Nurse Education in Practice 31 (2018) 182–187

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Nurse Education in Practice

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Clinical education

Australian final year nursing students′ and registered nurse supervisors’ T

perceptions of a gerontology clinical learning experience: A preliminary
appraisal
Colleen Ryana,∗, Pammie Ellemb, Leeanne Heatonc, Jennifer Mulvoguea, Marina Cousinsb,
Linda De George – Walkerd
a
Central Queensland University, School of Nursing, Midwifery and Social Sciences, 90 Goodchap Street, Noosaville, QLD 4566, Australia
b
Central Queensland University, School of Nursing, Midwifery and Social Sciences, University Drive, Bundaberg, QLD 4670, Australia
c
Central Queensland University, School of Nursing, Midwifery and Social Sciences, Sydney St, Mackay, QLD 4570, Australia
d
Central Queensland University, Social Innovation, 160 Ann St, Brisbane City, QLD, 4000, Australia

A R T I C LE I N FO A B S T R A C T

Keywords: Current international research suggests universities providing nursing education should focus on shifting stu-
Nursing student dents' attitudes towards valuing clinical learning derived from aged care settings, offering support and education
Gerontology for aged care facility staff supervising nursing students’ learning in the aged care setting, and encouraging
Clinical placement nursing graduates to consider pursuing careers in gerontology nursing.
Clinical learning model
Against this international backdrop, one Australian School of Nursing designed a structured clinical learning
Clinical learning
experience to offer final year nursing students an opportunity to further their knowledge and understanding of
the complexities of the role of the gerontology registered nurse. Additionally, this clinical learning experience
included provision for nursing academics to offer support and expertise to the aged care facility staff around the
role of supervising and assessing final year nursing students’ clinical learning.
The aim of this paper is to present fifteen final year nursing students' and nine registered nurse supervisors’
evaluations of the gerontology clinical learning experience and the success of the learning experience towards
meeting the project aims. Mostly participants reported positive experiences and agreed the experience illumi-
nated the role of the gerontology registered nurse. Participants in this study also provided suggestions about the
benefits and barriers of the clinical learning experience.

1. Introduction
Internationally, concerns have been expressed that first year nursing
clinical learning experiences in residential aged care settings are few,
designed mostly for developing fundamental nursing care skills, and
may be devaluing the clinical learning opportunities available within
the residential aged care setting (Banning et al., 2006; Neville et al.,
2008). Specifically, the advantages of nursing students’ clinical learning
experiences for improving student understanding of gerontology may
be lost as a result of the messages the students receive, either directly or
indirectly, from the acute focused undergraduate nursing curriculum
(Algoso et al., 2016). For example, in Australia, 68% of nursing clinical
learning experiences are offered in acute settings such as medical sur-
gical, emergency departments and higher acuity speciality areas with
only 9% in residential aged care facilities (Lea et al., 2017b). Thus,
nursing students could be forgiven for believing that residential aged
care clinical placements offer inferior experiences to acute care place-
ments.
Further, Grealish et al. (2013) reported that Australian students felt
disconnected and disadvantaged with their learning in aged care en-
vironments because they believed they were not exposed to the same
types of challenges and skills development available in the acute care
setting. Supervising staff reported these students’ lacked engagement in
the learning experiences available to them in the residential aged care
setting. This Australian study confirmed earlier research undertaken in
the United Kingdom where students claimed working in aged care was
much less rewarding than in hospital settings and did not provide them
with the necessary skills they needed to be a registered nurse (Banning
et al., 2006).
Other studies argue clinical learning experiences in aged care

∗
Corresponding author.
E-mail addresses: c.l.ryan@cqu.edu.au (C. Ryan), p.ellem@cqu.edu.au (P. Ellem), l.heaton@cqu.edu.au (L. Heaton), j.mulvogue@cqu.edu.au (J. Mulvogue),
m.cousins@cqu.edu.au (M. Cousins), l.degeorge-walker@cqu.edu.au (L. De George – Walker).

