Determining faculty clinical competence

[llg, PhD, RN]

My hospital is having an issue with the competence of some of the faculty members that are sent by the schools to supervise student clinical experiences. We are considering the establishment of a formal process whereby we must "approve" of the faculty person before they can supervise clinicals here. I am therefore searching for ideas.

How does it work where you live and teach? How do hospitals assure that the faculty members are actually competent clinically before allowing them to supervise patient care activities?

Thanks,

llg

[Corey Narry, MSN, RN, NP]

I am not sure if a protocol is in place regarding the issues you mentioned in our hospitals in this area. A few years back, I was employed as a clinical instructor for a semester at a community college teaching Med-Surg 1 clinicals at a community hospital and I was not required to present any documentation of my credentials during my courtesy meeting with the hospital's education director. By the way, that was a horrible experience and I never went back for another semester.

I also know that the universities and colleges that affiliate with my current hospital are required to undergo a day of hospital orientation prior to bringing students in but I am not aware of any formal process where their competence in teaching clinicals is determined. I even searched our computer database of policies and procedures and didn't find anything pertinent to this.

However, I definitely agree that it is worth looking into this issue because I've witnessed a few clinical instructors who have no business being around nursing students.

[vickynurse]

Have you discussed your concerns with the Nursing program directors? In MO, clinical instructors must be approved by the BON prior to beginning the rotation, so a facility approval process would seem to be redundant. I've taught for 12 years. Some of the facilities I've gone to have required 1-2 days of formal orientation prior to beginning clinicals. I suppose concerns could be brought up during that time period. Our school also requests a written evaluation of each clinical instructor to be filled out by the nurse manager at some point during the rotation. Together with student evals of the instructor, it seems that there is already a quite a lot of feedback.

[caliotter3]

I can only respond as a former student. I have no knowledge of that process at the school I attended. However, I wholeheartedly agree with your proposal. Our school had one such clinical instructor. She gave instructions beforehand to clinical preceptors on who was "to fail" and their part in the "failure" process and then, like a grand dame, went on vacation for the entire term (this was during summer session). According to her, this was her mo each summer term. The clinical class was the final one for the BSN program. There was more about her that was not part of a "good picture" but there is absolutely nothing students could do. So, yes, I agree with what you say. For .....sake, the clinical instructor should at least be in the hospital where her students are present!!!

[VickyRN, MSN, DNP, RN]

We attend at least one orientation day on our prospective unit, and meet with the staff, the charge nurse, the nurse manager or assistant nurse manager. They use a "check-list" system to ascertain that the faculty person is ready to have clinical students on the unit. It's not really a test of our clinical skills or nursing competency per se; just that we're adequately oriented to the unit and the computer charting system.

[ceecel.dee, MSN, RN]

We must attend a "new employee" orientation, go through the same computer training the staff does, and complete CBO's for each floor we will have students on. These are the competency based skills that new employees must check off to show they know the policies and can perform the skills. I also spent a couple of shifts with a nurse to get "a feel" of the floor.

I think your hospital has a legitimate concern.

[barb4575]

I agree with this idea, llg, but I think many educators would take offense to it. Of course, if they did react that way, this would be a grave concern too. The problem is: many of the instructors do not stay active in practice so they really are not effective.

I can also say that as a faculty member, I have seen many in nursing practice who are incompetent. The experience I just had was a perfect example of it. I met one nurse who was competent and a good role model for the students. If I can't trust the staff RN, this limits the students' experience. They do learn from staff nurses too. Sometimes, they learn valuable information about what they do not want to be when they graduate.

Barbara

[BeenThereDoneThat74, MSN, RN]

I agree with this idea, llg, but I think many educators would take offense to it. Of course, if they did react that way, this would be a grave concern too. The problem is: many of the instructors do not stay active in practice so they really are not effective.

I agree with you 100%. I could imagine the uproar something like this would cause with some.

After reading this, and thinking of my own experiences, teaching in three different schools and in five different hospitals) I can't believe how lax our area is. The only thing I ever needed to do was complete a mandatory annual inservice, a do-it-yourself slideshow and answer questions regarding HIPAA, JCAHO, fire safety, infection control, etc. My students needed to do the same. That is it. Noone ever asked me to prove my ability as a nurse tho.

I guess the problem is, there is no standard or certification or licensure one must hold to teach (other than being a nurse).

[whartonjelly]

There was an instructor on our floor. She got a job herself later on this floor. She was terrible. She eventually was fired from the hospital. Then she was rehired. She also had an affair with the husband of a long term employee. As a nurse the doctors didnt want her taking care of their patients. She didnt know enough to put a mag bolus on a pump. Eventually she got her FNP and moved on with the husband of the long term employeee. So sad. What a terrible role model for young nurses.

They should be screened.

[llg, PhD, RN]

I can also say that as a faculty member, I have seen many in nursing practice who are incompetent. The experience I just had was a perfect example of it. I met one nurse who was competent and a good role model for the students. If I can't trust the staff RN, this limits the students' experience. They do learn from staff nurses too. Sometimes, they learn valuable information about what they do not want to be when they graduate.

Barbara

If a hospital chooses not to fire an incompetent nurse, then the hospital takes responsibility for the consequences. At least the hospital is in a position to evaluate the RN's performance and make a conscious decision as to whether or not to fire the RN. However, very few schools (if any) evaluate their faculty's clinical competence in a similar fashion. They don't know if their faculty member is clinically competent or not. They rarely (if ever) ask the hospital for that kind of feedback -- and few educational administrators are in a position to judge.

Most important, hospitals rarely have much say in who the school chooses to send to suprevise the students in clinical. The hospital will be sued if there is a problem with the patient, but the hospital has little control over the quality of the faculty supervising the care. For example, schools have sent faculty members with NO inpatient peds experience to supervise clinicals in my tertiary care children's hospital. That's the type of problem I am trying to address by coming up with some firm requirements.

[vickynurse]

However, very few schools (if any) evaluate their faculty's clinical competence in a similar fashion. They don't know if their faculty member is clinically competent or not. They rarely (if ever) ask the hospital for that kind of feedback -- and few educational administrators are in a position to judge.

I don't know about that. I am FT faculty and am eval by the nurse manager on every floor where I teach. My director spends an entire day observing me every year (more time with PT faculty). I go through an entire day of orientation 4-5 days per year with each new group of students. In addition, students eval faculty, and believe me, they are brutal !

[vickynurse]

I

I guess the problem is, there is no standard or certification or licensure one must hold to teach (other than being a nurse).

In Missouri, even PT must be approved by the BON. FT must be certified.