"Let's Call a Spade a Spade. My Barrier is Being a Black Student": Challenges for Black Undergraduate Nursing Students in a Western Canadian Province.

BACKGROUND: We need more understanding of experiences that hinder or promote equity, diversity, and inclusion of Black students in undergraduate nursing programs to better inform their retention and success. PURPOSE: To explore documented experiences of Black undergraduate nursing students, review barriers affecting their retention and success, and suggest evidence-based strategies to mitigate barriers that influence their well-being. METHODS: We used a focused qualitative ethnography for recruiting Black former and current students (N = 18) in a Western Canadian province's undergraduate nursing programs via purposive and snowball sampling. Most participants were female, 34 years or younger, with over 50% currently in a nursing program. Five participants later attended a focus group to further validate the findings from the individual interviews. Descriptive statistics were used to describe participant characteristics; we applied a collaborative constant comparison and thematic analysis approach to their narratives. RESULTS: Challenges influencing Black students' retention and success fell into four main interrelated subthemes: disengaging and hostile learning environments, systemic institutional and program barriers, navigation of personal struggles in disempowering learning environments, and recommendations to improve the delivery of nursing programs. Participants also recommended ways to improve diversity and mitigate these barriers, such as nursing programs offering anti-oppression courses, platforms for safe/healthy dialogue, and more culturally sensitive learning-centered programs and responsive supports. CONCLUSIONS: The study findings underscore the need for research to better define nursing program conditions that nurture safe, learning-centred environments for Black students. A rethink of non-discriminatory, healthy learning-teaching engagements of Black students and the mitigation of anti-Black racism can best position institutions to promote equity, diversity, and inclusion of Black students.

"You have to strive very hard to prove yourself": experiences of Black nursing students in a Western Canadian province.

OBJECTIVES: This study explored the experiences of Black students in two western Canadian undergraduate nursing programs. METHODS: Using a qualitative focused ethnography design grounded in critical race theory and intersectionality, participants were recruited using purposive and snowball sampling. Data were collected through individual interviews, and a follow-up focus group. Data were analyzed using collaborative-thematic analysis team approaches. RESULTS: n=18 current and former students participated. Five themes emerged: systemic racism in nursing, precarious immigrant context, mental health/well-being concerns, coping mechanisms, and suggestions for improvement. CONCLUSIONS: An improved understanding of Black student experiences can inform their recruitment and retention. Supporting Black students' success can potentially improve equity, diversity, and inclusivity in nursing education programs and/or their representation in the Canadian nursing workforce. IMPLICATIONS FOR AN INTERNATIONAL AUDIENCE: The presence of a diverse nursing profession is imperative to meet the needs to provide more quality and culturally competent services to diverse population.

The impact of cultural immersion international learning experiences on cultural competence of nursing students: A critical integrative review.

BACKGROUND: Cultural immersion international learning experiences (CIILEs) are commonly offered in undergraduate nursing education programs worldwide, often with the goal to enhance students' cultural competence. PURPOSE: The purpose of this integrative review was to explore the most recent existing literature concerning the impact of CIILEs on nursing students' cultural competence and to cast a critical eye on the findings. METHOD: We searched the CINAHL database for articles published from 2015 to 2019 and found 30 that met inclusion criteria. RESULTS: The majority of the studies were descriptive or qualitative designs and reported positive overall student cultural competence outcomes. CONCLUSION: The findings support the use of CIILEs with a critical eye for potential negative consequences. The authors recommend further longitudinal, observational studies to identify factors that facilitate substantial long-term positive outcomes.

'We have to drive everywhere': rural nurses and their precepted students.

