Methods and Material: Forty NSs in their first clinical rotation in Bachelor of Science in Nursing (BSN) program at Biola University, La Mirada, California were invited to the study to examine skills learning opportunities and the students’ overall experiences of having both shorter and longer clinical days in one rotation. They have completed four semesters of general education required for BSN program and just begun learning basic nursing skills and pathophysiology in their fifth semester of BSN program. The expected learning outcome of the first clinical rotation is for NSs to demonstrate fundamental nursing skills, critical thinking, and clinical reasoning to enhance patients’ health outcomes and quality of life, by developing nursing care plans and applying theoretical content in the clinical setting. The novice NSs were divided into four groups. There were ten students with one clinical instructor in each group and four groups were placed on four different units in an urban community hospital. Each group stayed on the same unit throughout the rotation. Students were assigned to the same patients when available on two consecutive shorter clinical days and assigned to different patients on each longer clinical day. The clinical days were composed of two 6-hour clinical days per week for three weeks, then one 8.5-hour clinical day per week for the following five weeks, excluding pre and post conferences. At the end of each clinical day, students were asked to identify skills that they performed during the day. A Student T test was used to compare the mean numbers of skills performed in shorter clinical days to the ones in longer clinical days. On the last clinical day of the first rotation, students were also asked to describe benefits of shorter clinical days and longer clinical days. These qualitative data were analyzed using content analysis.
Results: Forty NSs in their first clinical rotation participated throughout the study. The skills performed significantly more in longer clinical days than in shorter days were glucometer use, taking input and output, and performing physical assessments (P=0.014, 0.015, 0.043, respectively). The skills such as patient teaching /discharge teaching, insulin administration, dressing change, oral medication administration, and subcutaneous or intramuscular injections did not show significant differences but there was a trend of more opportunities to perform these skills in longer clinical days. Bed bath/general hygiene, linen change, passing trays, observing a specific procedure, and receiving a new admission did not show any difference. For benefits of two shorter clinical days per week stated by NSs, there were two major themes related to the two shorter consecutive days of clinical experiences: less anxiety on the second consecutive day, and ability to provide continuity of care when NSs had the same patients on the second day. For the benefits of longer clinical days, students’ comments were more variable. Major themes that emerged focused on forming relationships with nursing staff and ability to see the progression of their patients’ status. Students stated more opportunity to develop collegial relationships with nursing staff, aiding NSs to experience additional learning opportunities, and better able to observe transitions of patients’ conditions over time. In addition, many students stated higher perceptions in their ability to provide more holistic care with enhanced opportunities to form relationship with patients and the family members. Overall, 26 out of 40 students recommended the longer clinical day during the first clinical rotation, three recommended the shorter clinical days, and 11 recommended a hybrid of both. Students reported that the benefit of a hybrid, or equally utilizing both, was providing students with a helpful transition from shorter days to longer days, as the clinical practices for the rest of the nursing program consist of only longer clinical days.
Discussion: The study was conducted to investigate the differences in the exposure and application of skills content of clinical experiences comparing a shorter clinical day to a longer day among novice NSs. As hypothesized, the data analyses indicated that more skills were performed on longer clinical days and better relationships were developed with nursing staff, patients and their family members. Students were more concerned about holistic care for their patients during longer clinical days, whereas they were more focused on the skill performance on shorter clinical days. Considering the high anxiety levels of novice NSs in the first rotation, they expressed less fear and anxiety on the consecutive second clinical day. Anecdotal data indicated that the students and clinical faculty members supported a hybrid clinical schedule combining both shorter days at the beginning and longer days thereafter during the first clinical rotation. Clinical scheduling involves the availability of space in facilities that receive NSs. When there is an opportunity where hybrid clinical schedule may be permissible, it is recommended to first introduce novice NSs to two shorter days per week and provide an eventual transition to longer clinical practice as they gain more experience even within the first clinical rotation for better outcome of clinical learning.