The aim of this paper was to examine whether the relationship between the clinical placement duration and total satisfaction with clinical training was mediated by supervisory relationship or learning environment. Overall, our results show that students were more satisfied with longer duration of the placements. Furthermore, participants’ who perceived a better relationship with the supervisor, a better learning environment, and considered the supervisor as the most important person to help them, were more satisfied than those involved in shorter duration in clinical settings. Satisfaction with supervision and good learning environment mediated the relationship between placement duration and total satisfaction of nursing students.
It seems clear the importance of providing a supportive clinical learning environment to enhance teaching and learning. Our results show that students with the greatest satisfaction with their clinical training were those who considered the supervisor to be the most important figure. A literature review has already shown that there is no universally key person available solely responsible for nursing professionals and development in clinical settings (Lambert and Glacken, 2005), and studies in other countries still point out that the assessment of different figures involved in the learning process reported by nursing students remains controversial (Dimitriadou et al., 2015). Furthermore, it should be highlighted the diversity of existing terms to describe those responsible for student’s supervision all across Europe (Andrews et al., 2006; Ramage, 2004; Wills, 1997). Additionally, the implementation of Higher Education has transformed the role of nurse teacher, who has become more responsible for the support of learners in practice placements (Fisher, 2005) and self-learning has become as an essential issue within this new learning context (Alotaibi, 2016).
Until now, several studies reported that the supervision provided by nurses, the level of interaction with the nurse teacher and the relationship between the student, supervisor and nurse teacher were the most important extrinsic factors that influenced the clinical learning experiences of students (Saarikoski et al., 2009; Warne et al., 2010). In accordance with Antohe et al. (2016), our results confirm that the longer the placement duration is, the better the satisfaction with their clinical training proves to be. As far as we know, the duration of clinical placements varies from one week in Slovenia (Žvanut et al., 2018) to 3 years in England (McCallum et al., 2016). In those cases where the clinical placement was short, a lack of familiarity between the staff and the students (Dimitriadou et al., 2015; Žvanut et al., 2018) and lack of opportunities to develop relationships with patients (Al-Anazi et al., 2019) were stated as the main drawbacks. Thus, McCallum et al. (2016) asseverate that hub placements appear to be a good way to increase the duration of the clinical training and stimulate the interaction with supervisors; when the student returns periodically at the same ward at different times during their nursing degree programme, the satisfaction with their clinical training increases. One of the explanations could be because the nursing team was previously trained, and therefore more experienced. Nevertheless, returning periodically at the same ward is not exactly equivalent to increase the duration of the placement. Similarly, Hutchings et al. (2005) suggest that performing the same week shift pattern as the nursing staff would offer opportunities for them to take advantage of learning opportunities.
The main factors for a good learning environment are the pedagogical atmosphere on the ward and establishing a supportive interpersonal communication with supervisors (Baraz et al., 2015). The literature stated that the students referred two core elements related to the pedagogical framework: envisoning the self as incompetent (Beck, 1993) and the feeling of being an outsider, i.e., not feeling as included as part of the working team (Chan, 2001; Melia, 1987). According to Christiansen and Bell (2010), peer learning seemed to be a good tool to minimize these two effects. Additionaly, it has been stated that intrinsic motivation and anxiety needs to be controlled as they affect academic achievement (Khalaila, 2015). Our results show that good learning environment mediates the relationship between duration of the placement and total satisfaction with their clinical training. Ip and Chan (2005) also found student involvement and personalization to be significant predictors of satisfaction. Nonetheless, neither of these variables were included in the CLES + T scale. Therefore further research on predictors of student satisfaction in the clinical settings and to clarify to what extent these variables depend on the duration of the placement is needed for widespreading generalizability.
Our study has several limitations that should be acknowledged. Firstly, even though the CLES + T scale was originally designed for measuring the level of satisfaction of nursing students with the clinical learning environment and the supervision in hospital settings (Saarikoski & Leino-Kilpi, 2002), its validation in community settings in Sweden (Bos et al., 2012) and New Zealand (Sims et al., 2010) proved to be a scale of reference in primary care practice settings. Nonetheless, as Bos et al. (2012) highlighted, the nursing students’ satisfaction could be increased in primary care practice settings by different factors such as one-by-one supervision, and caring for patients in their homes and under a long period of time. Consequently, these results cannot be inferred to primary care level. Therefore, an in-depth analysis on the degree of satisfaction of students in non-hospital settings would be necessary. Secondly, the cross-sectional design prevented us from making cause and effect inferences. Finally, complex models, including more than one mediator, moderation-mediation models or the longitudinal data would be useful in future research to confirm our findings.