1. Chappell, Kathy PhD, RN, FAAN, FNAP


Creating a safe and supportive clinical learning environment where students can learn collaboratively with each other and with practicing healthcare providers is the responsibility of Magnet(R) leaders. In this month's Magnet Perspectives, the Vice President of the ANCC Accreditation Program and Institute for Credentialing Research discusses the imperative for interprofessional learning environments.


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Healthcare students from all professions learn skills required to provide safe, high-quality patient care within Magnet(R) organizations. The clinical learning environment can be defined as "an environment in which any person who has the opportunity to influence the care of a patient learns" (National Collaborative for Improving the Clinical Learning Environment [unpublished work]; 2015). This definition encompasses the entire professional healthcare education continuum, from students in prelicensure programs to practicing clinicians participating in continuing professional development activities. It also implies that everyone who works, volunteers, supports, or receives care in a Magnet organization is accountable for creating and fostering the learning environment.

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Defining responsibility for learning creates opportunities and challenges for Magnet leaders. It requires members of different healthcare professions to work collaboratively rather than remain siloed within a single profession's educational model. This may require Magnet leaders to challenge conventional systems of training healthcare students in profession-centric rotations and create new opportunities for shared learning experiences in classroom settings, simulation, and clinical practice.


A clinical learning environment requires Magnet leaders to engage with individuals who may not traditionally be included in discussions about healthcare professional education, such as environmental services, transport, volunteers, and administrative or clerical staff. Although not formally licensed healthcare professionals, members of support professions can provide critical insight into processes and experiences that those in clinical practice might otherwise miss. This shared responsibility provides an opportunity for creating a collaborative learning environment.


Learning environments require that Magnet leaders strive to incorporate the patient and family as members of the healthcare team. The patient, as able, and the patient's family need to be responsible for supporting a learning environment and be accountable for their own learning needs. It is important that Magnet leaders encourage the patient and family to question, provide input, and participate in care without feeling that they are threatening or bothering healthcare providers. It also requires that Magnet leaders ensure patient education materials are at an appropriate reading level and provided in a language patients can understand, that patients and families are encouraged to take an active role in identifying and seeking out resources to meet their learning needs, and that patients and their families participate in care decisions. Learning opportunities created through mutual and shared understanding between healthcare providers and patients/families help foster trust, dignity, and respect.


Defining responsibility also requires that Magnet leaders develop close relationships with their academic partners. Leaders in both settings must be committed to collaborating. Healthcare students must be prepared to enter into the clinical setting with foundational skills that will continue to be developed and refined by preceptors and mentors. The healthcare system must be prepared to accept new graduates in a manner that fosters learning in a nonpunitive, supportive, enriching learning environment. Healthcare students enter academic programs with preconceived images of how members of that profession are perceived.1 It is important that these preconceptions, which can result in perceived professional hierarchies, do not hinder collaborative learning.


Historically, the process of transitioning from academia to clinical practice has been extremely stressful regardless of healthcare profession or site. In 1974, Marlene Kramer2 described the challenges that new graduate nurses experienced and wrote the seminal publication "Reality Shock: Why Nurses Leave Nursing." The Institute of Medicine's Future of Nursing report published in 2010 highlighted the challenges faced by new graduate nurses today.3 Within the medical profession, numerous authors have described the intensely competitive environment of medical school and residency, with associated negative consequences of high levels of stress, anxiety, and even suicide.4 Students in other healthcare professions, including physical therapy, occupational therapy, pharmacy, and social work, may experience similar stressors. In the best-case scenarios, healthcare students survive the transition into practice and become proficient healthcare providers, and patients are not harmed. In the worst-case scenarios, healthcare students never successfully make the transition and leave the profession altogether, or patient errors occur.


An environment that is not conducive to learning and collaboration can be dangerous or even deadly for patients. Quarterly, The Joint Commission publishes root causes of sentinel events. Communication, leadership, and human factors accounted for 3 of the top 4 root causes of sentinel events from 2004 to the present.5 A collaborative environment that supports clear communication, collaboration, and learning can help address some of the root causes and ultimately promote more positive patient outcomes.


The American Nurses Credentialing Center recently joined the National Collaborative for Improving the Clinical Learning Environment, a forum of organizations committed to improving the educational experience and patient outcomes within clinical learning environments. The National Collaborative for Improving the Clinical Learning Environment seeks to improve the quality of learning and patient care within clinical learning environments through shared learning and collaborative practice among its member organizations. Goals include:


* encouraging a national discussion to advance the quality of educational outcomes within the clinical learning environment in healthcare settings,


* increasing educational opportunities among organizations that are focused on improving the quality of learning and patient care in clinical learning environments,


* promoting interprofessional (both clinical and administrative) conversations across organizations on innovative strategies that enhance the quality of learning in clinical environments,


* seeking new, generalizable knowledge on successful strategies for enhancing educational experiences in clinical learning environments, and


* developing and disseminating common definitions, guiding principles, and best practices in support of improving learning within clinical environments (National Collaborative for Improving the Clinical Learning Environment [unpublished work]; 2015).



Magnet-credentialed organizations are industry leaders and innovators of exemplary practice and outstanding patient outcomes. Leaders of Magnet organizations have the skills and abilities to create new clinical learning environments that support a new generation of healthcare practitioners and the lifelong learning needs of those currently in practice.




1. Delunas LR, Rouse S. Nursing and medical student attitudes about communication and collaboration before and after an interprofessional education experience. Nurs Educ Perspect. 2014; 35( 2): 100-105. [Context Link]


2. Kramer M. Reality Shock: Why Nurses Leave Nursing. St. Louis, MO: C. V. Mosby Company; 1974. [Context Link]


3. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2010 Accessed October 4, 2015. [Context Link]


4. Goldman ML, Shah RN, Bernstein CA. Depression and suicide among physician trainees: recommendations for a national response. JAMA Psychiatry. 2015; 72( 5): 411-412. [Context Link]


5. The Joint Commission, Sentinel Event Data, Event Type by Year. Accessed October 5, 2015. [Context Link]