Difficulties Facing Nursing Students During Placement Assignment Sample

Introduction Of What Are The Difficulties Facing Nursing Students During Placement

Clinical placements give aspiring nurses the chance to put their theoretical knowledge to use in actual healthcare settings. Clinical placements are a crucial part of nursing education because they help students apply their academic knowledge in real healthcare settings. Aspiring nurses can improve their clinical judgement, develop critical skills, and cultivate empathy and communication with patients and interdisciplinary teams through practical experiences. These experiences offer priceless chances to adjust to difficult situations, comprehend the complexities of healthcare, and advance patient-centred treatment. They also encourage professional development, competence, and confidence, which results in the development of well-rounded nurses who can provide safe and effective healthcare services and have a thorough grasp of the difficulties they may encounter in their future employment. However, a student nurse's placement route is frequently fraught with several obstacles and hurdles.

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The purpose of this review is to examine the particular difficulties faced by student nurses in the United Kingdom (UK) while on clinical placements. This study has aimed to highlight on the numerous factors that contribute to these challenges by probing the experiences and viewpoints of student nurses. For educators and policymakers to successfully meet the requirements of student nurses, assure their well-being, and improve their learning experiences, it is imperative that they are aware of these difficulties (Stearns, 2022). According to research, identifying and addressing the difficulties that student nurses confront is essential to their success and well-being. According to a study by Labrague et al. (2017), student nurses experience significant levels of stress as a result of their demanding workloads, a lack of social support, and insufficient resources. Additionally, a study by Henderson et al. (2020) revealed that student nurses frequently struggle with mental health difficulties. In order to give targeted assistance and solutions, educators and policymakers must be aware of these challenges. This will help to foster a pleasant learning environment and improve the overall learning experience of student nurses. Future healthcare workers may do better in school and have better results in terms of their mental health as a result of this information.

This chapter will therefore include a concise background of the subject area along with the aim and objectives of the literature review and the rationale of the subject matter.

Research Background

The Placement accessibility and staffing are now becoming pressing challenges faced by nursing students across the UK In the UK, the placement for nursing students are being carried out by following the NMC standards. According to Donley and Norman (2022) Nursing students are required to complete supervised practise in a variety of healthcare settings according to NMC (Nursing and Midwifery Council) criteria for nursing placement requirements in the UK. These internships have to be varied, giving students exposure to various specialties and care settings and encouraging development on all fronts. The NMC specifies precisely how many hours and what kinds of experiences are needed, ensuring that students are exposed to a variety of clinical situations (Dashtipour et al., 2021.). By encouraging the growth of clinical expertise, critical thinking, and professional values, this helps prospective nurses get the training they need to provide safe, competent care after graduation and registration as licenced nurses.

In partnership with the CoDH Council of Deans of Health, the Nursing Times has surveyed nursing and healthcare educators to determine the current scenario of the students in nursing education (De Gagne et al., 2021). The results showcase an extremely worrying scenario followed by a declining rate of the number of students being accepted onto nursing courses during FY (Financial Year) 2022-23 (Jasemi et al., 2018). The survey which was supported by the CoDH and the universities' faculties that provide education to nursing students, midwiferies, and allied healthcare professionals has offered a snapshot of the major issues faced by nursing students in academics and programs. On asking about the current challenges in nursing education, the majority of the respondents addressed the placement accessibility issues (Günay and K?l?nç, 2018).

In recent times one of the major issues related to nursing placement in the UK that is coming to the forefront is NHS Pay challenges. In 2021, the government of the UK announced a pay rise for the NHS staff, including the nurses, but that was not met the target, and faced criticism from many people in this profession who felt that the increase is not enough to value their work effort (Ford, 2022). Low pay in the NHS can limit nursing placement options in the UK, potentially resulting in a labour shortage. A study carried out by Royal College of Nursing in 2020 showed that 36% of nursing staff members were considering quitting their jobs because of insufficient pay (Buchan et al., 2019). The availability of qualified staff to oversee and assist nursing students during placements may be impacted by this. Additionally, the inflation rate in the UK is at its highest peak. The Nursing Union has demanded to increase the PayScale for nurses by 14% by 2023-24, but that is above the inflation rate (Addisie et al., 2022).

