paediatric nursing February vol 19 no 1 31

education

Orientation to student placements:

needs and benefits
Abstract
A review of evidence on the benefits and challenges of student orientation is used in this article
alongside experiences of orientation days on a children’s ward to consider ways in which such
programmes could be improved. Orientation to clinical placements can enhance learning by helping
students to feel they ‘fit in, reduce anxiety and increase motivation to learn through early identification
of learning outcomes. However, there are challenges in the practical implementation of orientation
including timing of students’ starting dates, staff time, consistency and level of information and teaching.
Increased involvement of individual mentors could improve orientation and optimise students’ learning
experiences.

N
ursing education is traditionally based
upon learning through experience, which
involves placing students in clinical practice.
The first stage of this learning is ‘exposure’, where
the student is introduced to a learning experience
(Nicklin and Kenworthy 1995). Using their senses
and perceptions students decide whether to accept
or reject the experience; if they accept they will be
in the best position to learn. The importance of this
initial ‘exposure’ and its influence on learning is
supported in guidance from the Royal College of
Nursing (RCN) (2005). The English National Board
for Nursing, Midwifery and Health Visiting (ENB)
(2001) also recommended induction/orientation
programmes at the beginning of placements.
Clinical placement areas and universities approach
orientation programmes in different ways. For
example, the University of Salford informs students
that healthcare trusts will organise an induction and
orientation to the placement (University of Salford
2006). The University of York expects students to
organise their own orientation by meeting with
mentors, identifying their own learning outcomes
and organising a preliminary interview (University
of York 2004). King’s College London tells students
that they may receive an orientation programme
which will either be arranged by the placement area
or the link lecturer (King’s College London 2005).
In my clinical area, induction to the placement is
achieved by an orientation day organised by the ward
practice development team.
Given the importance of orientation, it would
be useful to explore the ways in which these
arrangements influence student learning with a view
to suggesting ways in which orientation days could
be improved. This article begins with identification
of how orientation days help students’ perceptions
of ‘fitting into’ the clinical area and reduce anxiety.
The ways in which orientation days can increase
motivation to learn through identification of learning Katie Worrall RN(Child),
outcomes will be discussed, and the practicalities of MN is staff nurse,
orientation days considered. Although the example Evelina Children’s
in this article is an inpatient ward area, the findings Hospital, Guy’s and St
of the analysis could be applied to induction Thomas’ NHS Trust,
programmes in other clinical placement areas. London
Fitting in
A number of studies report that students often
feel they do not ‘fit in’ to wards, particularly at the
beginning of the placement (Lofmark and Wikblad
2001, Nolan 1998). This feeling is worsened by
not being expected by ward staff and being in an
unknown environment (Hamill 1995, Gray and
Smith 2000). Maslow’s hierarchy of needs indicates
that lower needs, such as feeling safe and belonging,
must be met before being motivated to achieve
higher needs, such as striving for excellence (Hayes
1998). Students who do not feel a sense of belonging
in the ward may not be motivated to learn and
achieve excellence. Lofmark and Wikblad (2001)
found that when students feel they don’t fit in, their
learning is compromised as they use all their effort
trying to fit in.
Students who attended the orientation day offered
on my ward noted the positive experience associated
with being expected. They felt that a tour of the ward
helped them learn where the important rooms and
equipment could be found which led to feelings
of fitting in. The ENB (2001) and Nicklin and Key words
Kenworthy (1995) recommend that such content is ● Nursing: education
included in orientation days. Students should also be ● Clinical placements
introduced to key people within the ward (Hutchings ● Education: practical
and Sanders 2001), but this does not always happen experience
during our orientation day. There are many staff
working on the unit and the failure to introduce This article has been
subject to peer review.
students to key people could add to feelings of not To find related articles go
fitting in and belonging. It is recommended that to the archive section of
an introduction session to key members of staff www.paediatricnursing.co.uk
32 paediatric nursing February vol 19 no 1

There are many

staff working
on the unit
and the failure
to introduce
students to key
people could
add to feelings
of not fitting in
and belonging

is included in all orientation programmes. If the

student groups are small, these introductions could
be made during the tour of the ward which would
Tina Zellmer

limit the inconvenience to key people of coming to

the orientation day location on a regular basis.

