Abstract
Nursing clinical instructors are instrumental in shaping the future nursing workforce through mentorship and practical instruction in healthcare settings. However, these educators frequently encounter significant challenges that impact their ability to guide and support nursing students effectively. Despite the critical role of clinical instructors, there is limited research exploring these challenges from the perspective of clinical instructors in Jordan. This descriptive phenomenology qualitative study aimed to explore the challenges encountered by clinical instructors in clinical settings in the South of Jordan to facilitate clinical learning. Focus groups were employed to gain insights into clinical instructors’ challenges in clinical settings. Sixteen full-time clinical nurse instructors were recruited from the nursing college. Each session lasted 50 to 70 min, and the data transcripts were analyzed by using qualitative thematic analysis. Three major themes emerged from the data: (1) Lack of resources, including inadequate infrastructure and teaching materials; (2) Learner-related challenges, such as insufficient student preparedness and engagement; and (3) Institutional policies and regulations, which often conflicted with clinical teaching needs and created administrative burdens. These challenges collectively hindered the instructors’ ability to provide high-quality clinical education and maintain effective relationships with clinical staff.The results draw attention to contextual and structural obstacles that clinical nursing education in Jordan faces. Improving the quality of nursing education and preparing students for their professional duties require addressing these issues through focused policy reforms, increased resource allocation, and clinical instructor professional development programs.
Introduction and Background
Clinical practice is essential to nursing education, bridging theoretical knowledge and practical application (Phuma-Ngaiyaye et al., 2017; Saifan et al., 2021). As a practice-based profession, nursing relies heavily on clinical experiences for the professional growth of undergraduate students (Vizcaya-Moreno et al., 2018). Nursing students spend more than 50% of their time in clinical learning environments (CLEs), which include hospitals, clinics, and simulation laboratories, enabling hands-on practice (Flott & Linden 2016). CLEs are crucial for helping students build their professional identities while fostering their competence, confidence, and communication abilities (Kobekyaa & Naidoo, 2023).
Several authors have described the significance of CLEs. Baraz et al. (2015) state that CLE is an interaction network of forces inside the clinical setting that influences clinical practice. Panda et al. (2021) refer to the clinical settings where student nurses/midwives are deployed as part of their training curriculum to get clinical experience. CLEs not only prepare students for their future roles but also aim to improve patient care quality (Nordquist et al., 2019). However, the effectiveness of these environments depends on the quality of clinical teaching provided by instructors.
Clinical training is critical for teaching nursing students the necessary professional skills and abilities since it allows the development of confidence, connections, communication, and competence based on the learning needs of the students. Moreover, clinical learning is an important component of nursing education curricula because it integrates theoretical and practical learning experiences. Hence, it is critical for nursing students to gain the necessary skills and abilities and to develop their professional capabilities (Bawadi et al., 2019). Clinical nursing education is given special consideration by educators when developing nursing curricula because it is viewed as an essential component of nursing programs that allow nursing students to gain knowledge and skills in nursing practice. Additionally, make sure that students’ clinical performance has improved and that they have been socialized into the role of a professional nurse (Yamada & Ota, 2012), they are competent and safe when working with patients (Flott & Linden, 2016), and are being prepared to perform as nurses (Najafi Kalyani et al., 2019) as well as confident about their future in practice (Woo & Li, 2020).
The development of a supportive learning environment is necessary for clinical education since nursing students require support to be ready for their future careers (Jafarian-Amiri et al., 2020). Nurse educators and clinical personnel are expected to work together to support students’ learning and development of clinical skills during clinical practice (Phuma-Ngaiyaye et al., 2017). Erlam et al. (2018) made the case that the effectiveness of the learning environment has an impact on the acquisition of competence and the learning behaviors of undergraduate nursing students.
In Jordan, nursing colleges routinely recruit experienced nurses as clinical instructors to supervise and guide students in clinical settings. These instructors play a pivotal role in ensuring students acquire essential competencies and confidence in patient care (Yang & Chao, 2018). Despite their critical responsibilities, clinical instructors face numerous challenges, including managing student groups, resource limitations, and balancing academic and clinical obligations (Hababeh & Lalithabai, 2020). These challenges can undermine their ability to create a supportive learning environment, which is crucial for students’ readiness to transition into professional practice (Maalouf & Zaatari, 2024).
High-quality nursing education relies on effective clinical teaching, yet many challenges persist. Identified key barriers, such as a lack of opportunities for instructors to update their knowledge, students’ inadequate preparation, and insufficient instructor readiness for teaching roles. Saifan et al. (2021) highlighted additional challenges, including inconsistencies between theoretical and practical training, conflicts between educational objectives and clinical expectations, and gaps in students’ understanding of nursing roles.
