Teaching professionalism?

[beckinben, CNM]

Another question from a newbie clinical instructor...

My school has asked all the clinical instructors to have a clinical conference devoted to the issue of professionalism (yes, this is a result of several students displaying less than professional attitudes in clinical last week). Any one have any suggestions for me on how to do this? I was thinking of a case scenario where they have to work through dealing with unprofessional behavior from others in hopes of getting them to recognize it, but I'd love to hear any other ideas as well.

Thanks!

Becki

[BeenThereDoneThat74, MSN, RN]

That sounds like a good idea. How much time do you have? Do you have other faclty to help you (like to role-play)? I know our students get a kick out of role-playing, because iit makes it a little more fun, and less of a snooze-fest. It's hard to sit there and lecture, saying 'don't do this, don't so that' (you'll sound like their mother!!). Even give tem scenarios where one needs to be a b*tchy nurse, and the other needs to be the nurse manager, or a disgruntled patient, or the nurse who comes in dressed inappropriately, or late, etc. My hosp where I work per-diem did that in a customer service class. I got to be the nurse who had to tell rthe family member to get off the cellphone, and she was difficult. It was difficult to stay diplomatic, but it was fun!!

[caroladybelle, BSN, RN]

G-d help, it is sad that people need classes in this but they do.

Topics:

- Proper attire at work. Need to coordinate color of underclothes with what is worn over them. Need to bring proper coverups.

- Teach them that the cell phone goes OFF at work. That family/friends/lovers do not call work unless there is an emergency. Teach them what a true EMERGENCY is and that if it occurs more than twice per week, week after week, maybe one should reconsider work. That you do not leave work unless there is an emergency - and that is not when you loan your car to your lover of this week, and then get ticked that he is using it to party with another girl. That if you call in, it needs to be timely. That you plan your life and not expect others to accomodate you routinely at the last minute unless absolutely necessary.

Home is home and work is work.

- Require students to come to a class dressed in proper interview attire, and write a CV or resume, with a cover letter, that is professional. That they get to participate in mock interviews.

- Discuss the need to network, how to handle difficult work personalities, and brain storm professional difficulties with ethics, behavior, and legal issues.

- teach them reality. Despite the so called nursing shortages, they WILL work holidays, weekends. They will have nasty coworkers at times, deal with really difficult MDs, and feel put upon when rules get seemingly unfairly broken. And yet they have to learn to rise above it and not get mired in it.

[ukstudent]

From a student's point of few. Have clear written rules for dress and conduct. Enforce the rules from day one of clinicals, evenly for everyone. Have students during class at different points give presentations (my school gives points for professional dress and condut while presenting). And last but most importantly make sure that the teachers and clinical instructors demonstrate professional behavior.

[cholli]

We have a "uniform parade" before the first clinical and the peer group gives feedback on hairstyle, underwear, jewlery, length of pants etc.

I did a clinical postconference on professionalism last week, took a list of professional traits and definitions ie repectful, grooming, responsibility etc and gave to students in groups of 2 to role play, it was a crack -up especially since we are usually trying to stay awake that time of day. There was a lot of nursing instructor/nursing student interactions role-played....

The hard part is: they know what professionalism is- just don't always practice it!!!

[barb4575]

Cholli,

Those are terrific ideas for a postconference and I will remember it. In my clinical postconferences, we have always discussed professionalism because it is a debriefing time as well. There has always been at least one staff member that the students do not want to work with and it is usually due to their behavior. So, the behavior of the nurse would be discussed and it is imperative to focus on the behavior, not the RN. It is also important that students are aware that postconference is confidential.

A perfect example is when a student really liked this staff RN and considered her a "good" RN. However, she learned that being nice does not equate with the standard of being a "good nurse". This particular RN made four major errors in her practice that we witnessed. I evaluated each incident and when I decided it was unsafe practice, I reported it to hospital representative.

The bad part was that the nurse was spoken to by the clinical nurse specialist/educator and the nurse was hateful to all of us for the remainder of our clinical time. I also believe that the nurse discussed this with one of my students.

