Nurse Education Today 35 (2015) 888–893

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Nurse Education Today

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The visualisation of clinical leadership in the content of nursing

education—A qualitative study of nursing students' experiences
Waddah Démeh a,1, Kristina Rosengren b,⁎
a
Faculty of Nursing, Clinical Nursing Department, The University of Jordan, P.O. Box 850869, Amman 11185, Jordan
b
Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, SE-405 30 Gothenburg, Sweden

a r t i c l e i n f o s u m m a r y

Article history: Objective: The aim of this study was to describe nursing students' experiences of clinical leadership during their
Accepted 25 February 2015 last year of education.
Background: Work as a nurse is complex with several demands from stakeholders who are colleagues, managers,
Keywords: patients and relatives. Therefore, it is important to provide students with tools for a forthcoming professional life
Clinical leadership as a nurse.
Experiences
Setting, Participants and Method: A qualitative descriptive study was carried out in Jordan. Narratives (n = 20)
Nursing management
Nursing student
written by nursing students in their last year before graduation as a registered nurse were collected. The data
Transition were analysed by a manifest content analysis.
Results: The results formed one category: (Clinical leadership—safety in being a nurse), and three subcategories
(eye-opener, a role model and bridging the gap) described the students' clinical leadership experiences due to
the preparation process for being a nurse. Clinical leadership applies theory to practice by using a holistic view
in nursing.
Conclusion: Clinical leadership is a valuable tool for bridging the gap between theory and practice in nursing
education. Skills within nursing management clarify and simplify nursing activities, which facilitates the
transition from student to nurse. Focus on learning needs in nursing management is needed for stakeholders
within education and health care organisations to facilitate graduation of well skilled nurses.
© 2015 Elsevier Ltd. All rights reserved.

Introduction meet clients, students, and organisational needs. Nursing leadership is

The professional process to be a nurse includes the transition from
the education process for at least three years to manage caring and
nursing to patients and their families. Health care is carried out in
specific settings that are organised within certain routines, regulations
and cultural aspects. Evidence based nursing and course syllabi within
nursing education are tools that ensure professional delivery of safe
care. However, graduate nurses are not adequately prepared to be
leaders and to practice in today's complex and consistently changing
clinical environment (Benner et al., 2009; Heller et al., 2004). Kling
(2010) stated that nursing students lack managerial skills because of
limited resources and opportunities to practice different leadership
skills; they ‘follow’ and ‘observe’ instead of ‘lead’ or ‘do’. Meyer et al.
(2007) and Ousey (2000) confirmed that supportive clinical placement
provides valuable learning opportunities in regard to skills, knowledge,
practice reflection and socialisation. Clinical educators should design
course assignments and seek modalities and innovative strategies that
⁎ Corresponding author. Tel.: +46 31 7866059; fax: +46 31 7866050.
E-mail addresses: waddah.d@ju.edu.jo (W. Démeh), kristina.rosengren@gu.se
(K. Rosengren).
1
Tel.: +962 6 5355000; fax: +962 6 5300244.
identified by The International Council of Nursing [ICN] (2014) as one
of the five core values guiding nursing activities. Therefore, clinical
leadership is in the focus of this study to develop well skilled nurses.
Background
Emphasis on leadership in nursing has evolved in the last few
decades, and the number of publications on the topic has increased con-
siderably (Stanley, 2014). Changes and development in the healthcare
system, the complexity of diseases, and advancement of technology
present an urgent need for clinical leaders. Porter-O'Grady (2003)
added that knowledge power is another trigger for clinical leaders,
where the systems rely on the individual, not the organisation, to
carry out the change. Safe and competent nursing practice needs appro-
priate and visionary leadership (Supamanee et al., 2011). In addition,
leadership influences the quality of care, improves patient outcomes
(Cook, 2001; Davidson et al., 2006), innovation (Stanley, 2014), and
builds healthy workplaces (Cummings et al., 2010).
