Introduction

The senior practicum is a critical training experience for nursing students, but hospital nursing shortages impact the availability of placements. We piloted an innovative, accelerated practicum for students during the winter intercession. To explore students’ experiences, we developed an interview guide with open-ended questions.  We conducted two focus groups: accelerated practicum students (n=8) and traditional practicum students (n=7) and analyzed data using a qualitative descriptive approach. We found key group differences related to preceptor competence, work schedules & continuity of care, unit and role conflicts, and unit familiarity. An accelerated intercession practicum appears well-received by students and could be a promising approach to dealing with placement constraints. 

Background

The value of a nursing practicum is not disputed in the literature, however with the nursing shortage as well as the major transitions in healthcare following the global pandemic there is a demand for radical change in curriculum delivery to prepare graduates to be effective members of the health care team (Owens & Christian, 2021). It is important that nursing education responds to the call and re-examines the senior practicum to fortify the transition for future graduates. Nurse educators have been encouraged to implement innovative teaching strategies that promote development of student’s clinical reason and judgement skills (Owens & Christian, 2021). 

The transition from student nurse to registered nurse is overwhelmingly recognized in literature as a challenge. There is much discussion about easing the transition and preventing new graduate turnover which, when left unaddressed, only serves to compound the nursing shortage that health care continually faces. There is an evidenced based link between a well implemented final clinical practicum and the practice readiness of graduating student nurses (Kaihlanen et al., 2021).  The senior practicum can serve as the graduate’s foundation of working life experience prior to accepting their first job and thus can not only be used as an important recruitment tool but can also aid in lowering graduate turnover intentions once in the work force (Kaihlanen et al., 2021). 

Historically, nursing education is rooted in clinical apprenticeships, however in the 60 years since nursing has transitioned away from that model there has been a concerted effort to find the balance between clinical experience and didactic education. The incorporation of simulation and virtual learning have been used as means to supplement clinical rotations, but some argue there is no substitution for learning in the practice setting (Chicca, 2020). Many nurses do not feel prepared to manage the nurse’s normal work and patient load with high job demands and heavy workloads shown to be the most significant stressors affecting negatively on the transition period (Kaihlanen et al., 2020). The current traditional practicum model does not mimic or immerse graduates in the high job demands of the full-time registered nurse.

A study conducted by Kumm et al., (2016) looked at an 8-week immersive clinical practicum versus a 16-week traditional practicum and found that they resulted in the same student readiness. The ability to accomplish the senior practicum in less time reduces the cost associated with these programs as well as the demand and commitment required of preceptors and students.  The Winterim addresses these concerns by offering students a high quality, well implemented, immersive senior practicum. An immersive, accelerated senior practicum like the Winterim stands to offer students the opportunity to mimic autonomy as well as the registered nurses normal work and patient load, creates the possibility to feel belongingness which promotes and improves confidence and communication with the healthcare team (Kaihlanen et al., 2020, Nurfadhillah Awang Rosli et al., 2021). 

Methods

Our clinical practicum course requires 120 precepted clinical hours. The traditional practicum runs in the Spring semester of the nursing program concurrent with two other courses, and students have between 7-14 weeks to complete shifts.  

To pilot the accelerated practicum, we created a special section of the clinical practicum course to run over a 3.5-week “Winterim” term in January while students were not in class, prior to Spring semester beginning. Students completed 120 clinical hours in the 3.5-week period. All traditional senior nursing students were given the option to choose their preferred practicum experience (Winterim pilot, or the traditional Spring-semester practicum). 

All practicum students were then invited to take part in focus groups at the end of the semester, which was conducted by a researcher not associated with the course. The two focus groups both began with informed consent and were conducted in person. One focus group included only students who participated in the accelerated Winterim practicum experience (“Winterim” group; WG) and the second included only students who experienced the traditional senior practicum (“traditional” group, TG).  

Sample/Setting

The Spring 2024 semester provided a unique opportunity to compare the two practicum types due to the small class size, with ~50% of the class choosing the Winterim practicum (n=8) while the other half of the class completed the traditional spring practicum (n=7).  All eligible students were eligible and asked to participate and chose to take part in the focus group interview. The IRB at our institution reviewed human subjects procedures for this study and deemed it exempt. 

Instruments/Measurement

We chose a qualitative, descriptive approach to explore students’ perspectives on their practicum experiences. We developed an interview guide with open-ended questions regarding students’ decision-making around practicum type, and their experiences during the practicum, including challenges and benefits, how well prepared and/or well supported they felt, if there was anything that could be done to improve or change the experience.  