In Saudi Arabia, Mutair (2015) found that time pressures and resource constraints significantly impacted clinical teaching. Gaber et al. (2019) noted issues such as misaligned goals between academic institutions and clinical settings and students’ lack of clinical skills. Similarly, Elbilgahy et al. (2020) reported that challenges like inadequate procedural knowledge and negative instructor-student dynamics impaired teaching outcomes in Egypt and Saudi Arabia. These findings underscore the pressing need to address systemic barriers that hinder effective clinical education.
Although issues in clinical education have been studied in the past, most of the research has concentrated on student viewpoints rather than clinical instructors’ perspectives. Few studies have looked at the particular challenges faced by clinical instructors in Jordan, especially when it comes to developing student competency in environments with low resources. In order to create interventions that empower, clinical instructors and raise the standard of nursing education overall, it is imperative to comprehend these difficulties. By investigating the experiences of nursing clinical instructors in Jordan, this study aims to close this gap. It does this by highlighting obstacles and offering workable alternatives to enhance clinical teaching and learning settings.
Significance of the Study
Increasing student enrolment, faculty scarcity, and a lack of clinical training facilities are some of the developing issues facing nursing education in Jordan (Bawadi et al., 2019). Existing CLEs, which are essential for preparing students for professional practice, are under pressure from these problems. The efficiency of clinical instructors, who are essential in bridging the gap between theory and practice, is sometimes compromised by obstacles they face.
Clinical instructors encounter a number of problems, such as limited resources, administrative workloads, and issues with student readiness and engagement. If these problems are not resolved, they may cause instructors to become frustrated, which may have a detrimental effect on clinical teaching quality and student results (Halabi et al., 2012; Yamada & Ota, 2012). Creating plans to assist clinical instructors is crucial to raising their level of satisfaction, which in turn improves nursing students’ educational experiences (Yang & Chao, 2018).
By examining the challenges faced by clinical instructors at South Jordan Nursing College, this study aims to provide insights that can inform policy reforms and practical interventions. Addressing these challenges has the potential to improve the planning and delivery of clinical education, enrich the quality of student training, and ultimately contribute to the development of a competent and confident nursing workforce (N. Jamshidi et al., 2016).
Methods and Materials
Study Design
Clinical instructors’ descriptions of their daily experiences in clinical practice were utilized in this qualitative study, employing the descriptive phenomenological approach to address research concerns. This method aids in extracting rich, in-depth information on the topic under investigation (Polit & Beck, 2018). The focus group data collection method was employed in the study, as it is effective in eliciting complex narratives and achieving data saturation for both individual and collective viewpoints and perspectives, thereby providing a significant advantage over individual interviews (Tausch & Menold, 2016).
Population, Sample, and Setting
This study’s target population includes clinical instructors from the nursing faculty colleges in Jordan. The accessible population includes clinical instructors at an University in the South of Jordan. To recruit the study sample, a purposive sampling approach was adopted, which aided in achieving maximum variety and capturing a diverse range of perspectives.
In qualitative research, the primary focus is on exploring the depth, intricacies, and subtleties of a specific phenomenon rather than pursuing statistical generalization, as is typical in quantitative studies (Polit & Beck, 2016). For this study, 16 clinical instructors were recruited to participate in three focus group discussions. The groups were deliberately organized to include separate cohorts of male, female, and mixed-gender clinical instructors, ensuring a broad representation of diverse perspectives. Each group comprised four to seven participants, fostering an environment conducive to open and in-depth dialogue. This approach is consistent with the principles of qualitative research, which emphasize rich, detailed understanding over numerical breadth. The focus group discussions provided an intimate setting to thoroughly examine the complexities and nuances of the challenges faced by clinical instructors.
The sample size of 16 participants, while modest, was carefully determined in alignment with qualitative research principles, which prioritize depth and richness of data over large sample sizes. As outlined in section “Population, Sample, and Setting,” purposive sampling was utilized to maximize variety and capture a wide range of perspectives. The adequacy of the sample size was further validated by achieving data saturation, a critical benchmark in qualitative research. Following the third focus group discussion, a preliminary analysis of the transcripts revealed that no new themes or insights were emerging, confirming that sufficient data had been collected to address the research objectives. Although the sample was drawn from a single institution, the inclusion of diverse groups (male, female, and mixed) and the depth of the analysis enhance the credibility and transferability of the findings to similar contexts. This methodological approach ensures that the study provides meaningful insights into the experiences and challenges of clinical instructors, contributing to a nuanced understanding of the phenomenon under investigation.
The suitability of the sample size was determined by achieving data saturation, a fundamental principle in qualitative research. Data saturation refers to the point at which no new themes, insights, or patterns emerge from the data during analysis (Polit & Beck, 2018).
Data saturation was observed after the 11th interview when no new codes or themes emerged. For example, the transcript from participant 11 at 42:15 mentioned leadership impact on student engagement, echoing previous responses almost identically.
