Number of students in clinical placement and the quality of the clinical learning environment: A cross-sectional study of nursing and midwifery students

Background: Clinical placement is an important component of nursing and midwifery education. It exposes students to the real-world healthcare environment, where theoretical knowledge is put into practice. However, the quality of the clinical learning environment in sub-Sahara Africa has not been well explored. Objective: The objectives of this study were to assess trainees' perceptions of the number of students on the ward or clinical unit, and the quality of the clinical learning environment. Design: Cross-sectional survey. Setting: Nursing and midwifery students were recruited from three public hospitals in the Upper East Region, Ghana, between July and August 2019. Participants: 254 nursing and midwifery students were recruited using the convenience sampling technique. Methods: Data were collected with the Clinical Learning Environment and Supervision + Nurse Teacher questionnaire. Data were analysed using univariate, bivariate and multivariable analyses. Results: It was found that the participants rated supervisory relationship; pedagogical atmosphere; role of nurse teacher; leadership style of ward managers; and premises of care on the ward as average. Students' perceptions of the quality of the clinical learning environment were predicted by supervisory relationship (β = 0.219, 95% CI: 0.016-0.070), leadership style (β = 0.199, 95% CI: 0.011-0.133) and perception of number of students in clinical placement (β = 0.224, 95%CI: 0.022-0.093). The trainees indicated that the number of students on the ward did not correspond with the amount of medical equipment and supervisors. Conclusion: The quality of the clinical learning environment was perceived to be suboptimal. Leadership style, supervisory relationship and perception of the number of students on the ward were the salient factors that influenced students' perceptions of the quality of the clinical learning environment. Leaders of nursing and midwifery training institutions must liaise with stakeholders to enhance the quality of the clinical learning environment.