REPORT: May 2005

Research News You Can Use: Base Your Practice on Evidence

Does the presence of students improve your unit’s quality of care?

by Barbara Brown, MSN, RNC, CNN, Nursing Research Fellow, Council on Nursing Research

Clinical practice is an important factor in student nurse education. The most common place for this practical experience is a university-affiliated hospital. In this setting, students can develop clinical, professional, interpersonal and managerial skills. However, many managers do not see students as an efficient investment considering the time and attention required. Often overlooked is the fact that nursing students can prove to be beneficial to the patients and clinical environment. Past research focused primarily on the effects of this experience for the students. There is limited research on the effects on patients of the presence of student nurses. Zisberg and Krulik (2003) conducted a study to determine if the presence of student nurses on hospital units improved the quality of care given by staff nurses. Some suggest that when nursing students are present, nurses recheck and regulate their work more closely. There are also claims that in the presence of nursing students, nurses feel a need to present a good nursing image. For this study, researchers defined quality of care as the extent to which the nurses followed the nursing practice standards of their facility. These researchers wanted to know if it is possible that the presence of students focuses nurses’ attention on their role and encourages professional standards of practice in a way that results in better quality care.

Method

Nurses in 15 Israeli hospital units participated. The 67 registered nurses worked in general care, medicine, surgery, pediatrics, oncology, and cardiology in a large medical center. To be included the nurse needed to work at least two morning shifts per week, with an overall minimum of 18 hours per week and did not object to being observed. Of the subjects, 88% were women, with an average age of 32. Forty-six percent had a bachelor’s degree. Average seniority was 7.5 years. Staff nurses made up 77.5 % of the group while 4.5% were assistant nurses and 18% were team leaders. The Israeli Standard Nursing orientation and training checklist served as the basis for the questionnaire.

Without knowing the precise purpose of the study, observers studied nurses when students were present as well as when they were not. The nurses agreed to be observed but also did not know the precise nature of the study.

Results

It’s true! In the presence of students, nurses provided a higher quality of care than when students were absent. This effect was found for all quality of care measures observed in the study. The presence of students on the unit evoked a sense of self-awareness among the nurses, which contributed to a change in their behavior and standard of practice. The presence of students also may have reduced the actual workload, allowing nurses to provide better care; but this may balance with the extra time spent teaching students. Nurses reported a higher awareness of the presence of others when students were on the units and they felt that the presence of students observing their care as professionals resulted in positive role behavior changes, which contributed to better patient care.

What’s this mean for you?

You and your colleagues may view the time you spend with students as a burden. This study tells us these students may actually result in a better standard of care for your patients. Students ask challenging questions and seek clinical and theoretical information. Their presence influences you to check and validate your own level of care. Welcome them and accept the challenge, knowing that this is time well spent for the student, you, and ultimately, your patients.

References

Zisberg, A, Bar-Tel, Y, & Krulik, T. (2003). The Presence of Nursing Students and its Influences on the Quality of Care Provided by Staff Nurses. “Nursing Outlook” 51: 102-7.