Enhancing Practical Skills Learning in a Hospital Placement: Registered Nurse Mentors’ Experiences of Student Supervision

Abstract

Introduction

Practical skills supervision is essential in nursing placement education, allowing students to bridge theoretical knowledge with hands-on experience. Registered nurse mentors, with their professional experience and expertise, are key in this process. However, there is limited knowledge about registered nurse mentors’ experiences of practical skills supervision in clinical placements.

Objective

To explore registered nurse mentors’ experiences of practical skills supervision. This study therefore aimed to explore factors influencing registered nurse mentors when supervising student nurses during their practical skills learning.

Methods

An exploratory qualitative design was employed. The study was conducted at two hospitals affiliated with one bachelor nursing education program. The study employed a purposive sampling method, intentionally selecting registered nurse mentors based on their experience in relation to the study's objective. Data were collected during the Covid-19 pandemic through individual interviews including ten registered nurse mentors. The pandemic itself did not, however, influence the data. A thematic analysis approach was used for data analysis.

Results

Two main categories and four sub-categories related to registered nurse mentors’ experience with practical skills supervision were identified: (1) external factors at the clinical placement venue influencing registered nurse mentors’ supervision and (2) factors inherent in the registered nurse mentor role influencing supervision.

Conclusion

Educational institutions and clinical placements should work together to strengthen the supervision competencies of registered nurse mentors, as their collaboration is essential for optimizing students’ learning experiences and fostering the development of practical skills during hospital placements. Results from the present study can inform the design of registered nurse mentoring programs.

Keywords

clinical placement education hospitals learning nurses nursing nursing skills preceptorship qualitative research students

Introduction

Practical nursing skills are complex, involving psychomotor aspects, ethical considerations, theoretical and practical knowledge, communication and relational aspects (Bjørk & Kirkevold, 2000; Sommer et al., 2020). These skills are essential for ensuring patient safety in healthcare settings (Oster & Oster, 2024; Rahmah et al., 2022; Ravik & Bjørk, 2023). Competent registered nurses (RNs) with strong practical skills are vital for the provision of high-quality, safe patient care (Abdelaliem et al., 2025; Liou et al., 2020).

However, research indicates that many newly graduated nurses lack proficiency in practical nursing skills, often missing confidence and competence in areas such as peripheral vein cannulation (PVC) and other essential skills (Labrague & De los Santos, 2020; Liou et al., 2020; Ravik et al., 2023). These gaps in skill proficiency can lead to delays in care, diminished quality of care, and increased risk of adverse patient outcomes (Lee et al., 2022; Rothwell et al., 2021). This highlights a critical need to better understand student nurses’ practical skills learning during clinical placements.

This study delves into the less-explored realm of practical nursing skills learning within clinical hospital placements in nursing education, to understand factors influencing the supervision provided by RN mentors to student nurses (Abdelaliem et al., 2025; Bölenius et al., 2024; Ravik et al., 2025). Supervision by RN mentors plays a pivotal role in bridging the gap between theoretical knowledge and hands-on experience, particularly in guiding students through the complexities of skills transfer. By exploring factors that influence the supervision provided by RN nurses, this study aims to address a critical gap in nursing education research and contribute to the preparation of competent nurses who are capable of ensuring safe, high-quality patient care.

Review of Literature

Simulation-based practical skills learning offers substantial opportunities for student nurses to learn and develop clinical competence in a safe and controlled setting (Bölenius et al., 2024; Reierson et al., 2024; Vangone et al., 2024). To further learn and develop these practical skills in real-life settings, nursing education underscores the importance of continued skills learning within an authentic environment (Gregersen et al., 2021; Riddle & Doubleday, 2022). The transfer of simulation-based learning to clinical placement is a critical aspect of nursing education, as it bridges the gap between academic learning and real-world practice (Abdelaliem et al., 2025; El Hussein & Cuncannon, 2022; Høegh-Larsen et al., 2022; Ravik & Bjørk, 2023). However, many student nurses have reported this transfer process to be challenging (Abdelaliem et al., 2025; Høegh-Larsen et al., 2022; Ravik et al., 2023), emphasizing the importance of practical skills competence for its success (Abdelaliem et al., 2025). Clinical placements are more complex, unpredictable and challenging than simulation-based education (Leonardsen et al., 2021; Ravik & Bjørk, 2023; Ravik et al., 2023; Zhang et al., 2024). Studies show that effective learning during clinical placements relies on both a strong supervisory relationship and a safe learning arena (Abdelaliem et al., 2025; Adam et al., 2021; Dalsmo et al., 2022; Ravik et al., 2025; Rothwell et al., 2021).

