Clinical Post Conference

[lansgrl123]

i am a nursing professor, i am thinking of conducting a study on the benefits of clinical post-conferences.

i hated post-conferences as a student (25 years ago) and my feelings have not changed. i see nursing students who come to post-conferences wanting nothing more than to go home. i know i'm burned out, especially when i have two clinicals in a row. i understand a colleague of mine is instituting a 2-hour post-conference for our students--that means the clinical instructor will give another 2 hours of some sort of instruction after the students have had 8 hours of direct patient care. i believe this is asking too much of our students.

now, i know nursing scholars and faculty members who will recoil when they read that i think post-conferences need to go away. isn't that how change begins?

take a stand and say "no more." nursing students have changed so dramatically over the years, someone must take this into consideration. how many are single parents or work full time? patient acuity has changed leaving students drained at the end of the day.

as a nurse, i was exhausted after an 8 hour shift (or 12) and could not give another 2 hours to anyone, i wanted to go home. i believe debriefing is warranted after a simulation but not in the clinical setting. what do you think?

[jhanes]

Go ahead and do the study. Perhaps it will reveal something new, but make sure that your stated bias is considered as a potential factor affecting your findings. To my mind, when you expect less from people, you get less, so post conference may be of benefit in that students will learn and understand more, do better on boards and hopefully turn out to be better nurses because of the effort that they put in. I went to Nursing School in the 70s, worked 32-40 hours per week and still went to my classes and clinicals. It was worth the effort/sacrafice.

[brillohead, ADN, RN]

My med-surg clinical instructor does about a 20-minute pre-conference where she assigns us our patients and talks about anything we need to know about that's happening on the unit. Then an hour before clinical ends, we meet in a conference room for a post-conference session. If we have enough time, each person tells about a patient they had and things they experienced. Sometimes one patient might have something really complex and we run out of time before everyone shares their own story for the day, but not in a dominating-the-conversation way (LOLing about the "CEO and Jesus" comment here too!). The people who don't get a chance to talk one week get to talk first the following week.

I actually enjoy the post-conference time, with a few considerations:

--starting on time. Some of my classmates can't keep track of their time and come to post-conference late, so we just sit around twiddling our thumbs until they all arrive. I wish the clinical instructor would just start without them. They'll miss out on the first part of the discussion, but that's their own loss -- if they want all the info, they should finish up on time. I don't appreciate sitting there doing nothing for 20 minutes when I could be hearing about something really interesting instead.

--classmate participation. Some of my classmates don't have anything to say. Anything at all. I'm not sure if it's because they simply can't talk in front of people (only six students plus my CI, not some huge room of people), or if it's because they are so disinterested in the whole subject that they can't even be bothered to say, "I had a patient with a Foley" or "My patient had one of those air-blowing beds to prevent pressure ulcers" or SOMETHING. You don't have to have the world's most unique patient to have something to share with the group -- this is Med-Surg I for crying out loud.... EVERYTHING is new/interesting, no matter how mundane!

--instructor participation. It sounds like this is a problem with some posters in this thread, but fortunately my CI is great about this. She has 30-ish years of nursing experience, much of it in critical care, so she has witnessed all kinds of neat stuff that she shares with us. If one of our patients has XYZ condition, she'll tell us some complications to watch for, or we'll discuss meds, or she'll share some new research that has come out, etc. THIS is the stuff we need to know about -- the hands-on nitty-gritty stuff of med-surg nursing.

So provided the post-conference session includes the elements listed above, I see it as a worthwhile learning experience. If it's just for gossip, or if it's actual "academic instruction" time, or it drags on for too long (an hour is fine IME), then I'd vote no --- folks can gossip at lunch or after clinical, the lecture instructor does the "academic instruction" stuff and people aren't in sit-thru-lecture mode after clinical, and after an hour you're going to tune things out. If it's not going to offer a valid learning experience, there's no point in having it, IMO. But if it's going to help me learn about things I'm going to need to know for the NCLEX and for my nursing career, I'd vote yes.

