Navigating the rules of clinical practicum work: An interpretive study of the experiences of associate degree nursing students

Responding to changes in technology, economics, and the demographics of society, nurse leaders incorporate new ideas and systems into clinical practice. Nurse educators are challenged to adopt these ideas and systems and make them part of the nursing curriculum. Educators develop tools and strategies to help students gain knowledge and skills to work with patients in the clinical setting. The ways in which students use these tools and perceive and manage their clinical work is not understood. The dearth of research related to what students actually do in clinical practicum settings provided the backdrop for this study.; This is a grounded theory of how student nurses through a second semester clinical practicum. Ethnographic methods of observation and interviews were used to collect data with four groups of student nurses. The analysis shows that embedded within the educational requirements of the clinical practicum are a set of rules guiding the work of student nurses.; The central perspective, how students navigate the rules of their clinical practicum work, describes a set of strategies that students employ to complete the clinical practicum. "Rules" and "work" emerged as the most salient dimensions in this study with students following the explicit and implicit rules to complete the work expectations of faculty, nursing staff and patients. The analysis further shows that a hierarchy of work existed wherein faculty work and expectations influenced the ways in which student approached staff and patient work. At times the rules were not sufficient to manage contingencies that arose in the context of the clinical practicum and student nurses created new rules or modified the rules. Consequently, students came to view patients as objects to forward the educational requirement of the practicum and experienced tension and conflict in translating classroom learning to the care of patients on the actual clinical unit.; Nurse educators are challenged to prepare nursing graduates who are flexible, have the necessary skills for problem solving, and have the ability to advocate for patients. The results of this study help inform nurse educators about how students prioritize their learning activities in the clinical setting.