Difficulties of a nurse educator-Current and Future Educational Challenges for the Nurse Educator

Clinical education is the heart of professional education in nursing. The perspective of nursing students and clinical nursing educators as the main owners of teaching—learning process are of determinants affecting clinical education process. This study was conducted to explore and to describe the clinical education problems and strategies to improve it from the perspective of nursing students and clinical nursing educators. The study was conducted using a descriptive qualitative method in Participants included 35 baccalaureate nursing students and 5 clinical nursing educators from nursing faculty of Isfahan University of Medical Sciences, Isfahan, Iran.

Difficulties of a nurse educator

Difficulties of a nurse educator

Difficulties of a nurse educator

Difficulties of a nurse educator

Difficulties of a nurse educator

References 1. Status and strategies for improving nursing education in view of nursing students in Ardebil University of medical sciences. The lists of available congress participants were used, from which a record containing 1, e-mail addresses was drawn up. Hematimaslakpak M, Khalilzadeh H. Addison-Wesley; Menlo park: The opinions of the instructors Difficulties of a nurse educator the difficulties edicator experienced in the clinical environment were examined under 6 categories: Instructor-related difficulties, Student-related difficulties, Patient Care-related difficulties, Physical Environment-related difficulties, Nurse Team-related difficulties and Health Care Team-related difficulties. In this regard, the participants' experiences showed that insufficient readiness of student including insufficient Difficulties of a nurse educator students' inadequate mastery of cognitive components of clinical skills; and inadequate mastery of clinical skills in the skill lab have disturbed clinical education process.

From here to eternity wife. Introduction

International; Padstow, Cornwall, Great Britain: July 6th, 3 Comments. Faculty members fear that Diffficulties educators may instruct nursing students q they instruct novice nurses. Although the university faculty member group included two faculty members from the same university, all other participants in the group belonged to different universities and were not acquainted. A slight majority said they taught because of their love for the profession, while just a few Hot indian big tits them mentioned concern for Secret video of sex community, and their desire to improve quality of care Difficulties of a nurse educator reasons why they taught despite the lack of incentives. In general, the hospital s the authority to make Difficulties of a nurse educator decisions about taking in the clinical practice program or not, so that faculty members refrain from commenting to avoid issues like clinical practice programs being refused or a decrease in student acceptance. As reported by Japan Academy of Nursing Education[ 6 ], approximately half of all nursing education institutions in Japan conduct clinical practice at hospitals established by the same organization, such as universities, governments and healthcare corporations. Share Lf Page. Despite the importance of clinical teaching to the nursing Difficulties of a nurse educator, in multiple settings, Cameroon inclusive, student nurses are often taught by clinical nurse educators who usually have little or no prior formal teaching [ 1 ]. Make Your Voice Heard.

Clinical teaching is an important component of clinical education.

  • To clarify the current state of communication between clinical nursing educators and nursing faculty members and the perceived difficulties encountered while teaching nursing students in clinical training in Japan.
  • Clinical teaching is an important component of clinical education.
  • Nursing and healthcare are currently riding a steeply cresting wave of change and innovation.

Clinical education is the heart of professional education in nursing. The perspective of nursing students and clinical nursing educators as the main owners of teaching—learning process are of determinants affecting clinical education process. This study was conducted to explore and to describe the clinical education problems and strategies to improve it from the perspective of nursing students and clinical nursing educators. The study was conducted using a descriptive qualitative method in Participants included 35 baccalaureate nursing students and 5 clinical nursing educators from nursing faculty of Isfahan University of Medical Sciences, Isfahan, Iran.

Participants were selected using purposeful sampling method. Data were collected through semi-structured individual interviews and used qualitative content analysis for analysis. The 2 main categories, 7 subcategories, and 19 sub-sub categories extracted from interviews. One of the key characteristics of nursing as a science and profession is that its education requires a close relationship between theoretical domain and clinical domain. This means nursing is not educated only theoretically or clinically.

In Iran, nursing education program is offered by nursing faculty. Entry into nursing undergraduate is possible through centralized entrance examination taken throughout the country. It has 4-year course during 8 half academic years in the form of theoretical courses 70 units and clinical courses 65 units.

