Nursing Students' and Novice Clinical Instructors' Experiences With Clinical Instruction and Assessment.

Section 1: The Problem

Introduction

The clinical experience is an integral component of training for student nurses.

Clinical skill development is a significant facet of the nursing profession and largely

occurs in the clinical setting. It is essential for student learning to occur in the clinical

environment as student nurses are presented with opportunities to connect theory to

practice. One of the key elements of a rewarding clinical experience for nursing students

is the leadership and guidance of the clinical instructor. It is the clinical instructor's

responsibility to foster student confidence through providing a confidence-rich learning

environment (Lundberg, 2008). In the event a nursing student lacks confidence in his or

her abilities, the clinical instructor should implement teaching strategies to develop the

confidence that the student needs to be motivated to continue to improve clinical skills.

The problem motivating this study was the negative feedback on clinical

evaluations done by nursing students that were in many of the inexperienced clinical

nursing instructors' groups at a southeastern community college in the United States.

Much of the prior research related to this issue emphasized the method of socialization to

develop clinical instruction. Notzer and Abramovitz (2008) suggested providing brief

workshops to develop instructor skills. Mentoring and social influence were suggested by

other researchers as means of developing and understanding one's role (Cesareni, Martini

& Mancini, 2011; Wilson, Harwood, Oudshoorn, & Thompson, 2010).

Due to the global shortage of nurses, particularly in the area of nursing education,

part-time clinical instructors make up a substantial proportion of the clinical faculty in

many nursing programs nationally and internationally (American Association of Colleges

of Nursing [AACN], 2013; McDermid, Peters, Jackson, & Daly, 2012). The nursing

school where the problem existed that prompted this research had 15 adjunct clinical,

including three who had less than 2 years of clinical instructor experience. At the same

institution, one fulltime nursing faculty had less than 2 years of clinical instructor

experience. The AACN (2013) reported in 2011 that an insufficient number of faculty,

clinical sites, classroom space, clinical preceptors, and budget constraints caused many

nursing schools in the United States to turn away qualified applicants. Many schools of

nursing hire clinical instructors that are experienced clinicians with a wealth of

experience in the clinical setting. However, seasoned clinicians may have strong nursing

skills, but many lack the knowledge and the experience that is necessary to facilitate

learning among a group of nursing students within the clinical setting. Davidson and

Rourke (2012) reported that clinical nursing instructors are hired for their expertise in

clinical practice and most of them have little to no experience in clinical instruction.

Often times, the inexperienced clinical instructor assumes a role that he or she has not

properly been trained to execute. Learning experiences should be structured in a way that

will promote critical thinking, reflection, and deep learning (Killion, Reilly, & Gallagher-

Lepak, 2011). Tanda and Denham (2009) suggested the use of skill laboratories,

consistent clinical placement, effective clinical learning environments, and the

appropriate coaching by clinical educators positively affects student learning outcomes.

Students have a richer clinical experience when the clinical instructors possess the ability

to assist the nursing students with critical thinking, understanding nursing theory, and the

application of newly acquired skills.

Clinical instructors who do not have a clear definition of their role will cause the

student to suffer in the clinical area (Kowalski, et al., 2007). This was evident in a school

of nursing at a community college in the southeastern United States where the students'

clinical evaluations reflected decreased satisfaction in the clinical area with inexperienced

instructors as compared to the student clinical evaluations from nursing students who

were in the clinical groups of more experienced clinical faculty. Many of the student

complaints about the inexperienced clinical faculty related to inconsistency in clinical

expectations, untimely weekly instructor evaluations, lack of general knowledge about

the clinical facility policies and procedures, and the need to connect clinical experience to

what was being taught in the classroom.

In 2005, the National League for Nursing (NLN) published standards for practice

for academic nurse educators and was titled, Core Competencies of Nurse Educators©

with Task Statements. The competencies provide a comprehensive framework for the

preparation of new nurse educators, implementation of the new nurse educator role,

evaluation of nurse educator practice, and the advancement of faculty scholarship and

lifelong professional development (Kalb, 2008).

The eight NLN core competencies of nurse educators include the following:

Competency I: Facilitate learning; Competency II: Facilitate learner

development and socialization; Competency III: Use assessment and

evaluation strategies; Competency IV: Participate in curriculum design

and program outcomes; Competency V: Function as a change agent and

leader; Competency VI: Pursue continuous quality improvement in the

nurse educator role; Competency VII: Engage in scholarship; and

Competency VIII: Function within the educational environment (NLN,

2005)

The lack of role orientation has resulted in difficult experiences for inexperienced

clinical instructors and students at a community college associate degree nursing program

in the southeastern region of the United States, which also has resulted in a continuous

issue with the retention of adjunct clinical instructors. This local problem, which was the

catalyst for the study, will be discussed in the following section. A description of how the

problem unfolds in the local context and education situation will also be presented. The

rationale for choosing this problem was to discuss how nursing students’ clinical

experiences with novice nursing clinical instructors affect their learning. Terminology

associated with the research will be defined and the research question guiding the study

will be provided as well as a review of the literature.

Definition of the Problem

Paulis (2011) suggested adjunct clinical instructors are often hired based solely on

their clinical experience despite the importance of the clinical instructor's role in clinical

teaching. An individual is not necessarily proficient at teaching clinical skills even though

he or she possesses superior clinical skills. Morren, Gordon, and Sawyer (2008)

concluded that despite the various professional qualifications, experience, certifications,

credentials, and professional organizational memberships obtained by the clinical

instructor, the hypothesis was not supported that these factors were contributory to a

more satisfying clinical experience. Clinical instructors are responsible for guiding

nursing students through the application of fundamental principles of nursing as well as

advanced nursing skills and dosage calculations while in the clinical setting. Even though

these clinicians apply these principles and skills daily within their own professional

practice, they do not possess the knowledge or the experience to effectively facilitate

learning and apply instructional methodologies among the nursing students in their

assigned clinical groupings.

The transition from experienced staff nurse to new nurse educator is often times

frustrating for the instructor and the student. White, Brannan, and Wilson (2010)

suggested novice faculty are frustrated due to a lack of preparation to teach and a limited

understanding of what is required in the new role of nurse educator. White et al. also

pointed out that new nurse educators often lack adequate guidelines of how to function in

the role. Unless a nurse has obtained knowledge concerning nursing education, many are

not trained to be facilitators of learning. The students are then subjected to

inconsistencies among the faculty resulting in confusion and frustration among the

nursing students assigned to the inexperienced clinical instructor clinical groups.

If clinical instruction is to be effective, it requires a properly developed

infrastructure (Pugsley, 2009). Clinical instructors should be facilitators of learning and

possess knowledge of how to connect theory to practice for nursing students in the

clinical setting. The instructor should be required to teach the student instead of allowing

the student to shadow a nurse and simply observe the nurse’s patient care routine. For

instance, patient selection should be relative to concepts and disease processes that the

students are currently learning, which would connect theory to practice. Even when

hospitals and nursing schools contract hospital employed employees to execute the

clinical educator role, the registered nurses need adequate preparation for their role to

support and supervise nursing students in clinical placement to ensure the safe

development of student confidence and competence (Brammer, 2008). Therefore,

inexperienced clinical instructors should be oriented to their role as nurse educators in

order to facilitate learning in the clinical setting. In this study, I investigated

inexperienced clinical instructors and how they impacted nursing students’ clinical

experiences.

Rationale

Evidence of the Problem at the Local Level

As noted, the clinical component for the student nurse is paramount relative to

connecting theory to practice. Important empirical evidence concerning the influence of

highly effective clinical teaching and student learning was presented in two studies by

Blue, Griffith, Wilson, Sloan, and Schwartz, (1999) and Griffith, Georgesen, and Wilson

(2000). Both studies revealed that clinical instructors had significant effects on student

learning. Despite the evidence that supports the importance of student learning from their

clinical instructors during the clinical experience, a number of schools of nursing have no

established orientation for the new role of nurse educator within their nursing

departments in the region where the college is located that was the catalyst for the

research.

The job description posted for adjunct clinical nursing faculty position, as

approved by the State Department of Education, did not list teaching experience as a

requirement. The essential duties and responsibilities of an instructor, as listed in the state

approved job description included the following: commitments to students in the

classroom, the teaching discipline, students outside the classroom, the college, and the

community. These requirements may be difficult for a novice clinical instructor to

achieve without prior teaching experience or orientation to the role for which they are

expected to fulfill. A more detailed job description of nurse educator competencies and

role attributes should have included: Demonstrating knowledge of and engagement with

education theories, understanding and addressing multiple complexities related to

learning, facilitating learning and creating effective learning environments, and the ability

to disseminate nursing knowledge (Young, Frost, & Bigl, 2010). Additionally, Pratt,

Harris, and Collins (2009) identified six factors that could positively influence clinical

instruction which include the following: (a) meaningful and authentic engagement, (b)

explanation of complex topics at the student's level of understanding, (c) role model

desired behaviors, (d) display enthusiasm for teaching, (e) provide a safe and challenging

environment for learning, and (f) setting clear expectations. Novice clinical instructors

have decreased experience in the implementation of these components of instruction and

could benefit from an orientation to their role as a new nurse educator.

This project study may answer questions relative to how the lack of training of

clinical nursing instructors affects the experiences of students in the clinical setting. The

study may also make stakeholders, such as the Department of Postsecondary Education

and the State Board of Nursing, aware of the disadvantages that the lack of training may

cause in the clinical environment for inexperienced clinical nursing instructors and

nursing students across the state. The research may also result in positive social change

by having other nursing programs in the state consider developing a standardized role

orientation for their novice clinical nursing faculty.

Evidence of the Problem from the Professional Literature

The clinical experience is how theory is connected to practice for the nursing student.

Clinical faculty may have to be creative and implement techniques to motivate learning

among students within their clinical groups. Clinical faculty, both adjunct and fulltime,

serve as resources for students during their clinical experiences. The traditional clinical

model that has been practiced historically puts students in the clinical setting, where they

are assigned one to two patients, and are expected to take care of patients using linear

thought processes through the use of the nursing process. This model is rooted in

hospital-based apprenticeship models, and is no longer satisfactory for the modern,

complex, and constantly evolving, health care system (Benner, Sutphen, Leonard, & Day,

2010). Expert clinical faculty play a vital role in aiding students to acquire the intellectual

knowledge, affective attitudes, and psychomotor skills required for professional practice

(Gaberson & Oermann, 2007).

Phillips and Vinten (2010) developed an instrument, adapted from Bonk and

Kim’s (1998) list of sociocultural based teaching strategies for adults, to conduct a pilot

study to measure intent of instructors to adopt innovative teaching strategies within their

clinical practice. Some of the strategies included: role modeling, reflection and self-

awareness, cognitive task structuring, and direct instruction. In order for these teaching

strategies to be implemented in the clinical environment, the clinical instructor must have

knowledge of the innovative teaching strategies to use them effectively in the clinical

setting. The lack of training for the role results in many of the clinical instructors

developing role strain and results in the intent to leave academia within 5 years

(Cranford, 2013).

Definitions

The following terms that will be used throughout the research relative to the

nursing profession are defined.

Advanced beginner: After considerable exposure to the clinical environment and

situations, the nurse improves performance and mentoring and/or repeated experiences,

begins to use more facts and is versed with the use of the rules. (Wilkinson & Treas,

2011). He or she has gained enough experience in actual situations to identify meaningful

aspects that can be identified only through prior experiences (Craven, Hirnle, & Jensen,

2013).

American Association of Colleges of Nursing (AACN): This is an agency that

establishes quality standards for nursing education and assists college administrators to

implement those standards which influences the nursing profession, education, practice

and research (AACN, 2013).

American Nurses Association (ANA): This is a nursing professional organization

in the United States. Membership is open only to registered professional nurses and sets

the standards of practice for nurses (ANA, 2010).

Competence: This is achieved after a few years of practice. Individuals deemed

competent have had additional experience with more complex concerns. They are able to

prioritize situations and get more involved in the caregiving role. (Wilkinson & Treas,

2011). This is reflected in individuals that have been on the same job for 2 or 3 years who

consciously and deliberately plan nursing care in terms on long-range goals (Craven, et

al., 2013).

Expert: Expert nurses are able to see that needs to be accomplished and how to do

it. They possess a deep understanding of a situation and trust in their intuition. They have

expert skills and are consulted when advice or assistance is needed. (Wilkinson & Treas,

2011). The expert nurse has an extensive background of experience and has an intuitive

grasp of the situation and focuses on the problem (Craven, et al., 2013.).

National League for Nursing (NLN): A nursing organization that supports nursing

education with the goal of producing a well-prepared and diverse nursing workforce

(NLN, 2007).

Novice: This phase begins with the onset of education. The novice is receptive to

education and is "learning the rules" of the profession. (Wilkinson & Treas, 2011). A

person enters this situation when he or she has had no previous experience (Craven, et al.,

2013).

Nurse Educator: A nurse that generally has specific clinical specialties and

advanced clinical experience. People in this career role must continue to maintain

expertise in the practice setting, develop expert knowledge of theory, perfect classroom

presentation style, and have in-depth knowledge of curriculum development and higher

education (Craven, et al., 2013).

Nursing process: A systematic problem-solving approach toward giving

individualized nursing care. Nurses use the nursing process as a problem solving method

in all settings with patients of all ages to identify and treat human responses to potential

or actual health problems. (Craven, et al., 2013).

Nursing theory: provides the foundation for nursing knowledge and gives

direction for nursing practice (Craven, et al., 2013).

Proficient: These nurses are resources for less experienced nurses. They are able

to see the "big picture" and coordinate and forecast needs (Wilkinson & Treas, 2011). The

proficient nurse perceives situations as a whole rather than in terms of aspects and

manages nursing care rather than performing tasks (Craven, et al., 2013).

Socialization: This is a process that involves learning theory and skills and

internalizing an identity appropriate to a specific role. (Craven, et al., 2013).

