A review of the literature confirmed the lack of clinical sites available however viable and creative solutions for undergraduate pediatric nursing are not discussed. Ideas such as utilizing pediatric summer camps (Nash, 1987) and specialized internships (Webster et al., 2010) appear to solve one problem but create barriers such as finding preceptors, traveling to camps, and securing adjunct faculty to supervise clinical experiences. Although many articles cite the lack of clinical sites, only five were discovered that focused on the rural nursing program’s dilemma, and most of these were from other countries and/or directed toward medical training.
For TUDONH, the solution became a triphasic pediatric clinical rotation. Students spend four weeks in three clinical settings; a tertiary care facility, public schools (some with Wellness Centers), and in simulation. Each setting provides opportunities to meet student learning outcomes and expose them to various nursing specialties. This solution was not without problems such as long commute time to a tertiary care facility, extended clinical days, and difficulty obtaining contracts. Recently, events within Maryland School Systems created legal complications for clinical contracts that were not anticipated with this project.
During the planning phase, National League for Nursing (NLN) formatted simulations were reviewed, modified, and written to meet the clinical needs for students within the pediatric rotation. For the inpatient phase, adjunct clinical faculty were secured and teaching plans, student expectations, and clinical evaluation tools were revised to reflect expected outcomes. Pre and post conference topics and learning objectives were created. The expectation of collaboration with other pediatric disciplines such as Child Life, Pharmacy, Physcial, Occupational and Speech Therapies reinforce Benner et al.’s (2010) belief that students should not be educated in silos and interprofessional relationships enhance the quality of clinical experiences. In planning the public school nursing clinicals, several meetings with school nursing administration promised collaboration but details could not be confirmed until the first week of the semester due to volatility in the school nurse staff. Again, clinical expectations for both the school nurse and the nursing student were established.
Implementation of the triphasic clinical schedule has occurred for one semester. TUDONH has collected clinical feedback from the tertiary care, the public school systems and simulation environment. The verbal and written feedback is overwhelmingly positive. The situations that have arisen in the school system provide insight into the daily life, culture and health needs of local children. In the simulation phase problems with technology and student perception of simulation were experienced but the use of Standardized Patients has increased student satisfaction. Students were asked to complete a survey about the perceived value of simulation at the beginning of the semester and after they completed the simulation rotation. These results will be analyzed at the end of the semester.
The work of implementing a new and unique clinical rotation for pediatrics in a rural community has been challenging. Student mentoring from both faculty and preceptors in the field has created a non-threatening environment where student learning is encouraged. This new and creative educational approach to pediatric clinical education in a rural area has addressed the gaps identified in the literature.
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