Nursing care is pivotal in the health care services worldwide. Globally, nurses and midwives constitute 59% of the health workforce . In Ghana, out of the 115, 650 health workers employed by the government, nurses and midwives account for 58% . The axillary nurses (community and enrolled nurses; trained for 2 years) make up the majority (53%) of the total nursing and midwifery workforce whiles professional nurses (with at least 3 years of training resulting in the acquisition of diploma, undergraduate, postgraduate qualifications, or specific speciality areas of study) account for 47% [2, 3]. The nurse serves as the main vessel that convey most interventions and care necessary for individuals utilizing health care services. For nurses to efficiently perform the myriads of duties, it depends on their ability to apply theory to practice [4, 5]. Hence, nursing training involves both theory and practical training. Each aspect of the training carries important weight.
The clinical skills acquisition of nurses is so important that the Nursing and Midwifery Council (NMC) of Ghana, a body mandated to regulate the training of nurses increased the clinical contact hours of students to 432 h, 624 h and 576 h for the first, second and third year of training respectively . According to Benner , skills acquisition is not an event but a process where individual nurses start as novice and gradually become experts. Whiles the acquisition of knowledge on the theory is done in the classroom, the skills acquisition is done in the skills laboratory and clinical learning environment or setting depending on one’s level of study.
The clinical learning environment (CLE) is a complex and constantly changing setting . The CLE can be influenced by several factors such as the kind of supervisor, the quality of feedback received by students, the context and the students [9, 10]. Much of skills teaching are done by the nurses in clinical practice regardless of their level of education and expertise.
This implies that the quality of clinical teaching of students depends on the efficiency of the supervisor they meet in the clinical facility [11, 12]. In Ghana, it is regarded the responsibility of every registered nurse or midwife to provide teaching or guidance for students who work with them on their shift without any specific training for that purpose. The registered nurses supervise students and do not receive payments by any of the institutions for this service. Some of these supervisors may not be adequately prepared or motivated for the task of clinical teaching . According to Chan and Ip , their relationship is very key and determines the kind of learning environment created. A positive learning clinical environment is a result of good relationship between the supervisor and the students. Nursing students will always be motivated to learn in environments where there is mutual respect and students are involved in the team and supported with their decision making .
Constructs of the clinical learning environment positively influence students’ satisfaction with their learning activities . The pedagogical atmosphere, ward manager leadership style and supervisory relationship are important factors that contribute to satisfaction with the clinical environment. Students who have the chance to meet a supervisor on more regular basis tend to well appreciate the contribution of the clinical environment to their skills learning. Having access to a supervisor or mentor allows the student to learn more and improve the skills learning.
Despite the importance of clinical learning for nursing students, it comes with some challenges to students, faculty and supervisors. For students, depending on the level of study it can be demanding especially when students feel, they lack the right skills for a particular assigned task . They worry about the probability of supervisors holding negative perceptions about them which could affect their grading and therefore may come under “pressure” to please their supervisors .
Crowding of students in the clinical setting is a major challenge to clinical teaching and learning [16, 17]. Overcrowding in the ward makes it difficult for both students and clinical supervisors to engage meaningfully. When student numbers are high it means student-preceptor ratios will be higher than required for effective clinical learning. When students are more than the physical space can accommodate it becomes very difficult for staff to even assist them to learn clinical skills . In Ghana, the ration of a supervisor to student is approximately 1: 10 or more students in a shift . This is because students are required to do their clinical placement only in the hospital setting. Therefore, the need to improve clinical nursing education is an important aspect of training of nurses. Thematic areas of importance in improving clinical nursing education include having positive clinical environment, effective clinical supervision, adequate assessment of students and clinical-academic collaborations . However, there are no current studies reporting the student evaluation of their clinical placement experience in Ghana. We examined nursing and midwifery students’ evaluation of their clinical placement using the CLES+T.