In this study, a comprehensive preliminary analysis of the transcripts following the third focus group discussion confirmed that no new insights were identified, and recurring themes were consistently observed across all groups. This indicated that data saturation had been achieved, thereby supporting the credibility and rigor of the findings.
By prioritizing data saturation, the researchers ensured that the sample size was sufficient to capture the richness and depth of the data without unnecessary expansion. While the small participant size limits the ability to generalize the findings broadly, it aligns with the goals of qualitative research, which emphasize depth of understanding over numerical representation. This approach allowed for a nuanced exploration of the complex challenges faced by clinical instructors, providing detailed and meaningful insights into their experiences.
Data Collection
No pilot testing was conducted due to time constraints; however, the interview guide was reviewed by two qualitative research experts for clarity and relevance. Focus groups were used in the current study to understand better the difficulties clinical instructors face in clinical settings. Three focus groups were created: five female clinical instructors in group one, four male clinical instructors in group two, and seven male and female clinical instructors in the third focus group. Each focus group session lasted 50 to 70 min; with the participants’ permission, it was audio-recorded. Focus group meetings with the clinical instructors were conducted in person and a suitable meeting room in the College of Nursing.
To minimize bias, facilitators used the script: “All your opinions are valuable and will be treated confidentially. There are no right or wrong answers.” The facilitator was not involved in participants’ academic or clinical evaluations, ensuring a neutral environment that encouraged honest expression.
Clinical instructors can express their opinions and experiences about a topic of interest by participating in focus groups. The participants in the focus groups were first asked a general, open question on the difficulties they encountered in the clinical settings. Subsequent questions were then posed in response to the participants’ answers and responses. The researchers took field notes and observations throughout focus group meetings.
Initial coding was conducted in Arabic to preserve the nuance of participants’ responses. Translated quotes were discussed collaboratively among bilingual researchers. The term was initially translated differently by two coders. The team reached consensus by aligning with Benner's framework. Although inter-rater reliability was not calculated quantitatively (e.g., Cohen’s Kappa), we ensured consistency through team discussions. Future studies should consider using statistical reliability measures.
Data Analysis
The first step in the data analysis was transcribing the three focus groups verbatim and then analyzing them in the Arabic language to avoid compromising data quality. Qualitative researchers are often advised to conduct data analysis in the language of the interview. To ensure data quality, a multi-step verification process was implemented. Firstly, transcriptions were reviewed by an independent bilingual researcher to ensure accuracy and completeness. Secondly, thematic analysis was conducted in Arabic to maintain the authenticity of the data. Transliteration was applied only when specific concepts or phrases lacked direct Arabic equivalents, ensuring clarity without altering the original meaning. Finally, once themes were finalized in Arabic, the analysis was translated into English for reporting. In other words, only quotes were translated into English in adherence. Two of the authors translated the new English quotes back into Arabic language. The backed translated quotes were compared with the original Arabic quotes to ensure credibility. This process involved a rigorous cross-checking phase where bilingual researchers compared the Arabic themes and English translations to ensure consistency and fidelity to the original data.
Braun and Clarke’s (2012) thematic analysis method was employed to analyze the data. One of the authors transcribed the interviews verbatim, while the remaining authors assisted by reading the transcripts and making notes. The first phase, familiarization, involved actively listening to the interviews and transcribing them personally to develop a deep understanding of the data. In the second phase, initial codes were generated. The coding process started with open coding, where significant statements were identified and categorized. Axial coding followed, connecting related codes into overarching themes. To ensure the findings were reliable, two researchers independently coded the data and resolved discrepancies through discussion. An audit trail was maintained to document each step, enhancing the transparency and reproducibility of the analysis. Transcripts were imported into NVIVO (version 12 plus), where each interview was carefully reviewed line by line. The researchers asked themselves, “What is this person trying to convey?” to ensure no part of the transcript was left uncoded.
The third phase involved searching for themes. As the analysis progressed, related codes were grouped into a hierarchical “tree structure” (tree nodes in NVIVO software) to streamline the identification of themes and support theory development. The fourth phase, reviewing themes, included refining the codes and ensuring they accurately represented the dataset. During the fifth phase, defining and naming themes, three overarching themes were identified and clearly articulated. These themes were then integrated and finalized during the sixth phase, which involved producing the report. This final stage marked the beginning of drafting the results section.
All stages, including the initial data analysis and coding, were performed by one author. Two additional authors independently reviewed the transcripts, validated the themes, and confirmed the robustness of the analysis. Their review resulted in minor adjustments to ensure the nuances of the text were accurately captured and represented.
