Development and psychometric testing of the Clinical Learning Organisational Culture Survey (CLOCS)

The clinical learning environment, supervision and future intention to work as a nurse in nursing students: a cross-sectional and descriptive study

BACKGROUND

Clinical practice is a core component of nurse education. It is believed that nursing students' clinical placement experiences can affect their learning outcomes, satisfaction, as well as influence their choice of future career. To examine nursing students' perception of clinical learning environment and mentoring in hospital where they perform their clinical placement and the connection of these factor with intention to work as a nurse once graduated.

METHODS

Nursing students enrolled in clinical practice at least 6 months in hospitals in China were surveyed between January-March 2021. Percentages, frequencies, mean, standard deviation, t-test, ANOVA, and regression analysis were used to analyse the data.

RESULTS

Of the five scales in the CLES+T, 'Leadership style of the ward manager' scored the highest mean while 'Pedagogical atmosphere at the ward' scored the lowest. Nursing students with lower educational level, those supervised by fixed preceptor, and those intent to be a nurse in the future were significantly more satisfied with the CLES+T. Most of the nursing students are intent to work as a nurse in the future. CLES+T total scores and sub-dimensions (Premises of nursing on the ward) have significantly effectiveness on the intention to be a nurse in the future.

CONCLUSIONS

Given the significant correlation of between learning environments and nursing students intention to be a nurse in the future, ward managers need to build a good clinical teaching atmosphere and promote opportunities for theoretical and practical connections among students through effective feedback mechanisms, which can enable students to experience a better clinical learning environment and meaningful experiences to build their professional roles and competencies, thus helping to enhance students' willingness to pursue nursing careers in the future.

Developmental stages associated with organizational learning in hospitals: An instrument development study

AIM

To develop and test the Organizational Learning Instrument: Development Stages instrument, a measure of hospital units' readiness to engage in organizational learning.

DESIGN

Cognitive interviewing, expert review and a quantitative, cross-sectional survey.

METHODS

Item development was informed by previous research on organizational learning. Content validity was assessed and strengthened using cycles of cognitive interviewing and expert review. The resulting instrument was distributed by email to all nurses providing direct patient care in inpatient units in 11 Magnet® hospitals. Data were collected in 2018. Intraclass correlations, using hospital unit as the grouping variable, indicated the need to use multilevel methods to analyse the survey data. Thus, coefficient omega and multilevel confirmatory factor analysis were used to estimate the instrument's reliability and construct validity, respectively.

RESULTS

The Organizational Learning Instrument: Development Stages is a 35-item survey comprised of four scales: Identity & Ownership, Team & Respect, Accountability & Support and Reliability & Sustainability. The expert review yielded scale-level content validity scores from 0.90 to 1.0 and item-level content validity scores from 0.86 to 1.0. Survey participants were 1212 nurses, working in 99 inpatient units, across 11 Magnet® hospitals. Intraclass correlations ranged from 0.113 to 0.158. Coefficient omega reliability for the four scales was 0.981-0.993. Standardized factor loadings for the 35 items were 0.699-0.961, with acceptable model fit statistics (comparative fit index = 0.980, Tucker-Lewis Fit Index = 0.979, and root mean squared error of approximation = 0.060).

CONCLUSIONS

These results indicate the instrument meets or exceeds generally accepted criteria for content validity, reliability and construct validity instrument, and is suitable for further use and testing.

IMPACT

Nurse administrators, managers and researchers now have a valid, reliable instrument to better foster and study organizational learning in hospital units. Advances in organizational learning are expected to improve a variety of patient, staff and organizational outcomes in hospital units.

Graduate Nurse Transition Programs Pivotal Point of Participants' Practice Readiness Questioned During the COVID-19 Pandemic Crisis: A Scoping Review

BACKGROUND

The COVID-19 pandemic requires an accessible, practice-ready nursing workforce to assist with the increase in health service delivery. Graduate nurse transition programs are the entry point for most graduates into professional practice, and this review focused on both empirical studies and gray literature to identify at what point practice readiness occurs and what can assist graduate nurses' transition to become practice ready.

