A graduate nursing student recently observed that teaching in the clinical environment has not changed since her undergraduate days. Although I have not taught in the clinical setting for at least seven years, I reflected on how I did teach students and had to admit that the strategies I used mimicked those of my prelicensure education - despite immense changes in the practice of nursing. I asked myself: Why are we still teaching clinical the same way it was taught so many years ago?
The COVID-19 pandemic changed the landscape of clinical learning with the explosion of virtual simulated learning experiences since the very start. Furthermore, frontline nurses who worked through the first wave of the pandemic have recommended that nursing education programs focus on the formation of future nurses as critical thinkers, effective team members, and leaders who can adapt quickly to changing times (Badowski et al., 2021). Nursing students need to learn to use their voices to improve health care and address social determinants of health through public health and policy development. The recommendations in the Future of Nursing 2020-2030 report (National Academy of Medicine, 2021) echo the voices of our frontline nurses. They further stress that nurse educators must increase clinical learning experiences within community and public health settings, including telehealth and disaster preparedness. Also, they emphasize that learning in these settings must be inclusive and acknowledge and challenge racism.
Shifting the focus of clinical education to community or public health will not eliminate the need for acute care practice experiences in nursing education. These experiences will continue to be important and must be retained. However, even prior to the pandemic, health care institutions began limiting the size of clinical groups, and this trend has continued. Some health care institutions restrict student access to the electronic health record, and there are some that do not allow medication administration. As nurse educators, we must rethink the teaching strategies we use to overcome the barriers and landscape changes within the acute care setting. Simulation is one evidence-based solution we currently use, but it cannot be a complete substitute for clinical practice. We must acknowledge that the continued use of traditional methods in clinical education may not prepare our students with the knowledge, skills, and attitudes needed to address social determinants of health and racism in health care.
Nursing education has a strong body of scientific knowledge to support our practice. However, two recent systematic reviews by Leighton et al. (2021, 2022) found no quality quantitative or qualitative studies demonstrating the effectiveness of clinical learning other than improved student self-perceived self-confidence. We cannot say with certainty that our current manner of teaching in clinical works. The landmark study by Hayden et al. (2014) showed us that simulation is as effective as clinical learning when up to 50 percent of clinical is substituted with high-quality simulation. However, despite an abundance of scholarly work on simulation innovations and research in nursing education, there is a dearth of research on innovative strategies within acute care, community, and public health clinical settings. Technically, our current clinical practice is not broken, but we need evidence on student learning outcomes.
There is no better time than today for nursing faculty to reimagine clinical education. We need innovative teaching strategies within the acute care setting, and nurse educators need to take students beyond the walls of acute care into community and public health settings. Equally important is the integration of social determinants of health and the breakdown of discrimination within clinical settings to equip our students with the knowledge, skills, and attitudes needed for current developments in health care. I am confident there are nurse educators already implementing innovations or curriculum revisions that focus on these needed changes.
The Innovations Center section of Nursing Education Perspectives is an excellent platform to communicate your strategies to be replicated by others. However, the dissemination of innovation is not enough. Nursing education is in need of quality research studies that examine the impact of these innovations on student learning outcomes beyond self-perceptions of learning. These research articles can be submitted to Nursing Education Perspectives as full-length articles or as research briefs. Also, note that Clinical Education in Academic Learning Environments is the theme for the special NLN Summit issue for 2025. It is time to plan your research.
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