Information and knowledge

Researchers have found that students perceive their
skills and knowledge as inadequate, and feel anxious
and stressed before starting the placement (Hamill
1995, Lofmark and Wikblad 2001, Wilson-Barnett
et al 1995). If feelings of anxiety are overwhelming,
the ability to concentrate and do well may suffer
(Cruse 2005). According to Calvo and Ramos (1989),
anxiety reduces the efficiency of the processing
required for learning. Therefore, effort must be
made to reduce the stress students feel in relation to
their lack of skills and knowledge.
In my ward, students are given information
and taught about common conditions for which
children are admitted, assessing the child, and
documentation. Stuart (2002) recommends that
such information and teaching is provided to
help reduce anxiety. Students in Gray and Smith’s
(2000) study enjoyed quality time being set aside
for learning. However, the content and length of
time of our orientation days vary depending on the
staff available. This would indicate that for some
students little is being done to help them overcome
their stress. Increasing the number of staff who co-
ordinate the orientation day may prevent differences
in orientation days and standardise the learning
opportunities for all.
An important point to note is that if the theoretical
level of information and teaching provided to
students in the orientation day is beyond their
level of understanding, their level of stress may
paediatric nursing February vol 19 no 1 33

education

be increased rather than decreased. This problem
is not widely discussed within the literature, but
in one example some students on the ward joined
qualified nurses for a teaching session on acid
base balance and reported feeling scared because
they felt they had to understand such complicated
information. Nicklin and Kenworthy (1995) suggest
that if someone feels they may not succeed they will
not be motivated to participate and learn. Therefore
the content of the orientation days needs to be
appropriate for the students’ levels of learning to
help reduce the degree of stress they may feel when
starting a new placement.
Learning outcomes
Students on my ward reported that it had taken them
a few weeks to identify their learning outcomes
as they did not know what learning opportunities
there were. During this time the students may
not be motivated to learn as they may be unable
to appreciate the significance of the learning
experience (Nicklin and Kenworthy 1995). A session
during the orientation day should introduce some
of the potential learning outcomes of the placement.
This idea was well received in a pilot by Hutchings
and Sanders (2001) as part of a learning pathway
designed for students.
Practicalities of orientation days
Orientation days seem like a good idea in theory,
but experience suggests that their application is
often fraught with problems. We have experienced
problems such as a lack staff or time which meant
content changed, students were orientated at the
same time as qualified nurses, and some students
did not receive any orientation. These problems were
largely a result of students starting at different times,
which meant that orientation days were required
every week, often for only two students at a time.
This problem could be overcome if mentors from
the clinical area conduct the orientation day. For
example, when two students start on one day, one of
their designated mentors could orientate them both
to the unit.
There could be a rota to ensure all mentors take it
in turns to fulfil this role. With more staff available
to orientate students it is likely that all students will
be able to optimise their learning from the ward
through a comprehensive orientation day. Moreover,
the students’ learning would be enhanced as
mentors would be more familiar with the students’
learning outcomes and what they had covered on
the orientation day. This would allow mentors to
tailor further learning within the practice setting to
students’ needs and previous knowledge.
A review of the recommendations for mentors
from the RCN (2005) and ENB (2001) identified the
following factors for placement areas to consider
when organising student orientation programmes:
● Students should be given written information
about their placement: information about the
placement specialty, learning opportunities and
type of placement.
● Individual interviews should identify learning
outcomes and the ways in which they will be
achieved. Additional support needs should be
identified.
● The placement team should be introduced.
● Roles, responsibilities and expectations in terms of
standards and attitudes should be established.
● The orientation programme should be
comprehensive and jointly agreed by mentors,
assessors and link lecturers.
Conclusion and implications
Orientation days can play a large part in maximising
the learning potential of a placement area (Nicklin
and Kenworthy 1995, Stuart 2002). If designed
appropriately they can help students fit in,
reduce anxiety associated with a perceived lack of
knowledge and skill and help students focus on
the learning outcomes they can achieve. Evidence
suggests that appropriate orientation enhances the
quality of the students’ learning experience while
on the placement. Challenges such as timing,
staff availability and consistency of content can be
overcome, particularly if individual mentors take
responsibility for ensuring that all students allocated
to the clinical area receive a standardised and
comprehensive orientation PN

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