Students are apprenticed after or at the same time as learning theoretical courses. Clinical education is mainly done by faculty members. Without clinical education, training competent and efficient nurses is a distant goal, and any problem in clinical education makes their efficiency flawed.

According to a study by Kelly, poor preparation of clinical instructors and according to other studies,[ 8 ] fear and anxiety of making mistakes have been addressed as the problems of students in clinical education environment.

Studies performed in Iran show that there is a relatively deep gap between nursing education process and clinical practice. So that with existing clinical education, student does not gain the ability required for authenticating their merits and clinical skills and the education does not have required effectiveness.

What are the problems? This is a question that researchers try to find out its answer. In addition, to improve and enhance the quality of clinical education, it is required to continuously assess existing situations, to recognize the strengths, and to improve the weaknesses, and in this regard, opinions of clinical educators and students as the real owners of teaching—learning process can be the strategies for improve the education programs.

Thus, the present study has been aimed to disclose the problems of clinical education in nursing and to provide the strategies to improve it. This study was conducted to explore and to describe the clinical education problems and strategies to improve it. To achieve such an aim, clinical nursing educators and nursing students' experiences and perceptions about clinical education were examined through a descriptive qualitative method.

The goal of qualitative descriptive studies is to provide a comprehensive summary regarding everyday events. These studies are less interpretive than other qualitative approaches such as ones based on phenomenological or grounded theory.

Participants were selected from among the clinical nursing educators and nursing students of Isfahan University of Medical Sciences IUMS , Isfahan, Iran, with at least one clinical education course at hospital and interested in participating in the study. Sampling performed with maximum variation by considering the characteristics of participants regarding age, gender, half school year of students and clinical educators' years of clinical education, and their perspectives and experiences.

The data were collected from January to February using semi-structured individual interviews with the participants. All interviews conducted in a private room at the hospital or faculty.

The time and place of the interview determined with the participants' consent. The interviews were in-depth and semi-structured and began with general questions and continued with the main research questions, including:. The interview duration was 30—45 min. Selection of participants and data analysis continued to reach a saturation point where no new concept emerges from data analysis. Data saturation refers to the repetition of discovered information and confirmation of previously collected data.

This study used inductive qualitative content analysis, so we employed the qualitative content analysis method of Graneheim and Lundman for data analysis. First, SEF independently selected all meaning units sentences or paragraphs extracted from the participants' statements and condensed the meaning units of two selected manuscripts one clinical educator and one student.

After that, the authors discussed the meaning units; after resolving discrepancies, SEF extracted the condensed meaning units from the remaining transcripts and reviewed them with SAF and MSH. Finally, similar codes grouped into specific subcategories using an inductive process involving constant comparison, reflection, and interpretation by SEF. This study employed confirmability, credibility, dependability, and transferability to achieve the various aspects of rigor indicated by Guba.

To obtain the credibility, information approved by peer debriefing and reviews of the data, codes, subcategories, and categories. Recruiting participants with different demographic characteristics enhanced transferability of the findings. Verbal and written informed consent obtained from participants. After the introduction of the researcher and stating the importance and the objectives of the survey, the allowance of participants to interview obtained.

Participants confided that the information would remain confidential. We used numeric codes in place of personal names to secure the confidentiality of the interviews.

The participants were free to withdraw from the study anytime. Mean age of nursing students and clinical educators were 23 and 45 years, respectively. After analyzing the interviews, 2 main categories, 7 subcategories, and 19 sub-sub categories emerged [ Table 1 ]. The experiences of participants indicated that clinical educator's incessant criticism during the procedure and student's fear of improper care of the patients have impaired learning process.

I feared because after changing the wound dressing, clinical educator always says: why do you do it in that way? Attendance of patient relative at bedside and evaluating the students during the procedure were of the participants' experiences causing fear and inability in students, and consequently, they could not transfer their skills to clinical environment. Two of his relatives were there. I was always worried about what I do. I started to do venipuncture with fear and unfortunately I did not succeed.

In this regard, the participants' experiences showed that insufficient readiness of student including insufficient self-confidence; students' inadequate mastery of cognitive components of clinical skills; and inadequate mastery of clinical skills in the skill lab have disturbed clinical education process.