Clinical leadership includes tasks and activities that lead to improve-
ments in the safety and quality of health care. Moreover, clinical leader-
ship occurs at all levels of patient care and refers to the process of
leading a set of activities which requires competency in team leading

http://dx.doi.org/10.1016/j.nedt.2015.02.020
0260-6917/© 2015 Elsevier Ltd. All rights reserved.
 W. Démeh, K. Rosengren / Nurse Education Today 35 (2015) 888–893
(Swanwick and McKim, 2011). Clinicians, as nurses, need leadership
competencies to improve the planning, delivery and transformation of
health and social care organisations. The Clinical Leadership Competency
Framework (CLCF) includes five core domains that could improve
nursing management: “demonstrating personal qualities”, “working
with others”, “managing services”, “improving services”, and “setting
direction”. This framework is one useful tool for quality improvement
within health care (NHS, 2011). Nurses use various policies, guidance,
standards of proficiency, standards of education, codes of conduct and
ethical behaviour in their daily work to influence the work environment
and to improve health care (Rosengren et al., 2007; Rosengren and
Bondas, 2010). Clinical leadership includes a responsibility to contribute
to the effective running of the organisation. Therefore, the development
of leadership capability is an integral part of nursing education. Stanley
(2012) clearly declared that clinical leadership leads to innovation and
planned change toward improvement of care, services, quality, and
professionalism. He suggested that focusing on people and their contri-
bution to the organisation is the key to change and improvement.
Curtis et al. (2011) asserted that a job title does not make a leader; a
leader is determined by his/her behaviours, and excellent leadership
behaviours can be developed at the earliest stage of basic nursing
education and training. In addition, Cummings et al. (2008) suggested
that practicing leadership, modelling, and certain educational activities
and strategies can develop leadership. The gap between education and
leadership demand can be reduced by employing successful education
training programmes. However, graduate nurses are not adequately
prepared to be leaders and to practice in today's complex and consis-
tently changing clinical environment (Benner et al., 2009; Heller et al.,
2004). Kling (2010) stated that nursing students lack managerial skills
because of limited resources and opportunities to practice different
leadership skills; they ‘follow’ and ‘observe’ instead of ‘lead’ or ‘do’.
Educators need to be aware of the gap between nursing education and
clinical placement requirements and focus their efforts on reducing
this gap (Burns and Poster, 2008; Pellico et al., 2009). Moreover, educa-
tors must also prepare and train students with the knowledge and tools
they need to become competent and to provide high quality care. The
Jordanian National Nursing Strategies (2011–2015), proposed by The
Jordan Nursing Council (JNC), assert two objectives in the educational
domain: “ensure a safe and effective transition of graduates from the ed-
ucation and learning stage to the stage of actual professional practice,
and to ensure high quality nursing education” (JNC, 2011, p 14). In
these contexts, little is known about Jordanian nursing students'
experiences of clinical leadership. Therefore, the aim of this study was
to describe nursing students' experiences of clinical leadership during
their last year of education.
Methods
Design
A qualitative design could increase the understanding of nursing
students' voices, views and thoughts about clinical leadership. Therefore,
a descriptive study using content analysis (Graneheim and Lundman,
2004) was conducted to describe nursing students' experiences. Though
qualitative research relies on trustworthiness, transparency, verification,
reflexivity and is also ‘informant-driven’, the design could be helpful
to develop insightful and artful interpretations within the nursing
education process (Polit and Beck, 2012).
Setting
The total number of nurses in Jordan is 26,038, and 55.5% (n =
13253) of them are registered nurses (JNC, 2012).The Faculty of Nursing
(FoN) at the University of Jordan offered the first Baccalaureate Degree
in Nursing in 1972, and a total of 773 students were educated in year
2014. The FoN also offers masters and doctoral programmes
889
(University of Jordan, 2014). Nursing education covers both theoretical
and practical training to develop health professionals. Undergraduate
and postgraduate education includes general and specialised nursing,
for example, mental health and critical care nursing. The main objective
of the course “Management and Leadership in Nursing-Clinical” is to
give students the opportunity to integrate various management and
leadership concepts for example Hershey Blanchard Situational Model,
and principles into practical experiences within different health care
settings. It is expected that students should participate in selective
activities that enhance mastering different management and leadership
concepts and skills (University of Jordan, 2014). Course objectives are
achieved through designing teaching modalities such as: practicing
how to use hospital-related records (i.e., assignment sheet, end of shift
report, incident & narcotic reports, progress note, and staff schedule),
nurse leader role comparison discussion, departmental analysis project
and presentation, clinical conferences, clinical performance evaluation,
and final written exam that covers seminars and clinical experiences.
