Pre-registration student nurse placement hours, competency, and outcomes: A systematic review

Abstract

Aims: The aims of this systematic review were to a) identify studies on pre-registration student nurse placement hours, b) appraise the quality of studies to date, and c) synthesise the impact of different placement hours on student nurse competency and outcomes for people who use health services. Design: A mixed method systematic review involving five steps: framing questions, study identification, assessing quality using the Mixed Methods Appraisal Tool, summarising evidence around major focus areas, and interpreting findings, using thematic synthesis. Data sources: Searches were conducted to identify peer-reviewed studies, theses, and reviews in MEDLINE, EmBase, the Education Resources Information Center, the Cumulative Index to Nursing & Allied Health Literature, PROSPERO, Cochrane Library, PsycInfo, Web of Science (Social Science Citation Index), and the ProQuest Dissertations & Theses Global database. Review methods: The population was pre-registration nurses, and included peer-reviewed studies, theses, and reviews that referred to practice hours, the impact of practice hours on competency, and studies that linked practice hours to health service user outcomes. Searches were imported into Covidence software, with all documents screened independently by two reviewers at the title and abstract and full text stages. All authors independently assessed methodological quality with discussion occurring until consensus was reached. Reporting is consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the protocol is registered in PROSPERO. Results: A total of 4958 documents were screened, with 49 articles forming the final dataset. Overall, the literature is characterised by small scale evaluations in single universities, primarily focused on the replacement of practice hours with simulation. Conclusion: There is a lack of high-quality evidence to underpin practice placement hours. Given calls to significantly accelerate the graduation of nurses to address crisis-level nursing shortages the lack of a strong evidence base on practice hours warrants global attention.