The characteristics of an effective clinical instructor from the perspective of nursing students: a qualitative descriptive study in Iran

Clinical education is the heart of nursing education [1] and the costliest part of the nursing curriculum [2]. Clinical education is a part of health care education which is provided to students by experienced clinical instructors in educational and medical centres such as hospitals and outpatient clinics [3]. Evidence suggests that clinical instructors are the most important factor in achieving clinical outcomes [4, 5]. An instructor can compensate for the lack of textbooks and educational facilities, or turn the best learning environment and subject into a passive environment through their inability to make the desired emotional connection [4‐6].

Effective clinical instructors demonstrate commitment, internal motivation, problem solving skills, flexibility and creativity, time management, leadership and management, accessibility, lifelong learning, morality, and up-to-date knowledge and skills [7]. Research suggests that the clinical instructors’ characteristics such as teaching ability, behaviour, and character affect students’ learning [4, 5, 8]. Today, the use of effective clinical instructors has become a major concern for the academic education systems [4, 9].

One method used by universities to define an effective clinical instructor is to ask students for their perspective [10]. Understanding the student perspective can have a positive effect on learning in clinical settings [11, 12].

However, there are few studies reported in the literature that have examined the characteristics of an effective clinical instructor from the student perspective. These studies note good communication and teaching skills are important [5, 13, 14]. In addition, excellent literacy, enthusiasm for education, clinical competence, and non-judgmental disposition have been noted as important characteristics of a good clinical instructor [7, 15]. The purpose of this study was to understand the student perspective about the characteristics defining an effective clinical instructor.

Data saturation was achieved at the conclusion of twelve interviews with nursing students between the ages of 23 and 36 years old, seven of whom were female. Six of them were undergraduate and the other six were postgraduate students (Table 1). Emerging from the data were 780 codes, organized into nine subcategories and then consolidated into two categories. The major categories included “specific characteristics” and “general characteristics” and subcategories included “internal motivation”, “professional acceptability”, “clinical competency”, “teaching skill”, “clinical experience”, “values”, “being a faculty member”, “appropriate appearance”, and “communication skills” (Table 2).

The purpose of this study was to understand the perspectives of nursing students about the characteristics of an effective clinical instructor. The results indicated the characteristics of clinical instructors influenced the perspectives of the students regarding the effectiveness of their teaching. Students believed internal motivation was one of the special characteristics of an effective clinical instructor. Studies in line with the present study have also reported internal motivation as an important characteristic of a clinical instructor [14, 20]. Other researchers have reported that a good clinical instructor is willing to teach, makes the clinical learning enjoyable, is able to motivate students and get them involved in learning, provides learning opportunities for students, and makes the clinical environment attractive [14, 15, 21, 22]. Unfortunately, there is a false belief that every educated person and expert is an instructor, while such a claim is not always true, and many experts are not good instructors [20]. These factors necessitate the significance of employing motivated instructors for clinical education to support students in achievement of academic objectives.

Communication skills were considered an important behavioural characteristic of an instructor. Studies have also reported communication skills as an essential feature of a clinical instructor [4, 8, 13, 15, 20, 23, 24]. Evidence shows that teachers with good communication skills make the clinical environment attractive for the students and enhance their motivation for learning [20, 22, 25]. Teachers with good communications skills can manage the possible clinical conflicts and prevent the effect of these conflicts on the students’ learning process [20]. Appropriate teacher-student communication reinforces the students’ stress coping skills and facilitates learning [22]. Proper communication is necessary for learning and teaching, and instructors can bring about positive academic and behavioural changes in students by establishing a good communication with students.

Being a faculty member was another characteristic of clinical instructors. To achieve clinical education objectives, it is necessary to employ faculty members [10]. A nursing faculty member is someone who helps students to achieve clinical competence via various strategies. In some clinical wards, the clinical nurses are sometimes used as instructor due to the shortage of competent faculty members. The faculty members have a special position in the education system and can professionally teach the students owing to having characteristics such as interpersonal skills and academic and clinical competencies [21, 26]. To achieve the clinical education objectives, every university should have adequate faculty members and set short-term and long-term goals to hire the required faculty members.

