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Transitioning from staff nurse to clinical faculty, part 2

Luckowski, Amy PhD, RN, CCRN

doi: 10.1097/01.NURSE.0000456383.71144.85

Amy Luckowski was previously the director of clinical affairs and student placement in the school of nursing at Widener University in Chester, Pa., and is currently a faculty member.

The author has disclosed that she has no financial relationships related to this article.

IF READING PART 1 of this article whetted your appetite for transitioning to clinical faculty, what's next? After exploring a typical day for a clinical instructor, this article explains how to prepare students for their clinical studies.

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What's a typical clinical day?

To effectively plan assignments, a clinical instructor must arrive earlier than the students. The instructor needs time to talk with the nurses on the previous shift and review patient medical records to choose appropriate patients for the day. Check the course syllabus and try to find patients with diagnoses related to the topics covered, if possible. Think about the students' level of experience. Don't take the most challenging patients on the unit if you're instructing beginning students. Also, never take patients who've behaved inappropriately with staff. If your students are inexperienced, consider pairing two students with one patient for the first week.

Instead of holding a long preconference, you can quickly check in with your students and make patient assignments. Within reason, let advanced students choose their own patients. This practice also encourages students to arrive on time. Keep track of what student had what type of patient to make sure each student has a variety of experiences.

Review your plans for meal breaks and postconferences. Show the students the assignment board and have them introduce themselves to the clinical nurse and listen to report.

When students return from report, ask them to present a short summary of their patient. Clarify what was discussed, ask them questions, and plan the help needed for the day. Students often miss important information because of unfamiliar medical terminology used during report.

The student assignments should be posted near the assignment board and a copy should be given to the unit secretary. This encourages the staff to call the student if the patient has a need. Also let unlicensed assistive personnel know which patients have students so that the students can provide all the needed care.

Talk with all the nurses on the unit to explain the students' level. Tell the nurses which students, if any, are giving medications. A group of well-prepared senior students may reasonably be expected to give medications. But having all students in a group administering medications can be challenging, so some instructors assign giving meds to half the group at a time.

If the students are new to clinical, don't have them administer medications for several weeks, until their basic skills are sound. Make sure they've passed their medication calculation exam and review the steps of medication administration thoroughly.

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Before the first clinical day...

The school is responsible for having the students complete clinical clearance requirements before the first clinical day. These may include a drug screen, child abuse clearance, criminal background check, fingerprints, basic life support training, proof of immunizations (including an influenza vaccine), tuberculin skin testing, history and physical exam, Health Insurance Portability and Accountability Act training, and health insurance documentation.

The secret to making sure students have a great clinical experience is preparation:

  • Become familiar with all of the course materials, such as the syllabus, lecture notes, clinical assignments, and evaluation form.
  • Ask for a copy of the textbook and any other course materials.
  • Know the dress code and absence policy.
  • If permitted, ask the school if you can teach clinical at your own facility. Adjusting to a new role is much easier when you already know the documentation system, medication administration system, and personnel. A disadvantage is that some staff members may expect you to function in your usual role.
  • Contact the nurse educator or manager at the facility to find out the orientation requirements.
  • Attend any facility orientation related to computerized documentation or medication administration, and join mandatory staff development sessions. Some facilities may have an online training program.
  • If you're unfamiliar with the facility or unit, spend some time orienting to it. Get to know the staff and routines well before the first day.
  • Find out where the students will park and how to get a name badge. Ask where students can store their belongings and where you can hold your conferences.
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Benefits of a skills day

The students may spend a day on campus to review nursing skills before the first day at the clinical facility. This is similar to the RN competency days you may have attended. Examples of the skills reviewed include:

  • vital signs assessment
  • medication administration
  • medication calculation exam
  • patient assessment
  • glucose testing
  • insulin administration
  • urinary catheter insertion and care
  • wound care
  • drain care.

The great advantage of this day is that instructors can get to know their students' strengths, weaknesses, and level of experience before clinicals start. Share your professional background with your students, exchange phone numbers, and review directions to the facility and parking procedures.

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Orienting students

For their day of orientation at the facility, students will ideally arrive at the same time as they will for the clinical so they can get an accurate sense of the traffic and parking at that time of day. The instructor can greet the students in the hospital lobby, then meet with them in a conference room or the cafeteria.

A great way to start the orientation day is with an icebreaker, such as having the students write down facts about themselves that others don't know. Also have the students write a set of goals for the rotation so you can plan on how to help them achieve those goals.1

More students who have disabilities are being admitted into nursing programs. Many of these disabilities, such as learning disabilities and chronic illnesses, aren't noticeable. Ask the students to share with you privately if they have any disabilities or personal issues. For example, if a student has diabetes, you want to be prepared if he or she experiences hypoglycemia during the clinical rotation. Check with your course coordinator if any of your students have had challenges in clinical in the past. Knowing your students' experience in healthcare, their personal challenges, and any disabilities can help you provide the best learning environment for them.2

Collect their paperwork, and schedule photo IDs. Review the unit, such as types of patients, staff member roles, routines, and facility codes.Review any required clinical assignments such as care plans, concept maps, and reflective journals. Make sure the students know when these are due and if they should be in written or electronic format.

Explain that the clinical group is part of the unit's team. Emphasize that students shouldn't walk by a patient room when the call light is on; instead, they should check on the patient. Explain that they should always be willing to help other staff, and in turn, the staff will be more willing to teach them things. Review emergency procedures, the location of the crash cart, and the student's expected response to emergencies.

Give the students a sense of the unit's routine and what they're expected to complete at certain times. For example, “The vital signs must be completed and documented by 0830, your nursing assessment must be completed and documented by 1000, and all morning care must be completed by 1100.”

Have the students attend the facility's computer and medication administration training, or review it with them yourself. You may need to explain discrepancies between what the students learned in class and hospital policies and procedures.

Review the clinical assignments with the students. Discuss any observation days planned and how they should accompany their patients to any testing or procedures. Review your expectations, such as being on time. Schedule and discuss the plan for preconferences and postconferences and let the students know how to prepare for them.

Lead a tour of the facility and unit. Point out the conference and medication rooms, and tell them all codes. Some instructors make up a scavenger hunt where students locate items such as blood glucose machines, thermometers, saline syringes, isolation supplies, fire extinguishers, the code cart, personal care items, I.V. supplies, and policies, and places such as the dirty utility room and the staff bathroom.

Take the students to an empty patient room to demonstrate the call light, bed operation, and oxygen setup, and practice bed making. You can review head-to-toe physical assessment using a patient or student volunteer. Students can obtain a complete set of vital signs using the hospital's equipment on each other or designated patients.

Explain to the students that you're guests of the facility. Be willing to pitch in and help with other patients. Thank the staff for their help every day. Plan to have the students write a thank-you card and bring in food on the last day.

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Moving forward

If you're hooked on making the transition to clinical instructor, learn more by reading Part 3 in an upcoming issue.

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1. Kan EZ, Stabler-Haas S. Fast Facts for the Clinical Nursing Instructor: Clinical Teaching in a Nutshell. 2nd ed. New York, NY: Springer Publishing Company; 2013.
2. Luckowski A. The lived experience in the clinical setting of nursing students with disabilities. Unpublished doctoral dissertation. Chester, PA: Widener University; 2014.
© 2014 by Wolters Kluwer Health | Lippincott Williams & Wilkins.