Clinical educator as a major component of the education process plays a key role in effective clinical education. Participants' experiences indicated that many clinical educators do not have the necessary clinical skills and also do not teach nursing procedures directly. The participants said that clinical educators do not provide the necessary feedback after the students perform the skills, so students are not sure of the correctness of their performance.

I said yes. Inappropriate behaviors of doctors and nurses with nursing students and clinical educators and being neglected in clinical environment by doctors and nurses have reduced the participants' willingness to teach and to learn. Hence, they remember clinical environment as degrading environment.

In addition, the participants said that the nurses behave with medical students better and pay no attention to nursing students. These dual behaviors make nursing students disillusioned and unmotivated. The participants' experiences show that the doctors do not trust nursing students compared to medical students and this make nursing students disillusioned. He was surprised and said medical student to check the patient's pulse. The doctor left the room without paying any attention to me.

The participants suggested the using nursing education models and methods including nursing process, simulation, and peer learning in clinical education process as strategies to improve the education. They believed that nursing process enhances students' critical thinking and simulation through reducing the fear of harming to the patients improves the students' learning.

In addition, majority of the students said that the attendance of the students of higher semesters besides them enhances their learning. Simulation is one of the strategies suggested to enhance the clinical education by the participants. The experience of participants showed that the relationship between faculty and practice is an affective factor improving the clinical education process.

In addition, with the participation of clinical nurses in clinical education process, it can be helped to improve the relationship between the faculty and clinical environment to reduce the gap between theory and practice.

The participants' experiences indicated that, when clinical nurses are involved in education process, they will have a sense of responsibility and close relationship with students and the faculty and also will behave with nursing student better.

This reduces the degrading atmosphere of clinical environment. Many times, we don't know what we will learn and do and how we will evaluated. If the lesson plan is provided at the beginning and the training course continues according to it, repetition will be prevented…. In addition, the students said that after providing lesson plan, the clinical educator should examine the cognitive and emotional domain of the student before clinical skills education, and if it is necessary, reforming measures should be taken.

This study aimed to explore and to describe the experiences of nursing clinical educators and nursing students about clinical education problems and to provide the strategies to improve it. Fear is one of the problems experienced by the students. This result is consistent with the result of the study by Tahery et al. Inadequate skill of clinical educator in doing nursing procedures and indirect teaching were other problems noted by the participants.

Kelly in his study stated that clinical educator needs theoretical knowledge and practical skills to teach the nursing procedures. The students stated that the educator should criticize the students' performance and gives feedback to them.

Improper feedback causes disillusionment. To educate effectively, knowing the student's characteristic is very important. Despite the availability of proper education conditions, if the student is not in proper situation, the education cannot be done effectively. The participants' experiences indicated that the students did not acquire the necessary skills to do the procedures in clinical skills laboratory.

In addition, they do not have cognitive knowledge required for doing the procedure. In this regard, a study by Alavi and Abedi showed that, before clinical education, the students should acquire necessary preparation such as theoretical and practical knowledge for doing the procedures. Before starting the clinical education, the clinical educator must ensure that the student is ready cognitively and emotionally, and if there is any defect, required education should be provided.

The participants stated that doctors and nurses don't behave them well compared to medical students and they do not take the necessary support. The studies showed that improper behavior of the clinical staff causes negative attitude and discomfort of the students[ 8 ] and clinical staff can help to create a supportive learning environment through proper relationship with nursing students. The participants offered nursing process, simulation, and peer learning as the strategies to improve the clinical education.

Nursing process is an organized and systematic approach that nurses use it to care needs of patients. Despite the emphasis of Iranian nursing curriculum on the use of the nursing process in clinical education, according to the participants, it is not used effectively, so they emphasized on the full implementation of the nursing process in clinical education. In this regard, Adib-Hajbaghery et al. Today, with the teacher-centered to student-centered paradigm shift in education, using active strategies including peer learning is taken into consideration.

In some categories, the opinions of educators matched those of the faculty members, whereas in others, the problems differed according to position. Article PubMed Google Scholar The interviews were recorded and transcribed with the consent of the interviewed participants. The following resources are helpful to schools of nursing looking to accommodate students with disabilities. Often, even when faculty members come to supervise, it is brief. Faculty members need to become role models for education and to verbalize the aim of each educational relationship to make clinical educators aware of these differences. Also, when clinical educators ask students if they have learned a particular technique, they often give an ambiguous answer.

