Exploring clinical facilitation and student learning on undergraduate nursing placements through a community of practice lens: A qualitative study

Abstract

Background: High-quality clinical placement experiences are important for preparing undergraduate student nurses for practice. Clinical facilitation and support significantly impact student placement experiences and their development of skills, knowledge, and attitudes in the healthcare setting.

Aim: This research aimed to explore university-employed clinical facilitators’ perspectives on providing quality clinical facilitation and student learning on placement.

Design: An exploratory, descriptive research design was used to examine the perspectives of n = 10 university-employed clinical facilitators working in regional New South Wales, Australia (March 2020-December 2021).

Methods: Semi-structured interviews were used to explore the experiences of a purposeful sample of university-employed clinical facilitators. Data was thematically analysed using Miles et al.'s (2014) qualitative data analysis framework.

Results: Five key themes were identified 1) relationships at the core of quality, 2) a culture of commitment to student learning, 3) connection to the curriculum, 4) examining the model, and 5) empowering growth and development. Clinical facilitators perceive their role as misunderstood, undervalued, and isolating and that they require further preparation and ongoing professional development to provide quality facilitation. Building rapport and relationships with staff and students was at the core of quality clinical facilitation.

Conclusions: The clinical facilitator role has an important function in preparing student nurses for practice and needs further recognition and continued professional development. Education providers and healthcare organisations need to examine strategies to provide inclusive and supportive work environments, building communities of practice for clinical facilitators and stakeholders to share their experiences and knowledge, promoting individual and group learning, thus improving the student placement experience and fostering the professional identity of clinical facilitators.

Keywords:

• Clinical facilitation
• student nurse
• community of practice
• placement
• registered nurse
• collaboration
• preparation for practice

Impact statement

Clinical facilitators play an important role in preparing student nurses for practice. This research argues developing communities of practice will improve the quality of clinical facilitation and student experience and develop the clinical facilitator's professional identity.

Plain language statement

Globally, quality preparation of student nurses for practice is essential for meeting workforce needs and maintaining high standards of patient care. Clinical placement is an integral part of student learning as it provides an opportunity for students to translate theory into practice and learn in a real-world context. Clinical facilitators aim to provide stimulating and tailored learning experiences for students, enhancing their preparation for practice. Using semi-structured interviews with ten clinical facilitators in regional New South Wales, this research explored the clinical facilitator's role in providing quality clinical placement experiences for nursing students. A community of practice lens frames the research findings. This research found that opportunity exists in developing and consolidating the clinical facilitator's professional identity within the clinical setting. Organisation and clinical placement support require a collaborative approach with interlocking relationships between stakeholders at the core of success. Engaging communities of practice on horizontal (peer groups) and vertical (range of representation) levels creates social learning opportunities for individual and collective learning to improve and solidify best practices for clinical facilitation and placement experiences in the healthcare arena. This research is important as it demonstrates the importance of building relationships and communities of practice in the healthcare setting to improve the preparation of students for practice. The researchers recommend that the findings of this research extend beyond the nursing discipline and should be considered in other healthcare disciplines.

Introduction

Clinical placement is essential in preparing student nurses for practice. It allows students to apply their skills and knowledge and translate theory into practice. In Australia, undergraduate nursing programs require students to complete a minimum of 800 hours of clinical placement in real-word healthcare settings (Australian Nursing and Midwifery Accreditation Council (ANMAC), 2019). Students are provided the opportunity to complete placement hours in a variety of healthcare settings to broaden their understanding and experience of nursing care practices (Mackay et al., 2014). Clinical facilitators play an important role in preparing, educating, and supporting nursing students while in the clinical environment. The clinical facilitator role is complex and requires commitment, courage, empathy, and virtue to guide and shape the nurses of the future (Ryan & McAllister, 2019). A negative placement experience can impact the student and their intention to remain in the program (Moroney et al., 2022). Therefore, it is important to examine the role of the clinical facilitator in preparing student nurses for practice.