Ongoing support and supervision during clinical placements are essential for students to further develop and consolidate skills they acquired during simulation (Mikkonen et al., 2022; Ravik et al., 2025; Vabo et al., 2022). RN mentors support student learning through the provision of supervision, feedback, and hands-on learning opportunities (Abdelaliem et al., 2025; Dalsmo et al., 2022; Ravik & Bjørk, 2021; Vabo et al., 2022). However, supervising students adds an additional layer of complexity to the already demanding roles of RNs (Gustavsson & Bivall, 2025; Hoebes & Ashipala, 2023; Leonardsen et al., 2021). RN mentors face challenges in balancing patient care and student supervision, often reporting limited time for supervision (Gustavsson & Bivall, 2025; Hoebes & Ashipala, 2023; Rothwell et al., 2021). A recent study by Ravik et al. (2025) reported RN mentors’ challenges in supervising students during skills learning, particularly stemming from students’ lack of knowledge and motivation, negative attitudes, and emotional issues. Given these challenges, acquiring a comprehensive understanding of RN mentors’ experiences of cultivating high-quality learning environments for student nurses is vital (Abdelaliem et al., 2025; Hoebes & Ashipala, 2023; Portela Dos Santos et al., 2022; Ravik et al., 2025).

Consequently, the objective of this study was to explore factors influencing the RN mentor role when supervising student nurses during their practical skills learning. The following research question was developed: What factors influence the RN mentor role when supervising student nurses during their practical skills learning?

Theoretical Perspective

Exploring RN mentors’ supervision practices requires a conceptual framework, with Bourdieu's (1990) concept of habitus offering valuable insights. Habitus, shaped by social practices and experiences, guides actions and evolves through engagement in settings like clinical placements. For RN mentors, it reflects dispositions and tendencies formed through education, practice, and supervision, helping student nurses develop the professional habitus needed for their future roles.

To understand the dynamics shaping nursing supervision in teaching practical skills, Bourdieu's (1977) concept of doxa is key. Doxa refers to deeply embedded beliefs and assumptions within social structures, accepted as self-evident truths. In educational settings, it manifests as widely held views on what constitutes “appropriate” education or the “correct” way to learn. Bourdieu (1977) advocates for a heterodox approach, critically questioning these norms to uncover hidden power dynamics and highlight the influence of social and cultural contexts on accepted practices.

Bourdieu's (1990) concepts, cultural, social, and symbolic capital, and practical sense offer insights into supervision practices. Cultural capital reflects mentors’ expertise, passed to students through supervision. Social capital involves the networks that mentors use to support students and foster connections. Symbolic capital represents the authority and respect that mentors hold, shaping learning, though it can lead to symbolic violence, pressuring students to conform (Strand et al., 2024). Practical sense is mentors’ intuitive knowledge, enabling effective decision-making and student supervision in clinical placements (Bourdieu, 1990).

This theoretical lens was deemed useful for the present study to elucidate the perspectives of RN mentors on previously unexplored, but important factors affecting the supervision of student nurses during practical skills learning.

Methods

Design

This study used an exploratory qualitative design to investigate participants’ experiences and practices in naturalistic settings (Polit & Beck, 2020). This approach captures the complexity of human behavior, making it ideal for studying mentorship, supervision, and practical skills development in clinical placements. By focusing on participants’ narratives, the design provides rich, context-specific insights aligned with the study's objectives.

The study is part of a broader project (project number 863027) which explores student nurses’ practical skills learning during clinical hospital placements, and adheres to the COREQ (Consolidated Criteria for Reporting Qualitative Research) guidelines to ensure comprehensive and transparent reporting (Tong et al., 2007).

Setting

The study was conducted at two hospital placement venues in Norway, where student nurses underwent clinical rotation as part of their bachelor nursing education. Students have two mandatory hospital placements, each lasting eight weeks, during their second year of study, which often serve as the students’ second and third clinical placements. The course plans for these clinical placements focus on the nursing care provided to patients with acute, chronic, or long-term illnesses, in medical and surgical units. RN mentors serve as facilitators and role models, providing important professional perspectives and daily feedback to enhance students’ practical skills learning experiences. This study explored the experiences of RN mentors in supervising student nurses during their practical skills learning for adult and elderly patients (>16 years).

The supervision model applied during the clinical placement involved one student being assigned to one RN mentor who was responsible for supervision throughout the placement period. Over the course of the eight-week placement, students were required to complete a 30-h practice week, in addition to one designated study day each week. The RN mentor responsible for the student was tasked with participating in key meetings alongside the student and the nurse educator, including an expectations discussion at the start of the placement, as well as the midterm and final evaluations.

