Clinical Learning Environments



The limited capacity of clinical placements has resulted in exploration of newer and varied opportunities for clinical experiential learning for students. The use of placements overseas through exchange schemes highlights the issue of benchmarks for quality assurance of placements for learning. The clinical learning environment is at the core of effective professional learning for nurses or other healthcare professionals, patient safety, student experience and career intentions. Educational institutions do need a clear understanding of the clinical learning environment (CLE) students are entering and how it contributes to effective professional learning. It is therefore a necessity to not only understand it but also to be assured of the quality of it. This chapter will explore the findings from an EU funded project which focuses on compiling benchmark standards for European placements and the development for a measuring instrument for prospective assurance for clinical learning environments. The issue of what comprises a quality learning environment and how this can be measured and supported will also be addressed.


Learning environment Clinical learning Quality assurance Benchmarks 


  1. Arkan B, Ordin Y, Yılmaz D (2018) Undergraduate nursing students’ experience related to their clinical learning environment and factors affecting to their clinical learning process. Nurse Educ Pract 29:127–132. CrossRefPubMedGoogle Scholar
  2. Babenko-Mould Y, Laschinger HK (2014) Effects of incivility in clinical practice settings on nursing student burnout. Int J Nurs Educ Scholarsh 11(1):145–154. CrossRefGoogle Scholar
  3. Bergjan M, Hertel F (2013) Evaluating students’ perception of their clinical placements—testing the Clinical Learning Environment and Supervision and Nurse Teacher Scale (CLES + T scale) in Germany. Nurse Educ Today 33(11):1393–1398. CrossRefPubMedGoogle Scholar
  4. Brynildsen G, Bjørk IT, Berntsen K, Hestetun M (2014) Improving the quality of nursing students’ clinical placements in nursing homes: an evaluation study. Nurse Educ Pract 14:722–728CrossRefGoogle Scholar
  5. Button L, Green B, Tengnah C, Johansson I, Baker C (2005) The impact of international placements on nurses’ personal and professional lives: literature review. J Adv Nurs 50(3):315–324CrossRefGoogle Scholar
  6. Chan D (2001) Development of an innovative tool to assess hospital learning environments. Nurse Educ Today 21(8):624–631CrossRefGoogle Scholar
  7. Chan D (2002) Development of the Clinical Learning Environment Inventory: using the theoretical framework of learning environment studies to assess nursing students’ perceptions of the hospital as a learning environment. J Nurse Educ 41(2):69–75CrossRefGoogle Scholar
  8. Chuan OL, Barnett T (2012) Student, tutor and staff nurse perceptions of the clinical learning environment. Nurse Educ Pract 12(4):192–197. CrossRefPubMedGoogle Scholar
  9. Council of Deans of Health (CoDH) (2016) Educating the future nurse – a paper for discussion. Council of Deans of Health, LondonGoogle Scholar
  10. Davies R (2008) The Bologna process: the quiet revolution in higher education. Nurse Educ Today 28:935–942. CrossRefPubMedGoogle Scholar
  11. Department of Health, Australia (DH) (2014) Best practice clinical learning environments framework (Department of Health, Victoria 2014) [online].
  12. Dunn SV, Burntt P (1995) The development of a clinical learning environment scale. J Adv Nurs 22(6):1166–1173CrossRefGoogle Scholar
  13. D’Souza MS, Karkada SN, Parahoo K, Venkatesaperumal R (2015) Perception of and satisfaction with the clinical learning environment among nursing students. Nurse Educ Today 35(6):833–840. CrossRefPubMedGoogle Scholar
  14. Edgecombe K, Jennings M, Bowden M (2013) International nursing students and what impacts their clinical learning: literature review. Nurse Educ Today 33:138–142CrossRefGoogle Scholar
  15. EU directive 2005/36/EC Annex v2 (5.2.1) (2005) [online]. Accessed 28 Sept 2019
  16. Felstead I (2016) An exploration of role model influence on adult nursing students’ professional development: a phenomenological research study. Nurse Educ Today 37:66–70. CrossRefPubMedGoogle Scholar