Additionally, Academic staffing issues can also be considered as one of the major challenges that nursing students may face when it comes to moving forward with this career opportunity. According to the Nursing Times reports, the number of applications to study nursing in the UK has fallen by 20% along with the 20% increased rate of leaving the studies by nursing students or the degree before graduation (Ford, 2022). According to (Markowski et al., 2021), academic staffing issue in the UK universities can lead to the decline in nursing student application and can increase the rate of students leaving from the ongoing nursing programs. Nursing and Midwifery Council data from the academic year 2021–2022 showed a 12% increase in the number of nursing students quitting their degrees before finishing (Donley and Norman, 2022). This may be partially due to a lack of proper academic assistance and a paucity of staff, which makes it difficult for nursing students to receive the direction and support they need to remain enrolled in their programs.

Research Rationale

There are several research works have been carried out to highlight the major challenges evident in staffing programs in the nursing field across the UK. Some of the research has been carried out by focusing on the challenges or issues being faced by nursing students while proceeding with their careers as academics or as professionals (Markowski et al., 2021). Though there are very few studies which have addressed the major challenges being faced by nursing students during their placement (De Gagne et al., 2021). The current research articles are also lacking information and resources about the incidence of challenges being faced by nursing students regarding placement accessibility in the UK and the contributing factors related to challenges. Therefore, the importance of this review is that: this research work can provide a complete overview of the major issues being faced by nursing students while accessing job opportunities in the UK. additionally, this proposed work will also provide in-depth knowledge to future researchers about the potential factors, causes, and consequences of the challenges that nursing students used to face while accessing placement.

Aims and Objectives

Research Aim

This proposed Systematic literature review aims to address the major challenges being faced by students in nursing while accessing placement. To meet this purpose, the current scenario across the United Kingdom has to be taken for instance.

Research Objectives

Therefore, the objectives of this project on which the work will further proceed are as followed:

1. To address the challenging scenario in the nursing backdrop of the NHS, the UK
2. To address and evaluate the potential challenges or difficulties related to the placement accessibility by nursing students in the UK
3. To evaluate the contributing factors related to the potential difficulties being faced by nursing students while accessing placement in the field of interest

Research Questions

What are the difficulties student nurses face at the time of accessing placement in the UK?

Methodology (Search Methodology / Parameters)

Search criteria/search terms / Keywords identified

Considering the aim and objectives of the proposed project work, the secondary qualitative research method has been used as the preferred search method. The aim of this review is to highlight the major challenges faced by the nursing students while accessing placement in the UK. to meet this aim, Secondary qualitative research method has been used to collect and analyse the information from online sources. As a search strategy, PEO study design has been used along with keyword search strategy along with data base search, Inclusion and exclusion criteria.

The PEO study design:

For this proposed research work, the PEO study design has been used as a framework that will be helpful to formulate well-defined and searchable questions based on the research purpose. For this proposed work, PEO (P-Population, E- Exposures, O-Outcome) approach has been used to break down the above-mentioned objectives and underpin the search strategy (Newman and Gough, 2020).

Population (P) will include the population of interest. For this research work, the population will include nursing students who are accessing placement in nursing backdrop across the United Kingdom. For example Nurse OR Nursing Students

Exposure (E) includes the views or experiences. The term “to identify the Interest” is related to the identification of views and perspectives. For example, view or views OR Perspectives or perspectives of the participants.

Outcome (O) includes the context around the CLE. Terms to identify the context Co include challenges in CLE (“challenge” OR “challenges” OR “barrier” OR “barriers”). For this proposed work, the Outcome terms are Challenge OR Challenges OR Difficulties

The keyword search or database search strategy is another search criteria or process that has also been used as a tool to find out the most relevant literature and sources from online platforms (Ørngreen and Levinsen, 2017).

Keyword Search:

Search terms based on the setup objectives

Objective 1: Placement Issues, UK

Objective 2: Challenges, Nurses, Students, NHS

Objective 3: Challenges, Placement, Accessibility, Nurse, Students, UK

Objective 3: Factors, Placement, Challenges, Nursing students, Placement access

Information about databases

Database Search and Selection

The electronic databases of Medline, CINAHL, Embase, Web of Science, PsycINFO, and Google Scholar are begin taken into consideration as the source of primary qualitative data and information that highlight the overview of nursing students on the challenges that they face at the time of placement. Each of the retrieved papers or journals and articles is being reviewed independently based on the title, abstract, and full context.

Types of papers – qualitative/quantitative

The types of paper that have to be taken as the source of information will be qualitative in nature as it can provide an in-depth perception of the current scenario in the nursing field across the UK in terms of availability of placement (Snyder, 2019). Additionally, qualitative research papers and articles can also be underlying the factors and possible difficulties that nursing students might face while accessing placement in the field of interest.