Significance of the Problem

In many health related disciplines, clinical instructors are not trained for the

instructional roles for which they are hired. Many of these individuals develop their

teaching skills through trial and error, reflecting on experiences as students, reading

literature, and incorporating feedback from others (Buccieri, Pivko, & Olzenak, 2011).

The retention rate for newly hired inexperienced clinical instructors at the institution of

focus was low. Student clinical evaluations relative to their clinical experiences have had

more negative comments from those who are in the groups of newly hired adjunct clinical

instructors compared to fulltime nursing faculty. Some adjunct clinical instructors did not

return after just 1 semester of clinical instruction possibly due to the negative comments

from students. When individuals work competently within their scope of practice, their

perceptions of the quality of work life is generally positive, but any deviation from these

conditions led to a diminished quality of work life (Maddalena, Kearney, & Adams,

2012). The registered nurse accepted the position as a nursing clinical instructor without

being trained in the role and did not progress from the novice level of proficiency. The

need to provide support for novice nurses in the clinical setting has been established as

should the support be established for those entering into the new role of clinical

instruction without relevant experience as this may limit them to a novice level of

performance (Benner, 1984). The nursing program of focus would like to retain

competent adjunct nursing clinical instructors to enhance the clinical experiences of

nursing students. Craven, Hirnle, and Olzenak (2011) suggested the level of competency,

the third step in the level of proficiency, is reflected by the nurse who has been on the

same job for 2 to 3 years. Many of the past adjunct clinical instructors were not retained

long enough to achieve the advanced beginner, which is the second level of proficiency.

Novice clinical instructor confidence, competence, and capability have a greater chance

to be facilitated and strengthened if the adjunct clinical instructor role is clearly defined

so that the facilitation of learning may be perpetuated (Maguire, 2013). Despite the

emphasis of the necessity of clinical instruction, there is limited literature that articulates

principles to guide the process (Lynch & Happell, 2008).

Significance of the Study

This study may lead to positive social change by encouraging schools of nursing

to implement the proper training of newly hired inexperienced clinical instructors for

their role as a nurse educator, whether the instructor is a newly hired full-time nursing

faculty member, is independently contracted, or has been hired through collaboration

with a local healthcare organization. The study will also allow schools of nursing to

understand how the nursing student learning experience is affected by the clinical

instructor, with little educator experience, who may not fully understand how to provide

clinical instruction and create an environment conducive to learning in the clinical setting

for nursing students.

The Research Questions

The purpose of the study was to enable me to understand how the clinical

experiences of nursing students were affected by the adjunct clinical nursing faculty. The

research question was the following: Do novice nursing clinical instructors provide

quality clinical experiences for students, as outlined by the National League for Nurses?

The most appropriate research method to answer the research question was to conduct a

qualitative case study. This type of qualitative nursing research allowed me to examine

students’ and instructors’ subjective human experiences by using non-statistical methods

of analysis (Ingham-Broomfield, 2015). A quantitative research study method would not

have been used with this study because numeric and statistical data would not be relevant

to an in depth exploration of the nursing students’ experiences (Lodico, Spaulding, &

Voegtle, 2010). Questions that were used to augment and support the research question

included the following:

• How did the nursing students perceive the quality of learning they

received from the novice clinical instructor in the clinical setting?

• What aspects of the learning experience in the clinical setting were most

effective for the nursing students?

• What aspects of the learning experience in the clinical setting were least

effective for the nursing students?

Collecting data relative to these questions identified areas in need of improvement that

will benefit the novice clinical instructors as well as the nursing students.

Much of the literature has suggested the problem had been related to lack of

faculty to accommodate the number of qualified applicants applying to nursing programs.

This problem was evident at the local level. Due to the lack of qualified full-time faculty,

many staff nurses take on the role of adjunct clinical faculty. What was missing from the

literature was how most nursing schools were preparing these inexperienced clinical

instructors for their new role. Adjunct instructors often function by teaching as they were

taught and by trial and error. Many novice clinical instructors do not receive instruction

in teaching, adult learning theory, or orientation to their role prior to going into the

clinical setting with students.

In the clinical setting, students should be exposed to learning activities that extend

beyond bedside direct patient care to stimulate critical thinking. These learning activities

include but are not limited to role play, simulation, gaming, and the use of technology in

the clinical setting. Such activities are used to enhance the learning experiences of the

students in the clinical setting. The type of research that was needed to address the

problem was a case study that focused on how novice clinical instructors affect clinical

experiences of nursing students.

Review of the Literature

This review provides a detailed summary of the literature regarding the

importance of clinical instructors’ understanding of their roles while in the clinical

setting, experiences of students while in the clinical setting, methods of nursing instructor

professional development, the nursing shortage, and the conceptual framework of the

novice to expert theory.

Nursing and education databases were accessed in search of articles relative to

student clinical experiences. Literature searches were conducted with the use of the

Walden University online library, textbooks, and online nursing and health professional

journals, googlescholar.com, and various nursing websites. Databases used for this

literature search included EBSCO, MEDLINE, CINAHL, ERIC, Education Research

Complete, and ProQuest Central. After a voluminous literature search, saturation was

determined when search items became repetitious among the databases.

The topics that yielded the greatest results were clinical experiences, clinical

instruction, nursing instructor professional development, and the nurse faculty shortage.

A Googlescholar search did present a limited number of articles that focused on

developing mentoring programs and using hospital employed nurses to partner with local

nursing schools and the hospital to supplement the shortage of advanced degree qualified

nurses to teach inside the classroom as well as the clinical setting.

The International Council of Nurses (ICN) identified the shortage of nurses as a

crisis that has a negative effect on global healthcare. The shortage is also detrimental to

nursing education. A major factor of the nursing shortage is there are decreased numbers

of master’s prepared and doctoral prepared advanced practice nurses (Nardi & Gyurko,

2013). Nursing school applicant numbers continue to increase, but many students are

turned away due to insufficient number of faculty (Murray, Schappe, Kreienkamp, Loyd,

& Buck, 2010). Due to the shortage of qualified full-time faculty, adjunct faculty are used

more in the clinical setting to allow the full-time faculty to have adequate preparation

time to present theory in the classroom. Many clinicians who take on the role of educator

have not been properly trained to facilitate learning for students. They literally move

from a role as an expert clinician to a novice educator in the clinical environment

(Cangelosi, Crocker, & Sorrell, 2009). How did the lack of experience and training in the

role of nursing instructor affect the clinical experiences of nursing students?

Many health care organizations participate in clinical ladder programs, which

recognize and reward clinical nursing practice. These provide a means for professional

advancement through professional development. Benner’s (1984) novice to expert model

is the foundation for many of the clinical ladder programs around the nation. Her model

indicated that a nurse may have a high level of expertise in one particular area and be

novice in another. An example of this principle is a nurse who is an expert clinician but

who may also be a novice clinical educator. The minimal ability of the clinical teacher or

preceptor should be to understand the needs of the learner and be able to interpret and

respond to verbal and non-verbal feedback on learner response. Just as health care

organizations recognize and promote clinical expertise, so should schools of nursing

promote knowledge and expertise with clinical faculty.

Davidson and Rourke (2012) conducted a study to identify the skills and

knowledge required to be successful clinical instructors. A learning needs survey was

used to measure the learning orientation needs of newly hired clinical faculty. Descriptive

analysis was the method used to identify the respondents identified as significant or

insignificant to successful clinical instruction. The results of the study suggested

orientation content should contain basic orientation needs such as tools and resources as

well as information on student clinical policies and procedures, clinical simulation,

student clinical evaluation, curriculum content, and objectives.

A naturalistic qualitative study was conducted by Condon and Sharts-Hopko

(2010) to examine the socialization experiences of Japanese nursing students. The

Japanese culture forbids the students to ask questions about content that is presented to

them by their instructors. The students were not allowed to administer medications or

perform invasive procedures on live patients. The students primarily observe the

professional nurse in the clinical setting. The convenience sample participants were

interviewed, and a journal of observations was kept by the researchers. Themes that

emerged from data analysis include the following: The conclusion of this study suggested

the Japanese students encountered barriers to free communication, development of

professional values and behaviors, and interactive clinical experiences, which affected the

socialization process of learning the roles of the professional nurse. In American culture,

these components are essential for nursing instructors to use when they facilitate learning

in the clinical environment.

Effective clinical instructors are essential for maximizing student clinical

experiences (Parsh, 2010). Parsh conducted a qualitative study where students identified

six areas for optimal clinical instruction via informal interviews. The areas identified

included: personality, teaching ability, evaluation, nursing competence, interpersonal

relationships, and realism. A nursing school instituted a partnership with a local hospital

where the full-time nursing faculty member was grouped with two full-time hospital staff

nurses. The full-time hospital staff nurses were selected and paid by the hospital for their

clinical expertise and their interest in teaching students. Delunis and Rooda (2009)

suggested a potential disadvantage of the partnership was that although the staff nurses

were clinical experts, many may have had limited competencies to facilitate student

learning. The full-time faculty member was available to support and mentor the staff

nurses during the clinical experience with the students. The hospital staff nurses were

introduced to the instructor role by the full time nursing faculty member as they

interacted with student nurses in the clinical environment.

Clinical instructors influence the educational experience for students (Giordano,

2009). Clinical instructors have a vital role in teaching students to care for patients. The

student clinical experiences should be filled with opportunities to relate theory to practice

and provide development of knowledge, skill, and attitude to implement quality patient

care. Rye and Boone (2009) conducted a qualitative survey on preceptor training needs

and the results suggested that clinical instructors were set up to fail at this task without

proper training and support. The authors also recognized that many clinical instructors are

“thrown” into the position with little to no direction as to what is expected of their new

role.

Elisha and Rutledge (2011) conducted descriptive research using cross-sectional

survey methods on student registered nurse anesthetists (SRNAs) and found that even at

this level of nursing education, most certified registered nurse anesthetists (CRNAs) in

the United States do not receive instruction for their role as clinical educators. Most have

had minimal exposure to principles of adult learning and experience in education theory.

The researchers found that many students were dissatisfied with their instructors based on

the display of poor teaching skills, limited access, lack of feedback, and inappropriate

behaviors that were not conducive to learning in the clinical setting.

Ralph, Walker, and Wimmer (2009) conducted mixed-methods research on

nursing students who had just completed their practicum before graduating from nursing

school. The research was federally funded in Canada to compare and contrast post

practicum student responses of students in three professional disciplines: nursing,

engineering and teaching education. A survey was used to collect qualitative and

quantitative data. Some of the negative aspects of the nursing practicum, according to the

student nurses, were poor mentorship and assignment of unproductive tasks by some of

their clinical instructors. This was consistent with some of the nurses not having a clear

definition of their role as clinical instructors. The researchers wanted to use the negative

aspects the students’ responses to strengthen the clinical experience for nursing students.

Jahanpour, Sharif, Salsali, Kaveh, and Williams (2013) did a grounded theory

study on the experiences of Iranian nursing students and their perspectives regarding

factors that influenced their development of their critical thinking skills. Four main

themes were discovered in the data: clinical instructor incompetency, low self-efficacy,

unconducive learning environment, and the experience of stress. Some of the responses

revealed the students’ perspectives that some of their clinical instructors lacked clinical

experience and practical skill, which resulted in decreased self confidence in their role.

Instead of facilitating learning among the nursing students, some of the instructors

encouraged the students to follow the routine of the nurses. By doing this, the clinical

instructor put the students at risk for developing undesired habits and behaviors of the

staff nurses they followed.

A phenomenological qualitative study conducted by Wetherbee, Peatman,

Kenney, Cusson, and Applebaum (2010) was done to examine the perspectives of

academic and clinical faculty concerning standards for clinical education. The

perspectives of many of the participants in the study included training clinical personnel

their role, specifically, teach them how to teach students. They should be taught how

valuable their role is in developing the student for their professional practice within the

clinical setting. Findings in the study suggested a need to support and develop clinical

faculty.

A qualitative study conducted by Martens, et al. (2009) was conducted to examine

student views on the effective teaching of physical examination skills. Focus group

discussions, about teaching skills that helped them to develop physical examination

skills, were conducted among 30 randomly selected students. The results revealed

students wanted instructors to present didactic skills that stimulated deep and active

learning. These were skills that many clinical instructors did not possess due to lack of

knowledge and experience.

James and Chapman (2009) conducted a qualitative study on nursing students’

experiences in the clinical setting. The data collected from interviews of second year

nursing students were analyzed using a hermeneutic phenomenological process to

interpret the meaning of the students’ experiences. One of the main themes that emerged

was the students’ perceptions of the preceptors. The students expressed their experiences,

both negative and positive, that were directly influenced by their clinical preceptor. The

researchers concluded that the students’ clinical experiences may impact decisions about

their future nursing practice. Therefore, preceptors should try to motivate students and

facilitate positive experiences in the clinical setting.

Kapucu and Bulut (2011) conducted a qualitative study in Turkey to determine the

perspectives of students toward their clinical learning environment. Semi-structured

interviews were conducted with four groups of eight nursing students. The analysis of the

data collected revealed that students were affected by their patients, clinical educators,

and professionals in the clinical setting. The clinical educators were responsible for

providing clinical experiences that would stimulate problem-solving, cognitive,

psychomotor, and affective skills. Thus, an enriching clinical environment is an important

component to achieve teaching and learning process goals.

Heydari, Yaghoubinia, and Rousdari (2013) conducted a qualitative study to

explore the experiences of students and teachers and student-teacher relationships in the

clinical setting in Iran. Results showed that the clinical teachers displayed supportive

actions toward the nursing students. Semi-structured interviews and observation of

participants were used to collect data. The three major themes that emerged from the data

were educational support, emotional support, and social support. The conclusion

suggested clinical teachers should gain more knowledge on how providing support to

students would influence their learning in the clinical setting.

Bengtsson, Kvarnhall, and Svedberg (2011) conducted a qualitative study to

obtain a deeper understanding of the experiences of nurses who supervise students in

clinical practice. Fifteen experienced nurses who conduct clinical were interviewed. A

grounded theory approach was used to analyze the data. Four themes emerged from the

analysis: sufficient time, working cooperation, sufficient knowledge, and confirmation.

