculty perceptions of nursing student stress have been relatively unexplored. There was no published research, located to date, specific to clinical nursing faculty perceptions of nursing student clinical stress.
Methods:
A qualitative descriptive design was used to provide a rich description of clinical nursing faculty perceptions of undergraduate baccalaureate nursing student clinical stress. A purposive sample of 14 clinical nursing faculty with at least 4 semesters of clinical nursing faculty experience from accredited, generic baccalaureate nursing programs in the Northeast region of the United States participated in open-ended interviews using a semi-structured format. The 14 clinical nursing faculty interviews took place between August 2017 and October 2017, and were digitally recorded and transcribed. Before and after each interview, field notes, observations, and reflections were detailed to document the surroundings and non-verbal expressions of the participants. Furthermore, a reflective journal was kept by the researcher throughout this study. Sample size adequacy was justified when saturation of data was achieved, and qualitative content and thematic analysis were used to sort the descriptive data to generate themes.
Results:
The four themes that surfaced from the interview data were: feeling overwhelmed when encountering the unknown, which included the sub-themes of facing self-doubt and experiencing insecurity in nursing actions; struggling with personal life factors, enduring uncivil clinical interactions, and contending with nursing faculty interactions. Feeling overwhelmed when encountering the unknown illustrated the strong emotional effect that participants believed students perceived when they were exposed to unknown clinical conditions. Participants conveyed that new clinical encounters tended to emotionally overpower the nursing students and acknowledged this “shock” as a considerable contributor to nursing student clinical stress.
The data in the sub-theme facing self-doubt illustrated the uncertainty and unsureness that clinical nursing faculty participants perceived nursing students experienced when exposed to new and changing clinical situations in the clinical environment. The sub-theme experiencing insecurity in nursing actions illustrated the participants’ perception of nursing student uncertainty and hesitancy in their nursing actions. Furthermore, faculty participants perceived that the absence of clinical faculty supervision in the clinical environment contributed to this insecurity in nursing students when performing clinical nursing actions. Many participants relayed exemplars of their inability to closely monitor and adequately assist their students in the clinical setting due to the disproportionate student-to-faculty ratio and the vast amount of responsibilities they have in this complex clinical environment.
Participants described the theme struggling with personal life factors as stressors derived from individual life events and aspects outside of the clinical environment as affecting the student emotionally and contributing to nursing student clinical stress. The theme enduring uncivil clinical interactions represented the sometimes difficult, discourteous, and rude behaviors and communication that nursing students were confronted with in the clinical environment. Difficult communication with staff nurses was most frequently perceived by clinical nursing faculty participants as causing nursing student clinical stress. Most of the participants identified that many staff nurses stated they did not want to work with nursing students, and described situations in which students were “belittled” by staff nurses. Terms such as mean, horrible, rude, and nasty were used by these participants to describe nurses’ attitudes and behaviors towards students in the clinical environment.
The data in the theme contending with nursing faculty interactions identified dealing with and managing nursing faculty interactions as a significant student clinical stressor. Participants perceived nursing faculty interactions were manifested in a wide variety of ways, including individual faculty expectations, instructional and evaluative discrepancies, and verbal and non-verbal communication. Data depicted the insecurity, apprehension, and increased susceptibility to stress that nursing students can face when clinical nursing faculty behavior creates an unpredictable and unstructured learning environment within the already chaotic clinical setting.
Conclusion:
Particular components worthy of attention in the current study were the terms and descriptions that were used by participants when communicating the negative clinical interactions between students, and both nursing staff and clinical faculty. Participants used powerful terms such as “mean”, “horrible”, and “nasty” when describing clinical interactions with staff nurses that contributed to nursing student clinical stress. In contrast, less severe terms such as “inappropriate” and “difficult” were used by participants to describe negative interactions with clinical nursing faculty in the clinical environment. This finding may indicate a lack of recognition and acknowledgment by participants that particular faculty behaviors may produce excessive student stress.
Study participants overwhelmingly communicated that clinical nursing faculty contribute to nursing student clinical stress; however, less than half of the participants acknowledged that they in their clinical nursing faculty role contributed to this stress. The remaining participants maintained that they have seen or heard anecdotal stories of other clinical faculty demonstrating behaviors that contributed to nursing student clinical stress, but they did not contribute to this stress. This finding in the current study is in striking contrast to the abundance of current literature on what nursing students perceive as stressful in the clinical environment. Therefore, there may be disparate perceptions of student clinical stress between nursing students as discussed in the current literature and clinical nursing faculty participants in the current study, as related to the impact of nursing faculty behaviors and actions on nursing student clinical stress.
Transitions Theory is presented as a theoretical framework supporting the findings of this study, as the undergraduate baccalaureate nursing student transitions into the clinical environment. The application of the four themes and related sub-themes described in this study to Transitions Theory assists in further understanding clinical nursing faculty perceptions of undergraduate baccalaureate nursing student clinical stress.
Implications of this study from the perspective of nursing science and research offer a view of nursing student clinical stress from the clinical nursing faculty educating undergraduate baccalaureate nursing students in the clinical environment to advance the science of nursing education. In nursing practice, study findings may aid in the identification of strategies to decrease undergraduate baccalaureate nursing student clinical stress, thus being transferable to new graduate nurses, nursing preceptors working with new graduate nurses, and the onboarding of new nurses.
Implications for nursing education include providing faculty a clearer understanding of the stress phenomenon, so they may better educate a student and evaluate a student’s progress in the clinical environment to decrease nursing student clinical stress. Additionally, assisting clinical faculty to understand how their interpersonal interactions with students can help or hinder the learning process may aid faculty to create new instructional strategies or modify existing techniques with students in the clinical environment to reduce student stress, improve nursing education practices, and ultimately promote more effective clinical learning.