Difficulties of a nurse educator

Difficulties of a nurse educator

Difficulties of a nurse educator

Difficulties of a nurse educator. 6 essential traits of nurse educators

The average years of service as a nurse were Inclusion criteria for faculty members specified that the candidates were required to have been in charge of basic nursing or adult nursing classes and have had directly instructed students within the past year. Seven faculty members from one technical college and four community colleges and universities participated in the FGIs.

Four were assistant professors and one was an associate professor. FGIs were conducted for 60—90 minutes with six groups comprising clinical nursing educators, nursing technical college faculty members, and nursing university faculty members in each group Table 1. Interviews with faculty members were conducted in meeting rooms at the affiliated community college of the researchers, and interviews with clinical nursing educators were conducted in meeting rooms at the affiliated hospitals of clinical nursing educators.

Six FGIs were conducted. The average duration of the interviews was 81 minutes. Although the university faculty member group included two faculty members from the same university, all other participants in the group belonged to different universities and were not acquainted. The interviews were recorded and transcribed with the consent of the interviewed participants.

The FGIs were analyzed focusing on the perceived difficulties encountered while teaching nursing students in clinical practice. As per Lofland and Lofland[ 26 ], interview transcripts were repeatedly read and coded to express interview content as conclusions for each unit of meaning. The data were coded by one person, who played roles as both coder and interviewer.

The coding process was started after finishing all of the FGIs to reduce influences on the derivation of themes. Subcategories arose from the coding, and categories were extracted from the subcategories.

Coding process were supervised by a researcher who is experienced in qualitative data analysis. A member from each group was requested to check the validity of the analysis, but only two FGI participants joined in the member checking activity. Their opinions were solicited on the validity of the categories. Interviews were conducted after obtaining written consent and after explaining that survey collaboration would be independently undertaken and that uncomfortable questions were not required to be answered.

Participants were assured that individuals and affiliated institutions would not be disclosed. Difficulties in providing clinical practice teaching for nursing students mentioned by both clinical educators and faculty members were classified into four categories, as discussed below and as shown in Table 2. In some categories, the opinions of educators matched those of the faculty members, whereas in others, the problems differed according to position.

Clinical educators and faculty members stated that the difficulty of directly exchanging opinions was the primary problem in clinical practice teaching for nursing students, which they avoided to escape being criticized or offending their counterparts.

Clinical educator. A clinical educator, aware of the importance of exchanging opinions for problem resolution, said that because of her experience, she gave up exchanging opinions with faculty members, and so she entrusts the problem solving to others. From this incident, I determined that improving communication with the faculty members would benefit both sides. A case involving a difference in opinion with a faculty member When our attitudes were similar, I could tell my opinion to a faculty member.

But when our attitudes were not similar, I experienced difficulty in telling her my opinion. When I worked as a clinical educator, sometimes I was afraid of the nursing faculty. And I thought that the faculty might laugh if I said something incorrect.

Faculty member. Thus, clinical educators may tend to avoid direct opinion exchange because of the differences in educational background of faculty members and students. One faculty member spoke of an instance arising from consulting with an educator:. Conversely, some faculty members felt that they could not criticize training facilities and educators because they had requested the clinical practice opportunity.

In general, the hospital has the authority to make the decisions about taking in the clinical practice program or not, so that faculty members refrain from commenting to avoid issues like clinical practice programs being refused or a decrease in student acceptance.

Although increasing clinical instructor educational influence on students is expected, expressing expectations of greater intervention are avoided because of the difficulty of such requests. Nurses would say that sometimes they could not supervise the students when they were busy because of their responsibility to turn over the beds.

And the tendency is especially strong when the hospitals face a new fiscal year when new nurses commence work. I can completely understand that. But clinical educators think that it is difficult for nursing students to administer these treatments to patients at the clinical practice site[ 27 ]. We often entrust care-related teaching to the nurses.

If the individual nurses show consideration in such aspects towards patients, the students will also remember to consider such points. I know that the range of techniques that nursing students can perform has increased. One day, I asked a faculty member if a nursing student could perform a certain technique such as urinary catheter insertion.