Community of practice

To provide a deeper insight and increase the translation of the findings into practice, this study is framed using a community of practice lens. A community of practice is when a group with a shared identity comes together to create learning partnerships for knowledge sharing and innovation about best practices (McDonald & Cater-Steel, 2017; Wenger, 1998; Woods et al., 2016). Communities of practice have a shared repertoire (practice) (language, behaviour, actions, and methods), mutual engagement (community), and joint enterprise (domain) (common purpose) (McDonald & Cater-Steel, 2017; Wenger, 1998; Woods et al., 2016). The concept of “community of practice” has evolved since it was proposed by Lave and Wenger in 1991 (Buckley et al., 2019). The original concept focused on situated learning in the context of an apprentice moving from peripheral participation as a neophyte to gaining the skills and knowledge to move to full participation with mastery and knowledge in the community of practice. Learning occurs through participation and socialisation within the community (Lave & Wenger, 1991).

Buckley et al. (2019) argue that the concept of a community of practice has moved from an in situ social learning process to an intentional instrument or tool for knowledge development in health professional education. As a tool, this offers the opportunity for the development of communities of practice that support individual and collective learning. Despite the evolution of the theory, the central premise of participatory social learning remains at the core of the community of practice theory of learning (Buckley et al., 2019). This means that a community of practice extends beyond just a group of people. Rather, they are “socially configured spaces that necessarily involve learning as an aspect of membership” (Tummons, 2018, p. 4 in Buckley et al., 2019, p. 764). In this study, a community of practice has been conceptualised as a tool for learning through the purposeful socialisation of clinical facilitators.

Background

There are various models of clinical facilitation. This study explores the clinical facilitator model in which the education provider contracts an experienced nurse with appropriate qualifications to educate and assess students in the clinical setting. In this model, students are partnered with registered nurses and participate in the coordination and delivery of patient care. The clinical facilitator observes the students and relies on feedback from the registered nurses to monitor student progression. This clinical facilitation model was the focus of this study as it was the primary model used in the region of interest.

The clinical facilitator role is a multifaceted role incorporating supervision, teaching, assessing, liaising, and pastoral care (Ryan & McAllister, 2019). Needham et al. (2016) identify that clinical facilitation is complex because the role requires a comprehensive understanding of the education and assessment needs of the student, the expectations of the education provider and curriculum, and knowledge and understanding relevant to the clinical environment. Ryan and McAllister (2019) support the argument that clinical facilitation is a subspecialty of nursing, requiring a complex blend of knowledge, understanding, and communication skills.

Research has found that the clinical facilitator role is not well understood in the clinical setting and the core competencies are not clearly defined (Rosina et al., 2022). There is tension in the perception of the value of the role and its contribution to preparing students for clinical practice. Ryan and McAllister (2019) highlight that some registered nurses perceive clinical facilitators are only there to tick boxes rather than support and provide positive student experiences. In recognition of the significance of the clinical facilitator's role, Brunelli et al. (2022) argue the importance of making the invisible work of clinical facilitators visible in practice. Clinical facilitators are commonly casual employees working autonomously. However, they play a significant liaison and representative role between industry and education providers, negotiating for the support needs of students (Needham et al., 2016).

Clinical facilitators are emotionally intelligent leaders with critical thinking skills and resilience (Rosina et al., 2022). They engage with students, education providers, and health organisations to provide quality, inclusive, and welcoming placement experiences to diverse student populations in complex learning environments. Clinical facilitators act as role models and influence the attitudes and skills of the future nursing workforce (Rosina et al., 2022). There is a need for further insight into the role of clinical facilitators in preparing student nurses for practice.

This study forms part of a strategic review of the preparation and transition of registered nurses into Regional New South Wales, Australia. This study is important as there is a focus on building workforce capacity, enhancing capabilities and creating a positive workplace culture to assist with addressing and managing nursing workforce shortages in the region (Northern New South Wales Local Health District (NNSW LHD)., 2020). New South Wales public health system is the largest in Australia and provides safe and high-quality care to over 8 million people (New South Wales Ministry of Health., 2022). Regional New South Wales supports approximately just over a quarter of the state’s diverse population in major regional centres, coastal cities, small towns, and remote communities. A broad range of healthcare services are offered, with access to general and specialist services (New South Wales Government., 2023). As part of the New South Wales Regional Health Strategic Plan for 2022-2032, focus has been placed on strengthening the regional workforce and enabling better access to safe, high-quality, timely health services (New South Wales Ministry of Health., 2022). This highlights the importance of understanding and supporting the preparation of new graduate nurses for practice through high-quality supervision, support, and assessment.

