Before you begin, investigate the floor in which you will be having the clinical. It is our responsibility as nurse educators to facilitate our students' education. In other words, we partner together with our students for their learning. It is our responsibility to create the best environment possible for learning. Cultivate an amicable learning environment by meeting with the unit manager and unit educator. Chat informally with some of the nurses just to get a "feel" for the floor. Attend one of their unit meetings or change of shift report sessions, just to give them opportunity to know you better and to be comfortable with you. Discuss the clinical expectations and limitations. Find out which nursing staff would like to work with students. This little bit of "PR" work up front can earn tremendous dividends later. You may want to "shadow" on the unit for 6-8 hours; this will help you become familiar with supplies, policy and procedures, medication delivery systems, IV pumps, charting, and primary care providers.
It is very helpful to bring some "goodies" at the end of the semester to leave on the floor as a gesture of appreciation. All the students in the clinical group should sign a thank-you card to leave on the unit after the semester is finished.
Other Suggestions
Have clear expectations, even to the point of "stating the obvious." Make a list of things students should be doing to help organize and prioritize their day. Set deadlines and remind them often. This is especially important with first semester students, who often have little prior clinical experience. Include the basics of hand hygiene, communication with staff and patients, safety, and documentation.
Require students to research their patient assignments before coming onto the unit. This maximizes precious clinical time and enhances student learning, as well as the quality of their patient care.
Start each semester with very basic assignments. Have objectives for the day and stick to them. Start simple and evolve to more complex assignments as the rotation progresses. At the same time, set the bar high for expectations. People tend to rise to the level of whatever is expected of them. Be consistent and objective, and follow the facility's and school of nursing's protocols and guidelines.
Consult with the charge nurse or staff as to suitable patient assignments for the students. Make sure the total assignment load is realistic (and not overwhelming or unsafe) for the clinical instructor to manage.
It helps immensely to assign a "student charge nurse" or "team leader" role to rotating students each week. This "student charge" will be your right hand person, strategic in keeping the other students on track during the clinical day. This arrangement works well, even with first semester students.
Communication
Cultivate open communication. If you encounter a problem with staff on the floor, don't just ignore the problem, but address it at the point of conflict in a professional manner. Go up the chain of command if necessary, until the situation is satisfactorily resolved. Work diligently to maintain positive communication with the nursing staff and the unit manager. That good rapport on a unit is worth its weight in gold, but sometimes takes a lot of work.
Always treat your students with dignity and respect. Strive to be fair and consistent. Intimidation makes for poor learning. We certainly cannot be personal friends with our students or cross professional boundaries by becoming "buddies," but we should encourage them and let them know we are invested in their success. There is a right way and a wrong way to correct a student. When you must correct a student, (if at all possible) never do so in front of the patient, staff, or other students. Correct in a private area, as soon after the incident as possible. Start out with a positive statement, then gently bring correction, then end with another positive comment (the "sandwich" approach).
On the other hand, issues concerning patient safety can never be compromised. These situations require immediate intervention. Also, I do not tolerate an "I do-not care" attitude, sloppiness, laziness, being late for no valid reason, lack of preparation, or treating the staff/ patients rudely. If you do encounter an unsafe, ill-mannered, or unprepared student (which, thankfully, is a rare occurrence), make sure you document the situation thoroughly and objectively on the student's clinical competency form.
Conferences
It is a good idea to have a "quick" pre-conference before the students go out on the floor, to go over patient assignments. You can also quiz the students as to which of the patients has the top acuity or the best way to prioritize the day.
The post-conference is an invaluable time for the students to debrief, discuss patient concerns, and share insights and knowledge they have gained. You can also question them about patient diagnoses and other pertinent matters: "What does congestive heart failure mean in your own words? How has this affected your patient? Why is Impaired Gas Exchange in the nursing plan of care?" Aim to inspire enthusiasm and critical thinking in your students.
Being a clinical instructor is a challenging position, but with adequate planning and preparation, will prove to be a very rewarding experience. It is thrilling to watch the students grow and develop over the semester and to witness the "light bulb" moments, when it all starts coming together.