Therefore, we have to take responsibility if a problem arises, and thus we are hesitant to let the students perform certain techniques. Before the clinical practice program begins, the faculty members and clinical educators have a meeting to discuss and confirm in writing and through verbal conversation which clinical practice goals, content, and techniques are to be taught. Despite this, educators do not always seem to completely understand these contents.

Although I received written materials on techniques to be taught and demonstrated in clinical practice at the meeting, I did not actually have the time to read them.

Even if the student expresses a desire to attempt many kinds of nursing techniques, it can be difficult because I am unsure of the extent of their training.

Also, when clinical educators ask students if they have learned a particular technique, they often give an ambiguous answer. Additionally, there is not sufficient time to talk with clinical educators and faculty members during the clinical practice program.

Therefore, clinical educators tend to avoid clarifying what the students have learned and to simply let the student perform various nursing techniques.

This is based on a holistic assessment of the patient through the nursing process. However, at the clinical site, nurses tend to pay attention to the disease and its treatment rather than to the holistic point of view. Because novice nurses should concretely understand pathophysiology and treatment of disease in the course of their work, their training emphasizes this point.

Faculty members fear that clinical educators may instruct nursing students as they instruct novice nurses. Some educators have acknowledged that the anticipated achievements of nursing students may be confused with those of novice nurses.

We expect students to ask many questions of us, but I have realized that we have this expectation because this is our approach to the novice nurses, to encourage them to ask many questions.

However, students and novice nurses are not the same, and treating them the same would be stressful for the students and for us. I want students to actively approach their training. Instead of expecting us to instruct them, we want them to approach us with their own goals for what they want to do. Many students seem to wait for someone to approach them because they have been brought up in an environment where people offer help before the students have to ask for it.

Issues raised by faculty members included students blaming others without reflecting on themselves and not being good at coping with stress. A student got angry at having to repeat the clinical practice for a certain thing. Some students faced this problem in clinical practice, despite the emphasis of direct interaction with patients and on determining patient needs by observation.

Problems mentioned included an unsuitable clinical environment, inability to obtain information from patients, and inability to incorporate the information obtained from patients into care. One clinical educator questioned whether sufficient time was being spent with patients.

Some students are insensitive to the opinions and ideas of patients and make decisions based on their own perspectives even after speaking with patients. This is usually recognized by faculty members before the clinical practice program, becoming clear from interviews between student and teacher at school and conversations with students of these schools. Faculty members have addressed the issues that such students are unable to devote themselves to clinical practice and that relationships between patients and the nursing process do not progress past a superficial level because of the absence of a clear goal to become a nurse.

Since a mother had urged her daughter to become involved in the medical field and she had qualified on the exam, the student enrolled in nursing school although she was not particularly interested.

Few differences were observed between faculty members and clinical educators in in dealing with students who demonstrate a low level of readiness for clinical practice, as both groups struggled in a similar manner with these problem students. Concerns were raised that learning effectiveness in clinical practice is diminished because of human and time limitations in teaching.

Sometimes we are unaware of the progress of our students, their nature, or their ambitions because we are teaching and managing patients simultaneously. Teaching five or six students in one ward is difficult. In some facilities, one faculty member is in charge of multiple wards; therefore, they cannot be in one ward for very long, making it difficult to find the time to talk with students.

Clinical educator dissatisfaction with faculty member limitations was particularly pronounced when teaching content for students was insufficient. Because nurses face difficulties in supervising students who are poor learners, students should seek educational advice from faculty members.

Often, even when faculty members come to supervise, it is brief. Therefore, we have had problems because faculty members were unavailable when students had difficulties in their studies. Although the clinical nursing educators and staff nurses usually teach students when they provide direct care to patients, support from faculty members is expected when clinical educators and staff nurses are busy.

This was a source of dissatisfaction. Based on FGIs of clinical nursing educators and faculty members providing clinical practice programs in Japanese hospitals, the problems of teaching in clinical practice were classified into four categories, as discussed below.

This may aggravate the sense of alienation between the two groups. Nevertheless, there seems to be inadequate communication between clinical educators and faculty members at the teaching sites.

One study has revealed that there have been difficulties in the UK in strengthening the relationship between the clinical and educational sectors due to insufficient time[ 10 ]. We observed this cultural characteristic in the relationships of clinical educators and faculty members, which lacked frank opinion exchange and involved vague information exchange.

