Staff nurses make a difference in student clinical experiences.
- A nursing student’s sense of belonging in the clinical setting enhances learning and supports a more confidently prepared graduate to enter the workforce.
- In acute care settings where nursing students feel a sense of belonging with the unit in which they complete their clinical experiences, healthcare organizations may have employment leverage in recruitment considerations
- Healthcare professionals can foster a sense of belonging by socializing nursing students to the unit and the profession through inclusion in patients’ plans of care and recognition of students’ contributions to the healthcare team.
The provision of safe and effective nursing care involves the integration of knowledge, skills, and attitudes to make sound critical thinking and clinical judgment decisions. Good nursing student outcomes rely on effective teaching models and real-world clinical experiences. These essential nursing attributes and other influencing factors, such as a sense of belonging, are introduced and practiced during clinical placements.
Levett-Jones and Lathlean define belongingness as a personal experience related to how secure, accepted, included, valued, and respected by a defined group a person feels; their connection with the group; and the alignment of their professional and personal values with those of the group. The degree to which nursing students feel they belong and the factors that shape these clinical experiences can prove vital to the nursing profession. (See What the research says.)
Integrating opportunities to increase belongingness can support development of a professional nursing identity, an American Association of Colleges of Nursing (AACN) core competency. In light of this research on belonging and the AACN’s focus, we conducted a 4-year study to gauge nursing students’ sense of belongingness in their clinical setting.
What the research says
Metzger and Taggart report that belongingness requires inclusive clinical learning environments in which students thrive. Marjadi and colleagues support the need for inclusiveness in the clinical setting along with addressing person-centered care needs. Charania and Patel add that inclusivity prepares a diverse nursing workforce.
According to studies by Levett-Jones and colleagues, relationships nurtured among healthcare team members and nursing students provide the fundamental social context for acceptance and effective learning. When students develop a sense of professional identity and meet the necessary knowledge and practice outcomes, they also develop a sense of confidence, competence, and satisfaction. However, research conducted by Patel and colleagues indicates that some students may experience difficulty in their clinical placements. Students who don’t gain a sense of belonging can feel invisible, isolated, excluded, and neglected.
Belongingness study
We collected data from students in semesters 2, 3, and 4 of both a 2-year upper-division traditional and accelerated baccalaureate of science in nursing (BSN) program. In each data collection period, we asked students to reflect on their medical–surgical clinical experience in that semester. Semester 2 participants completed a demographic survey. All students rated their sense of belonging on the Belongingness Scale – Clinical Placement Experience (BES-CPE) survey. The BES-CPE is a 34-question, 5-item Likert response survey that asks respondents to rate their level of agreement about their sense of belonging in their clinical placements. Two additional free-text questions ask what made students feel as if they belonged in the clinical area and what made them feel as if they didn’t. (See Demographics.)
Survey response rates and student demographics
At this midwestern university with five campuses statewide, average total pre-licensure semester enrollment over the data collection period included 561 traditional and 70 accelerated BSN students. Across the 2-year data collection period, 2,444 students were enrolled in the various semesters of the program. In all, 988 students answered the anonymous survey for a response rate of 40%. Of those, 664 (67%) answered one or more of the free-text questions. We didn’t stratify the free-text responses for any demographic variable; we analyzed them for content as one group. Student perceptions of belongingness remained consistent across the data collection period. Our analysis identified three themes: communication, inclusivity, and relationships.
Communication
Belonging. Although nursing students serve as supplementary members of assigned staffing models, they feel the impact of and also influence unit culture. From the moment nursing students walk onto the unit, they report effective communication as a forerunner to feelings of belongingness.
- “The nurse I was with would talk to me like a coworker and not like a student that didn’t know anything.”
- “Being greeted upon arrival.”
- “Having a provider pull me aside to get my input on the patient.”
- “Not berating me for asking questions.”
Lack of belonging. Students indicate clinical units that communicate unwelcoming messages or appear unreceptive pose barriers to learning. Students report an inability to understand or clarify staff expectations without sufficient communication efforts. Some students say they use personal resilience strategies to compensate for this lack of communication.
- “A nurse shutting the door on me.”
- “Complaining about having a student.”
- “No one acknowledged me when I got there—they just stared at me.”
- “When I have to ask them about every little thing that they are doing for clarification.”
Inclusivity
Belonging. Nursing students feel included when staff embrace their presence and take the necessary time to nurture their personal and professional learning journey.
- “People remembering my name.”
- “When I am asked for my opinion.”
- “When I am included in the small talk between nurses.”
- “When the primary nurse asks for my input on the patient’s care.”
- “Nursing staff mentioned how well I did.”
- “All nurses on the floor reach out to me when a technical nursing skill pops up so that I can practice and learn.”
Lack of belonging. Regardless of clinical placement sites, indifferent, dismissive, uncivil, or unfriendly staff adversely affect the nursing students’ ability to fully engage in the clinical environment.
- “Not being greeted or oriented when I arrive.”
- “There were nurses who didn’t want us to be there. . . felt we just made things worse and bothered them. . .”
- “When staff don’t appear interested in my personal life in any way.”
Relationships
Belonging. Nursing students believe that the quality of interpersonal relationships developed on the unit determines their acceptance as learners in the clinical environment. Feeling accepted by staff nurses results in a sense of connectedness and fitting in.
- “I can be involved in group conversations with nurses on the unit.”
- “Ability to work with interprofessional teams independently.”
- “Employees talking to me and guiding me through our day.”
- “Students that help me when I need it, and I help them too.”
- “Sharing clinical experiences helps me see where we are at and see where I am at compared to my peers.”
