Teaching - An Investment in Your Future

[traumaRUs, MSN, APRN]

AN recently interviewed Audrey Wirth, MSN, RN-BC, CVRN-BC, who is an adjunct clinical instructor with Aurora University's School of Nursing and Allied Health about teaching clinicals and provided us with some pearls.

1. What advice would you give new educators teaching clinicals?

Do not blur the lines of being an instructor, mentor, resource, and friend to your students. You must gain their respect, and model high performance in the clinical setting. This begins immediately, on the first clinical day. Set clear expectations for your students so they know exactly what is expected of them, and how their learning will be monitored and assessed throughout the rotation. Review the learning outcomes in the clinical syllabus during orientation and periodically throughout the rotation to ensure each student is meeting them. Be sure your assessments and assignments for the students measure these outcomes effectively.

You must teach students how to become professionals beyond the bedside. This includes professional demeanor and appearance. They are watching you during your interactions with staff and patients on the unit. They are also watching you during clinical conferences, lunch breaks, and even your interactions with people walking in the hospital halls. Model high performance at all times.

Explain to the students that you need them to be accountable for their own learning experience. If there is a concept they do not understand, they should come to you. I have seen many students who are afraid to admit what they do not know. Many instructors presume students know or should know more than they actually do. This is a breakdown in the student and clinical instructor relationship. Ideally, the instructor and students work together, and communicate learning needs clearly to achieve safe clinical nursing practice.

A few more pieces of advice come to mind, such as knowing your clinical site, staff, and policies. Meet with the manager of the unit you will be teaching on prior to the start of the clinical rotation. Ask for a tour of the nursing unit. Gather important phone numbers including the unit's nursing station phone, manager phone, house nursing supervisor phone, and your course coordinator's cell phone. Meet with your course coordinator and didactic instructor before the start of the rotation. Be sure to understand their clinical expectations for your students. Ask for a syllabus from the didactic course you are teaching clinicals for. This way, you can understand what the students are learning about in their didactic coursework, and do your best to match patient assignments to reinforce concepts being learned in the classroom.

2. How should the clinical instructor "jump start" a passion for being proactive on the floor?

In my time at Aurora University, I have found that checking in on my students regularly throughout the clinical day has proven to facilitate their critical thinking. I ask them specific pointed questions, such as "What is your biggest nursing priority right now?", "Who is your most critical patient and why?", "What patient and family teaching can you conduct with your patient?", and many others. These questions typically open a dialogue between us, and encourage active thinking. This also holds the students accountable for their own patient care.

Clinical post conference is a time for reflection of the clinical day. Students can decompress, but also have some extra time to process and share their thoughts. They can collaborate with each other to understand all of the patients cared for that clinical day. As they do this, I as the instructor, serve as a clinical expert. I walk them through clinical decision making and critical thinking. Helping the students to understand why nurses intervene, and the rationales for doing so, is important to wire their brains to think like nurses.

Failure to rescue is a concept that has called on more research recently. In fact an article was published this year by Mushta, Rush, and Andersen (2018) that defines failure to rescue as a cascade of events that includes errors of omissons in care, failure to recognize changes in patient condition, failure to communicate changes, and failures in clinical decision making. Early recognition is key, along with picking up on subtle changes that may serve as early warning signs for complications. Also embracing the clinical expertise of fellow nurses and clinicians to benefit the patient outcome. This is something I reinforce daily with my students. Nurses should feel comfortable conferring with other nurses and reviewing patient cases to ensure the best possible outcome for the patient.

Mushta, J., L. Rush, K., & Andersen, E. (2018). Failure to rescue as a nurse sensitive indicator. Nursing Forum, 53(1), 84-92. doi:10.1111/nuf.12215

3. Any tried and proven tips for clinical instructors in keeping on top of student assignments?

In the beginning of a clinical rotation, I make a spreadsheet that serves as a means of tracking all required assignments for the entire course. For example, if each week the students are to turn in a reflection journal, care plan/concept map, and an evaluation...then I have each of those listed with a checkbox for each. This way, at a glance, I can keep track of everything on my end. Feedback on clinical assignments should be thorough, and given to the student prior to their next clinical day. Students can grow from the feedback, and alter their practice by implementing suggestions from the clinical instructor during their next clinical experience.

4. How can students make the most of the pre- and post-clinical experiences?

Clinical nursing students should come to clinical charged and ready to learn. Clinical days often start at times much earlier than didactic courses. Students should allow themselves plenty of time in the morning to wake up, eat a good breakfast, and come to clinical alert and ready to learn. The same goes for the clinical post conference at the end of the day. Students should exit the clinical unit with an interest to share, decompress, and learn about not only their day, but the experiences of their peers. Your instructor is there to facilitate, teach, clarify, supervise, and enhance your clinical learning experience. Ask any and all questions you have to get the most out of your clinical conference times.

5. Any other tips for students/clinical instructors?

I think that we must remember our role...we are breeding the next generation of nurses. I have been teaching long enough in the same area that I have now seen many of my former clinical students mentoring my current nursing students. It is a proud time for me, but also it reminds me how important clinical expertise really is. Nurses are with patients 24/7 in the hospital. We are the eyes, ears, and much more for the physicians and other members of the patient care team. Oftentimes, clinical decisions are based on nursing assessments and recommendations because we know the patients very well. Clinical competency is imperative at the bedside.

[traumaRUs, MSN, APRN]

I've considered teaching but needed more info - thanks for the update