Smapling technique:

A random sampling technique will be followed for selecting the articles, journals, and review papers for the proposed research work from online sources. Randomized studies will also be included in this random selection process. For this proposed work, inclusion and exclusion criteria have been followed to ensure that the chosen papers, reviews, and articles are relevant enough.

Inclusion/exclusion criteria

Inclusion Criteria:

1. English language studies
2. The articles and journals contain information about nursing studies and placement accessibility
3. The articles, review papers, and journals that contain data and information about the challenging scenario and the factors related to the difficulties that nurses might face while accessing placement
4. The articles, journals, and review papers which are published on or after 2013

Exclusion Criteria:

1. Articles, journals, and review papers that are not written in the English language
2. The articles, journals, and review papers that do not contain any information about the nursing studies and placement accessibilities
3. Articles, journals, and review papers that do not contain placement-related information
4. Articles and journals that were published before 2013

Databases used (PRISMA tool)

How were articles appraised?

A total of 50 studies were retrieved from database searching, out of which 100 studies were included from selection by abstract and titles for the full context review. After, excluding the papers and articles based on the wrong study design, incorrect methodological quality, scarcity of data, and relevance of information, 8 papers were taken into consideration for carrying out a systematic literature review.

Critical Review of the Literature

Table 1: CASP table

Research Title, Authors (et al. if more than 2 authors) Date	Location of Study	Research Methodology	Population and Sample Size	Main Findings (approx. 100 words)	Strengths and Weaknesses of research / methodology	Implications for practice
Ford, (2022)	United Kingdom	A quantitative survey of the nursing students associated with the CoDH	Survey – 35 undergraduate nursing students fron third and forth years	Staffing issues are an important challenge related to placement accessibility by the nursing students Student attrition rate, filling of nursing courses., regulatory burden, and financial challenges are the major issues or difficulties that nursing students used to face while accessing placement in the nursing background	Strength: this research paper includes statistical data and information about the nursing job opportunities and challenges faced by nursing students in placement Weakness: this paper is lacking information about the exact challenging scenarios that nursing students face in placement.	This research article will help to explore the key challenges faced by nursing students in education in the UK
Ching et al. (2020).	Hong-kong	Qualitative research method	24 final-year undergraduate nursing students, whose ages ranged from 21 to 25, participated in ten focus groups. The HR&LBO group had 13 students (7 males and 6 females), whereas the LR&HBO group had 11 students (4 males and 7 females).	The findings indicate that although the students' perceptions of the difficulties related to their clinical placement were similar, there were differences in the coping strategies used by students with different levels of resilience and burnout. This had repercussions for both their career and their emotional health. The findings are consistent with Rees' (2016) model, which links self-efficacy, mindfulness, and preferred coping strategies to levels of student resilience and burnout. Nursing students experienced stress as they attempted to match their expectations with the demands of their clinical placement.	Strength: This is a well-focused qualitative research paper. The method of interview was undertaken through well-defined questionnaire which enable the research to meet the research objectives quite effectively Weaknesses: One of the weaknesses of the research is that the interviews were taken in focused grouped format rather than individually which sometimes affects the willingness to speak. the	The study's findings help us understand how certain coping strategies used by nursing students throughout their clinical rotation relate to stress, resilience, and burnout ratings. High-scoring students demonstrated coping mechanism 17 of self-awareness. They practised self-control, acknowledged their stressors, understood their limitations, and used ways to build resilience.
Hamadeh et al. (2021).	Australia	Mix method (Quantitative research and qualitative)	A cross-sectional descriptive technique was used during COVID-19 to collect quantitative and qualitative data about nursing students' resilience. Participants were undergraduate nursing students who were enrolled in a Melbourne metropolitan institution. Participants were invited from all three-year levels (n = 340). In the study, convenience sampling was employed.	The results of this study demonstrated that students' resilience was low during the pandemic, and they suggested that initiatives to boost resilience should be taken into account. In order to complete their nursing degrees and get ready for their future careers, students must develop greater resilience. It's critical to acknowledge the challenges nursing students face during periods of high stress and to set up the proper support to assist these students.	Strength: The study is well focused and consider both quantitative and qualitative approach which allow it to consider multiple aspects in drawing the conclusion Weaknesses: The study considers too many factors which makes it difficult to understand for the readers.	The study helps to understand the nursing students level; of resilience during the pandemic and also analyzes the factors behind that which enable in future more effective strategies for the nursing students.
