What is missing in our clinical education? – The Student Voice

Karla Maria Hamlet – Canterbury Christ Church University, First Year Nursing Student

  • First Prize Creative Enquiry

Give Me My Voice

If I am without my voice, how do I challenge fault and advocate for my patients?

If I am without my voice, how do I flatten hierarchy and empower my colleagues?

If I am without my voice, how do I debate solutions and extend praise?

If I am without my voice, how do I speak with the family of a dying patient?

If I am without my voice, how do I lead, and, how do I learn?

If I am without my voice, how do I bring resolution to conflict?

If I am without my voice, how do I raise my self-esteem and develop my competence?

If I am without my voice, how will you know my limitations?

If I am without my voice now, tell me, how am I to ever truly be effective in the future?


University may develop my intellect and deepen my empathy, but neither of these can have a significant impact on my aptitude, if my voice remains silent and my assertiveness is still sleeping. The scope of my knowledge and the compassion of my heart, yearn for a conduit to be expressed through. I am a whole being of mind, body and soul, and my voice is my power to create the change I wish to see in this world, and, in the world of healthcare. My voice, my assertiveness, will be the role model for the next generation of student nurses! My voice, my assertiveness, will enable other voices, and cut through the silence of fear and oppression. For the colleague and the supervisor who are too scared to bring forth their valid concerns, train my voice and it will help amplify theirs. I don’t need a soap box to stand upon, I just need my voice box to be valued. So, train my assertiveness, exercise my vocal cords, and prepare me well for the professional life ahead.

My creative submission expresses my heart felt passion for enabling the voices and the assertiveness of my fellow students and registered nurses alike. To support my advocacy, Ayhan and Seki Öz (2021) state that, self-confidence, problem-solving and decision-making abilities, as well as academic and professional achievement, may all be positively impacted by assertiveness. It is my belief that with robust training in assertiveness through examples such as workshops, roleplay and virtual simulation, students may develop greater levels of self-awareness and self-esteem, enabling their ability to speak up with confidence and diplomacy.

Furthermore, to support my idea, McCabe and Timmins (2002) highlight the importance for nurses to receive sufficient preparation throughout their undergraduate studies, thus, teaching assertiveness skills is of utmost relevance to nurse educators. They further remark that certain nursing schools throughout the United Kingdom, have assertiveness training within their curricula. However, assertiveness education does not follow a prescribed structure, nor have regular class times or protected hours. For myself, as a first-year student nurse having not experienced any type of training in assertiveness so far at university, understanding that assertiveness training nationwide is sporadic, and at best left to the discretion of the tutor, is disheartening and only exacerbates the issue of what is ultimately a sincere lack of advocacy, on the part of academic faculties, towards all student nurses.

The importance of our student and future nurse voice is further highlighted by our commitments to the Nursing and Midwifery Council (NMC) Code (2018). Cl. 3.4 states “Act as an advocate for the vulnerable, challenging poor practice and discriminatory attitudes and behaviour relating to their care”. Cl. 9.3 “Deal with differences of professional opinion with colleagues by discussion and informed debate, respecting their views and opinions and behaving in a professional way at all times”. Finally, cl. 20.8 “Act as a role model of professional behaviour for students and newly qualified nurses, midwives and nursing associates to aspire to”. Without well-developed verbal and assertive communication skills, how are these clauses to be truly fulfilled?

Through the medium of graphite pencils and oil pastels, I feel my creative submission conveys my intended message well. My art expresses the need for greater focus of assertive development for nursing students. The headless grey figure representing the student nurse, female in gender to reflect myself, but inclusive of all genders as the womb brings forth life. She encapsulates lack of identity through her hidden head and face. Only when she has established her voice will her face appear, and her identity be complete. From her heart she grows, and her right hand becomes her intellect. Nonetheless, she lacks colour because she has not yet become whole in her development. She is naked to represent the transformational journey of self-progression and improvement, through the stripping away of old habits and rebuilding herself anew.

Similarly, the blended colours and faint pod like shapes within the surrounding oils, represent the emergence of self, maturity, and success from the humble state of beginnings. The hue and flow of colours representing the materialisation of possibilities once the nurse becomes assertive and develops her voice. The larynx stands larger and higher than the figure, heart, and brain, to indicate the significance of its development. The shades of yellow and orange encircle the larynx, to signify the organ as a torch of light (inspired by the torch of the statue of liberty and by Florence Nightingale “the lady with the lamp”), a tool which may lead and guide others through its warmth, it’s light, it’s power and brightness.

Reference List

  1. Ayhan D, Seki Öz H. (2021) ‘Effect of assertiveness training on the nursing students’ assertiveness and self-esteem levels: application of hybrid education in COVID-19 pandemic’, Nursing Forum, 56(4), pp. 807-815. doi:10.1111/nuf.12610.
  2. McCabe, C., Timmins, F. (2002) ‘Teaching assertiveness to undergraduate nursing students’, Nurse Education in Practice, 3(1), pp. 30–42. doi:10.1016/S1471-5953(02)00079-3.
  3. Nursing and Midwifery Council. (2018) The code. Available at: www.nmc.org.uk/standards/code/read-the-code-online/ (Accessed: 10/07/22).