As the nursing faculty continues to grow older and many instructors retire, it is difficult for schools to produce more nurses creating a staffing crisis. The impact of COVID-19 has only made things more challenging. Hospitals have ongoing nursing shortages while nursing school applications are increasing. These issues mean that there is a need for more faculty at nursing schools to meet the demand for students to enroll and to increase the available staff nurses.
One solution is for bedside nurses to bring their clinical experience to nursing education. In many ways, active clinical nurses make excellent clinical instructors for students. Clinical instructors who are working at the bedside know what nursing is current like in a way that many academic faculty may not. As instructors, these nurses also provide relevant knowledge about institutional policies and procedures.
Despite some graduate nursing programs focusing on education, nurses may not be fully prepared to act as instructors for an academic institution. In fact, when transitioning to working as a clinical instructor, many nurses feel like a novice all over again. Often, new instructors feel like there are few supports in place and they are left to figure out how to structure a clinical day and what to cover in post-conference. The reality is that many of the skills acquired over years of clinical practice are very relevant to being a guide for students as they navigate their clinical learning environments. These tools can go a long way to ensuring clinical instructors are using effective instructional strategies.
A nurse who is new to clinical instruction brings several transferable skills from his or her clinical setting. Skills honed in multiple professional interactions with patients, families, and other healthcare workers are invaluable when employed as an educator. The context in which these skills are used is different, but the core know-how is the same.
Here are three excellent ways to adapt your clinical nursing prowess when functioning as a clinical instructor:
Ask Good Questions
Over many patient and family interactions, nurses learn to ask difficult questions sensitively and objectively. When teaching students, use the same parts of the nursing process you already have deep in your core.
Start with an assessment of the student’s readiness to learn. Ask about the student’s fears and concerns. Give permission for them to be awkward, embarrassed, or even terrified. Starting the introductory clinical day with a phrase like, “Many students feel apprehensive about making mistakes. What kinds of mistakes are you worried about?” can normalize the complex emotions and provide insight into the challenges students are facing. Follow up with questions at the end of the clinical day about what actually happened and how the real-time interactions felt. This helps students to strengthen their own emotional intelligence and to be self-reflective.
In addition to addressing the status of the student, good questions will challenge the student to make new cognitive connections and to apply knowledge in a holistic way. Ask students about the patient they are caring for in a way that guides critical thinking. What is the relationship between multiple medical diagnoses? What medications may help with one issue but are concerning for the side effects it may produce for a second issue? What assessment findings are aligned with the patient’s medical history?
Model Clinical Problem-Solving
Nursing instructors do not know everything, and should not be expected to know everything. This can be a huge relief for a novice instructor. However, there is an excellent opportunity for the instructor to model handling the disorientation of a new clinical setting and new interprofessional relationships smoothly and professionally. The clinical instructor role can often be uncomfortable. Unless the instructor is educating students in his or her own workplace, there is a lot for the instructor to learn. There are nurses with a variety of personalities and skill levels interacting with students. The nurse-physician relationship is raw and fragile for the instructor. Supervising students and giving feedback may be a new experience or is occurring in a new power dynamic.
The instructor can deliver a reassuring phrase such as “let me check on that and get back to you” or even “I don’t know, but I’ll find out,” and then modeling problem-solving in order to find a solution. It can be powerful for students to see the instructor accessing the online drug guide to confirm information about a statin that is less familiar than the instructor typically administers. The instructor can also demonstrate how to navigate challenging interactions on the unit. Finally, the nursing instructor can demonstrate asking for assistance learning how to best use a new brand of angiocath or IV pump.
While there is much a clinical instructor will know, seasoned nurses have already learned how to be problem solvers. Taking a few extra minutes to verbalize the thought process and critical thinking involved in novel or complex situations is a teaching skill that will directly benefit students. The modeling of problem-solving can also be combined with asking good questions to begin to instill the same skills in students.
Repeat. Repeat. Repeat
Nursing education is theoretically designed to help students build a foundation of knowledge and then add on more layers. Unfortunately, based on the multiple classes over many years, students do not always have the ability to quickly and easily recall the most important information. Nursing clinicals are the place where students finally get to put it all together.
Memory and recall are built through spaced recall and review. So, ask the students the number to activate a code blue, repeatedly. Review the mechanism of action of a beta-blocking medication, repeatedly. Review the seven rights of medication administration, repeatedly. When students respond with an eye roll or start to answer questions before you even ask them, you know that knowledge is more deeply settled into the long-term memory.
Put it Together
As the students progress, combine the three skills and ask students to begin to proactively anticipate their patient’s trajectory. A set of five questions can be helpful in guiding students through this thinking process:
Given the patient’s current status, what medical emergency is the most likely to occur?
What changes in the patient’s condition would be the early signs of a change in status or an evolving problem?
What assessments or tests would help you to confirm that the emergency is occurring?
What interventions would you implement independently?
What orders would you anticipate requesting from the provider?
Every day as a nurse involves new patients, new physicians, new visitors, and new interactions. This is even more true for a clinical nursing instructor and students who are temporary guests engaged in learning. The mechanics of providing clinical instruction are reasonably straightforward, but the approach is key. Asking good questions, modeling professional learning, and repeating to ensure deep retention will all be keys to supporting nursing students to become professional nurses.
American Association of Colleges of Nursing (AACN). (2020, September). Nursing faculty shortage.
American Association of Colleges of Nursing (AACN). (2020, April 1). Student enrollment surged in U.S. schools of nursing in 2020 despite challenges presented by the pandemic.
American Nurses Association (ANA). (n.d.) Nurse Staffing Crisis.
Grainger, L. (2021, February 25). Nursing faculty shortage in the U.S.: Has a pandemic compounded an existing problem? Wolters Kluwer.
McLernon, L.M. (2020, November 30.) COVID-related nursing shortages hit hospitals nationwide.
National Advisory Council on Nurse Education and Practice (NACNEP). (2020, December). Preparing nurse faculty, and addressing the shortage of nurse faculty and clinical preceptors.