Clinical supervisors in this course are master-prepared in general
nursing with a minimum of one year of nursing experience; half of the
supervisors are part-time employees and hold a Bachelor's degree in
Nursing. Usually 40–50 students are enrolled in the course every
academic semester, and the students spend 10 hours for 16 weeks in
clinical areas.
Data Collection
This study was designed to understand the education process within
the University of Jordan. The inclusion criteria for participation were
nursing students in their last year of education at the bachelor level
for general nursing, registered and completed the course called
“Management and Leadership in Nursing-Clinical” at the University of
Jordan, over age 18, and able to understand and speak Arabic and
English. Data were collected from May to July, 2014. All student who
met the criteria were invited to participate in the study (n = 32). The
response rate was (62.5%). Female respondents were (78%) and male
respondents were (22%), and their age varied from 21 to 26 year.
Students received their training in medical, surgical, and orthopaedic
floors. The study comprised a total of 20 written narratives, and ethical
guidelines for human and social research were considered throughout
the study (Codex, 2014). Participants were informed about the aim
and study procedures, and confidentiality was assured. The narratives
were based on two open ended questions concerning participants' ex-
periences of clinical leadership: “What are your perspectives of clinical
leadership experience?” and “What are the characteristics associated
with clinical leadership?” The data collection focused on nursing
students' experiences of clinical leadership and was collected at the
end of the course.
Data Analysis
The narratives were analysed using manifest qualitative content
analysis in a step-by-step procedure (see Table 1), as suggested by
Graneheim and Lundman (2004). Written words from the narratives
were used for the analysis. Texts were read to acquire a first impression
of the content about clinical leadership. The manifest analysis addressed
questions about nursing students' experiences of clinical leadership. The
analysis was performed in the following steps: (1) Written words were
read and re-read to obtain an understanding of, and familiarity with the
text about clinical leadership; (2) Meaning units (words, sentences or
paragraphs) corresponding to the content areas were selected for
(a) new knowledge area, and (b) being prepared; (3) Each meaning
unit was condensed into a description of clinical leadership and
labelled with 25 codes; and (4) Categories were identified and
clustered into categories such as “Clinical leadership—safety to be a
nurse”, “eye-opener”, “a role model” and “bridging the gap”.
The emerging findings are illustrated by quotes.
890 W. Démeh, K. Rosengren / Nurse Education Today 35 (2015) 888–893
Table 1
Example of description of data analysis.
Meaning unit
I found how important this course is and how it can present
an excellent picture about nursing if we use it in a proper
way…I felt that I am a part of the system; with help from the
supervisor and instructor
Ethical Considerations
Ethical approval and permission for the study were obtained from
the dean of the Faculty of Nursing, University of Jordan. No ethical ap-
proval was used due to Jordanian rules and guidelines for research
using students' evaluation of education. Respect for the individual stu-
dent was a main concern during the study. All students were informed
about voluntary participation and consented to participate in the study,
knowing their right to withdraw at any time (regarding the use of the
narrative) and that their answers would be kept confidential. Moreover,
students were informed that their participation would not influence
their education results at the university. In addition, the data analysis
followed a scientific systematic analysis to ensure the trustworthiness
of the results. Ethical guidelines for human and social research have
been considered throughout the study (Codex, 2014).
Results
The results formed one category: Clinical leadership—safety to be a
nurse and three subcategories: eye-opener, a role model and bridging
the gap. Clinical leadership was described as visualising theory into
practice by a holistic view. The education process could be described
as a transition to become a nurse which begins with an eye-opener,
followed by a role model that bridge the gap of knowledge about
nursing activities.
Categories are presented by Fig. 1.