INTRODUCTION: Travel safety culture is a vital aspect of nursing in rural western Canada, where long distances and severe weather are commonplace. However, this culture is poorly understood owing to the absence of official policy, and the tendency of rural nurses to take travel risks and burdens in stride, rather than advocating for change. Travel risks and burdens include extreme weather events such as tornadoes and blizzards; unmarked routes and hazards; distance, time and expense; and driver fatigue. In such rural settings, the safety and health of visitors, novices and students are of particular concern. The researchers sought to elicit the tacit knowledge of rural registered nurses, and their students undertaking rural nursing preceptorships, pertaining to rural travel issues and best practices for safety and wellbeing. METHODS: Through purposive and snowball sampling, the researchers recruited seven senior nursing students and five nurse preceptors. Seven rural acute and community care sites, between 42 km and 416 km distant from the students' primary place of study, were covered by the study. Photovoice, a participant action modality, was employed to collect photographic and qualitative interview data from participants over 10 weeks, between February and April 2016. The data were analyzed thematically, in collaboration with participants, who in turn validated the results. A digital storytelling initiative was attempted, to further involve participants in dissemination of findings, but only one participant took part in this phase of the project. RESULTS: The central finding of the study was that nursing students learn to accept and manage limitations - and to recognize and capitalize on opportunities - when undertaking rural preceptorships. With regard to road safety, the students were found to be particularly vulnerable to long distances, hazardous conditions, fuel and cellular data expenses, and fatigue. These issues were compounded by the students' reluctance to speak up, or to miss shifts, when they felt unsafe or unwell. Their preceptors role modeled autonomy and community ethos as the foundations of a frontline, extemporaneous road safety culture. This entailed personal safety measures borne from rural experience and background, familiarity with the countryside, and community connectedness with other healthcare sites in place of any official public alert system. The preceptors furthermore benefited from strong union protection for occupational health and safety concerns, but students being taught in rural settings had no such advantage. CONCLUSIONS: Nursing students should have the same occupational health and safety protections as their rural preceptors, especially the right to refuse travel, without penalty, in unsafe circumstances. Better travel subsidies and road safety measures during rural preceptorship may help increase the likelihood of students considering a rural career path. Furthermore, the frontline, community-based road safety experience of rural nurses is an untapped source of information for educators and policymakers. Such information will become more and more vital as a diminishing number of rural nurses are called upon to care for an aging client base.

Exploring the issue of failure to fail in a nursing program.

A study using a qualitative descriptive design was undertaken to explore the issue of "failure to fail" in a nursing program. Individual in-depth interviews were conducted with nursing university faculty members, preceptors, and faculty advisors (n=13). Content analysis was used to analyze the data. Results indicate that: (a) failing a student is a difficult process; (b) both academic and emotional support are required for students and preceptors and faculty advisors; (c) there are consequences for programs, faculty, and students when a student has failed a placement; (d) at times, personal, professional, and structural reasons exist for failing to fail a student; and (e) the reputation of the professional program can be diminished as a result of failing to fail a student. Recommendations for improving assessment, evaluation, and intervention with a failing student include documentation, communication, and support. These findings have implications for improving the quality of clinical experiences.

Putting the evidence into preceptor preparation.

The term evidence-based practice refers to the utilization of knowledge derived from research. Nursing practice, however, is not limited to clinical practice but also encompasses nursing education. It is, therefore, equally important that teaching preparation is derived from evidence also. The purpose of this study was to examine whether an evidence-based approach to preceptor preparation influenced preceptors in a assuming that role. A qualitative method using semistructured interviews was used to collect data. A total of 29 preceptors were interviewed. Constant comparative analysis facilitated examination of the data. Findings indicate that preceptors were afforded an opportunity to participate in a preparatory process that was engaging, enriching, and critically reflective/reflexive. This study has generated empirical evidence that can (a) contribute substantively to effective preceptor preparation, (b) promote best teaching practices in the clinical setting, and (c) enhance the preceptorship experience for nursing students.

Preceptorship: using an ethical lens to reflect on the unsafe student.