Chan, Z.C et al., (2019)- Curriculum design and attrition among undergraduate nursing students: A systematic review	United States of America	Qualitative research method- thematic analysis	16 studies were included in this review	Student attrition is closely related to the policies of nursing facilities Academic failure, poor clinical performance, and stress are the factors that arise as challenges for the nursing student in placement Unsatisfactory clinical experiences, lack of academic or in-hand practice, and lack of interaction between nursing students and institutions can cause challenges for nursing students in placement.	Strength: this research article is based on Pico questionnaires and qualitative research methods helps to address the contributory factors related to the challenges that nursing students face in placement Weaknesses: this study is not applicable in every country and this study focuses solely on undergraduate nursing programs. The heterogeneity of the sample limits the generalizability of this study	This research paper can highlight attrition rate as a global issue for nursing students and possible factors of the challenges that nursing students face in placement.
Donley and Norman (2018)	United kingdom	Qualitative phenomenological inquiry	Personal interviews, and focus group discussion- 100 nursing students Thematic analysis	No hierarchy exists in general practice a need for one-on-one mentoring. Need for a response that is favorable Necessity of the student-centric teaching approach and strategies that are conducive to successful learning.	Strength: clinical learning experiences in general placement practice have been highlighted in this research paper. Here it has been mentioned that GP placement provides a high-quality learning environment and factors identified enabling the development of analytical decision-making and professional autonomy which considered as important factor for the placement of nursing students Weaknesses- this research paper is lacking of factors that contribute to the challenges faced by nursing students in placement of the United Kingdom	To get an in-depth insight into the perspective of nursing students related to their clinical learning experiences in general practice placement
Harrison-White and Owens (2018)	United Kingdom	Methodological approach (qualitative)	Focus group and one-to-one interview- 15 experienced LLs were invited to participate in the focus group discussion	The Significance of proper Mentoring in CLEs Relationships between students and mentors in nursing studies as a potentially critical challenge faced by students in Clinical learning environments	Strength: this study investigates the nurse link lecturers' perception of challenges faced by student nurses in clinical learning environments. Weakness: this study lacks statistical information about the factors that cause placement challenges for nursing student	The review and the findings of this research article can highlight the challenges faced by nursing students in CLE
Panda et al., (2021)	United Kingdom	Qualitative research method	A systematic review of electronic databases like Medline, CINAHL, Embase Ovid- 32 studies	The behaviour of the clinical staff, and instructors has a significant impact on the clinical learning of the nursing students Lack of sense of belongingness and self-motivation to learn and perceive fear of doing something error act as demotivating factors Workload and inconsistencies between theory and practices of accessing placement in the nursing field	Strength: this study investigated existing literature to highlight the challenges nurses face in placement Weakness: this study lack of direct implication of the challenges or challenging factors related to nursing students in placement	This research article can provide an in-depth understanding of the perspective of the students regarding the challenges faced by nursing students during access to placement
Addisie et al., (2020).	United Kingdom	Qualitative research method	The self-administrated questionnaire, recording of the telephonic interview of the students- logistic regression analysis carried out to identify the independent predictors and content analysis approach and ATLAS have been used to formulate meaning, extract the significant statements and categorize the coding allocated from the interview	Prevalence of challenges among nursing Religion, entrance year, and learning institution are associated with the challenges among the nursing students Lack of job opportunities, instructors' responsibilities, inadequate support structure, and communication, lack of communication and equipment related to the challenges related with difficulties of placement for the nursing students	Strength: phenomenological study method has been adopted to examine the mindset of third- and fourth-year undergraduate nursing students towards the challenges they face in placement. In this research, lack of role models, instructors' responsibilities, inadequate support structure and communication, lack of equipments are considered as major factors that create challenges for nursing students in placement Weakness: this research paper lacks statistical data and information and lack highlight on actual challenges that nursing students face in placement	The future implication of this research is to explore the challenges being experienced by nursing students during clinical placement

Thematic Analysis:

The key three themes that have emerged are:

Theme 1: The support structure

The Attitude of the clinical staff and Other- key factors:

When it comes to accessing placement opportunities in any educational field, the attitude of the staff and other significant personnel associated with that respected field can never be denied. Considering the proposed subject matter, it can be stated the students' adjustment to the clinical learning environment and their learning approach can strongly be determined by and dependent on the attitude of clinical staff (Jasemi et al., 2018). More specifically, the positive attitudes or behavioral approach of the clinical staff toward the nursing students can provide a positive impact on the overall learning process as well as the accessibility of placement. According to the article, written by Donley and Norman, (2018), in England, the general practice is continuing to enhance its use as a placement area for nursing students. In the UK, currently focus has been given to the new general practice placement process and requirements to ease the placement opportunities for nursing students and to ensure the development and managing a quality learning environment for the students (Newman and Gough, 2020). In this article, a qualitative study has been carried out to understand the perspective of the nursing students about the major factors that are affecting their clinical learning environment and practices, and negatively impacting their placement accessibility. The findings of this article suggest that the lack of student-centric GP placement opportunities, and high-quality learning environments restrict nursing students to access placement (Jamshidi et al., 2016).