Aim

The aim of this study was to explore clinical facilitators’ perspectives on providing quality clinical facilitation and student learning on placement, focusing on a) their experience of the clinical facilitator models of supervision, b) performing the role of a clinical facilitator, and c) the role of the registered nurse in student learning on placement. The question guiding this research was: what are the experiences of university-employed clinical facilitators in preparing student nurses for practice in regional New South Wales, Australia? This study contributes to the evidence on preparing student nurses for clinical practice. This research is examined through a community of practice lens.

Design

An exploratory, descriptive research design (Hunter et al., 2019) was used to examine the perspectives of university-employed clinical facilitators working in regional New South Wales, Australia.

Methods

Study setting and participant recruitment

A purposeful sample of university-employed clinical facilitators were recruited to inform this research. This study was part of a larger multi-arm, longitudinal, mixed methods study that examined the preparation of new graduate nurses for practice in a Local Health District. The larger project followed a cohort of students from their first year of undergraduate training to the end of their first year of practice as newly qualified nurses. Clinical facilitators working with this group of students were eligible for this study. The clinical facilitators were employed by the education provider and allocated one hour per day, per student. They were unable to participate in direct patient care in this healthcare service. Email and snowballing methods were used for recruitment. Ten clinical facilitators were recruited and interviewed between March 2020- December 2021. Clinical facilitators from acute, subacute, community, and mental health settings participated. Recruitment ended when data adequacy was reached, when no new themes were emerging form the data (Vasileiou et al., 2018).

Ethical consideration

Ethical approval was gained for this study North Coast NSW Human Research Ethics Committee LNR219 – LNR/19/NCC/16. Clinical facilitators were sent a copy of the participant information form and were offered the opportunity to ask questions before signing a consent form and participating in the research. Participants were reminded that their participation in the research was voluntary and that it would have no impact on their employment with the organisation.

Data collection

Semi-structured, individual, online, or phone interviews were used to collect participants’ experiences. Demographic and clinical experience information was collected (Table 1). Interviews were approximately 45-60 minutes long. The interviews were conducted by the primary investigator. These were audio recorded and transcribed verbatim. A code was given to each participant, and all identifying information was removed from the transcripts to maintain privacy and confidentiality. All information was digitised and stored on a password-protected computer.

Table 1. Demographics and Experience.

		No. Participants
Age (years)	30–39	1
	40–49	4
	50–59	3
	60+	2
Gender	Female	8
	Male	2
Registered Nursing Experience (years)	10–19	1
	20–29	4
	30–39	4
	40+	1
Clinical Facilitation Experience (years)	1y-4	5
	5y-9	2
	10+	3
Formal Clinical Facilitation Training	Yes	8
	No	2

Interview guides were developed with experienced researchers, clinical placement academics, and local health district representatives. These guides were piloted with two experienced clinical facilitators who were not eligible to participate. The interview guides focused on three key areas: performing the role of the clinical facilitator, models of clinical facilitation, and the role of the registered nurse in undergraduate student nurse clinical placement experiences (Table 2).

Table 2. Semi-Structure Interview Guide.

Semi-Structured Interview Guide

What is the role of the clinical facilitation in the undergraduate student nurse work Integrated learning experience? Discuss your experience of clinical facilitation of undergraduate nursing students. Describe the strengths and weaknesses of the model of clinical supervision you practice in. Describe what you perceive as barriers and enablers to providing students with high quality clinical faciliation and WIL experience. How would you improve the model of clinical facilitation to enhance the quality of the clinical supervision and the student WIL experience? Describe your training and education in clinical facilitation and how this has informed your practice. Discuss the strategies you undertake to support the students during their work integrated learning. Describe your key priorities when conducting student assessments? Reflect on your confidence in providing constructive feedback and how this feedback is received by students. What is the role of the buddy nurse/preceptor nurse in the undergraduate student nurse work Integrated learning experience? Discuss your perception of the importance of role modelling behaviour within the WIL environment and how this translates in the student learning experience? Describe your perception of the preparedness of nursing staff to act as preceptors/ buddy nurses for nursing students in the healthcare setting? What do you perceive as barriers and enablers to an effective buddy nurse/ student learning partnership? What could be done to support nurses to improve their understanding of role modelling and being and effective buddy nurse? How do you think we could best prepare student nurses for registration and healthcare delivery?