Clinical Leadership—Safety to be a Nurse
The category “Clinical leadership—safety to be a nurse” describes
students' experience of clinical leadership regarding preparation to be
a nurse. Feelings of reality shock were expressed regarding being a
nurse in a complex health care organisation. Students expressed anxiety
at the beginning of the course due to a lack of knowledge and skills in
nursing management. However, clinical leadership was stressed as an
eye-opener regarding the forthcoming work. Students stressed the
Clinical
leadership -
safety to be
nurse
Bridging
the gap
A role
model
Eye-opener
Fig. 1. The four categories of results.
Condensed content Coding Subcategory Category
Picture of nursing…part of the Overview A role model Clinical leadership—
system with help from supervisor safety to be a nurse
need for a role model in nursing education, for explaining different per-
spectives which facilitates and simplifies nursing. Students highlighted
the significance for supervisors to act as a resource for them on a daily
basis. In addition, improved knowledge about clinical leadership
(theory and practice) prepared them for the forthcoming role as a
nurse. Students highlighted that clinical leadership should be practiced,
not only observed, to improve the quality of care. Managerial aspects as
organisation and leadership were tools that simplified procedures in
nursing and caring. One example was that hospital policies clarified
the use of standardisation to improve the quality of care. Moreover,
students stressed the importance that supervisors translate nursing
theory into practice. Clinical leadership was described as an overall
task that visualises nursing activities within health care. This was
expressed as:
I think that this course would help to shape the perception about
nursing as a profession and can help students in the transition to
the role of a registered nurse (student 7)
Students argued that knowledge of clinical leadership is useful, and
they wish that the content had been introduced in an earlier stage of
the education process. This knowledge helped the students to shape
the nursing profession by adding new and different perspectives within
clinical leadership that visualises a deeper holistic perspective in
nursing.
Eye-opener
The subcategory “Eye-opener” describes nursing students' experi-
ences of clinical leadership as a new area of knowledge that changed
their way of thinking about nursing. Students described that their
supervisor explained different types of demands, for example, policies,
regulations and job descriptions as well as nursing activities for patients
and relatives. New content about nursing management was introduced,
and one student expressed it as:
It introduced many new concepts that qualify me to be a leader….I
acquired new experiences in different situations I faced (student
15).... I think what is learned was an excellent tool for us to use in dif-
ferent situations, especially what we learned about decision-making
and leader's styles. This course changed my way of thinking, my
relations and my view towards the future (student 17)
Students argued that clinical leadership is not an option; it is a neces-
sity to be taught and applied throughout nursing education. Moreover,
they also stressed that clinical leadership skills could be used in their
personal and professional life, and could be a general theme throughout
the nursing programme. Informants highlighted that clinical leadership
increased the awareness and use of organisational and leadership skills
in their daily work as a nurse.
I became aware about political issues in the floor. The supervisor was
organised, planned and evaluated the work, they were reasonable
and ethically responsible, built self-confidence and trust into their
fellows (student 2)
In addition, students highlighted that awareness and knowledge in
clinical leadership improve health care through developing vision and
 W. Démeh, K. Rosengren / Nurse Education Today 35 (2015) 888–893
goals. They also stressed that nursing skills in clinical leadership provid-
ed them with opportunities to prioritise between tasks and work with
fulfilment for high quality of care. Clinical leadership was highlighted
as both administrative tasks and nursing activities which formed an
overall picture of the forthcoming work as a nurse.
A Role Model
The subcategory “A role model” was described by the students as
someone who shapes the experience about nursing as a profession
into the transition to be a registered nurse. Supervisors (nurses) were
described as resource-persons, teachers, consultants and advisors that
provided guidelines to encourage others. This was described as:
The nursing supervisor showed support to their fellow nurses in all
aspects, they provided knowledge and information; they were
resource-persons and teachers (student 1)
Students argued that communication skills were the main tool used
by nurses to address difficulties that arise in daily work, for example,
discrepancies or conflict within the unit. They highlighted the
importance of interpersonal communication as the cornerstone for
clinical leadership, a tool to visualise nursing. Nurses that handle
communication in a constructive manner become role models. To
improve health care, students highlighted the fact that supervisors use
communications that include both carrot and stick. By being present
and using verbal and non-verbal communication skills in nursing
activities, improvement of work within health care could take place.