The conclusion suggested nurses should be prepared and possess knowledge to support

student learning in the clinical setting.

All of the literature reviewed either reported data on perceptions of students, full

and part-time faculty, or part-time clinical instructors. For this research, I used a

qualitative case study design to address the local problem. This approach yielded data

that were coded to identify themes from electronic anonymous surveys. I reviewed

student clinical experience surveys for the past 3 years to support the findings for more

credible results.

Conceptual Framework

The conceptual framework that was used for this study was the novice to expert

theory developed by Benner in 1984. Another conceptual framework that supported the

primary framework was the social cognitive theory developed by Bandura in 1986.

The primary conceptual framework that was used for the research was the novice

to expert theory that was developed based on the study of acquiring and developing

clinical nursing skills (Benner, 1984). This theory was adapted from the Dreyfus and

Dreyfus (1980) model for skill acquisition. Benner (1984) identified five levels of

nursing experience through which an individual progresses and demonstrates change

based on their experiences. The five levels of nursing experience are (a) novice, (b)

advanced beginner, (c) competent, (d) proficient, and (e) expert (Benner, 1984). The

individual must complete the first level before progressing to the subsequent levels. This

theory was meant to explain why some nurses excel in practice and others are stagnant. It

represented the basis of how nurses learn and develop the skills of the profession. The

same may be applied toward acquiring knowledge and skill when introduced to different

roles in nursing practice (Benner, 2004).

The beginner has no reference to act according to situations they may encounter.

Furthermore, the novice clinical nursing instructor has no prior experience to guide his or

her actions in the clinical setting. They lack confidence in their ability to conduct clinical

effectively. Instead, they operate by following rules and instructions because they lack

discretionary judgment (Benner, 1984). The advanced beginner has developed knowledge

from past experiences to be able to make decisions in certain situations. They may have

to consult more experienced individuals occasionally but are usually able to make sound

decisions independently (Benner, 1984). The competent nurse is confident and able to

solve problems based on organized, purposeful critical thinking. Competence is achieved

after an individual has worked in the same capacity for 2 to 3 years (Benner, 1984). The

proficient nurse views situations as a whole and considers outcomes instead of in pieces.

The individual anticipates what to expect based on experiences and is able to make

modifications in response to situational changes (Benner, 1984).

A conceptual framework that supported the study’s primary conceptual

framework was the social cognitive theory which started out as the social learning theory

in the 1960s by Bandura. In 1986 the social learning theory evolved into the social

cognitive theory when Bandura (1986) theorized that learning occurs through all

developmental stages and occurs due to social interactions with people, behavior, and the

environment. There were five constructs that made up the original social learning theory.

A sixth construct was added with the evolution to the social cognitive theory. The

constructs were (a) reciprocal determinism, (b) behavioral capability, (c) observational

learning, (d) reinforcements, (e) expectations, and (f) self-efficacy (Bandura, 1986).

Reciprocal determinism was the central focus of the theory that was relative to the

reciprocal interaction between individuals, behaviors, and the environment. An individual

develops learned experiences in an environmental social context that results in specific

behavioral responses (Bandura, 1986). Behavioral capability involves the individual

acquiring basic knowledge and skills to perform a specific behavior. An individual must

possess the knowledge to know what to do and do it in a correct manner. People learn

from the consequences of their actions, which ultimately affects their environment

(Bandura, 1986). Observational learning is when individuals observe others performing a

skill and replicate the actions. Individuals are able to correctly reproduce the behavior as

a result of the behavior being modeled by someone who has knowledge of the desired

behavior. (Bandura, 1986). Reinforcements are either initiated environmentally or are

self-initiated. This construct is closely associated with environment and behavior. The

reinforcements may be positive or negative and may influence whether a behavior

continues or ceases (Bandura, 1986). Expectations are based on experience. Individuals

contemplate the potential outcomes of their behavior before taking part in the behavior

that may affect the culmination of the behavior. An individual weighs the value of their

behavior and how it will affect the outcome (Bandura, 1986). Self-efficacy is relative to

the individual’s confidence level of performing a behavior. Environmental factors and

personal abilities contribute to individual confidence levels (Bandura, 1986).

Implications

In the study, I endeavored to show the importance of novice clinical faculty

understanding their roles as educators as it applies to the nursing students’ clinical

experiences. A nurse instructor role orientation was developed based on the findings of

the data collection and analysis. The findings were that the omission of a role orientation

for novice clinical instructors affected the clinical experiences of nursing students. Due

to the various schedules of the clinical adjunct instructors, an online role orientation

would be more beneficial to offer to the novice full-time and part-time faculty rather than

a face to face meeting that could have possibly conflicted with their work schedules.

Moreover, an online role orientation would increase the number of those clinical adjunct

instructors who would receive the knowledge that would result in a more effective

teaching experience for the novice instructor and learning experience for the nursing

student in the clinical setting. Much of the prior research has dealt with the effectiveness

of face to face workshops and training for clinical faculty. Hence, the focus of this study

was to examine how the nursing students’ clinical experiences were influenced by the

guidance of clinical instructors with limited experience in clinical instruction.

Summary

The problem that motivated this research, and described in Section 1, was the

decreased student satisfaction noted on the clinical evaluations of a number of nursing

students in novice clinical instructor groups at a nursing school in the southeastern United

States. The rationale for choosing the problem was due to the lack of role preparation of

the novice clinical instructor which may have led to the decreased student satisfaction of

their clinical experiences. The nursing shortage, particularly in education, was identified

as a tremendous factor in the increased use of hospital staff nurses as clinical adjunct

instructors. These instructors were experienced clinicians; however, many lack

experience with the facilitation of learning as they tried to function in their new roles.

Most clinical adjunct instructors are consequently employed on semester to semester

contracts. Due to the impermanent nature of the position, schools of nursing are

continually recruiting nurses to the position (Andrews & Ford, 2013). Key terms relative

to the problem were defined. The local effects of the problem supported why the problem

should be addressed. The significance of the study highlighted current research and how

social change may be undertaken. The research question used to guide the study was

identified. A thorough literature review was conducted and the conceptual framework was

discussed. Implications for the study were also presented. Data collection and analysis

will be discussed in Section 2.

Section 2: The Methodology

Introduction

Using the concepts of Benner’s (1984) novice to expert theory, the purpose of the project

study was to examine how adjunct clinical instructors that had 2 years of experience or

less affected the nursing students’ clinical experiences. The students who had

experiences in clinical groups of clinical instructors with 2 years or less of clinical

experience were sought after for the study because Benner (1984) suggested competence

is achieved after an individual has worked in the same capacity for 2 to 3 years. Some of

the students may not have known the experience of the clinical instructor, but their

description of their clinical experiences with their instructor may have indicated the

performance of a novice instructor. The clinical instructors with 2 years or less were

ideal participants for this research; however, potential participants who wished to

participate and had more than 2 years of clinical instructor experience were asked to

reflect back to their performance during the 2 two years of their role as clinical instructor

to answer the open-ended electronic questionnaire.

The research question was as follows: Do novice nursing clinical instructors

provide quality clinical experiences for students as outlined by the National League for

Nurses? Other questions that guided the study included the following: How did the

nursing students perceive the quality of learning they received from the novice clinical

instructor in the clinical setting? What aspects of the learning experience in the clinical

setting were most effective for the nursing students? What aspects of the learning

experience in the clinical setting were least effective for the nursing students?

A qualitative research design was used for the research. The specific type of

qualitative research method was a case study. A case study requires a variety of data

collection tools to gather data. Lodico et al. (2010) suggested no one qualitative method

is used in a case study; instead, multiple techniques including focus group interviews,

observations, and at times the examination of documents and artifacts may also be used.

The data collection methods for the research included conducting an electronic open-

ended questionnaire of nursing students at three participating nursing schools with the use

of Survey Monkey®. All three nursing schools operated under the same statewide

curriculum. The electronic questionnaire was mostly open-ended questions to explore the

nursing students’ perceptions of their clinical experiences.

A separate electronic questionnaire was conducted to explore the perspectives of

inexperienced instructors and how they felt concerning their ability to provide effective

learning environments for the students. Full-time and part-time novice instructors were

asked to elaborate on their current clinical instruction methods, while more experienced

part-time and full-time faculty were asked to reflect on their instructional methods during

the first 2 years of their role as clinical instructor. The novice to expert theory (Benner,

1984) was the theoretical framework used to guide the methods for data collection and

data analysis. The social cognitive theory (Bandura, 1986) was used to support the

framework. The students and clinical instructors were from three other institutions in the

same college system as the nursing program that prompted the study. Finally, documents

such as student clinical experience evaluations were analyzed, within the three

participating institutions, to explore how the nursing students had described their clinical

experiences over the past 3 years.

The research design and how it was derived from the research problem will be

discussed in the following section. Participant selection, justification for the number of

participants, methods for gaining access, and the course of action to protect the rights and

identities of the participants will also be discussed. Data collection, data analysis, and

methods to determine credibility will be described in detail.

Research Design and Approach

Design

A qualitative research design was used for the study. The type of qualitative

research approach that was most appropriate was a case study. A case study focuses on

small groups or individuals within a group and document the group’s or individual’s

experience in a specific setting (Lodico et. al., 2010). The type of case study for the

research was an instrumental case. Creswell (2012) defined an instrumental case as

focusing a specific issue, which is the focus of the qualitative study, with a case or cases

used to illustrate the issue. Stake (2003) described an instrumental case study as using a

case study of one case to gain insight into a particular phenomenon, where there is likely

to be a question or a set of predetermined criteria or a theory that is being explored or

tested through the case study. In the case study, I explored how inexperienced clinical

instructors influenced the learning environment of nursing students in the clinical setting.

Creswell (2012) suggested either the case itself or a significant occurrence within the

case may be the focus of the research inquiry. Creswell also concluded that instrumental

case studies are pursued in order to provide insight about a particular issue that may be

generalizable. The case that was explored was the clinical experiences of students under

the supervision of inexperienced clinical instructors. The phenomenon in question was

how nursing students’ clinical experiences were influenced by the inexperienced clinical

instructors. In the research, I investigated how nursing students perceive their clinical

experiences, and how nursing faculty perceived their instructional methods during the

first 2 years in their role as clinical instructor.

Approach

A case study was used for the study to examine nursing students’ clinical

experiences in three college nursing programs in the southeastern United States.

Purposeful sampling was used for participant selection. Lodico et. al. (2010) described

purposeful sampling as participants being selected through nonrandom methods

depending on whether those selected have vital information relative to the research

question. All nursing students at the three participating institutions were invited to

complete an electronic questionnaire. The ideal nursing student participant had to be at

least 18 years-old and have completed at least 1 full semester of clinical. The division

chairperson from each institution who agreed to participate in the research made my

invitation (Appendix C) available for all nursing students. Eight to 10 student participants

from the participating institutions was the ideal sample to provide valuable information

concerning how their clinical experiences were influenced by their clinical instructors.

The division chairperson also made a separate invitation (Appendix D) available

for all full-time and adjunct faculty participation. Three to five instructor participants

from the participating institutions was the desired sample to provide rich information

concerning how the instructors felt they fulfilled the role of clinical instructor during the

first 2 years as facilitators of learning within the clinical setting with nursing students.

The students and the nursing faculty that wished to participate in the research were asked

to complete the electronic questionnaire by the 14

day after it had been made available

to them.

Other types of qualitative research were not appropriate for this study.

Ethnography was inappropriate because I was not investigating communities or cultures

and the attitudes, knowledge, values, and beliefs that influence the behaviors of a distinct

group of people (Lodico et al., 2010). Phenomenological research was inappropriate for

the research because the study was not going to be conducted over a prolonged period of

time to include observation and reflection of an individual’s interpretation of his or her

experiences (Lodico et al., 2010). Finally, a grounded theory research approach was not

appropriate because multiple techniques of data collection over a long period of time to

develop a theory was not the purpose for the research (Lodico et al., 2010).

Participants

This study included participants based on purposeful sampling. This type of

sampling warranted the participants to be able to provide vital information that is

meaningful to the research (Creswell, 2012). This type of sample also aided me to better

understand the problem and the research question (Creswell, 2009). The programs of

study involving the nursing programs that were included in the research were composed

of various nursing programs with semesters consisting of theory, lab, and clinical

components that were consistent the state nursing standards of nursing education.

The nine student participants in the study, at minimum, were practical nursing

students. There were three groups of nursing students, from three different nursing

programs in the state other than where I am employed. The students did not necessarily

belong to the same clinical groups, but they all should have had at least 1 full semester of

clinical experiences. This allowed the students to present a variety of rich perspectives for

data collection.

The six clinical faculty participants in the study had either practiced in the role of

clinical instructor less than 2 years or were experienced faculty who were asked to reflect

on their experiences during the first 2 years of clinical instruction. Full-time and adjunct

faculty were invited to participate in the research.

The demographics of the students and nursing faculty that were included in the

participant groups were diverse. The groups consisted of a representation of various

ethnic and racial groups, gender, and age ranges. I did require that the participants be at

least 18-years-old to participate in the research. Both traditional and nontraditional

students were included in the participating groups of students. No interested participant

who was at least 18 years of age was excluded from participating in the research. The

diverse groups of nursing students provided an ample number of student perspectives

relative to their clinical experiences. This allowed the students to present a variety of rich

perspectives for data collection.

Selection of Participants

A purposeful selection of nursing student participants required the students to

have had clinical experiences for at least 1 semester in their nursing program. A

qualitative research method was used for the research. Creswell (2012) suggested an

objective of qualitative research was to present the complexity of a site of the information

provided by individuals. I allowed the department chairpersons from the three nursing

programs to decide the method that would be most appropriate to make the invitation

available for the potential participants. An electronic post on a message board or hard

copies in a common area where students frequent was suggested. The data provided by

the students from each participating institution that completed the electronic

questionnaire by the designated date was used for the research. The designated date was

14 days from the original posting of the invitation. The same procedure for participant

selection was done for the nursing clinical faculty. The number of student and instructor

participants varied based on the participation from each participating institution. The

number of respondents who completed the electronic questionnaires consisted of nine

students and six clinical faculty. After 14 days, all of the responses from the participants

were collected. Due to the method of data collection the identity of all participants was

anonymous.

