Advice For a New Instructor Please!

PositiveEnergy, MSN, PhD, RN, APN · Feb 6, 2023

The first thing that jumps out at me is not to give the staff the task of writing out your student assignments. You might involve the staff by asking them which patients might benefit/appreciate having a student assigned to them and what nurses are most receptive to having students assigned to them. Remember, you know what your clinical objectives for the day or clinical course are, so you would be the best one to make assignments that best addresses the students needs. Many times staff have a totally different perception of what students should be focusing on. An important piece for you is to be sure the staff understand what the students are focusing on that semester in clinical. Take the time to share this with the staff. You would be surprised how many nurses will then seek out students to participate in something that is occurring at the moment which addresses their objectives.

To prevent students from standing around you have to get creative: Some things I always found helpful:

1. Discuss not standing around in groups with the students. Share you would prefer they not hang out in groups even if they are "charting" or working on their client's plan of care.

2. Suggest they volunteer to do some activities they have been passed on that might help the staff - even if they think little of the task they will always take something away from the experience and improve interaction skills. First, though they must be on target with their assigned patient's care. Example: tell staff they will do vital signs on all the patients in the unit at a particular time (including charting of the vitals). Have students volunteer to assist the nurses in little task like re-positioning patients, spending time talking or sitting with patients, answering any of the ringing "call bells" not just their patients....whatever you can think of to give students learning experiences. Some students might gripe but other will be happy the day goes by quickly and they are helping both patients and staff. In time I have found nurses will come to appreciate your students and be glad when they know your students are coming on.

3. If the staff member is agreeable assign students to shadow nurses or other disciplinary members that interact with patients on your particular assigned unit - example med nurse, charge nurse, an IV nurse, a physical therapist, play therapist (great for peds rotation), social worker...There is alot of take away for their own future practices by sharing in such interdisciplinary activities. Their future patients might benefit.

4. Most in-patient facilitates still have physical libraries. If a question comes up or there is an "interesting patient scenario" (even if not one of the students assigned clients) assign 1 or 2 students to go to the library, if reasonable close. If only an e-library is available have them use this. Be sure and have another student/s cover the leaving students patients. Have the students look up related information and plan for them to share what they found in a post conference.

5. Ask students for ideas of how they think they might be able to add to the units functioning. Even if they work in pairs for moral support.

6. Ever think about having students go in the unit's supply closet/shelving area and ask themselves "what might this item, tube, instrument...be used for? Do I know how to use it? Can I explain the use/purpose of everything here. By encouraging students to check these kinds of items out when they have down time imagine how much quicker they might retrieve those tubes or instruments in emergency situations. They would know where it is and what it is. Think about all the wasted time in emergencies because people have no idea how to use or operate a needed item.

Just remember - any activity is a teachable moment for students. Even if it isn't obvious to the student at the moment. You might have to remind them of this when you come up with a creative idea that no other instructor has encouraged them to do. Just remember they have to meet their assigned patient's needs first.

Hoosier_RN, MSN · Feb 6, 2023

I'm going to add, yes, the unit manager has every right to direct that manual pressures be done. Sometimes dynamaps, etc are scarce and employees need first. Using an outside electronic is usually against facility policy. Your class is there as guests, the employees are there doing their daily groove.

That said, realize that many nurses are working short staffed, and are doing their best, so find the patients and nurses that are more receptive to students. I used to arrive an hour or so early just to get this info. Some days are better than others, some nurses and patients are more/less receptive.

Like suggested prior, find out the extra activities like scopes, x-rays, other testing, that may be going on, and plan to send a student with the patient. Also, task lists are helpful as well.

Think back to when you were a student, and a direct patient care nurse, what do you think would have been good experiences?

Home Health Columnist / Guide · Feb 6, 2023

Allnurses Nursing Educators, Faculty has advice for new instructors + provide peer support.

Check for a library or conference room in another section of hospital where your students can gather for conference and use resources.

PositiveEnergy, MSN, PhD, RN, APN · Feb 6, 2023

"The energy is kind of bad on the unit." "My students literally cried about..."

I read these statements above and had flashes of all the conferences, papers written, general presentations, and professional dialogue on "Nurses Bullying Nurses" or "Nurses Eating Their Young" and I hear this sentiment here. Honestly, it feels like we talk and talk about this behavior, but it still keeps happening. And here we have novice nursing students learning from the modeling of senior nurses and what are they learning on how nurses treat one another. I only hope they say when I am a "real nurse" one day I am never going to treat students like I was treated. I am going out of my way to show them the ropes.

JKL33 · Feb 7, 2023

PositiveEnergy said:

Honestly, it feels like we talk and talk about this behavior, but it still keeps happening.

All the papers and the talking and lecturing should have been aimed at a lot bigger audience. Specifically it should have involved the ones crapping on, short-staffing and then constantly criticizing staff-level nurses day in and day out, which in my opinion has only accelerated in recent years. Nothing [else] has changed (for the better)--why would sentiments and attitudes improve? Just because staff-level nurses have been lectured that they must stop the NETY and the "violence?"

I don't say this to mean the behavior is excused--just that it should come as no surprise.

I work in a different environment now (no longer inpatient). In this particular workplace employees (RNs, MAs, clerical staff) are treated far better than I have ever seen before...and all I can say is how positively people respond. There is exceedingly little drama, complaining and poor interpersonal conduct. Which only reinforces my beliefs that I wrote in the first paragraph. You can't kick a dog all day and then be all exasperated about why he is running away, whimpering, snarling, growling or even biting people.

