On the first day of my nursing consolidation placement, I introduced myself to the nurse who would be supervising me.
“I have a student?” she asked.
I assumed it was simple miscommunication. In hospitals and large institutional settings, student placements are structured far in advance – onboarding packages are sent out, supervisors are notified, backup systems exist.
This is the process nursing students get introduced to early, while still in group placements. I trusted that a similar structure must be in place in my placement, because what would it be otherwise?
The nurse assigned to me was new to the clinic – not new to nursing practice but newly hired in that setting. What I did not know at the time was that she was still under probationary conditions and retained the right to resign without notice.
On my third day of placement – she did. What I wasn’t aware of, at the time, was that there was no other staff member qualified to supervise my practice. No second nurse on staff. No backup plan. My placement ended in a single email, letting me know not to come in the next day.
In many health-care environments, such as small private practice clinics, one nurse on staff may be enough. That reality is not the issue. The issue is when such environments qualify as placement sites, without needed structural clarity.
After my preceptor’s resignation, there was no other Registered Practical Nurse (RPN) or Registered Nurse (RN) on staff authorized to supervise me. Fortunately, this happened early in the semester. Had this occurred midway through the term, I may not have graduated on time – despite being an A student who followed every rule and guideline. I had already received university acceptances for the fall – a delayed graduation would have forced me to defer those offers. In that moment, my academic future felt uncertain and my education at risk. There was nothing I could do except escalate the issue to school faculty, placement officers and coordinators and “be patient.” Students are evaluated on professionalism, reliability and accountability. But in this case, I had no control over what disrupted the placement.
Ontario nursing schools operate within frameworks outlined by the College of Nurses of Ontario (CNO). Educational institutions enter in affiliation agreements with clinical sites, such as hospitals, long-term care facilities, rehabilitation facilities and specialized practices, to give their students hands-on experience within the profession.
Before a nursing student proceeds to preceptorship-based training, they participate in various placement settings in groups, with direct supervision of clinical instructors. In their consolidation, nursing students are trained one-on-one, following the preceptor’s schedule and responsibilities.
My current preceptor, an RPN with more than two years of experience, and other experienced preceptors at my current placement explained that eligibility for preceptorship is a formal arrangement. It requires the completion of training, signed agreements and ongoing internal evaluation processes. These include competency and institutional audits to ensure that preceptors are both clinically capable and reliable in supporting student learning.
“(the organization) doesn’t let just anyone be a preceptor” – she said – “you have to prove that you are competent, reliable and capable to even be considered.”
However; these audits are internal processes focused on finding workers within the institution who are eligible for preceptorship. In university/college-affiliated institutions, such processes are directed by dedicated education departments that have the internal structure needed to provide students with the best possible education.
Smaller and more specialized clinical settings, however, may not have the capacity to maintain a dedicated education department – though this is not necessarily an issue as long as comparable educational standards can be enforced. However, a gap occurs when all placement sites are trusted to carry out these processes internally, without further clarification of educational structures in place at individual organizations.
The question is not whether small clinics provide valuable learning experience – they do. The question is what additional guidelines can be enforced to support organizations that lack the resources for formal educational operations while ensuring that students continue to benefit from the unique learning experiences placements have to offer.
Examples of such guidelines should include:
- Documented consent from the preceptor to supervise a student.
This would ensure that:
- The assigned nurse understands the responsibilities that come with hosting a student, including reliability and sufficient working hours
- Student practice boundaries are made clear, limiting opportunities for miscommunication
- The preceptor is protected from workload increase while supervising a student.
- At least two employees qualified for preceptorship on site.
Any clinical site hosting students should demonstrate that:
- A minimum of two qualified nurses are employed
- Both are in good standing with the CNO
- Both are willing to supervise a student.
This way if the initial preceptor resigns, the student’s education is protected.
- Written Contingency Plan.
Clinical sites willing to host students should be required to demonstrate a contingency plan outlining:
- What happens if the primary preceptor resigns or is unable to continue to supervise because of unforeseen circumstances
- Who assumes supervisory responsibility
- How continuity of education and evaluation is maintained.
Unlike large organizations, where multiple nurses across units provide flexibility, smaller clinics often operate with a limited number of staff, making them more vulnerable to sudden changes in availability. Thus, verification of placement eligibility should be conducted on a term-by-term basis.
When my preceptor left, the clinic no longer had the capacity to host a student. This situation highlights how quickly placement availability can change and underscores the importance of ensuring sufficient structural stability within clinical sites.
I was fortunate. My program and faculty were able to intervene early enough to protect my graduation timeline by reassigning me to the only other available placement spot. But I left the experience shaken: Should my ability to graduate on time really depend on whether one person stays employed?
Clinical education is a regulated and mandatory component of professional entry-to-practice. Strengthening placement guidelines could help anticipate shifts in placement availability by promoting clearer expectations and safeguards.
Such measures would support all parties: placement sites by providing them with structural support; educational institutions by reducing risk of placement disruptions; and students by helping maintain continuity, clarity and a more reliable learning environment, all while reinforcing the principle that education – like patient care – should never rest on a single point of failure.