https://doi.org/10.1016/j.nepr.2018.06.003
Received 6 October 2017; Received in revised form 27 February 2018; Accepted 8 June 2018
1471-5953/ © 2018 Elsevier Ltd. All rights reserved.
C. Ryan et al.
facilities provide students with complex, diverse, multifaceted clinical
settings in which they can develop critical thinking and advanced skills
in working with a variety of professional teams, families and care givers
(Willetts et al., 2017). Instead of the nursing profession perceiving aged
care clinical learning experiences as inferior to those experiences of-
fered in the acute sector, there is need for a change in mindset in order
for gerontological focussed clinical learning experiences to be valued.
The challenge then, for nursing educational organisations is to change
an embedded mindset and to unlock the positive experience of ger-
ontology nursing for students. This discussion paper presents the ex-
periences and preliminary evaluation of final year nursing students and
supervising registered nurses of a clinical learning experience in a re-
sidential Australian aged care facility. The literature review that follows
identifies the following as crucial for drawing future graduates to ger-
ontology nursing: creating positive clinical learning environments,
building mentoring capability and learning opportunities, and ensuring
well-equipped teachers and clinical leaders to provide constructive
supervision and clinical facilitation (Lea et al., 2017a).
2. Review of the relevant literature
The culture and attitudes of staff and academics involved in student
clinical learning experiences in aged care settings is critical to the
student experience and their consideration of aged care settings as a
graduate employment option. For example, recently in Australia,
Grealish et al. (2015) offered nursing staff and students at three re-
sidential aged care facilities an educational programme, designed to
improve organisational learning cultures. The organisation was keen to
further develop and improve the learning environment after previously
witnessing nursing students' positive impact on staffs' learning. The
education program positively impacted staff and students' leadership
skills and staff ability to promote student learning opportunities. This is
important because several earlier studies speak to the need for support
and education of registered nurses supervising nursing students’ clinical
learning in aged care facilities. In another Australian study, Xiao et al.
(2012) sought to educate registered nurses who were ill-prepared and
lacked confidence in their work with students, before allocating stu-
dents to the facility for clinical learning experiences.
Presenting another perspective, Neville et al. (2008) argued Aus-
tralian university nursing academics' inexperience in gerontology im-
pacted the preparation of nursing students for aged care clinical
learning experiences because they lacked experience, skills and
knowledge of gerontology nursing. Banning et al. (2006) suggested
registered nurses working to supervise nursing students in aged care
settings, in the United Kingdom, lacked ability to assist students to
develop the specific skills and knowledge required to work with older
persons. A Norwegian study of nursing students' clinical learning ex-
periences, confirmed insufficient organisational staff expertise was
available to supervise students’ clinical learning in five residential aged
care sites (Brynildsen et al., 2014).
Student clinical supervision models vary in student nursing pro-
grams, however, and in addition to culture, preparedness and attitude,
the engagement between student and clinical supervisor is essential for
the success of aged care placements (Ingram et al., 2014). In Norway,
Struksnes et al. (2012) designed a project to empower registered nurses
working with students in aged care settings. One key component of the
program required the registered nurses' attendance at group reflections,
facilitated by nursing academics, which sought to develop their as-
sessment and reflective practices. On completion of the program, the
participating registered nurses were found to be more self-confident
with assessment, reflection and communication with nursing students.
Australian researchers, Ingram et al. (2014) revealed an apparent link
between students’ clinical learning experiences, structured clinical
learning programs and engaged on-site supervisors when they observed
15 final year nursing and occupational health students undertaking an
aged care clinical learning experience. Two students reported a positive
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Nurse Education in Practice 31 (2018) 182–187
experience, which they attributed to the structured program of clinical
activities designed to guide their clinical learning, and the registered
nurses welcoming and supportive attitudes (Ingram et al., 2014).
International studies examining the experiences of final year nur-
sing students in the residential aged care settings are few. Of those
studies available, most consistently claim the learning opportunities for
senior nursing students in residential aged care settings are diverse and
beneficial. Grealish et al. (2013) argued for more final year nursing
students to experience aged care clinical learning experiences to de-
velop an understanding of the complexities of the role of the ger-
ontology registered nurse. Recently Australian researchers Willetts
et al. (2017) reported on the rewards and benefits of an aged care
graduate nurse program. The aged care organisations, the neophyte
registered nurses, and the university involved in the program concluded