METHOD

A scoping review was conducted using the Joanna Briggs Institute scoping review framework.

RESULTS

Consensus purports supportive environments, ideally in formal structured graduate transition to practice programs, to enhance graduate nurses' clinical skills and confidence development. With nursing confidence and competence gained through professional practice experience, it is apparent that for a sustainable nursing workforce, greater access for graduating nurses to transition programs is imperative.

CONCLUSION

Recommendations include restructuring transition programs with possible time reductions, limited rotations, comprehensive orientations inclusive of preceptorship, and dedicated educators to increase and enhance supportive graduate nurse transitions. [J Contin Educ Nurs. 2021;52(8):392-396.].

Systematic review of tools to measure preceptors' perceptions of their role in undergraduate health clinical education

OBJECTIVE

Evaluate tools used to measure preceptors' perceptions of their role in the clinical education of health undergraduate students.

BACKGROUND

Measurement of preceptors' perceptions of their role in students' learning in practice lacks consistency. The preceptor role makes an important contribution to quality clinical education.

DESIGN

A systematic literature review informed by PRISMA Guidelines.

DATA SOURCES

Major databases CINAHL, ProQuest, Nursing and Allied Health, Medline, Health Reference Centre, Joanna Briggs Institute, PsychInfo and Google Scholar were searched.

REVIEW METHODS

The search strategy yielded a total of 166 papers. Screening for inclusion resulted in 28 papers for critical appraisal and review.

RESULTS

Twenty-two individual tools were identified. Fourteen were named. Nine tools were new, study-specific and untitled. Eight tools were informed by previous research. A third of studies were appraised as being of good quality. A lack of consistency in measures, use of small convenience samples and reliance on self-reported outcomes limited the generalisability of findings.

CONCLUSIONS

Two tools were suitable measures of preceptors' perceptions of their role or an appropriate measure for preceptor effectiveness in students' learning in practice. These tools were tested on the nursing profession only. Ensuring quality in clinical education requires consideration of experiences of key stakeholders and standard measurement of perspectives, effectiveness and preparedness to achieve quality clinical learning outcomes for students.

Nursing and Midwifery Students' Satisfaction with Their Clinical Rotation Experience: The Role of the Clinical Learning Environment

BACKGROUND

The clinical learning environment and clinical rotation experience of students are integral to nursing curriculum and are a crucial component of nursing education which helps transform theoretical knowledge to clinical practical skills.

OBJECTIVE

This study was aimed at assessing the role of the clinical learning environment on undergraduate nursing and midwifery students' satisfaction with their clinical rotation experience.

METHOD

The study employed a quantitative cross-sectional survey design. Data was collected from a sample of 240 undergraduate nursing and midwifery students of the University for Development Studies, Tamale, Ghana, using a structured questionnaire. Ethical approval was obtained from the University of Cape Coast Ethics Review Board. Descriptive analysis was displayed as frequencies and percentages. Inferentially, Fisher's exact test, linear regression, and Spearman's correlation tests were used to test for and quantify associations between independent and dependent variables at p ≤ 0.05.

RESULTS

The level of students' satisfaction with both clinical rotation experience and the clinical learning environment was high (65.6% and 63.5%, respectively). A statistically significant association of the students' satisfaction with their clinical rotation experience was found. There was a statistically significant relationship between the clinical learning environment (χ 2 (9, N = 224) = 80.665, p < 0.001), pedagogical atmosphere in the clinical area (r s  = 0.379, p < 0.001), the leadership style of the ward manager (r s  = 0.340, p < 0.001), the premises of nursing in the ward environment (r s  = 0.501, p < 0.001), and the students' satisfaction with their clinical rotation experience.

CONCLUSION

These findings provide nurse educators and clinicians with meaningful understanding about areas to prioritise when planning clinical learning opportunities in such a way that skills learning and practice of nursing skills are successful and satisfactory for undergraduate student nurses and midwives.