Now I'm going to probably really make some people mad, but here is another take of mine:

New-Instructor said:

My students literally cried about it

That also is unacceptable.

Since the students do not have enough to do such that they are congregating around the nurse's station (which should have been a big obvious no-no from the word go), in addition to the excellent suggestions in the posts above mine I would consider giving bonus points to whomever is willing to take on the challenge of building rapport with various staff members. They can summon up courage and get in there like many of the rest of us did. I have learned so much from a handful of nurses over the years, each of whom were rumored to be either difficult or standoffish or some other scary thing. I think student nurses still need to learn rapport building in difficult circumstances? That hasn't changed and is a skill they're going to need for patient care, let alone working with other disciplines and their own peers.

klone, MSN, RN · Feb 7, 2023

JKL33 said:

I think student nurses still need to learn rapport building in difficult circumstances? That hasn't changed and is a skill they're going to need for patient care, let alone working with other disciplines and their own peers.

This bears repeating.

Also, I am reminded of a particular nurse at my first job as an RN. I had started there as a student extern and she had a rumor of being "NETY". When I made an error as a student, she is the one who caught the error and VERY bluntly. told me what I did wrong. She scared the heck out of me, and I always avoided her. Over time as I gained experience and confidence a an RN, I learned to recognize her for who/what she was - a wonderful source of knowledge. 4 years later, she wrote me a letter of recommendation for midwifery school.

Hoosier_RN, MSN · Feb 7, 2023

klone said:

This bears repeating.

Also, I am reminded of a particular nurse at my first job as an RN. I had started there as a student extern and she had a rumor of being "NETY". When I made an error as a student, she is the one who caught the error and VERY bluntly. told me what I did wrong. She scared the heck out of me, and I always avoided her. Over time as I gained experience and confidence a an RN, I learned to recognize her for who/what she was - a wonderful source of knowledge. 4 years later, she wrote me a letter of recommendation for midwifery school.

Sometimes people are called out for bullying, when in actuality, they've just stated something in a way that wasn't the way the receiver of the message wanted to hear. I've been told in the past that many see me as mean/gruff, but come to realize that I'm just direct, so that there's no mistaking the message. I'm also the one who will have your back and die on that hill for you, if you've done your job as it should be done. The ones who are "nice" are usually passive-aggressive, and are in the bosses office all day telling on every little infraction known to man. It just goes to show that bullying isn't always bullying

JBMmom, MSN, NP · Feb 7, 2023

I think it's natural for the students to congregate initially, but they have to be refocused into spending time with patients and staff. That's how they're going to learn. Can you give each student an additional assignment about assessment/history for their patients? Give them tasks that require they spend more time in the room with their patients? That will help the nurses because they can do things like get the patient a drink or maybe see how the techs help them ambulate to the bathroom. The patients, for the most part, will also love the extra attention. Can they be assigned a teaching point on medications or discharge instructions for the patients? And yes, manual blood pressures are a great thing to have them do! Building the basic skills is SO important- I still ask ICU nurses for manual pressures all the time, relying solely on bedside monitors is not good practice.

We were almost always assigned a nurse for the shift. Some were great, some were not, but it's a representation of the real world they will be joining.

Best of luck to you and your students.

allnurses Guide · Feb 7, 2023

New-Instructor said:

This unit manager is also asking for manual blood pressures from the students. And she wants them in the chart. Is that normal? I felt like I should be the one telling them if I want them to do manuals. I know they will be asking me to double check all their manual pressures. They were checked off on those last semester and I would rather move on to higher level skills before they go to the next course.

IMO every nurse should be able to take manual BP. When you put your hands on the patient to do thi you learn valuable information for your assessment. Also the machines are not always accurant and can require some pretty odd adjustments to get accurate number. I will tell you more about fuzzy logic later.

Hppy

JBMmom, MSN, NP · Feb 7, 2023

hppygr8ful said:

I know they will be asking me to double check all their manual pressures. They were checked off on those last semester and I would rather move on to higher level skills before they go to the next course.

The skill might seem basic, but once they were checked off how many of them really retained proficiency? Repetition is NOT a waste of time. Have them do more in depth assessments related to cardiology and pulmonology. How many nurses finish school and are still not confident on their heart and lung sounds? I know I wasn't. Because we got checked off and moved on, not really incorporating everything into the next set of skills. If one student has a patient with a heart murmur, or rhonchi- get the other students in there to hear it. If the nurses on the floor see some value in having the students there, like they can address small tasks to help the nurses, then they might be willing to look out for things the students might want to see. They have to be very active participants in their clinical learning and while they may have gotten off to a rocky start with the nurses, it's still early in the semester, they can end up great! (Maybe bringing in some cookies as a thank you to the nurses or something will help them thaw a little bit)

vintagegal, BSN, DNP, RN, NP · Feb 7, 2023

I teach at a rural for profit hospital. The first day if looks could kill! I strolled up to the unit, pulled the charge aside and boldly proclaimed "wow what a great opportunity for your nurses and these students to learn civility ! This is going to be a tight fit with everyone but aren't you so glad our small community has now expanded to have a major university creating new nurses for our shortage?” Yeah the charge wasn't impressed but she was too embarrassed to act like a fool.