it was exciting to work together to improve students' and others’ un-
derstanding and raise the profile of gerontology registered nurses. Al-
though the graduate program was in its infancy, the researchers re-
ported one-fifth of the neophyte registered nurses indicated intention to
remain working in the aged care setting.
The literature about the benefits and barriers to students' aged care
clinical learning experiences and the value to the residential aged care
organisations, generally overlooks the relationship between student and
aged care facility residents. Annear et al. (2014) offered some insight
reporting how second year nursing students worked alongside non-re-
gistered carers at an aged care facility, with the intention nursing stu-
dents would be directly involved in residents’ intimate care. Although
nursing students in this study reported being frustrated providing per-
sonal cares to the residents, some students benefited from building in-
timate relationships with the residents and experienced a sense of pride
in the depth of care they had provided.
In summary, the literature review has outlined benefits and barriers
evidenced in the published nursing literature around clinical learning
experiences in an aged care setting. The influence of education provi-
ders on the mindsets of students because of academics' clinical back-
grounds, the importance of well prepared and welcoming supervising
staff to enhance student learning, structured learning models and po-
tential relationships between students, residents and their families have
been highlighted. This discussion paper explores the experiences of
final year nursing students and the supervising registered nurses un-
dertaking clinical learning experiences in a residential Australian aged
care facility. In particular, the paper is preliminary evaluation of
whether the two aims of the clinical learning experience model were
realised. The first aim was to assist final year nursing students to un-
derstand the complexities of the role of the gerontology registered
nurse, and the second aim was to support gerontology registered nurses'
to supervise and assess nursing students’ clinical learning. To begin, a
description of the following is provided: the background to the project,
the development of the clinical learning experience model, and the
initial information sessions provided to participants.
3. The CQUniversity gerontology clinical learning experience
3.1. Background
In 2016, a regional residential aged care facility manager ap-
proached the university seeking assistance with recruitment of neo-
phyte registered nurses. This enquiry prompted the design and of a two-
week residential aged care clinical learning experience for final year
nursing students that incorporated critical elements identified in the
literature review and as described in detail in the next section.
Fifteen final year nursing students were randomly allocated to this
clinical learning experience. Nine aged care facility registered nurses
were involved in supervising and assessing the students’ clinical
learning and two university staff supported the registered nurses and
the nursing students. This support was necessary because in planning
for the clinical placement, the facility manager and the registered
C. Ryan et al.
nurses expressed concern at being inadequately prepared to work with
final year nursing students. Nursing studies in a variety of clinical set-
tings highlight this concern and have identified the burden of super-
vision when registered nurses are inadequately prepared for the role
(Broadbent et al., 2014; Xiao et al., 2012).
University ethics committee approval was sought and granted to
conduct a preliminary appraisal of this clinical learning experience.
3.2. The CQUniversity gerontology clinical learning experience model
The aim of the clinical learning experience was twofold. Firstly, for
final year nursing students to experience and value the complexities of
the role of the gerontology registered nurse, and secondly to support
gerontology registered nurses' to learn to supervise and assess nursing
students’ clinical learning. To meet these aims an integrated clinical
learning model was designed.
McLeod et al. (1997) explained models of clinical education are
important tools enabling clinical educators to frame clinical learning
experiences for students. Integration models of clinical education in-
tend to provide a framework for coordination between academic and
clinical learning (McLeod et al., 1997). In nursing, this model may be
particularly applicable because the practice-theory gap that students
experience between classroom learning and clinical experiences can be
a challenge (Benner, 2015). One integration model, described by
Pickering (as cited in McLeod et al., 1997) was chosen to frame the
clinical learning experience in this project. This version of the in-
tegration model focuses on integrating students' learning through solid
relationships between clinical education staff and academic staff. This
meant students were accompanied into the clinical learning environ-
ment by clinical educators who understand the curriculum. Ad-
ditionally academic staff offered organisational staff information about
the students’ learning objectives and clinical assessment requirements.
By utilising this integration model the authors were confident students
would have opportunity to practice and develop necessary skills (Brown
and Crookes, 2016).
As detailed in Table 1, skills included clinical skills and also lea-
dership, time management, teamwork and delegation, patient assess-
ment and efficient communication—skills deemed necessary for un-