This was expressed as:
My supervisor showed a high level of credibility as his role modelled
in everything: leadership roles or clinical skills. Feedback was pro-
vided at the completion of a task and by the end of the day; provided
positive and negative feedback (student 5).
The role model is important for improvement within the education
process. Students highlighted the idea that knowledge in clinical
leadership improved social skills. They argued that support is crucial
for their personal growth during transition to be a nurse. Moreover,
students described the need for security in forthcoming work as a
nurse, and why the coaching and learning process from the supervisor
were significant to achieve their professional self-image. One student
described it as:
Yes, this is what I've been waiting for, have room to grow and devel-
op my personal and professional skills, to know about being a real
nurse and how they can help…..Supervisors and instructors facilitate
work and break down barriers to success. They empowered staff,
delegated tasks and provide guidelines with few instructions
(student 6).
Another perspective that the students noted regarding the role
model was that they empowered patients to participate in planning
process for nursing and caring.
Bridging the Gap
The subcategory “Bridging the gap” describes nursing students'
experiences about combining theory and practice into a holistic
perspective of nursing. They expressed that theoretical parts were
used as guidelines within clinical leadership and helped them to
understand their forthcoming work as a nurse. Students described
that they have to handle strength and weakness to be prepared for
unprepared nursing tasks, though different demands that appear in
daily work visualise the understanding for nursing activities. Skills
within clinical leadership facilitate work and break down barriers.
Different management functions as an application of leadership
891
models, concepts of delegation and teamwork were used to integrate
and refine theoretical and practical skills in nursing. This was
expressed as:
The course was an application of what we learned in theory class, for
example the application of leadership models, concepts of delega-
tion, teamwork and documentation (student 3) ...... we linked what
we learned in class to the opportunities we had in clinical, that
was wonderful (student 2).
However, the opposite experience was also reported, as a lack of
integration between theory and practice occurred. Then, students
described difficulties in understanding the overview of theory and
nursing, and they highlighted that supervisors are crucial to bridge the
knowledge gap within nursing. Informants also noted that those learn-
ing activities are dependent on continuity of the supervisors within the
education process (theory and practice). Furthermore, students
highlighted the significance of a kind and welcoming environment at
the floor/ward to improve self-support. Students described themselves
as nervous to manage patient care in the future as a nurse. Therefore,
they stressed the importance of an ethical responsibility of supervisors
to help build self-confidence and trust in their followers. One student
described it as:
This course strengthened my personality, enriched me and taught
me how to be a leader, how to deal with a different situation in clin-
ical settings, introduced me to new concepts in leadership, clarified
and explored the differences between concepts (student 19)
Students argued that self-support and autonomy bridge the gap to
being a nurse. They stressed that co-operation and collaboration be-
tween staff members facilitate development towards self-reliance and
self-confidence in nursing. One student expressed bridging the gap as:
I liked leadership, it helps shape part of the nursing profession, and
added something to me, and I look to things differently, deep and
whole. The supervisor was willingly providing help and support to
us and the staff. Also, she motivated others, was approachable, ac-
cessible and available at all times (even when they were off-duty),
were consultants and advisors (student 3)
In addition, students argued for the importance of being prepared to
make differences in a patient's life. They highlighted that the integration
of different knowledge helped them on the right track towards being a
nurse. The content of clinical leadership made them understand what
and how to work with a holistic perspective. They described it as an
overview of different tasks that could be solved in everyday practice, a
tool that prepared them to be a nurse.
They (supervisors) were integral, consistent, and collaborative. They
believed leadership roles should be practiced not observed, and that
they should be considered with their staff as well as with quality care
provided to patients (student 10).
Discussion
The aim of this study was to describe nursing students' experiences
of clinical leadership during their last year of education. The study
revealed a better understanding of the transition process, from student
to becoming a registered nurse. Clinical leadership could be a valuable
tool to bridge the gap between theory and practice in nursing.