According to the research paper, written by Harrison and Ownes, (2018), in the United Kingdom, nursing students spend approximately half of their educational career in practical settings which can commonly be referred to as CLE or Clinical Learning Environment. The term "clinical learning environment," or "CLE," refers to the actual healthcare facilities where nursing students do their clinical rotations. It includes the resources, support systems, and physical and social environment that promote learning, skill development, and the use of theoretical knowledge in the context of patient care (Panda et al., 2021). In this article, the focus has been given to the significance of CLE in accessing the placement and negative experiences by the nursing students to indicate the challenging scenario related to the learning and placement accessing opportunities by the students across the country. As per this proposed review paper of Günay and K?l?nç, (2018), the nursing students in the chosen country used to spend up to 20% of their educational time with the Lecturers, whose major responsibility is to provide teaching time support to the student nurses in CLE. Link Lecturers' proximity in CLE refers that they are well-versed in the articulation of the potential and possible challenges that student nurses might face in the context of accessing placement (Günay and K?l?nç, 2018). According to this review papers, lack of synchronization between the universities and new standards of placement programs, lack of transparency in the process of validation, and several other factors used to create difficulties for the nurses to access placement. The majority of the time, the negative influence or negative motivation by the Link Lecturers can cause difficulties for the student nurses to find placement opportunities in a respected field of interest (Chan et al., 2013). The importance of mentors in CLEs can be unequivocally characterized by the level of ability of the students to find opportunities for learning and accessing placement in the challenging clinical environment.

Nursing students and placement challenges

There are several papers, articles have been taken into consideration to derive the impact of clinical instructors and their attitudes and attributes towards the difficulties related to placement accessibilities by student nurses (Tyrer, 2023). Some of the reports mentioned this as a motivating factor, and other research articles described how negatively it can impact on the learning process of the student nurses and in turn, can create difficulties related to placement accessibilities for the respective population. According to the article by (Raghavan et al., 2023), the attitude and attributes of clinicians, or mentors within CLE are important in terms of facilitating learning opportunities, supervising, and assessing the student's abilities in practice settings. A proper and positive attitude and attributes by the mentors and Clinical supervisors at CLE can motivate and expand the placement scope and opportunities for the student nurses and it also expands the scope for qualified nurses to undertake the role along with additional clinical responsibilities. In this article, negative behavioral approaches and attributes by the mentors have been represented as the negative factor to create difficulties for the student nurses in terms of accessing placement opportunities. In 2015, Royal College of Nursing published a report on the importance of good mentorship in terms of enabling the transference of knowledge and placement Scope, while fostering the learning culture within the Clinical Learning Environment (Mamaghani et al., 2018).

Sense of Belongingness- discrimination and disrespect:

According to the article Arkan et al., (2018), being actively involved in clinical practice can provide students with a feeling of being part of a team and being accepted by a team. On the other hand, another article, written by Baraz et al., (2015), argued that sometimes this sense of belongingness can restrict student nurses to access placement or job opportunities. According to the article, negative working environment, discrimination, and disrespect at workplace setup, specifically, when it comes to providing health care and support to people with specific needs can come up as potential difficulties for nursing students to access placement. According to Arkan et al., (2018), a lack of sense of belongingness can be considered as one of the major demotivating factors in the Clinical Learning Environment. Being the feeling of “singled out” and lack of positive communication between job seekers and the universities and job providers in the healthcare sector, being treated as outsiders along with a lack of support structure in CLE as well as in the healthcare sector in the UK can be considered as one of the major building blocks for the nursing students to access placement opportunities in their field of interest across the UK and other countries (Mamaghani et al., 2018). In nursing educational environemnt, most of the student nurses, specifically the new first-year students found these experiences a bit challenging and scary to cope with the learning process, which in turn restricted them from finding or accessing suitable placement scope or opportunities. The student nurses used to express this scenario through the feeling of being demotivated as well as discouraged in the CLE and they gradually lose their self-identity. According to the article written by Addisie et al., (2020), improper treatment, inadequate knowledge skills, and support structure in the current healthcare sector, discrimination and disrespect, and lack of communication skills with new joiner can lead the student nurses towards the onset of stress and anxiety, and inferiority complexes. According to this article, in the majority of the cases, the student nurses, who join to any healthcare setup as interns, used to have rounds with the senior doctors and nurses. In an interview, some interns mentioned that when the senior professionals found us as nursing students and doing intern at the respective healthcare organization, they used to give their reasons for not coordinating or collaborating with them and this can be considered as a practice of discrimination (Tyrer, K., 2023). Such a scenario is another reason or potential difficulty that nursing students used to face while finding or accessing placement scope. According to the proposed article, in current times, the degree of discrimination between nursing students and students coming from another medical science backdrop in healthcare setups is 80.2% - a recent survey mentioned that the majority of the nursing students in the UK and across the world used to raise a complaint against the practice of discrimination between the student nurses and other clinical staff and nurses at workplace set up (Buchan et al., 2019). According to the qualitative studies carried out by Donley and Norman (2018), and according to many students nurses, and participants in medical surveys, have mentioned that “they used to feel discriminated when they are not being allowed to take part in patient rounds with other healthcare professionals or nurses and even with the student of medicine”. This proposed qualitative study result also showcase that, 9.3% of the respondent who is an active participant in the survey program used to face discrimination between them and the students who come from medical science backdrop (Dashtipour et al., 2021). The comparison between the nursing students and the students from medical backgrounds and medicine can be considered as one of the foremost challenging scenarios that cause difficulties for the student nurses to access placement, as this can violate the dignity of the nursing students and give them an inferior sense of professionalism.