[merrywhiterose]

Nobody has the time or energy for long post-conferences. You KNOW that most instructors would let the students go early because you'd run out of things to talk about and noone would be paying attention. It's unrealistic to change post-conference to 2 hrs.

[nurseprnRN, BSN, RN]

here's my take. post-conference is a chance to learn, and what faculty would short that? that said, it's the faculty's responsibility to make it worthwhile. these are some of the things i did as a student and as faculty, and they seemed to work out pretty well ::she says modestly:: .

1) on time or you're late. part of this is socialization into the work mode. students have to learn that being late for an assigned shift is never going to be acceptable, absent a true emergency. "i didn't get my charting done yet" isn't a true emergency. expectation of timeliness helps push them into learning and practicing organization.

2) many clinical faculty are not part of the instructional (lecture) faculty; often they are not included in faculty meetings for curriculum development or evaluation. i used my post-conf time in part to evaluate how what my students were getting in class was translating (or translatable) into clinical. one year i learned from my students that my colleagues only allowed one student per day to give meds because that was all the time they felt they had to check them-- so the students gave meds maybe twice a semester, and everyone thought that was just fine. i thought that was nuts, because i made it a priority to have them do their meds so i could check them on their hows and whys, pathophys, pharmacology, med math, and assessment skills, while we did it. because of this i never got to go to a meal break, so i made a deal with the group that i would give somebody money for a sandwich, a bottle of milk, and a cookie, and in the first 5 minutes of conference they would take a 5-question med math quiz and i would wolf down my lunch.

this semester was how i learned that my senior students a) weren't getting nearly enough practice in giving medications, and b) didn't know how to answer 4/5 simple med math questions. they learned that too. we were all shocked. so post conference included quick-and-dirty how to do accurate med math on the quiz results, they got better (average 4/5 at the end of the semester) and felt better about it, and i had data to take to my department head. "they all passed pharmacology" was her response. "maybe so," said i, "but they couldn't tell me how to pull 100mg out of a 250mg/5cc vial." heads rolled on that one.

3) while i don't believe that faculty are entertainers first and foremost, you have to take responsibility for doing your best job, and that includes a certain amount of showmanship and audience participation. without going into a lot of details, suffice it to say that i did what i could about that.

clinical was generally 2x/wk, so for one clinical/wk we had a guest speaker-- the head nurse on the alzheimer's unit on management of behavioral issues; the speech-language therapist on swallowing and evals; the special procedures room nurse on prepping and postcare for conscious sedation... you get the idea. for the non-speaker days, i had the students sign up to give a 20-minute presentation on a topic of their choosing-- could be a surgical procedure, a case study, a diagnosis, a med, recreational therapists... this had the effect of giving them practice on speaking (think:report), integrating what they had seen in clinical with some background, and making them the go-to guy/gal on that issue for their classmates (think: collegality). they loved it. (they also signed up to bring snack for every conference, with the recipe-- so at the end we all had a great file of those, too (think: other skills) ) i did a few too, on unexpected ways to look at problems, and other nonclinical aspects of nursing practice; pm me if you want to hear about the demos we put together.

my students gave me terrific evals, and not because i was a pushover-- i was universally acknowledged to be a tough b****-- but because they knew i expected a lot of them, they reached down inside to find it, and they knew i worked as hard as i expected them to work to get them there.

rethink your reflex dislike of post-conferences. don't give up on them. make them great. you'll be doing your job to make better nurses.

[LadyinScrubs, ASN, RN]

go ahead and do the study. perhaps it will reveal something new, but make sure that your stated bias is considered as a potential factor affecting your findings. to my mind, when you expect less from people, you get less, so post conference may be of benefit in that students will learn and understand more, do better on boards and hopefully turn out to be better nurses because of the effort that they put in. i went to nursing school in the 70s, worked 32-40 hours per week and still went to my classes and clinicals. it was worth the effort/sacrafice.[/quote]

the study would have to be done at the doctorate level because it would be original information not information obtained from previous research.

yes, there would have to be safeguards to eliminate bias, etc. this is an area that is virgin and ripe for study.

