The experiences of undergraduate Assistants in Nursing (AIN)

The influence of prior work experience in aged care on nursing students' views on aged care nursing: A systematic review

BACKGROUND

Nursing students' experiences during clinical training in aged care placements is a well-studied topic. However, there is less research on the connection between nursing students' prior experiences as assistants in nursing (AIN) and their perception of aged care nursing.

AIM

The aim of this study was to identify and synthesize undergraduate nursing students' experiences as working as AIN in aged care settings.

METHOD

A systematic review was carried out by searching the CINAHL, Scopus, Medline and Medic databases, supplemented by manual searches. The searches focused on peer-reviewed scientific empirical research articles published in English, with a 10-year date limitation. The data were analysed by the qualitative content method.

RESULTS

The review identified 11 articles, which showed that nursing students' prior work experience shifts their perceptions of older adults' care. The findings were organized under four major themes. Through their employment as AIN, (1) nursing students' ability to reflect and develop skills needed in clinical work strengthened, (2) they became aware of the independent role of the nurse, (3) they feel part of the workplace community and (4) they recognized their feelings and views about aged care as a career.

CONCLUSION

Students' work experience in aged care helps them to observe aged care settings as a unique set up and nursing comprehensively from the perspective of an older adult's care needs and they can observe the dynamics of a workplace community. They can see many positive features in working in aged care and assess their experience with positive descriptions.

Do internship students do well in a clinical environment? A qualitative naturistic study

Background

The internship year marks the culmination of the nursing program across all Saudi universities, bridging theoretical learning and practical application. The significance of the internship year lies in the application of skills acquired during the preceding years of study. Understanding interns' experiences, identifying influences, and sharing their recommendations for best practices become crucial.

Objective

This study aimed to explore the experiences of internship students and address the challenges they encountered in a clinical environment.

Methods

A qualitative naturistic descriptive approach was employed, involving 20 purposively selected participants from internship students in two regions in Saudi Arabia. Data were collected in January 2023 through semi-structured interviews, focus group discussions, and observation. A conventional content analysis approach was used for data analysis.

Results

Four major themes were generated: 1) Transferring Shock, 2) Self-Learning, 3) Supportive Environments, and 4) Factors Facilitating Learning. Transferring Shock comprised two subthemes: feeling lost and feeling left out.

Conclusion

Internship students acknowledged the utility of orientation and mentorship programs in advancing the practical skills of new nurses and enhancing patient safety. The findings also indicated that those with prior preparation and robust communication skills reported a positive experience. Consequently, integrating communication courses into the nursing education curriculum could be beneficial. Establishing a supportive learning environment for nursing interns is imperative to address challenges and ensure the delivery of safe and effective patient care.

The introduction of registered undergraduate students of midwifery in a tertiary hospital: Experiences of staff, supervisors, and women

BACKGROUND

The Registered Undergraduate Student of Midwifery (RUSOM) workforce model provides final year midwifery students an opportunity of paid employment and gain experience as an assistant to midwives. A RUSOM supports the work of midwives by providing care to women and their newborns. Little is known about how the RUSOM role impacts the range of stakeholders in maternity care settings.

AIM

To evaluate the acceptability of the RUSOM role, how it is experienced by staff and women, and its impact on quality of care.

METHODS

A mixed-methods approach including 9 qualitative focus groups (n = 41) and 4 descriptive surveys (n = 135) was used.

FINDINGS

The introduction of the RUSOM role has numerous benefits for the service, midwifery staff, women, and the RUSOM themselves. The RUSOM relieved the burden on the postnatal ward, giving midwives more time to work at their higher end of scope in direct clinical care. Having a clear scope of practice for the role ensured there were clear boundaries between the RUSOM and the midwife, resulting in the positive satisfaction for the maternity services team and women in their care.

DISCUSSION

Employing RUSOM staff has both immediate and long-term benefits for maternity services. The role had the potential to improve the professional development of upcoming midwives, leading to high quality and experienced graduates that are an invaluable asset to a maternity service.

CONCLUSION

The positive outcome from this evaluation provides evidence for the expansion of the RUSOM model which can enhance the quality of care for women.

