Nursing faculty orientation on a medical unit

[sassysmart66]

Veteran nurses:

I need some input from those of you who are in management or who have been around awhile. I am nursing faculty in a baccalaureate program at a small private college. My background is Community Health, outpatient, ambulatory settings, and patient education. When I was hired into this position, I made it clear that I had not worked in med-surg for 15 years and only did it for about 18 months back then. I have been in this position for 3.5 years and the dept head continually puts me in to teach senior students on a very busy medical unit every spring. I have voiced concerns about being required to work in an area where I feel uncomfortable, but have been told to "just go work on the unit for 40-60 hours and you'll be fine." I feel that this attitude just perpetuates the "a nurse is a nurse is a nurse" refrain.

Well, I am so uncomfortable that I am starting to push back. I feel like it is unsafe for me to guide students in this environment and I feel that this practice is endangering my license. The dept head has told me that since we are so small (7 full time and 1 part time faculty) we need to be able to double up on the clinicals that we teach. I am considering leaving nursing education because of being put into an untenable situation like this.

What are your thoughts? How long would a nurse like me require to orient to your unit? Is 5- 12 hr shifts or 8- 8 hour shifts enough? If you read Benner, even if you are an expert practitioner, when you change jobs, you end up going back to novice or advanced beginner. How long does it take to get back to competent in a very foreign specialty?

Thanks for your input.

Sassysmart 66

[classicdame, MSN, EdD]

I think a lot would depend on the level of students you are teaching. Students in Fundamentals (or Foundations or whatever you call basic nursing) will not challenge you as much. If they do not give a med or do a procedure without you RIGHT THERE, then you might not have reason for concern. It all comes down to YOUR comfort level. Sorry you are in this spot.

[Whispera, MSN, RN]

I'm a psych CNS who has taught for about 15 years. I also worked various jobs, including as RN a med-surg setting, in a very busy hospital, for over 6 months. I got pretty good at all the med-surg skills but still didn't feel comfortable that I knew everything I should know. The others were glad to help but were often too busy to help. If I was you, some things I'd think about are: how much experience do you already have in skills that are needed in med-surg? Have you been competent in them in the past? What other things might come up that your students would need to do, that you would HAVE to be able to do in order to monitor and instruct them? Do you feel ok about those things? As an instructor, how helpful are the nurses that work in the facility? Do they help you when asked? Are they too busy? Are they in them vs. you mindset (I've seen this many places)? Could you get someone to help you with those skills you don't feel comfy with?

Working 40-60 hours is not enough if you don't have ingrained skills that only need a refresher. Benner says it takes about a year to get past the advanced beginner stage. If you're novice, you will feel terribly uncomfortable, and even as an advanced beginner, you won't feel competent most of the time. You also won't be able to give your students what they need to get from you. You could put patients, your students, and your license at risk. You also don't want to come across as a fool to your students.

I've refused to teach peds, even though I've worked in that setting too.

If your boss continues to push this, if you have an ok relationship with him or her, I'd say you ought to have a serious talk with her. I'm sure the reason for pushing it is so all the instructors can maintain their full time status by teaching the courses where an instructor is needed. They don't want to have to hire anyone else when they have people with open hours they're already paying.

If talking with her doesn't work, maybe it's time to teach somewhere else. Not everywhere pushes us outside our expertise. As instructors, I think we should be experts in what we're teaching. Otherwise, it's not fair (or RIGHT) to anyone involved.