Supporting learners in clinical practice: capacity issues.

AIM: The aim of this paper is to report a study exploring, from the perspective of key stakeholders (mentors of nurses, managers of nurses, and modern matrons) in one English acute sector hospital, how decisions are made on how many learner nurses can be supported in clinical practice. The objective was to identify what factors are taken into consideration in making these decisions.

BACKGROUND: Supporting increasing numbers of students is a demand of current service provision in the English National Health Service, as part of an expansion in the numbers of all healthcare professionals. This is particularly the case in nursing, where the government announced a required increase in numbers of qualified nurses of 20 000. This expansion of numbers has implications for the quality of placement learning in clinical placements.

METHODS: Data were collected using three focus group interviews with a total of 12 participants in 2003/04. Recruitment was on a purposive basis. Subsequent analysis identified themes, which were compared across groups. A short questionnaire was also used to establish participants' biographical details prior to the focus groups.

FINDINGS: Three key themes were identified: 'capacity issues', 'enhancing support in practice' and 'issues impacting on learning in practice'. 'Capacity issues' identified factors that impact on the capacity of placements to support learners. 'Enhancing support in practice' identified necessary roles and strategies to enhance learning in practice. Finally, 'issues impacting on learning in practice' identified learner groups where support could be enhanced through structured management of the placement experience.

CONCLUSIONS: Decisions on learner numbers to be supported at any one time are complex, with a multitude of dimensions. These include identification of types of learners and numbers of mentors available to support them and other operational issues. 'Educational staff' are needed at operational and strategic levels to support learning in practice. Timely and appropriate audit information to support allocation decisions and identify strategies to enhance the quality and support of learning in practice, are also required.

RELEVANCE TO CLINICAL PRACTICE: Increases in learner numbers and National Health Service modernization have had an impact on clinical placements' capacity to support learning, and potentially, on learners' achievements in practice. Findings from this study are thus important in evaluating the impact of these policy initiatives.