Nursing students' expectations and career preferences before clinical placement in mainland China: A qualitative exploration

AIM

To explore nursing students' expectations and career preferences before their clinical placements.

BACKGROUND

Clinical placement is an important adaptation stage through which nursing students become nurses. Nursing students' expectations of clinical placement are not always met. There is a huge demand-supply gap in the nursing labor force and ensuring successful nursing placements could offset this gap.

DESIGN

This study adopted a descriptive qualitative design.

METHODS

Each participant was interviewed in the weeks before the start of their clinical placement. Interviews were semi-structured and audio recorded. Data were analyzed using Clarke and Braun's thematic analysis.

RESULTS

This study included 25 students (11 males and 14 females; age 20-21 years), which was sufficient to reach data saturation. We identified 138 codes and six themes emerged: a) expectations of role transition; b) expectations of self-enhancement; c) expectations of teaching styles; d) fears and worries; e) preliminary career preferences; and f) motivating and obstacle factors of engaging in a nursing career.

CONCLUSIONS

Nursing students had various expectations of their upcoming clinical placements alongside certain worries and fears. More predictive and targeted strategies need to be considered to ensure the success of clinical nursing placements. Further research should explore and verify strategies to meet nursing students' expectations and promote their preference for a nursing career.

Supporting the midwifery workforce: An evaluation of an undergraduate midwifery student employment model at a large tertiary maternity service in Victoria, Australia

BACKGROUND

In 2020, in response to major maternity workforce challenges exacerbated by the COVID-19 pandemic, the Victorian Department of Health implemented a number of workforce maximisation strategies, one of which was employment of undergraduate midwifery students called 'Registered Undergraduate Student Of Midwifery' (RUSOM).

AIM

To evaluate the RUSOM model implemented in a tertiary maternity service in Melbourne, Australia.

METHODS

A cross-sectional online survey was distributed to all RUSOMs and midwives at the study site in August 2021.

FINDINGS

Twenty of 26 RUSOMs (77%) and 110 of 338 permanent midwives (33%) responded. Both groups considered the model to be a positive workforce strategy that contributed to work readiness of students, and increased confidence and competence to practise. RUSOMS and midwives reported positives for the organisation including improving workload for midwives on the postnatal ward, enhancing quality of care and outcomes for women and babies, and the value of RUSOMs as team members. RUSOMs felt well supported, supervised and clinically and theoretically prepared. Both groups considered RUSOMs were underutilised, and that they could undertake additional duties, and both thought that the RUSOM model should continue.

CONCLUSION

The model was highly valued by both RUSOMs and midwives. There was strong agreement that the model should continue and that the list of duties could be expanded. Given these findings, further research should explore the expansion and sustainability of RUSOMs in the maternity workforce.

Student Employment Models for Undergraduate Nurses and Midwives in Australia: A Scoping Review

Introduction

Evidence has shown that throughout their undergraduate years, many nursing and midwifery students obtain paid employment in a wide variety of clinical and non-clinical positions. Across Australia, inconsistencies exist in the models of clinical employment available to these student groups. Previous Australian studies have described the employment of undergraduate nursing and midwifery students in regulated and unregulated clinical roles. No studies have reported on the various regulated roles available to both student nurses and midwives in Australia. The purpose of this scoping review is to identify and synthesize evidence related to nursing and/or midwifery students employed in regulated and unregulated clinical roles in Australia.

Methods

This scoping review utilized published recommendations for data screening, abstraction, and synthesis. One of the authors, a librarian, undertook systematic searches in CINAHL Complete (1937-present), Emcare on Ovid (1995-present), Scopus (1969-present), and Ovid MEDLINE(R) (including Epub Ahead of Print, In-Process, and In-Data-Review & Other Non-Indexed Citations, 1946-present). The initial searches were completed in April 2019 and repeated in March 2021 and May 2022 to identify any new literature. Manual searching of reference lists in the included papers was also undertaken, together with selected organizational websites. The extracted data included the lead author, date, title, study design, study sample and location, and key findings.