Securing new training hospitals has proven to be problematic for some communities in Japan as the establishment of new nursing universities continues. Accepting clinical training programs for the hospitals provides the opportunity to evaluate nursing quality by improving nurse teaching abilities. Creating a system whereby hospitals benefit from offering clinical training guidance is important for conducting effective training. In addition, the articles reported the inability of faculty members to propose specific learning methods for each training progression[ 22 ].

For faculty members, the goal for students in providing nursing care is to demonstrate a profound understanding of the physical and psychological aspects of patients while properly administering basic nursing techniques learned in school, such as sanitary care and physical assessment. However, in the clinical setting, basic nursing techniques that are given high priority in school are neglected. Clinical educators observe that teaching treatment-related techniques is difficult because it is unclear who will be responsible for the techniques that students must administer during training, including medication, injections, and urethral catheterization.

Allowing students to administer techniques after confirming their technical level places an enormous burden on clinical educators and staff nurses. Langan[ 7 ] observed this tendency in the United States. Gaberson and Oermann[ 32 ] emphasize that academic skill and clinical ability are required for nursing faculty; however, Japanese faculty members who engage in faculty practice are uncommon[ 29 ].

Faculty members need to become role models for education and to verbalize the aim of each educational relationship to make clinical educators aware of these differences. Although the proportion of students with a low level of readiness for training was not determined in this study, all clinical educators and faculty members in FGIs commented on the difficulties of relating with such students.

Unwilling students with low motivation may negatively influence other students and increase the time that faculty members and clinical educators spend on their issues, thereby reducing teaching time with other students, exhausting the faculty members and clinical educators, and rendering them unable to make a fair evaluation[ 34 , 35 ].

Unwillingness, emotional immaturity, and lack of patient-centered thinking can be signs of psychological problems, such as students having family problems or depression, low sense of self-esteem, and so on. Some problems might be difficult to solve during clinical practice programs. In Japan, faculty members and clinical educators often work together in teaching nursing to students in clinical practice.

However, clinical educators must handle student education when faculty members cannot teach at the clinical site. These findings are consistent with those of Langan[ 7 ] and Clifford[ 10 ]. Although clinical educators can allocate time to support the care provided by students, it is difficult for them to supervise students when not performing direct care.

When clinical educators are too busy, they expect faculty member to teach students direct care and check their assessment, but faculty members are often away from the clinical site. Allocating time for discussions with faculty members is not possible. Thus, a sense of inadequacy in teaching and uncertainty about the school and faculty members may arise.

Because of manpower constraints, some faculty members are in charge of multiple wards. They still feel the strain of their teaching role, whereas clinical educators consider the involvement of the faculty members to be inadequate. Gaberson et al. Some clinical educators have expressed dissatisfaction that faculty members entrust the supervision of patient care provided by students to clinical educators.

For faculty members, clinical ability diminishes as teaching experience increases, leading to the possibility that faculty members may lose confidence in their ability to conduct patient care.

Although as faculty members they want to prioritize support for student learning over patients, as nurse-educators, they want to prioritize the fulfillment of patient needs. However, students are the main priority of those involved in nursing education.

The result of proper training of the students will be passed on to the patients as excellent care. Faculty members and clinical educators must ensure that excellent care is the ultimate goal of nursing education. However, some sub categories were different between the groups. If clinical educators recognize that some faculty members think that way, it can be a cue to start discussions to solve the problems arising in the clinical practice programs.

Rather than criticizing clinical educators, this shows acceptance of the difficult situation of nursing educators. Fear of criticism might be a cause of lack of communication between faculty members and clinical educators. Jones, Robin. Marks, B. Journal of Nursing Education, 46 2 , Success for Students and Nurses With Disabilities. Neal-Boylan, L. Treat me like everyone else: The experience of nurses who had disabilities while in school.

Clinical teaching is an important component of clinical education. In nursing, clinical teaching is ensured by clinical nurse educators CNEs. This study aimed at describing the major challenges faced by CNEs in Cameroon. A total of 56 CNEs participated in the study, of whom, as many as CNEs attributed these challenges in major part to the lack of incentives and poor health policies.

