Calling all (good) clinical nurse instructors-help needed!!

DoubleJRN · Mar 1, 2011

I can't believe noone has any feedback, so I changed my username in case anyone thought it was lewd (it wasn't, theres a good reason behind it). Any help is appreciated....

classicdame, MSN, EdD · Mar 2, 2011

really hard to answer in this forum as it takes lots of words to get the concepts across. Instead of standing around the student can attach themself to a nurse and assist, observe all sorts of things, even if not within LPN scope of practice. Anything they see helps understand what patient is experiencing. Hope someone else with more recent clinical exp. will respond!

CT Pixie, BSN, RN · Mar 2, 2011

Not being an instructor or even an RN can I chime in as an LPN in LTC.

I, for one, LOVE grabbing a student that's in our facility to watch a procedure I might be doing, or a treatment. Or just to shadow and watch how the MAR/TAR is done and how we document things. Or even just showing them something on a resident that is common place to the more seasoned nurse (for example, I had an actively dying resident and the family ok'd students being able to care for the resident) I'd show them the s/s of actively dying people. The breathing patterns, the mottling, etc. They had never seen anything like that they only read it. I remember a particular nurse in one of the facilities I did clinicals in, she was always grabbing me and pulling me in to watch or assist with something. I loved it and learned so much from her.

If possible while you are observing the small group, maybe you can find out which of the nurses are willing to have the students shadow us.

DoubleJRN · Mar 2, 2011

Thank you both so much for responding. Classicdame, I have never had the students shadow anyone besides myself, and I think this would be very helpful. CT Pixie, your input as an LPN in a LTC is perhaps more valuable than an instructor or an RN, so thanks again. Thanks again for your input.

allnurses Guide · Mar 4, 2011

Have you thought about some skills that don't need you right with them, the kind of stuff that "would be nice" if someone just had the time? Such as passive ROM of some of the bedridden, foot care on diabetics (learning to trim nails and assess), getting some extra PT or exercises for WC bound folks?

Long ago in an LTC I was at, the physical therapist was only part time. One day I happened in on a group session, and we did silly song exercises such as "head shoulders knees and toes" or "hokey pokey", and the residents got quite a chuckle and some exercise out of it. The PT asked if I could come regularly! but as we all know, LTC nurses don't get a lot of "down time" to do that. Getting people moving is truly a nursing skill, and assessing how residents respond (both increased ROM and attitude) could be a project.

DoubleJRN · Mar 5, 2011

:yeah:Thank you so much for your awesome suggestions. I also finished reading the tips for improving the clinical day that were posted by VickiRN, and they were excellent as well. Thank you all SO much because I feel excited and anxious to get to the facility tomorrow, and that hasn't happened in a while! I knew that I wasn't doing the best possible job for my students, and that truly is my goal. Thanks again to you ALL!!:redbeathe

TooterIA · Mar 7, 2011

Well the first problem is 9-11 students. I would not work for a college that allowed that many in a clinic group, but that is just me. I usually have 5-7.

Some things I do:

Rotate students out to do other experiences. Each student gets one day with the assistant living nurse, treatment nurse, charge nurse, and rehabilitation nurse. This only works if you have quite a few clinic days so everyone gets a turn and they still have enough days on the floor to do skills.

On the first day, observe everyone do a set of vitals so you know they are capable. Then each clinic day, have each student go do vitals on a group of residents. At this early stage in their nursing career, the more BPs they do, the better they will become at it.

Each day one or two students does a head to toe assessment. I watch to make sure they are capable. Then, on other days, they can assess pts on their own. Again, the more they do, the better they become.

Always have a stack of activities for them: worksheets on meds, case studies, etc.

Make sure the nursing home staff know they are there as NURSES. I just make it very clear each day to the staff nurses and CNAs that if we are caught up, we will be glad to do baths, answer lights, etc, but they first need to get all their other stuff done.

How long of a postconference do you have? I have an hour where we talk about the day, then do activities. Each student is assigned to bring a game for one day (like medication BINGO, crossword, etc) that we do as a group. Another student has to do a presentation related to the elderly, on their topic of choice. I get great feedback from students on this type of postconference.

DoubleJRN · Mar 8, 2011

Thanks so much. Your suggestions sound awesome. This past Saturday, I rotated the students out to assist nurses on other units with their med passes, and that worked really well. We usually have an hour postconference as well and we usually use the time to review different experiences that the students had, as well as reviewing NCLEX questions so the students can become comfortable with the required critical thinking. Thanks again, I can feel myself growing as an instructor

AOx1 · Mar 15, 2011

Here are a few more options:

Form small assessment groups. Have the students in groups of 2-3 go to a patient's room and perform a physical assessment (assuming the patient does not mind). The instructor also assesses the patient. Findings are then discussed. We also do this with a targeted assessment. For example, if a patient has pneumonia, I ask the students to demonstrate the most important components of a physical assessment.

I have also had the students perform clinicals cases on walking rounds with their small group (again, only if the patient gives permission). The students must first look up the diagnosis and form a basic plan of care. They discuss this with the resident/patient and include their input. Then, they present the case to their small group at bedside. They must include the resident/patient and not discuss them as if they are not present. The resident/patient is offered the chance to discuss how illness or being in the hospital or LTC has impacted their life.

We pull labs and compare them, both over the course of an illness and between patients. For example, I might point out a low albumin level and ask the students if they think this patient might be at risk for increased side effects/medication effects. I have them compare lab levels since admission or since beginning of a treatment regimen and ask if the treatment is working.

We also have medication day at post-conference. Each student is to describe a medication they have given that week and tell us one new thing they learned about administration and evaluation of the medication.

We discuss things like the National Patient Safety Goals, HIPAA, Insitute of Medicine Competencies, etc and how they might apply to a nurse.

Part of it depends on what level of student you are teaching. For basic students who are anxious just going in the room, their first task is simple: they go to introduce themselves with a classmate and must learn one new thing about the resident or patient. I also let them play a "game" in which they are then asked to list all the things they noticed about the room. Their ability to quickly observe and assess grows quickly. For example, on their first day in the hospital:

me: "Did the patient have IV fluids?"

student: "I'm not sure."

At this point they are nervous. I teach them that clinical decisions must be made quickly, and to always observe things like overall color, mentation, affect, speech, activity, presence of IV or other meds, foley, and all the things in a quick basic general survey. By the end of the rotation, they are getting much quicker and more accurate in their observations.

Those are just a few. I also don't try to give all meds with all students in a day. For example, I might give early morning meds with three students, then afternoon meds with two more. The next day, I give meds with the rest of the clinical group. I like to have time to discuss the medications thoroughly with the students.