Theme 2: Personal Factors

A facilitator of learning in the CLE was feeling motivated to learn. According to the research paper (Cleary-Holdforth and Leufer, 2020), obstacles in the CLE were cited as a lack of readiness, motivation, and confidence. Many individual elements were cited as making the learning process difficult. In this setting, three subthemes were formed (Dashtipour et al., 2021).

Lack of motivation to learn- the key factor related to the difficulties related with accessing placement by the student nurses:

Through an in-depth analysis of the chosen articles, research papers, and journals, it can be evident that there are multiple reasons for why students lack in their motivation and interest in learning nursing in the Clinical Learning Environment. Lack of support from the clinical instructors and educators, clinical staff, peers, and perceptions, and lack of respect at the workplace set up as interns contribute to the lack of enthusiasm to learn or continue with this career in the CLE (Rezakhani Moghaddam et al., 2020). According to the article, by Panda et al., (2021), the behaviour of the clinical staff, and instructors always had a significant impact on the clinical learning of the student nurses. According to this review or journal, “The behaviour of the staff with the students from nursing backdrop is used to be unfair and thus they have lost the motivation and do not like to take any placement in this respective field or to learn further”.

According to the article, written by Ford, (2022), across the UK, and within nursing education, almost in 84% of the cases, placement accessibility issues become very visible. According to the article by Rezakhani Moghaddam et al., (2020) inadequate organisational atmosphere, and lack of educational structure in CLE can cause insufficient work commitment which in turn can trigger the motivation to access placement or learn further by the student nurses in this field of interest. More specifically, as per this article, the repetitive and boring work environment, and continuous discrimination between the student of nursing and medicine can limit the literacy rate among the nurses and lower their work ethics among them. On the other hand, as per many research papers and article, inadequate resources can cause low staffing in the nursing backdrop, which limit the training facilities for student nurses. On the other hand, low staffing can come up as one of the difficulties that nursing students face while accessing placement. According to the article, Addisie et al., (2020), the challenging characteristics that nursing students face in clinical settings as well as in placement scenarios. In this article, lack of proper communication between the student and instructors has been represented as one of the significant challenges for which students in respective fields used to lose their motivation and find difficulties while accessing placement. This article also highlights the mismatch between the job of staff Nurses and scientific principles, which can be represented as another difficulty that nursing students may face while accessing placement (Levett-Jones et al., 2015). Studying and thorough analysis of many studies and existing literature reviews, like (Hughes and Byrom, 2019) the independence and willingness among nursing students to learn at the time of real-time practice sessions have been revealed as one of the important aspects for nursing students to reach optimum learning benefits. “Some students said that the nursing students used to come to the clinical practice settings with several negative perspectives regarding the staff behaviour, and opportunities to excel in a career in healthcare setup. These scenarios do not motivate them to be engaged in clinical responsibilities”. (Addisie et al., (2020).

In the review paper by Fagan et al., (2021), the lack of role models and lack of support and guidance is being represented as the key factors of personal issues or lack of motivation, for which nursing students face difficulties while accessing a place in the field of interest in the UK and across the world.