CNEs in Cameroon do indeed face major challenges which are of diverse origins and could adversely affect teaching in clinical settings. Nurses constitute an important element of the medical team. Clinical teaching lies at the heart of nursing education and its importance cannot be overemphasized. This is because it is in the clinical setting where student nurses are primed for the reality of their professional roles. In other words, clinical teaching and learning helps to prepare students for the kind of work they will have to do as practicing nurses.

Therefore, clinical practice enables student nurses to become competent practitioners. Despite the importance of clinical teaching to the nursing profession, in multiple settings, Cameroon inclusive, student nurses are often taught by clinical nurse educators who usually have little or no prior formal teaching [ 1 ].

Indeed, there are no guidelines to assist clinical nurse educators on how to effectively teach and supervise student nurses. As a result, they face challenges and may not adequately teach, guide, supervise and assess student nurses during clinical placements, thus potentially reducing their effectiveness as educators. Considering that effective clinical teaching is vital for quality nursing practices, and because of the importance clinical nurse educators are to the profession, there is a need for clinical nurse educators in particular and the health system in general to identify and address the challenges faced by clinical nurse educators.

An understanding of these challenges could provide a template for the clinical nurse educators to be empowered with teaching skills and thus improve teaching outcomes. This informed the objective of this study. Specifically, we sought to describe the major challenges nurses faced as clinical educators, identify the factors responsible for these challenges, assess the impact of the challenges on the quality of clinical teaching and supervision, and describe strategies used by CNEs to overcome these challenges.

The ultimate goal is to provide data that could ensure good nursing practice after training. This was supplemented by quantitative analyses. The study population was made up of clinical nurse educators who had taught for at least three years and gave their consent to participate in the study. These sites represented rural, semi-urban and urban areas respectively. A sample of 24 clinical nurse educators were enlisted in each health district giving a total of 72 participants envisaged for the study.

In each district the 24 CNEs were selected by consecutive sampling at the major hospital in the district. Questionnaires made up of both open and closed ended questions were used to collect data. Before administering the questionnaire was pre-tested to validate study questions.

This was done by administering ten copies of the questionnaire to ten clinical nurse educators who were not part of the study population. Their responses confirmed the clarity and validity of the questions. The questionnaires were then administered to the selected study participants who completed the various sections of the questionnaires.

Data collected were entered into an electronic dataset. Data were analysed using both qualitative and quantitative methods. Key themes which emerged from the responses were identified and grouped into predetermined categories. For the quantitative data, frequencies of responses were determined. All respondents provided written consent before responding to the questionnaire. A total of 56 out of 72 clinical nurse educators participated in the study giving a response rate of Approximately a-third of the participants came from each health district Table 1.

Females made up As many as The major challenges faced by CNEs could be grouped into two: those related to their students and those related to the CNEs themselves or their environment.

Amongst the challenges related to the CNEs, the lack of opportunities to update knowledge and skills A number of factors were enumerated as being responsible for the challenges Table 3. These ranged from lack of financial incentives The lack of financial resources and high workloads were also mentioned as being responsible for challenges. As hypothesised, the challenges had a series of negative impacts on the training of student nurses Table 4.

Study participants reported that these challenges influenced the quality of clinical teaching in many ways including making teaching difficult Consequences of challenges clinical nurse educators face on the quality of clinical teaching and supervision. A variety of strategies were reportedly employed to deal with these challenges Table 5. Study participants reported improvising There is little or no information on the challenges nurses faced as clinical educators in Cameroon.

This is perhaps because of little interest on clinical teaching methods in our setting. This study which was aimed at investigating the challenges nurses faced as clinical educators in Ekondo Titi, Buea and Limbe health districts in the South West Region of Cameroon, serves as a first step in understanding the challenges this group of nurses face during clinical teaching and supervision. This agrees with Irby [ 3 ] who holds that teaching in the clinical setting is not without challenges.

The challenges were of diverse natures. Hence, students should be allowed to spend adequate length of time in clinical placements. This finding is in line with a study carried out by Penman and Oliver [ 5 ] in South Australia which indicated that students on clinical placement felt they were inadequately prepared for clinical learning.

It was further revealed that students lack orientation before clinical placement as well as lack basic knowledge and skills to carryout common procedures. Students could be prepared by preceding each clinical teaching session with clearly spelled-out objectives, reading materials and demonstration in the skills lab. Some of the clinical educators were dissatisfied with the number of students they supervised per placement , and some of them further reported large number of students during clinical placement as challenging.