The students’ responses about their clinical experiences provided distinct

perspectives on how their clinical experiences had been shaped by the instructor. The

nursing faculty responses gave insight into how the instructors conducted clinical and

how they felt about their ability to do so in an effective manner during the first 2 years of

clinical instruction.

Gaining Access to Participants

Before moving forward with the study, I obtained approval from Walden

University’s Institutional Review Board (IRB). Any IRB applications required by the

individual institutions were submitted and coordinated with the Walden IRB. To gain

access to the participants, a letter of intent was mailed to the education coordinator of the

Department of Postsecondary Education in the state where the research took place

(Appendix G). The letter explicated the research, its purpose, and possible benefits to the

organization. The letter explained that potential participant identities were going be

anonymous. Similar letters with the necessary information were mailed to the

presidents/deans and/or other responsible individuals at the Colleges of potential

participants, and the IRBs or Research Committees of the institutions that participated in

the research (Appendix H). If the presidents/deans and/or other responsible individuals

approved the study they responded in writing to me. The next step after the approval from

the responsible individuals of the colleges was to notify the nursing division chairperson,

if he or she was the responsible individual, with a letter acknowledging permission was

granted to conduct the study within their program (Appendix I). The nursing chairpersons

were instrumental in assisting me by making the Letter of Invitation available to potential

participants. Documents such as collective de-identified clinical experience evaluations

were also used as a source of data.

Ethical Protection of Participants

The research was conducted at institutions other than my workplace. The groups

of students and the clinical instructors from the three participating institutions were

informed of the purpose of the research and ensured that their identities were to be kept

anonymous in the Letter of Invitation (Appendices C & D). The potential participants

were given 14 days to consider being a participant and complete the electronic

questionnaire. The participants were informed in the invitation that the research was not

for their institution, but solely for my research. All of the participants were also informed

that they would not be compensated for choosing to participate in the research and there

were no costs associated with this research other than the 15-20 minutes that may be

required to complete the electronic questionnaire. The responses of the students and

clinical instructors was an integral component in the data collection for the research. The

research posed minimal risks to the participants. The questions included in the

questionnaire may have resulted in possible discomfort of some participants. The

participants were informed that their participation in the research was voluntary and their

decision about whether or not to participate, or to stop participating prior to the

completion of the electronic questionnaire, would not jeopardize their affiliation with the

participating institution where they were enrolled. The participants was also informed

that they may choose not to answer some of the questions, withdraw from participating in

the research, or not participate at all. I had no connection with the three nursing programs

I utilized for the research.

Data Collection Methods

The study was approved by the Institutional Review Board (IRB) at Walden

University. The approval number was 10-03-14-0036089. The IRB was provided with a

copy of the research proposal and other documents relative to the research. Data

collection did not begin until after participants had consented to participate and the

researcher had received authorization to have access to the participants. Two of the

participating community colleges did not require IRB approval from their organization.

One of the participating colleges did require completion of a letter of interest in

conducting research within their institution. I completed the required Research Request

Submission Form, which had to be approved by the college’s research committee. I

waited three weeks for approval from the institution.

After I experienced a lack of participation with soliciting face-to-face interviews,

I decided to change the method of data collection. I requested a change of procedure for

data collection from Walden University’s IRB by completing a Change of Procedure

form. On the form, I indicated the reason for the change request, what the new procedure

would entail, and that I had approval from my assigned committee chairperson, second

committee chairperson, and University Research Reviewer (URR). I was later granted

approval from the IRB and I was informed that I would use the same approval number

that I was previously given to conduct research (10-03-14-0036089) by a research ethics

support specialist in the Office of Research Ethics and Compliance. I then notified my

point of contact of the change of data collection procedures at the institution that required

the research request. The institution informed me that I did not have to submit another

form and the point of contact would make note of the change in my method of data

collection.

Data collection and analysis for the research were relative to the identified

problem and research questions. Data was collected using mostly open-ended questions

on an electronic questionnaire for students and nursing faculty. The open-ended questions

enabled the participants to provide the researcher with more in depth descriptions of their

clinical experiences (Appendices E & F). The data that was collected and was stored on a

USB flash drive and placed in a locked drawer within my home where it will remain for

at least five years, after which it will be destroyed.

The use of a document in qualitative research often provides “written or recorded

material” not prepared for the purpose of the evaluation or at the request of the research

that may provide insight into a setting or a group of people (Guba and Lincoln, 1985).

The clinical evaluation document that was used in the research was created, and had been

used previously, to gather information from the nursing students relative to their clinical

experiences. The clinical experience evaluation tools of the nursing programs that were

analyzed for evaluation results that answered the research question. These clinical

evaluation tools were used to gather data concerning the students’ clinical experiences at

particular clinical sites as well as their overall clinical experiences. There was a separate

student clinical instructor evaluation that was not used during the research due to

employee confidentiality issues. Neither were personnel faculty evaluations used. The

clinical experience evaluation tools that were reviewed were collective and de-identified.

Electronic Questionnaires

A peer reviewer evaluated the questions for each questionnaire and informed me

which questions required revisions. The majority of questions that were included in the

questionnaires for the nursing students and the nursing faculty were open-ended.

However, two closed-ended questions were also utilized in each questionnaire to support

concepts and theories presented in the literature (Creswell, 2012). Open-ended questions

on the questionnaires allowed the researcher to further explore the reasons the

participants chose the responses to the closed-ended questions. The open-ended responses

also allowed participants to elaborate beyond the closed-ended responses. The nursing

students provided information about how their assigned clinical instructor influenced

their clinical experiences. The full-time and part-time nursing faculty were allowed to

give in depth accounts of how they felt they currently conduct, or previously conducted,

clinical during the first two years in the role of clinical instructor. I used the data from

the clinical instructors to determine the feelings, perspectives, and interpretations of their

personal clinical performance as novices.

After the participants had been invited to participate in the research they were

asked to complete an electronic anonymous questionnaire, which was accessible via a

link at the conclusion of the invitation. The overlapping data in the participants’

responses was what I used to identify the themes that were mentioned by the participants.

The questions that were included in the electronic questionnaires for the nursing students

and nursing faculty were included in Appendices E and F, respectively.

Clinical Experience Evaluations

I traveled to each of the three participating institutions to review the collective de-

identified clinical experience evaluation documents for the past three years. I spent 2.5-3

hours at each institution if paper documents were still used for the clinical experience

evaluations, and 1.25 hours at the institution that had electronic records. I read through

the documents at each organization to identify themes within each organization. After I

gathered data from the clinical experience documents from each organization, I compared

the data to identify themes among the three organizations to support the data that was

collected from the student and instructor open-ended questionnaires. The clinical

experience evaluations included data about perceptions of students’ and instructors’

experiences in the clinical setting that supported the data collected from the electronic

questionnaires.

Managing Collected Data

After the data was collected from the electronic questionnaires that were

completed by the students and the nursing faculty, the data was organized, coded, and

categorized. Creswell (2012) suggested the coding process of qualitative research should

include: Reading through text data, dividing the text into segments of information,

labeling the segments of information with codes, and collapse the codes into themes. Due

to the amount of data that was collected, I did the coding process by hand instead of using

a coding computer software program. The codes that I found from the data analysis were

reduced to themes. Themes were another way to analyze qualitative data by forming

major ideas also known as core elements. Merriam (1998) declared themes reflect the

purpose of the research study.

The themes that came from the data were classified with the use of the conceptual

frameworks to answer the research question. The Novice to Expert theory, which was

used as the conceptual framework for the study, justified the notion that nursing students’

clinical experiences were facilitated by their clinical instructor and should assist students

to progress in their clinical knowledge and demonstrate change in behavior that would

resemble that of a professional nurse (Benner, 1984). The Social Cognitive theory

supported the conceptual framework by the suggestion that learning occurs through

developmental stages and occurs due to social interaction with people, behavior, and the

environment (Bandura, 1986). The nursing instructors should make an attempt to control

these major factors which greatly contribute to nursing students’ experiences within the

clinical setting.

Role of the Researcher

I am a full-time nursing faculty working in a community college associate degree

nursing program. I had no association, personally or professionally, with the three other

nursing programs that were included in the research other than being in the same state

community college system or under the same nursing education policies mandated by the

State Board of Nursing. I have worked in this position for nine years. I am a lead

instructor of various nursing courses and I supervise the adjunct clinical instructors that

have been assigned to coordinate clinical experiences for my courses. Prior to working at

the college, I worked as a staff registered nurse at a local hospital. I have a total of 18

years of nursing experience. I was initially a Licensed Practical Nurse (LPN). I furthered

my education and obtained a Bachelor’s of Science Degree in Nursing and a Master’s of

Nursing Degree with a Specialization in Nursing Education, respectively. The adult care

areas that I have worked in include: Long-term care, orthopedics, oncology, neurosurgery,

medical-surgical, surgery, the post anesthesia care unit, and nursing education.

One of the biggest dilemmas I have encountered while being employed at the

college where I am currently, is the lack of role preparation for the clinical nursing

faculty when they are hired. It has concerned me that there is a high turnover rate of

clinical adjunct instructors and that many of the students in the clinical groups of these

instructors are not satisfied with their clinical experience, according to their clinical

experience evaluations and verbal accounts. However; these circumstances have caused

me to vow to remain objective throughout the proposed research and not to rely on my

own biases that could affect the outcome of the proposed research. I kept a journal

containing reflective field notes throughout the research (Module O). Reflective field

notes allowed me to reflect on my own feelings, experiences, and values to increase my

awareness of my own biases and how they may influence my conclusions. I endeavored

to conduct research in the study that would positively affect teaching/learning in the

clinical setting, which may result in positive social change within my work environment.

Data Analysis

Merriam (2009) described data analysis as a process of making sense out of data

which involves, consolidating, reducing, and interpreting what participants have said and

how the researcher makes meaning of the data. It was the process that was used to answer

the research question. Creswell (2012) suggested reading through the data multiple times

to prepare and organize the data. The next step was to review and explore the data, which

involved gaining an overall idea of the contents of the data and whether the amount of

data that was collected was sufficient. The third step was to code the data, which further

identified recurrent themes that existed within the data. Small pieces of data were

examined in order for a connection to be made between them so that general categories

may be developed to organize information within the data. (Lodico et al., 2010) I

repeated these steps until enough meaning was extracted from the data. The data was

reexamined to ensure that valuable information was not overlooked and that the data was

coded correctly. The next step was for me to develop a research report wherein I provided

a 1-2 page summary of what the data meant and distributed it to all of the stakeholders at

the participating colleges to include: The representative at the State Department of

Education, the College Presidents/Deans/ or responsible college personnel, division

chairpersons, nursing faculty and staff, and nursing students. The final step was to

develop a project based on my findings and disseminate it to my own institution

stakeholders.

Evidence of Quality

Throughout the data collection and analysis process, I validated findings through

data triangulation. Triangulation was the process of validating evidence from various

individuals, type of data, or methods of data collection in descriptions and themes in

qualitative research (Creswell, 2012). Triangulation has been found to be beneficial in

providing confirmation of findings, increased validity, and enhanced understanding of

studied phenomena (Bekhet & Zauszniewski, 2012). The data collected from the student

and nursing faculty electronic questionnaires (Appendices J & K) was examined to find

evidence to support themes that existed from the data. The data that was collected from

both sets of electronic questionnaires was analyzed for similar themes. The perspectives

of these two sources of data supported the validity of the findings better than from having

one source of data.

Finally, the existing documents that were reviewed were the students’ comments

on previous student clinical evaluations of their overall clinical experiences for the past

three years (Appendix L). Documents are sources that provide valuable information in

helping researchers understand central phenomena in qualitative studies (Creswell, 2012).

My review of the archival documentation of the students’ clinical evaluations of their

clinical experiences gave an in depth look into the students’ clinical experiences. The

student clinical experience evaluations were archival data that included students’

perspectives concerning their clinical experiences. Some of the similarities observed were

as follows: students wanted more than one patient to care for, inconsistencies between

class and clinical, clinical instructors not adhering to school policies, untimely feedback,

and outdated teaching practices. These similarities are indicative of the inexperience of

the clinical instructors. Most of the instructor responses to the electronic questionnaire

indicated that they had no orientation to their role, which led them to conduct clinical the

best way they knew how. The methods that many of the novice instructors used were

those methods that were used by their instructors when they were nursing students.

Many of those methods are antiquated and have been found to cause students to assume

short cuts and undesired habits displayed by the nurse they had been paired with for

observation. The review of this compilation of data allowed me to identify patterns that

existed with students whose clinical experiences were under the supervision of novice

clinical instructors.

Limitations

Limitations that presented themselves in this research include the time that was

required to get clearance from all of the participating agencies to conduct research within

their organizations. It was difficult to get in contact with two of the individuals that had

been designated as my points of contact within the institutions. At times I became

discouraged when responses to phones calls or emails were not returned in a timely

manner. However, I did have tremendous support from one of the participating

institutions’ contact people. This individual was very prompt with responses via

telephone and email. She made the process seamless for my research. I used the

experience with that institution to be the framework for how I collected data from the

other programs.

Findings

The purpose of this study was to explore how novice clinical instructors effect the

clinical experiences of nursing students in the clinical setting. The research question was:

Do novice nursing clinical instructors provide quality clinical experiences for students as

outlined by the National League for Nurses? Two questions that were used to support the

research question were as follows:

• How did the nursing students perceive the quality of learning they

received from the novice clinical instructor in the clinical setting?

• What aspects of the learning experience in the clinical setting were most

effective for the nursing students?

• What aspects of the learning experience in the clinical setting were least

effective for the nursing students?

The method of data collection chosen for this research was student and instructor

electronic questionnaires, along with existing de-identified student clinical experience

evaluations. For this study, three nursing schools agreed to participate in the research.

