Theme exclusive to fourth-year student nurses
Closely associated with students was the dissatisfaction expressed regarding the clinical placement as an opportunity to enhance clinical skills. Students felt that their exposure and experience in new practices was inhibited by a number of reasons. One reason cited was the apparent high activity of the ward. Some students felt that they were not working with the preceptor all of the time or felt that support from the preceptor was inadequate. Communication with other nurses was again cited as a perceived difficulty, particularly in relation to addressing their learning needs. One student commented on the perceived lack of opportunity to ask questions or find preceptor / staff nurse to explain anything. This comment was further qualified with the acceptance that it was due to heavy workload rather than lack of cooperation by the staff nurses. Despite the previous two years in supernumerary status one student felt that she/ he was learning everything the hard way and one student felt that positive feedback is lacking. Overall there appeared to be a perceived lack of conformity in work practices, styles and opinions within the learning clinical environment, which impacted negatively on the student nurse’s learning experience.
Other pressures placed upon student in relation to learning needs were deemed to affect their stress levels. This included the pressure to get student documentation to be signed off. Some felt that there was too much paperwork e.g. writing portfolios whilst on placement. There appeared to be a perceived pressure on the student to learn on the clinical placement, though time and resources were perceived to inhibit this experience. This was typified by one comment whereby a student felt that:
This sense of limited learning exposure was expressed in the frustration of student nurses at not being given enough responsibility or independence or given too much responsibility. One student remarked about being given a lot of criticism and a small degree of responsibility. This was a reported as a source of conflict between the student nurse and the preceptor particularly in relation to allocation of responsibility when wanting to carry out a particular procedure.
In contrast, many students expressed frustration at being given too much responsibility with little guidance. One student remarked that the expectations on student nurses were too high. This perceived discord between allocations of responsibility with level of competence is articulated in this comment:
‘You can feel like others are constantly looking over your shoulder and while you need a certain amount of supervision it’s hard to strike a balance.’(S34)
This view of imbalance of allocation of responsibility appeared to impact on the student’s view of the clinical environment as a place of learning.
4.2.12 Conclusion
The overall mean score for newly qualified nurses was 44.95 out of a range of 0-102. This compares to 45.69 from fourth-year student nurses. The statistical hypothesis stated that ‘perceived stress is higher in newly qualified nurses compared to fourth- year student nurses’. This was tested inferentially and this hypothesis was rejected, therefore concluding that while stress frequency was encountered at least occasionally by both groups and comparatively high to other studies. ‘Perceived stress is not higher in newly qualified nurses compared to fourth-year student nurses for the following factors; death and dying, inadequate preparation, lack of staff support, uncertainty concerning treatment and conflict with other nurses. However, perceived stress in relation to workload and conflict with physicians is higher in newly qualified nurses compared to fourth-year student nurses’. Hence it is necessary to reject the null hypothesis and accept that there is a significant difference in the scores in each group with regard to workload and conflict with physicians.
Qualitatively, both groups identified both common stressors and stressors that were exclusive to each group. Newly qualified nurses concurred with student nurses about excessive workload, short staffing and the dissatisfaction at having to perform non- nursing duties when time was already perceived to be limited. This appeared to impact on both group’s ability to provide basic and holistic nursing care. Student nurses expressed dissatisfaction in relation to the perceived inadequacies regarding relationships with other nurses in the clinical environment. This perceived poor relationship left the student nurse feeling isolated and not part of the team. Relationship difficulties were cited by newly qualified nurses, but to a much lesser
degree and were directed in a wider context such as other members of the multidisciplinary team rather than confined to other nurses.
Notwithstanding the fact combining academic work with working full time were extraneous to the study, students clearly expressed the impact that these difficulties had on them while in the clinical environment. The ward environment was not always seen as a place to facilitate learning and was a cause of stress for some student nurses. However there was a sense that this perception of stress and stressors was transient as cited by a newly qualified nurse.
Positive attributes of this transition were also cited by newly qualified nurses and were more vocal in the provision of suggestions that may improve the alleviate stress in the clinical environment. In particular, the need and benefit of an induction period supported by supernumerary status in the initial period was frequently advocated. A notable difference in this group was the frequent citing of moving wards and agency work as contributing to stress. This was coupled with the perception of lack of preparedness and lack of confidence in this new role. Numerous detailed responses and the language used have confirmed that respondents in both groups experience stress in the clinical environment. These findings support and build on the findings from the quantitative results by providing an insight into the minds of the respondents and providing suggestions for improvement in the clinical environment.