Clinical Practice for Novice Nursing Students : Shorter Clinical Day or Longer Clinical Day ?

Summary: Despite the importance of clinical education as an integral portion of nursing education, little literature exists studying the best length of a clinical day. The aim of this study was to identify a better length of a clinical day for novice nursing students for the best clinical learning outcome.

patient teaching /discharge teaching, insulin administration, dressing change, oral medication administration, and subcutaneous or intramuscular injections did not show significant differences but there was a trend of more opportunities to perform these skills in longer clinical days.Bed bath/general hygiene, linen change, passing trays, observing a specific procedure, and receiving a new admission did not show any difference.For benefits of two shorter clinical days per week stated by NSs, there were two major themes related to the two shorter consecutive days of clinical experiences: less anxiety on the second consecutive day, and ability to provide continuity of care when NSs had the same patients on the second day.For the benefits of longer clinical days, students' comments were more variable.Major themes that emerged focused on forming relationships with nursing staff and ability to see the progression of their patients' status.Students stated more opportunity to develop collegial relationships with nursing staff, aiding NSs to experience additional learning opportunities, and better able to observe transitions of patients' conditions over time.In addition, many students stated higher perceptions in their ability to provide more holistic care with enhanced opportunities to form relationship with patients and the family members.Overall, 26 out of 40 students recommended the longer clinical day during the first clinical rotation, three recommended the shorter clinical days, and 11 recommended a hybrid of both.Students reported that the benefit of a hybrid, or equally utilizing both, was providing students with a helpful transition from shorter days to longer days, as the clinical practices for the rest of the nursing program consist of only longer clinical days.

Discussion:
The study was conducted to investigate the differences in the exposure and application of skills content of clinical experiences comparing a shorter clinical day to a longer day among novice NSs.As hypothesized, the data analyses indicated that more skills were performed on longer clinical days and better relationships were developed with nursing staff, patients and their family members.Students were more concerned about holistic care for their patients during longer clinical days, whereas they were more focused on the skill performance on shorter clinical days.Considering the high anxiety levels of novice NSs in the first rotation, they expressed less fear and anxiety on the consecutive second clinical day.Anecdotal data indicated that the students and clinical faculty members supported a hybrid clinical schedule combining both shorter days at the beginning and longer days thereafter during the first clinical rotation.Clinical scheduling involves the availability of space in facilities that receive NSs.When there is an opportunity where hybrid clinical schedule may be permissible, it is recommended to first introduce novice NSs to two shorter days per week and provide an eventual transition to longer clinical practice as they gain more experience even within the first clinical rotation for better outcome of clinical learning.Despite the importance of clinical education as an integral portion of nursing education, little literature exists studying the best length of a clinical day.The aim of this study was to identify a better length of a clinical day for novice nursing students for the best clinical learning outcome.

Purposes of the study
To identify effects of different length of clinical hours on novice nursing students (NSs)' learning outcome in acquiring nursing skills.
To identify effects of different length of clinical hours on novice NSs' learning outcome in developing relationships with nursing staff and patients.

Results
Skills that were performed significantly more on longer clinical days: glucometer use, taking input and output, and performing physical assessments (P=0.014,0.015, 0.043, respectively) Patient teaching /discharge teaching, insulin administration, dressing change, oral medication administration, and subcutaneous or intramuscular injections showed trends of more opportunities in longer clinical days.
Bed bath/general hygiene, linen change, passing trays, observing a specific procedure, and receiving a new admission did not show any difference.
The benefits of two shorter clinical days per week stated by NSs: less anxiety on the second consecutive day, and ability to provide continuity of care when NSs had the same patients on the second day.
The benefits of longer clinical days: ability to form relationships with nursing staff aiding NSs to experience additional learning opportunities, and ability to observe transitions of patients' conditions over time.

