Clinical learning environments for student nurses: key indices from two studies compared over a 25 year period.

In 1978, a longitudinal study commenced in England to illuminate criteria for the evaluation of hospital wards as clinical learning environments for student nurses. It derived measures to quantify the clinical learning experienced by 71 students in three cohorts in three training hospitals over their entire programme. In 2003, a second study, based in one English School of Health Studies, using clinical placements in three NHS trusts, employed a retrospective, cross-sectional, analytic survey design with anonymised, self-completion questionnaires, to map the clinical learning of 272 students as part of a quality assurance and enhancement initiative. This paper explores changes over time by comparing data based on five key indices, devised in the first study and revisited in the second. Concepts of clinical learning and supervision are reviewed as part of this changing context and background together with limitations implicit in the comparison. The findings suggest an average 20% improvement in the quality of hospital based clinical learning environments over a 25 year period, based mainly on trained staff personally supervising students more extensively, testing their theoretical knowledge more frequently and spending more time performing practical procedures with them. However, unacceptable variations in clinical learning opportunities persist for some students.