Therefore to reduce the challenges nurses face during clinical teaching, the number of supervisee per supervisor should be moderated. It was also found that some students did not take clinical learning seriously. The clinical educators further reported that some students were irregular, lacked respect for staff, and were not willing to learn.

This is in line with Cederbaum and Klusaritz [ 7 ] who state that clinical instructors may encounter difficulties with students such as personality conflicts and lack of interest on the part of the students. While some of the challenges as described above were related to students, many other challenges were related inherent to the clinical educators. Clinical nurse educators reported that they lack knowledge in certain areas of nursing and they were often challenged by some students.

This study agrees with McAlister et al. The question that often comes up is whether or not they are up to date with knowledge and their ability to teach and model skills. Effective clinical educators need to be well prepared and keep updated with current trends in nursing. In addition, clinical educators need to possess effective communication and professional teaching skills.

Nurses in general, and clinical nurse educators in particular, need to keep updated with the continuously changing nursing knowledge. In a study conducted by Morag and Lorraine [ 9 ] it was found that student expected their clinical teachers to be knowledgeable and skilled in the field of nursing.

Health care is always changing therefore nurses must seek continuing education. About half of the clinical educators did not receive financial incentives for clinical teaching. Lack of incentives was also listed as one of the difficulties they faced.

This implies that clinical educators may not be sufficiently motivated to teach. It was interesting to discover that even without financial incentives, this group of nurses still taught the students on clinical placements. A slight majority said they taught because of their love for the profession, while just a few of them mentioned concern for the community, and their desire to improve quality of care as reasons why they taught despite the lack of incentives.

Wright [ 11 ] stipulates that nurses involved in clinical education tend to be energetic individuals with an infectious enthusiasm that comes from self confidence, excitement about nursing and pleasure in teaching. A high proportion of the clinical educators were not well prepared for clinical teaching.

Clinical nurse educators should be well prepared and trained in order for them to produce competent nurses who will carry out safe patient care. The study also revealed that there are difficulties such as lack of orientation for clinical teaching, lack of knowledge in some areas of nursing and lack of clinical supervision. These findings suggest that those who supervise students may be insufficiently equipped for the role. Limited time for clinical teaching was also a problem.

This is in conformity with Craddock [ 15 ] who states that in a busy setting, there may be limited time for teaching and feedback. Therefore clinical educators should be well prepared in order to be equipped with clinical teaching skills to enable them maximise clinical teaching time.

The lack of working materials on the part of the students and inadequate teaching materials were further listed by nurses as challenges faced during clinical teaching and supervision. The often old and dilapidated hospital infrastructures could worsen the situation indicating that some of the challenges faced by clinical nurse educators may stem from sectors other than the health sector - thus addressing these challenges may also require a multi-sectorial approach.

The perceived factors responsible for these challenges are poor government policies, laxity on the part of the hospital administration, negligence on the part of the government and poor health care policies.

Some mentioned lack of orientation to the clinical teaching task, no opportunities for further studies and heavy workloads. Nurses may be dissatisfied with their work because of their inability to attend continuing education programs or due to heavy workloads.

The challenges were perceived to have numerous consequences on the quality of clinical teaching and supervision. They made teaching difficult, impaired effective teaching and learning and led to poor teaching outcomes. To overcome these challenges, some of the clinical educators improvised, while others kept abreast with current changes in nursing by carrying out self research, by internet searches and by reading books. This agrees with Friendly and Roos [ 10 ] who state that, the internet provides a range of information such as tutorials, books, classes and scholarly journals which can help nurses to keep current.

It was interesting to note that, despite the absence of a formal continuous education system with certification, a substantial proportion of CNEs carried out continuous learning and research in nursing by themselves. This implies that nurses are aware of the current changes in nursing or that nursing is constantly evolving and they need to keep current. A few limitations to this study need to be recognised. The use of a non-probability sample may have reduced the representativeness of our study sample.

A further limitation of this study is the premise that training nurse educators would increase their output as educators. We could not identify any study in a sub-Saharan setting that evaluated the impact of training and or providing incentives on CNEs, on their output.

Difficulties of a nurse educator

Difficulties of a nurse educator