Furthermore, skills within clinical leadership as nursing management
contribute to clarify and simplify nursing activities by integrating
theory into practice. This facilitates the transition process to the forth-
coming work life as nurse (Pepin et al., 2011), and ensures that nursing
graduates deliver safe and effective care (Lekan et al., 2011).
892 W. Démeh, K. Rosengren / Nurse Education Today 35 (2015) 888–893
The importance of the learning process in a nursing education
programme should be discussed. Nursing students highlighted that
nursing benefits from learning needs regarding nursing management.
The study showed that clinical supervisors are crucial for students to
link theory into practice in nursing, which is in line with earlier research
(Henderson et al., 2010; Porter-O'Grady, 2003; Supamanee et al., 2011).
Managerial skills as organisation and leadership facilitate nursing activ-
ities (Rosengren et al., 2007; Stanley, 2014) regarding learning by doing,
a concept within a pedagogical viewpoint (Rogers, 1969; Dewey et al.,
2004). The facilitator (supervisor) helps students to elicit and clarify
the vision and goal for the health care, as well as the more general
aim for nursing is highlighted. For example, learning how to use equip-
ment without adding new resources could be explained as thinking for-
ward and backward as a type of problem solving strategy. Students
manage uncertainty by using a learning process in complex organisa-
tions in health care by using supportive clinical placements that provide
valuable learning opportunities (Livsey, 2009; Meyer et al., 2007).
The process of making and doing nursing activities is crucial within
education. When supervisors use learning by doing (Dewey et al.,
2004; Kolb, 1984; Rogers, 1969) and then pull students aside for
short, one-to-one oral quizzes (for example case management), giving
guidance only when necessary, students start to ask questions. Asking
questions and problem solving regarding nursing management skills
contribute to the development of well skilled nurses. Knowledge within
clinical leadership gives possibilities to cover the nursing process from
novice to expert (Benner, 1984). Furthermore, skills in clinical leader-
ship prepare students to understand what and how to work as a nurse
regarding a holistic perspective in nursing. These skills affect and im-
prove students overall overview of different tasks that could be solved
in everyday practice and could be described as a tool that prepares
them for the forthcoming work as nurses by using theoretical options
in practical settings, which is in line with other researchers (Benner
et al., 2009; Burns and Poster, 2008; Kling, 2010; Meyer et al., 2007;
Supamanee et al., 2011).
Moreover, supervisors (theoretical and practice teaching) could also
facilitate learning by using a situational leadership theory (Hersey et al.,
2008). The Hersey–Blanchard Situational Leadership Model rests on
concepts; leadership style and the individual or group's maturity level.
First, telling is characterised by one-way communication defined the
roles of students as what, how, why, when and where to do the nursing
activities or tasks, as an eye-opener. Second, selling provides students
with socio-emotional support that allows them to influence the learning
process in nursing by using two-way communication, for example the
supervisor becomes a role model. Third, participating includes shared
decision-making about aspects of how the nursing task is accomplished.
The supervisor maintains a high relationship behaviour, which builds
self-confidence and trust in students. The fourth and last step, delegat-
ing, is described as responsibility that has been passed to the student,
and the supervisor stays involved in nursing. The supervisor needs to
be flexible and adapt the nursing situation to influence the transition
for the student to become a nurse (Kelly, 2007). Effective clinical leader-
ship could be described as task-relevant, and the most successful super-
visors are those that adapt their leadership style to the maturity of the
students they are attempting to lead or influence in health care
(Hersey et al., 2008).
A supportive learning process that supports integration of theory and
practice in nursing is needed at universities and within health care to en-
able graduation of well skilled forthcoming nurses (Davidson et al.,
2006). Clinical leadership (Stanley, 2012, 2014) is one tool to naturally
link theoretical concepts (for example leadership style, organisational is-
sues, and evidence based nursing, quality improvement) into practice
when nursing is practised. This merging of knowledge (fact and tacit)
is like art, knowing what with difficulties to know how. Competence in
nursing is described by Garside and Nhemanchena (2013) as a “nebulous
concept defined in diverse ways by different healthcare practitioners”.