Data analysis

The primary researcher transcribed and reviewed all transcripts immersing themselves in the data. NVIVO was used to display and organise data. Data were coded manually. Data analysis was framed by Miles et al.'s (2014) qualitative data analysis framework. A continuous iterative process of data condensation, data display, and conclusion drawing/verification was undertaken. Data condensation was comprised of two steps. The first cycle involved inductive, descriptive, and in vivo coding. Pattern coding was used in the second coding cycle to summarise codes into categories and themes. Information was presented systematically using NVivo to enable conclusions to be drawn from the data. The primary research practiced reflexivity acknowledging their own potential bias as part of the data analysis process. Two additional research team members verified the conclusions drawn from the data analysis process and checked for bias and representativeness of the data.

Results

Data analysis identified five key themes: 1) relationships at the core of quality, 2) a culture of commitment to student learning, 3) connection to the curriculum, 4) examining the model, and 5) empowering growth and development. Table 3 provides a summary of themes, subthemes, and codes.

Table 3. Results Summary.

Theme	Subtheme	Code	Supporting Quotation
Relationships at the core of quality	Building community and connection with clinical facilitators	Clinical facilitation feelings of isolation	… can be quite a lonely job because you've got no one to bounce things off all the time like you would do on the ward CF1
		Building a better understanding of the clinical facilitation role	they need to take the CF role a bit more seriously. Sometimes I get the feeling they just think we get paid a lot of money to stand around … there is a real lack of understanding of what we do … and they don't see the value in what we're doing CF2
		Championing the need for connection and community	having the support of the other CFs at that same placement or certainly people you could talk to was amazing … Just knowing you're not on your own in the role … it would be really great to catch up with other CFs or a system where CFs talk to each other a bit more CF2
		Learning from role models in place	it's been really good having the support of those [clinical facilitators] and just being able to bounce off them … they're very good, very experienced and we all have different strengths and we utilise each other's strengths for different areas CF3
	Building rapport and trust with nurses	Effective clinical facilitation requires partnership and RN engagement	Their [registered nurse's] role is invaluable to us, we couldn't do our role without them. I feel that the role of the registered nurse is to support the student, work alongside the student, be a role model. I feel like at times they are also assessing the students CF2
		Overcoming the outsider status develeoping trust and rapport for collaborative working partnerships	You have to prove yourself first before they kind of trust you CF4
		Preparing and supporting RN to have the confidence to provide learning opportunities and constructive feedback	I think that's really important because that's part of facilitating making sure that everyone in this workplace is aware of what level these students are at so they can support them … So that's really important you are the person that has to pave the way for them so that the staff are all aware CF7 Often trying to get negative feedback from registered nurses can be difficult as a clinical facilitator unless you can pull them aside to a private space and ask directly. Often that negative feedback isn't forthcoming. So there have been instances where I go in and the recent feedback I get from registered nurses is very positive but after five days, the NUM [Nurse Unit Manager] might grab me and go actually, there is an issue, which is quite surprising CF4
		Balancing RN workload removing the stigma of seeing students as a burden	I also think it is difficult because they have one lot of students after another and they don't really get a break, and having a student is hard work it's like you've got to take your full patient load and a student and as much as they can help if you've got a new student or a student that needs a bit more attention often it can be difficult for that nurse to find the time. I don't believe that some nurses really have a passion for wanting to do that to be honest CF2
	Developing an understanding of the individual student	Building rapport with students important to learning	I get to know them, and they get to know me so I can understand what they need and why they need it CF3
		Tailoring teaching to student needs	Picking up on where they might have any weaknesses or strengths and talking to them regularly to find those out … just bringing out the best in them and letting them, have a go at practicing skills that they just don't get the chance to do CF1