dergraduate nursing students to practice and master before emerging as
neophyte registered nurses (Brown and Crookes, 2016). Students were
also required to demonstrate that they could function professionally
within the Australian legal and professional nursing framework. In
Australia, nursing curriculums are designed to meet the Registered
Nurse Standards for Practice defined by Nursing and Midwifery Board
of Australia [NMBA] (NMBA, 2016). Clinical assessment tools must also
reflect these national standards. One validated tool is the Australian
Nursing Student Assessment Tool [ANSAT] (Ossenberg et al., 2016). At
this university, nursing students attending clinical learning experiences
and their supervising registered nurses must complete two ANSAT as-
sessments, one formative and one summative. Additionally nursing
students must meet the learning outcomes for the academic unit of
study associated with the clinical learning experience and these focus
on demonstrating and application of: cultural competence and ad-
vanced communication skills; principles of patient safety and quality to
deliver evidence based, and person-centred care; and consider relevant
health promotion models.
Paper author CR designed the model in her role as Industry Liaison
Educator. Paper authors LH and MC in their respective roles of Head of
Bachelor of Nursing and Unit Coordinator approved the use of the
model for this clinical learning experience.
The following section now describes the information sessions of-
fered to nursing students and residential aged care registered nurses
who participated in the clinical learning experience.
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Nurse Education in Practice 31 (2018) 182–187
3.3. Student information session
Participating nursing students were provided an information session
prior to the clinical learning experience. This information session took
place during the students' compulsory, on campus learning sessions and
offered an opportunity for students to ask questions and to meet the
residential aged care facility staff. As noted in the literature review,
Neville et al. (2008) reported universities traditionally offer residential
aged care facility placements in the first year of study to develop fun-
damental skills, which may devalue the scope of practice and skills
emerging graduate registered nurses can learn in this setting. Students
at this university had traditionally undertaken clinical learning ex-
periences in the aged care sector in the first year of study and the au-
thors were curious if this student cohort might share similar concerns.
The conversations at the information session emphasised the learning
students could gain from spending time experiencing the complexities
of the aged care registered nurse role, and the benefits of understanding
gerontology and offering and providing care to residents with a variety
of comorbidities. The CQUniversity Gerontology Clinical Learning Ex-
perience Model (Table 1) was shared with the students at this time.
Students’ responses at the information session remained mixed, how-
ever, mostly students indicated they would approach the learning ex-
perience positively.
3.4. Orientating supervising registered nurses to their role
International nursing studies have found residential aged care fa-
cility staff supervising nursing students clinical learning, who are first
supported and prepared for the requirements of their role, benefit
professionally and are more able to offer students improved clinical
learning experiences (Brynildsen et al., 2014; Grealish et al., 2015;
Struksnes et al., 2012; Xiao et al., 2012). Thus, participating registered
nurses and facility managers were required to attend an education
session as part of regular education sessions for registered nurses su-
pervising nursing students’ clinical learning. Full details of these edu-
cation sessions are not discussed in this paper. Four supervising regis-
tered nurses and two facility managers representing the two separate
sites owned by the aged care facility attended. Content of the session
engaged participants in scenarios about formative and summative
clinical assessments using ANSAT, reflective frameworks, and the
clinical reasoning cycle (Levett-Jones et al., 2010; CQUniversity, 2015;
Ossenberg et al., 2016). Academic co-ordinators attended the sessions
to meet and brief participants on learning objectives and assessment
requirements. Additionally, the participants from the aged care facility
attended a separate session to introduce them to the clinical learning
experience model.
Following completion of the teaching semester, participants’ views
of the clinical learning experience were collated from a variety of
sources.
4. Participants’ experiences
4.1. Student experiences
Students’ evaluations of this aged care clinical learning experience
were collected as part of the university online student experience
feedback questionnaire. This questionnaire is made available to all
students enrolled in an academic unit of study. The coordinators for the
clinical unit and the teaching team are able to access the results of the
student feedback in the final week of each teaching semester, after
grades have been finalised. The university ethics approval permitted
use of this archival student feedback data for the appraisal of the aged
care clinical learning experience. Eight out of a possible 15 student
feedback responses clearly pertaining to the aged care clinical experi-
ence were identified. As the online student experience questionnaire is
anonymous, evaluations from the other students participating in the
C. Ryan et al. Nurse Education in Practice 31 (2018) 182–187