Sample and Recruitment

The study included RN mentors who were selected through a purposive sampling strategy that was designed to intentionally select participants who are most relevant or experienced regarding the study's aim. This method collects rich, detailed data from individuals with direct experience of the phenomenon studied (Patton, 2014). After approval from ward leaders or student nurse coordinators, potential RN mentors were invited to participate via recruitment emails containing study details and a consent form. Ten RN mentors agreed to participate, and the second author (GMB) contacted them individually to arrange interview times and locations. According to Malterud et al. (2015), the inclusion of ten participants is generally considered as sufficient in this type of study, based on the information power. Data from the ten RN mentors provided rich and relevant data. Thus, their information was sufficient to ensure the data's validity and reliability.

The ten RN mentors attended an information meeting that explained the study's objectives, procedures, and expectations, and signed the consent forms, and interviews were scheduled at their convenience.

Inclusion and Exclusion Criteria

The inclusion criteria encompassed experienced RN mentors (who had more than three years of experience as RN mentors and who were responsible for supervising student nurses during their practical skills learning) in hospital placements. The exclusion criteria encompassed RN mentors who did not supervise second-year student nurses during practical skills learning in hospital placements.

Data Collection

Individual interviews, conducted between May 2021 and June 2022, provided valuable insights into participants’ perceptions and experiences (Polit & Beck, 2020). Five interviews were held in a hospital meeting room, and due to the Covid-19 pandemic, five interviews were conducted using Zoom. The data collection took place during the second year of the pandemic, and the prevailing conditions may have affected experiences. However, as the data reflect the participants’ experiences prior to the pandemic, the pandemic itself did not influence the findings provided in this context.

The interviews followed a semi-structured interview guide (Supplemental File 1). The questions in the interview guide focused on areas such as positive and negative experiences of practical skills supervision, the use of guidelines in practical skills supervision, collaboration in practical skills supervision, and challenges and unaddressed aspects in practical skills supervision. The interviewers strove to establish rapport and trust (Polit & Beck, 2020). The participants could express themselves freely, with follow-up questions being posed where appropriate. The ten RN mentors provided rich information regarding their experiences and perceptions. The interviews typically lasted from 21 to 46 min, and were audio-recorded and transcribed verbatim.

Data Analysis

The analysis employed Malterud's (2012) systematic text condensation—a structured, stepwise approach for inductively identifying themes in qualitative data. This method ensured themes emerged directly from participants’ experiences, free from predefined frameworks (Reichertz, 2007). Unlike basic content analysis, it goes beyond counting words or phrases, focusing instead on patterns and themes central to participants’ perspectives, aligning with the interpretive goals of thematic analysis (Malterud, 2012).

Systematic text condensation consists of four iterative steps for thematic analysis of written text. Although described chronologically, the process is inherently iterative (Malterud, 2012). In the first step, “Total impression—from chaos to themes,” the text was read comprehensively to gain an understanding of its content and identify preliminary themes. In the second step, “Identifying and sorting meaning units—from themes to codes,” the text was scrutinized line-by-line to pinpoint text fragments containing information pertinent to the study's aim and research question, termed “meaning units.” These were then allocated to the preliminary themes, marked with codes—shorthand labels that succinctly capture the essence of the meaning units. These codes were then organized into groups, where related codes were clustered together. This organization into code groups facilitated a more systematic and structured approach to analyzing the data, enabling identification of deeper insights and patterns across the dataset. In the third step, “Condensation—from code to meaning,” the code groups were subdivided into sub-groups, and the meaning units within these sub-groups were synthesized into condensed statements in the first-person form, using the participants’ own words, to preserve the original terminology. Illustrative quotations, translated into English, were thoughtfully crafted to vividly convey experiences, ensuring clarity while retaining the essence. Finally, in the fourth step, “Synthesizing—from condensation to description and concepts,” the condensed text from each sub-group within a code group transcended the initial condensates in the first-person form, resulting in the generation of new interpretive descriptions about the studied subject, presented in the third person (Malterud, 2012).

To ensure high inter-coder reliability, three authors (MR, GMB, IÅR) independently reviewed and coded the data before collaboratively refining interpretations. They engaged in iterative discussions to align perspectives and resolve discrepancies in codes, sub-categories, and categories. Disagreements were addressed through dialogue until consensus was reached. This systematic, collaborative approach reduced bias and enhanced the credibility, consistency, and trustworthiness of the findings.

Ethical Considerations

This study was approved by the Norwegian Agency for Shared Services in Education and Research (863027) and the involved hospitals, ensuring compliance with institutional and ethical standards. It adhered to the Declaration of Helsinki, prioritizing respect for human dignity, autonomy, and participants’ rights (WMA, 2013). Participants received detailed written and verbal information about the study's purpose, procedures, and ethical safeguards, with an emphasis on voluntary participation and the right to withdraw at any time without consequences. Written informed consent was obtained before enrolment. Confidentiality was maintained by anonymizing all data, excluding personal identifiers such as age, gender, or professional background. Data were securely stored on a password-protected university server, with access limited to the research team. These measures ensured compliance with ethical standards and safeguarded participants’ privacy throughout the study.