Student nurses' perceptions of their educational environment at a school of nursing in Western Cape province, South Africa: A cross-sectional study

Background

Educational environments have been found to bear a substantial relationship with the academic performance and success, as well as the retention, of students.

Objectives

The study objectives were to (1) evaluate the educational environment as perceived by undergraduate nursing students at a school of nursing (SON) in Western Cape province and (2) investigate whether the educational environment, or components thereof, is perceived negatively or positively among undergraduate nursing students of different year level, gender, home language and ethnicity.

Method

A quantitative research method with a cross-sectional design was implemented. Data were collected from 232 undergraduate nursing students from a SON at a university in Western Cape province, South Africa. The subscales and the items of the educational environment questionnaire were compared among undergraduate nursing students. Data were analysed by means of the IBM Statistical Package for Social Sciences (IBM SPSS-24) using analysis of variances (ANOVAs), independent-sample t-tests, mean scores, standard deviations and percentages.

Results

The mean score attained for the entire participant group was 195 (standard deviation [SD] = 24.2) out of 268 (equivalent to 72.8% of maximum score), which indicated that the educational environment was perceived substantially more positively than negatively. The overall mean score was significantly higher (p < 0.05) for male students (M = 202; SD = 21) and for black students (M = 202; SD = 21). The digital resources (DR) subscale was the only subscale with a statement or item that was rated as absolute negative (M = 1.9; SD = 0.9).

Conclusion

The educational environment at the institution concerned was perceived as predominantly positive by its undergraduate nursing students. Although the educational environment was predominantly perceived as positive, the results of this study also indicated that enhancements are required to improve the physical classroom conditions, skills laboratories, DR and the implemented teaching and learning strategies. It is vital for university management to prioritise the creation of an educational environment which would ensure that quality learning takes place.

Keywords

student’s perceptions; educational environment; nursing education; Western Cape; South Africa.

Translation and validation of a Vietnamese version of the modified Clinical Learning Environment Inventory (V-CLEI)

The quality of students' experiences in an education environment directly affect learning outcomes. In an applied profession such as nursing, students undertake work-integrated learning in unpredictable health settings where multiple influences interact. Understanding students' perspectives with a valid instrument is the first step in improving learning environments and maximizing learning outcomes. It is important that language and cultural nuances are accounted for when instruments are translated. This paper reports translation and psychometric properties of the Vietnamese language version (V-CLEI) of the modified English language Clinical Learning Environment Inventory (CLEI) (Newton et al., 2010). The V-CLEI was tested with a convenience sample of 209 Vietnamese nursing students to assess clinical learning experiences in hospitals in central Vietnam. The internal consistency, test-retest reliability, content validity and factor structure of the V-CLEI were examined. Results indicate that the V-CLEI is unlikely to be valid and reliable in the Vietnamese context and revision is required. This study informs research, particularly the different cultural dimensions considered when translating and adapting instruments.

Development and initial validation of the interprofessional team learning profiling questionnaire

Informal workplace interprofessional learning occurs as health professionals interact with each other as part of everyday work practice. Participation in interprofessional team meetings is a practical way to foster learning. However, a gap exists in the availability of a reliable and valid instrument that adequately captures the nuances of informal workplace interprofessional learning in this setting. The purpose of this study was to develop a questionnaire to measure the different components of interprofessional learning that contribute to the quality of interprofessional learning within the interprofessional team meeting. Questionnaire items were developed from a review of the literature and interviews with health professionals. Exploratory factor analysis was used to determine the underlying factor structure. Two hundred and eighty-five health professionals completed a 98-item questionnaire. After elimination of unreliable items, the remaining items (n = 41) loaded onto four factors named personal and professional capacity; turning words into action-"walk the talk"; the rhetoric of interprofessional learning-"talk the talk"; and inclusiveness. Internal consistency was high for all sub-scales (Cronbach's alpha 0.91, 0.87, 0.83, and 0.83, respectively). Content, construct, and concurrent validity were assessed. The instrument developed in this study indicated consistency and robust psychometric properties. Future studies that further test the psychometric properties of the questionnaire will help to establish the usefulness of this measure in establishing evidence for the perceived effectiveness of interprofessional learning in a healthcare setting.