  17. Flott EA, Linden L (2016) The clinical learning environment in nursing education: a concept analysis. J Adv Nurs 72(3):501–513. CrossRefPubMedGoogle Scholar
  18. Gopee N (2015) Mentoring and supervision in healthcare, 3rd edn. Sage, LondonGoogle Scholar
  19. Healthcare Quality Improvement Partnership (HQIP) (2017) Social care audit guidelines [online]. Accessed 14 Sept 2019
  20. Healthcare Quality Improvement Partnership (HQIP) (2018) Clinical audit: a simple guide for NHS Boards & partners. Accessed 1 Nov 19
  21. Hegenbarth M, Rawe S, Murray L, Arnaert A, Chambers-Evans J (2015) Establishing and maintaining the clinical learning environment for nursing students: a qualitative study. Nurse Educ Today 35(2):304–309. CrossRefPubMedGoogle Scholar
  22. Henriksen N, Normann HK, Skaalvik MW (2012) Development and testing of the Norwegian version of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES + T) evaluation scale. Int J Nurs Educ Scholarsh 9(1):23. Accessed 28 Oct 19
  23. Hosoda Y (2006) Development and testing of a Clinical Learning Environment Diagnostic Inventory for baccalaureate nursing students. J Adv Nurs 56(5):480–490. CrossRefPubMedGoogle Scholar
  24. Houghton CE, Casey D, Shaw D, Murphy K (2012) Staff and students’ perceptions and experiences of teaching and assessment in clinical skills laboratories: interview findings from a multiple case study. Nurse Educ Today 32:e29–e34. CrossRefPubMedGoogle Scholar
  25. House of Commons Health Committee and Parliament (2018) The nursing workforce. Crown, LondonGoogle Scholar
  26. International Organization for Standardization (ISO) (N.D.) ISO 9000 family – quality management. Accessed 01 Oct 2019
  27. Jacobone V, Moro G (2015) Evaluating the impact of the Erasmus programme: skills and European identity. Assess Eval High Educ 40(2):309–328. CrossRefGoogle Scholar
  28. Johansson UB, Kaila P, Ahlner-Elmqvist M, Leksell J, Isoaho H, Saarikoski M (2010) Clinical learning environment, supervision and nurse teacher evaluation scale: psychometric evaluation of the Swedish version. J Adv Nurs 66(9):2085–2093. CrossRefPubMedGoogle Scholar
  29. Levett-Jones T, Lathlean J (2009) The ascent to competence conceptual framework: an outcome of a study of belongingness. J Clin Nurs 18(20):2870–2879. CrossRefPubMedGoogle Scholar
  30. Mansutti I, Saiani L, Grassetti L, Palese A (2017) Instruments evaluating the quality of the clinical learning environment in nursing education: a systematic review of psychometric properties. Int J Nurs Stud 68:60–72. CrossRefPubMedGoogle Scholar
  31. Marshall JE (2017) Experiences of student midwives learning and working abroad in Europe: the value of an Erasmus undergraduate midwifery education programme. Midwifery 44:7–13. CrossRefPubMedGoogle Scholar
  32. Mid Staffordshire NHS Foundation Trust Public Inquiry (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry: executive summary. Retrieved from
  33. Milne A, Cowie J (2013) Promoting culturally competent care: the Erasmus exchange programme. Nurs Stand 27(30):42–46CrossRefGoogle Scholar
  34. Moscaritolo LM (2009) Interventional strategies to decrease nursing student anxiety in the clinical learning environment. J Nurs Educ 48(1):17–23CrossRefGoogle Scholar
  35. Nursing and Midwifery Council (2008) Standards to support learning and assessment in practice. NMC standards for mentors, practice teachers and teachers. NMC, LondonGoogle Scholar
  36. Nursing and Midwifery Council (NMC) (2010) [online] Standards for pre-registration nursing education [online]. Accessed 09 Sept 2019
  37. Nursing and Midwifery Council (NMC) (2011) Requirements, guidance and advice for learning outside the UK for pre-registration nursing and midwifery students. Annexe 1 [online]. Accessed 28 Sept 2019
  38. Nursing and Midwifery Council (NMC) (2013) Quality assurance framework for nursing and midwifery education [online]. Accessed 20 Aug 2019
  39. Nursing and Midwifery Council (NMC) (2018a) Standards Framework for Nursing and Midwifery Education. Available at Accessed 01 Oct 2019
  40. Nursing and Midwifery Council (NMC) (2018b) Standards framework for nursing and midwifery education – what must be in place [online]. Accessed 28 Sept 2019
  41. Nursing and Midwifery Council (NMC) (2019) Quality assurance framework for nursing, midwifery and nursing associate education [online]. Accessed 28 Sept 2019