Results

From the 53 items retrieved, 23 peer-reviewed studies met the inclusion criteria and were included in the review. All items were published between 2011 and 2022. Only four of the studies focused upon student midwives. Undergraduate nursing and midwifery students in Australia obtain paid employment in a variety of regulated and unregulated clinical roles.

Conclusion

The literature reported here demonstrates that there are differing models, nomenclature, educational requirements, and pay scales in place for student employment in clinical roles across Australian states and territories.

Improving the health assistant in nursing employment model through entry to practice nursing student perceptions: a cross-sectional study

IMPACT STATEMENT

Graduate entry to practice nursing students offer direction on how to improve the Health Assistants in Nursing employment model.

Nursing Student Medication Administration Performance: A Longitudinal Assessment

BACKGROUND

Nurses must be adequately prepared for safe medication administration.

PURPOSE

The specific aims of the study were to compare first- and final-semester nursing students' medication administration performance, describe graduating nursing student performance, assess the long-term effect of an Individual Simulation-Based Experience (ISBE), and determine if nursing assistant experience impacted performance.

METHODS

The study was a longitudinal, descriptive, experimental, 2-group pretest-posttest design. The Medication Administration Safety Assessment Tool was used to assess nursing student (n = 68) medication administration performance at 3 points in time: after learning the skill, after participation in an ISBE or traditional practice session, and prior to graduation.

RESULTS

Only one-third of senior nursing students accurately demonstrated medication administration. There was no significant difference between first- and last-semester performance.

CONCLUSION

Findings suggest nursing students are not prepared for safe medication administration upon graduation. The reality of practice opportunities to perform this skill throughout a nursing program should be examined.

Supplementing Clinical Practice in Nursing Homes With Simulation Training: A Qualitative Study of Nursing Students' Experiences

Introduction

Limited access to nurse supervisors, insufficient learning support and staff with high workloads are well documented in the research literature as barriers to nursing students´ learning in clinical practice in nursing homes. Due to these barriers nursing students may benefit from additional learning support from nurse educators during their clinical practice period.

Objective

The study aimed to explore nursing students' experiences of supplementary simulation training as a tool to support learning during clinical practice in nursing homes.

Methods

A descriptive qualitative design was used. Twenty-seven first-year nursing students from a university college in Norway were interviewed after attending a seven-week practice period in nursing homes with supplementary simulation training. Three semi-structured focus group interviews were audio recorded, transcribed, and analysed using systematic text condensation.

Findings

Three categories of student experiences were identified: enhancing the reasoning behind care, transferring knowledge and experiences between the learning environments and enhancing the sense of mastery.

Conclusion

The supplementary simulation training seemed to complement clinical practice by consolidating the students' learning during the clinical practice period, enhance the students' motivation and sense of mastery, and consequently their efforts to seek out new challenges, explore and learn both in the clinical and the simulated environment.

A systematic review of activities undertaken by the unregulated Nursing Assistant

AIM

To identify activities performed by Nursing Assistants in acute and primary healthcare.

DESIGN

Systematic review.

DATA SOURCES

The databases MedLine/PubMed, ProQuest and Google Scholar were searched for empirical studies published in the English language between 2008 and 2018 that addressed the work of Nursing Assistants.

REVIEW METHODS

From an initial yield of 2,944 publications, 71 publications were retained for full text review and 20 publications included in this review. Activities undertaken by Nursing Assistants from eight countries were extracted and categorized into one of six categories.

RESULTS

Over 200 activities were identified as being delegated to Nurse Assistants globally. Many of these activities are beyond the training of the Nurse Assistant and are being performed with limited Registered Nurse supervision.

CONCLUSION

Patient safety is at risk. Nurse Assistants' roles vary widely, with some seeing their role as similar to that of a regulated nurse, while recognizing their need for additional training.

IMPACT

Over 31% of activities delegated to Nurse Assistants require skill and comprehension beyond their level of training. Patients and regulated nurses need to have confidence that Nursing Assistants responsible for care provision are appropriately trained and practicing within regulatory standards.

The relationship among BSN students' employment, educational, and health-related characteristics and semester grades: A multi-site study

BACKGROUND

While many nursing students work during clinical semesters, little is known about employment characteristics and relationships among employment, academic success and other variables.