Table 1
The CQUniversity gerontology clinical learning experience model.
Day Daily Planner

Day 1 0700–1200 Facility staff conduct an organisational orientation

• Fire and safety
• Physiotherapy and manual handling
• Infection control notification systems
• Introduction to specialised dementia care program
• Electronic medication administration and documentation systems
University staff introduce case study projects
• All nursing students to research and present a five (5) min presentation guided by any of the following: Clinical Reasoning Cycle, (Levett-Jones
et al., 2010); Professional Codes of Conduct; Professional Code of Ethics; Registered Nurse Standards for Practice (NMBA, 2016); Australian
National Safety and Quality Health Service Standards (ACSQHC, 2012)
• Suggested topics for case study projects
o Interview a resident and research their medical history. Present a report outlining and linking co-morbidities to the resident's care program.
o Use the clinical reasoning cycle (Levett-Jones et al., 2010) to present an incident or an encounter you have experienced on this clinical
placement.
o Present a report on one resident's current medications focusing on pharmacokinetics and pharmacogenetics. Discuss any interventions you
might like to address or change.
1315–1500 o Present a review of one resident's care plan. Outline evidenced-based rationale and patient assessment data to justify your recommended
changes.
o Outline an evidenced-based organisational change that might benefit the organisation.
o Student's own topic after approval from the unit coordinator/supervising RN and/or facility manager.
Finalise rosters
Meet and greet RN supervisors
Lunch
Move to work areas
Days 2 &3 0630–1500 RN supervisors orientate/buddy with students
• Medication rounds
• Physicians rounds
• Wound rounds
• Resident assessments
• Electronic documentation
• Organisational policies and procedures

Days 4, 5, 6 & 7 0630–1500

• Handover
Students assume responsibility for providing cares, delegating to team members, attending physicians' rounds, documentation and handover
under supervision of RN
• Students administer medications for a minimum of 8 of the 32 residents, under the direct supervision of the RN
• On completion of medication round for 8 residents, student exits to prepare for wound, physician and Nurse Practitioner rounds (indirect RN
supervision) - RN supervisor completes the medication round
• Students may conduct the wound round under indirect supervision however must only attend to wounds previously known to them AND may
not implement changes without approval of RN supervisor
• Time throughout the day is allocated to preparing the case study
Meet with university staff at a time that does not disrupt students' work
• Review learning objectives
• Conduct debrief session framed by evidenced based reflective cycles known to students
Formative assessments (completed by Day 6)
• RN supervisor conducts assessments with student and university staff attends to provide support

Days 8, 9 & 10 0630–1000

• University staff offers RN supervisor debrief and feedback without student present
Students to work as RN team leader under direct and indirect supervision of RN supervisor

1030–1200
• Case study presentations
Lunch
1200–1230 Return to work areas
1230–1500 Complete summative assessments by Day 10
• Completed by RN supervisor with/without support of university staff
• University staff offers RN supervisor debrief and feedback without students present

Note. RN = Registered Nurse, SRN = Student Registered Nurse.

aged care clinical learning experience may have been overlooked if they
did not clearly identify the organisation in their feedback.
Student comments confirming the organisation's supportive
learning environment were common.
“I felt supported the entire time, and felt independent to achieve tasks
autonomously within my scope with confidence.”
“The nursing staff were fantastic and everyone was willing to buddy up
with me. I learnt a lot about time management and medication. This was
one of my favourite placements, I really enjoyed my time here.”
“Paired with a supportive RN who provided many opportunities to
clinically assess and discuss clinical findings post assessment of clients
with suspected urinary tract infections, DVT and the end of life cares.”
Other positive evaluations focussed on the opportunities students
were offered to practice and observe advanced leadership and com-
munication skills, and clinical reasoning and critical thinking.
“I was able to utilise the clinical reasoning cycle, conduct clinical as-
sessments, administer medications and injections, discuss the pathophy-
siological changes occurring in end of life and disease”.
“I built on my communication skills with staff, residents and external key
people including Pharmacist, Doctors, specialist, and anyone else in-
volved in the residents care”.
“Opportunity to get to know residents and their families by utilising
therapeutic communication especially with the family of an end of life
pathway as well as spend quality moments with clients”.