Gender-cultural perspective:

The nursing profession is always considered as one of the filed where the dominance of the female staff is high. This was described by the male student nurses as a demotivating factor and difficulties to access placement in this field. Additionally, this factor also affects the learning practice in Clinical Learning Environment, negatively. According to the article, by Buthelezi et al., (2015), “Towards the male nursing student, it can be stated thatall of these issues arise because you will soon enter a field that is predominately female (a profession), and no one even informed us, male students, that this field is also predominately female”. Though some of the articles and literature reviews argued with the fact that “being male nursing students can be a positive aspect in several ways, specifically when it comes to access placement”. For example, as per the article, written by Chan et al., (2013), “ the ward staff sometimes seem to be happy to see male classmate. Gender diversification in healthcare setup can improve the atmosphere and working environment within the ward”. Though, this article also mentions that “male nursing students used to experience various risks and stress in the clinical placement process, due to the gender inequalities”. In this article, the highlight has been given on the link between the cultural difference and the problem along with the difficulties that male nurses might experience while offering care and treatment to the female patients. Additionally, throughout the placement process, male nursing students might go through negative emotions due to stereotyping. According to a survey, some of the male nursing students agreed with the fact that isolation that they might experience in a clinical setting can become a reason to quit the nursing program (Raghavan et al., 2023). Therefore, for male nursing students, the gender discrimination, and stereotyping scenario can come up as major difficulties while accessing placement. According to a study conducted in the UK, male student nurses experiences various source of stress in NHS and other healthcare organisations, during maternal care and clinical practice (Morrison et al., 2023).

Theme 3- Planning and organization: influence of Extrinsic factors

Lack of resources to facilitate the need-based training:

Lack of resources and required facilities, and accessibility to the physical resources are being reported in chosen literature reviews like (Hughes and Byrom, 2019) as one of the key factors in the Clinical Learning Environment which restrict the learning process and placement accessibility of nursing students. According to the article, by Donley and Norman (2018), “most of the time the nursing students used to get allocation in government hospitals. In government hospitals like NHS, sometimes, materials and resources are not enough or the nursing students used to get restrictions about accessing the facilities, which in turn negatively impact their learning process as well as career growth”.

According to the article, by Ford, (2022), student attrition, and financial challenges in the NHS can be considered as the major factors that cause difficulties for nursing students to access placement in their field of interest.

Workload and placement scope:

The chosen studies of Mamaghani et al., (2018) reported that the high degree of activity in the CLE, being busy and stressed among the clinical staff, both by physically and mentally can be considered as the demotivating factor in the learning process. According to the article, by Levett-Jones et al., (2015), “This is a concerning scenario that nursing students used to almost everything to do with the clinical placement. The long hours and the stressful working scenario can be considered as the worrying aspect that the students of nursing do not know how to cope with”. According to this article (Newman and Gough, 2020), “the clinical placement is one of the central and/or focal points to the nursing education and specifically designed to facilitate the learning opportunities”. According to this review article (Panda et al., 2021) and several other articles, nursing students frequently experience a high level of stress and anxiety at the first clinical placement. And this can negatively impact of their performance and professional growth in the workplace setup. In many review papers and articles, the highlight has been given on multiple sources of anxiety, stress, and distress for nursing students in their first placement program (Thomas et al., 2023). For example, in many articles, lack of clarity at the time of first placement, misconception about the roles and responsibilities of the nursing students, and feeling of unwelcome and unwanted in comparison to the student from the background of medicine and other medical background in the clinical environment have been represented as the major difficulties or challenging issues that nursing students may face while accessing placement. According to the research article (), lack of instructors' responsibilities in an educational environment, inadequate support structure and communication, lack of equipment, and college responsibilities are the major factors that restrict the provision of proper facilities for nursing students to get in-hand support at clinical settings. This in turn can create challenges for nursing students in placement.

Summary

This systematic literature review has offered multiple of relevant evidence that can be related to the challenges faced by the nursing students in the Clinical Learning environment and at the time of placement accessibilities. Considering the in-depth analysis of the literature reviews and articles, it can be stated that the lack of support structure in the Clinical Learning Environment, and difficulties to cope with the attributes and attitudes of the clinical instructors and nurses are the key challenges that nursing students may face while accessing placement. On the other hand, discrimination between the students of nursing background and background of medicine, discrimination between the male and female nursing students at workplace setup, lack of motivation to carry out with nursing studies, and resources to excel in career growth by the nursing students in clinical practices- these are the major difficulties being discussed within three key themes as the major challenges that nursing students may face while accessing placement.