PURPOSE

To describe the demographic, educational, and health-related characteristics of clinical nursing students and the relationships among employment, semester grades and other characteristics.

METHOD

Descriptive, correlational.

RESULTS

Participants were BSN students (N = 1014) from four southern US universities who were 22.6 years old (SD = 4.6) and most likely to be Caucasian (N = 832, 82%) never married (N = 852, 84%) females (N = 886, 87%) with mean GPA of 2.97 (SD = 0.61). Most students (N = 670, 66%) reported semester employment averaging 16.7 (SD = 8.3) hours/week. Although no relationship was found between hours worked and semester GPA (r = -0.017, p = .588), race/ethnicity (F [2, 1003] = 19.87, p < .0001) and nighttime sleep hours (F [3, 997] = 7.841, p < .0001) had significant effects. Students working in healthcare had higher GPAs (M = 3.09, SD = 0.61, p < .0001) than non-healthcare workers. Students working daytime (M = 3.04, SD = 0.65, p = .031) or irregular shifts (M = 3.04, SD = 0.56, p = .036) had higher GPAs than students working evenings.

CONCLUSION

While employment status did not influence GPA, race/ethnicity and amount of reported sleep did. Additional research is needed to provide evidence-based advisement recommendations for employed students.

Learning experience of nursing students in a clinical partnership model: An exploratory qualitative analysis

BACKGROUND

Clinical teaching models are crucial for nursing students' learning experiences as students learn and socialise in a complex clinical context. An innovative clinical partnership model, employing hospital-based clinical teachers to provide supervision and university teachers to liaise with students, has been developed to facilitate clinical teaching and enhance learning experiences.

OBJECTIVES

The study aims to explore nursing students' learning experiences under this clinical partnership model.

DESIGN

An exploratory qualitative study using focus group interviews.

PARTICIPANTS

Twenty-eight pre-registration nursing students at undergraduate and postgraduate level participated in this study.

METHODS

Students formed four groups with each consisting of six to eight students. Semi-structured interviews were conducted to explore students' experiences and perceptions of clinical learning in the clinical partnership model. The data analysis was guided by an inductive approach using content analysis.

RESULTS

The narrative data relates to the clinical learning environment and experience. Nursing students found the clinical partnership model provided a conducive learning context facilitating their adaption to the new environment and integration with the healthcare team. Though students spent time developing mutual understanding with their clinical teachers, they were satisfied with the ample opportunities to practise and learn from their teachers. They appreciated the fact that teachers enriched their learning through bridging the theory-practice gap and acting as role models.

CONCLUSION

The clinical partnership model enriches students' learning experiences. It provides a student-centred learning approach and supportive clinical environment which engages nursing students in learning.

Experiences and perceptions of the theory-practice gap in nursing in a resource-constrained setting: A qualitative description study

AIM

To describe experiences and perceptions of theory-practice gap in nursing in a resource-constrained setting. Theory-practice gap is extensively discussed and studied in some parts of the world. Interventions to bridge the theory-practice gap have been varied and depend on an understanding of the contextual healthcare environment. Experiences and perceptions of the theory-practice gap in a resource-constrained setting have not been comprehensively described.

DESIGN

A qualitative description methodology was used.

METHODS

Maximum variation sampling based on role in the events of theory-practice gap was used to recruit student nurses, nurse faculty and clinicians from two study sites for focus group discussions. Data were analysed using conventional content analysis.

RESULTS

Five themes were identified: system inadequacies; resource constraints; challenges of the clinical learning environment; clinical placement and supervision; and nurse faculty factors. Systems inadequacy and resource constraints formed the spine of the challenges contributing to the theory-practice gap in the research setting.

