*3.2.2 Criterion 2: student recruitment, admission, and selection*

According to council on higher education accreditation criteria, criterion 2 focuses on "recruitment, access, and selection procedures are effected in line with the University's policies and procedures. They are appropriate for the program's academic requirements, within a framework of widened access and equity. The number of students selected takes into account the program's intended learning outcomes and its capacity to offer good quality education." Learner nurses (56%) perceived one of the minimum standards of criterion 2 (requirements for admission) as an obstacle to the nursing training program. For instance, A total of 89% of learner nurses confirmed that minimum requirements constituted by high levels in mathematics and physical science are an obstacle for many matriculates' to pursue a bachelor of nursing and midwifery. The concern about minimum requirements for nursing qualifications has been discussed by several authors [9, 18–20]. The findings indicate continuous trends of concern regarding minimum entry requirements that require urgent attention.

#### *3.2.3 Criterion 3: staffing*

We acknowledged the role of staffing in ensuring good outcomes of the nursing curriculum by asking how learner nurses perceived staffing for support of their classroom and clinical learning for the bachelor of nursing and midwifery training program. A total of 54% perceived staffing as inadequate to support their clinical learning for the bachelor of nursing and midwifery training program. Furthermore, learner nurses perceived modules facilitated by one nurse educator as a barrier to their learning. Similarly, Mlaba and Emmamally [21], with other scholars [22–24], also reported inadequate clinical staff support and a lack of clinical educators for mentoring learner nurses' clinical learning as an obstacle within the nursing training program.

#### *3.2.4 Criterion 4: program coordination*

Criterion 4 ensures that the program is effectively coordinated to facilitate the achievement of its intended purpose and outcomes. The majority of learner nurses (63.4%) reported a concern regarding one of the minimum standards—stating that the regulatory body (South African nursing council) requires lots of clinical hours, which is a challenge to accumulate due to various factors. Learner nurses (86.3%) also reported concern about the duration of clinical allocation, which is perceived as short to meet the required clinical hours. In contrast, the South African nursing Council (SANC) requires 4000 clinical hours in clinical learning experiences under supervision over four years for a bachelor of nursing and midwifery [2]. There are fewer or limited scholarly studies that aimed to challenge the requirement of SANC.

#### *3.2.5 Criterion 5: teaching and learning*

The majority of learner nurses (83%) reported that some of the modules offered from levels 1 to 4 for the bachelor of nursing and midwifery program seem to be not related to the nursing profession. For example, learner nurses struggle to understand why their training program requires them to study chemistry and sociology. Learner nurses expressed concerns as they fail these modules offered outside the nursing disciple than those under the nursing. Similarly, Lewis [25] deliberated on

the implications of failing modules, which included emotional, social, and financial consequences as well as the impact on the student, institution, and nursing profession at large.

#### *3.2.6 Criterion 6: learner assessment*

Suganya [26] explained that feedback is one of the essential components of the nursing curriculum. For the feedback to be effective, it should be given in a regular manner and in a supportive environment. However, our findings demonstrate that 62% of learner nurses fail to receive assessment feedback, thus being an obstacle to the successful implementation of the nursing training program. Nursing educators and supervisors should ensure they provide feedback promptly and specific to the learner's performance. Specific and high-quality feedback comments make feedback effective and valued by the learner nurses when compared to nonspecific evaluative feedback [27]. It provides an opportunity to self-assess their skills and capabilities and also it provides direction that increases motivation, confidence, self-esteem, cognitive skills, and behaviors. Effective feedback gives confidence and reassurance to the learner nurses. So, nursing professionals should give importance to feedback in their learning process and implement a mechanism by which the quantity and quality of the feedback are monitored [26].

#### *3.2.7 Criterion 7: infrastructure and resources*

The criterion requires that suitable and sufficient venues, IT infrastructure, and library resources be available for students and staff in the program. Efficient provision of infrastructure and resources is needed for the proper implementation of the nursing training program by creating well-established academic support centers [28] and keeping up with the demands of the healthcare system [6]. Leary et al. [29] also note that the provision of adequate infrastructure and resource allocation is a strategic way for enhancing the innovation of the nursing training program. Pesut and Greig [30] emphasized that the existence of proper resource allocation has fruitful results in the implementation of the nursing training program. However, most learner nurses (66%) perceived infrastructure design and allocations of resources (staff and materials) as not adequate to assist them with their learning needs. In contrast, Mothiba et al. [31] regarding the role of infrastructure in the nursing program noted a diverse positive impact of the newly established clinical skills laboratory on the clinical learning of learner nurses in the study setting. Therefore, inefficient provision of proper infrastructure and resource allocation hinders the successful implementation of the nursing training program. Subsequently, this deters the plan of action for scaling up quality nursing and midwifery education and practice for the African region 2012–2022, which requires adequate resource allocation. There is a continuous need for nursing regulators, institutions/schools, and educators to invest in proper infrastructure and adequate resource allocation to ensure effective implementation of the nursing training program.

#### *3.2.8 Criterion 8: coordination of experimental learning*

According to the council on higher education of South Africa, criterion 8 ensures that the coordination of work-based learning should be done effectively in all components of applicable programs. This includes an adequate infrastructure, effective

#### *Obstacles in the Nursing Training Programs DOI: http://dx.doi.org/10.5772/intechopen.109191*

communication, recording of progress made, monitoring, and mentoring. Learner nurses (51%) reflected a shortage of clinical nurse educators that impact negatively on clinical learning. During the clinical exposure, most learner nurses reported monitoring and mentoring for clinical learning. Clinical learning is a significant component of the nursing training program, as such, failure to achieve the component defeats the purpose of the whole nursing training program. Flott and Linden [8] reported similar concerns, regarding factors that influence clinical learning, including the physical space, psychosocial and interaction factors, the organizational culture, and teaching and learning components. Najafi Kalyani et al. [32] reported inadequacy of the educational environment faced by learner nurses that resulted in "confusion of professional identity." The aforementioned authors emphasized improving the clinical environment by identifying professional models and increasing their influence on management, education, and clinical education.

#### *3.2.9 Criterion 9: learner retention, student throughput, and program impact*

The criterion indicates that the program should take steps to alleviate shortages of expertise in relevant nursing, in cases where these are the desired outcomes of the program. However, learner nurses (76%) reflected that this is not the case within the nursing training program, where expertise is sourced outside the department. For example, expertise in sociology, chemistry, physiology, anatomy, and psychology is offered by non-nursing professionals. Sourcing of expertise outside the department contributed to the slow throughput rate of the nursing program, with more learner nurses failing at the second level. Therefore, failure to alleviate shortages of expertise is an obstacle for the nursing training program. Similarly, Fawaz et al. [33] noted the desire for growing nursing experts that occurred from a shift in the age of the nursing workforce to ensure the successful implementation of the nursing training program.

#### *3.2.10 Criterion 10: program review*

Nursing programs aim to prepare nurses who can deliver safe and high-quality care and would be able to adapt to the evolving environments of practice. However, according to learner nurses (58%), nursing has not been able to prepare adequately prepared nurses to provide safe high-quality services due to various factors that impacted the implementation of the nursing program. A few of these various factors include an increased disease burden, an overloaded healthcare system, and a shortage of nurses in schools and clinical healthcare settings. Few of the learner nurses (8%) expressed the desire of having program evaluations annually to improve the implementation. To adapt to the rapidly varying and advancing healthcare settings; nurse educators must regularly assess and review education curricula, teaching-learning strategies, and programs [33].
