At a "catch-up lunch," my former student, now colleague, and I reminisced about the differences in our student clinical education experiences in university-based nursing programs 50 years apart. I asked about her "best and worst" student clinical experiences, hoping that she might shed light on how to improve the current system. The best experiences occurred for both of us in psychiatric/behavioral health facilities and home health/public health practice where mentors emerged and cheered us on. Many of our negative experiences were also comparable; "being turned lose on patients without much prep or background knowledge," and "lack of communication between the academic clinical instructor and the staff." My colleague's most disturbing experience occurred in a facility where nursing staff encouraged students to practice skills on patients who were too confused or unaware to object. This denigration of the patients' dignity was shocking and was best expressed with my colleague's assertion, "The patient is not a mannequin!" (personal communication with Victoria Daughen, MS, BSN, RN).
The evolution of nursing education in the United States is at a pivotal point. US hospitals adopted the Nightingale system of nursing education and maintained exclusive control of both didactic and clinical education for the first half of the 20th century. Nursing students learned and worked in hospital schools. In some cases, they worked without compensation in addition to being students until Boards of Nursing created regulation around the work issue. In the early 1900s, there were calls to move nursing education into the mainstream of higher education. By the 1950s and beyond, nursing education moved steadily from hospital control to academic control in universities, colleges, and community colleges. Affiliation agreements between academic nursing programs and practice agencies now specify the terms of student clinical practice including, for example, the units where students would practice, academic faculty to student supervision ratios, health requirements such as immunizations, and privacy and indemnification issues. The nature and quality of the clinical experience fall to the creativity and dedication of the academic clinical faculty and the interest of the unit staff in educating students. Most often there is no overall design, jointly crafted by academic and practice partners.
It is time to redesign clinical nursing education through which students develop and hone nursing skills in real practice time under the purposive and collaborative guidance of academic instructors and agency staff. Collaborative clinical education will result not only in person-centered, holistic care with great clinical outcomes but also in creating a new generation of nurses with an unsurpassed readiness to practice upon graduation and a deeper understanding of the term "quality nursing care."
-Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor in Chief