Key people in Clinical Placements

The success of a Clinical Placement is, to a large extent, determined by two key people:

1. The Clinical Supervisor at the clinical placement venue.  This supervisor often comes from VCHN.
2. The Preceptor – the preceptor comes from the aged care or hospital facility. 

The role of the Clinical Supervisor
The main roles of the clinical supervisor in relation to students can be summarized as follows:

• To provide clinical learning opportunities for students in their clinical setting
• To give students appropriate feedback in order for them to learn and develop clinical skills

• To participate in assessment of students’ clinical competencies.
•  Selecting residents and providing learning experiences appropriate to clinical objectives.
• Observing the student directly and providing constructive feedback.
• Providing frequent feedback concerning student's clinical progress, discussing both strengths and weaknesses.
• Planning with the student for additional experiences.
• Validating student's progress through written evaluations.
• Sharing evaluations with the student and the Course Coordinator

The clinical supervisor should be available at all times to assist the student in the clinical setting. Through self-appraisal tasks and personal development plans, students should be encouraged to develop their own critical evaluation skills, as these will be vital when they are fully qualified professionals.  However, most students appreciate support in developing these skills during their training.

Students are adult learners and, as such, each student is responsible for their own skills development in a learning environment where they are given appropriate opportunities and feedback. Clinical supervisors must always feel confident that the participation or involvement of students is not compromising their clients’ needs.

Students can learn usefully in the clinical setting without the immediate presence of the clinical supervisor - for example attending and observing a particular procedure with their preceptor or other staff.

Students can also learn from completing tasks which are not directly related to client contact, such as reviewing a client’s care plan, history and coming together as a group and undertaking reflective practice on care provided during the shift.

The role of the preceptor
The preceptor assists the clinical placement by:

• Participating and supporting students in a client /resident care environment.
• Observing the student directly and providing constructive feedback.
• Providing frequent feedback concerning student's clinical progress, discussing both strengths and weaknesses.
• Planning with the student for additional experiences.
• Sharing evaluations with the student and the Clinical Supervisor

The role of the participant/student in clinical placement:

• Obtain comprehensive health histories.
• Conduct physical assessments.
• Present findings clearly and concisely.
• Order and interpret screening and diagnostic laboratory tests.
• Identify, evaluate, and manage common acute conditions and stable chronic conditions.
• Co-manage patients with complex health problems.
• Determine health knowledge and practice to identify risk factors.
• Evaluate the emotional and social well-being of clients/residents.
• Identify primary health care needs within the context of the socio-cultural environment.
• Develop health education and health promotion interventions.
• Recognize the influences of cultural diversity in health care.
• Collaborate with other health care professionals and make appropriate referrals.
• Document findings in an organised, thorough manner.
• Evaluate and absorb feedback from their preceptor.

Process for Completing Clinical Practice

• Participants will only progress into the clinical component of the course once they have successfully completed all assessments for the theoretical component.
• Participants will be placed into a clinical group, usually between 6 and 8 students, and this group will be placed into clinical placement at a recognized and reputable High care Aged care facility in Victoria.
• Each group will have their own clinical supervisor, normally from VCHN
• On completion of clinical practice the Clinical Supervisor and course coordinator will meet to review the Clinical Assessment Tool and discuss each student’s level of competence and any issues regarding the clinical practice.
• Once documented evidence is provided that competency has been achieved, the course coordinator will complete the competency check list form.
• All outcomes of assessment and course completion will be reviewed by the Training Manager. The Training Manager will review the processes undertaken, assessment results and confirm the outcome.

Assessment of Clinical Placement Competencies
This clinical tool is to be used by the clinical supervisor in the Heallth/Aged Care Facility to record the assessment process and should reflect a variety of supporting evidence for each competency.

Assessment is ongoing throughout the participant’s clinical practice experience. The assessor (the Clinical Supervisor) gathers evidence from a variety of sources such as direct observation, interview, and analysis of documentation. Assessment should be continuous and documentation of assessment should be made throughout the clinical placement time.

In recording an assessment of competence, the assessor has the responsibility to ensure that recommendations regarding a participant for registration are based on valid and reliable assessments.