The good part is that this particular student did withdraw. She was the same student who's first patient requested that she not take care of her any longer. The staff RN informed the student not to tell me or she would get in trouble. I found that action highly unprofessional and inappropriate.

When I did find out, the patient was so upset. A nurse manager and the staff RN had already been in her room discussing these issues. With ten minutes of talking to the patient and explaining that the student would not be back in that room, she was fine. The patient went a step further with her discussion and stated that it was her opinion that this student should not be a nurse. This was a first for me.

Barbara

[Nurseonwheels]

Point out good role models. They are probably already known to others. I often find the conversations that go on between nurses are unprofessional for the workplace. Perhaps bring up communication techniques and topics that should be off limits. Good luck.

[llg, PhD, RN]

Cholli,

Those are terrific ideas for a postconference and I will remember it. In my clinical postconferences, we have always discussed professionalism because it is a debriefing time as well. There has always been at least one staff member that the students do not want to work with and it is usually due to their behavior. So, the behavior of the nurse would be discussed and it is imperative to focus on the behavior, not the RN. It is also important that students are aware that postconference is confidential.

A perfect example is when a student really liked this staff RN and considered her a "good" RN. However, she learned that being nice does not equate with the standard of being a "good nurse". This particular RN made four major errors in her practice that we witnessed. I evaluated each incident and when I decided it was unsafe practice, I reported it to hospital representative.

The bad part was that the nurse was spoken to by the clinical nurse specialist/educator and the nurse was hateful to all of us for the remainder of our clinical time. I also believe that the nurse discussed this with one of my students.

Barbara

I am sure that you did your best to be diplomatic and fair in the situations discussed above, but I just want to point out that this is one major reason that staff nurses sometimes don't like to have students on their floor. Sometimes the staff feels that they are being scrutinized (and judged) by people they don't know well enough to trust. Students often wonder why staff nurses aren't more welcoming: this is one of the reasons why.

For example, we had one instructor at my hospital who regularly assigned her students to watch for examples of poor practice, make written lists, and discuss them in post-conference. These examples were then reported to the nursing management. In some cases, the students and the instructor were wrong in their assessments of what was considered appropriate and that added tothe tension. With assignments like that, it's no wonder that the staff nurse did not like to have that instructor and her students on their unit! It got so bad that we finally had to insist that the instructor not make those assignments any more. We had to tell her (and her supervisor) that if she could not be more supportive of our staff (and stop looking to find fault all the time), she would not be allowed back to teach at our institution.

Certainly, it is appropriate to discuss questionable practices with the unit's leadership team (and with the students) -- but instructors and students need to remember to be very careful about how they do that.

[barb4575]

I agree with you, llg. I would never make such an assignment, but if the students are upset about it--it does need to be addressed. Like I said, postconference is also a debriefing. Often times, the outcome is that the student misunderstood what was appropriate and what was not. They also have those rose-colored glasses on and have to be reminded that they have 1-2 patients and not the caseload that the staff nurse has...when it is addressed in this manner, they often times understand the situation and the nurse better.

If there is something that is observed and it was inaccurate, it is best to discuss how it could have been handled better and not a discussion about the RN. Issues that occurred this last rotation included: sterile dressings not being performed per sterile technique and not even washing hands between dirty and clean dressing changes, throwing dirty linens with BM onto the floor, not verifying identity and birthdate when administering meds (this is their policy), no discharge teaching, and not wearing gloves with injections and IV inserts. These are things that I want them to know are absolutely inappropriate.

Barb

[cholli]

It certainly is difficult, for the most part my students observe good practice. I am always glad when they are able to identify what is improper about a technique/practice. I always use this for a discussion starting point about decision making and how they will choose to practice. I have very rarely gone to a manager about any individual nurse's practice- if I am the one seeing it, I try to correct diplomatically in the moment-"what size gloves do you wear, I will grab them for you".

I always remind my students that we are not there to evaluate the staff but to care for the patients...

[Nurse Beth, MSN]

Specifically, what kind of behavior was involved that was unprofessional?

Do you feel this class is needed by all, or is this a disciplinary issue?