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C. Ryan et al.
Several students utilised the feedback facility to reflect on the re-
lationships they experienced with residents at the facility.
“It was very humbling, empowering and a great experience to be included
in care planning and delivery, and the residents themselves were fantastic
in supporting my learning journey.”
“An opportunity to reflect on why I wanted to be a nurse and this pla-
cement I was able to indulge myself in my passion for caring for people.
The joy on a person face when you stop and have a chat, the hugs you
can give the family who are watching their loved one die, the laughter
you have with a patient when you have done something ridiculous and
the compassion you can show when confusion has set in.”
Some students wrote of their newly acquired understanding of and
deepened appreciation for the role of a gerontology Registered Nurse.
“I would definitely consider aged care RN, and my previous “inter-
pretation” of what that role was has been clarified to be such more in-
teresting, rewarding, challenging and ever evolving. I think it is a positive
experience, and I really enjoyed it!”
“As an AIN [assistant in nursing] previously employed in a nursing
home, I never stop and give it even a second thought how busy and in-
volved the role of the RN actually is. I have gained an appreciation,
insight into how busy, versatile, complex and individual the role is.”
Two students provided comments that demonstrated undervaluing
of gerontology nursing placements when compared to acute clinical
placements.
“Placements for 3rd year students in an aged care facility did very little
to add to my nursing skills or knowledge. Aged care would be better
suited to first year students”.
“The placement at an aged care facility that had poor processes and staff
education was by far the worst placement I have ever endured. This
placement needs serious consideration if it is to be continued as a third
year placement.”
4.2. Supervising staff experiences
The partner organisation's staff experiences were collated though an
anonymous online survey. The School of Nursing Manager for work
integrated learning is responsible for emailing a generic university
survey to all host organisations. Open-ended questions seek general
information around student presentation, preparation for clinical pla-
cement and the support offered by the university to the host organi-
sation. Six registered nurses supervised the nursing students, with three
providing feedback responses about the benefits of having final year
students undertake a gerontology clinical placement.
“Working with 3rd year students provided a fantastic mutual learning
experience and I enjoyed teaching aged care approach. I was also im-
pressed with the clinical knowledge of the students.
“On the whole there were several benefits of having 3rd year students at
our facility being: mutual benefits of learning; introducing younger/new
nurses to aged care and developing partnership with University will im-
prove learning within the facility.”
However, organisational staff requested more preparation and
support for themselves and the students, prior to and during the clinical
learning experience.
“Improvements required: increased education with drugs and usage may
be required due to not having MIMs on hand for education. More edu-
cation required for staff taking on students.”
“The experience was challenging with initial groups. There were chal-
lenges were there was a lack of knowledge of the student scope. In ad-
dition, there was some aspects of aged care not included in learning of
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Nurse Education in Practice 31 (2018) 182–187
unit course e.g. Webster system and electronic medication system. Ways
to improve the program: learning guide/objectives for aged care …”
5. Discussion
Comments confirming the undervaluing of the aged care clinical
learning experience were evident in the feedback, and consistent with
the findings from previous research (Algoso et al., 2016; Banning et al.,
2006; Grealish et al., 2013). These comments were, however, a min-
ority and most comments illuminated many benefits of offering final
year nursing students’ clinical learning experiences in gerontology
nursing.
Another theme reflected in the feedback was that of the supportive
learning environment provided by the organisation and the supervising
registered nurses. Supportive learning environments; relationships be-
tween supervising staff, university staff, and students; and support for
supervising registered nurses in learning their roles are paramount to
students benefitting from clinical learning experiences (Broadbent
et al., 2014; Grealish et al., 2015; Ingram et al., 2014). Findings from
other studies around aged care clinical learning experiences has found
students express disappointment with aged care clinical placements
because of poor instruction and clinical supervision, which results in a
lack of stimulation in their gerontological learning (Brynildsen et al.,
2014; Lea et al., 2017a; Neville et al., 2008). Struksnes et al. (2012)
found offering academics’ support for supervising registered nurses,