This assessment tool is based on the following Principles of Assessment:

1. Accountability
The Clinical Supervisor (assessor) is accountable to the profession and to the VCHN College of Health and Nursing:

• To make valid assessments about a participant’s performance and for recommending that the candidate being assessed meets the competency standards required.
• Maintaining confidentiality at all times.
• Declaring any conflicts of interest where impartiality cannot be assured.

2. Assessment of Performance
The assessment is based on total performance including knowledge, skills, attributes, values and abilities. Clinical competence is performance based and carried out by qualified assessors in the clinical setting.

3.  Context based
The context in which the assessment occurs is considered to be an essential component of the assessment due to variability of the clinical environment. Factors such as environment, relationships, behaviours and peers should be considered.

4. Evidence Based Assessment
Evidence based means that an assessment is based on a model of evidence based on professional judgment. The use of significant cues assists the assessor to infer that competence has been reached in a particular competency.
The assessor gathers evidence and draws inferences about competence. These inferences are made about performance and related knowledge, attitudes and skills and a judgment can be made on all of these combined aspects.
Sources of evidence may include:

• Observation of performance
• Screening of documentation
• Interviewing and discussions with participant
• Reviewing nursing care plans
• Discussions with peers and patients
• Written papers and other knowledge challenges
• Self assessment by the participant

Reflection and re-interpretation of evidence about the performance of the Clinical Placement student is essential and adds to the reliability of the assessment judgment.

5. Validity and reliability
Validity in the assessment process is the extent to which assessment meets the intended outcomes. Reliability in the assessment process refers to the consistency or accuracy of the outcome of the assessment process.

The quality of the assessor’s knowledge and ability to use the tool is essential in the validity of the assessment.

6. Collaboration and participation
The participant and the assessor should develop a relationship based on participation and collaboration. Both the participant and assessor should feel confident in the assessment method.

The assessment model requires a high level of communication and negotiation, reflection on and re-interpretation of performance. Processes are in place to deal with grievances and concerns regarding the assessment process. These processes also enable review of the results of assessment judgments.

Using the Clinical Assessment Tool
As the clinical component of the course comprises over 50% of course delivery, it reflects the importance of clinical review. The clinical review will be comprised of a number of processes.  Core aims of the clinical review process are to ensure that the clinical practice undertaken by the participant enhances knowledge and skills, and that participants obtain maximum clinical experience during their supervised clinical practice

The clinical review process includes:

• The Course Coordinator meeting with the Clinical Supervisors on a weekly basis for participant progress, feedback and support.
• The Course Coordinator meeting with participants in the clinical setting on an ‘ad hoc’ basis and as required. A minimum of weekly meeting will be organized.
• Evaluations being undertaken to gather data for review. 

Participant Progress in the clinical area

• Clinical Supervisor will be encouraged to discuss participants’ clinical objectives with the participants in the first two days of clinical practice.
• Participants’ progress will be monitored on a daily basis with feedback from the supervisor and the preceptor.
• Documented examples should be provided by the Clinical Supervisor as evidence of the development of competence.
• If necessary, the assessor will assess the participant on a competency on more than one occasion until the final assessment is achieved.
• Participants’ progress will monitored at the weekly meetings. Where there are areas of concern regarding progress, meetings will be set up with the participant, clinical nurse supervisor and relevant others.
• Following these discussions, learning needs of the participant will be identified.
• If necessary, Learning Objectives will be developed in negotiation with the participant, and time frames set.
• Where there are concerns with accomplishing an area of clinical competency, the Clinical Nurse Supervisor will be allocated to work with the participant in attaining the required level of competency.
• Where there is a recognized knowledge deficit the College will be responsible for providing relevant education materials to use in the workplace.
• Where appropriate, other support services may be initiated to support the participant e.g. counselling
• The Training Manager will review all participants that do not meet the requirements of the course and have the opportunity to review the processes undertaken and make further recommendations if required.
• The assessor is responsible for ensuring documentation is completed and the Clinical Assessment Tool is kept up to date.
• At the end of clinical practice the participant will return the Clinical Assessment Tool to the course coordinator and the participant will be provided with a copy of the tool.

This document should be read in conjunction with:
Assessment of Competencies – Procedure