Methodological Considerations

To maintain rigor of this qualitative study, credibility, dependability, transferability, and confirmability, as described by Lincoln and Guba (1985) (Figure 1), were taken into account.

Figure 1.

Rigor criteria (Lincoln & Guba, 1985).

Credibility was ensured through the use of an interview guide to maintain consistency during data collection. Additionally, transcribing the interviews verbatim ensured an accurate and comprehensive portrayal of the RN mentors’ responses. Dependability was assured by providing detailed descriptions of data collection and analysis procedures. Furthermore, direct quotes from RN mentors were included to illustrate the connections between the results and the data. To promote transferability, thorough descriptions of the research context are provided. The qualitative aspect of the research design, with close exploration of RN mentors’ experiences and perceptions, made it necessary to concentrate on detailed, context-specific insights, rather than a large sample size (Malterud et al., 2015). Confirmability was ensured by employing investigator triangulation, with three out of four authors engaging in discussions and revisiting transcripts to verify that interpretations were supported by the data (Lincoln & Guba, 1985).

Results

RN mentors’ experience of factors influencing their supervision of student nurses’ practical skills learning during clinical placement in hospitals revealed two main categories, each with two sub-categories (Table 1). These categories emphasize the multifaceted nature of factors influencing RN mentors’ supervision of practical nursing skills. External factors, such as accommodating conflicts and limitations, impact mentors’ ability to supervise effectively. Meanwhile, inherent aspects of the mentor role, including collegial support and the balance of rewards and challenges, shape mentors’ responses to these external factors. Understanding this interplay is crucial to improving practical skills learning in clinical placements.

Table 1.

Main Categories and Sub-Categories Pertaining to the Study's Research Question.

Main Categories	Sub-categories
External factors at the clinical placement venue influencing RN mentors’ supervision	Accommodating conflicts
	Limitations associated with practical skills performance
Factors inherent in the RN mentor role influencing supervision	A supportive collegial community
	The mentors’ role—rewarding as well as challenging

Main Category I: External Factors at the Clinical Placement Venue Influencing RN Mentors’ Supervision

The first main category “External factors at the clinical placement venue influencing RN mentors’ supervision” highlighted how Accommodating Conflicts and Limitations Associated with Practical Skills Performance influenced RN mentors’ supervision of student nurses during their practical skills learning.

Accommodating Conflicts

Due to heavy workloads in hospital wards, the participants all experienced challenges when supervising student nurses. Student supervision was an added responsibility on top of their normal tasks, with patient care as their top priority. Aligning normal tasks with the students’ learning rhythm sometimes created practical imbalances.

It's challenging to allow students to perform the practical skills, when ideally, I should have completed the skills half an hour ago. (P3)

One participant described instances of intense ward activity that required leaving a student during practical skills performance to address urgent matters. These time constraints and limited supervision were considered detrimental to learning, potentially causing student insecurity.

In a bustling hospital ward, multiple events often occur simultaneously. There can be instances where I have to leave a student midway, even while supervising their learning and performance of a practical skill on a patient. Time is a key factor in being able to provide students with appropriate supervision. (P1)

RN mentors described that effective supervision required their constant presence and adequate time allocation, calling for a calm, secure environment for optimal learning of practical nursing skills.

Limitations Associated With Practical Skills Performance

Several participants agreed that patient-related factors, such as a shortage of inpatients requiring practical nursing skills, influenced students’ opportunities to perform these skills.

First and foremost, it is about what happens [in the unit], and that there are practical skills to perform. It is important that the placement ward has patients who need practical skills as part of their medical treatment. (P3)

In situations where practical skills were too complex, RN mentors performed these skills themselves to ensure patient safety. Examples include patients with compromised immunity whose condition demanded great precision and expertise.

Particularly in the case of haematological patients, we hold back when it comes to the insertion of a urinary catheter, due to their compromised immune system. (P10)

PVC was particularly challenging for student nurses to learn and master, with some being prevented from performing it due to complex and challenging patient situations.

We have a patient group on the ward for whom the insertion of PVCs is notably challenging. (P9)

Participants also reported occasions where patients were hesitant to let students perform practical skills on them, adding another layer of complexity to the students’ learning experience.

Some patients enjoy interacting with students, while others find it entirely inappropriate. (P5)

Adequate space for supervision was highlighted. Limited space due to the architecture of the ward or merging of units could hinder students’ engagement in effective learning processes. Moreover, space restrictions also had hygiene consequences.