Patient safety has become a worldwide health concern, and health care professionals have a moral and ethical responsibility to promote patient safety. The clinical education of many health care professionals often involves a preceptorship or field experience wherein students are assigned to work one-to-one with a preceptor or field educator so that they can be socialized into the profession and receive a reality-oriented experience. Health care professionals who accept the responsibility of being a preceptor face additional workload and stress, especially when the students to whom they are assigned are not meeting the expectations of safe, professional practice. Taking a stand against unsafe students is an important way for preceptors to promote patient safety. Given the nature of the stress and the inherent ethical issues associated with precepting an unsafe student, it is useful to examine this experience through an ethical lens. Included in this article is a brief overview of preceptorship as a model of clinical education, together with a discussion of the nature of the ethical decisions that preceptors face when precepting an unsafe student. Ethical theories, namely, virtue ethics and utilitarianism, are also explored and serve to provide the ethical lens through which preceptors can reflect upon their experiences with unsafe students.

Characteristics of unsafe undergraduate nursing students in clinical practice: an integrative literature review.

Providing quality clinical experiences for nursing students is vital to the development of safe and competent professional nurses. However, clinical educators often have difficulty identifying and coping with students whose performance is unsatisfactory. The purposes of this integrative review were to examine the extent and quality of the literature focusing on unsafe nursing students in clinical settings and to describe the characteristics of nursing students considered unsafe in clinical settings. A structured literature search yielded 11 relevant articles: five theoretical articles and six research studies. Analysis of findings revealed three themes: ineffective interpersonal interactions, knowledge and skill incompetence, and unprofessional image. The themes reflected the attitudes, actions, and behaviors that influenced students' ability to develop a safe milieu for client care. The findings provide clarity for early identification of students in need of increased support and facilitate clinical educators in meeting students' learning needs to ensure patient safety.

Preceptorship: shaping the art of nursing through practical wisdom.

With so much emphasis having been focused on the development of nursing science and most recently on evidence-based practice, little attention has been directed toward the art of nursing or the practical wisdom that constitutes the spirit of that art. Practical wisdom is the performance of actions intended to preserve and enhance the well-being of others regardless of the context or circumstances involved. Although technically and from a knowledge perspective, nurses consider the most effective and efficient way to administer care, it is through their use of practical wisdom that they actually engage in the art of nursing to provide that care. Because preceptorship is so pivotal to influencing students in the way they approach their nursing care, this approach to teaching-learning in the clinical environment provides an excellent modality by which to cultivate practical wisdom and ultimately to shape the art of nursing.

Views on unsafe nursing students in clinical learning.

Clinical education is a cornerstone of undergraduate nursing education programs. Although protecting patient safety in clinical learning experiences is a standard of practice, no standard definition of the "unsafe" student exists. The purpose of this study was to describe the viewpoints of undergraduate student nurses and their clinical educators about unsafe clinical student practices. Using Q methodology, 57 students and 14 clinical educators sorted 39 unsafe student practice statements. These statements were generated from an integrated review of nursing and related literature and two undergraduate student focus groups. The use of centroid factor analysis with varimax rotation produced three dimensions of unsafe student practices. An unsafe student was characterized by his/her Compromised Professional Accountability, Incomplete Praxis, and Clinical Disengagement. A shared attribute among these three features was violated professional integrity. While students' affective, cognitive, and praxis competencies were priority elements in the conceptualization of unsafe student practice, this study also identified the salient role of educators as active participants in preparation of safe practitioners.

Preceptor preparation: an investment in the future generation of nurses.

Nurse preceptors fulfill a primary role in the success of preceptorship experiences during the education of student nurses in their final year of study. Evidence suggests that this success depends greatly on adequate preceptor role preparation and support. The purposes of this qualitative, descriptive study were to explore and describe preceptor role support and development within the context of a rural and northern mid-sized Canadian community. More specifically, in this study the following are described: preceptors' (a) perception of past role preparation and current role support; (b) use and evaluation of the existing print-based fourth-year Preceptor Resource Manual (PRM); (c) perception of role support facilitators and barriers; and (d) recommendations for improvements to preceptor role preparation and support. Data were collected through individual and group interviews. Through content analysis four major themes emerged: accessible resources, role complexity, partners in precepting, and role development.

The preceptorship experience: an examination of ethical and accountability issues.