A culture of commitment to student learning		Quality placement experiences require commitment from all stakeholders	sometimes the facility that you are working for aren't always supportive or put education as number one … I was working slowly with the student that was having some trouble with confidence and I really had to negotiate quite a lot with the ward team and they really didn't listen to me very well. They just wanted to put forward what they wanted to do and it was more in relation to helping their staff have less work. So, barriers like that can be really challenging you really need to have good communication skills CF2
		Preparation and planning of placement essential for learning	that's really important that your organised, that you know exactly where the students going to be and what you're hoping them to get from their placement … and how you are going to achieve that and the different members of staff that you identify are going to help to bring that about CF7
		Enhancing student learning through appropriate student and resource allocation	it doesn't enhance the placement process or their experience or their learning if you put too many students on because they will just end up doing their assignments down the back of the ward instead of actually doing patient care CF7 sometimes staffing levels hamper that [quality placements], so being understaffed and it is often a problem CF1 I had to talk to a student that was very upset, you cannot even get a private place where you can actually have a conversation with somebody CF5
		Setting expectations for effective RN engagement and student learning	part of their [registered nurses’] role each year is to facilitate students or be preceptors. It's part of your registration. So, I think that needs to be made clearer to a lot of RNs CF1 I think the registered nurses who work in the field who feel that students shouldn't be there [are barriers]. There are some who are really good with students, and then there are other people who have forgotten what it's like to be a student, and have little patience for students CF10
		Recognising the importance of creating welcoming placement environments	the facility did not welcome us at all. I had six third-year students they didn't even want us there. There was no one there to show us around … . have the students touch or do anything CF6 [The NUM] said “oh have we got students again, we weren't expecting them” and I could see the students were just like “oh my god they're not expecting us, they don't know we're coming” and it was just a really horrible experience. It's not the first time, but I felt really bad for the students, and I thought what a bad way to start placement CF2
Connection to the curriculum		Consolidating student learning needs through connection to the curriculum.	… . we have no access to what the students learn we can't actually get on the BlackBoard [student learning platform] and see it, which I think might be helpful sometimes CF9
		Continuity of theory and clinical teaching for student learning and clinical facilitation development	I actually teach within the Bachelor [program] I'm aware of the level of education the majority of the students have actually had, even from session-to-session CF5
Examining the model		Healthcare organisation provided clinical facilitation model pros and cons	If you are an internal facilitator the down side of that is that you can get stuck in the politics; however you know the place inside out and backwards. You just have a better understanding sometimes CF2 I feel sometimes students missing out on skills because there just wasn't the time for the nurses to help them do those skills. Whereas, if I was allowed to assist with those skills, and perform interventions on patients with them, they might have had more opportunity … they [nurses] don't have the time for students do it, so it will actually alleviate some of the workload on the hospital staff because the clinical facilitator could be hands on CF4
		University employed clinical facilitation model pros and cons	my total focus is on facilitating the student within the placement … I have got a lot more time to spend with students [to support] sound clinical reasoning CF5 I think that's the downside, not feeling part of the facility … lack of ownership of the program … so facilitators have to really work hard to maintain engagement with everybody … even just to get the lecture room is a battle so that we can orientate the students CF5
Empowering growth and development		Rewarding role	It's also very rewarding in terms of its amazing to see the students at the beginning of the placement and the working towards their goals and sometimes they have ups and sometimes they have downs and then at the end of the placement being able to see them come out with some kind of new learning CF2
		More preparation and professional development desired	I think the preparation for the role could be improved like the organisation could prepare people better for the role CF2
		Clinical facilitators want to feel connected and part of a community	I think we need a bit more consistency. I think we need more feedback, the whole time I've been there, I've never had any sort of education or group meeting CF5