Assistants in nursing working with mental health consumers in the emergency department

Nursing students, regardless of setting, require skills in working with people with mental health issues. One way to provide students with learning opportunities within the context of limited undergraduate mental health content and lack of mental health placements is through employment as assistants in nursing (AIN). The purpose of the study was to investigate the use of AINs employed in an emergency department in South Australia to supervise (continuous observation) mental health consumers on inpatient treatment orders. Twenty-four participants took part in the study, with AINs (n = 8, all studying in an undergraduate nursing programme), nurse managers (n = 5), and nurses (n = 11) participating in semi-structured interviews. Data were analysed using thematic analysis. Themes focused on (i) the AIN role, their practice, boundaries or restrictions of their role, and the image consumers have of AINs; (ii) learning through experience, where the AIN role was a practical opportunity to learn and apply knowledge obtained through university studies; and (iii) support, which focused on how AINs worked with nursing staff as part of the healthcare team. Overall, participants believed that AINs played an important role in the ED in supervising consumers on involuntary mental health treatment orders, where their unique role was seen to facilitate more positive consumer experiences. The AIN role is one way for nursing students to develop skills in working with people with mental health issues.

Undergraduate nursing assistant employment in aged care has benefits for new graduates

AIMS

To determine how undergraduate assistant in nursing employment in aged care helps to prepare new graduates for clinical work as a Registered Nurse.

BACKGROUND

The amount and quality of clinical experience afforded by university programs has been the subject of constant debate in the nursing profession. New graduate nurses are often deemed inadequately prepared for clinical practice and so many nursing students seek employment as assistants in nursing whilst studying to increase their clinical experience.

DESIGN

This paper presents the first phase of a larger mixed-methods study to explore whether undergraduate assistant in nursing employment in aged care prepares new graduate nurses for the clinical work environment. The first phase involved the collection of quantitative data from a modified Preparation for Clinical Practice survey, which contained 50-scaled items relating to nursing practice.

METHODS

Ethics approval was obtained prior to commencing data collection. New graduate nurses who were previously employed as assistants in nursing in aged care and had at least 3 months' experience as a Registered Nurse, were invited to complete the survey. Social media and professional networks were used to distribute the survey between March 2015 - May 2016 and again in January 2017-February 2017. Purposeful and snowballing sampling methods using social media and nursing networks were used to collect survey responses. Data were analysed using principal components analysis.

RESULTS

110 completed surveys were returned. Principal components analysis revealed four underlying constructs (components) of undergraduate assistant in nursing employment in aged care. These were emotional literacy (component 1), clinical skills (component 2), managing complex patient care (component 3) and health promotion (component 4).

CONCLUSION

The four extracted components reflect the development of core nursing skills that transcend that of technical skills and includes the ability to situate oneself as a nurse in the care of an individual and in a healthcare team.

Examination of a therapeutic-recreation based clinical placement for undergraduate nursing students: A self-determined perspective

Nursing students across the globe are expected to undertake clinical placements. To date, there have been no studies that have examined the potential educational benefits for undergraduate nursing students engaged in a mental health clinical placement grounded in self-determination theory. The present study examined the experiences of undergraduate students engaged in a mental health clinical placement termed Recovery Camp. An ethnographic methodology within a case study approach was used. The researchers were immersed in the clinical placement, which took place at a YMCA camp facility. Participants were 20 3rd year undergraduate nursing students. To gain insight and understanding, the researchers used interviews, observations, and reflective journals. The constant-comparative method was used to analyse the data. Emergent themes identified from systematic analysis were: (a) social connection and (b) experiential learning. Recovery Camp facilitated a sense of inclusion and positive/supportive behaviour. It also enhanced student learning and understanding of symptoms of mental illness. Findings from this study support and extend findings for the use of therapeutic-recreation based work placement experiences in the clinical education of future nurses. Findings demonstrated a link between this type of placement and undergraduate student's development of deeper knowledge of symptoms and experiences associated with mental illness.

Exploring undergraduate nursing students' perceptions of working in aged care settings: A review of the literature

OBJECTIVES

To explore undergraduate nursing students' perceptions of working in the aged care setting through a review of the literature.

DESIGN

A review of available literature relating to undergraduate nursing students' attitudes, perceptions and experiences in the aged care setting, or in the care of older adults.

DATA SOURCES

CINAHL Plus with Full Text was the primary database used. Other databases include PsycINFO and Health Source: Nursing/Academic Edition.

REVIEW METHODS

Studies focused on undergraduate nursing students and their experiences in the aged care setting and on the perceptions and attitudes of nursing students toward older adults, were included. Studies that did not present an original study or those that did not meet the aim of the study were excluded from the review.

