How to spell relief for the nursing shortage: S-T-U-D-E-N-T-S

Howard, Valerie Bender

Win them over now and you’ll be more likely to reap future rewards.

As nursing instructors in a teaching hospital, we have extensive experience with nursing students in the clinical setting. A positive clinical environment certainly enriches learning, but it can also aid recruitment efforts: Students with fond memories of a particular setting are more likely to return as graduate nurses.

For this reason, our nursing school and medical center conducted a project to investigate students’ clinical practice experiences. Students and staff nurses who participated identified problems and suggested improvements. In this article, we’ll share some of their quotes, then we’ll spell out how nursing instructors, nurse-managers, staff nurses, and students can create a more supportive clinical setting for everyone. (For an overview, see How to Put a Positive Spin on Clinical Rotations.)

Focus on the positives

From the moment we walked into the unit, the staff nurses would say, “Leave while you can! Get out of nursing now!” Of course, their managers and our instructor never heard this!

-Junior nursing students

After reading this, I asked a group of students, “Who might be interested in working in this unit after graduation?” Dead silence. Besides having a negative impact on the learning environment, such comments make nurses look unprofessional and might impede recruitment. Practicing nurses need to understand the consequences of their remarks, and instructors must work with students to defuse their risk of encountering negative attitudes. Here’s how each group can help:

Nurse-managers should try to schedule staff nurses who are receptive to teaching on days students will be in the unit. Encourage all staff to focus on the “pros” of nursing and the unit and to address the “cons” constructively.

Nursing instructors can use interactive techniques at clinical postconferences to help students understand negative clinical experiences. For example, role-playing and values clarification can heighten their awareness of the nursing shortage and how it impacts staff morale and behavior. With the instructor playing the “overworked staff nurse,” students can practice confronting negative comments.

Students can help by learning therapeutic communication techniques to defuse negative behaviors. For example, “You seem very busy. Can I do anything to help you?” Just as we expect positive and professional behaviors from staff nurses, expect positive and professional behaviors from students too.

Focus on learning

When students are in the unit, we get overwhelmed with the number of questions they ask. Sure, we can be a resource, but the clinical instructor should be able and available to answer these questions.

-Medical/surgical nurses

A thorough orientation for the nursing faculty and students helps decrease the number of questions students ask staff during clinical rotations. Besides being knowledgeable and current on nursing skills, instructors have an obligation to know the unit. With a good understanding of the unit and its procedures, instructors should be the primary source of information for the students.

Nursing students need to be aware of the many responsibilities staff nurses have and to prioritize their own needs accordingly. Instructors should encourage self-motivated, independent learning and give students resources to find answers on their own. Only when a student can’t find an answer and the clinical instructor isn’t available should the student approach a staff nurse with a question.

Maybe the nursing instructor and students could do some educational presentations for the unit. We’d love to have updates on new medications, procedures, and so forth.

-Medical/surgical nurse

Encouraging student presentations for staff nurses is a great way to foster a collaborative relationship between school and practice. Some instructors grade postconference presentations and projects and invite staff nurses to attend. Others assign students to do poster presentations and leave the posters in the unit for staff to review at their convenience.

On the flip side, unit managers and staff nurses can enhance learning in several ways, such as inviting students to training and continuing-education programs or to observe interesting procedures in the unit. If you’re a staff nurse, explain rationales and techniques for specific interventions and ask the students critical thinking questions throughout the shift. Share your knowledge and experiences with them and never assume that they already know something.

Focus on communication

I had no idea what was going on with the student’s patient for the entire shift! I received no updates and had to search for the patients medication administration record each time he requested a p.r.n. med.

-Medical/surgical nurse

If they had told us we shouldn’t sit in the unit secretary’s seat or use that phone to call the pharmacy, we wouldn’t have done it!

-Sophomore nursing student

Good communication among instructors, students, and staff is integral to a supportive learning environment. Instructors need to communicate unit procedures to the students and student expectations to the nurses. One instructor reminds the nurses that a student will be administering a patient’s medications by placing a note on his medication administration record. This minimizes the risk of administering duplicate medications.

Because ultimate responsibility for the patient lies with the nurse, students should independently communicate their assessments, interventions, and evaluations to the staff nurses, and clinical instructors should make sure they do. Instructors can also encourage students to assist in the unit as needed once they’ve attended to their own patient’s needs. Students can assume such tasks as answering call bells and feeding patients so long as they’re meeting their own clinical learning objectives.

Staff nurses can be role models for professional behavior and communication techniques. Speaking professionally to other members of the health care team demonstrates effective communication. Other positive techniques include giving students and instructors patient updates and discussing new orders, procedures, and diagnostic test results. Students are eager to apply classroom learning to clinical experiences, and applying this knowledge reinforces key concepts.

The payoff

Viewing each nursing student as a potential new hire upon graduation is a great motivator to foster learning, express your opinions about the art of nursing with students, and remain an advocate for the nursing profession. With memories of a positive clinical experience, those students may be eager to return. The better you educate them today, the better your chance of recruiting quality graduate nurses tomorrow.


American Association of Colleges of Nursing


National League for Nursing


Sigma Theta Tau International Honor Society of Nursing


Last accessed on August 5, 2004.


Jackson, D., and Mannix, J.: “Clinical Nurses as Teachers: Insights from Students of Nursing in Their First Semester of Study,” Journal of Clinical Nursing. 10(2):270-277, March 2001.

Mamchur, C., and Myrick, F: “Preceptorship and Interpersonal Conflict: A Multidisciplinary Study,” Journal of Advanced Nursing. 43(2):188-196, July 2003.

By Valerie Bender Howard, RN, MSN, and Frederick J. Tasota, RN, MSN

Valerie Bender Howard is a clinical assistant professor of nursing at Robert Morris University in Moon Township, Pa., and Frederick J. Tasota is a research project director in the department of acute and tertiary care at the University of Pittsburgh (Pa.) School of Nursing.

Copyright Springhouse Corporation Sep 2004

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