The table of themes shows that partnership, connection, and community were central to the findings of this study. The importance of collaboration and commitment between healthcare organisations, education providers, clinical facilitators, registered nurses, and students for effective student learning emerged from the rich discussions with the participants. Student learning on placement does not occur in isolation. Instead, it is an integrated process requiring planning, preparation, engagement, resources, and supportive systems and processes to build positive, welcoming learning environments. Clinical facilitators need to work together as part of a learning community to support the preparation of the next generation of nurses. This entails confidently communicating to provide quality learning experiences and honest, constructive feedback.

Theme one: relationships at the core of quality

There were three core relationships at the centre of the clinical facilitator role in this study. Firstly, their relationship with students which required building trust and rapport to tailor teaching to individual student needs. The second key relationship was between the clinical facilitator and the staff on the ward. This relationship again relied on rapport and trust to move from the outside in to facilitate effective partnerships in deliver high quality student learning experiences. The third key relationship was the connection clinical facilitators had with others in the same role, providing role modelling, advice and reducing feelings of isolation.

It was evident in this research that further effort is needed to support clinical facilitators and build on the broader team's understanding of the role of the clinical facilitator in practice. There was a sense of isolation, being an outsider not only in the clinical setting but also as a casual employee of the education provider. There is a need for further recognition of the value of the clinical facilitator role and the provision of resources, training, support, and professional development to support and develop this role in practice. One participant highlighted this: “I know that as casual teachers … you kind of feel like you're not part of the team, who you work for, and where you work, which can be a bit disorientating at times. Valued, that's what people wanna feel”, CF9. Role models and connections with other clinical facilitators and the broader team were important for clinical facilitator development and role satisfaction, and the participants desired more formal approaches to build these connections. There is a need for further development and acknowledgment of the symbiotic relationship between clinical facilitators and RNs. Clinical facilitators rely on RNs to support student learning in practice, and RNs also have the opportunity to learn from clinical facilitators as part of this engagement process. Which also connects with creating welcoming learning environments.

Theme two: a culture of commitment to student learning

Provision of quality student placements and preparation for practice required commitment from key stakeholders, including the education provider, healthcare organisation, clinical facilitator, registered nurses, and students. Clinical facilitators identified “there is quite a bit of prep work involved prior to placement for [clinical facilitators]” CF4. They stressed the importance of being prepared and orientated for placement. Clinical facilitators also argued the healthcare organisation’s commitment to learning impacted the provision of quality clinical placements stating “sometimes the facility that you are working for aren't always supportive or put education as number one” CF2. They described the negative impact that can occur when clinical facilitators and students felt unwelcome in the placement setting reflecting “the facility did not welcome us at all. I had six third-year students they didn't even want us there CF6”. The participants highlighted the importance of preparing and setting expectations for RN support of student nurses. Clinical facilitators identified the workload associated with RNs supervising students and promoted the need to support this in practice. However, they did argue the importance of removing the stigma of the student nurses as a burden.

I think the registered nurses who work in the field who feel that students shouldn't be there [are barriers]. There are some who are really good with students, and then there are other people who have forgotten what it's like to be a student, and have little patience for students CF10

Theme three: connection to the curriculum

Clinical facilitators guide and assess student learning across year levels, institutions, and healthcare settings. There is a need for clinical facilitators to be closely connected to the curriculum and have a thorough understanding of placement requirements and learning outcomes as “I think sometimes it's not clear what the actual focus of the placement experience is” CF2. Where clinical facilitators taught in both theory and clinical environments, this continuity enhanced their support of student learning and preparing students for practice and assisted in providing continuity between theory and practice.

Theme four: examining the model

There was no consensus on whether a university-employed (external) model of clinical supervision or a healthcare organisation (internal) employed clinical facilitator model was preferred by clinical facilitators, with some participants providing benefits and barriers to both models. The benefits of already being part of a team are that “I've already built up that trust with my workmates that they know I am there for everybody” CF6. Being able to participate in clinical skills and knowing the environment were promoted. However, they were cautious of this model due to the risk of role ambiguity and being drawn back into the workflow. As stated by one participant, “My role is to look after the students, not to look after the patients. So, you do have to be wary” CF7. This was supported by another participant when they stated, “My experience of internal facilitation was I often get caught up in workflows, especially when the ward was short of staff” CF9.

Theme five: empowering growth and development

Clinical facilitation is a rewarding and valuable role that promotes the growth and development of students and also for the clinical facilitators themselves: “I learn more from the students sometimes than I'm teaching them about being more open-minded and acknowledging my own learning or teaching” CF6. The participants agreed that preparation, ongoing professional development and increased connection to the education provider and healthcare service would improve their experience and performance in the role.

Discussion

This study examined university-employed clinical facilitators’ perspectives on providing quality clinical facilitation and student learning on placement through a community of practice lens. In this research, the concept of a community of practice focuses on social learning through community engagement for individual and collective growth and development. Providing quality student clinical placement experiences is a collaborative partnership between the student, healthcare organisation, clinical facilitator, registered nurses, and education provider (McKellar et al., 2018; Sweet & Broadbent, 2017). In this study, relationship development and interpersonal interactions were vital to the function and performance of the clinical facilitator in their role. The importance of relationship building and rapport development in the practice of clinical facilitation is supported by previous literature (Dev et al., 2020; Lim et al., 2023; Martin et al., 2022; Molesworth, 2017; Needham et al., 2016; Ryan & McAllister, 2019; Sweet & Broadbent, 2017). Due to the essential interplay and relationships between stakeholders, this research argues for the formation of formal communities of practice with a range of stakeholders to develop and support best practice in clinical facilitation and placement experiences through social learning opportunities.

