Enhancing Prelicensure Nursing Student Clinical Experience through Post-Conference Discussions

Prelicensure nursing students are often anxious and cannot comprehend the situations they will be exposed to as they develop clinical judgement. Early clinical rotations help them familiarize themselves not only with the healthcare environment but with their own emotional adjustment to patient care. They learn to process core elements of care and establish rapport with patients and families. Some baccalaureate schools of nursing postpone the first clinical rotation until the second semester of the first year. Many others delay nursing courses for two years after entry into their program. At the Frances Payne Bolton (FPB) School of Nursing at Case Western Reserve University, however, students begin caring for patients on a medical- surgical hospital unit in the first semester of their first year of nursing school. One educational strategy that helps students grow clinical skills and self-confidence is participating in post- conferences led by a psychiatric advanced practice nurse faculty member following their clinical experience. 

Today’s nurses have evolved from self-servient and self-sacrificing roles [1] to nurses who embrace self-care, self-awareness, and self-reflection. The goal is to teach beginning nursing students how to be independent thinkers as well as to be aware of their own needs as they provide care. At the core, Dorothea Orem’s self-care deficit theory posits that a nurse’s role goes beyond tending to patients’ physical needs; it involves supporting them on their journey to independence. Students are taught to understand how their own self-care needs are as equally important when providing nursing care to others. Based on Orem’s theory, [2] Cunningham, and May (2021) proceeded to develop a compelling self-care text and workbook designed for new nursing students that provides the learner with ways to incorporate self-care practices into their daily routine, enhance resilience, improve the ability to cope with challenges, and sustain a passion for nursing throughout their careers. Their resource has assisted students and new nurses to understand that self-care empowers them to become role models for their patients and colleagues alike, inspiring a culture of wellness within the healthcare environment. Concepts such as stress, growth, wisdom, mental wellness, self- compassion, sleep, exercise, nutrition, and self-care reflection, ultimately influence clinical practice and professionalism. With this backdrop, beginning students learn to care for themselves so they have the fullest capacity to provide healthcare. 

In post-conferences, nursing students build confidence and are encouraged to ask questions with assertiveness. Learning new concepts and ideas helps them improve in their nursing abilities and positive self-talk. Self-care practices also make them feel more empowered by increasing their self-esteem and autonomy. Psychiatric nurse leaders model for the students the experience of having a life-long mentor. They teach students communication skills as well as how to reflect, respect, and respond to nursing care issues as a basis for life-long learning [3]. Bachelor of Science in Nursing (BSN) freshmen students at Case Western Reserve University are assigned to a medical-surgical hospital unit four hours per week. Before each four-hour clinical experience, students meet with their clinical faculty for a preconference discussion to prepare for their assignments. After caring for patients, students then meet in a group post-conference with 8 to 10 students on their clinical units for 30 to 40 minutes. A psychiatric-mental health nursing faculty member leads the student discussion. The faculty member is not associated with the grading process and creates a safe environment that frees students to share personal beliefs, unfiltered thoughts, and raw emotions based on their nursing interactions. 

This group-based approach to professional identity allows students to explore values, standards, and ethics related to the clinical experience. Sharing powerful clinical narratives with each other gives students an opportunity to ask questions about their completed assignments. Age, cultural values, and religious differences present challenges never before confronted; therefore, faculty support assures students they are not alone in dealing with the anxiety, frustrations, and conflicts that can affect patient care and their own self-confidence. For some students, entering a patient’s room or talking with a family member is an intimidating experience as they may have never dealt with persons in a health crisis or a near death experience. Students become fundamentally aware that patient interaction and communication promote effective nursing care [4]. 

Clinical rotations during their first semester present new challenges for BSN students, as it may be their first time caring for anyone who is ill outside of their own family. Providing care so personal, such as bathing and feeding patients, may increase anxiety about infringing on the privacy of another person. Students may also identify with patients by relating them to their own family and feeling uncomfortable caring for someone the same age as their parents or grandparents. Some patients may be more difficult to care for than others, requiring two students to provide care for one individual. This team approach can lessen their fear of harming a patient when carrying out a procedure or protocol while at the same time increasing their individual proficiency. 

A post-conference topic that frequently arises is the amount of time needed to complete assignments or the importance of getting to the clinical unit on time. Developing nursing care plans can also create anxiety about time management. Students sometimes discuss instances when patients refuse to have a nursing student care for them. The students learn that such incidents happen and are encouraged to talk about their frustrations. 

There are many educational advantages of early clinical experience. The opportunity for early clinical experience serves as a recruitment strategy. Students select the FPB School of Nursing because of its first-year access to clinical exposure. Most BSN freshmen students are 17 to 18 years of age, with little or no life experience to prepare them for the challenges and responsibilities of patient care. Those who have worked in hospitals or nursing homes caring for older adults can build on those experiences and share with the other students. 

The small group post-conference experience provides a safe environment where students can work through issues of psychological well-being and professional identity. No subject for discussion is off the table. Students are encouraged to give suggestions and provide support for others or relate their own experience in a similar situation. When the focus is on one student’s concern, other students participate in problem-solving. For example, they adapt strategies for processing the transition from home to independent college campus life and to the nursing profession where they become responsible for themselves and for the patients and families in their care. 

Students’ conversations sometime center on resilience and the importance of intentionally seeking out resources for handling stress. They learn that stress can lead to physical as well as mental health problems if not addressed. Protecting their own healthcare practices can be another source of apprehension. In addition to clinical issues, beginning students mention problems with their study habits and how expectations in high school significantly differ from those at the university. Some students are referred for further assistance from the university’s health counseling services. A few, however, discover that nursing is not their chosen profession after all, and elect to transfer into another discipline. 

Feedback from student evaluations indicate that post-conferences facilitate increased confidence when carrying out their clinical assignments and critiquing clinical problems. The students say that clinical post-conferences assist them as they progress in the program. 

Consequently, faculty support this strategy of having group discussions following their clinical experience. Post-conferences as a teaching strategy are a valuable tool in the students’ transformation to the nursing profession and their commitment to nursing.

1. BMJ (2018) Subservient nurse stereotype is old fashioned 363: k5086.
2. Fontaine DK, Cunningham T, May N (2021) The Self Care for New and Student
3. Hernandez M (2024) Reflect, respect, respond: Enhancing nursing through infection prevention and Nursing Centered-2024 Sigma Theta Tau International Homor Society of Nursing.
4. Orem DE (2005) Part one: Dorothea E Orem’s self-care deficit