Trustworthiness of Data
The following guidelines from Lincoln and Guba (1985) were used to assess the credibility, dependability, transferability, and confirmability of this study. The contents under each studied theme regarding the comments from the participants were checked with their feedback to ensure the credibility of the research findings. The study team and two faculty members with substantial experience in qualitative research conducted a session of reciprocal inspection and discussion to assess dependability, and they gave their approval at the session’s conclusion. The research team explained the research background, the participants, the data analysis, and the conclusions to support transferability. Finally, when presenting the results, quotes from the clinical instructors were used to increase confirmability.
Transferability of Findings
This study recognizes the significance of addressing the transferability of qualitative findings to contexts beyond the immediate study setting. Although the research was conducted within a single institution, the detailed description of the study context, participant demographics, and methodological approach provides readers with the necessary information to evaluate the applicability of the findings to similar environments. To further strengthen transferability, future research could expand the sample to include multiple institutions or regions, offering a broader and more diverse perspective on the challenges encountered by clinical instructors. Such an approach would enhance the generalizability of the findings while maintaining the depth and richness characteristic of qualitative researc
Social Desirability Bias and Group Conformity
The potential for social desirability bias and group conformity in focus group discussions is a valid concern. To mitigate these effects, the facilitators emphasized the importance of honest and open communication at the outset of each session. Additionally, the structured separation of male, female, and mixed-gender groups aimed to create a comfortable environment for participants to express their views freely. While these measures were implemented, we recognize that these biases cannot be entirely eliminated and have included this as a limitation in the revised manuscript.
Translation Process and Data Integrity
The translation process adhered to WHO guidelines and included a back-translation procedure to ensure accuracy. However, we acknowledge the need for greater transparency regarding inter-rater reliability and the language of coding. In this study, the coding process was conducted in English after translation, as the research team was proficient in both Arabic and English. While this approach ensured consistency in analysis, we recognize that conducting coding in the original language (Arabic) could have added an additional layer of rigor. This limitation has been explicitly noted in the revised manuscript, along with recommendations for future studies to consider dual-language coding and inter-rater reliability checks to further strengthen data integrity.
Ethical Issues
The research and ethics committee of the University reviewed and approved the presented study on December 21, 2022. The ethical review reference is (EC2/2022). Participating in the focus group was the main source of data collection and did not pose any risk to participants. Furthermore, study participants were made aware that their participation was completely optional, that the focus groups would be kept private, and that any remarks they made would not specifically mention any specific patient, medical facility, or clinical location. Participants signed the informed consent. Focus group interviews were audio-taped and transcribed by the researchers for analysis. Audio records were deleted after analysis.
Results
The participants consisted of 16 clinical instructors (CI), 5 males (31.25%) and 11 females (68.75%). Participants’ years of experience ranged from 8 to 17 years, with a mix of Nursing specialties. Table 1 presents the details of the participants.
Details of Clinical Instructors.
The Thematic content analysis identified three primary themes: “Lack of resources,”“Learners/students,” and “policies and regulations.” These themes, along with their sub-themes, illustrate the complex interplay of factors that challenge clinical teaching in nursing. The analysis not only highlights the isolated challenges but also underscores their interconnections, revealing broader systemic patterns affecting the training process.
Lack of Resources
The theme “Lack of resources” emerged as a critical barrier, encompassing material, human, and systemic deficiencies that significantly hinder students’ clinical training process. This encompassed several sub-themes, including inadequate resources in clinical settings such as teaching hospitals, patients, and transportation. Additionally, human resources were scarce, specifically CTs, within the Nursing college.
The unavailability of teaching hospitals was repeatedly emphasized, reflecting its foundational role in clinical training quality. Participants noted that existing clinical settings lacked essential facilities such as seminar rooms and student workspaces. These gaps adversely impacted students’ ability to gain hands-on experience.
The main challenge is that there are few training places available to train students. (FG3-Participant 3) Hospitals available for training are not classified as teaching hospitals… They don’t contain rooms for training students or other facilities for training like teaching hospitals. (FG2-Participant 1)
The lack of proper facilities was further compounded by restrictions on access to hospital electronic health systems, such as the Hakeem program, limiting students' ability to practice with patient electronic records. This systemic limitation was viewed as a significant barrier to effective training:
Nursing students are not allowed to view patient data or use the hospital system called Hakeem, which greatly hinders the training. (FG1-Participant 4)
Additionally, participants highlighted the absence of diverse patient cases in clinical settings, restricting students’ exposure to essential learning experiences. More importantly, the participants explained that these hospitals lack facilities and equipment that facilitate students’ hands-on training.
Lack facilities in the clinical settings such as …. No rooms for seminars, toilets, or even a cafeteria. (FG1-Participant 2) The available training places are not suitable for training in terms of facilities, lack of patients, and study cases that match the learning objectives of the clinical courses. (FG2-Participant 2)
The transportation challenge was another resource-related issue affecting clinical training and reducing opportunities for effective student learning.