[Rob72, ASN, RN]

I don't believe they can be "done away with". Post-conference should be the students' report, given to each other and the clinical supervisor. Like GrnTea says, its a good time to identify areas where they're being shorted in didactic, or in last semesters clinicals. Realistically, tho' I would say 30-90 minutes should be more than adequate, with most being right at an hour (5-10 mins/student).

[ymaudy]

OMG 2 hours!!!???!?! That's just crazy. My last med/surg clinical professor did 45 min max. I can't imagine what would be important enough to warrant 2 hours! Clinicals are clinicals, not extra time for teaching in a classroom setting. I think your colleague is from crazytown.

[tine14]

As a student with a 12 hr clinical, I am in support of post-conference. It is actually built into our clinical time and our instructor changes it according to what we need to discuss that particular day. It usually runs about 1 hour. A couple of selected students give report on their patients and we discuss the most interesting cases of the day. My instructor also happens to be a lecturer for our classroom course taken concurrently so she makes sure to include information that is helpful during clinical and for our lecture tests. This semester (med surg 3/ICU) we did short quizzes over EKGs and math titration problems which are no different than what we've been learning in the accompanying lecture component of the course. I actually didn't mind them too much b/c we've been watching EKG monitors all day, have to know what's going on.

Previous instructors had required us to do presentations (which really dragged on) and that was stressful and exhausting afterward a 12-hr day. Wasn't a fan of that.

[HazeKomp, BSN, RN]

:yeah:I appreciate this thread, and the comments from both faculty and students!

I work full time in L&D. I do clinical instruction one day a week. I only get the students for 6 hours (seems short time to both them and me) so it is a PACKED day! We have brief pre-clinical conference: give out pt assignments, discuss goals, gather paperwork, etc. On the floors from 7a, report time, until 11:30. Off to post-conference x 1 hour.

Our post-conference covers brief description of "their day", Examples of "good nursing" and "bad nursing" observed by the students, discussing areas of questions/concerns,a 5" oral presentation w/ Q&A period per one student a week. I then discuss in detail a pathophysiology area that students seem to be weak in, or something high risk that they may not be able to experience.

I do NOT start late, waiting for tardy students. I do make a conscientious effort to be out on time or 5" early.

Hopefuly MY students find this a proper use of their time!

[holisticallyminded]

I always thought post-clinicals were very contrived and used as a way to avoid more individualized (one-on-one) time with students. Why was that instructor always too busy to meet with me? Were they just working with all of the other students? For the full shift?

Best nursing instructor I ever had sat in a central location on the unit and let us come as needed to discuss, vent, ask questions, etc. Didn't focus on the bs paperwork- just let us work and come to her for guidance. And she knew what was going on with every patient on the unit so she could predict situations as they arose. I loved her! I actually learned from her.

[Riseupandnurse]

I had the privilege last November of listening to Dr. Molly Sutphen talk about the research she and Patricia Benner and others did on nursing education, which led to the revolutionary IOM report on transforming nursing and our role in health care. She called post-conference, when done correctly, the "crown jewel of nursing education." It is very instructor-dependent. It is not a time to teach new information unrelated to the clinical day. The purpose is for the instructor to help the students take what they have learned that day, reflect on it with others, and then make the connection to what they learn in the classroom to what they see in clinical. Exactly!! That is what makes an excellent nursing instructor. We need to be doing that for our students. And yes, I teach cllinicals. I have tried it many ways, done many things, and when I heard what she said the light went on in my head. Yes, yes, this is what works!!

[NurseB_, BSN, RN]

I LOVE post conference! Now 2 hours is a bit long I would say. I've had great clinical instructors so far and really appreciate the post conference time. Now, a lot of my classmates hate post conference and are just anxious to go, but I'm different I guess. I find learning about what my classmates did throughout the day a great learning experience. My instructors have been good about asking us questions to challenge our critical thinking abilities or to build upon knowledge that we already know. There have been times that I knew the answer to test questions from things we have talked about in post conference. Our instructors make sure we stay on topic because she knows that most are ready to go and are not paying much attention anyway. I'm always eager to learn something especially in the hospital because I've loved my clinical experiences so far. So, my vote would be to keep post conferences, but maybe not limit them to no more than one hour.