The triangular arrangement of placing the trash bin and clean zone in relation to each other, which students have learned in school, is often not feasible due to limited space. (P4)

Main Category II: Factors Inherent in the RN Mentor Role Influencing Supervision

The second main category, “Factors inherent in the RN mentor role influencing supervision,” highlighted how A Supportive Collegial Community and The Mentors’ Role—Rewarding as Well as Challenging, further impacted students’ acquisition of practical skills.

A Supportive Collegial Community

Participants experienced a change in supervision routines during clinical placement periods. Previously, two RN mentors could share responsibility for supervising a single student over an eight-week placement. However, the current approach assigned one RN mentor per student for the same duration.

You are the only one responsible for student follow-up. (P1)

The participants supported each other in student supervision, especially when busy schedules forced students to observe rather than do. Covering for colleagues during absences was essential for continuity, but challenges arose due to non-familiarity with students’ skills and learning needs.

It's quite challenging to instantaneously discern a student's capabilities. (P2)

Participants described that they participated actively in group discussions and self-reflections on complex student situations, e.g., proficiency and attitudes that were challenging to address directly with the students.

We strive to be there for each other, and we discuss matters concerning the student, from knowledge-based to attitude-related challenges. (P1)

Moreover, participants who doubted their assessments of students’ proficiency and growth in practical nursing skills found it helpful to seek their colleagues’ input for a more accurate assessment of student performance.

Occasionally, we allow the student to pair with other nurses when performing a practical skill, recognising that we all have our strengths and weaknesses. (P6)

Participants used diverse supervision techniques and valued learning from each other through discussions and reflection, especially when needing clarification or adjustments in their strategies.

Yes, we do. We often discuss among colleagues. One should discuss with colleagues when help with student supervision is needed. (P10)

Some participants described that newly graduated nurses were often rapidly assigned as RN mentors, which could be challenging. To mitigate this, experienced mentors discussed supervision strategies with them and supported those nervous about student questions regarding practical skills.

It's the academic aspect, where newly qualified nurses, about to become RN mentors, might feel apprehensive about receiving academic questions from the students. (P8)

It was also highlighted that newly qualified nurses could serve as resources in students’ practical skills learning, due to their recent experience of being students and up-to-date skills training.

There are practical skills that newly graduated nurses tend to have freshly etched in their memory. (P9)

The Mentors’ Role—Rewarding as Well as Challenging

Participants experienced the supervision role both as a substantial responsibility and a rewarding experience, helping students transition from novices to competent nurses. The level of commitment varied among RN mentors, with some weary from the heavy workload supervision entails.

If you’ve been supervising students for 5 years, 10 years, or even 20 years, it can become wearisome. It's acceptable to admit that you’re tired and need to take a break from the RN mentor role for a while. (P7)

Despite recognizing the importance of their supervising role and the value of structured RN mentorship training, the participants had limited opportunities to attend courses and proposed increasing these opportunities.

I certainly found the two-day structured RN mentorship training that was offered by the nursing education programme a few years ago to be extremely beneficial. I had hoped it could continue so that all RN mentors would have the opportunity to participate. (P2)

Some participants pointed to age-related differences in supervision styles. Novice RN mentors, often closer in age to students, tended to foster friendships, while experienced RN mentors, confident from extensive experience, provided more corrective feedback. Despite valuing rapport, participants emphasized maintaining the mentor–mentee dynamic, especially when addressing learning progress or practical skills development.

Older RN mentors have a wealth of experience, having supervised a diverse range of students with varying levels of academic progression. They understand how to supervise each individual student appropriately. (P5)

Discussion

This study explored RN mentors’ experiences with practical skills supervision, revealing that both external placement factors and inherent mentor role aspects influence supervision. The findings underscore the need for educational institutions and clinical placements to strengthen RN mentor competence, which is essential for improving student learning and developing a skilled future nursing workforce.

Key results include the dynamics of the student–RN mentor relationship, the limited opportunities for RN mentors to provide supervision, and the vital role of structured RN mentorship training programs in enhancing supervision quality.

The Dynamics of Student–RN Mentor Relationships During Practical Skills Supervision

This study suggests that addressing time-related challenges faced by RN mentors could improve the quality and effectiveness of student supervision in clinical placements. Busy hospital environments present unique challenges for nursing education and mentorship (Ellis et al., 2021; Gustavsson & Bivall, 2025; Maassen et al., 2021; Makhaya et al., 2023), particularly due to the mismatch between university expectations and workplace realities. This highlights the need for improved communication and collaboration between placement managers and universities to bridge this gap (Gustavsson & Bivall, 2025).