The nursing schools gave students and instructors access to the invitation to participate in

the research. This was done to offer the opportunity to a variety of participants. If the

students or instructor accepted the invitation to participate, they anonymously completed

an electronic questionnaire. Nine students and six instructors took the time to complete

the electronic questionnaires.

From the analysis of the data collected from this research, novice nursing clinical

instructors provide clinical experiences for students, as outlined by the National League

for Nurses, if they have been oriented to their role and taught how to be more effective in

the clinical setting by more experienced clinical faculty. The instructor responses to the

electronic questionnaires indicated that two out of the six instructors that participated in

the research received some type of orientation to their role (Appendix K). The aspects of

the learning experiences in the clinic setting that were most effective for the nursing

students were (1) they felt that their instructors were approachable and (2) the instructors

treated them with dignity and respect. (Appendix J). The aspects of the learning

experience in the clinical setting that were least effective for nursing students were (1)

inconsistencies between the classroom and clinical instructors; (2) knowledge deficits of

clinical instructors relative to school policies and procedures and (3) the novice

instructors’ fear of allowing students to provide care for more than one patient

(Appendices J & L). The data that were collected demonstrates an obvious gap in practice

for newly hired clinical instructors.

Electronic Questionnaires

The student and instructor electronic questionnaires were accessed by the

participants by using the link at the conclusion of the student or instructor invitations.

After the students or the instructors accessed the anonymous electronic survey, they

answered a series of questions that were mostly open-ended (Appendixes E & F). This

allowed the participant to give rich, detailed accounts of their experiences. Use of the

SurveyMonkey® electronic questionnaires allowed the data to be collected and grouped

according to the order the questionnaires were done. For the purpose of coding, student

respondents were given numbers: S1, S2, S3, S4, S5, S6, S7, S8, and S9. The instructors

were assigned numbers as well for the same purpose: I1, I2, I3, I4, I5, and I6.

The students completed the questionnaires within 14 days of them having access

to the invitation to participate in the research (Appendix E). The amount of time the

students took to complete the questionnaires ranged from a little over 13 minutes up to

over 3 hours. The various times showed that students took the time to think about their

responses to the questions to provide the valuable feedback that was desired for the data

collection for this research. A list of the dates, and the amount of time to complete the

student questionnaire is shown in Table 1. Question 2 was omitted by respondents S8 and

S9 (Appendix J).

Table 1.

Student Response Times on Electronic Questionnaire

Student

Date questionnaire

completed

Time to

complete

S1 12-10-2014 21 min 17 sec

S2 12-10-2014 3 hrs 08 min 38

sec

S3 12-15-2014 18 min 17 sec

S4 12-29-2014 13 min 42 sec

S5 12-31-2014 18 min 57 sec

S6 1-02-2015 15 min 49 sec

S7 1-09-2015 12 min 10 sec

S8 1-12-2015 21 min 28 sec

S9 1-12-2015 24 min 52 sec

The participating instructors also completed the questionnaire within 14 days after

they were given access to the questionnaire link. A list of the dates, and the amount of

time to complete the instructor questionnaire is shown in Table 2.

Table 2.

Clinical Instructor Response Times on Electronic Questionnaire

Instructor

Date Questionnaire

Completed

Time to

Complete

I1 12-02-2014 21 min 48 sec

I2 12-03-2014 50 min 30 sec

I3 12-03-2014 30 min 31 sec

I4 12-05-2014 13 min 36 sec

I5 12-05-2014 2 hrs 58 min 08

sec

I6 12-13-2014 33 min 06 sec

All of the participating instructors completed all questions in the questionnaire (Appendix

K).

Student Questionnaire

The first three questions of the student questionnaire were to gather data about

how they perceive their clinical instructor conducts clinical (Appendix J). (1) Please

provide examples of how your clinical instructor assigns clinical activities which parallel

current classroom instruction, (2) Describe how your clinical instructor explains disease

processes, procedures, medications and clinical situations, and (3) What is your

perception of your clinical experiences thus far? After analysis, it was determined that

four of the nine student respondents felt that their instructor did not provide clinical

activities that paralleled classroom instruction. Two respondents, S8 and S9, omitted

question 1. For question 2, all of the respondents felt that their clinical instructor

adequately explained disease processes, procedures, medication and clinical situations.

Four of the nine student respondents felt that their clinical experiences were good, but

could use some type of improvement that directly involved the clinical instructor in

question 3. The responses to support the findings include, “….I wish they would allow us

to have more than one patient sometimes because it seems to drag at times with just one

patient” (S1), “Clinical would be much better if you have an instructor that will allow you

to participate with total care of your patient and learn from not only the instructor, but

nurses, doctors, and any other person involved with the patient” (S3), “The clinical

experience was generally good, but could be improved by making sure students get an

opportunity to practice skills taught in the classroom” (S4), and “Clinical has been good

so far, but sometimes the instructor seems to spend more time with some students and I

feel that others in the group miss out on learning opportunities because she takes up so

much time with them” (S5).

Question 4, Describe how your clinical instructor abides by clinical policies and

procedures outlined in the Nursing Student Handbook, was asked to gather information

about how clinical instructors followed set institutional rules. All of the student

respondents felt that their clinical instructors followed the school’s policies and

procedures. Respondent S3 answered, “My clinical instructor abided by clinical policies

and procedures detailed for our program, but I feel we were limited when we cared for

our patients because our instructor was afraid to allow us to do certain procedures.” This

type of behavior by the instructor may lead the student to believe that the instructor did

not have confidence in the students’ abilities or the student may perceive that the clinical

instructor may have been incompetent.

Question 5, Does your clinical instructor display that he/she is approachable and

treats students with dignity? was asked to collect data about how the students felt they are

treated by their clinical instructor. All of the student respondents felt that their instructor

was approachable and treated them with dignity. However, respondent S3 said, “My

clinical instructor was approachable and she did treat us with dignity. She was a very

respectable person, she just seemed afraid to let us do certain things, like give narcotics,

or care for a patient with tuberculosis.” All of the things that the student spoke of that the

clinical instructor would not let them do are important areas that the student should be

exposed to during their clinical experience.

Question 6, Describe how your clinical instructor provides pre and post

conference activities, was asked to find out what types of activities were facilitated by the

clinical instructor in pre and post clinical. All of the students reported “discussion” for

pre and post clinical conferences. Other methods such as, role play, concept mapping, and

gaming could be used in the clinical setting in pre and post conference to encourage

critical thinking among the students. These are tools that could be presented to clinical

instructors in a formal orientation to be used to facilitate learning in the clinical setting.

Questions 7 and 8, (7) What evaluation criteria does your clinical instructor use

to provide feedback for written clinical assignments and clinical behaviors? and (8) Does

your clinical instructor provide you with feedback in a timely manner?, asked about

instructor feedback. For question 7, only three of the nine students (S1, S2 & S3) referred

to the evaluation tool as being the criteria the instructor uses for written assignments and

clinical behaviors. All of the student respondents felt that they were provided feedback in

a timely manner. Three of the 9 student respondents, (S1, S3 & S6), reported that they

received feedback from the clinical day on the next clinical day of the following week.

Three of the 9 student respondents, (S2, S4 & S7), reported that their instructor gave

them feedback immediately after they performed skills or at the end of the clinical day.

This is the desired amount of time for clinical instructors to provide feedback to students.

Two respondents, (S5 & S9), answered “yes” to the question, but did not explain their

answers.

Question 9 asked the students to List the qualities you feel that a clinical

instructor should possess. All of the students responded with descriptions of nurses in the

clinical setting. None of the respondents mentioned experience in the role of clinical

instructor.

Question 10 asked the students Is there anything you would change about your

clinical experiences thus far? Why? There were various responses to this question.

Respondent S1 said, “… I wish we were allowed to have more than one patient.”

Respondent S2 said, “I would say increase hands on experience within the clinical

setting….” Respondent S3 said, “Yes, we need to make sure the clinical instructor and the

classroom instructor have some type of regular communication so that what we are

learning in the classroom can convert to some things we can pick up in clinical.”

Respondent S4 said, “Yes. Need more time in areas where students can practice skills

more.” Respondent S5 said, “I would probably change hospital selection.” The other

respondents, (S6, S8 & S9) reported they were satisfied with their clinical experiences.

Instructor Questionnaire

Questions 1 and 2 on the instructor questionnaire (Appendix K), (1) How would

you describe your leadership and guidance of the students in the clinical setting during

your first two years as a full-time or part-time clinical instructor?, and (2) Describe how

you connect theory to practice in the clinical setting, are about the clinical instructors’

perceptions of their teaching abilities in the clinical setting. Respondent I2 reported, “I

really did not have any orientation to the clinical area on the academia side so I drew on

my experience as a nurse and clinical coordinator in the hospital.” Respondent I3

reported, “During the first year- I felt completely lost guiding students. I really was not

given much direction at all.” Respondent I6 reported, “I instructed my students based

mainly on my clinical experience. I focused on what I learned through my years of

experience.”

Question 3, How would you describe your rapport with other health care

professionals in the clinical setting? was asked to gather data on how the instructors felt

about their relationship with other professionals in the clinical setting. All of the

respondents felt that they had a good relationship with other professionals in the clinical

setting. They all felt a good rapport with other healthcare professionals in the clinical

setting was very important for the students to have a good clinical experience.

Question 4, Describe how you abide by policies and procedures outlined in the

Nursing Student Handbook, was asked to gather data on how the instructors feel they

adhere to the organization’s rules. Respondents I1, I2, I4, I5, and I6 all reported that they

at least read the Nursing Student Handbook to make sure that were upholding standards

when in clinical. Respondent I3 reported, “When I first started teaching clinical I never

saw a nursing student handbook. It was later in my years that I was ever given a

handbook, and I have taught for a variety of schools over the years.”

Question 5, Explain how you display that you are approachable and treat students

with dignity in the clinical setting, was asked to gather data on how the instructors

perceived their relationship with the students. All of the instructors reported that they felt

they were approachable and gave examples of how they demonstrate dignity when

interacting with students.

Questions 6 and 7, (6) Describe how you provide pre and post conference

activities, and (7) Explain how to evaluate and give feedback for written clinical

assignments and clinical behaviors, were asked to gather data on their teaching ability

facilitate learning and provide feedback in the clinical setting. All of the respondents,

with the exception of respondent I3, reported that they have verbal discussion for pre and

post conference. Respondent I3 reported, “Assignments may be given to bring back to

post conference. I also review patients, discuss assignments, and provide teaching

activities for the students.” All of the respondents mentioned that they use the assessment

tool as a guide to provide feedback in the clinical setting. Only respondent I2 mentioned a

time frame for when they provide student feedback, which was “after the performance of

clinical behaviors.”

Question 8, During the first two years as a clinical instructor do you feel that you

provided quality clinical experiences for your students? Please explain your answer, was

asked to obtain data concerning the instructors’ perceptions of the quality of clinical

experiences they provided for their students. Respondents I1, I2, I4, and I5 felt that they

provided quality experiences for their students during the first two years as a clinical

instructor. Respondent I3 reported, “Not really. I did ok since it was my home unit. I

learned something new every semester. I really would have enjoyed talking with the

primary instructor to see exactly what I needed to cover.” Respondent I6 reported, “I

think I did well with the skills part for my students, but I think I lacked the theory that

they needed also.”

Question 9, List the qualities you feel that a clinical instructor should possess,

was asked to gather data on the qualities a clinical instructor should have. All of the

respondents, with the exception of respondent I1, listed qualities that were expected of a

nurse. Respondent I1 listed, “Knowledge, passion for nursing, understanding of clinical

procedures and role of the clinical instructor.”

Question 10, How did you become oriented to your clinical instructor role? was

asked to gather data on how the instructor became acclimated to their role as clinical

instructor. All of the respondents, with the exception of respondent I6, reported that they

were not given a formal orientation, they were self-taught, and learned on the job.

Respondent I6 reported, “I was oriented by a full time instructor at the college where I

was going to act as adjunct. I also was given an orientation book for adjuncts.” There was

no indication that this adjunct instructor got the orientation within the state where the

research took place, but they had the ideal pre-clinical preparation before going into the

clinical setting with students.

De-Identified Clinical Evaluations

The questionnaire components of the de-identified clinical experience evaluations

from each nursing program was used as another method to collect data. The responses of

the students to the questionnaire components of the clinical experience evaluations was

desired because their responses were candid and uninhibited due to the anonymous nature

of the clinical experience evaluations. These responses provided richer, detailed accounts

of their clinical experiences, rather than the Likert-scale component that was used in two

of the three clinical experience evaluation tools used by the participating nursing

programs.

Some of the responses could support the answers to the student and instructor

questionnaires. For question 7 on both questionnaires that asks about how feedback and

evaluations are done, many of the responses on the clinical experience evaluations by the

clinical instructor included: “She is doing great!”, “Good job!”, “Stays busy.”, “Lots of

skills today.”, “Hard worker.”, and “I enjoyed being your instructor” (Appendix M).

These statements are superficial and do not give students a true evaluation of their skill

performance and professional behavior. Many of the instructor listed skills that were

performed during the clinical day with no mention of how well the student performed the

skills. Some of the desired documentation that instructors included in the clinical

experience evaluations were: “You did a great job with administering meds through a

PEG tube today.”, “You did a good job with removing the Foley catheter with minimal

assistance from me.”, “You did well teaching your patient the correct way to change the

dressing on his leg,” and “Your documentation is getting better, but you still need to work

on documenting your evaluations for your interventions” (Appendix N). These

evaluations are specific and clearly identify where students are competent and where

there are challenges.

The student responses on the clinical experience evaluations in reference to

question 7, also contained details that support the lack of appropriate feedback from

clinical instructors. One of the students wrote, “I received a score that equals below safe

level of novice learner in clinical at the end of my clinical rotation, even though my

instructor did not tell me what I was doing wrong along the way.”, “My instructor would

identify problems with my skills, but did not offer solutions on how I could get better.”,

and “I wanted my instructor to give more verbal feedback.” Here were examples of how

feedback in a timely manner was so important for students.