Identifying Barriers and Enablers as a First Step in the Implementation of a Midwife-Led Psychoeducation Counseling Framework for Women Fearful of Birth

BACKGROUND:Around 20% of women report high levels of childbirth fear. An evidence-based psychoeducation intervention delivered by midwives reduced maternal childbirth fear and increased confidence for birth. Implementation of the intervention into practice is now required. Translating evidence into practice, however, remains challenging.

AIM:This study aimed to explore organizational factors, including barriers and possible solutions that may impact on the successful application of the midwife psychoeducation intervention in practice.

METHODS:Mixed methods data collection included a self-administered survey (n= 62), clinician-led focus groups (n= 28), and interviews with key stakeholders (n= 5). Simple descriptive statistics were used to analyze the quantitative data. Latent content analysis was used to analyze the qualitative data.

RESULTS:Midwives were perceived to be best placed to deliver psychoeducation to women fearful of birth. Support for normal birth was high. There was, however, disparity between positive attitudes toward evidence-based practice in theory and its clinical application. Similarly, although the workplace learning culture was generally assessed as positive, many participants believed changing practice was difficult and reported a low sense of agency for challenging or facilitating change. Participants reported that barriers to implementing the evidence included time constraints and heavy workloads. There was a lack of awareness and confidence to implement evidence-based practice (EBP) with participants identifying that resistance to change was often the result of clinician fear and self-interest. The way services were routinely structured was considered problematic as fragmentation actively worked against midwives forming meaningful relationships with women. Enablers included organizational support, education, local champions, and continuity of midwifery care.

CONCLUSION:The study identified the clinicians’ readiness, barriers, and possible solutions to the widespread implementation of an evidence-based psychoeducation intervention delivered by midwives for women fearful of birth at one maternity facility in South East Queensland, Australia. Many of the identified barriers were commensurate with the international literature on translating evidence into practice.

Evaluating, understanding and improving the quality of clinical placements for undergraduate nurses: A practice development approach

Supervision and support is central to sustainability of clinical placement experiences of undergraduate nurses, but open to influences that impact nurses' capacity to undertake the role. Whilst supervision of learners is integral to the role of health care professionals, the primary responsibility is to deliver safe and effective care. Supervision of learners in practice is impacted by low levels of organisational support, variable individual preparedness, and lack of feedback and recognition for the role from education and industry partners. Over a period of five years the Quality Clinical Placement Evaluation research team, consisting of a partnership between health care and tertiary sectors have developed, and utilised a practice development approach to understand and support the quality of clinical placement for undergraduates and supervising ward nurses involved in Tasmanian clinical placement programs. Importantly, the approach evolved over time to be a flexible three step program supporting the translation of findings to practice, comprised of an education session related to supervision support; survey distribution to undergraduates and supervising ward nurses following clinical placement; and workshops where stakeholders come together to consider findings of the survey, their experience and the local context, with resultant actions for change. This paper reports on findings from the program after successful implementation in urban tertiary hospitals as it was implemented in non-traditional clinical placement settings, including community, aged care and rural settings. Feedback from clinicians identifies the utility of the three step program across these settings. The unique partnerships and approach to evaluating, understanding and improving quality of clinical placements has potential for transferability to other areas, with the value of findings established for all stakeholders.