Participants in the present study experienced difficulties balancing their dual roles as RNs and mentors due to heavy workloads, often prioritizing patient care over student supervision. These results align with Gustavsson and Bivall (2025) and Hoebes and Ashipala's (2023), who reported that heavy workloads left RN mentors with limited time for student supervision. Gustavsson and Bivall (2025) further emphasized the challenge that RN mentors faced in balancing students’ learning objectives with the practical demands and realities of the workplace. The shortage of RN mentors and challenges with supervision continuity during placements (Frøiland et al., 2022; Gustavsson & Bivall, 2025; Laugaland et al., 2021) could be closely linked to this lack of time, as supervision was often deprioritized in busy, understaffed environments (Rothwell et al., 2021). Prioritization of patients over student supervision can be interpreted through Bourdieu’s (1990) concept of habitus, emphasizing how individuals’ positions in the social structure influence their practices and choices. In this context, RN mentors’ habitus may reflect how their roles and responsibilities are shaped by institutional and social expectations within the healthcare system. The expectation that RN mentors should manage both patient care and student supervision (Tuomikoski et al., 2020) reflects this tension, where the mentor's habitus positions clinical care as the main priority, potentially sidelining mentorship. This may also reflect an embedded doxa within the healthcare environment, where clinical responsibilities are viewed as inherently more urgent or valuable than educating or supervising student nurses.

Despite their willingness to supervise, one participant in the current study sometimes left students to navigate practical skills independently, due to other obligations. Although fostering autonomy and problem-solving skills in students, which are crucial nursing competences (Ang & Lau, 2024; Silén et al., 2024; Tuomikoski et al., 2020), the participants in the present study, expressed concern as to whether inconsistent supervision compromised the quality of practical skills learning, potentially leading to student uncertainty and a challenging learning environment. Several studies have reported suboptimal learning opportunities for student nurses (Cant et al., 2021; Frøiland et al., 2022; Gustavsson & Bivall, 2025; Ravik & Bjørk, 2021). Inconsistent supervision may limit students’ access to what Bourdieu (1990) describes as symbolic capital, which includes recognition, validation, and support from RN mentors—essential components of professional development in nursing education. In this context, lack of supervision prevents students from accumulating symbolic capital in the form of mentorship and feedback that is critical for their development and confidence (Adam et al., 2021). Additionally, the stress of managing practical skills learning without consistent supervision could impede a student's ability to transfer skills from simulation to clinical placement (Høegh-Larsen et al., 2022; Ravik & Bjørk, 2021) and hinder students skills acquisition (Araújo et al., 2023; Ravik & Bjørk, 2021). This underscores the need to allocate sufficient time for RN mentors to provide quality supervision (Gustavsson & Bivall, 2025; Hoebes & Ashipala, 2023).

Given students’ initial challenges when performing practical skills on real patients (Ravik & Bjørk, 2023; Ravik et al., 2023), and the reported lack of practical skills proficiency among student nurses (Abdelaliem et al., 2025; Ravik et al., 2023), the issue of mentor allocation becomes crucial. Results from the present study revealed insufficient RN mentor resources for individual student supervision, with responsibility shifted from two RN mentors to just one for each student. Reinstating the practice of pairing two RN mentors per student could help distribute responsibilities more evenly (Frøiland et al., 2022), ensuring better support, skill transfer, and practical skill development. A heterodox approach, where assumptions that are taken for granted are challenged (Bourdieu, 1977), could disrupt the status quo (doxa) and foster critical reflection and improve mentorship allocations.

RN Mentors’ Limited Opportunities to Supervise Student Nurses During Practical Skills Learning

Participants in the current study reported limited supervision opportunities, which was often because suitable patients were unavailable or because patients preferred to not receive care from students. These results align with previous research identifying barriers to RN mentors’ supervision of students (Hoebes & Ashipala, 2023) and raise ethical concerns related to patient autonomy and consent (Olejarczyk & Young, 2024). This limited supervision and reduced patient engagement may also help to explain the observed perceptual gap: whilst students rated their own competence slightly below the midpoint, patients evaluated the care they received considerably lower (Ulupınar & Karasu, 2025). Although fostering student learning is crucial, it should not encroach upon patients’ rights. A balance must be struck between facilitating student learning opportunities and respecting patients’ preferences and comfort (Gil-Santos et al., 2022). We suggest that patient unavailability requires further examination, as it limits RN mentor supervision and thereby influences students’ skills transfer and learning. This highlights the need to challenge doxic assumptions in clinical education, such as patient availability and willingness of patients, by adopting a heterodox approach (Bourdieu, 1977). Addressing this challenge is critical, as the transfer and application of learned skills from a simulated context to real patients constitutes an invaluable part of nursing education, enabling students to connect simulation-based learning with real-world practice (Høegh-Larsen et al., 2022; Ravik & Bjørk, 2023). Balancing ethical patient care with student learning requires rethinking practices and exploring alternative solutions.