In this article, the authors examine ethical and accountability issues that emerged from a recent retrospective grounded theory study exploring the challenges for preceptors when working with nursing students whose clinical practice is unsafe. A primary goal of nursing education is to prepare safe and competent practitioners who can be accountable for their own actions (M. Smith, Y. McKoy, & J. Richardson, 2003). Within the context of preceptorship, both preceptors and faculty have an academic, legal, ethical, and professional responsibility not only to teach but also to evaluate students' clinical performance to ensure that as graduates of their programs they are competent to provide the public with safe nursing practice (P. Boley & K. Whitney, 2003; M. Smith, Y. McKoy, & J. Richardson, 2003). The findings of this study have implications for nurse educators and administrators in preparing and supporting both preceptors and students, especially in difficult or challenging teaching-learning situations.

The one-to-one relationship: is it really key to an effective preceptorship experience? A review of the literature.

Currently, considerable focus is directed at improving clinical experiences for nursing students, with emphasis placed on adequate support and supervision for the purpose of creating competent and safe beginning practitioners. Preceptors play a vital role in supporting, teaching, supervising and assessing students in clinical settings as they transition to the graduate nurse role. Intrinsic to this model is the assumption that the one-to-one relationship provides the most effective mechanism for learning. With the current Registered Nurses (RN) shortage, among other factors, the one-to-one relationship may not be feasible or as advantageous to the student. Thus, nurse educators need to carefully assess how this relationship is configured and maintained to assist them in fostering its evolution. In this review of the literature, the authors explore the assumption that a one-to-one relationship in the preceptorship experience fosters a rich and successful learning environment, and implications for nursing education, practice and research are outlined.

Hallmarks of unsafe practice: what preceptors know.

During a preceptorship experience, certain students do not progress in their learning at the same rate as others and may engage in unsafe practice. Twenty-two preceptors working with fourth year baccalaureate nursing students for 340 hours in a final practicum were interviewed. This study reaffirmed that early identification and intervention of unsafe practice are critical and consist of red flags regarding knowledge, attitudes, skills, and professionalism.

Strategies for precepting the unsafe student.

Precepting a student who is unsafe is distressing both for the preceptor and the student. This article derives from a grounded theory study that describes the careful thought reflected in strategies used by preceptors to teach students who are unsafe. Both preceptors of undergraduates and new employees may find these strategies useful, with the ultimate goal being patient safety. The findings have implications not only for preceptor preparation in the area of evaluation but also for faculty support and the need for evaluation guidelines.

"Failure to assign failing grades": issues with grading the unsafe student.

In a grounded theory study examining the process of precepting an unsafe student, it was found that preceptors assigned passing grades to students who in fact should not have passed. Although preceptors perceived their role as gatekeepers for the profession, by not assigning failing grades to students who should not have passed a course, essentially they were abdicating their responsibility. Indeed, the simple act of assuming responsibility for precepting a student implies professional as well as pedagogical accountability.

Precepting an unsafe student: the role of the faculty.

According to a recent study, one of the central findings indicated that preceptors require significantly more support than they are currently receiving from faculty especially when precepting a student who is engaging in unsafe practice. In this grounded theory study, 22 preceptors were interviewed. The findings reveal some interesting implications not only regarding the staffing of preceptorship programs but also the process of preparing faculty as to how to provide preceptors with sufficient and appropriate support throughout the preceptorship experience.

Preceptorship and mentorship: not merely a matter of semantics.

In academic writing on mentoring and preceptorship there is little consensus on the meaning or characteristics surrounding these terms. The writers of this paper contend that the correct usage of preceptorship and mentorship, which gives credence and respect to the very different concepts embedded in each, is a very important precursor to the evolution of these two concepts in nursing education, both academically and within practical application. Although language is continually changing, lack of clarity robs language of its richness and complexity and interferes with clear thinking about the issues. In professional terms, clarity demands that concepts, around which a body of knowledge is growing, be consistent in their meaning and characteristics. Such clarity between the related educational concepts of mentor(ship) and preceptor(ship) is lacking.