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Conclusion

In chapter 3, some important themes are taken into consideration when analyzing the topic. The research had three major objectives, such as addressing the challenging scenario in the backdrop of nursing of the NHS, UK; the evaluation of the potential challenges and the contributing factors related to potential difficulties being faced by the nursing students. From the critical literature review, the evaluation of these objectives is done to fulfil them in the study.

The purpose of Objective 1 in this review was to identify the current challenges that nursing student face regarding placement in NHS, UK. According to the thematic analysis, it can ve concluded that In the nursing context of the NHS in the UK, difficult situations with relation to placements are well-documented. The lack of experienced employees to oversee and direct nursing students during placements is a recurrent problem for the NHS. According to a Health Foundation analysis from 2021, certain NHS trusts still have nearly 40% of nurse positions open. As a result, this puts pressure on the clinical learning environment, restricting students' access to a variety of learning opportunities and reducing their chances to acquire crucial competencies. These difficulties may affect how well-equipped future nurses are to manage complicated healthcare requirements and effectively contribute to patient care. They may also lower the quality of nursing education. In relation to objective 2, it can be stated that Nursing students in the UK faced a variety of difficulties during the academic year 2020–21. Hospitals prioritised addressing the COVID-19 epidemic, which curtailed clinical chances and limited students' exposure to a range of cases. To protect student safety, access to some specialty or high-risk areas was prohibited. Additionally, the demand on healthcare systems reduced the number of preceptors available, which had an effect on the standard of supervision and mentoring. For nursing students, other sources of stress and uncertainty included disruptions to practical learning experiences and ambiguity over placement plans. Despite these difficulties, students showed resiliency, flexibility, and dedication to their nursing education in a healthcare environment that was continuously changing. Considering the 3rd objective of this review and analysis of the secondary resources, it can be concluded that there are several contributory factors that lead to potential challenges for nursing students during placement in the UK. First, there may be rivalry for a limited number of slots due to the demand for particular specialisations exceeding the supply of placement chances. Second, there may be geographical inequities where jobs are concentrated in some places, making it difficult for students from other areas to reach their chosen settings. Additionally, the ability to accommodate students may be constrained by personnel shortages in healthcare institutions. Additionally, pandemic-related disruptions, financial limitations, and logistical challenges may make placements harder to come by. In order to maximise placement chances and provide a comprehensive nursing education, it is necessary for educational institutions and healthcare providers to work together to address these problems.

In this review, total of 50 studies are retrieved from the database searching. The studies are divided into three themes: the support structure, personal factors, and planning and organization where influence of extrinsic theme is created. The papers discuss the inconsistencies between theory and practices of accessing placement in the nursing field. The self-motivation. With thematic analysis, it became easier to research the articles and reach a point. The key themes that are adopted from this study are the support structure, personal factors, and planning and organization as the influence of extrinsic factors. It is found out that the lack of support or supportive structure in the Clinical learning environment or CLE is one of the key challenging factors being reported in five research articles and review papers. On the other hand, the attitude of the staff and other significant personnel associated with that respected field can never be denied. So it can be said that the objectives are fulfilled and the aim is achieved.

limitations

There are some limitations in the evaluation that are as follows:

• The limitation of the current review is the lack of information about the statistical data and information with which an indication about the actual challenges with placement among the nursing student in the UK can be acquired. More research could have been conducted in negative behavioral approaches in the nursing sector.
• It is important to take part in collaborative studying which is not done in this case. There is also need of more keywords based search not limiting to only the UK and healthcare organisation but to cover other institutions as well.
• Lack of time can also be considered as another limitation which restrict to search more reliable data and information about the challenges that nursing students currently facing at the time of placement

Complications and recommendations for future practice

In the future, improper treatment, discrimination and disrespect, and lack of communication skills should be avoided in the nursing sector to motivate the nurses to grow ethically and professionally. In future practice, it is necessary to develop courses that focus on such points. In Clinical Learning Environment, most of the nurses, specifically the new first-year students found placement a bit challenging and scary and failed to cope up in a discriminative society, which in turn restricted them from finding or accessing suitable placement scope or opportunities (Buchan et al., 2019). This should be avoided without fail in the future so that nurses get right opportunities and treated equally in the UK (Dashtipour et al., 2021). In all the hospitals and health institutions, nurses are supposed to get equal treatments. The factors that give rise to discrimination and lack of opportunities should be removed from the recruitment policies as well (Baraz et al., 2015). It is found out that negative working environment, discrimination, and disrespect at workplace setup are major issues which should be removed from the hospitals like NHS. Big organizations should come together to support the recruitment based on merit only. As the thematic analysis proved to be useful in finding the challenges, it is necessary to continue building more themes to support the research in this topic.

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