Where do they find these clinical instructors?

nurseprnRN, BSN, RN · Apr 26, 2012

you know, teaching is great, i love it, i was famous for being a tough instructor (crusty since my thirties, thanks) but i always got great evals, and i will never be able to do it again. why? because the pay is approximately 60% of what a staff nurse makes, and less than that in some places. bsn programs usually require a phd/dns at least in progress; with my msn i can teach in asn programs now, and the idea of a doctorate is interesting but beyond my reach financially. if i didn't have an msn i couldn't even teach in asn programs except as clinical, and they prefer someone who can teach classroom as well. so yes, sometimes they do not have a huge selection of applicants.

and you think you know about aggravation in nursing staffs, you ain't seen nothin' until you you see faculty. henry kissinger once famously said that the fights in academia were so vicious precisely because the stakes were so small. also, you think it's a pain preparing for joint commission visits, you should see what you have to do to prepare for your nln acceditation study. it's a year of meetings, writing, and reporting...and there's no overtime in academia, either.

some of you have heard me tell the story of my third-grader coming upon me grading care plans one lovely saturday afternoon.(sixteen clinical students in two rotations, 45-60 minutes per care plan, you figure it out) "whatcha doing, mom?" "oh, just some homework, sweetie." (shocked)"you have weekend homework?" umm, yeah, and every night homework too. for every hour of lecture i gave, three hours of prep, at least. and office hours, and faculty meetings, and curriculum meetings, and lab.

when i left my last teaching job i got calls for several years from other schools asking me to come work there (god only knows how they knew about me or where to find me...probably just had a list of every rn in the county and started at the top..). broke my heart to say no, but i had a family to support.

so... i'm not sure if that explains why not every clinical instructor is a cross between cherry ames and e.o.wilson, but there you have it. you get what you pay for sometimes.

Zatara142 · Apr 27, 2012

Warning: Major ranting ahead...

I know what you mean. I think they are desperate for clinical instructors, especially in areas where nurses are paid well. My understanding is that being a CI doesn't pay much...

I recently had a horrible clinical experience (all my others have been great!). The nurse was late or left early half the time, used her phone for personal matters during the shift, only ONCE came to work with me and my patient, ... and then canceled the last clinical at 2am the day of via email. I showed up bright and early at 6:30am that day only to realize an hour later that clinical was canceled. When I told the instructor she really should have texted/called if she was canceling clinical at the last minute (c'mon--I was asleep at 2am), she responded with, "I texted everyone. I also emailed." No apology. And a bold-faced lie. Half of us never got a text from her, and her email was in the middle of the night! What a double standard that we have to call if we are sick and going to miss clinical (if we don't call, we get "written up"), but she can just send out an email.

I have taught before (biology), and once I have a few years' experience as an RN under my belt, I hope to be a clinical instructor--I know I could do a much better job.

NCRNMDM, ASN, RN · Apr 27, 2012

I don't think it's fair to assume that you could do a better job as a clinical instructor until you know exactly what it's like. As GrnTea said, there are so many things that go into being an instructor that we, as students, sometimes don't think about. We are often so wrapped up in the assignments we have to do, the notes we have to take, the papers we have to write, and the studying we are forced to do, that we forget that the instructors have to do just as much work as we do. If the truth is told, instructors probably do more work than we (the students) do.

They are preparing PowerPoint presentations, grading assignments, trying to figure out how to convey their material in clear and concise ways, reading all the chapters in the textbooks, attending faculty meetings, writing exams, grading exams, supporting us during clinicals, fielding all of our questions (and there are thousands of them), replying to our emails, supervising us during the clinical day, teaching skills lab, holding office hours, acting as advisers on advising day, and doing so many other things. I, for one, don't know how they get it all done. Also, the pay isn't nearly what a practicing RN in a clinical setting would make.

Because of all these things, I understand why some instructors aren't joy and light all the time. Frankly, I wouldn't run around like a ball of sunshine all the time if I was an instructor. I'm sure that instructors get jaded, burnt out, tired of the hours and the work, sick of the low pay, and fed up with dealing with students who seem to think they are entitled to everything. There are some great nursing students, but there will always be at least one who thinks that their nursing program owes them something. It would get very irritating dealing with all of this. Just something to think about.

theantichick · Apr 27, 2012

GrnTea - thanks for the insight on the other side. I had no idea that the requirements were THAT high, and the pay THAT low. Seems to me there needs to be a sea change in the way faculty are recruited, trained, and compensated.

Matt - I don't think it's fair for you to assume anything about me. I cannot go into detail on a public forum about just *how* bad these CI's have been. Some of the stuff I've witnessed or been subject to could land the school in some very hot water if someone wanted to get nasty about it (which I don't). Also, this is not my first rodeo. I've taught adult classes on a variety of subjects in several industries and know how to appropriately set and communicate expectations, as well as how to treat people with dignity and respect. I completely understand how frustrating teaching can be, and I also recognize that I don't have the right temperament for it. That doesn't mean I cannot, or HAVE NOT been an effective teacher. It also doesn't mean that I cannot accurately judge whether or not an instructor is being effective, or detrimental. If they are that burned out that they're pulling some of the insanity I've witnessed, they need to find somewhere else to be. The schools should also be looking at the effectiveness of the instructors, and working to modify their behaviour or let them go. Also please reference my statement that I've had more good (and some phenomenal) CI's than bad. My post was to try and find out what the factors and conditions are that are contributing to schools keeping on CI's that are known to be detrimental to the learning of the students.

