key: cord-0686015-oznhdjdq authors: Goers, Jama; Mulkey, David; Oja, Kenneth title: A call to reform undergraduate nursing clinical placements date: 2022-02-24 journal: Nurs Outlook DOI: 10.1016/j.outlook.2022.01.005 sha: 838667f995e987008a4db33930bb582a2032bf19 doc_id: 686015 cord_uid: oznhdjdq nan Undergraduate nursing clinical placements became a universal challenge for academia and clinical practice partners during the coronavirus 2019 (COVID-19) pandemic. Many clinical practice partners canceled clinical rotations to focus on caring for patients, protecting students and faculty from contagion exposure, and conserving personal protective equipment (PPE) supplies for front-line staff. As a result of this action, nursing schools were forced to replace direct care clinical experiences with 100% simulation. While this seemed like a necessary reaction to the unknown of the pandemic, it caused a decrease in nursing knowledge and critical thinking that are obtained in direct care clinical experiences; consequently, many prospective nursing students were delayed from graduating due to clinical hours required by State Boards of Nursing (National Council of State Boards of Nursing, 2020). The cascade of canceling clinical placements prevented students from obtaining licensure and joining the nursing workforce. Traditionally, nursing student clinical experiences are blocks of time that correlate with curriculum progression and vary between clinical sites and locations. Traditional clinical experiences for nursing students have not followed a longitudinal model. Longitudinal clinical experience models have been well studied in medical education and other health disciplines. Exploring longitudinal clinical rotations for undergraduate nursing students could help with the deficits experienced during the COVID-19 pandemic by enhancing student learning in a single healthcare system. Longitudinal placements are gaining popularity as an alternative to traditional block rotations. Programs are considered longitudinal when a student has recurrent clinical placements in the same setting over time (Thistlethwaite et al., 2013) . Continuity is the organizing principle, with positive outcomes arising from the Available online at www.sciencedirect.com N u r s O u t l o o k 0 0 0 ( 2 0 2 2 ) 1 À3 www.nursingoutlook.org continuity of care, supervision and curriculum, and continuity with peers and systems of care. Continuity allows students to be immersed in a single health system and experience several related microsystems within a system (Hudson, Poncelet, Weston, Bushnell, & A Farmer, 2017) . Longitudinal placements provide enough time for the continuities of care, supervision, assessment, learning, and context to be established (Ellaway et al., 2013) . In addition, students can establish relationships between education and practice while meeting their professional goals and objectives (Ellaway et al., 2013) . Discontinuity creates an inefficient and disjunctive system that produces frustration and anxiety in learners and challenges for teachers (Hudson et al., 2017) . There is some debate on how long a program needs to be in order to be considered longitudinal. A few weeks are insufficient, and while a whole year seems to be long enough, it may be more time than some schools can secure (Ellaway et al., 2013) . Too short a time may increase student's anxiety about the demands of the program without allowing students to reap the benefits or for preceptors to benefit from their learners' contributions to their practice (Ellaway et al., 2013) . Students may experience feelings of uncertainty up to complete disorientation and confusion regarding their professional knowledge and abilities for the first 3 months and may require up to 7 months to build confidence (Dub e, Schinke, Strasser, Couper, & Lightfoot, 2015). It may take even longer for a student to be accepted as a team member and become an asset to the practice and not considered a burden (Ellaway et al., 2013) . Occasional relationship challenges between learners and preceptors may disrupt learning. Additional barriers to a longitudinal model may include the resistance of existing faculty to change (Ellaway et al., 2013) , departmental boundaries and culture, failure to recognize the value of this preceptorship model, and inflexibility from accreditation and regulatory bodies (Hudson et al., 2017) . In addition, student orientation is essential to optimize their level of preparedness (Roberts, Daly, Held, & Lyle, 2017) . The transition struggle might occur only once at the beginning of the rotation rather than at the start of each clinical rotation (Dub e et al., 2015) . Students who participate in a longitudinal clinical experience program have reported increased satisfaction, learning, engagement, personal growth, performance, and preparedness for practice (Dub e et al., 2015; Ellaway et al., 2013; Roberts et al., 2017) ; increased confidence as a result of repeatedly encountering common conditions and completing standard procedures (Dub e et al., 2015) ; improved understanding of the culture of their placement context and contribution to the learning environment (Ellaway et al., 2013; Roberts et al., 2017) ; increased opportunities for richer teaching experiences such as peer teaching, team teaching, and interprofessional learning with other health professional learners (Ellaway et al., 2013) ; enhanced relationships between schools, clinical faculty, and partner communities (Ellaway et al., 2013) ; and sustained relationships for learning (Hudson et al., 2017) . A longitudinal clinical placement model has the potential to benefit both academia and clinical practice partners. One benefit of the longitudinal model is the consistency in clinical placements for nursing students. Nursing students will only have to orient to the clinical setting once during their clinical experience instead of at the beginning of each rotation. The reduction in orientation time will allow preceptors to focus more on patient care rather than orienting to the institution. The PPE, such as N-95 masks, are specific to each healthcare system. N-95 fit testing for longitudinal clinical placements guarantees the students have the appropriate PPE during their clinical rotations, allowing them to continue to learn in the clinical setting. In addition, clinical practice partners will have a direct pipeline of potential nursing students already oriented to their institution. This may increase the nursing applicant pool and decrease the amount of orientation time required for new-hire nurses. This innovative approach to hiring may, in turn, address the current demands of the nursing workforce. It is evident that undergraduate clinical placements merit greater attention. Now is an ideal time to reform the traditional clinical placement model, given the heightened attention on the nursing workforce due to the COVID-19 pandemic. Collaborative efforts among academia and clinical practice partners are needed to develop a creative approach for undergraduate clinical placement models that all institutions support. A longitudinal clinical placement program may promote more consistent student experiences while reducing the burden of orientation and preceptor time. A longitudinal model may allow academia and clinical institutions to truly partner together and create a commitment to educating the next generation of nurses. Conceptualization, Writing-original draft, Writing À Review & Editing, Supervision. David Mulkey: Writing À original draft, Writing À Review & Editing. Kenneth Oja: Writing-original draft Transition processes through a longitudinal integrated clerkship: A qualitative study of medical students' experiences Twelve tips for designing and running longitudinal integrated clerkships Policy brief: U.S. nursing leadership supports practice/academic partnerships to assist the nursing workforce during the COVID-19 crisis Social learning in a longitudinal integrated clinical placement A review of longitudinal community and hospital placements in medical education: BEME Guide No. 26 This research did not receive any specific grant from funding agencies in the public, commercial, or not-forprofit sectors.