  42. O’Mara L, McDonald J, Gillespie M, Brown H, Miles L (2014) Challenging clinical learning environments: experiences of undergraduate nursing students. Nurse Educ Pract 14(2):208–213. CrossRefPubMedGoogle Scholar
  43. Palese A, Zabalegui A, Sigurdardottir AK, Bergin M, Dobrowolska B, Gasser C, Pajnkihar M, Jackson C (2014) Bologna process, more or less: nursing education in the European economic area: a discussion paper. Int J Nurs Educ Scholarsh 2(11):63–73. CrossRefGoogle Scholar
  44. Papastavrou E, Dimitriadou M, Tsangari H (2015) Psychometric testing of the Greek Version of the Clinical Learning Environment-Teacher (CLES + T). Global J Health Sci 8(5):49573. CrossRefGoogle Scholar
  45. Papastavrou E, Dimitriadou M, Tsangari H, Andre C (2016) Nursing students’ satisfaction of the clinical learning environment: a research study. BMC Nurs 15:44. CrossRefPubMedPubMedCentralGoogle Scholar
  46. Papathanasiou IV, Tsaras K, Sarafis P (2014) Views and perceptions of nursing students on their clinical learning environment: teaching and learning. Nurse Educ Today 34(1):57–60. CrossRefPubMedGoogle Scholar
  47. Ruddock H, Turner S (2007) Developing cultural sensitivity: nursing students’ experiences of a study abroad programme. J Adv Nurs 59(4):361–369CrossRefGoogle Scholar
  48. Saarikoski M, Leino-Kilpi H (2002) The clinical learning environment and supervision by staff nurses: developing the instrument. Int J Nurs Stud 39:259–267CrossRefGoogle Scholar
  49. Saarikoski M, Isoaho H, Leino-Kilpi H, Warne T (2005) Validation of the clinical learning environment and supervision scale. Int J Nurs Educ Scholarsh 2(1).
  50. Saarikoski M, Isoaho H, Warne T, Leino-Kilpi H (2008) The nurse teacher in clinical practice: developing the new sub-dimension to clinical learning environment and supervision (CLES) scale. Int J Nurs Stud 45:1233–1237CrossRefGoogle Scholar
  51. Saarikoski M, Kaila P, Lambrinou E, Pérez Cañaveras RM, Tichelaar E, Tomietto M, Warne T (2013) Students’ experiences of cooperation with nurse teacher during their clinical placements: an empirical study in a Western European context. Nurse Educ Pract 13(2):78–82. CrossRefPubMedGoogle Scholar
  52. Salvage J, Stilwell B (2018) Breaking the silence: a new story of nursing. J Clin Nurs 27(7–8):1301–1303. Accessed 2 Apr 2019CrossRefGoogle Scholar
  53. Sand-Jecklin K (2009) Assessing nursing student perceptions of the clinical learning environment: refinement and testing of the SECEE inventory. J Nurs Meas 17(3):232–246. CrossRefPubMedGoogle Scholar
  54. Stuart C (2013) Mentoring, learning and assessment in clinical practice. A guide for nurses, midwives and other health professionals, 3rd edn. Churchill Livingstone, EdinburghGoogle Scholar
  55. Sundler AJ, Björk M, Bisholt B, Ohlsson U, Engström AK, Gustafsson M (2014) Student nurses’ experiences of the clinical learning environment in relation to the organization of supervision: a questionnaire survey. Nurse Educ Today 34(4):661–666. CrossRefPubMedGoogle Scholar
  56. Tomietto M, Saiani L, Saarikoski M, Fabris S, Cunico L, Campagna V, Palese A (2009) Assessing quality in clinical educational setting: Italian validation of the Clinical Learning Environment and Supervision (CLES) scale. G Ital Med Lav Ergon 31(3 Suppl B):B49–B55PubMedGoogle Scholar
  57. Traynor M, Mehigan S (2014) Clinical learning environments: a scoping literature review [Online]. Accessed 08 Aug 2019
  58. Vizcaya-Moreno MF, Pérez-Cañaveras RM, De Juan J, Saarikoski M (2015) Development and psychometric testing of the Clinical Learning Environment, Supervision and Nurse Teacher Evaluation Scale (CLES + T): the Spanish version. Int J Nurs Stud 52(1):361–367. CrossRefPubMedGoogle Scholar
  59. Warne T, Johansson UB, Papastavrou E, Tichelaar E, Tomietto M, Van den Bossche K, Moreno MF, Saarikoski M (2010) An exploration of the clinical learning experience of nursing students in nine European countries. Nurse Educ Today 30(8):809–815. CrossRefPubMedGoogle Scholar
  60. Zabalegui A, Maciá-Soler L, Márquez J, Moncho J (2006) Changes in nursing education in the European Union. J Nurs Scholarsh 38(2):114–118. CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Adult, Child and Midwifery, School of Health and EducationMiddlesex UniversityLondonUK

Personalised recommendations