The limited resources of [university name] reduce training opportunities, such as the small number of buses and visits allowed to training settings, which reduces training opportunities and affects them negatively. (FG1-Participant 5)
The participants frequently reported a significant shortage of CTs within the faculty, which did not align with the notable increase in the number of Nursing students. This imbalance between the current number of CTs and the growing student population was a prevalent concern raised by the participants.
Despite the huge number of nursing students joining the college, there is a lack of recruiting CT in the college. (FG3-Participant 3)
In an attempt to address the shortage of CTs, numerous adjunct CTs were recruited from the industry. However, these adjunct CTs lack proper training and endorsement of teaching and evaluation skills, which has resulted in negative consequences for the quality of the training and learning process outcomes.
To overcome the shortage of CTs, they [Nursing faculty] try to recruit adjuncts from outside the industry, and that honestly affects the quality of supervising students in clinical settings. (FG3-Participant 7)
The analysis highlights how these resource limitations collectively hinder the training process, adversely affecting both the clinical instructors’ effectiveness and the student’s learning outcomes.
Learners/Students
The second emerging theme concerns students, who play a significant role in the learning process in clinical settings, particularly in healthcare education. They are vital in clinical teaching and learning. Their active participation in patient care, application of knowledge, collaboration with the healthcare team, and commitment to professional values contribute to their development and the overall quality of healthcare delivery. Therefore, “Students” as a theme was repeatedly reported by the participants.
Students’ increasing numbers and varying preparedness emerged as significant challenges in clinical settings, affecting both learning outcomes and teaching quality. Participants consistently reported that the rising number of nursing students, particularly after the COVID-19 pandemic, strained the capacity of existing clinical settings.
The number of Nursing] students has increased compared to previous years, which makes it difficult to train such a large number and to find opportunities for all. (FG2-Participant 2)
Clinical settings could not also accommodate large groups, further limiting opportunities for effective training.
A CT cannot train a large number of students in the clinical setting that has a capacity of 12-15 students, but the number of students usually exceeds this number. (FG2-Participant 3) The presence of a large number of students from other academic institutions and different colleges reduces training opportunities. (FG3-Participant 5)
The impact of the COVID-19 pandemic was a recurring sub-theme, with participants observing a decline in students’ motivation and academic performance, particularly among those who experienced online learning during the pandemic.
The consequences of COVID-19; students become lazy, not active during clinical training, and prefer online courses. (FG1-Participant 2)
Discrimination against nursing students in clinical settings was also highlighted, with participants noting unequal treatment compared to students from other disciplines. This negatively affected students’ opportunities to engage in patient care:
Discrimination between medical students and nursing students was obvious from health care providers, and they don’t let the nursing students be involved in patient care and just ask them to stay inside patient rooms. (FG1-Participant 5)
These results show how structural and resource problems are intricately linked to student-related difficulties, which together impair the standard of clinical education.
Policies and Regulations
The third theme is regarding the University policies and regulations that are applied in the clinical settings. The study participants highlighted the lack of specific University policies and regulations that support the role of CTs at University as a significant challenge. This encompasses issues such as the absence of a designated job title for CTs as they are assigned as administrative staff, inadequate professional development (PD) training opportunities for career advancement, and a dearth of incentives to motivate and recognize their contributions. Furthermore, CTs were not classified according to their respective specialties and experiences.
Our job position is a CT, but we are officially assigned as administrative staff. Which makes us slightly confused. (FG1-Participant 5)
The lack of recognition for CTs’ specialties and expertise was another challenge, resulting in the ineffective matching of instructors to appropriate clinical departments.
Our specialties were not recognized. As a result, CTs may supervise students from another department. (FG2-Participant 3)
The absence of professional development opportunities, such as workshops or conferences, was viewed as a major factor contributing to low job satisfaction among CTs.
The college doesn’t give us a chance to participate in workshops or attend conferences … This makes us frustrated compared to our colleagues in other colleges. (FG3-Participant 4)
Participants linked these systemic challenges to a decline in CTs’ motivation and passion for teaching, ultimately affecting the quality of clinical training.
Previously there was internal motivation among CTs to teach nursing students … But sadly nowadays, we are frustrated with our job and have lost that motivation. (FG1-Participant 5)
This theme emphasizes how flaws at the policy level have a domino effect, making it harder for nurses to instruct and assist students effectively. The analysis revealed interconnected patterns across the three themes of “Lack of Resources,”“Learners/Students,” and “Policies and Regulations.” The difficulties in handling the growing number of students were strongly related to resource constraints, such as inadequate facilities and a lack of staff. At the same time, policy gaps made it more difficult for CTs to adequately handle these issues, which made clinical education even more burdened. These interrelated issues show that in order to raise the standard of nursing education, structural, resource, and policy-level obstacles must be addressed holistically.