Academic learning for specialist nurses: a grounded theory study

The aim was to explore the major concerns of specialist nurses pertaining to academic learning during their education and initial professional career. Specialist nursing education changed in tandem with the European educational reform in 2007. At the same time, greater demands were made on the healthcare services to provide evidence-based and safe patient-care. These changes have influenced specialist nursing programmes and consequently the profession. Grounded Theory guided the study. Data were collected by means of a questionnaire with open-ended questions distributed at the end of specialist nursing programmes in 2009 and 2010. Five universities were included. Further, individual, pair and group interviews were used to collect data from 12 specialist nurses, 5-14 months after graduation. A major concern for specialist nurses was that academic learning should be "meaningful" for their professional future. The specialist nurses' "meaningful academic learning process" was characterised by an ambivalence of partly believing in and partly being hesitant about the significance of academic learning and partly receiving but also lacking support. Specialist nurses were influenced by factors in two areas: curriculum and healthcare context. They felt that the outcome of contribution to professional confidence was critical in making academic learning meaningful.

The significance of 'facilitator as a change agent'--organisational learning culture in aged care home settings

AIMS AND OBJECTIVES

To explore the impact of an educational programme focused on social behaviours and relationships on organisational learning culture in the residential aged care context.

BACKGROUND

The number of aged care homes will continue to rise as the frail older elderly live longer, requiring more formal care and support. As with other small- to medium-sized health services, aged care homes are faced with the challenge of continuous development of the workforce and depend upon registered nurses to lead staff development.

DESIGN

A mixed-method evaluation research design was used to determine the impact of an educational programme focused on social aspects of learning on organisational learning culture.

METHODS

One hundred and fifty-nine (pre) and 143 (post) participants from three aged care homes completed the Clinical Learning Organisational Culture survey, and three participant-researcher registered nurse clinical educators provided regular journal entries for review.

RESULTS

While each site received the same educational programme over a six-month period, the change in organisational learning culture at each site was notably different. Two aged care homes had significant improvements in affiliation, one in accomplishment and one in recognition. The educators' journals differed in the types of learning observed and interventions undertaken, with Eucalyptus focused on organisational change, Grevillea focused on group (student) change and the Wattle focused on individual or situational change.

CONCLUSION

Clinical educator activities appear to have a significant effect on organisational learning culture, with a focus on the organisational level having the greatest positive effect on learning culture and on individual or situational level having a limited effect.

RELEVANCE TO CLINICAL PRACTICE

Clinical educator facilitation that is focused on organisational rather than individual interests may offer a key to improving organisational learning culture.

'Newcomer adaptation': a lens through which to understand how nursing students fit in with the real world of practice

Aims and objectives

To present a discussion on newcomer adaptation as a lens through which to understand how nursing students adapt to clinical practice and raise awareness of strategies that can be used to enhance their learning experiences.

Background

Socialisation is an important factor that facilitates students’ learning in the clinical setting. Therefore, it is beneficial to examine organisational socialisation literature, particularly that pertaining to newcomer adaptation.

Design

This is a critical review of organisational socialisation literature.

Methods

Seminal literature and more recent research in the field of organisational socialisation and newcomer adaptation were accessed. In addition, nursing and allied health literature examining students’ socialisation and the clinical learning environment was retrieved.

Conclusions

It is revealed in this article that to create an appropriate clinical learning environment, an understanding of socialisation tactics could be beneficial. Role modelling is deemed crucial to successful newcomer adaptation. Peer support is necessary but must be advocated with caution as it can have a negative impact when students form a ‘parallel community’. Students with some knowledge of the workplace tend to adapt more easily. Likewise, students’ disposition and, in particular, their confidence can also enhance the socialisation process.

Relevance to clinical practice

Both the organisation and the student can impact on how successfully the nursing student ‘fits in’. Understanding this through the lens of newcomer adaptation means that strategies can be put in place to facilitate this process.

Views and perceptions of nursing students on their clinical learning environment: teaching and learning

INTRODUCTION

The clinical learning environment constitutes an initial area of professional practice for nurses and student opinion contributes to its improvement.

PURPOSE

The assessment of students' views and perceptions of a Greek nursing school on their clinical learning environment.

