12 hour clinicals

purplemania, BSN, RN · Jan 28, 2005

My ADN program used them because the program was set up for 2 nights a week as lecture and 1 weekend day for clinical. There is a lot to be said about consistency and being able to see the results of some of your actions, but 12 hrs is awful long. We were on the floor 11 hrs and had an hour conference at the end.

VickyRN, MSN, DNP, RN · Jan 28, 2005

My ADN program used them because the program was set up for 2 nights a week as lecture and 1 weekend day for clinical. There is a lot to be said about consistency and being able to see the results of some of your actions, but 12 hrs is awful long. We were on the floor 11 hrs and had an hour conference at the end.

We utilize them in our program intermittently, but only in the senior year. We have had only positive feedback from the students and the students actually seem to prefer this schedule (more convenient, saves on gas), and it is easier to find qualified instructors and clinical sites with this type of schedule. The downside is that it can be exhausting for the instructor. Like purplemania, the students are on the floor for 11 hours and then have an hour post-conference.

llg, PhD, RN · Jan 28, 2005

I am the liaison between my hospital and several different schools who use my hospital.

The "best" school in our area was using 12-hour shifts, but stopped for several reasons. One of the reasons was that the students did not seem to be learning as much. With only having 1 assignment for the whole 12 hours, they weren't getting enough variety of experience even though the total number of hours in clinical was the same as 2 6-hour sessions.

The students who had 2 days per week of 6-hour clinicals got more exposure to a wider variety of patients and procedures. If they had the same patient both days, they saw how that patient progressed from one day to the other. If they didn't get the same patient assignment, they got to see an additional patient. Also, the 12-hour once-per-week clinical schedule folks seemed to lose more of what they learned in between sessions.

We have seen a similar phenomenon in staff development in the field of orientation. We have found that orientees working only 3, 12-hour shifts per week tend to progress a little more slowly and seem to regress a little more when they miss a few days a few days due to illness, vacation, etc. The 5, 8-hour shifts per week people get a more frequent reinforcement of their learning and simply get more repitition of meeting a new patient, doing an initial assessment, etc.

You simply get less experience with 12-hour shifts --- and the experiences are farther apart and therefore reinforced less frequently.

I'm not saying that it can't be done well ... but anyone considering it should be aware of these issues and take them into consideration in the planning.

llg

VickyRN, MSN, DNP, RN · Jan 29, 2005

I am the liaison between my hospital and several different schools who use my hospital.
The "best" school in our area was using 12-hour shifts, but stopped for several reasons. One of the reasons was that the students did not seem to be learning as much. With only having 1 assignment for the whole 12 hours, they weren't getting enough variety of experience even though the total number of hours in clinical was the same as 2 6-hour sessions.
The students who had 2 days per week of 6-hour clinicals got more exposure to a wider variety of patients and procedures. If they had the same patient both days, they saw how that patient progressed from one day to the other. If they didn't get the same patient assignment, they got to see an additional patient. Also, the 12-hour once-per-week clinical schedule folks seemed to lose more of what they learned in between sessions.
We have seen a similar phenomenon in staff development in the field of orientation. We have found that orientees working only 3, 12-hour shifts per week tend to progress a little more slowly and seem to regress a little more when they miss a few days a few days due to illness, vacation, etc. The 5, 8-hour shifts per week people get a more frequent reinforcement of their learning and simply get more repitition of meeting a new patient, doing an initial assessment, etc.
You simply get less experience with 12-hour shifts --- and the experiences are farther apart and therefore reinforced less frequently.
I'm not saying that it can't be done well ... but anyone considering it should be aware of these issues and take them into consideration in the planning.
llg

Excellent response, llg - thanks so much for sharing your experiences and perceptions in this matter. You bring up many valid considerations.

pmchap · Feb 3, 2005

Without stretching a point to far then llg - the arquement for shortening exposure time - to allow more and increased variety.... would it not be better then having 3x4hrs sessions or perhaps 4x3 hrs? I know I am taking it to the extreme but I think that there is a trade off between quality of learning or care attention (in the case of clinical exposure) and the commitment from students/staff to impact on their lifestyle.

In lab sessions what is the 'normal' lab duration? (for us no more than 3 hrs)

Take my example for instance - very few students or staff would be willing to attend 4 3 hr sessions or training (unless they lived next door top the hosital) because of the pre and post session time personal commitment to getting to and from etc. In a 12 hr session there are as you mentioned only certain periods of usable learning time. What I have found is that given an 8 hr shift there seems to be a useable 6hr window for education in a morning shift - in an afternoon even less. The only real value in extended (ie 8, 10 or 12 hr) clinicals is that the students become aclimatised to the shift cycles of the nurse. So what is the real reason for the clinical time - exposure to the work of a nurse or clinical learning as a seperate thing?

