Impacted clinical placements for BSN students?

Some input from Canada about Community Health placements from a 2011 article in the International Journal of Nursing Education Scholarship. ( doi: 10.2202/1548-923X.2297 ) Developing guidelines for quality community health nursing clinical placements for baccalaureate nursing students

The Quad Council of Public Health Nursing have been working to update the Public Health Nursing Competencies that can be used at the generalist (BSN) and specialist MSN) levels of nursing education. I recall that members of the Association of Community Health Nurse Educators have shared similar concerns about community clinical placements for students. Another challenge in community/public health practice settings, the role and education requirements of the nurse vary greatly. These are issues in nursing that we need to continue to work through with our partners to make increasing the number of nurses with BSNs a reality.

I wanted to offer my thoughts as a current nursing student, and friend of many current nursing students in various schools across California. Different schools are offering very different experiences to meet the Community Health clinical requirement, and feedback from student peers varies widely. As for Leadership students, in my opinion it is helpful to partner with an RN leader, but it's not imperative. Linking up with a truly gifted leader, regardless of licensure or role, can lead to incredible learnings for the student.

Thanks Summer for sharing some great perspectives as a student.

I would also like to add what I can from the role of a current nursing student. I am completing my Community Health clinical rotation at a local church that employs volunteers and nursing students to run a health outreach program for the underserved in the area. This church is also responsible for a clothes closet, a food donation program, an after school children's group promoting fitness, and a number of parenting classes- all of which the nursing students take part in. I have found that although I have not utilized my clinical skills beyond taking blood pressures, I have made incredible strides in my ability to educate my patients on a number of topics. This clinic and the other services the church provides are run by a Deacon who is also a practicing nurse. She has been an invaluable role model for me, in that she has the years of practical experience in the acute care setting, but is also aware of the needs of the community outside of the hospital, and puts her skills to use there. She is a great example of how the role of the nurse really knows no bounds. Although this clinical placement is not one in which I can hone my hands on skills, I have had the pleasure of learning under a community nurse leader and I have gained many insights into community health I hope to utilize once I begin practicing.

Austin, What a great example of learning the needs of individuals to maintain their health while they are in the community! You also had the rich experience of learning leadership from an inspirational mentor in the same setting. You can take this important learning and apply it as you work with more acutely ill patients and their families in hospitals. Individuals in the hospital have come from a community and will return to a community. One change in the current health care environment focuses efforts of nurses and other providers in hospitals on preventing unnecessary readmission to the hospital. Acute care nurses must now increase their knowledge of how individuals stay healthy in the community to improve their discharge planning skills. Thanks for sharing a great example of clinical experiences for students that prepare nurses for the changing environment in health care.

I am also a student finishing my community health clinical rotation. I have had the opportunity for exposure to a broad selection of community health programs, with a rotation of public health/school nursing/home health/free clinic settings. I know this has been in large part to a lack of available positions for us to work with. One aspect of community health nursing I feel we are missing is the building of a nurse/patient relationship. Austin mentioned having the experience of working with one location. I am feeling more like a visitor to a working relationship as opposed to a true participant.

Hi Austin, I love your example of your community health clinical rotation at a local church. This allows students the unique opportunity to assess needs within this community, understand the social determinants of health and educate patients on the importance of wellness and prevention in a non-traditional setting. Perhaps schools of nursing could consider this model of faith community nursing as an opportunity for community health rotations.

Lisa and Austin, your comments really enrich the dialog! Austin, it is great that you are recognizing that "hands on" is only one skill set that will be required of you. It's the very nature of nursing (especially but not exclusively community / public health nursing) to see the whole person, and to address the environmental factors which are sometimes KEY to resolving health concerns. Lisa, it sounds as if you have some great feedback for your faculty. It is unfortunate not to have time to develop relationships, but remember that, again, there is a different expertise to be sharpened here. Sometimes nurses must establish a "relationship" in mere moments. Think about the ER nurse, or the nurse speaking to a patient wheeled into surgery. As an NP I may only have 10 minutes with someone to establish the connection I need. You can surely hone those skills in your current situation.

Hi All, I am another soon-to-be BSN graduate here to add my commentary on this issue. It is not news to me; I had heard a few times in my program that clinical placements were not only difficult in community health, but also areas like pediatrics. Fortunately, these rotations all worked out, and with a little flexibility I feel that my experience has been very well-rounded. To start - I will say that one of the biggest take-home messages I have received in my ASBSN program is the truth to the sentiment, "you can do just about anything in nursing." My class has been very fortunate to have especially experienced this in our community health rotations. To start, we were able to meet with a local parish nurse, who explained the role of a nurse within a parish community. She also worked with the local hospital to reach out to the Hispanic female population who are affected by breast cancer. Her understanding of the culture, and involvement with the predominant religion made her invaluable to this population. We also got experience shadowing nurses in a home health agency, discharge planning/case management nurses, public health nurses working on communicable disease cases, and school nurses. We spent some hours working a flu shot clinic in the local homeless shelter and implemented teaching projects, which allowed us to interact and provide valuable health education to the people using the shelter's services. Lastly, we were able to collaborate with our clinical hospital on a committee that was developed to reduce readmission rates. Unique to this committee was the fact that it was composed of only nurses, so their feedback to this major issue of nursing practice was absolutely imperative. For part of our clinical fulfillment, we attended these meetings, and collaborated with researching academic journals and other publications to work on policy implementation and forming a grant for future funding towards this program. While my program didn't partake in any specific "leadership" rotations, I feel strongly that I have experienced many aspects of leadership through all of my rotations and educational experiences. Maybe an interesting read regarding this topic would be an article I read awhile back, for which I can only offer a citation: Rossman, C.L., Dood, F.V., Squires, D.A. (2012). Student nurses as school nurse extenders. Journal of Pediatric Nursing. 27, 734-741. The current recommended ratio from Health People 2020 is 1 nurse per 750 students! As a pilot study implemented by a BSN program, this article discussed the use of the students under the supervision of faculty in the role of the school nurse. It is almost unfortunate that we have statistical data showing the positive outcomes of a school nurse within a smaller ratio of students, and the benefits for certain at-risk children can be life altering in the long run; however, this area of nursing is still very shorted. The benefit of this project was that the students were able to provide an increase of 400 school nursing hours through their case loads, and also provide the valuable health services that we know are optimal during the school-aged years. I thought this would be an interesting bit of information to maybe provide you with some more ideas! Thanks so much for sharing your thoughts, and giving me an outlet to add my two cents - I really appreciate it, and I look forward to joining the profession with all of you nurses very soon!

Megan, thanks for the thoughtful input. I am interested in the use of student nurses to expand the workforce (though I admit I don't like the "extenders" language). In my rural area of California, we have seen student nurses provide a very valuable contribution to the Care Transitions team. They follow up on patients recently discharged from acute care, to assure that they understand their follow-up instructions and medications, as well as verifying that they have secured outpatient follow up appointments. They have been very successful in finding medication errors and in facilitating the appropriate post discharge care to prevent a re-admission. Can you clarify though whether the students in this model are supervised by their nursing faculty or by faculty at the school where they are providing services? I would have concerns about that latter!

Hi Pat! Thanks for responding, and I apologize for any lapse in time on my behalf. In the article that I mentioned, the student nurses were supervised by their nursing faculty in collaboration with the school nurses. I hope this helps!