Question 5 on the student questionnaires about treating students with dignity and

instructor approachability, was supported by some of the comments made on the clinical

experience evaluations such as: “My instructor talks down to us. Nobody wants to asks

questions.”, “My instructor embarrassed me in front of the clinical group when I had

questions about a skill I was about to perform.”, “I heard my instructor tell one of the

nursing staff that one of the other students in my clinical group would never make it as a

nurse.”, and “My instructor seems to get irritated when anyone in my clinical group asks

questions.” These responses showed that some instructors need training on how to be

respectful of students and how to make themselves approachable.

Question 4 on both set of questionnaires focused on instructors abiding by

policies and procedures. Some of the student responses on the clinical experience

evaluations include: “We are not allowed to have our cell phones in clinical, but my

instructor is seen texting all of the time.”, “My instructor wears artificial nails to

clinical.”, “My clinical instructor wears fake eyelashes in clinical.”, “My instructor needs

to communicate with my classroom instructor. One requires one thing and one another.”

These behaviors were contrary to what the students were taught, which could have easily

caused frustration among the students.

The Themes

The major themes that were identified during data analysis of the student and

instructor anonymous electronic questionnaires (Appendices J & K) and the student

clinical experience evaluations (in the order of the number of occurrences were: (1) no

formal orientation, (2) no preparation for the clinical instructor role, (3) self-taught to

the role, (4) subjective instructor evaluations, and (5) lack of instructor feedback. Both

the student and instructor questionnaires consisted of 10 questions. All 10 of the

instructor questions were open-ended. Three of the student questions were closed-ended

with an open-ended explanation added as a second part to the questions. All of the

instructor respondents reported that they had no formal orientation to their role of clinical

instructor. Two of the instructor respondents did report that they met with the lead

instructor to discuss the student paperwork and shadowed a more experienced clinical

instructor in the clinical setting for a few hours. No preparation for the clinical

instructor role and Self-taught to the role were equal with 83% of the instructors’

responses falling under these themes. Five of the six instructors reported that they felt

they had no preparation for the role of clinical instructor. Five of the six instructors

reported that they were self-taught when it came to preparing for the role of clinical

instructor (Appendix K). Five of the 9 student respondents reported that their evaluations

were more subjective than objective, even though the clinical instructors should have

been following an evaluation tool (Appendices J & M). They reported that the written

comments by the clinical concerning skills and behavior were not clear, and they did not

offer solutions to the deficiencies that the students may have been experiencing in these

areas while in the clinical setting. And finally, three of the 9 students reported that they

had feedback from their clinical instructor the following week (Appendix J). One student

expressed the need for more verbal feedback from her instructor (Appendix L). Students

should receive feedback right after they complete skills and at least at the conclusion of

the clinical day. The clinical experience evaluations contained student and instructor

feedback to support the identified themes from the student and instructor questionnaires.

The following sections will contain the data to support these themes.

Conclusion

Section two of this project study addressed methods of data collection and analysis. The

research question was answered by utilizing a case study research design. Descriptions

and justification for participant selection, participant criteria, and the process of gaining

access to the participants was also discussed. Ethical collection and data analysis methods

were also discussed. The researcher’s role in the research was identified. The major

themes that were identified included: (1) no formal orientation, (2) no preparation for the

clinical instructor role, (3) self-taught to the role, (4) subjective instructor evaluations,

and (5) lack of instructor feedback. The results of the research will hopefully cause

nursing programs to take a closer look at how novice clinical instructors’ guidance in the

clinical setting may affect the experiences of students and will justify the need for an

appropriate role orientation for novice clinical nurse educators.

I communicated my research findings to my committee and we agreed that a

professional development program was the most appropriate project. After the

committee’s approval, I was allowed to progress to Section 3. The dissemination of the

findings of the research will be discussed in the next section.

Section 3: The Project

Introduction

Data analysis showed that many of the student respondents would change

something about their clinical experience that was directly related to the clinical

instructors’ performance in the clinical setting. Out of the clinical instructor respondents

who completed the clinical instructor questionnaire, only one had some type of formal

orientation for their role as clinical instructor. Therefore, a professional development

program will be used to present a solution for the gap in practice. The professional

development will be presented over a period of 3 days and will include various teaching

strategies such as lecture with the use of PowerPoint, group discussion, interactive

learning, and simulation (Appendix A).

Project Purpose and Goals

The purpose of the professional development is to offer learning opportunities for

novice clinical faculty to conduct clinical in a manner that is conducive to learning for

nursing students. The professional development will be designed to ease the transition

from clinical nurse to nurse educator in the clinical setting. The target audience will be

clinical instructors with less than 2 years of clinical instruction experience, as well as

experienced clinical faculty who wish to stay abreast of best practice techniques to

conduct clinical experiences with students. The program objectives (Appendix A) were

created based on the findings from the research. The objectives will be used to determine

if the clinical instructor has acquired knowledge and skill, and is able to demonstrate the

behaviors that are necessary to meet the student learning needs in the clinical setting as a

result of attending the professional development program. The professional development

will provide knowledge, skill, and the application of those skills to novice clinical

instructors to utilize in the clinical setting to positively affect nursing students’ clinical

experiences. The project will include presentations in lecture form, group discussion,

interactive learning, and simulation.

Rationale

A professional development project genre was chosen because of the noted

problem of transition from clinical expert to clinical educator. Garet et al., (2001)

identified two distinct models of professional development. The traditional model of

professional development categorizes instructors as similar individuals with congruent

learning styles and needs who attend common instructional opportunities. The reform

model of professional development categorizes instructors as individual learners who are

involved with learning activities that are associated with their specific professional

practice.

The reform model of professional development is the preferred method for this

project. This model of professional development supports the idea that novice clinical

nursing instructors should be involved in learning activities that assist them with the

transition from clinical experts to effective nurse educators in the clinical setting (Garet,

Birman, Porter, Yoon and Desimone, 2001). It also is the basis for the belief that

professional development should be a continuous process by which clinical instructors

may gain and maintain the knowledge and skill of being effective facilitators of learning

for students in the clinical setting.

Review of the Literature

The purpose of this literature review was to search the literature to support the

subject matter and actual content of the project. The chosen method of delivery for this

project study was a professional development program. Professional development

programs should provide relevant content that creates an opportunity for reflection and

personal growth (Kemp & Baker, 2013). The foundation of the professional development

was grounded in the eight NLN (2005) core competencies of nurse educators that

includes the following:

Competency I: Facilitate learning; Competency II: Facilitate learner

development and socialization; Competency III: Use assessment and evaluation

strategies; Competency IV: Participate in curriculum design and program

outcomes; Competency V: Function as a change agent and leader; Competency

VI: Pursue continuous quality improvement in the nurse educator role;

Competency VII: Engage in scholarship; and Competency VIII: Function within

the educational environment.

I also wanted to include the use of simulation that will allow the participants to apply the

skills and knowledge they have acquired within a controlled environment to prepare them

for real-life situations that may occur in the clinical setting with students. The use of

simulation to teach novice clinical instructors may be a learning tool that they may

consider using when connecting theory to practice for nursing students (McNeill, Parker,

Nadeau, Palayo & Cooke, 2012).

Rainsburg and Childress (2012) conducted a descriptive study that used a cross-

sectional design to analyze the skill acquisition of nurse educators. The framework for

their research was the Dreyfus model of skill acquisition (Dreyfus & Dreyfus, 1980) and

the NLN core competencies for nurse educators, (NLN, 2005). A total of 339 nurse

educators were surveyed using an instrument that assessed the skill among nurse

educators. This method was designed to assess skill acquisition and to assist nurses with

the development of personal development planning. The conclusion from this research

was that the nurse educators who took part in the research felt that they were competent

in their abilities, but the majority of the respondents reported that they had more than 5

years of education experience. They also concluded that attending professional

development would allow nurse educators to achieve what is needed for them to operate

effectively. Clinical instructors need to be excellent clinicians as well as good teachers,

but they often lack formal education and professional development opportunities to meet

the need that their role in the clinical setting requires (Altman, 2011; Dahlke,

Baumnusch, Affleck, & Kwon, 2013; McAllister, Williams, Malko-Nyhan & Jones, 2011;

Zohar & Smith, 2010). I wanted to research the nurse educators who were considered

novice in their instructor role to identify how they affected the clinical experience of

students. I used the information that I gathered through the study to design a professional

development program to prepare clinical experts for their new role of nurse educators.

Young and Shellenbarger (2012) discussed how the use of the NLN Jeffries

framework, which is usually a learning tool for undergraduate students using simulation,

may be used to teach clinical educators the knowledge and skill that is required to teach

nursing students. The Jeffries framework is composed of five conceptual components:

teacher factors, student factors, educational practices, simulation design characteristics,

and outcomes (Jeffries & Rogers, 2007). They felt that the use of these components

incorporated with the use of high fidelity simulations, which are true to life situations,

were just as effective with preparing new nurse educators for their roles as it was with

preparing nursing students for practice in the clinical setting. This will allow the more

experienced instructors, who will serve as mentors, to provide constructive feedback for

competencies that may require further development.

Stiles, Pardue, Young, and Morales (2011) conducted an interpretive

phenomenological study to explore nurse faculty leadership. In the study, 24 nursing

faculty were asked to describe their experiences of becoming nurse faculty leaders. Their

findings revealed that leadership develops when individuals are proponents for change.

The researchers concluded that advancing change in nursing education is essential for

leadership development. Experienced nurse educators can be instrumental in facilitating

the professional growth of novice nurse educators by helping them to overcome their

challenges and fears associated with teaching and become leaders (Ashton, 2012).

Faculty should strive to become leaders in order to create more effective learning

environments for students to transform the nursing profession (Patterson & Krouse,

2015). Implementing change and leadership development are two of the NLN core

competencies for nurse educators. These two topics will be included in two of the

modules that will be presented during the professional development.

Another phenomenological study conducted by Gardner (2014) was done to

explore the nurses’ experiences that contributed to their development and competence.

Eight peer-nominated effective teachers participated in the research. The data showed that

the faculty felt their development and competence was due to the support that they

received from their peers and administrators, which led to their retention. The researchers

concluded that the participants learning to teach was greatly influenced by the support

they received. Retention and flourishing of the nurse educators will greatly depend on

providing theory and evidence-based strategies for teaching and learning by more

experienced nurses (McAllister, Oprescu, & Jones, 2014). One of the NLN core

competencies for nurse educators is being willing to support the faculty, which will be

included in the professional development.

The literature search also revealed other research related to the topic of supporting

the faculty. Faculty development programs should be presented by expert faculty to

support other nurse educators to emphasize the importance of education and to keep

faculty current (Barksdale et al., 2011). The researchers also believed that this type of

professional development prepares novice nurse educators and keeps experienced

educators current in their roles. Many expert clinicians are transitioning to the adjunct

clinical faculty role to supplement the decreased number of clinical faculty (Schaar,

Titzer, & Beckham, 2015). Faculty support will be necessary to acclimate the faculty to

their role as quickly as possible. Supporting the faculty is a topic that will also be

addressed in a professional development module.

The mixed-methods study conducted by Nishioka, Coe, Hanita, and Moscato

(2014) concluded faculty-nurse relationships, rather than the traditional model of clinical

education, provided a better clinical experience for students. The traditional model

depicts nurse faculty as the primary clinical instructor for students. The dedication

education unit (DEU) model, is based on faculty-nurse relationships. The nurse faculty

trained interested staff nurses how to educate students in the clinical setting. The

researchers discovered that the nurses who participated in the DEU model reported that

their commitment to teaching improved their practice and their work satisfaction. In order

to be prepared for their role, clinical instructors should possess a clearer professional

identity (Adams, 2013). This supports the modules on how to facilitate learning in the

clinical setting, continuous quality improvement, and the nurse educator’s role within the

educational environment.

Smith, Hecker-Fernandes, and Duffy (2012) conducted a study to describe the

relationships between mentors and preceptors. The researchers described preceptorship as

a quick method of instruction on “what to do.” They concluded that mentoring, which

results in a longer lasting relationship between individuals, is a better method for training

novice faculty, which leads to a development of scholarship and ultimately, retention

within the education environment. Formalized role orientation, to include mentoring, can

prepare and socialize nurse educators for their academic roles, which will increase job

satisfaction and retention (Baker, 2010; Roughton, 2013; Wilson, Brannan & White,

2010). Clinical instructors should have a mentor who will assist them with being more

effective in their role, function within the academic environment to be familiar with the

curriculum, and properly evaluate student behavior (Weins, Babenko-Mould, & Iwasiw,

2014). The presence of a mentor is meant to encourage the novice clinical instructor to

further develop their role. The role development is achieved by continuously seeking

formal and informal professional development and continuing education related to their

area of teaching and clinical practice (Tanner, 2010). This is how faculty may add

scholarship to their faculty role, which is important when seeking and maintaining

accreditation for nursing programs. The professional development will highlight the

benefits of mentoring for novice clinical faculty and the importance of scholarship in the

faculty role.

Suplee, Gardner, and Jerome-D’Emilia (2013) conducted a descriptive study that

determined that gaps existed in the preparation of clinical faculty. Many clinical faculty

conduct clinical in the manner they were taught as a student, instead of using evidence-

based practice for the most effective and current methods of instruction. The researchers

concluded that continuing professional development is essential to ensure clinical faculty

are able to manage and evaluate student learning. The researchers also identified areas

that were most challenging for the clinical instructors to include: working with students

who have learning disabilities, physical disabilities, emotional disturbances, and incivility

among students. Incivility and learning disability will be addressed during the simulation

exercises.

A qualitative study conducted by Shahsavari, Yekta, Houser, and Guiyasvandian

(2013) was done to identify primary factors that affected the student-instructor

relationship within the clinical environment. The researchers concluded that a great deal

of the relationship between the student and the instructor is built on trust. The researchers

felt that an instructor that the students perceived as competent and professional was very

important with forming a good student-instructor relationship. Student-teacher

relationships will be discussed in the module that emphasizes learner development and

socialization.

