NURSE INTERNS' SATISFACTION WITH THE CLINICAL LEARNING ENVIRONMENT: A CROSS-SECTIONAL STUDY.

This Methods: descriptive was 70 qualified nurses were sampled with a response rate of 93%. Data was collected using a structured questionnaire. Ethical approval was sort from of Ethics Review Data was analyzed using Statistical Package for Social Results: The study results showed that 97% of respondents expressed satisfaction with internship program. Satisfaction with the clinical learning environment was associated with hospital staff relationship with the interns: staff were interested in supervising interns (χ 2 =17.048, df=2, p=0.001), easier to approach (χ2= 34.72, df=2, p=0.000), gave feedback on performance (χ 2 = 8.49, df=2, p=0.021) and nurse managers allocating duties fairly χ 2 = 8.35, df=1, p=0.019). Conclusion: The study demonstrates that nurses on internship are happy with their preparation to practice nursing. Therefore, it is important to ensure that resources needed are availed to support student nurses during internship.


ISSN: 2320-5407
Int. J. Adv. Res. 7 (6), 164-169 165 competencies as they seek to become registered nurse (Jons´en, 2013). Kaşli & Ilban (2013) suggested that, a successful internship period will facilitate the transition and may yield a fruitful outcome in terms of enhancing graduates' competency. Despite its importance, clinical internship can also be a source of frustration to students and can lead to some choosing to work away from the clinical nursing set-up (Nabolsi et al., 2012). Smith, (2006) indicated that clinical internships enable students to apply theory to practice in a supervised real-life environment that supports the development of essential skills. The clinical internship usually requires the student to be placed in a clinical environment that is detached and disassociated from the college or university. Such placement is associated with feeling of isolation and detachment from the college and university, as well as from the lecturers and friends that students have built relationships with. Jamshidi et al (2016) indicated that challenges faced by nursing students during internship affects their overall health and disturbs their learning process. Changiz et al (2012) indicates that nursing students face three types of stress. These are; stress from nursing program; stress from clinical environment and stress from individual student life. Jamshidi et al (2016) also indicated that nurses on internship face discrimination from regular staff. Such discrimination can affect the professional identity of nurses and in a way violates nursing students' personal dignity and could give them a sense of professional inferiority (Sana et al., 2013). The discrimination worsens the internship experience as learning is disturbed, nurses become anxious and end up being less motivated to learn (Jamshidi et al 2016).
In Kenya, the Nursing Council requires that students graduating from degree programs complete a one year of clinical internship placement (Appiagyei et al., 2014). The success of this clinical internship depends on experiences arising from interaction with hospital staff and institutional structure during the internship period (Jamshidi et al 2016). While it is the desire of every nurse intern to undergo and successfully complete the internship program as directed by the Nursing Council of Kenya, there is little information that documents experience and satisfaction with clinical internship. Therefore, this study intended to determine nurse interns' satisfaction with the clinical learning environment.

Methods:-
This was a descriptive cross-sectional study that was conducted at Uasin Gishu County hospitals. 70 nurse interns were sampled with a response rate of 93%. Census sampling method was used to select participants. Data was collected using a structured questionnaire. Ethical approval was sort from University of Eastern Africa, Baraton Ethics Review Board. Participants were required to give a signed, voluntary informed consent prior to participation in the study without coercion. The anonymity of participants was ensured by serializing the structured questionnaires. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 22.0. Chi-square test was used to determine significance of relationships between nominal variables. A P-value of ≤ 0.05 was considered significant.

Results:-
A higher proportion of respondents were females compared to males. Majority of the respondents were in the age bracket of 25-29 years. More than two-thirds of nurses completed between 10-12 months of internship. This is illustrated by table 1 below.

Level of satisfaction of the clinical internship
The study results showed that majority (97%, n=68) of the respondents expressed satisfaction with internship while 3% (n=2) expressed dissatisfaction with clinical internship program. This is indicated by figure 1 below.

Discussion:-
The study revealed a higher proportion of respondents expressed satisfaction with the nursing internship. In concurring with findings of this study, Makhlof et al (2017) in their study observed that nurses on internship were generally satisfied internship.
It is important to observe that, contrary to Makhlof et al (2017) in their study they observed that gender of the interns was related to level of satisfaction with internship, however in this study, gender was not significant. Furthermore according to Loch (2013) differences that existed across demographic and academic characteristics most often were present with the group of interns that have not, nor plan to participate in a clinical healthcare internship. Students who do not have plans to do a clinical healthcare internship were more likely to be less than full-time, slightly older, more likely to be married, and more likely to have children living with them, than students who plan to or have participated in a clinical healthcare internship. The finding from this study is supported by Al-Mahmoud et al (2013) in who in their study showed that satisfaction with internship program does not depend on socio-demographic characteristics of nurse interns.
Relationship between the intern and hospital staff is one of the factors that impacts successful completion of clinical internship (Nash et al. 2009). As observed in this study majority of the nurse respondents indicated that hospital staff were easy to approach and work with. Hence it is possible to conclude that interns were accepted as part of the nursing team in the respective hospitals, a fact that is further demonstrated when interns indicated that hospital staff regarded nurse interns as key resource personnel in the hospital. In concurring with the findings of this study Nabolsi et al (2012) demonstrated in their study that proper treatment and establishment of a communication with interns is an important item for preceptors to be a role model for students. They indicated that a training which involves value and respect facilitates the teaching-learning process and socializes the students into the nursing profession. This also concurs with Chang & Chu (2009) As literature demonstrate, hospital staff and preceptors provide feedback to nurse interns on their performance (Al Mamari et al., 2015). This study observed that more than two-thirds of nurse interns concurred to have received feedback from hospital staff. A fact that demonstrates good relationship and willingness of the hospital staff to help interns learn and improve. Consistent with findings of this present study, Al-Mamari et al (2015) observed in their study that most nurse interns indicated they received constructive feedback from their preceptors. They concluded that that preceptors provided emotional support and nurtured interns with the sense of responsibility and accountability that in turn led to increase level of graduates' independence and maturity. In contrast to the findings of this present study, Makhlof et al (2017), observed in their study that most interns felt that preceptor didn't provide them with regular feedback on their strengths and weaknesses.
Furthermore, this study observed that nurse managers allocated duties fairly while taking into consideration their clinical internship learning needs. It is the view of the researchers that, fair allocation of duties that takes into consideration the objectives of clinical internship promote learning in the sense that an intern can learn thus feel they have accomplished the objectives of their learning experiences. In concurring the findings of this present study, Nash et al (2009) and Bakr et al (2013) argued that high level of satisfaction with internship program would occur when nurse managers ensure that learning needs of the interns' area taking care off when planning and allocating for duties in a nursing unit.

Conclusion:-
This study revealed that satisfaction of nurse interns with the internship is high. Nurse interns had a positive experience during internship and there was availability of adequate clinical learning situations to support acquisition of skills during internship. The implications of this study are that internship ensures human resources in health 169 sector are better prepared to practice nursing. Therefore, it is important to continue availing resources needed by nurse interns during internship.