Data Analysis

Focus groups were audio-recorded and transcribed verbatim, with transcriptions confirmed and edited for accuracy by two team members. To center students’ voices, we used a non-abstracting qualitative description approach, with line-by-line coding, grouping codes into similar categories, and identifying emerging themes. Data was tagged by themes in the web-based application Looppanel (https://www.looppanel.com/). Lincoln and Guba’s (2013) quality enhancement criteria were used to enhance rigor and trustworthiness and reduce bias, including bracketing, ensuring transcript accuracy, maintaining comprehensive field notes and audit trails, and data reviews by other research team members.

Results

Four themes emerged from the two focus groups. We found that both groups of students generally reported positive practicum experiences, and nearly all reported their experience was heavily influenced by preceptor competence – i.e., the attitude, experience, and willingness to teach from the preceptor. However, notable differences in the students’ experiences emerged from the focus groups related to work schedule & continuity of care; unit conflict; and unit familiarity. 

Preceptor competence

Many students commented along the lines of “the preceptor makes the experience.” For example, one shared, “Just seeing how much she enjoyed teaching things really, like, made me want to learn more” (TG). Similarly, another said, “My preceptor was really good at, like, giving me the reassurance that I needed, but also, like, giving me helpful critiques” (WG). 

Work schedule & continuity of care The largest contrast between groups was demonstrated in the discussion of shift scheduling.  WG students were not scheduled for other classes during their practicum, and often were able to either decrease their work hours or take time off given the short duration of the practicum. A WG student commented: “it just made the most sense schedule-wise. And just like, how we felt in the semester, like, with classes prior to that, it was like, oh my gosh, we can’t do this to ourselves again.” The opportunity to choose whether to use Winter break as a time to complete course requirements was a benefit to some students. Being able to complete 3 or more practicum shifts in a row — not typical for students in the traditional practicum — positively impacted student learning:

“It definitely felt like it was easier to grasp way more, and it felt more effective because I didn’t feel like I was taking a break on learning stuff. It was like, whatever I had questions about. I got to come back the very next day and follow up on those questions” (WG student).

WG students were also more likely to have the same patients when completing multiple practicum shifts in a row, which also impacted their learning positively:

“Yeah, I was able to have the same patients … I saw how those interventions, like, played out the next day or the next couple of days. That was awesome. So that really helped me learn a lot. Just saying that, like, progression of care. So that continuity.”

Scheduling practicum shifts was also challenging for TG students, for different reasons. These included not having staff nurse schedules available far enough in advance, as students juggled practicum shifts, classes, work, and family. As one student commented: “[my preceptor] was [scheduled] Monday, Tuesday, Wednesday nights, and I couldn’t do any of them because I had class on Tuesday morning and Wednesday morning … the problem with, like, having class as well on top of it.” However, some TG students felt relaxed due to the fact they had so much time to complete their shifts: “I didn’t have a problem scheduling or, like, feeling rushed, because I know I had until May 2 to get all my days in. Ten days in three months was not scary for me.” 

Unit conflicts 

A key difference between groups was that TG students were sometimes competing with students from other nursing and health professions programs on the units. One commented her “one-on-one” practicum preceptor was routinely precepting other assigned students at the same time, noting, “So it kind of felt like we’re all trying to… trying to compete for experiences.” Conversely, WG students had the units “to themselves”, with students in other programs in this busy urban area on winter break.  

Unit familiarity 

WG students were far more likely to report feeling part of the team during their practicum, which they attributed to working, essentially, full-time hours for their practicum experience. One compared her practicum experience favorably to her prior clinical rotations: 

“I think the biggest struggle as a student nurse is you’re orienting to the unit itself, but you’re also orienting to the people that you’re working with. Like, I remember clinical days would be the worst because our instructor would be like, all right, this is [the nurse] you’re assigned. And you’re like, okay, but who are they?”

Conversely, during her accelerated practicum, she reported:  

“You got familiar with all the other people on that shift. They knew who you were. So it was very easy to know, not just who your preceptor was every shift, but you also knew the people you were working with so you could really utilize and actually, like, follow through, building upon relationships with the other staff members. And it was very helpful.” 

Another WG student added:  “it’s like just the consistency of the people, the consistency of the building, the consistency of, like, I know which systems work with what. So if you had a traditional practicum, it might have felt different.” 

Similarly, some TG students were already employed on their practicum unit as a tech or certified nursing assistant, and/or were in practicum-to-practice programs that resulted in a new graduate job offer. Notably, these students often described a similar sense of belonging and comfort as the WG students: “… it was really flexible and a lot more manageable than I was expecting and just very enjoyable.” 

The Winterim practicum provided an immersive experience that positively influenced students’ assimilation into the profession of nursing. The ability of students to schedule full-time hours during an “off” period without coursework was hugely beneficial to their learning. Additionally, students during January Winterim were not competing with other students for time or experiences on the units. These findings support the benefits of a Winterim practicum experience as an alternative to the traditional senior practicum. 

