Practice placements are essential to pre-registration nurses, midwives and allied health professionals, providing theoretical underpinning and developing professional identity. Professional bodies clearly stipulate the amount of practice required. For example, in the UK, it is 50% of the pre-registered nursing programme (Health and Care Professions Council, 2018; Nursing and Midwifery Council, 2018; Social Work England, 2021).
Wenger's (1998) classic work describes the concept of practice as:
‘Including both the explicit and the tacit … what is said and what is left unsaid, what is represented and what is assumed, subtle cues, untold rules of thumb; most of which may never be articulated, yet they are unmistakable signs of membership of the community of practice.’
This highlights the silences – the unwritten and implicit rules of the game. Tacit knowing has gained recognition as a vital source of knowledge that informs clinical decision-making. It is therefore questionable how we capture and transfer tacit knowledge so that learners are able to ‘play the game’.
Practice supervisors influence students' accountability for learning and close the gap between theory and practice, reinforcing the need for the entire team to value practice learning (Henderson and Eaton, 2013). The complexities of learning have tended to be discussed in terms of bridging the theory-to-practice gap (Rolfe, 1996), with less emphasis having been placed on how students learn within the practice setting. An appreciation of the pedagogy of practice learning can help academics and practice supervisors to support students in translating practice experiences into meaningful learning. Careful scaffolding of support from expert ‘others’ is required to enhance the translation of learning into practice, and this should commence during preparation-for-practice sessions in university settings.
Preparation for practice
Preparation for practice fosters increased autonomy (Repsha et al, 2020), and elicits deep learning, often originating from uncomfortable interactions that require the examination of thoughts, feelings and behaviours. Critical reflection before, during and after practice experiences using careful questioning and coaching further challenges beliefs to manage student expectations and shift layperson perspectives. The readiness to have one's own assumptions and beliefs challenged is imperative for those engaging with practice learning. This is met by the realistic and transparent management of student expectations of what practice learning is and should be, including the contemporary challenges faced not just by health and social care workers but also by society.
Students quickly navigate the complexities of practice environments and ultimately transition to being registered nurses (Van Gennep, 2019), but experience anxiety, stress, feelings of incompetence and insecurity during the period of transition (Duchscher, 2009). Indeed, Dunbar and Carter (2017) assert that ‘belongingness’ is a prerequisite for learning and professional development. Hence, it falls to practice supervisors and assessors in clinical practice and academic staff in universities to create safe landscapes for learning, not least because the attitude and empathy of both academics and clinical nurses can help to lower the attrition rate (King et al, 2018).
Students emphasise the importance of sufficient supervision and support in practice, while the development of lifelong skills is fundamental because this does not end on graduation (Hatzenbuhler and Klein, 2019). These skills are necessary for times when the terms on which the ‘game’ is played may change. For example, in settings where there are no direct supervisors, but successful indirect supervision is being used, such as in placements that enhance societal learning (learning in a charity setting, for example) (Knight et al, 2022), students continuously learn unwritten rules from the culture in which they are immersed. This community of practice enhances the need for a whole-team approach, which again helps students learn the ‘rules of the game’.
‘An appreciation of the pedagogy of practice learning can help academics and practice supervisors to support students in translating practice experiences into meaningful learning’
A sense of belonging
Successful practice learning requires a sense of belonging, security and respect facilitated by practice supervisors (Roberts and Leigh 2020). Dunbar and Carter (2017) stress that students need to feel a sense of belonging to the teams they join, although Jacobsen et al (2022) suggested that students find it hard to adjust, never feeling like part of the team. Safe landscapes for learning, and empathic academics and clinical nurses can lower the attrition rate (King et al, 2018).
Levett-Jones et al (2009) suggested that relationships forged between students and their clinical supervisors strongly influence the sense of belonging, positively impacting on the quality of their placement, learning, confidence, and improved professionalism. These relationships gained even more significance for students during the pandemic (Santos, 2020).
Creating a sense of belonging using the alliance formed between students and practice supervisors using contemporary pedagogy may be a way forward to reduce anxiety and pave the way to registration.