Clinical Faculty-Student Ratio Survey

Georgia Nursing, Feb-Apr 2004

The Commission on Nursing Practice (CNP) of the Georgia Nurses Association (GNA) surveyed the participants at the October 2003 GNA Convention to ascertain their perceptions about whether a safety issue exists with the current Clinical Faculty-Student Ratio in their practice environments. The question was originally raised by a member of the CNP and other nurses subsequently voiced the same concern to the CNP members. However, the nursing literature is essentially absent of articles that directly address the ratio. Even so, the problem of stress related to clinical supervision has been addressed (Oermann (1998).

Purpose

The purpose of the survey was two-fold: To determine if the survey participants consider the current Clinical Faculty-Student Ratio to be a safety issue and to gather data about the actual ratios in place at the health care institutions represented by the participants.

Methods

A one-page questionnaire was developed by the CNP members and distributed by GNA staff at the 2003 GNA Convention. The questions are represented in Table 1.

Findings

Item No. 1: Are you a Department/School of Nursing faculty member with clinical supervision responsibilities. If yes, which category of students do you supervise? How many students do you supervise in the clinical area(s)?

Of the 66 participants, 39 (59%) reported they were not in faculty positions, 26 (39%) were clinical faculty, and one participant offered no response. The faculty members supervise three levels of students (multiple respondents reported they supervise two different levels of students): baccalaureate (N=19), associate degree (N=10), RN-BSN (N=3), and practical nursing (N=1). The participants supervise from 2 - 10 students but primarily 7 - 10 students. A wide range of clinical areas were represented including adult health, primary care, and maternity nursing.

Item No. 2; Do you consider a Faculty-Student ratio of 1:10 a patient safety issue?

Greater than half (N=33, 60%) of the participants who responded to the question indicated there is a patient safety issue associated with the current Clinical Faculty-Student Ratio of 1:10 Sixteen participants chose not to answer the question.

Item No. 3; What is the ideal Faculty-Student ratio?

The ideal Faculty-Student Ratio identified by the participants ranged from 1:2-3 to 1:10 with 1:6 (N=20) being the most common response. Comments that the clinical area of supervision should serve as a guide to the ratio were noted.

Item. No. 4: What strategies do you use to manage up to 10 students in the clinical area?

The participants reported a variety of strategies used to manage students including the following:

1. Students work one-on-one with a staff member.

2. Assign students to clients with a variety of activity levels.

3. Assign students to units with a low nurse-client ratio.

4. Assign students to observational experiences.

5. Team assignments: assign two students to the same client.

6. Ensure students are prepared ahead of time.

Item No. 5: Are you a staff nurse/unit director in a hospital or other facility? If yes, how many students are allowed on your unit at one time? If fewer than 10, how/why was that decision made?

Eighteen of 50 participants indicated they are staff nurse/unit directors in a hospital or other facility. The number of students allowed on their units ranged from "one" to "no set limit" but "2" and "10" were the most frequent responses. In response to the question of how the decision was made to allow fewer than 10 students on their units, participants noted the acuity of patients, availability of staff, and the unit size as the criteria for determination.

Item No. 6: Please write additional comments/suggestions.

The participants made several suggestions and comments including the representative sample below.

Suggestions

1. Would like to see the Georgia Board of Nursing change the maximum ratio to no greater than 1:8.

2. Assign faculty to their areas of expertise.

Comments

1. Faculty need to stay clinically competent.

2. Staff nurses are assigned to the same patients multiple days. Faculty with 10 students have to interface with [at least] 10 patients and family. This is unacceptable.

3. Ratio depends on level of student and area.

4. Nurse faculty put their license and reputation on the line every day.

5. I have worked with faculty for many years. The 1:10 ratio is unsafe.

6. With complexity of care, I believe the 1:10 ratio is unsafe.

7. Many hospitals will not allow 10 students on a unit.

8. Ratio of 1: 5-7 faculty to students more practical and effective.

Discussion and Conclusions

The survey findings indicate there is a concern among the participants about patient safety relative to the current maximum Clinical Faculty-Student Ratio of 1:10. Those concerns were expressed in view of the complexity of client health problems and nurse staffing. Some health care institutions were reported to handle the Clinical Faculty-Student ratio by limiting the number of students allowed on their units.

The limitations of a low return rate, small sample size, and a previously untested questionnaire must be considered. Additional data will be sought in the future via the GNA website and/or Georgia Nursing. In the meantime, the Commission on Nursing Practice asks that nurses who want to voice their opinions on this issue please contact GNA at gna@georgianurses.org with their comments.