Establishing and maintaining the clinical learning environment for nursing students: A qualitative study

Background: Experience in the clinical setting is viewed as a crucial aspect of nursing education. Evidence suggests that students experience acceptance to alienation on the clinical unit. Little is known about preceptor beliefs underlying their approach with students, and the perspective of unit management is absent. Objectives: To provide a description of the beliefs and processes that emerge at the unit level regarding the clinical learning environment for nursing students. Design: Multiple case study design. Setting: Four units from across an urban university health center who have a demonstrated ability to accept students. Participants: A purposive sample of four nurse managers, four assistant nurse managers, three advanced practice nurses, and six staff nurses with recent and recurrent precepting experience were recruited from across four units. Methods: Semi-structured focus group interviews were conducted with all participants from each unit. Content analysis was used to identify major themes and categories in the interview data. Results: Two overarching themes were revealed: (1) Influencing factors included cultural factors and contextual factors that either inform units' beliefs about the ideal learning environment, or affect their ability to provide it. (2) Willingness refers to a willingness to invest in students and the forms that investment takes. It includes openness, taking them under wing, and structuring to meet goals. The influencing factors provide the foundation upon which the unit's work to accommodate students is built. Conclusions: The degree to which a unit is able to manage the contextual factors determines how well they can shape the students' environment. The sturdiness of their culture with regard to hosting students determines the pervasiveness of their approach by staff on the unit. (C) 2014 Elsevier Ltd. All rights reserved.