Modifiable Clinical Setting Factors Contributing to Belongingness in Undergraduate Nursing Students in the Clinical Learning Environment

Abstract

Background: Exacerbated by the impact of the COVID-19 pandemic, the current global nursing shortage continues to grow and the need for competent new graduate nurses is greater than ever. Clinical placements are recognized as a critical component in nursing students’ preparation to enter professional practice. Nursing schools are tasked by accrediting agencies to ensure these experiences are robust, safe, and supportive for students. Encompassing feelings of acceptance, connection, and value alignment, the concept of belongingness has been linked to positive personal and educational outcomes in undergraduate nursing students in the clinical learning environment. These include increased learning, participation, confidence, and professional socialization as well as decreased anxiety and increased satisfaction with clinical experiences. A gap in the literature has been identified surrounding evidence-based interventions to foster these important feelings of belongingness in undergraduate nursing students in the clinical learning environment.

Methods: Three studies were completed. First, a scoping review synthesized evidence from 47 articles related to undergraduate nursing students’ feelings and experiences with belongingness in the clinical learning environment. Second, a pilot study was undertaken at a nursing school in the southern United States to adapt the Belongingness Scale – Clinical Placement Experience tool for use with nursing students in the U.S. Third, a national study was performed in which the U.S. version of the Belongingness-Scale – Clinical Placement Experience was paired with items assessing demographics, program/clinical structure, and students’ experiences with and perceived value of modifiable clinical setting factors in four categories (clinical format factors, clinical site factors, relationship and interpersonal factors, and miscellaneous factors) derived from the literature as potentially increasing feelings of belongingness.

Results: The scoping review identified key areas related to belongingness in undergraduate nursing students in the clinical learning environment to include educational and personal outcomes of belongingness and alienation, contributing factors to belongingness, interventions to foster belongingness, and measurement of the concept. The pilot study established a psychometrically sound 25-item scale, the U.S. Version of the Belongingness Scale – Clinical Placement Experience, to effectively measure belongingness in U.S. undergraduate nursing students. The third study identified 1 program/clinical structure factor and 10 modifiable clinical setting factors that significantly impact belongingness, five of which potentially predict these feelings.

Conclusion: This research underscores the importance of fostering belongingness in nursing education programs to ensure students meet learning outcomes while having positive experiences in the clinical learning environment. Together, this body of work provides a foundation for nursing educators to understand, measure, and develop interventions that foster belongingness in U.S. undergraduate nursing students in the clinical learning environment. This work is of critical importance for nursing programs, pedagogy experts, and clinical agencies as efforts are made to increase the nursing workforce with skilled, professional new graduate nurses.