In this study, clinical facilitators worked with registered nurses to support, educate, and assess students in the clinical environment. A barrier to effective clinical facilitation and contribution to the preparation of nurses for practice was the perception of the clinical facilitator as an outsider. This isolation and dissociation from the clinical team and the faculty team created a hurdle for clinical facilitators to overcome. This sense of disconnection and isolation may be reduced through the implementation of formal communities of practice, recognising the importance of interacting and learning together, independent of role or job title (Gonzalo et al., 2017).

Preparatory work and rapport building by the clinical facilitator before and during the placement using effective communication and positive engagement were essential to creating welcoming and supportive learning environments for students, which was supported by previous research (Dev et al., 2020; Lim et al., 2023; Molesworth, 2017; Needham et al., 2016; Ryan & McAllister, 2019; Sweet & Broadbent, 2017). Developing formal communities of practice would offer a point of connection enabling clinical facilitators to build greater partnerships with the aim to improve the student learning experience and the quality of feedback. McKellar et al. (2018) also support the benefits of developing registered nurses’ understanding of student learning needs and creating learning opportunities to improve student placement experiences. A benefit of this connection is the ability to establish clear role expectations for both the clinical facilitators and registered nurses. The importance of this is supported by Van De Mortel et al. (2020) in their study on a cluster model of clinical facilitation.

More work is required to construct the clinical facilitator's professional identity as misunderstandings of the intention of the role and its place in the nursing team continue. To compound this, clinical facilitators have reported having limited preparation and professional development opportunities, similarly recognised by Needham et al. (2016), thus inhibiting their ability to consolidate their understanding and performance of the role. Woods et al. (2016) argue the value of purposefully constructed communities of practice to engage in social and collaborative learning, benefiting individual and shared identity formation. Through participation in communities of practice, the clinical facilitator's professional identity may be further developed and consolidated, thus increasing confidence and consistency in the practice of student support and supervision. The benefit of connecting with other clinical facilitators was demonstrated in this research and supports the premise of the advantages of developing more formal opportunities to come together as a community. This is further supported by the finding of Needham et al. (2016), who reported networking beneficial to building clinical facilitator understanding and developing strategies to perform their role.

The clinical facilitation role is very important to student learning and quality clinical facilitation is a balance between high-level knowledge about clinical practice and effective teaching and learning strategies (Needham et al., 2016). Opportunities for clinical facilitators to connect with the curriculum and academic team provide chances for clinical facilitators to move towards full participation in the education community and improve education practices. McKellar et al. (2018) argue that contracted clinical facilitators who worked within the University have a deeper understanding of student learning needs and education pedagogy. Further innovative solutions such as implementing mobile applications and technology solutions, may also assist in providing further transparency and understanding of the curriculum for clinical facilitators when supporting students in the clinical environment (Wilson et al., 2022). It is important that the value of the clinical facilitator role is recognised and communities of practice are formed to support knowledge sharing and development at an individual and group level to collaboratively improve the preparation of students for practice.

Limitations

This study was undertaken during the COVID 19 pandemic which may have impacted the clinical facilitators experience at that time. All clinical facilitators were contracted by one education provider to work in one local health district. However, all participants were experienced clinical facilitators and drew from their experiences in other facilities and with other education providers as part of their reflections. The research was conducted in a regional setting and may not be generalisable to all contexts. Further research on developing and implementing communities of practice for clinical facilitation in nursing and other health disciplines is recommended.

Conclusion

Creating a culture of commitment to student learning is important for developing sustainable, clinical placement experiences for students in healthcare settings. As the demand for clinical placements continues to grow, Healthcare organisations and education providers must consider the resources and training required to support clinical facilitators and registered nurses in providing students with positive and engaging learning experiences. The clinical facilitator role has an important function in preparing student nurses for practice and needs further recognition and continued professional development. Education providers and healthcare organisations need to examine strategies to provide inclusive and supportive work environments, building communities of practice for clinical facilitators and stakeholders to share their experiences and knowledge promoting individual and group learning, thus improving the student placement experience.

Data sharing statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Ethics number

LNR219 – LNR/19/NCC/16.

Disclosure statement

No potential conflict of interest was reported by the author(s).