Nurse educators acting as change agents, is another facet of the core competencies

that will addressed in the professional development program. Schriner et al. (2010) are

nurse educators who were instrumental with implementing change within a school of

nursing. Lewin’s (1951) change theory was the framework for the organizational

restructuring that took place. Along with the college administration, the nurse educators

were able to restructure their institution. Data collected from students and nursing faculty

were instrumental with providing the proof that change was necessary and inevitable. As

a result of the collaboration with the nursing faculty and college administrators, new

positions were created, and there was more efficient use of their resources.

One of the most difficult responsibilities of the clinical instructor is to determine

if the behaviors of students should result in failure of clinical. Tanicala, Scheffer, and

Roberts (2011) conducted an inductive qualitative study on passing and failing clinical

behaviors of nursing students. The focus of the study was to identify behaviors that were

considered to be unsafe in the clinical environment to prevent students from causing

harm to patients. They concluded that clinical instructors should be able to discern the

student behaviors that will ultimately result in patient harm. The evaluation tools that are

used in the clinical setting serve as clearly defined expectations that are aligned with the

nursing program conceptual framework and program outcomes (Hunt, Curtis, &

Sanderson, 2013; Yonge, Myrick & Ferguson, 2011). An unambiguous, succinct, and

adaptable evaluation tool is necessary when evaluating students’ clinical performances

(Walsh, Jairath, Paterson, & Grandjean, 2010). Patient safety and student behavior will be

discussed in the module on assessment and evaluation strategies.

Implementation

After the training is completed, the novice participants will be assigned mentors,

who are existing experienced clinical faculty. The mentors will periodically contact the

novice clinical instructors to monitor their progress in the clinical setting. Also, the

mentors will be available for the novice participants for questions and assistance with

dilemmas that may arise in the clinical setting.

Potential Resources

Curriculum, defined by Keating (2006), is a formal plan of study that provides

philosophical foundations, objectives, and guidelines for the delivery of a specific

educational program. The training curriculum for the project will be congruent with the

conceptual base of basic knowledge and skill necessary to facilitate learning in the

clinical setting for students. Jarrett, Horner, Center and Kane (2008) identified examples

of basic knowledge and skill necessary to facilitate learning in the clinical setting to

include: encouraging critical thinking, teaching-learning theory, ways to deal with

challenging students, and how to make patient assignments to best connect theory to

practice. The main objective of the training curriculum is to create effective clinical

instructors. Billings and Halstead (2012) indicated effective clinical instructors are

knowledgeable and know how to present concepts to students in engaging ways, are

clinically competent, and have interpersonal skills that have a positive influence on

students’ learning.

The training curriculum was created based on the NLN Core Competencies,

collaborative input from full-time and part-time clinical faculty, the data provided by

students and instructors from the anonymous surveys, and the clinical experience

evaluations also contributed to the development of the training curriculum. The clinical

instructors will conclude the training with simulation wherein the participants will

demonstrate how they will facilitate learning in the clinical setting. The simulation allows

the instructors to practice the basic concepts they learn during the training in a safe

practice environment and have constructive feedback from more experienced clinical

faculty. An electronic version of a summary of the training, in the form of a PowerPoint,

will be available as a reference for novice and experienced clinical instructors via the

college “Y-drive”, which houses documents utilized by various departments on the

college campus.

Training Materials

The training that will be conducted is designed for the participants to gain

knowledge about how to become effective clinical instructors and apply the knowledge

they learn in the clinical setting with students. The type of materials used for the training

is influenced by educational goals, content to be learned, learner developmental

characteristics, and the design and availability of training materials (Mazgon & Stefanc,

2012). The training materials that will be used for the project will include: a checklist

with training objectives; the departmental adjunct faculty orientation manual; faculty

presented orientation and teaching, via PowerPoint, about the role and responsibilities of

a clinical instructor; the Simulation lab; and an evaluation of the training experience.

Learning objectives depict the behavior change expected from the learner after

training (Merli, 2011). A checklist with training objectives (Appendix A) will be used to

ensure that the participants gain the desired knowledge and skill, and justify correction as

necessary. The training facilitators will know that learning has occurred when the

participants are able to display the behavior that is necessary to meet the course

objectives, which will also be an indicator of course effectiveness.

Being that many clinical instructors are adjunct faculty, the departmental adjunct

faculty orientation manual will be used to introduce them to various college and

departmental policies during the training session that will be geared toward defining their

place and responsibilities to the Health Sciences Department. Experienced clinical faculty

will use this portion of the training as a review and to receive clarification on policies and

procedures.

PowerPoint will be used throughout the training to present the role and

responsibilities of a clinical instructor. Dahlke, Baumbusch, Affleck and Kwon (2012)

reported the characteristics of effective clinical instruction should include: setting clear

student expectations, correct undesired behavior, is approachable, and display good

nursing judgment and clinical skills. The clinical instructor will be taught to set clear

expectations for the nursing students by setting an example of professionalism and

provide bedside care in a patient-centered manner instead of a nurse-centered approach.

Klunklin et al. (2011) believe an effective clinical teaching tool is role-modeling

behavior. Clinical skills, critical thinking, and making sound nursing judgment will be

critical areas of instruction for the training program. These areas are paramount when

providing bedside nursing. The instructors will also be taught to connect classroom

theory to clinical practice. Heshmati-Nevabi and Vanaki (2010) report clinical instructors

should support students by possessing knowledge of both the curriculum and the clinical

environment. The instructor must build a rapport with the student to be approachable,

but still be objective and use clinical objectives and student learning program outcomes

to correct undesired behavior. It is imperative that clinical instructors foster a supportive

learning environment (Moscaritolo, 2009). Occasionally, students become anxious in the

clinical setting when they have to use critical thinking to care for living, breathing

patients, instead of the training mannequins that are used in the nursing lab. The clinical

instructor should be trained to identify students that lack confidence with their critical

thinking skills and require assistance with implementing patient care.

The Simulation lab will be used to incorporate various situations that may occur

in the clinical setting where the clinical instructor will be allowed to make decisions in a

safe practice area. The instructor will make decisions using critical thinking skills that

have been developed while attending the training. Elder and Paul (2010) describe critical

thinking as using ongoing self-assessment to improve one’s thinking ability. The clinical

instructor will be taught to make decisions in the clinical setting by analyzing their

thought process and knowledge base when facilitating learning and problem solving,

rather than the use of random thinking that may cause the instructor to overlook pertinent

factors or exacerbate issues that may be detrimental to students’ competence and success

in the clinical setting. Simulation provides transferable experiential learning which may

be used to improve clinical and non-clinical skills (Roots, Thomas, Jaye & Birns, 2011).

Training Sessions

The training sessions to prepare nurses for the role of clinical instructor, will be

implemented as a form of professional development (Appendix A) over the course of

three days. The participants will be able to obtain continuing education credits (CEUs),

which are required for biennial state license renewal for nurses. The institution that will

host the professional development training is a state board of nursing approved

continuing education provider. The state board of nursing issued a provider number to the

institution which allows the institution provide courses or activities in a single session or

multiple sessions lasting at least 25 minutes, which would be equivalent to 0.5 contact

hours. A continuing education contact hour would be equivalent to a session lasting at

least 50 minutes. The sessions will include module formats prevalent to college and

departmental policy and procedures, teaching and learning methods in the clinical setting,

and technique implementation and critique with the use of simulation.

Continuing Education

Continuing education programs for nurses should be relevant to current clinical

practice (Kowitlawakul, 2013). There are various continuing education programs that

focus on specific clinical skills, disease processes, equipment, and other entities that are

associated with patient care in the clinical setting. However, there are very limited

continuing education programs available to nurses to increase the knowledge, skill, and

interest of clinical instructors when it comes to best practice methods in the clinical

setting.

In the last two years, the healthcare arena has had significant changes in the

clinical setting with issues such as The Patient Protection and Affordable Care Act and

the global effects of the Ebola virus. Ebola has emerged as a major public health and

global humanitarian crisis (Piot, Muyembe, & Edmunds, 2014), and as we move closer to

another election year, the discourse over the The Affordable Care Act will intensity, and

the future of health care reform will be highly uncertain (Oberlander, 2014). These major

issues in healthcare have introduced challenges in the clinical setting, not only for the

medical staff and nurses caring for patients that may be affected by either of these

entities, but also the clinical instructors and students who are in the clinical settings. The

clinical instructor should be knowledgeable on how to present up to date, effective, and

safe, evidence-based practice to support and assess the competence of students while they

are in the clinical setting (Gopee, 2010). This is where more nursing schools should be

proactive and provide continuing education for clinical faculty on how to present these

types of issues to students, as they emerge, while they are in the clinical setting.

Potential Barriers

A potential barrier may be the number of days and the times the training will be

offered. It may be difficult for adjunct clinical instructors to attend a three-day

professional development if they are employed full-time elsewhere. An incentive may be

the opportunity for free continuing education credits (CEUs), which are requirements for

the nurse licensure renewal within the state. The institution that will host the professional

development is a state board of nursing approved continuing education provider site.

Another potential barrier is to get the buy in from college administrators and other

nursing faculty. They will be presented with the results of this research so that they will

have the necessary information to see the need for the professional development, and for

consideration of the nursing faculty to have the event on the campus. I believe that once

the gap in practice is presented with the results of the research, most will agree that the

professional development is necessary.

Proposal for Implementation and Timetable

The data collected from the instructor questionnaire showed that all, but one of

the clinical instructor participants, had some type of orientation before conducting

clinical with nursing students. The data from the student questionnaire showed that most

of the student participants felt that there should be changes to improve their clinical

experience.

The project’s case study design was based on the analysis of this study. The data

analysis showed that there was an obvious need for training in the form of professional

development. To implement the professional development, the project will first need to

be presented to the division chairperson of health sciences. The next step is for the project

to be presented to the nursing faculty in a faculty meeting so that the faculty is exposed to

the purpose, content, and intended outcome of the project. The faculty was encouraged to

participate in the project by offering content suggestions and to be responsible for various

presentations to be included in the three day training sessions. Nursing students were also

involved, on a voluntary basis to provide input about specific areas that they perceived as

clinical instructor challenges in the clinical setting. The final step will be for the division

chairperson to present the need for the training to the campus administration for

immediate implementation.

The timing of the project is very important. It will need to be implemented before

newly hired faculty go into the clinical setting with students. The time that will most

likely be chosen for the professional development will be on days that the state has

designated for required faculty professional development. This time is usually between

semesters when faculty are free from classroom and clinical obligations.

The venue for the training will need to be one that is spacious, has technological

capability for projector use for PowerPoint presentations, and also include a simulation

laboratory for implementation and critique of the learned skills. The hosting college may

also invite other nursing program clinical faculty that are in close proximity to participate

and provide training for other individuals that may be experiencing similar challenges in

the clinical setting.

Roles and Responsibilities of Student and Others

My responsibility is to develop and facilitate the project. The full-time nursing

faculty, and experienced clinical faculty, will provide input. The role of the full-time

nursing faculty and the experienced clinical faculty is to assist with program facilitation

as well as act as mentors to novice clinical faculty. The full-time faculty will be

responsible for assisting with planning and implementing the modules included in the

training sessions. The role of the clinical faculty, which may include newly hired full-

time faculty as well as adjunct clinical faculty, will be that of learners. The novice clinical

faculty will be responsible for attending the training sessions to acquire the knowledge to

be facilitators of learning for nursing students in the clinical setting.

I will also be responsible for securing the location for the professional

development, providing the purpose for the professional development to the clinical

faculty, providing handouts and materials required for the workshop registration, and

have light refreshments available for breaks. Due to local and state budget cuts, lunch

will be at the expense of the participants to maintain cost effectiveness for the event.

Project Evaluation

An outcomes-based evaluation will be used to ensure that the participants meet

the objectives that will be presented at the beginning of the workshop. Formative and

summative evaluations are also planned for the project deliverable. This will inform the

project developers of what areas of the workshop were most effective and what areas

need revision.

Evaluation Goals

Formative and summative evaluations will be used as evaluation tools for the

professional development. Formative evaluations will be conducted throughout the three-

day course. At the conclusion of each module, an anonymous paper evaluation will be

distributed to the participants to make sure that the content in the presentations are clear

and to identify areas that will require revision. The formative evaluation will also include

an area for questions that will be answered at the start of the subsequent module included

in the workshop (Appendix A).

Summative evaluations will be used at the conclusion of the workshop to assess

how effective the participants felt the three-day workshop equipped them to be

facilitators of learning in the clinical setting with nursing students. The summative

evaluation will also allow the participants to anonymously present their concerns and

offer suggestions for improvement for future professional development workshops. As a

program developer for this project, I will strive to make improvements based on the

participant feedback.

Outcome Measures

The outcome measures will be based on the NLN (2005) core competencies of

Facilitate Learning, Facilitate Learner Development and Socialization,

Use Assessment and Evaluation Strategies, Participate in Curriculum Design and

Evaluation of Program Outcomes, Function as a Change Agent and Leader,

Pursue Continuous Quality Improvement in the Nurse Educator Role, Engage in

Scholarship, and Function within the Educational Environment.

There are tasks statements that exist under each heading. Those tasks statements

that directly relate to facilitating learning in the clinical setting will be used as outcome

measures. Some of the tasks that are under such competencies as, “Pursue Continuous

Quality Improvement in the Nurse Educator Role” and “Engage in Scholarship,” will be

presented to the participants in a presentation, but will be evaluated at another time,

possibly during yearly faculty evaluations.

Key Stakeholders

Key stakeholders include nursing students, clinical instructors (full-time and

adjunct), full-time and adjunct classroom nursing faculty, college administrators, and the

post-secondary agency administrators in the state.

The nursing students will benefit from having clinical instructors that are well-

trained in their roles as facilitators of learning, which will increase nursing student

clinical experience satisfaction. Clinical instructors (full-time and adjunct) will benefit by

gaining knowledge on how to practice in the clinical setting with confidence as a result of

well-defined roles and best practice teaching and learning techniques. Full-time nursing

faculty will have the support from the clinical faculty to connect theory to practice in the

clinical setting. The clinical faculty will be equipped with the tools to provide the nursing

students’ with a learning clinical experience. They will also be able to objectively

evaluate how students apply the skills they have learned in the nursing lab to real-life

patient situations in the clinical setting.