Discussion
The findings of this study provide valuable insights into the challenges faced by clinical instructors in a nursing college in the Southern region of Jordan, particularly within the clinical learning environment. While the results section has been improved with better synthesis and integration of findings, this discussion aims to offer deeper critical reflection and stronger linkages to established theoretical frameworks in clinical education. By moving beyond descriptive analysis, we seek to contextualize the findings within broader theoretical and practical perspectives, addressing the limitations and implications more robustly.
Key Findings and Theoretical Integration
The study highlights several critical challenges, including resource limitations, organizational inefficiencies, and cultural factors that hinder effective clinical education. The lack of resources, such as teaching hospitals and transportation, emerged as a significant barrier, aligning with findings from similar contexts (Bvumbwe & Mtshali, 2018; Duffy, 2022; Malik et al., 2015). These challenges are particularly pronounced in developing countries like Jordan, where systemic inefficiencies in both education and healthcare systems exacerbate resource constraints. This finding resonates with
The study also underscores the impact of prolonged detachment from clinical practice among instructors, a phenomenon that contributes to the theory-practice gap. This aligns with
Organizational and Cultural Factors
The study reveals that organizational and cultural factors significantly influence the clinical education landscape. For instance, the bureaucratic nature of non-teaching hospitals creates an environment that is unfriendly to interactive learning, negatively impacting students’ experiences. This finding aligns with
Additionally, the limited exposure of students to diverse clinical cases due to regional healthcare disparities further restricts their ability to apply theoretical knowledge in practice. This aligns with
The current study is a unique one in different ways. Firstly, the qualitative design raised several issues about the challenges clinical instructor face in a Nursing college in the South of Jordan regarding the clinical learning environment. By delving into the lived experiences of clinical instructors, the study provides valuable insights into the barriers to effective nursing education. Lack of resources was the main challenge facing clinical instructors. This included a lack of teaching hospitals and challenges regarding patients and transportation. These findings are similar to the findings of several studies (Bvumbwe & Mtshali, 2018; Duffy, 2022; Malik et al., 2015).
This seems logical as Jordan is not developing and suffers from a lack of resources at several levels, including the education and health system. This might interpret this finding. Secondly, the study showed many specific organizational, technical, and cultural factors that influence teaching nursing students in clinical settings. This underscores the complexity of the clinical education landscape, where systemic inefficiencies and cultural norms compound resource limitations. Thirdly, and more importantly, the current study produced rich and deep information about several suggestions and solutions to improve the quality of clinical nursing training in Jordan.
The study included 16 clinical instructors with diverse backgrounds and 8 to 17 years of experience. While this reflects their potential for high-quality teaching, many participants noted that their prolonged detachment from clinical practice negatively impacted their teaching effectiveness. In Jordan, clinical instructors are not required to renew their nursing licenses after graduation (Saifan et al., 2015), which may exacerbate the gap between theory and practice. Moreover, the transition of clinical instructors to academic roles without maintaining clinical engagement creates a disconnection from current healthcare practices. This finding aligns with prior studies indicating that this disconnect contributes to the theory-practice gap in nursing education (Saifan et al., 2021; Abu Salah et al., 2018).
The necessity of incorporating professional development opportunities for clinical instructors, such as frequent clinical re-engagement and licensing renewal requirements, is crucially highlighted by these gaps. By filling in these gaps, nursing education could become more high-quality by reducing the gap between clinical realities and educational practices.
The current study’s findings showed that clinical instructors suffered from a lack of resources, such as a lack of teaching hospitals and transportation. These findings are compatible with the results of several studies (Bvumbwe & Mtshali, 2018; Duffy, 2022; Malik et al., 2015). Nursing students currently receive training in hospitals that are not classified as teaching hospitals, where nurses lack formal training in teaching methods. These hospitals operate within bureaucratic systems that discourage interactive learning, creating an environment that is unfriendly to students. This dynamic can negatively affect students’ learning experiences and the information they receive.
The role of hospital nurses in training students also warrants critical reflection. The nurses who train the students may not have the right information so that they will transfer the wrong information to students (Abu Salah et al., 2018). More importantly, it was clear that hospital nurses do not have ideas about the nursing curriculum or recognize nursing students’ needs (Fawaz et al., 2018). This may explain the findings of an older study in Jordan, which has explained that the theory-practice gap in nursing education may result from a lack of interaction between the clinical instructors and the nurses in the hospitals (Saifan et al., 2015). However, this study included only nursing students and did not focus on clinical instructors. Moreover, the focus of this study included only students from a private university, and it was conducted in an urban and the biggest city in Jordan. Another study showed that nurses in hospitals do not differentiate between students’ levels and deal with them as they are all at the same level (Bvumbwe & Mtshali, 2018). This means that clinical instructors and nursing colleges have duties to communicate with hospitals and nurses and orient them about their curriculum and the needs of nursing students at different levels. The nursing colleges may organize orientation programs for the nurses in hospitals and give them ideas about the training needs of each group of nursing students (Huston et al., 2018).