through structured debrief sessions, and professional development
around assessment of students learning was beneficial, for not only
students, but also supervising registered nurses and the host organisa-
tion.
The CQUniversity Gerontology Clinical Learning Experience Model
utilised in this study was designed to engage and assess nursing stu-
dents in their gerontology learning and align the clinical experiences
with their classroom learning, learning objectives, and relevant nursing
legislation. The design of this aged care clinical learning experience
provided the staff mentorship opportunities to help students make sense
of theory and practice relevant to the gerontology registered nurse and
the care of the ageing client. Participants' evaluations of this project
appeared to favour the CQUniversity Gerontology Clinical Learning
Experience Model, including quality supervision, for providing them
enhanced learning experiences. In addition to enhanced learning
around clinical reasoning and communication, participants’ evaluations
revealed a deeper understanding of the role of the gerontology nurse.
Furthermore students reported a sense of satisfaction from the re-
lationships they formed and the care they provided residents and their
families, reinforcing to them why they had chose nursing as a profes-
sion. This is an important but possibly overlooked benefit of offering
nursing students structured and supportive, clinical learning experi-
ences in aged care settings.
For recruitment into the gerontological speciality, education pro-
viders and residential aged care organisations must work together to
illuminate this registered nurse role to nursing students. The ger-
ontology registered nurse role is complex and diverse, and for those
students who work in the aged care sector as assistants in nursing and
other roles, the complexities of the registered nurse role may go un-
noticed (Algoso et al., 2016). This preliminary evaluation illustrates
final year nursing students may be able to better experience the role of
the gerontology registered nurse with a structured clinical experience,
supportive supervision, and a final year placement close to graduation
and employment as neophyte registered nurses. This is different to the
first year nursing student aged care clinical learning experience—first
year students are not yet equipped with knowledge and theory to en-
able them to appreciate the complexities of caring for the ageing client.
Positive outcomes from the clinical learning experience were evi-
dent in supervising registered nurses' evaluations indicating their ap-
preciation of the opportunity to encourage contemporary educated
C. Ryan et al.
registered nurses to consider gerontology nursing and they admired the
nursing students' advanced theoretical knowledge. Supervising regis-
tered nurses commended students' questioning about individual and
organisational practices. Some of these enquiries led to re-assessing
organisational policies and individual staff practices. To improve the
clinical learning experience, supervising registered nurses' requested an
understanding of nursing student's gerontological nursing scope of
practice, in particular around administration of pre-packaged medica-
tions working with electronic medication administration systems and
medication safety checks as this is integral to the role of gerontological
registered nurse. Furthermore, host organisational staff suggested nur-
sing students be offered additional and authentic education to deepen
their understanding of the ageing client.
6. Conclusion
Designing, planning and offering final year nursing student clinical
learning experiences in aged care settings, including support and
training for supervising registered nurses appears beneficial for both
participants and the host organisation. This initial evaluation of an aged
care clinical learning experience model has provided some evidence of
these positive outcomes for students and aged care facilities, however
warrants further empirical exploration. Thus, there are plans for a re-
search higher degree student to evaluate aged care clinical learning
experiences for final year nursing students at this university. The study
will further develop the Gerontology Clinical Learning Experience
Model, and evaluate students' and staff experiences with regard to the
model's success in ultimately changing mindset around the ger-
ontological registered nurse role and the skills and experience that may
be gained from clinical learning experiences in the aged care setting.
Furthermore, we expect these studies may support participating aged
care facilities in recruiting neophyte registered nurses to their organi-
sations.
Disclaimer
The views expressed in the submitted article are our own and not an
official position of the institution or funder.
Conflict of interest declaration
None to report.
Acknowledgements
The authors would like to express their deepest gratitude to the
participants of the study for making this research possible by con-
tributing their valuable time and thoughts.
Appendix A. Supplementary data
Supplementary data related to this article can be found at http://dx.