Lack of belonging. When nursing students feel alienated or notice differences between their own values and those practiced in the clinical setting, they report being emotionally challenged, which risks disengagement.
- “Being used as an extra [certified nursing assistant] rather than following a nurse and learning about nursing skills.”
- “Sometimes at the start of the day the charge [nurse] will ask the floor nurses who wants to precept and no nurse will volunteer.”
- “Having a nurse say they regretted becoming a nurse; being asked why I would ever want to do this.”
- “Physicians that do not care about students.”
These identified themes provide evidence of how nurse clinicians and others influence students during clinical placements. Although each theme works on its own to aid belongingness, when combined they form a picture of the need for common, everyday civil behavior. The American Nurses Association (ANA) Position Statement on Workplace Violence provides support for creating and sustaining healthy and safe work environments. The statement advocates for nurses to “act civilly to each other with respect, kindness, and dignity.” Unsafe and unhealthy work environments have been linked to nurse turnover and patient safety issues.
Most study participants named respect among student peers, faculty, staff, and interprofessional team members as most important to their feeling of belongingness. A juxtaposition exists with regard to most student reports of belonging and lack of belonging. For example, a given behavior can contribute to belongingness while the absence of the behavior can contribute to a lack of belonging. Nursing students realize that there’s a time and place on the unit for personal communication, but when it’s completely absent, they feel as if they don’t belong and aren’t valued or wanted. Inter- and intrapersonal rapport can have a considerable influence on nursing students’ perceptions of clinical belongingness.
Implications for clinicians
As themes remained unchanged throughout the study, we identified a fundamental need to belong. The lack of belonging had toxic effects on student clinical experiences, which can impact employment considerations. The AACN reports the departure of nurses younger than 35 years employed by hospitals as a result of dissatisfaction with pay, work–life balance, and workload. A feeling of belonging—influenced by clinical instructors, preceptors, strategic partnerships, and peers—on the unit might reduce some of these concerns.
Clinical instructors
As collaborators with staff nurses, clinical instructors serve a vital role in helping to reduce social exclusion, which impedes learning. Clinical instruction includes providing pre-clinical student preparation, facilitating welcoming environments through introductions, role modeling professional behaviors, focusing on student expectations based on course objectives, and informing staff nurses of student competencies. LeBlanc and Patel recommend similar approaches when assisting nursing students.
Preceptors
Dedicated preceptors can support student belonging as they help bridge the theory-practice gap, provide meaningful feedback, and support socialization to the profession. Unit nurses who serve as preceptors require a clear understanding of a student’s program journey (first semester vs fourth semester) and realistic expectations of their knowledge and skills.
Precepting provides an environment for new nurses to experience belonging within the unit and offers organizations a unique recruitment opportunity. Wakefield and colleagues found the role of the preceptor team to be central in enabling students’ feelings of belonging through inclusive behaviors. Interprofessional healthcare providers also can contribute to the student’s sense of belonging by acknowledging students with introductions, eye contact, and appreciation for their engagement and assistance. An incentive mechanism may prove beneficial to adding precepting roles within an organization.
Clinical–academic partnerships
Strategic academic partnerships with clinical and community agencies serve to bolster undergraduate nursing students’ sense of belonging. Healthcare organization leaders, policy makers, and other stakeholders can prioritize strategic initiatives that support cultures of belonging.
Peer-to-peer relationships
Study participants noted the importance of peer-to-peer relationships to their sense of belonging. Students reported the necessity of having lunch together and being invited to spontaneous group-think sessions to problem-solve or collaborate about patient care. Clinicians can reinforce this socio-developmental need by seeking out students individually or as a group to include in patient care discussions.
Limitations
Despite strong participation from students, this study represents the perceptions of only one college of nursing where the student population is primarily white. We also don’t know if other demographic variables contributed to variability across the responses to the free-text questions.
The curricular plan includes clinical experiences with matching didactic courses that focus on specific concepts in each semester, which students then synthesize and apply in the clinical setting. Because students received orientation to their respective units per individual organizational policies, the orientation lacked standardization across the five campuses and multiple organizations. In addition, the nature of the study methodology and anonymous student responses meant that we encountered difficulty verifying theme accuracy.
The influence of belonging
Healthy workplace environments create safe, nonjudgmental, and engaging learning conditions to support the achievement of knowledge, skills, values, and attitudes to enhance levels of student confidence, competence, and satisfaction. Students who participated in this study reported that the creation of a culture of inclusion promoted healthy communication and relationship building. New nurse graduates who’ve experienced belonging as a member of a healthcare team may be better prepared to contribute to excellent patient outcomes, meet the needs of the nursing workforce, and lead the profession.
The authors work at the University of Nebraska Medical Center College of Nursing. Missy Ofe Fleck is an assistant professor in Omaha. Cathrin Carithers is a clinical associate professor and assistant dean in Kearney. Lynnette L. Stamler is emerita associate dean for academic programs and professor in Omaha. Leeza Struwe is an associate professor in Lincoln.
American Nurse Journal. 2025; 20(7). Doi: 10.51256/ANJ0725101
References
American Association of Colleges of Nursing. The Essentials: Core Competencies for Professional Nursing Education. April 6, 2021. aacnnursing.org/Portals/0/PDFs/Publications/Essentials-2021.pdf
American Association of Colleges of Nursing. Fact sheet: Nursing shortage. May 2024. aacnnursing.org/Portals/0/PDFs/Fact-Sheets/Nursing-Shortage-Factsheet.pdf
American Nurses Association. Position Statement on Workplace Violence. nursingworld.org/globalassets/practiceandpolicy/nursing-excellence/incivility-bullying-and-workplace-violence–ana-position-statement.pdf
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Key words: belongingness, inclusivity, communication
