"Flipped Classrooms" for nursing internships

nurse2033, MSN, RN · Jan 18, 2014

Which is why my next thesis will be "Benner was an optimist". That's why 65% of nurses never get past advanced beginner.

I guess that also explains why 49% of nurses are below average.

nurse2033, MSN, RN · Jan 18, 2014

This is a wonderful instructional model. The students are expected to do all of the "lecture-y" stuff via self-study prior to class. Then, class time is devoted to interactions designed to apply or enlarge on the material. It has been reported to be much more engaging than the typical lock-step instructional models. An example: students review ESI (triage) criteria prior to class. In class, the instructor presents "real life" ED arrivals (actors, videos, case studies, etc) and hits a buzzer... students are asked to immediately hold up cards assigning a triage level. The instructor facilitates discussion and learning. It feels like a game, but it's a very powerful learning exercise.
I have introduced this to my clinical educators - they are enthusiastic and want to use it . . . BUT they report ongoing problems with participants just failing to do the prep work. Most of the participants won't do anything on their own - they want everything handed to them; if we ask them to do anything on their own, they want to know how we are going to pay them for the time it takes. Srsly. It's a catch 22... according to FLSA, employers have to pay for any education mandated for non-exempt staff.
Are you having the same problems?

I assume you are talking about professional education. I believe it is unethical to ask employees to "work at home" without pay. When I am home I have other responsibilities. Educators should appeal to managers to provide money to pay for education. In a typical 36 hour work week, 4 hours of education can be added without incurring overtime.

Utilizing "down time" is a typical, low hanging fruit, lame, poor excuse for a solution. Nurses are having less and less down time as efficiency is cranked up. I agree that even if there is down time, it is full of distractions and not a good learning environment. Down time might be a good time for supplemental education, but not required education. You could send employees to a break room for 2 hours to study and rotate among staff members. But most units will send someone not needed home. Again, this is where educators must seek and utilize some degree of power to fulfill their mandate.

I think the model discussed here would be excellent for students however. They have to do a lot of home study anyway. Perhaps one way to deal with the preparation problem is to give them a test prior to class. The test would verify that they did study the material.

CraigB-RN, MSN, RN · Jan 23, 2014

I"m confused as to why it's unethical to ask a professional to be prepared for a class they are taking. When I'm teaching my Trauma Nurses Specialist class, I expect to be able to spend 4 hours on practical application, not spend 2 hours or whatever going over basic anatomy & physiology, signs and symptoms. I want to spend the time on application. I'm not talking about studying for a 4 credit course or anything like that. whether you do read the material, watch the video, whatever, I don't care when you do it, home, downtime, in the bathroom or wherever, just be prepared when you get to class

Doesn't being considered a professional also bring with it certain amount of responsibility? Like reading at home? Off the clock?

Yes it can be overdone, and that is something that you have to keep an eye on.

llg, PhD, RN · Jan 23, 2014

I"m confused as to why it's unethical to ask a professional to be prepared for a class they are taking.

It depends whether or not the education is voluntary or mandatory -- and if the employee is exempt or non-exempt. I am an exempt employee, with flexible working hours and a certain amount of flexibility/freedom in my job. I am allowed to leave work a little early if I can, come in a little late, linger at lunch, etc. I am not paid by the hour: I am salaried. Therefore it is not illegal (nor unethical) for my employer to ask me to work extra for no pay. "It evens out in the end" if you know what I mean.

But non-exempt employees are treated differently by the law -- and that changes the ethics of the situation. Non-exempt employees are not given the same degree of freedom in scheduling, work hours, etc. The "contract" they have is paid by the hour worked, not on the basis of their overall contribution to the employer's facility. They work under a different set of rules and have to deal with the negative aspects of those rules as well as the benefits. They enjoy the benefits of overtime pay, shift differentials, holiday pay, etc. in exchange for giving up things like schedule flexibility and autonomy.

Non-exempt benefit: Extra pay for extra work and for working unpopular shifts. Certain protections of "due process" in disciplinary actions.

Non-exempt disadvantage: Less schedule flexibility (and maybe more -- less autonomy, smaller benefit packages, etc.)

Exempt benefit: Schedule flexibility, more autonomy, sometimes better benefits overall

Exempt disadvantage: Not paid extra for additional work, no shift differentials, no holiday pay, etc.

By asking an non-exempt employee to work extra for free ... you are asking them to bear the disadvantage of the exempt employees without giving them the benefits those employees enjoy. The employer who does that is trying to "have it both ways" -- to the employer's benefit and to the worker's detriment. That is why it is unethical (and illegal).

I hope that explanation makes sense.