RESULTS

Following removal of duplicates and exclusion of articles not meeting the aim of this paper, 24 articles remained. Three main themes emerged from the review of the literature: perceptions of aged care placement, attitudes to working in aged care, and experiences in aged care.

CONCLUSION

The experiences of nursing students employed as undergraduate AINs in the aged care setting can provide an immersive clinical learning experience in preparation for their new graduate (NG) year. Furthermore, it is an opportunity to challenge ageist attitudes and instil core nursing values in novice nurses such as promoting compassionate care.

Assistants' in nursing perceptions of their social place within mental health-care settings

An international nurse shortage, tightening fiscal constraints, and increased service demands have seen health systems increasingly turn to employing assistants in nursing (AIN) as a cost-effective means to meet demand. This paper describes social positioning from the perspective of 11 AIN who were employed to work in specialist mental health settings in a metropolitan health service in Sydney. Data was collected by means of semistructured interviews. Interview questions encouraged AIN to explore their experience with reference to positioning within the service, role perception, role development, staff relationship, and role satisfaction. Thematic analysis was utilized to generate themes and explore meaning within the data. The following themes emerged: role definition and clarity; socialization and adaptation; and enhancing education. Analysis suggests that whilst AIN were integrated into mainstream service, the scope of activities or role remains geographically variable and inconsistent. Encouragingly, as AIN became familiar with their work environments and teams, they considered themselves to be of value and were able to play a meaningful role. A desire for learning and a need for continuing education also emerged as a primary theme. Findings from the data suggest that AIN in the mental health setting remain a novel and, to some extent, poorly utilized resource.

The influence of critical thinking skills on performance and progression in a pre-registration nursing program

BACKGROUND

The importance of developing critical thinking skills in preregistration nursing students is recognized worldwide. Yet, there has been limited exploration of how students' critical thinking skill scores on entry to pre-registration nursing education influence their academic and clinical performance and progression.

AIM

The aim of this study was to: i) describe entry and exit critical thinking scores of nursing students enrolled in a three year bachelor of nursing program in Australia in comparison to norm scores; ii) explore entry critical thinking scores in relation to demographic characteristics, students' performance and progression.

METHOD

This longitudinal correlational study used the Health Sciences Reasoning Test (HSRT) to measure critical thinking skills in a sample (n=134) of students, at entry and exit (three years later). A one sample t-test was used to determine if differences existed between matched student critical thinking scores between entry and exit points. Academic performance, clinical performance and progression data were collected and correlations with entry critical thinking scores were examined.

RESULTS

There was a significant relationship between critical thinking scores, academic performance and students' risk of failing, especially in the first semester of study. Critical thinking scores were predictive of program completion within three years. The increase in critical thinking scores from entry to exit was significant for the 28 students measured. In comparison to norm scores, entry level critical thinking scores were significantly lower, but exit scores were comparable. Critical thinking scores had no significant relationship to clinical performance.

CONCLUSION

Entry critical thinking scores significantly correlate to academic performance and predict students risk of course failure and ability to complete a nursing degree in three years. Students' critical thinking scores are an important determinant of their success and as such can inform curriculum development and selection strategies.

The Use of Unregulated Staff: Time for Regulation?

Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurses with unskilled nursing support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. We argue that it is timely to consider regulation of nursing support workers with their role and scope of practice clearly defined. Further, the addition of these workers in a complementary model of care (rather than substitutive model) should also be explored in future research, in terms of impact on patient and nurse outcomes.

Challenges to student learning in the clinical setting: a qualitative descriptive study

Clinical education is used throughout nursing to promote competency. Although this experience can be rewarding, students may face a variety of challenges within this context. The purpose of this qualitative descriptive study is to explore senior nursing students' perceptions of challenges to learning within the clinical setting. Three interrelated themes emerged from the data: (a) internal reactions to external limitations; (b) barriers experienced within the clinical environment; and (c) ineffective programme organisation. Findings are meant to guide educators and policy makers during decision making. The goal is advancement towards making the clinical environment a superior form of nursing education.