Confessions of a Clinical Instructor (CI) - Part I

Unfortunately, most nurses have no idea what it's like to be a CI or understand the position we occupy in the world of nursing education. This two-part article series is based on my experience as a CI and includes the harsh realities, valuable advice, and words of encouragement that I have collected. Part I looks the relationship between CI and their full-time colleagues from the college/university as well as the relationship with staff at the clinical site where they are working.

Confessions of a Clinical Instructor (CI) - Part I

Let's face it, no one ever made millions off of being a nursing clinical instructor (CI) or entered nursing academia for the glitz or glamor. Most people become a CI because they are (a) passionate about their specialty, (b) have a strong clinical knowledge base, and © genuinely desire to teach the next generation of nurses. One of the biggest challenges for any CI is trying to balance the need to prove their "academic chops" to their full-time faculty peers while demonstrating their "clinical competency" to students and the clinical staff of practicum sites.

What your colleagues think...

In the hierarchy of nursing academia the adjunct CI is about as low on the totem pole as you can get (a rung just above the graduate student TA, I suppose). The fact is that for most nursing programs you are desperately needed so that the full-time faculty can teach didactic courses and conduct the research that brings colleges notoriety and supplemental funding, but that does not mean that you are always welcomed. Attitudes towards adjunct instructors from the full-time faculty depend largely on the culture of your institution and the example set by the administration. Behavior can range from condescending, passive-aggression, limited acknowledgment and indifference, or a quiet respect for the clinical skills that you bring to the students' education. There is also the belief by some full-time educators that nurses who remain as adjunct CI do not possess the same spirit of scholarly inquiry and do not have the aptitude for terminal degrees or research. This mindset is isolative to novice educators and dangerous for the morale of a department, not only does it create a divide between faculty but discourages adjunct CI from seeking terminal degrees or full-time faculty positions in the future.

I consider myself lucky because the department chair of my program is a strong leader, supportive mentor, and remains open to suggestions about how to improve the clinical experience for students. With that being said, I received limited formal orientation to the role of CI from my program and sometimes I feel like I am on my own in uncharted waters when issues come up that are not addressed in the student or faculty handbooks. I have taken the initiative to meet some of the full-time faculty of my program, and they have largely been positive and professional. However, I wish there were more ways as a CI that I could become involved with projects at the college/university so that I could gain more experience in higher education.

Inadequate orientation for new faculty members can result in role confusion and feeling unprepared to assume the responsibilities of being a nurse educator, but sadly this is not a rare occurrence (Jackson, 2015; Schoening, 2009). Having a substantial orientation is a great start for new educators, but we must also take it upon ourselves to attend conferences, engage in continuing education, and network with experienced educators who can serve as professional role models and mentors. Experienced CI should also remember what it was like to be a novice educator and take the initiative to offer guidance and support to new CI colleagues; their enthusiasm and fresh perspective may recharge your passion in teaching as well.

What staff at the clinical site think...

When you first begin taking students to a clinical site the staff may be hesitant to embrace you and your students because they are not sure what to expect. As the instructor, it is your job to monitor what your students are doing to ensure that they are positively contributing to the care of patients and not engaging in behavior that is counterproductive, unprofessional, or dangerous. What you cannot change initially is the previous experience that staff at the facility had with other faculty and students from your school or the reputation that your program holds within the facility. If the staff have only seen condescending, incompetent instructors or students that impede care rather than contribute to it, then the staff will not likely embrace you warmly. If they have only seen knowledgeable, professional instructors with students that are proactive and helpful, then they are more likely to welcome you with open arms.

I have seen instructors who are arrogant and interact with the nursing staff as if direct care is beneath them, which leads to a poor learning experience for students. On the other hand, I have also seen instructors who are diplomatic, appreciative and acknowledge the contributions of staff to student learning, which leads to a richer experience for students. In my experience, nurses at clinical sites have a wide variety of views about CI. Some nurses place minimal value on the graduate education of a CI or feel that instructors only teach because they "couldn't hack" bedside nursing. Other nurses appreciate the level of education required to be a CI and may even seek out the expertise of a CI when they have students on the unit.

