title: Establishing and maintaining the clinical learning environment for nursing students: a qualitative study.
abstract: BACKGROUND
  Experience in the clinical setting is viewed as a crucial aspect of nursing education. Evidence suggests that students experience acceptance to alienation on the clinical unit. Little is known about preceptor beliefs underlying their approach with students, and the perspective of unit management is absent.
  
  
  OBJECTIVE
  To provide a description of the beliefs and processes that emerge at the unit level regarding the clinical learning environment for nursing students.
  
  
  METHODS
  Multiple case study design.
  
  
  METHODS
  Four units from across an urban university health center who have a demonstrated ability to accept students.
  
  
  METHODS
  A purposive sample of four nurse managers, four assistant nurse managers, three advanced practice nurses, and six staff nurses with recent and recurrent precepting experience were recruited from across four units.
  
  
  METHODS
  Semi-structured focus group interviews were conducted with all participants from each unit. Content analysis was used to identify major themes and categories in the interview data.
  
  
  RESULTS
  Two overarching themes were revealed: (1) Influencing factors included cultural factors and contextual factors that either inform units' beliefs about the ideal learning environment, or affect their ability to provide it. (2) Willingness refers to a willingness to invest in students and the forms that investment takes. It includes openness, taking them under wing, and structuring to meet goals. The influencing factors provide the foundation upon which the unit's work to accommodate students is built.
  
  
  CONCLUSIONS
  The degree to which a unit is able to manage the contextual factors determines how well they can shape the students' environment. The sturdiness of their culture with regard to hosting students determines the pervasiveness of their approach by staff on the unit.
authors.affiliation: Ingram School of Nursing, McGill University, Room 204, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7, Canada. Electronic address: michael.hegenbarth@mail.mcgill.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Hegenbarth
authors.affiliation: Ingram School of Nursing, McGill University, Room 204, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7, Canada. Electronic address: svea.rawe@mail.mcgill.ca.
authors.forename: Svea
authors.initials: S
authors.lastname: Rawe
authors.affiliation: Clinical and Professional Staff Development, McGill University Health Centre, 1650 Avenue Cedar, Suite D6-179.4, Montreal, Quebec H3G 1A4, Canada. Electronic address: louise.murray@muhc.mcgill.ca.
authors.forename: Louise
authors.initials: L
authors.lastname: Murray
authors.affiliation: Ingram School of Nursing, McGill University, Room 204, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7, Canada. Electronic address: antonia.arnaert@mcgill.ca.
authors.forename: Antonia
authors.initials: A
authors.lastname: Arnaert
authors.affiliation: Clinical and Professional Staff Development, McGill University Health Centre, 1650 Avenue Cedar, Suite D6-179.4, Montreal, Quebec H3G 1A4, Canada.
authors.forename: Jane
authors.initials: J
authors.lastname: Chambers-Evans
mesh_terms: D001291:Attitude of Health Personnel; D004508:Education, Nursing, Baccalaureate; D006801:Humans; D009718:Nurse Administrators; D015402:Nursing Education Research; D015279:Organizational Culture; D011231:Preceptorship; D036301:Qualitative Research; D013338:Students, Nursing
keywords: Education; Learning environment; Organizational culture; Pedagogy; Preceptorship