908 - Using Alternative Clinical Experiences to Meet Essential Clinical Objectives in a Rural Landscape

Finding appropriate clinical experiences continues to be a challenge for many nursing programs. Rural programs have additional challenges due to limited access to specialty services. Alternative clinical experiences can provide meaningful and equitable learning experiences for students and promote development of clinical judgment.

Each year, over 80,000 qualified applicants are denied admission to nursing programs in the United States (AACN, 2022). The most cited reason is the lack of adequate clinical sites (AACN, 2020). Small hospitals in rural communities often welcome students but limit clinical groups to small numbers due to size constraints and low patient census. Rural programs also face limited access to specialty experiences, including critical care, mental health, pediatrics, and women’s services. Finding alternate clinical experiences is necessary to provide all admitted students an equitable opportunity to meet clinical objectives, develop clinical judgment, and prepare for entry-level practice.

Ranger College is a small rural community college located in central Texas with a service area of over four thousand square miles. The college is essential to the nursing workforce in the area, with over 80% of students remaining in the communities the college serves. Currently, students must meet 640 clinical hours in clinical courses across four semesters, not including the skills course. Students complete sixty-four clinical hours in semester one and 192 hours in each of the remaining three semesters.

In the Fall of 2021, clinical hours were mapped out to meet objectives across a concept-based curriculum, with students meeting half (320 hours) of their clinical requirements with traditional face-to-face hospital-based experiences and the remaining 320 hours in a variety of alternative experiences including computer-based experiences, long-term care experiences (40 hours), simulation (50 hours), and community experiences (41 hours). Clinical experiences were also mapped to align with didactic content in each semester. The clinical evaluation tool was modified to incorporate documentation of how students learn from their community experiences and meet the clinical objectives, which are based upon the NCSBN Clinical Judgement Measurement Model.

There are numerous benefits to alternative clinical experiences for both the student and the program. When planned appropriately, alternative clinical experiences add value, develop clinical judgment, meet clinical objectives, and enhance the student learning experience. These experiences also help address clinical placement challenges. Community-based clinical experiences expand community connections and provide opportunities for students to deepen their understanding of social determinants of health for rural citizens. Students are provided opportunity to learn about services offered within their own communities and are able to identify unmet needs. One student reflected on the dialysis experience “My biggest takeaway from this experience was how drastically these patients’ lives changed once dialysis was prescribed. They must completely alter their lives to undergo treatment by dedicating three to four hours of their day three times a week to maintain some quality of life.” Rural nursing students, also community citizens, learn about services they may need themselves, to help with resources during nursing school.

Having students in community-based clinical experiences also increases program visibility which improves the program's reputation and helps with marketing and recruiting future students. Being in the community has also increased the number of agencies reaching out and asking to work with our students. The alternative experiences meets a dire need for clinical placement, and when planned appropriately, aligned with the clinical objectives and measurement of learning, also help students develop clinical judgment.