Professional acceptability was another characteristic of a clinical instructor. Various factors are associated with the acceptability of a clinical instructor, the most important of which are a good sense of humour, good professional communication with the personnel and patients, criticizability, and honesty [20, 27, 28]. Teachers with adequate clinical acceptability can finely manage the possible clinical conflicts and facilitate the students’ learning [20]. A teacher’s clinical acceptability can make the clinical learning experiences enjoyable for the students and provide them with maximum advantage of the clinical possibilities for learning.

Consistent with previous research [20, 24, 29, 30], clinical competence is another significant characteristic of an effective clinical instructor. There is no consensus over the characteristics of instructors with clinical competence; however, characteristics such as ethical codes, updated theoretical and clinical knowledge, effective communication with students, and managerial capabilities have been proposed as important factors in this regard [9]. Inadequate clinical competence of an instructor reduces the students’ trust and disrupts student-teacher communication [25]. Considering the significance of clinical education, clinical instructors should be aware of their professional responsibility, make their attempt to enhance their theoretical and clinical knowledge, and consider the principles of professional ethics. Furthermore, they can gain more knowledge by working with their more experienced colleagues.

Teaching skills was found to be another clinical characteristic of the clinical instructors. Studies have emphasized that clinical instructors should have academic competence [13‐15, 24, 25]. The most important academic characteristics of clinical instructors include being available, using new teaching methods, encouraging students, providing regular feedback, avoiding negative feedback in the presence of the patients and staff, and using objective criteria for assessment [10, 25, 31, 32]. As the main pillar of education, an instructor should have sufficient learning and teaching skills to convey complex clinical concepts to students in an organized and comprehensible manner.

The results indicated clinical instructors should have adequate clinical experience. Other studies have also reported sufficient experience as an important property for a clinical instructor [23, 24]. Evidence shows that an experienced instructor has higher self-confidence and is more efficient in achieving academic objectives [33, 34]. In this regard, there is a Persian proverb which says experience is the mother of science. If clinical instructors do not have sufficient experience, their academic status will be questioned by the students and personnel, and they will not have the required efficiency [20]. Given the significance of clinical education, adequate clinical experience should be considered while choosing clinical instructors.

Ethical orientation was considered another characteristic of a clinical instructor. Similar studies have also emphasized that clinical instructors should be good role models for their students, should have characteristics such as honesty, confidentiality, criticizability, sense of humour, and sincerity, and should encourage their students [9, 10, 20, 25, 35]. Studies have shown that a clinical instructor’s morality can make the clinical experiences enjoyable for the students [22, 36]. The ethics-oriented instructors as role models can boost the professional ethical values in students.

Appearance was another characteristic of a clinical instructor. Appearance deals with an instructor’s physical features, neatness, and clothing. A qualitative study in Iran showed the nursing students believed the physical characteristics of a clinical instructor were an influential factor involved in clinical education [37]. Another study in Iran indicated the nursing students reported having a neat and tidy appearance as the most important feature of a clinical instructor [38]. The nursing instructors as role models [21] should pay enough attention to their appearance.

The most important characteristics of an effective clinical instructor were having intrinsic motivation, teaching skills, adequate clinical competence, professional ethics, sufficient clinical experience, appropriate communication skills, professional acceptability, and appropriate appearance and being a faculty member. When selecting clinical instructors, the schools of nursing should consider these characteristics. The faculty members are required to continuously enhance their professional competence to increase the students’ clinical learning quality. Their knowledge of the indices of an effective clinical instructor from the perspective of students can help them in promoting the quality of their teaching skills. The results of this study can be employed by the novice nursing instructors to consider the behaviours that promote students’ learning behaviours. Despite sufficient studies about the characteristics of effective clinical instructors, further studies are still needed in this regard.