Maria MacKay Director of Clinical Learning / Senior Lecturer University of Wollongong

How do students influence a ‘healthful’ relationship with their clinical supervisors in clinical practice?

Authors: Alicia Congram, Sally-Anne Guymer , Louise Hoogenboom, Tanya King, Ionna McCarthy and Daniel Kostiainen All of the authors are students enrolled in the Bachelor of Nursing at University of Wollongong, NSW Australia.

We (a group of students in the Bachelor of Nursing (BN) at a metropolitan university in Australia) have been lucky enough to be involved as co-researchers in a research project, which hoped to equip students with a new work experience placement (known by many as a clinical placement) assessment document. The project was entitled – How do students influence a ‘healthful’ relationship with their clinical supervisors in clinical practice? As a group, we enjoyed the experience of being a student that is involved with research which aimed to facilitate a positive relationship between a bachelor of nursing student on clinical placement and their clinical supervisor. The output that was achieved was the development of a student led conversation form for students to create shared ways of working with their clinical supervisor. This new approach, we believe, will be instrumental in developing a more effective communication and enabling students to feel more confident in starting their clinical placement. We believe this may bridge the communication gap that now exists as opening communication provides clarity and a way forward. At the early stages of the research, group members joined together to reflect on the challenges that students face, including feelings of fear and nerves during a clinical placement. A positive aspect that came from this reflection, was an understanding that most student experience some feelings of nervousness and fear during their first contact with a clinical supervisor on placement. Ideas were then brainstormed to create a tool that might help ease this initial contact and create a person-centred approach to connection. It is our belief that this tool will enable more open and empathetic communication between clinical supervisors and students, and in turn lead to a more harmonious and understanding relationship, which we feel was broken or lacking originally.

This picture is the drawing we collectively undertook in exploring the ideal relationship between a student and their clinical supervisor. The way through the confusion and stress, we believe, is to understand your goals, learning objectives and open up lines of commutation. By considering these factors, we can help identify new strategies and by making small changes, help students and clinical supervisors to be more effective and enjoy the placements. Healthcare organisations, too, have a role to play in supporting students and creating person-centred learning environments. We are hoping this new work placement experience assessment document will also equip them with the necessary tools and enable them to provide students with support and encouragement throughout their clinical placement.

Student reflections on the challenges they faced The challenge for me as a student on placement is it takes time to build a relationship with your clinical supervisor. Being comfortable with my clinical supervisor is important to me as I have difficulty communicating how I feel in new situations and can get very stressed. Doing this research allowed for me to express my thoughts, values and potential challenges which facilitated open communication throughout the length of placement. By establishing expectations early, I was able to have a stress-free placement and felt comfortable communicating openly and honestly with my clinical supervisor. I always found it challenging to establish a rapport with my clinical supervisors during student clinical placement. Creating the ‘ice breaker’ introduction sheet with my peers was a fantastic way of building an initial rapport with my clinical supervisor as well as allowing me the time to sit down with them and discuss what I would like to get out of my placement. It also gave me the opportunity to learn what my clinical supervisor expected of me as a student during placement. A negative experience with the sheet was that some clinical supervisors did not understand what the sheet was for and some expressed it was a waste of their time. This was challenging for me as I could see the benefits of the exercise not only from a student’s perspective, but also from an the clinical supervisor perspective.

The challenge for me as a student on placement is it takes time to build a relationship with your clinical supervisor. Being comfortable with my clinical supervisor is important to me as I have difficulty communicating how I feel in new situations and can get very stressed. Doing this research allowed for me to express my thoughts, values and potential challenges which facilitated open communication throughout the length of placement. By establishing expectations early, I was able to have a stress-free placement and felt comfortable communicating openly and honestly with my clinical supervisor. I always found it challenging to establish a rapport with my clinical supervisors during student clinical placement. Creating the ‘ice breaker’ introduction sheet with my peers was a fantastic way of building an initial rapport with my clinical supervisor as well as allowing me the time to sit down with them and discuss what I would like to get out of my placement. It also gave me the opportunity to learn what my clinical supervisor expected of me as a student during placement. A negative experience with the sheet was that some clinical supervisors did not understand what the sheet was for and some expressed it was a waste of their time. This was challenging for me as I could see the benefits of the exercise not only from a student’s perspective, but also from an the clinical supervisor perspective.

Shared Key learnings This process has highlighted key learning opportunities, one example was in initial rapport building with clinical supervisors, students felt they are in a safe environment and this assisted if they need to disclose any incidents to their clinical supervisor. This process has provided us with great insight not only into our own fears about clinical placements, but has also enabled us to assist the other students in preparing for their clinical placements. We believe that in bridging the communication gap between students and their clinical supervisor can be achieved by understanding your own values and ethics, as well as openly communicating our goals and what we hope to learn from our time within the facility. We believe that by implementing these small communication changes, it will lead to a drastic but positive impact upon the way students experience their clinical placements. It is our hope that by implementing these small changes with the new workplace experience assessment document that we can enable open communication and shine a light on the stresses and fears for now over 1500 students. Another key learning opportunity was discovering how useful a tool that supports connection between student and clinical supervisors was. It was helpful to know, that as a student entering a new clinical placement we would be able to utilise an ‘ice breaker’ introduction sheet that opens the channels of communication and provides the opportunity for both the student and the clinical supervisor to express expectations, outline goals and establish a rapport. Conclusion Overall, we believe that participating in this research study was a very positive experience. Using a tool to have a conversation with our clinical supervisors allowed us as students to negate any feelings of fear or anxiety regarding communication with them or the facility in general. We believe that communication barriers that may have been present before the research study were no longer present and establishing that initial and very crucial impression and rapport with the clinical facilitator and facility seemed effortless. Acknowledgement The students involved in this research would like to acknowledge and thank Maria Mackay, Carley Jans and Professor Jan Dewing for their wonderful support and encouragement throughout the research process and developing this blog.

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