Students' other comments:
Higher perceptions in their ability to provide more holistic care with enhanced opportunities to form relationship with patients and the family members in longer clinical days.
The benefit of a hybrid, or equally utilizing both, was providing students with a helpful transition from shorter days to longer days, as the clinical practices for the rest of the nursing program consist of only longer clinical days.
Students' recommendations: 26 out of 40 students recommended the longer clinical day during the first clinical rotation, 3 recommended the shorter clinical days, and 11 recommended a hybrid of both.

Discussion
More skills were performed on longer clinical days and better relationships were developed with nursing staff, patients and their family members.
Students were more concerned about holistic care for their patients during longer clinical days, whereas they were more focused on the skill performance on shorter clinical days.
Students expressed less fear and anxiety on the consecutive second clinical day.
Recommendation: to first introduce novice NSs to two shorter days per week and provide an eventual transition to longer clinical practice as they gain more experience even within the first clinical rotation for better outcome of clinical learning.

Primary Presenting Author
Practice for Novice Nursing Students: Shorter Clinical Day or Longer Clinical Day? Keywords: Length of clinical days, Novice nursing students and Skill performance Tobar, K., Wall, D., Parsh, B., & Sampson, J. (2007).Use of 12-hour clinical shifts in nursing education: Faculty, staff, and student response.Nurse Educator, 32(5), 190-191.Wallace, L., Bourke, M. P., Tormoehlen, L. J., & Poe-Greskamp, M. V. (2015).Perceptions of Clinical Stress in Baccalaureate Nursing Students.International Journal Of Nursing Education Scholarship, 12(1), 1-8.doi:10.1515/ijnes-2014-0056Abstract Summary: : Forty novice NSs in BSN program in their first clinical rotation.The composition of the clinical days during the first rotation: Two 6-hour clinical days per week for three weeks, then one 8.5-hour clinical day per week for the following five weeks, excluding pre and post conferences.Quantitative data collection: Number and types of skills performed per each clinical day by 40 NSs Qualitative data collection: Students' perceptions of benefits for shorter clinical days and longer clinical days (Faculty) September 2009-Present.Associate Professor, Department of Nursing, Biola University.Teaching areas: 1. Theory teaching: Adult medical/surgical nursing, focusing on immunology-related diseases and oncology care.Pharmacology theory on oncology, infection, inflammation and women's health.Introduction to Nursing Research and Applied Research.Introduction to immunology as a guest lecturer for Dept. of Biology.2.Clinical teaching: For students in first and second clinical rotations for adult medical surgical and oncology nursing.(Research in mucosal immunology) September 2001-July 2008.Post-doctoral research fellow, Smith-McCune Laboratory, UCSF Cancer Research Institute.Research area: Mucosal immunity in cervical dysplasia and cancer: To characterize local mucosal immune response to HPV in high-grade cervical dysplasia and cervical squamous carcinoma.Author Summary: She received her Ph.D. in nursing from University of California, San Francisco in 2001 and has been teaching both theory and clinical nursing for novice students, as well as nursing research to senior students in BSN program since 2009.Recently she has been studying on various aspects of clinical education for novice nursing students for their better clinical learning outcomes.Biola University Associate Professor of Nursing Implement College's philosophy, curriculum, program outcomes and course objectives through didactic and clinical instruction providing an educational experience leading to student credentials and gains in nursing positions of employment as baccalaureate prepared nurse.Clinical instruction for first clinical semester students, physical assessment and obstetric nursing.2013 Biola University La Mirada, CA Obstetrical/Woman's Health Clinical Instructor Author Summary: She is an Associate Professor of Nursing at Biola University.Professional experience includes practice in two specialty areas: Critical Care and Women's Health as well as providing patient care as a Family Nurse Practitioner.As a nurse educator, she is passionate about assisting students to discover new knowledge.Her areas of interest and research include promoting best pedagogical practices in the clinical arena, mentorship, first-generation scholar success and advocacy for those with disabilities.