This is a very interesting paper (Mooney 2007) because one of the main problems that nursing education and practice needs to solve is revealed. It is true that nursing education has made many changes, worldwide, over the years. Some countries have changed curricula, others have changed aims and others have changed nurses’ clinical roles and thus nursing education has tried to educate students to fulfil these roles.
All these changes have made to prepare student nurses for professional clinical practice (ENB 1998). The title of the paper, by itself, can be used to ask educationalist, clinical managers and researchers, ‘what nursing, as a science, has achieved with all these changes?’
All universities are based on the ancient Greek concept of the ideal education known as ‘paideia’. The literature indicates that ‘paideia’ builds up the appropriate environment and conditions for the creation of new values, knowledge, skills and life-styles (Purdy 1994). Truly, nursing education is trying to provide the knowledge and skills to ‘build’ professional nurses. Consequently, the competencies of nurses are based on the education and the knowledge it provided (Camiah 1998). Although nursing education has changed the curriculum, from the biomedical model to the holistic model and health promotion, with positive effects (Bakalis et al. 2004), there are issues in nursing education that need to be addressed.
For example it seems, as the author tries to articulate, that the clinical environment, which is the main source of information for students, is problematic. The paper, which is well structured and well developed methodologically, although the small sample size and sampling technique must also be considered, reveals issues that nurses in all fields (education and clinical practice) need to consider. It refers to the fact that supernumerary students have ‘insufficient’ opportunities, learning the ‘basics’, felt ‘unsure’ about the nurses’ role, feeling like ‘a shadow’, they are ‘invisible’ and learning opportunities varied depending on ‘ward allocation, morale and teaching ethos on the ward’. All these conclusions, which based on research, are very ‘illustrative’ of how students feel about nursing education. As the author points out, there is a need for such research in this area, especially in countries that there is no published papers with this topic.
The paper also raises some considerations: why do staff nurses exclude students from clinical practice? The author suggests that lack of time and busy wards seem to be the main reasons. However, this problem is not new. It is generally accepted that, although nurses are the only health providers giving 24 hours bedsides care, most hospitals complain of a shortage of nursing staff (Palmier 1998). Most countries face this problem and most of the time it becomes an issue even in the political arena.
It seems that nurses have no time to supervise students because of the increasing roles that they have to support. More precisely, a nurse practitioner has an educational, managerial, research and care role to fulfil. All the above functions are important and require time. In addition, if nurses are insufficiently prepared for their clinical supervision role, they will not positively influence students’ learning. Consequently, if student nurses feel that they are not part of the team, and they are not well-prepared to meet the actual clinical nursing roles, they will continue to have these feelings even later as a registered nurses, and, even worst, they will think to change profession.
Another consideration is: why student nurses believe that they are not ‘accountable’ and when enter to clinical practice, as a nurse, the ‘whole scene’ is changed? The author reports that patients and their relatives, doctors and even staff nurses, behave completely different; probably because student nurses are not considered important to patients’ care. They are ‘the eyes’ and ‘ears’ of staff nurses. They are not accountable for their practice and their knowledge and skills need to be improved. It will be interested to search the reasons of this different behaviour in such short period of time.
Finally, nursing, as a science, has tried over the years to ‘update’ its social prestige. Moving to this philosophy, nurses extend their clinical roles, introduce guidelines and protocols, change nursing curricula and emphasise clinical research. All these have established to make nurses autonomous decision-maker and thus increase authority in their actions. Nevertheless, if student nurses realise that the clinical environment is not appropriate for learning and are discouraged from improving skills such as clinical decision making, reflection and critical thinking, then nursing, as a science, needs to re-consider issues that are significant to nursing as an art but, most important, as a science.