Just some thoughts.... :uhoh3:

llg, PhD, RN · Feb 3, 2005

Without stretching a point to far then llg - the arquement for shortening exposure time - to allow more and increased variety.... would it not be better then having 3x4hrs sessions or perhaps 4x3 hrs? I know I am taking it to the extreme but I think that there is a trade off between quality of learning or care attention (in the case of clinical exposure) and the commitment from students/staff to impact on their lifestyle.
Just some thoughts....

I think the thoughts you shared are great ones, pmchap. Thanks for continuing the discussion of an interesting topic.

I think that there is a need for some balance in the decision of how long a clinical lab should be -- pehaps some shorter shifts and some longer shifts. That way, the student can experience the advantages of each shift length without suffering too much from the disadvantages of any particular shift length. I don't see any reason why they all have to be the same length.

llg

pmchap · Feb 4, 2005

We are currently tackling this exact issue regarding an upgrade in one of the ecrtifications that you can recieve as a nurse (EN's in Australia are being certified to give medications under the supervision of an RN). Currently there are only 2 different courses available for this and the institutions running the courses have left the clinical exposure time relatively open. The only stipulation that one has set is that clinical time must be in blocks of a minimum of 4 hours. Otherwise the courses have been written with phrases such as 'adequate time to gain insight and understanding into the administration of medications in the ward setting'.

This flexibility can be frustrating for some clinical educators (they would prefer a more clearly defined schedule) while I enjoy it because I am able to taylor sessions based on the students I have a the time. One student I do spend the enitre shift. Another I will spend 4 hours. We all know that students learn differently and being able to be flexible with students allows me to develop a learning program that provides the best experiences for the individual.

MultipurposeRN · Feb 21, 2005

I taught clinicals for 5 years at an ADN program. The first year we did 2 eight hour clinicals, but by far preferred the 12 hr day. So much easier to work around classes, etc. Plus, my 2nd year students were generally taking 4-6 patients each on the medical floor after the first week o, so they had a good all around exposure to what most of them would be doing after they got out. They graduated at a fair comfort level for doing their own meds w/ a team of patients, etc. I kept them on the floor about 10 to 10 1/2 hours, then we would post conference.

I feel that the 12 hour clinical is more realisitic. Plus it could give them time to interact with staff, watch some procedures on other patients, etc.

llg, PhD, RN · Feb 21, 2005

I taught clinicals for 5 years at an ADN program. The first year we did 2 eight hour clinicals, but by far preferred the 12 hr day. So much easier to work around classes, etc. Plus, my 2nd year students were generally taking 4-6 patients each on the medical floor after the first week o, so they had a good all around exposure to what most of them would be doing after they got out. .

Interesting. Thanks for the input. I'm curious .... If each student takes 4-6 patients, how many students do you have on a unit at a time? How many patients are on a unit? How many students does one instructor supervise? etc.

Each of our units only has 10-20 patients. Each clinical group has about 10 students. So there just aren't enough patients for the students to have more than 1 or 2 patients at a time. So, you can probably see that 12 hours with 1 patient doesn't always provide enough variety. If the rotation is 6 weeks long, the student may only get to interact with 6 patients.

llg

perfectbluebuildings, BSN, RN · Feb 21, 2005

From a student's point of view... I have had both 6 hour and 12 hour clinical days. I am currently in 12 hour days because it is my senior preceptorship class and we work around the nurses' schedules. I enjoyed the 6 hour days and went home still able to do other work; after 12 hour days I am exhausted (like probably most nurses are too after a day's work, I can understand that), and still have lots of homework to do and it is hard to focus and I usually end up just heading straight for bed (of course, these 12 hour clinicals are an hour or more drive away so that probably plays into it as well). I can see the saving gas arguements though, and it is good to get an idea of the shift of the "real world" nurse rather than a student. However personally, since it is all new environment for me (in an ICU right now), and am learning something new all the time, it is mentally exhausting and by the last few hours of the shift I find myself just marking time till it will be over and not really registering things any more. I know this will probably make me a bad nurse and such, but it's the way I am right now. And also between clinicals I do forget things, and will not be exposed to as many different patients due to the less days. The six hour days can be kind of short, maybe 8 hours would be better. Sorry to be so long and convoluted, but was actually thinking about this today and have a lot of thoughts on it right now. Am not really enjoying my clinicals right now- feel extremely, extremely stupid and not nearly ready to take on a nursing position, but that is another story for another time. Carry on...

Edited to add: Maybe you could post this question also in the student forum and see what other students' thoughts may be... I just stumbled on this from the "last 24 hours posted" section. i think they will have valuable input for you.

carolynd · Feb 21, 2005

Generally our ADN program uses 6 hour clinicals for the first year students and 8 hour clinicals starting during the Practical Nurse summer then throughout the entire second year. In the spring of second year we do a Focused Practicum experience in which students take on the shift of their preceptor for a total of 72 hours. This preceptorship is generally the first time students have the option of a 12 hour shift. Our instructors believe student learning is reduced after 8 hours plus non of the instructors want to commit to 12 hours. On occasion, when a student is doing a community clinical (precepted) we will allow 12 hour shifts. This is simply because many of our students live up to 1 1/2 hours away from their assigned clinical site.