“Oh, no, I have a student today!”
“You don’t want a student? I’ll take her!”
“You want my student? Don’t you just cringe when the students ask you all those questions, and they move so slowly? I can’t get my work done!”
“I used to feel like that, but not so much anymore. Now I can see distinct advantages to precepting students, and I’m trying to shift how I work with them so that we all have a better day.”
“Well, please share because I’m just not a teacher and don’t have the patience. I don’t know how to partner well with them.”
Nurses in clinical settings report a variety of thoughts and emotions about precepting students in patient care experiences. Some nurses look forward to having a student and are always seeking ways to make the encounter work better. Other nurses feel frustrated and anxious when they have a student. Clinical staff nurses often wonder if they are directing students in ways that are congruent with the student’s academic instruction and if they are asking too much or too little. Nurses fret over their lack of ability or time to instruct, debrief, and build relationships with students. Navigating close encounters with students and faculty while efficiently delivering excellent patient care is a skill to be learned and refined.
The issues clinical nurses face in precepting students arise amidst a world-wide trend toward strengthening partnerships between academic and clinical entities. At the systems level, academic-clinical collaboration creates a pipeline for new nurse recruitment and better prepared graduates who stay in practice. In addition, academic-clinical partnerships help close the research-practice gap and improve quality of patient care. Academic centers are assured of clinical sites to place students and better opportunities to conduct nursing research.
The value added for systems is clear, but what do close academic-clinical partnerships mean for the clinical nurse at the bedside, who is called on to precept students? It means the clinical nurse must have the skills and knowledge to help bridge the clinical and academic worlds and integrate students’ learning needs with patients’ needs for care.
What’s in it for the stakeholders?
Clinical nurses and faculty both benefit from a close partnership. Clinical nurses
- gain a sense of fulfillment from investing in a future nurse and becoming part of the student’s life story.
- enhance recruitment of new nurses, as students may come and work in their facility.
- experience inner satisfaction in transferring their knowledge and preparing nurses who will stay in the profession and practice safely and effectively.
- try out teaching as a possible career path and, if masters prepared, become an adjunct faculty member or negotiate a joint appointment.
- include precepting on annual performance evaluations or as part of a clinical ladder criterion.
- develop a relationship with academic faculty, who may become a mentor or can support their professional work, write a letter of reference, offer career guidance, or collaborate with on future projects.
- learn about new research evidence for evidence-based practice from the student and faculty that can improve patient care outcomes.
- gain advantages from employer or the academic partner, such as paid travel to a conference, partial tuition support for completing educational methods courses, tickets to sporting events, library access and services, or recognition at an awards celebration.
- act as the clinical connection for research for the school of nursing.
- stay up-to-date on new clinical innovations.
- share evidence-based practices with clinical nurses.
- act as a conduit for communication between the clinical setting and school of nursing.
- optimize accurate and fair evaluation of students’ clinical performance.
- provide more student interactions with experienced clinical nurses.
- allow more faculty time with individual students.
Five specific approaches to nurse-student-faculty partnering can help make precepting better, contribute to the global good of graduating well-prepared nurses, and provide clinical nurses with personal and professional satisfaction.
Move in close
Clinical nurses can develop a commitment to student learning as part of their professional nursing role, acknowledging that being part of a practice profession means devoting energy and time to nurturing new practitioners.
In some institutions, only designated nurses precept students. In others, all nurses are expected to be skilled in student supervision.
Clinical nurses can create a culture that values students and welcomes them as colleagues by making the nurse-student partnership visible. For example:
Andrea, RN, introduces the student to the patient’s interprofessional team on rounds: “I want you all to welcome Ava. She is a sophomore nursing student, and she knows Mr. Thomas as well or better than I do. Ava, feel free to speak up as we review his case.” Andrea writes Ava’s name on the white board as a member of the care team. Ava helps give handover reports and takes breaks with Andrea, enjoying some moments of informal socialization. At the end of the shift, Andrea slips Ava a handwritten note, thanking her for her work and contribution, planting a seed that she might want to come and work on this unit after graduation. Through such simple kindnesses, Andrea becomes part of Ava’s unfolding professional story, boosting the student’s confidence, energizing her to study harder, and creating a sense of belonging for Ava in the clinical world.
Get up close with faculty
An essential element to a successful nurse-student partnership is a strong, mutually respectful relationship between the clinical nurse and the student’s faculty member. Clinical nurses should expect—and pursue, if necessary—clear communication from faculty about student capabilities, expectations for the shift, and desired feedback for evaluation purposes. A communication tool, such as a one-page clinical expectations overview can convey key information from the faculty to the clinical nurse. (See Critical care nursing units preceptor and student guidelines.) Faculty can modify the tool for specific academic courses and experiences.
Critical care nursing units preceptor and student guidelines
Critical care nursing clinical experience
Nurse preceptor: The nurse preceptor will
Nursing student: The nursing student will
In addition, clinical nurses, faculty, and students can have an end-of-the-day huddle in which the clinical nurse can update the faculty on the student’s activities, areas of mastery, and areas for improvement, with the student present to hear and respond. Ideally, faculty and nurses, with the support of the unit manager, could set aside time for weekly or biweekly meetings at designated times in a quiet environment to share information. Faculty and nurses can explore the use of technology in their communication, including texting or voice texting throughout the clinical day.