Another critical issue identified in the current study was the limited exposure of students to diverse clinical cases. Hospitals in the Southern region of Jordan lack facilities for major surgeries and specialized diagnostic procedures, which are often referred to hospitals in Amman. This lack of exposure deprives students of the opportunity to apply theoretical knowledge to a wide range of practical scenarios, limiting their clinical competence. These findings align with earlier studies indicating that limited clinical services in certain regions contribute to the theory-practice gap (Al-Ghabeesh et al., 2020; Saifan et al., 2022).
Similar to the findings of older studies (Attia & Ibrahim, 2023; Wu et al., 2021; Yang & Chao, 2018), the participants showed that they face pressure in performing their job properly. They explained that they are assigned to large groups of students. The huge number of students limits the ability of clinical instructors to fill the gap of absence of teaching hospitals or unqualified teacher nurses (Fawaz et al., 2018; Jasemi et al., 2018; Saifan et al., 2015). The clinical instructors deal with this problem by distributing the students to different departments in the hospital or the clinical area. This adds more physical pressure on the clinical instructors, as they have to keep moving between these different clinical areas. They are also requested to be ready to answer any questions and support students when doing procedures, as they have responsibilities to supervise these students all the time and be sure that they are safe and practice safely (Rodger & Juckes, 2021; Soroush et al., 2021). The participants in the current study admitted the trials of their colleges to solve these issues by recruiting adjunct clinical instructors. However, they showed that these adjunct instructors do not have the teaching skills and are not qualified enough to teach properly. They stressed the need to put more effort into preparing these instructors before assigning them to teach the nursing students.
It seems clear that the number of students who joined the nursing colleges in Jordan increased dramatically after COVID-19 (Rayan, 2023). This has led to a higher student-to-instructor ratio, limiting instructors’ ability to provide individualized supervision. While nursing colleges have attempted to address this issue by recruiting adjunct instructors, participants expressed concerns about the teaching qualifications and preparedness of these adjuncts. The findings suggest that a more structured preparation program for adjunct instructors is essential to ensure that they can effectively support student learning.
Many of the participants indicated the role of online teaching during the COVID-19 pandemic. They explained that online education produced weaker and less motivated students. The student’s knowledge and skills were viewed as less than the students at their levels before the pandemic. However, it should be indicated that this study included only nursing instructors from one university in Jordan. Therefore, these findings might not be transferred to other Jordanian universities. There is a need to evaluate the situation in other universities quantitatively and qualitatively to be able to generalize this information. This seems in agreement with the findings of many studies (Kim & Park, 2021; Ulenaers et al., 2021; Wang et al., 2021). These studies explained that online teaching negatively influenced nursing students. Moreover, it was explained that the impact of online education was more evident in developing countries, as these countries were not prepared to face these conditions (Agu et al., 2021; Oducado & Estoque, 2021). The absence of many resources such as computer labs, communication software, students and academic skills, and internet services negatively influenced the effectiveness of online teaching (Agu et al., 2021; Saifan et al., 2022). The reliance on online teaching during the pandemic has underscored the need for blended learning approaches that combine online and in-person training to maintain student engagement and skill development.
Many of the participants indicated the role of weak policies and regulations in disappointing the clinical instructors. Moreover, they critiqued the system in their university. In other words, the university did not support these instructors by assigning them clear job descriptions or providing regular training. The instructors explained that the nursing college did not consider their specialties when assigning them to train students in the clinical areas. This means that they might train students in different departments regardless of whether they have experience in these departments. These issues were not surprising, as many studies and nursing researchers indicated the role of the presence of clear policies and regulations in improving nursing instructors’ satisfaction and job conditions (Abu Salah et al., 2018; Fawaz et al., 2018; Maheshwari & Schools, 2022). Universities should consider implementing policies that recognize instructors’ specialties, provide regular training opportunities, and offer incentives to motivate clinical educators.
Limitations
One notable limitation of this study is the relatively small sample size of clinical instructors involved in the qualitative research. While the insights gained from this group provide valuable qualitative data, the findings may not fully represent the diversity of challenges experienced by nursing clinical instructors across a larger population. The study focused on a specific region, Jordan, in a single setting, which may have unique contextual factors influencing the challenges faced by nursing clinical instructors. As such, the generalizability of the findings to other geographical regions or healthcare systems should be made cautiously. The qualitative nature of this study relied on the subjective experiences and perceptions of clinical instructors. While this approach provides rich insights, it may also introduce bias or limitations associated with self-reporting and individual interpretations. The study’s findings are based on data collected within a specific time frame. As clinical education and healthcare systems can evolve, the identified challenges may have shifted, or new ones may have emerged since the data collection.