MATERIAL AND METHODS

The study was concurrent and included 196 students. We used the published questionnaire "Clinical Learning Environment Inventory (CLEI)" which is a tool for identifying and assessing Nursing students' perceptions of the psychosocial characteristics of their clinical learning environment. The questionnaire was anonymous and completed by the students themselves during their clinical training at the hospital. We conducted inductive and descriptive statistics. The level of statistical significance was set at p<0.05. The statistical program SPSS 16.0 was used.

RESULTS

The highest mean score for the Actual Clinical Learning Environment was observed in the scales of "Personalization" (23.97) and "Task orientation" (23.31) while for the Preferred Clinical Learning Environment in the scales of "Personalization" (27.87), "Satisfaction" (26.82) and "Task orientation" (26.78). The lowest mean score for the Actual Clinical Learning Environment was found in the scales of "Innovation" (19.21) and "Individualization" (19.24) while for the Preferred Clinical Learning Environment in the scales of "Individualization" (22.72) and "Involvement" (24.31). Statistically significant positive correlation was found between "Satisfaction" and all other scales of the CLEI.

CONCLUSIONS

There is a noticeable gap between the expectations and reality of the clinical learning environment for the students in nursing. Reorganization of the educational framework is needed with an emphasis on innovation and individualization.

Development and reliability testing of the quality clinical placement evaluation tool

AIMS AND OBJECTIVES

To develop and test the content and face validity, and reliability of the quality clinical placement evaluation tool.

BACKGROUND

The importance of clinical experience during undergraduate nursing degrees is undisputed. To date, tools available to measure quality of clinical placements have focused on single perspectives, that of the undergraduate or that of the supervising nurse. The quality clinical placement evaluation tool was proposed to provide an assessment of clinical placement experiences informed by supervising ward nurses and undergraduate stakeholders.

DESIGN

The study employed a cross-sectional design.

METHODS

The internal validity of an existing instrument was evaluated by an expert panel and modified for use in the acute care sector. Surveys were completed by undergraduate students (n = 48) and supervising ward nurses (n = 47). Factor analysis was used to identify themes drawn from the literature and explore redundancy of items. Reliability was assessed using Cronbach's alpha for internal consistency and test-retest (five to seven days apart).

RESULTS

Reliability testing showed good internal consistency for the tool; test-retest reliability testing results were moderate to good for students and fair to moderate for nurses. Factor analysis identified three core themes related to supervising ward nurse responses that could also be applied to undergraduate nurses. The domains identified were the following: welcome and belonging; support to meet learning needs; and confidence and competence: reflections on learning.

CONCLUSIONS

The quality clinical placement evaluation has shown statistically acceptable levels of reliability and validity for measuring the quality of clinical placement from perspectives of undergraduates and supervising ward nurses.

RELEVANCE TO CLINICAL PRACTICE

The tool provides tertiary institutions, acute care facilities, wards and individuals with the means to capture views of the quality of clinical placement which can also be used to undertake comparisons over time and between sites.

Impact of engaging middle management in practice interventions on staff support and learning culture: a quasi-experimental design

AIM

This study evaluated the impact of different levels of engaging middle management in ward based strategies implemented by a project educator.

BACKGROUND

The challenge for learning in practice is to develop effective teams where experienced staff engage and foster learning with students and other novice staff.

DESIGN

A quasi-experimental pre- and post- intervention four group design was conducted from November 2009 to May 2010 across four general surgical and four general medical inpatient matched units in two settings in South East Queensland, Australia.

METHOD

Staff survey data was used to compare control and intervention groups (one actively engaging nurse managers) before and after 'practice learning' interventions. The survey comprised demographic data and data from two validated scales (support instrument for nurses facilitating learning and clinical learning organisational culture).

RESULTS

Number of surveys returned pre- and post-intervention was 336 from 713 (47%). There were significant differences across many subscales pertaining to staff perception of support in the intervention groups, with only one change in the control group. The number of significant different subscales in the learning culture was also greater when middle management supported the intervention.