Lastly, how instructors end the semester is just as important as how they begin the semester. It is not uncommon for an adjunct CI to be dismissed by a college/university from teaching for the following semester if a clinical site reports to the nursing program that they would not like to have a CI return to their site. One goal for every CI as a representative for their college/university is to maintain a positive and professional relationship between a nursing program and the clinical site. A small but significant gesture is that I make a point of ending the semester by bringing a gift to the nursing staff of the unit that I bring my students to which usually includes a thank you card and food/baked goods (pizza and cake are my personal favorites). I do this to show them our appreciation for all that they do but also to ensure that the nursing staff and management team remember our students fondly and will continue to welcome us back each semester.

Read the 2nd part of this article at Confessions of a Clinical Instructor (Part II)

References

Jackson, B. A. (2015). Nursing students' and novice clinical instructors' experiences with clinical instruction and assessment. Walden Dissertations and Doctoral Studies. Retrieved from "Nursing Students' and Novice Clinical Instructors' Experiences With Cl" by Bridgett Alveta Jackson

Schoening, A. M. (2009). The journey from bedside to classroom: Making the transition from nurse to nurse educator. Educational Administration: Theses, Dissertations, and Student Research. Retrieved from "The Journey from Bedside to Classroom: Making the Transition from Nur" by Anne M. Schoening

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cjcsoon2bnp

About cjcsoon2bnp, MSN, RN, NP

cjcsoon2bnp has been a registered nurse (RN) for six years and his specialties are emergency nursing and psychiatric/mental health nursing. He recently completed a MSN in Nursing Education degree and is currently pursuing a post-graduate certificate in family nurse practitioner (FNP) studies. He also teaches as an adjunct clinical instructor and is interested in problem-based learning, ethical dilemmas in nursing, and promoting success in the workplace through professional mentorship.

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As a nursing student going into her final semester, I really appreciated your insight. I have had a few adjunct professors in my program who seemed to have no idea about the online class format we use, grading, or tests and have always chalked it up to being unprepared much to my disappointment. This gives me a new outlook that it may be they themselves have not been given the proper orientation to learn these things beforehand. Many of them seem like fish out of water in the clinical setting but I forget they are human too and getting used to a new role is not easy!

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Specializes in Emergency Nursing.
SaltySarcasticSally said:
As a nursing student going into her final semester, I really appreciated your insight. I have had a few adjunct professors in my program who seemed to have no idea about the online class format we use, grading, or tests and have always chalked it up to being unprepared much to my disappointment. This gives me a new outlook that it may be they themselves have not been given the proper orientation to learn these things beforehand. Many of them seem like fish out of water in the clinical setting but I forget they are human too and getting used to a new role is not easy!

Thanks for sharing your experience! I will say that it highly likely that these adjunct faculty members received insufficient orientation, especially if the classes are in an online format. Online teaching is becoming a big new frontier in nursing education and while many educators have jumped to sign up to teach online courses it doesn't mean that everyone has the right skill set to be an effective teacher in that type of setting. I'm very interested in teaching online courses but am struggling to get my food in the door. I was in an online program for my graduate program and have helped to design course sites using the Blackboard/myCourses format but right now most institutions are looking for instructors that are seasoned/experienced and hold a doctoral degree in order to teach online courses.

!Chris :specs:

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cjcsoon2bnp said:
Thanks for sharing your experience! I will say that it highly likely that these adjunct faculty members received insufficient orientation, especially if the classes are in an online format. Online teaching is becoming a big new frontier in nursing education and while many educators have jumped to sign up to teach online courses it doesn't mean that everyone has the right skill set to be an effective teacher in that type of setting. I'm very interested in teaching online courses but am struggling to get my food in the door. I was in an online program for my graduate program and have helped to design course sites using the Blackboard/myCourses format but right now most institutions are looking for instructors that are seasoned/experienced and hold a doctoral degree in order to teach online courses.

!Chris :specs:

How do you like your online classes? Did it impede your FNP learning ability( assuming that is what you are going for )?

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Specializes in Emergency Nursing.
injured1 said:
How do you like your online classes? Did it impede your FNP learning ability( assuming that is what you are going for )?

I was in an online program for my MSN in Nursing Education and I really enjoyed it. I did not decide to go through an online program for my Post-Master's Certificate in FNP studies for a few reasons. I think that there are a lot of great online programs out there and many have solid NP offerings but finding your own clinical placements during school and the challenges you can experience with finding a job after school are what concerns me so I decided to go with a local program that has a strong reputation.

!Chris :specs:

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