Occasionally, safety considerations restricted participants in the current study to merely observing RN mentors performing practical skills. Although observation aligns with Bourdieu's (1990) concept of practical sense and can contribute to professional development, it should not be the sole learning method (Ayu Eka et al., 2023; Frøiland et al., 2022). Continuous observation without participation could result in what Bourdieu (1990) refers to as marginalization—a sense of being excluded from full engagement in the practice of the field. Limited participation may leave students feeling excluded from professional practice as they are still in the process of acquiring the habitus. Diverse teaching strategies must therefore be applied that accommodate the complexity of practical skills and students’ various learning needs (Abdelaliem et al., 2025). Some practical skills posed unique supervision challenges (Paterson et al., 2022; Ravik & Bjørk, 2021, 2023), for example, PVC, highlighting the need to evaluate current methods and alternatives considered, such as in-situ simulations for practice in clinical placements (Bai et al., 2023; Karlsen et al., 2024).

Enhancing Practical Skills Supervision by Implementing Structured RN Mentorship Training Programs

Overall, results from the present study suggest that structured RN mentorship training programs could enhance the quality and effectiveness of practical skills supervision during clinical placements. Participants in the current study generally found the RN mentor role rewarding, albeit demanding, which is in line with previous research (Pramila-Savukoski et al., 2020; Wang et al., 2024). However, engagement levels in student supervision varied among participants in this study, mirroring concerns raised in earlier studies (Gustavsson & Bivall, 2025; Hoebes & Ashipala, 2023). Pramila-Savukoski et al. (2020) revealed that RN mentors’ perceived competence influenced their supervision engagement, with competence referring to their belief in successfully fulfilling their role. Most participants in this study lacked structured mentorship training, which is recommended but not mandatory for RN supervisors in Norway. As Bourdieu (1990) argues, this lack of training can be viewed as symbolic violence, where social systems unintentionally undermine mentors’ confidence and efficacy by failing to equip them with essential skills.

Participants’ lack of structured RN mentorship training highlights a gap in preparation for the RN mentor role, as training improves supervision competence (Mikkonen et al., 2022). Interestingly, this study found that supervision of practical skills was often a collaborative process, with teamwork playing a key role. While this approach may raise questions about the independence of RN mentors in their supervision role, Tuomikoski et al.'s (2020) review posits the necessity of cohesive collaboration with fellow professionals. We suggest that such collaboration among RN mentors fosters a learning culture that values teamwork while preparing students for future roles. According to Bourdieu (1990), the lack of structured RN mentorship training reflects a deficit in cultural capital, which includes knowledge, education, and skills. However, mentors’ collaboration and support networks demonstrate strong social capital, which became crucial when cultural capital was lacking. Without formal mentorship training, RN mentors in this study relied on clinical experience and communication skills for supervision. Given students’ diverse learning needs (Pooja Gill et al., 2021), this alone may be insufficient. Additional training in areas like individualized supervision, communication, and cultural competence is essential (Tuomikoski et al., 2020).

Being an RN mentor demands responsibility, expertise, interpersonal skills, and dedication (Antonsen et al., 2023). This study highlighted concerns about newly graduated nurses prematurely taking on mentorship roles. While they bring up-to-date nursing knowledge, they often lack the clinical experience that is essential for effective supervision (Pramila-Savukoski et al., 2020). Using Bourdieu's (1990) concept of capital, new graduates possess valuable but limited cultural capital, which may affect mentorship quality (Wang et al., 2024). Additionally, adapting to their professional roles while managing supervision responsibilities can be overwhelming, especially in complex nursing contexts where knowledge gaps may arise (Moreno et al., 2023). This study found novice RN mentors lacked structured training, relying instead on guidance from experienced colleagues, reflecting social capital (Bourdieu, 1990). However, this informal approach may be insufficient. Formal mentorship training could strengthen their skills, confidence, and symbolic capital, improving supervision quality (Wang et al., 2024). Furthermore, juggling peer and student supervision creates time constraints, underscoring the need for organizational support, time management strategies, and accessible training programs for novice RN mentors.