doi.org/10.1016/j.nepr.2018.06.003.
References
Algoso, M., Peters, K., Ramjen, L., East, L., 2016. Exploring undergraduate nursing
187
Nurse Education in Practice 31 (2018) 182–187
students' perceptions of working in aged care settings: a review of the literature.
Nurse Educ. Today 36, 275–280. http://dx.doi.org/10.1016/j.nedt.2015.08.001.
Annear, M., Lea, E., Robinson, A., 2014. Are care workers appropriate mentors for nursing
students in residential aged care? BMC Nurs. 13 (1), 1–16. http://dx.doi.org/10.
1186/s12912-014-0044-8.
Australian Commission on Safety and Quality in Health Care (ACSQHC), 2012. National
Safety and Quality Health Service Standards. Retrieved August 11, 2017. www.
safetyandquality.gov.au/wp-content/uploads/2011/09/nsqhs-standards-sept-2012.
pdf.
Banning, M., Hill, Y., Rawlings, S., 2006. Student learning in care homes. Nurs. Older
People 17 (10), 22–24. http://dx.doi.org/10.7748/nop2006.01.17.10.22.c2403.
Benner, P., 2015. Curricular and pedagogical implications for the Carnegie Study,
Educating Nurses: A call for radical transformation. Asian Nurs. Res. 9 (1), 1–6.
http://doi.org/10.1016/j.anr.2015.02.001.
Broadbent, M., Moxham, L., Sander, T., Walker, S., Dwyer, T., 2014. Supporting bachelor
of nursing students within the clinical environment: Perspectives of preceptors. Nurse
Educ. Pract. 14 (4), 403–409. http://dx.doi.org/10.1016/j.nepr.2013.12.003.
Brynildsen, G., Bjork, I.T., Berntsen, K., Hestetun, M., 2014. Improving the quality of
nursing students' clinical placement in nursing homes: An evaluation study. Nurse
Educ. Pract. 14, 722–728. https://doi.org/10.1016/j.nepr.2014.09.004.
Brown, R., Crookes, P., 2016. What are the 'necessary' skills for a newly graduating RN?
Results of an Australian survey. BMC Nurs. 15 (23). http://dx.doi.org/10.1186/
s12912-016-0144-8.
CQUniversity, 2015. CQ23 Bachelor of Nursing Curriculum (2016–2020). CQUniversity
Australia, Rockhampton, Qld.
Grealish, L., Henderson, A., Quero, F., Phillips, R., Surawski, M., 2015. The significance of
‘facilitator as a change agent’: Organisational learning culture in aged care home
settings. J. Clin. Nurs. 24, 961–969. http://dx.doi.org/10.1111/jocn.12656 961.
Grealish, L., Lucas, N., Neill, J., Mcquellin, C., Bacon, R., Trede, F., 2013. Promoting
student learning and increasing organizational capacity to host students in residential
aged care: A mixed method research study. Nurse Educ. Today 33 (7), 714–719.
http://dx.doi.org/10.1016/j.nedt.2012.11.017.
Ingram, L., Barry, A., Pit, S., Sproule, N., Moore, K., Wickham, K., 2014. Developing
Clinical Placement Opportunities in Aged Care: a Report. Health Education and
Training Institute Retrieved July 15. http://www.heti.nsw.gov.au.
Lea, E., Andrews, S., Stronach, M., Marlow, A., Robinson, A., 2017a. Using action research
to build mentor capacity to improve orientation and quality of nursing students' aged
care placements: What to do when the phone rings. J. Clin. Nurs. 26 (13–14),
1893–1905.
Lea, E., Marlow, A., Altmann, Courtney-Pratt, H., 2017b. Nursing students' preferences for
clinical placements in the residential aged care setting. J. Clin. Nurs. 1–10. http://dx.
doi.org/10.1111/jocn.13859.
Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S.Y.-S., Noble, D., Norton, C.A., 2010.
The ‘five rights’ of clinical reasoning: An educational model to enhance nursing
students' ability to identify and manage clinically ‘at risk’ patients. Nurse Educ. Today
30 (6), 515–520. doi:https://doi.org/10.1016/j.nedt.2009.10.020.
McLeod, S., Romanini, J., Cohn, E.S., Higgs, J., 1997. Models and roles of clinical edu-
cation. In: McAllister, L., Lincoln, M., McLeod, S., Maloney, D. (Eds.), Facilitating
Learning in Clinical Settings. Stanley Thornes, UK, pp. 27–60.
Neville, C., Yuginovich, T., Boyes, J., 2008. A stocktake of existing aged care clinical
placements for undergraduate nursing students in Australia. Aust. J. Adv. Nurs. 26
(2), 17–26.
Nursing and Midwifery Board of Australia [NMBA], 2016. Registered Nurse Standards for
Practice. Retrieved August 11, 2017. http://www.nursingmidwiferyboard.gov.au/
Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-
practice.aspx.
Ossenberg, C., Dalton, M., Henderson, A., 2016. Validation of the Australian Nursing
Standards Assessment Tool: A pilot study. Nurse Educ. Today 36 (1), 23–30. https://
doi.org/10.1016/j.nedt.2015.07.012.
Struksnes, S., Engelien, R.I., Bogsti, W.B., Moen, O.L., Nordhagen, S.S., Solvik, E.,
Arvidsson, B., 2012. Nurses' conceptions of how an alternative supervision model
influences their competence in assessment of nursing students in clinical practice.
Nurse Educ. Pract. 12 (2), 83–88. http://dx.doi.org/10.1016/j.nepr.2011.07.009.
Willetts, G., Aberdeen, S., Hood, K., Cross, W., 2017. The dynamic role of the graduate
nurse in aged care: An Australian experience of delivering an aged care graduate
nurse program. Collegian 24 (4), 397–402. https://doi.org/10.1016/j.colegn.2016.
07.002.
Xiao, L.D., Kelton, M., Paterson, J., 2012. Critical action research applied in clinical
placement development in aged care facilities. Nurs. Inq. 19, 322–333. http://dx.doi.
org/10.1111/j.1440-1800.2011.00579.x.