They argue that academics and professionals provide different
definitions, which has compounded what competence is in relation to
nursing practice. Competence could be described as a progressive expe-
rience from novice to expert (Benner, 1984). Furthermore, awareness
that competence is a context and time specific idea regarding nursing
education is a valuable tool to provide quality improvement (Garside
and Nhemanchena, 2013). Chavez and Yoder (2014) and Mannix et al.
(2013) identified three preliminary clinical leadership attributes: clinical
ability, effective communication, and relational consideration. All super-
visors (universities and health care settings) have to collaborate within
the same goal and vision to train and prepare students to be nurses,
and skills in clinical leadership could be one tool to visualise nursing as
a forthcoming profession (Zilembo and Monterosso, 2008). However, a
sound definition of the word competence should be used (Cowan et al.,
2005).
In addition, nursing as a profession (Meleis, 1997) has to be
visualised by performing activities in daily practice. Transition could
be highlighted as a journey, from the student perspective (under super-
vision) to be an autonomous registered nurse. Different learning strate-
gies are used to provide a coherent learning experience. The link
between theoretical knowledge and pedagogical techniques is not
easy to do within a professional clinical experience. Universities aim
to equip students with broad generic, transferable knowledge and skills
in preparation for lifelong learning (Cowan et al., 2005; Kling, 2010).
Students learn by doing (Rogers, 1969) and need guidelines to follow
with few detailed instruction that enable the possibility for individual
growth regarding each student's learning needs and learning processes.
This study indicates the opportunity for health care to improve tacit
knowledge of supervisors and students in a systematic way by using
skills in nursing management. Positive impacts could be expected in
terms of a smooth transition from student to a working life as a nurse.
Moreover, the management and human resources systems within uni-
versities and health care organisations have to have a common vision
regarding high quality care and developing professional staff members.
Clinical leadership (Bégat et al., 2005; Burns and Poster, 2008; Cook,
2001; Curtis et al., 2011; Kling, 2010; Stanley, 2012, 2014; Swanwick
and McKim, 2011) is one way to cover a common picture of nursing pro-
fession and to improve nursing and caring within health care.
Limitations
There are limitations to these findings. First, the data collection
procedure could be a limitation. Narratives regarding students'
evaluation of one course within a general nursing programme at
one university were selected and used. A broader sample with
students from other universities could enrich the data and the cred-
ibility and transferability of the study. However, the trustworthiness
and dependability of the results were ensured through a scientific,
systematic analysis using a well-documented methodology of quali-
tative content analysis (Graneheim and Lundman, 2004; Elo and
Kynga, 2008). Understanding narratives (Price, 2013) can inform us
about education needs and in turn, help universities and supervisors
to make decisions to improve the transition from students to nurses.
Furthermore, the study's validity could be discussed due to its data col-
lection procedure (narratives from one course at one university), and
further studies are needed to develop knowledge of nursing students'
experiences of clinical leadership during education regarding learning
needs for transition in nursing.
Conclusion
Clinical leadership can be a valuable tool for bridging the gap be-
tween theory and practice in nursing education. Theoretical knowledge
should be learned by doing instead of viewing within a practical part of
the education process. To be competent is a concept which is defined in
different ways by different scholars with no universal definition.
However, the vision is to integrate theory and practice in nursing for
 W. Démeh, K. Rosengren / Nurse Education Today 35 (2015) 888–893
forthcoming nurses. Therefore, stakeholders in universities and health
care organisations have to focus on the learning needs in nursing to fa-
cilitate graduation of well skilled nurses. Skills within clinical leadership
and nursing management could visualise, clarify and simplify nursing
activities, which facilitates transition from student to nurse.
Ethical Approval
Ethical approval was not required for this paper.
Contributions
Study design: WD, KR; data collection: WD; data analysis: KR; and
manuscript preparation: WD, KR.
Sources of Funding
The authors received no financial support for the research,
authorship, and/or publication of this article.
Acknowledgements
We thank all nursing students at the University of Jordan who have
written narratives in the summer of 2013 and the University of
Gothenburg Centre for Person-Centred Care (GPCC), Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden.
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