Discussion

We found when we offered nursing students the choice between an accelerated winter intercession practicum pilot (WG) and a traditional spring semester practicum (TG), both options were equally popular and students in both groups reported being generally satisfied with their practicum experience. Providing students with a choice regarding their senior clinical practicum was a positive attribute of this innovative program. All students (n=15) were successful in the course, despite which practicum option they participated in. 

As Kaihlanen et al (2020, 2021) have found, the quality of the preceptor was a key determinant of students’ satisfaction with their experience, but WG students were advantaged also by the immersive nature of the accelerated practicum. This appeared to increase WG students’ unit familiarity — their comfort and sense of belonging with other staff and the unit in general. WG students also reported enjoying benefits related to learning and continuity of care, less competition with other students, and often reported an easier time scheduling shifts when they were not juggling classes and work at the same time. 

The evidence is clear on the benefits of senior practicum experience (Chicca, 2020; Hsu et al., 2018; Kaihlanen et al., 2021), but the nursing shortage makes finding quality preceptors and sites increasingly difficult (Morris, 2023). To our knowledge, little evidence exists regarding accelerated, immersive practicum experiences during intercessions as an alternative to semester-long placements. More rigorous evaluation is needed to establish the impact of an intercession practicum experience. However, our students’ voices suggest this may be a promising option to explore for the future. In addition, our findings underscore the importance of thoughtful preceptor selection and preparation (regardless of practicum type).

Limitations

We completed this pilot program at a small, private University in an urban mid-Atlantic area of the United States; larger nursing programs and those in different geographic areas may have different considerations. Due to class census, the sample size was small. Additionally, students self-selected into practicum type, however, this may be a strength as well, as different practicum experiences may suit different students (e.g., working students, student parents). 

Conclusion

Nurse educators are constantly challenged to ensure our graduates are prepared to practice safely and competently upon graduation, all while facing the barriers of limited clinical placements, faculty shortages, and pressure to increase capacity. Innovations like the accelerated Winterim practicum experience help address a few of these challenges, specifically limited capacity for clinical or practicum placements. The Winterim practicum experience was considered superior to the traditional experience for some participants due to the ability to truly be immersed in the work on the unit during their experience. The accelerated Winterim practicum experience was not without its challenges, but this evaluation suggests that the benefits for students’ readiness for practice support the implementation of such programs in Schools of Nursing.

References

Chicca, J. (2020). Should we use preceptorships in undergraduate nursing education? Nursing Forum, 55(3), 480–484. https://doi.org/10.1111/nuf.12452 

Hsu, P.-L., Wang, H.-H., Eng, C.-J., & Yang, M.-S. (2018). Student nurses’ transformation process during a clinical practicum in a two-year bachelor’s program. Collegian, 25(4), 435–440. https://doi.org/10.1016/j.colegn.2017.11.001 

Kaihlanen, A., Gluschkoff, K., Koskinen, S., Salminen, L., Strandell-Laine, C., Fuster Linares, P., Sveinsdóttir, H., Fatkulina, N., Ní Chianáin, L., Stubner, J., & Leino-Kilpi, H. (2021). Final clinical practicum shapes the transition experience and occupational commitment of newly graduated nurses in Europe—a longitudinal study. Journal of Advanced Nursing, 77(12), 4782–4792. https://doi.org/10.1111/jan.15060 

Kaihlanen, A.-M., Elovainio, M., Haavisto, E., Salminen, L., & Sinervo, T. (2020). The associations between the final clinical practicum elements and the transition experience of Early Career Nurses: A cross-sectional study. Nurse Education in Practice, 42, 102680. https://doi.org/10.1016/j.nepr.2019.102680 

Kumm, S., Godfrey, N., Richards, V., Hulen, J., & Ray, K. (2016). Senior student nurse proficiency: A comparative study of two clinical immersion models. Nurse Education Today, 44, 146–150. https://doi.org/10.1016/j.nedt.2016.05.023 

Lincoln, Y. S., & Guba, E. G. (2013). The constructivist credo. ProQuest Ebook Central https://ebookcentral.proquest.com

Morris, G. (2023). The effects of the nursing shortage on clinicals. NurseJournal. https://nursejournal.org/articles/the-effects-of-the-nursing-shortage-on-clinicals/ 

Rosli, N. A., Choo, T. Y., & Idris (2021). Impact of preceptorship models for undergraduate nursing students and its implementation: Systematic review. International Journal of Nursing Education, 14(1), 111–118. https://doi.org/10.37506/ijone.v14i1.17764 

Owens, R. A., & Christian, S. J. (2021). A hybrid concept-based Clinical Practicum Course: An innovative approach to baccalaureate nursing education in a rural area. Nursing Education Perspectives, 42(6). https://doi.org/10.1097/01.nep.0000000000000823