BlkQueen8 · Apr 27, 2012

This term I have the CI from HELL! She calls in all the time so we end up with different subs that are great teachers but most of them don't know the facility or the students. Are are not familiar with our daily routine so they take it from our actual CI that just recycle's the last weeks' assignments of who's doing med pass and who's doing blood glucose readings. The same students end up doing it over and over while others do not get the experience. Our papers are never graded because our teacher "claims" the subs are not turning it into her. We ask her to teach us something that the other clinical group is getting and instead she argues that it's for the theory class however clinical gives us the advantage of hands on. When we ask her questions, she makes you feel stupid for asking and constantly gives us the heavy sigh of annoyance with our questions. She'll tell us "You should know this by heart now" but when are we suppose to learn it when she's NEVER there and the other teachers do not go over it.

This term I look forward to each and every theory class because I have a wonderful teacher and an open environment to ask questions to help me learn. I dread each and every weekend that I have to go to clinical. It's not something I look forward to like I did last term but something I try to "overcome" like a boulder in the road standing between me and my LVN license.

Our instructors even told us that she applied to our school as an instructor as a "joke". Enough said :cry:

classicdame, MSN, EdD · Apr 27, 2012

as a former instructor who left for more money in a hospital I will say that yes, there are bad instructors. There are bad students too.

anonymousstudent · Apr 27, 2012

It's not a pay issue here. They are making more than twice per hour what the floor nurses in our hospital make. I'm at a CC, so they seem to be treated like normal adjuncts - sink or swim. I've never once seen anybody come to observe a CI, though our coordinators have oversight responsibility for them.

I've only ever had one that was absolutely terrible. She would disapear for an hour at a time, leaving us to fend for ourselves (this was early in our program). I've also had some great CI's, who I've learned a lot from.

It doesn't seem like anybody really cares if these people can TEACH. Of course they are nurses, so they can do some level of patient teaching (assumably) but that doesn't mean they can provide what student nurses need to know.

Fiona59 · Apr 27, 2012

Sometimes I think it's the "old girl network". One still stands out. Alcoholic, passed out on one of our rotations. The student who cleaned up her got excellent marks for that one. She's still working and it's an open secret.

Esme12, ASN, BSN, RN · Apr 27, 2012

I think part of the problem is requiring the "advanced degrees" for teaching. I don't think more schooling makes a better CLINICAL instructor, generally speaking, although I am an advocate of advance schooling overall......like APN, CRNA. There are those of us who would love to teach but only have a BSN or ASN....with 30 years experience. I used to be able to teach at my college/school of graduation with a BSN. Once I moved I am no longer good enough or smart enough......I mean degree enough....to teach anyone anything. Lecture? You can keep it, that is where academia/degrees should live. Clinically? I think experience and knowledge at the bedside should count.

Clinical instructors should have CLINICAL experience....not just the right amount of college debt to be able to teach. It's become about hiring the of the degree and not the most qualified clinically that is what some instructors are lacking.......IMHO.

AOx1 · Apr 28, 2012

As mentioned, many programs are beginning to require a doctorate to teach full time. This means that I am in the classroom up to 24 hours a week, spend 16-24 hours a week in clinicals with my students, 15+ hours of grading and lecture prep, 8-12 hours a week at my clinical nursing position (so I can stay current), and up to 20 hours a week on my PhD coursework. What this means is that I work 7 days a week with almost no time to myself. I do this for half of what I could make elsewhere. This also does not include University committee or department committee service.

I want to throttle people who ask if I love having such an "easy" job. An instructor must be:

Fit enough to handle the extensive time demands (the first semester I gave out my cell # for emergencies, only to have a student call me at 11pm to ask a question that was answered in the syllabus; this happened several times).

Resilient enough to handle multiple pressures with rare appreciation.

Able to financially afford the extremely low pay most schools offer.

Constantly "on": caring, competetent, and a role model. I love what I do, but it is incredibly difficult. In practice, my patients frequently say thank you; my students rarely do, although my evaluations are excellent.

My pay shows that the role of educator is not valued by society.

Several things need to happen. We need to pay teachers in general what they are worth and support them in the political arena. A decent salary would attract better educators who can't currently afford the pay cut. I can only afford it because of my husband's salary.

When better candidates are available, schools should apply higher standards to selection. There should be more accountability and more frequent review.

nurseprnRN, BSN, RN · Apr 30, 2012

esme, i agree to a point; i was working half-time in icus for much of my teaching life when i was an impoverished single mother. one day in november i was in the department and the secretary said, "grntea, i have some checks for you. ""check-ssss?" i said, "as in, checks, plural?" "yes," she replied. "we get paid twice a month." "oh, lordy," i said. "i thought it was monthly. do not tell barb (department head) that i've been working for half pay and happy to have it.":d it was helpful to have up-to-date clinical info (meds, new toys, protocols, and the like) in addition to the supplementary income hospital nursing pumped into my little corner of the economy.

otoh, in grad school i did learn a lot about curriculum design, adult learning, testing, and evaluations. knowing the difference between -- even the existence of-- high, medium, and low levels of cognitive, affective, and psychomotor learning made it easier to tailor clinical assignments to the students' individual needs. knowing how the classroom learning was designed to integrate with progressive clinical placements was helpful.

(for those who have no idea what i mean, and believe me, i have been in your shoes, a very brief summary: cognitive is the facts, ma'am. it's data, knowledge.

affective is easiest described as, "why do we care?" which is a question i asked (and ask) often. it's how we think about a problem and use a process to solve it. closest to the "critical thinking" process.

psychomotor learning is the hands-on skill set: tasks, hands-on assessment techniques, physical actions that have to be mastered.

nursing demands success in all these domains of learning. knowing that in greater depth, how to design a test to see how the students are progressing in all three, and learning how to write a student eval that took all three into account when giving feedback was something i couldn't have learned otj.)