IMPLICATIONS FOR NURSING MANAGEMENT

Middle management should work closely with facilitators to assist embedding practice interventions.

Using a critical reflection process to create an effective learning community in the workplace

Learning circles are an enabling process to critically examine and reflect on practices with the purpose of promoting individual and organizational growth and change. The authors adapted and developed a learning circle strategy to facilitate open discourse between registered nurses, clinical leaders, clinical facilitators and students, to critically reflect on practice experiences to promote a positive learning environment. This paper reports on an analysis of field notes taken during a critical reflection process used to create an effective learning community in the workplace. A total of 19 learning circles were conducted during in-service periods (that is, the time allocated for professional education between morning and afternoon shifts) over a 3 month period with 56 nurses, 33 students and 1 university-employed clinical supervisor. Participation rates ranged from 3 to 12 individuals per discussion. Ten themes emerged from content analysis of the clinical learning issues identified through the four-step model of critical reflection used in learning circle discussions. The four-step model of critical reflection allowed participants to reflect on clinical learning issues, and raise them in a safe environment that enabled topics to be challenged and explored in a shared and cooperative manner.

Nursing students' perceptions of learning in practice environments: a review

Effective clinical learning requires integration of nursing students into ward activities, staff engagement to address individual student learning needs, and innovative teaching approaches. Assessing characteristics of practice environments can provide useful insights for development. This study identified predominant features of clinical learning environments from nursing students' perspectives across studies using the same measure in different countries over the last decade. Six studies, from three different countries, using the Clinical Leaning Environment Inventory (CLEI) were reviewed. Studies explored consistent trends about learning environment. Students rated sense of task accomplishment high. Affiliation also rated highly though was influenced by models of care. Feedback measuring whether students' individual needs and views were accommodated consistently rated lower. Across different countries students report similar perceptions about learning environments. Clinical learning environments are most effective in promoting safe practice and are inclusive of student learners, but not readily open to innovation and challenges to routine practices.

Impact of a learning circle intervention across academic and service contexts on developing a learning culture

Partnerships between university schools of nursing and health services lead to successful learning experiences for students and staff. A purposive sample of academics and students from a university school of nursing and clinicians from three health institutions involved in clinical learning (n=73) actively participated in a learning circles intervention conducted over 5 months in south east Queensland. Learning circle discussions resulted in enhanced communication and shared understanding regarding: (1) staff attitudes towards students, expectations and student assessment; (2) strategies enhancing preparation of students, mechanisms for greater support of and recognition of clinicians; (3) challenges faced by staff in the complex processes of leadership in clinical nursing education; (4) construction of learning, ideas for improving communication, networking and sharing; and (5) questioning routine practices that may not enhance student learning. Pre-post surveys of hospital staff (n=310) revealed significant differences across three sub-scales of 'accomplishment' (t=-3.98, p<.001), 'recognition' (t=-2.22, p<.027) and 'influence' (t=-11.82, p<.001) but not 'affiliation'. Learning circles can positively enhance organisational learning culture. The intervention enabled participants to recognise mutual goals. Further investigation around staff perception of their influence on their workplace is required.

Shifting workplace behavior to inspire learning: a journey to building a learning culture

This article discusses the process of building a learning culture. It began with establishing acceptance and connection with the nurse unit manager and the ward team. In the early phases of developing rapport, bullying became apparent. Because bullying undermines sharing and trust, the hallmarks of learning environments, the early intervention work assisted staff to recognize and counteract bullying behaviors. When predominantly positive relationships were restored, interactions that facilitated open communication, including asking questions and providing feedback-behaviors commensurate with learning in the workplace-were developed during regular in-service sessions. Staff participated in role-play and role modeling desired behaviors. Once staff became knowledgeable about positive learning interactions, reward and recognition strategies began to reinforce attitudes and behaviors that align with learning. Through rewards, all nurses had the opportunity to be recognized for their contribution. Nurses who excelled were invited to become champions to continue engaging the key stakeholders to further build the learning environment.