Clinical nurses need to know from the faculty what supervision model is in place. One model is that the faculty directly supervise the student and the clinical nurse fills in as needed. Such a model, which was the common approach for many decades, is no longer highly effective in settings that are fast-paced and have regulatory time requirements for administering medications and completing interventions, such as placing or removing catheters. The faculty cannot effectively supervise 10 students caring for 10 to 20 patients at one time without compromising patient care and outcomes. A newer model calls for clinical nurses to take the lead in supervising students, overseeing all patient care activities and documentation. The faculty member circulates and offers support to students and confers with students to connect classroom learning with clinical experiences.
A supervision model that matches nurses with the same students for a semester holds many benefits for all stakeholders. Maintaining the same partnerships over time reduces anxiety for students, nurses, and faculty and allows for better translation of knowledge.
Clinical nurses often express a lack of confidence in their abilities to teach students, making statements like, “What if I tell them to do something that their faculty member doesn’t support?” Clinical nurses can text the faculty in the moment or ask in a scheduled meeting about any aspect of learning that is unclear.
An approach for clinical nurses to teach and coach students without taking time away from patients is narrating care. In this approach, nurses talk out loud about what they are thinking, assessing, decisions they are considering, what the patients’ signs and symptoms mean. The narration of care can benefit patients and families, who can learn about medications and care plans throughout the day. For example, the clinical nurse might say, “Mr. Smith, Ashley and I are working together today. Ashley is a junior nursing student. I’m going to be talking out loud as we work and you can listen in, comment, ask questions any time. Right now, we are going to do a morning assessment. First, I’m going to check your blood pressure because I’m going to be giving you two new medications that affect your blood pressure, and I want to know how your blood pressure is doing.”
Narration of care allows nurses to accomplish much of what is bulleted on the one-pager overview regarding student learning. The clinical nurse can discuss lab results in relation to medications, discuss mobility as a goal for discharge the next day, and give updates on wound healing through narration at the bedside, as the student, patient, and family listen. Narration allows the clinical nurse to provide rationale for patient care strategies. Sensitive information can be discussed away from the bedside. Clinical nurses can make narration of care the norm on their unit, with the understanding that, “If I have a student, I’ll be talking all shift.” Eventually, as students advance their knowledge and confidence, they can narrate care as the clinical nurses, patient, and family listen.
Clinical nurses can look for opportunities to share stories with students, as another way to support student learning through their own experiences. Much knowledge is embedded in stories and students tend to remember them. If the clinical nurse is uncertain about the content of the stories, the nurse can share them with faculty who can point out key learning points and suggest aspects to emphasize. Nurse colleagues on a unit can cover for a precepting nurse while the nurse, student, and faculty have an end-of-shift huddle to review accomplishments and next steps for the student. In the huddle, the clinical nurse can ask for what else he/she needs to be effective in the supervisory role.
Learn about clinical teaching
Clinical nurses may express a desire to learn more about clinical teaching. Clear communication and a strong working relationship between faculty and nurses is the foundation of an effective student experience. (See Clinical nurse success story.)
Clinical nurse success story
“There was so much to do in those first few moments when the patient returned from cardiac surgery. The faculty person offered to take the student out of the way, but I told the student to stay right with me wherever I went. I pointed to a place at the end of the bed for the faculty person to stand. I thought she might as well see what I was doing and compare it to what she taught students in the classroom. I talked as I briskly connected pumps and lines, explaining the importance of every tube and wire and what the rhythm and numbers and sounds of the equipment all meant. The patient’s daughter was listening. Suddenly she whispered, “Even with all this support, the doctor said my mother might not make it.” I turned from the ventilator, leaned close to her, and said, “Sadly, I’m afraid you are correct, Mel. We are going to do all we can this evening for your mother. You feel free to stay right here at her side and talk to her all you want to.” With Mel to my left, I turned to the student and asked, “Any thoughts on my response to Mel?” The student murmured, “I would have probably given her some false reassurance, like “Everything is going to be OK.” I replied, “That’s why I wanted you with me.” I looked to the faculty person and asked, “Thoughts?” She said, “Just one: You are an expert clinician and communicator.” That was a moment I will remember for a long time. After that, I wanted to take a student every week!”
Faculty may encourage clinical nurses to develop teaching tools that they use with each new student, such as a diagram with the coronary arteries, electrical conduction system of the heart, and the placement of the 12 leads of an ECG. While resources regarding teaching are not abundant, some can help guide the clinical nurse as he or she coaches the student. These include taking classes at a near-by university or community college, connecting with a mentor, accessing resources online (request the academic partner to buy access to sites that require a fee), and obtaining a teaching certificate.
A satisfying experience
The presence of university faculty on the unit as expert teachers in collaboration with expert clinical nurses is the best model for “close encounters” for students, clinical nurses, and faculty. Academic and practice partnerships produce confident new nurses, improve patient safety and care outcomes, and satisfaction for the triad of students, clinical nurses, and faculty.
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Debra Siela is an associate professor at Ball State University School of Nursing, Muncie, Indiana. Renee Twibell is an associate professor at Ball State University School of Nursing and a nurse researcher at IU Health Ball Memorial Hospital in Muncie. Mahnaz Mahmoodi is an instructor at Ball State University School of Nursing and a staff nurse in the cardiac intensive care unit at IU Health Ball Memorial Hospital. Sarah Mahboubi is a staff nurse in the cardiac intensive care unit at IU Health Ball Memorial Hospital.