One limitation is the absence of member checking, due to participants’ limited availability during exam periods and potential discomfort revisiting recorded statements.
Future research may employ a mixed-methods or longitudinal design to explore how leadership development influences clinical teaching over time and address issues of causal inference and participant reflection.
Implications
Educational Policy
The findings of this study underscore the need for educational institutions and policymakers to critically reevaluate and revise existing training programs and policies for nursing clinical instructors. The challenges identified, such as interpersonal conflicts and inadequate preparation for clinical teaching roles, suggest that tailored training programs and updated policies are essential to better equip clinical instructors. These programs should focus on enhancing communication skills, conflict resolution, and adaptability in diverse clinical settings. Additionally, policies should be developed to provide institutional support, such as clear guidelines for role expectations and access to resources that facilitate effective teaching. By addressing these gaps, institutions can create a more supportive environment for both instructors and students, ultimately improving the quality of nursing education.
Professional Development
Nursing institutions must prioritize ongoing professional development for clinical educators to ensure they remain competent and confident in their roles. This could include structured workshops, mentorship programs, and access to resources that focus on improving teaching methodologies, emotional intelligence, and strategies for managing interpersonal challenges. Collaboration between healthcare institutions and educational facilities is also crucial. Such partnerships can help align the expectations of clinical staff and educators, ensuring that nursing students receive consistent and relevant training. By fostering a collaborative environment, institutions can bridge the gap between theoretical knowledge and practical application, enhancing the overall learning experience for students.
Research Continuation
While this study provides valuable insights into the challenges faced by nursing clinical instructors in a specific context, further research is needed to explore these issues on a broader scale. Future studies should investigate similar challenges in different geographic regions, healthcare settings, and cultural contexts to identify common themes and unique variations. Comparative studies could also examine how different interventions, such as training programs or policy changes, impact the effectiveness of clinical instructors. Additionally, longitudinal research could provide insights into the long-term effects of these interventions on both instructors and students. By expanding the scope of research, the nursing community can develop a more comprehensive understanding of the challenges faced by clinical instructors and identify evidence-based strategies to address them.
Implications for Practice
The study proposes integrating clinical instructor training into annual faculty development programs. A suggested model includes three modules per semester: (1) communication skills, (2) reflective supervision, and (3) mentorship assessment tools. These strategies could be implemented by the Jordanian Nursing Council in collaboration with university nursing faculties. Resource limitations such as faculty workload and financial constraints must be considered in adapting these programs sustainably
Ethical Considerations and Methodological Rigor
This study adhered to ethical guidelines, including obtaining informed consent and ensuring participant confidentiality. However, we acknowledge the need for greater transparency in addressing ethical considerations, particularly in focus group settings. To mitigate confidentiality risks, participants were reminded of the importance of maintaining privacy and refraining from sharing discussions outside the group. While member-checking was not explicitly performed, the research team ensured the accuracy of findings through iterative data analysis and cross-verification among researchers. Future studies should consider incorporating member-checking to further validate findings and enhance the trustworthiness of the research.
Conclusion
This study sheds light on a multitude of challenges present in the Jordanian nursing clinical learning landscape, and these challenges have a substantial impact on students’ capacity to excel. Within this context, enhancing the quality of clinical education becomes paramount. Instructors must take a proactive stance by prioritizing the provision of robust support to clinical educators. This support can be further fortified through the implementation of comprehensive training programs tailored to the specific needs of these instructors. Simultaneously, there is a call for thoughtful policy adjustments that can better align educational practices with the evolving demands of the nursing clinical environment. In this way, a concerted effort can be made to address the identified challenges and ultimately create an environment conducive to optimal learning and clinical practice.
Footnotes
Acknowledgements
The researchers thank all clinical instructors for their genuine eagerness to take part in and contribute to the creation of the new information. The researcher would like to thank the participants for their input in the current study. Without their cooperation, this study would not have been able to be completed. We sincerely thank each nursing college for their insightful suggestions on the study’s design. We much value your contributions.
Ethical Considerations
The study was reviewed and approved by the Research and Ethics Committee of the University on December 21, 2022 (Reference No. EC2/2022). Participation in the focus group discussions was entirely voluntary and involved minimal risk. Participants were informed that their input would remain confidential, with no reference to specific patients, facilities, or clinical sites. All participants signed informed consent forms. Focus group discussions were audio-recorded for transcription and analysis, and all recordings were permanently deleted after transcription was completed.
Author Contributions
Literature review: Raed M. Shudifat.
Study design: Hammam Leimoon.
Data collection: Mona M. Almalik.
Data analysis: Abdullah Algunmeeyn.
Discussion: Raed M. Shudifat.
Study supervision: Ahmad Saifan.
Critical revisions for important intellectual content: Raed M. Shudifat and Abdullah Algunmeeyn.
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 Statement
Data are available on request due to privacy/ethical restrictions.