Through Bourdieu's (1990) lens, the varying supervision approaches the participants in the current study reported, such as younger RN mentors favoring a camaraderie-based style due to shared experiences with students, can be viewed as expressions of habitus. This approach creates a relaxed learning environment and strong mentor–mentee relationships (Smith et al., 2021), representing a form of social capital (Bourdieu, 1990). However, balancing camaraderie with professionalism relates to symbolic capital (Bourdieu, 1990), as professional boundaries and the provision of constructive feedback help to sustain the RN mentor's authority and respect within the field. This study found that experienced RN mentors often relied on traditional supervision methods, drawing on their extensive cultural capital, accumulated knowledge, expertise, and refined techniques (Bourdieu, 1990). However, they may struggle with adopting newer teaching methods, technologies, or modern communication styles (Hill et al., 2022). In contrast, novice mentors, often from younger generations, tend to favor more collaborative, student-centered approaches, reflecting a shift away from traditional methods. This emerging heterodoxy highlights the need for further research into diverse mentorship practices. Continuous professional development, essential in the rapidly evolving healthcare field (Mlambo et al., 2021), could enhance cultural capital and bridge gaps between traditional and modern mentoring approaches (Bourdieu, 1990).

Strengths and Limitations

Individual interviews allowed for in-depth exploration of participants’ experiences, providing rich, qualitative data in a private and safe setting. This approach enabled follow-up questions, minimized group biases and ensured all voices were fully represented (Polit & Beck, 2020).

This study provides rich insights but has limitations. Interviewer bias and reliance on self-reported data may affect accuracy (Tavory, 2020). Variation in interview formats (face-to-face vs. digital) could impact data comparability, as in-person interviews capture non-verbal cues better. Despite systematic analysis and researcher collaboration, findings are context-specific and not broadly transferable. A small sample size and the focus on RN mentors, excluding student nurses, may limit perspective diversity. Still, the study offers valuable insights into factors influencing RN mentors in supervising student nurses.

Implications for Practice

It is recommended to implement and evaluate structured RN mentoring training programs focused on practical skills learning and supervision to optimize support for RN mentors and student nurses, improve supervision quality, and enhance clinical learning experiences.

Conclusions

This study highlights the challenges RN mentors encounter in juggling their dual roles, often prioritizing patient care over supervision of students’ practical skills, due to heavy workloads. Limitations in RN mentor supervision were noted, often due to a lack of suitable patients or patients’ preference to avoid student involvement. The results indicate differences in the professional development of RN mentors. Despite the pivotal nature of mentorship, formal training opportunities were generally limited. Lack of training can engender challenges in understanding students’ learning needs, providing appropriate feedback and managing dual roles, leading to inconsistencies in mentorship quality. Implementing accessible, relevant structured mentorship programs for novice RN mentors could promote effective supervision, enhancing students’ learning and professional development in practical nursing skills. Future research should focus on conducting needs assessments to inform and guide tailored RN mentorship training, addressing gaps in understanding student needs, feedback and dual role management. Moreover, the practical skills learning experiences of student nurses during their clinical placements could be more thoroughly explored.

Supplemental Material

sj-docx-1-son-10.1177_23779608251414385 - Supplemental material for Enhancing Practical Skills Learning in a Hospital Placement: Registered Nurse Mentors’ Experiences of Student Supervision

Supplemental material, sj-docx-1-son-10.1177_23779608251414385 for Enhancing Practical Skills Learning in a Hospital Placement: Registered Nurse Mentors’ Experiences of Student Supervision by Monika Ravik, Gry Merete Bjerkelund, Sigrun Hvalvik and Inger Åse Reierson in SAGE Open Nursing

Footnotes

Acknowledgments

We would like to thank all the RN mentors who made the study possible. Thanks to Randi Kristin Sandbakk, University of South-Eastern Norway for her valuable contribution in the data collection.

ORCID iD

Monika Ravik

Ethical Statement

Prior to data collection, this study was approved by the Norwegian Agency for Shared Services in Education and Research (863027) in 2021 and the hospitals involved. The study adhered to the ethical guidelines in the Declaration of Helsinki (WMA, 2013). All participants were provided with both written and verbal information about the study, emphasizing the voluntary aspect of participation and the right to decline or withdraw. Written informed consent was obtained from all participants before enrolment. To maintain confidentiality, personal details such as age, gender, educational background, and years of experience as RN mentors in clinical placements were not disclosed. All data were anonymised and stored on a secure university research server, to maintain confidentiality and safeguard personal information. Only the researchers involved in the study had access to the transcripts generated from the interviews.

Author Contribution

All the authors made contribution to the conception and design of the study. MR: writing—review & editing, writing—original draft, supervision, methodology, investigation, formal analysis, corresponding author. GMB: writing—review & editing, methodology, data collection, investigation, formal analysis, project leader. SH: writing—review & editing, supervision, methodology, investigation. IÅR: writing—review & editing, writing—original draft, supervision, methodology, investigation, formal analysis. All the authors approved the final manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability

To access the data in this study, please contact the corresponding author.

Supplemental Material

Supplemental material for this article is available online.

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