Still looking for leadership--who is responsible for student nurses' learning in practice?

The study on which this paper reports examined how the widespread changes in the NHS workforce and in higher education which have transformed nurse education in recent decades have impacted on responsibility for the leadership of student nurse learning in clinical practice. Findings from this mixed methods case study carried out at four English higher education institutions between 2006 and 2007 suggest that link lecturers' presence in clinical areas is diminishing, and that practice nurses' involvement with pre-registration students' learning may be limited. Ward managers lead learning at ward level but changes to their role limit their presence on the wards, so that mentors lead student learning on a day to day basis, which they must balance with caring for patients. Changes to the nurse's role mean that modelling bedside care often falls to health care assistants. This deficit of leadership for learning may be understood as a manifestation of the 'uncoupling' of education and practice following the move of nurse education into higher education and subsequent changes to nursing roles. Strengthening leadership for learning is likely to be associated with recoupling practice and education and indicators to assess the quality of leadership for learning in clinical practice are suggested.