Implications Including Social Change

Local Community

The goal of the local community is to provide clinical experiences for nursing

students that are commensurate with the learning experiences that are presented in the

classroom setting. A key element in starting a training program for clinical instructors is

to get the stakeholders to recognize the need for the program and provide support to the

program developers. The data that was collected from this research will be used to inform

the college administrators of the problem of student dissatisfaction that exists with the

clinical experiences of many nursing students. The administrators will also be informed

that the problem can be resolved within the Health Sciences department in a manner that

is timely and economically feasible for the college.

Far-Reaching

If nursing students are to have a clinical experience that is an environment

conducive to learning, the clinical instructor should be equipped with the knowledge and

skills necessary to transform the clinical setting into a bridge where theory and clinical

skill make a connection. The clinical instructor has a direct influence on the clinical

experience of the student. The facilitation of learning, or the lack there of, by the clinical

instructor impacts how the student views the clinical setting. Social change will occur if

the coordinated efforts of those that are responsible for the knowledge that nursing

students receive in the clinical area, are directed toward providing training and clearly

defined roles for the clinical instructors who are entrusted with providing quality learning

experiences for students in the clinical setting.

Conclusion

Through data collection, and analysis, I discovered that professional development

for novice clinical instructors is greatly needed. According to the student questionnaire,

most of the student felt that they would make changes, if they could, concerning their

clinical experiences. The changes that were mentioned were directly related to the

responsibilities of the clinical instructor. All but one of the clinical instructor participants’

responses on the questionnaire reported that they did not have any introduction to their

role as clinical instructor before going to the clinical setting with students. The lack of

preparation for the role of clinical instructor had a direct influence on the clinical

experiences of the students that were assigned to that instructor. This project will aid the

novice clinical instructors by equipping them with the knowledge and tools necessary to

incorporate teaching and learning techniques in the clinical setting. Social change may be

achieved by presenting the research data to stakeholders so that they may understand how

important a workshop, that clearly defines the role of clinical instructor, is to the novice

clinical instructor and nursing students that are assigned to that instructor.

Section 4: Reflections and Conclusions

Introduction

This study project was developed to improve the clinical experiences of nursing

students by providing the training that is necessary for clinical instructors to be effective

facilitators of learning within the clinical setting. Data were collected using a qualitative

method. Based on the data that were collected, I decided the project should be in the form

of a professional development workshop that focused on preparing nurses, who are expert

clinicians, for the roll of adjunct clinical faculty. In this section, I will review the project’s

strengths and limitations, recommendations for alternative approaches, and possible

impact on social change. My perspective concerning scholarship, project development,

leadership and change, and my reflection on the importance of the work will also be

discussed. This section will also contain project implications, applications, and directions

for future research.

Project Strengths

The purpose of the study was to explore the experiences of nursing students under

the guidance of novice clinical instructors at a college in the Southeastern United States.

The qualitative data that were collected showed that most clinical instructors had no

structured introduction to their role as an educator. It was determined that professional

development, in the form of a 3-day training session, was necessary to provide a solid

foundation to facilitate learning when conducting clinical with nursing students. The

professional development will highlight the perceptions of nursing student participant

experiences, as well as the clinical instructors’ perceptions of how they performed in their

new role. Novice nursing faculty have found the transition from the clinical role to the

educator role as stressful with little guidance to help them adjust (Shoening,

2013).Therefore, this project may be the start of required orientation programs for newly

hired clinical faculty.

One of the strengths of the project is that the data that was collected confirmed

that a need exists for professional development for novice clinical faculty. Another

strength is that the data collected also identified specific areas of weakness that may be

developed by the full-time and more experienced clinical faculty to meet the needs of the

novice clinical instructor.

Project Limitations

Although this study and project was based on research findings, there are

limitations that exist. One of the greatest limitations of the study is the projected length of

the clinical faculty training. Specifically, the plan for this workshop is to be conducted

over a 3-day period, but due to work schedule conflicts, it is unrealistic that a clinical

adjunct will be able to attend the entire workshop. Since a great number of clinical

faculty are employed by colleges and universities on a part-time basis, and may be

employed full-time in a clinical setting, it may be difficult for adjunct faculty to attend 3

days’ worth of training sessions. This will require them to have to take time off of their

full-time jobs to attend training for a part-time commitment, which may result in a lack of

participation and a decrease in the number of clinical adjunct faculty as a whole if the

training will be mandatory. Both full-time and adjunct clinical faculty have time restraints

that will make on-site mentoring and orientation sessions difficult, which would warrant

an online orientation as an alternative (Fura & Symanski, 2014). Often times, colleges

and universities may recommend adjunct faculty attend a faculty meeting at least once

per semester, but it is not required because many have full-time employment with some

local healthcare organization

Another limitation to the project is the possible lack of buy-in from the faculty to

assist with the presentation of the training. Often times, it is difficult to initiate change

and have everyone agree that change is even necessary. The nursing faculty already have

a number of duties, other than teaching students, that may discourage them from wanting

to take on another initiative such as assisting with professional development training

sessions. Mentoring junior faculty and fulfilling traditional responsibilities of teaching

courses, adds to the faculty workload (Waldrop & Chase, 2014). If there is limited

acceptance of the need and development of the training by key stakeholders, there will be

very limited project effectiveness if the project is implemented.

Recommendations for Remediation of Limitations

The professional development time may be more flexible by using technology as

a training resource. Technology-based learning is on the increase and is perceived as an

excellent resource that offers flexibility (McColgan & Rice, 2012). Due to this fact, many

healthcare organizations use the computerized version of the American Heart

physical classroom training. I believe that the clinical instructor should be given the

option to attend a physical classroom setting or use technology for the content that will be

presented in the classroom, with the exception of the simulation and critique. Simulation

will enable the clinical instructors to apply what they have learned in the training session,

whether the training took place in the classroom setting or with the use of technology-

based learning, if the instructors are only able to attend the day that includes the use of

simulation, they will still gain a wealth of knowledge from the decision-making that is

displayed in the simulation presentation.

Scholarship

As a scholar, one of the things that intrigued me the most during the literature

search was that one of the many definitions of teaching described it as a scholarly

endeavor, especially in nursing education. The role of the faculty must continue to evolve

to meet the trends and needs of the population. Currently, the need to involve technology

in content delivery is a great challenge for many nursing programs. Electronic and

traditional methods may be used to facilitate student learning in the classroom and

clinical environments. Billings and Halstead (2012) felt that the heart of the faculty role

could be found in the scholarship of teaching. They suggested that it is most important

that the faculty has the ability to effectively communicate knowledge they possess to

students. This is the premise of the training for professional development for the novice

clinical faculty.

I have been very grateful for the insight that I received from the input of my

coworkers at my place of employment. I have also benefitted from the critique and

expertise of my committee chairperson and second committee chairperson. The multiple

submissions for IRB approval also greatly added to my learning experience throughout

this journey. I learned that clarity and incisiveness are the leading attributes when

wanting others to read and understand what I want to express through my writing.

Project Development and Evaluation

The purpose of the research was to analyze and seek a solution for the gap that

existed within my professional practice. After collecting and analyzing the data, I wanted

to share the information that I had discovered with stakeholders that include: full-time

nursing faculty, college administrators, part-time and full-time clinical instructors, and

nursing students. All nursing faculty, veteran or novice, would benefit from the data that

were obtained during the research process to create a better learning environment for

students in the clinical setting.

I had originally planned to conduct focus group interviews with nursing students

who had completed at least 1 semester of clinical, and face-to-face interviews with

clinical instructors that had less than 2 years of clinical instructor experience. I submitted

student and instructor invitations to three nursing programs that agreed to participate in

my research. The division chairpersons of each of the participating programs posted my

invitation electronically and physically in areas where nursing students and clinical

instructors frequent. I only had two student responses and two instructor responses after

the invitations had been available for 1 month. I brought my concerns to my committee

chairperson about the lack of participation. He helped me to realize that even though the

invitation mentioned that identities would be kept confidential, individuals still may not

have felt comfortable sharing their perspectives with me. He told me to consider another

method to gather data. I then decided to conduct separate anonymous electronic

questionnaires for students and clinical instructors.

Before I could employ the alternate method, I had to notify Walden University’s

IRB and submit a form that indicated the changes in my research process. After I got

approval for the change from the IRB, I asked the division chairpersons from each of the

three participating colleges to post another invitation letter for nursing students and

clinical instructors that included a web link to the anonymous survey. I broadened the

potential participants for clinical instructors by inviting all clinical instructor to

participate, instead of just those who had 2 years or less of clinical instructor experience.

If they had more than 2 years of clinical instructor experience, I asked them to reflect

back to their first two years of conducting clinical. I also broadened the potential

participants for nursing students by inviting all nursing students to participate as long as

they were 18 years of age and had completed at least 1 semester of clinical.

The final step in the data collection process was to review clinical experience

evaluations that had been completed by nursing students over a 5-year span. Data from

the anonymous electronic questionnaires of the students and clinical instructors and the

nursing student clinical experience evaluations for the past five years were triangulated as

a final step to assist me in deciding the project that would be most beneficial to address

what I discovered from the data.

The coding process, which involved reading and rereading the responses of the

instructor and student questionnaires, assisted me with identifying themes within the data.

From those themes and triangulation with the use the existing data of the nursing student

clinical experience evaluations, I determined that professional development, in the form

of a 3-day workshop, would be the most beneficial method to present teaching and

learning methods to novice clinical faculty. Even though the workshop will be geared

toward novice clinical instructors, experienced clinical instructors will also be

encouraged to attend so that they may stay abreast of the latest best practice methods as

well as take advantage of the continuing education units that will be offered for attending

and participating in the interactive learning activities.

Leadership and Change

I have become a leader among my colleagues in the work place. Because they

practice as nurses, they seek evidence to support the best-practice teaching and learning

techniques currently used. I have also led the way by being the first person in the history

of the nursing program to successfully obtain a doctorate degree at the completion of this

program. I was also successful with leading two others within my department to pursue

their doctoral degrees at Walden University.

In order for change to occur, someone must take the initiative to lead the way.

Throughout my doctoral journey, I was encouraged by some of my colleagues to share

what I was learning with them. I was elated to inform them about the data collection

process and what I discovered through data analysis. Billings and Halstead (2012)

believed that nursing is an evidence-based practice profession, which builds on the

knowledge generated by the scholarship of discovery. The process of coding the data

identified common themes within the participant responses that directed me to seek a

solution to the problem that existed with the majority of clinical instructors that worked

less than 2 years as clinical instructors. I will use that evidence to evoke change within

my department within my workplace.

Analysis of Self as Scholar

When I began my doctoral journey, I was oblivious to the amount of time and

commitment the entire process would take. Now that I am at the end of this journey, I

have discovered that I enjoyed the research process and I am actually looking forward to

the next research challenge within my professional practice. I also am confident that I

may effectively assist my colleagues who are pursuing their doctoral degrees by acting as

a peer reviewer if they desire my input concerning their research.

One of the challenges I faced as a scholar was using all of the critique and

recommendations of my work as learning experiences. I became frustrated with the

number of revisions I encountered during the process of submitting my work to the

Walden University IRB for approval. I was encouraged by the insight and support of my

committee chairperson, methodologist, and university research reviewer. I also repeatedly

encouraged myself to take each revision recommendation as a learning experience to

improve my writing. As I reviewed the revision recommendations, I realized that I

needed to clarify what I was writing so that others understood what my intentions were.

the amount of time that was put toward revisions ended up being a lot more than I had

anticipated in my semester plan. Another time factor was the time that was spent waiting

on potential participants to respond to my initial method of data collection. Through self-

reflection, I am able to understand that those occurrences were obstacles that I had to

overcome on this journey to reach my goal.

I am thankful that I was able to find a balance with my studies, work, and other

social obligations. During this journey, I had to learn to say no to individuals and turn

down invitations to events due to assignments and work deadlines. I found myself

actually sitting down and weighing the consequences of my actions if I chose one thing

over another. Of course, I had to meet my work obligations to maintain an income, but I

often did not attend social functions or participate in activities that I have deemed hobbies

because I chose to make my studies a high-ranking priority. My mentor constantly

reminded me that this journey was a temporary interval that was meant for me, which

would allow me to impact others for a lifetime. I am forever grateful for his stimulating

conversation and the invigorating confidence he had in me, even when I lacked

confidence in myself.

Analysis of Self as Practitioner

As a nurse educator, I realized that difficulties and gaps existed within my

professional practice, but I was unaware of the correct approach to implement change

within my organization. The professions of nursing and education are similar in that they

both rely heavily on the most current information to support best-practice methods in the

respective fields. My coursework has aided me in how to identify challenges and how to

search classic and current literature to discover what research has been conducted relative

to the identified challenges. The doctoral program coursework also served as a guide for

me to develop my own research project.

After I had chosen my research topic, I encountered other areas in my

professional practice that could be further developed and revised as a result of research. I

hope to conduct future studies to enhance student learning and best-practice methods for

instructors within the classroom and clinical setting. I am also interested in research to

identify the best nursing program entrance criteria to predict student success. The results

of that particular research would be very beneficial to the state’s effort to keep admission

policies and procedures standardized.

Analysis of Self as Project Developer

During the process of developing this project, I became very frustrated due to

some of the outcomes of my carefully thought-out plans. I experienced major setbacks

with slow responses to invitations to participate in the research, making changes to my

methodology, and unexpected major internal changes within one of the participating

institutions. There were times that I would ask myself if all of this stress and

disappointment that I was enduring was worth it? I would then think about why I chose

nursing education as a career. I often reminded myself that I was not only fulfilling a

personal goal, but I was possibly making positive changes to how clinical instructors

influence nursing students’ clinical experiences. I kept telling myself that, ultimately, my

greatest responsibility is to the student. It is my quest to make sure that they receive the

greatest clinical experiences within the clinical setting as they progress through the

nursing program.

The Project’s Potential Impact on Social Change

If nursing students are to have clinical experiences in environments that are