TEACHING FOR PRACTICE
By Linda Koharchik, DNP, MSN, RN, CNE
Delineating the Role of the Part-Time Clinical Nurse Instructor This challenging but rewarding adjunct teaching position is crucial to nursing education. This article is the first in a new quarterly series on the roles of adjunct clinical faculty and preceptors, who teach nursing students to apply knowledge in clinical settings. Topics will include the preparation of clinical instructors and preceptors for these roles, the student evaluation process, and overcoming challenges that can come with teaching in the clinical field and with adjunct teaching.
N
ursing education begins in the classroom, but perhaps the most meaningful learning happens at the patient’s bedside. Patricia Benner notes that knowledge, theory, and science must be integrated with clinical know-how and ethical behavior to successfully prepare professional nurses.1 Along with preceptors (usually staff nurses who mentor new nurses on a unit as part of their job), clinical instructors are invaluable guides for nurses as they learn to apply classroom knowledge in the field. Because of the ongoing shortage of nursing faculty, programs have become increasingly dependent on part-time clinical faculty. Also called adjunct clinical faculty, part-time instructors are RNs who may concurrently hold other nursing jobs. Part-time clinical instructors’ weekly workload varies: some may work as little as six hours a week, while others may take on more than one clinical assignment and work more than 16 hours a week. Some nurses may be full-time educators and work with students in the clinical setting as part of a larger teaching load.
WHAT DOES A PART-TIME CLINICAL INSTRUCTOR DO?
It is the responsibility of full- and part-time clinical instructors to teach nursing students how to plan and carry out patient care in hospitals and clinics as well as community sites. The clinical instructor works collaboratively with staff nurses, who retain responsibility for their assigned patients, to provide students with opportunities to learn skills such as patient assessment and medication administration as well as documentation practices. The clinical instructor helps students review patient histories and [email protected]
physical exams, laboratory results, diagnostic tests, and progress notes so that they may understand how a diagnosis and plan of care are determined. Evaluation of student performance in the clinical arena is also the responsibility of the clinical instructor. Ideally, faculty from the school of nursing keep clinical instructors abreast of the current theory students are learning, and assignments link classroom topics to clinical situations. (For example, if a student is learning about cardiovascular disease, the instructor would assign the student to care for a patient who has a cardiac condition.) Clinical faculty may receive information about the classroom curriculum through e-mail, online learning sites, or in-person meetings. They may also have access to all or some of the same learning resources as their students, such as electronic textbooks, online skill modules and case studies, and course information. To supplement classroom learning, clinical instructors lead student conferences before and after each clinical day. In the brief conference at the beginning of the day, students are told the plan or goals for that day. The conference at the end of the day is roughly an hour long and is included in the students’ required clinical hours. The instructor may then engage students in discussions about patients’ clinical states and illnesses or debrief students when they have witnessed particularly disturbing or emotional situations. If, for example, a student’s patient has died, the clinical instructor might encourage the student to discuss her or his thoughts and reactions to the event. Similarly, the instructor might focus a discussion on patients’ experience of illness, helping AJN ▼ May 2014
▼
Vol. 114, No. 5
65
TEACHING FOR PRACTICE
teach, a nurse must, in most cases, be at least one educational level above the student. To teach in a baccalaureate program in Pennsylvania, for example, an instructor must have a graduate degree in nursing or be enrolled in graduate education with an intention to complete the degree within five years.2 The tuition discount is a win–win situation for nurses and educational programs.
DRAWBACKS OF THE JOB
Tami Olson, MS, RN, adjunct clinical faculty in Heartland Community College’s nursing program, provides care at the bedside while supervising nursing student John Cook at Advocate BroMenn Medical Center in Normal, Illinois. Photo © Associated Press.
students to see the patients’ perspective and develop empathy for their suffering.
WHY BECOME A PART-TIME CLINICAL INSTRUCTOR?
Teaching nursing students in the clinical setting can be an extremely rewarding experience. Educators may act as mentors, working closely with students and modeling empathy for them. Clinical faculty have the satisfaction of witnessing the transformation of a student afraid to touch or awaken a patient into one who confidently plans, organizes, and carries out the care of several patients. Student–faculty relationships can last a lifetime—and nothing is more gratifying than being on the receiving end of nursing care provided by a former student. Often receiving little formal training in education, clinical instructors may use their personal and clinical experience as the foundation for their teaching. Teaching also enables the clinical educator to keep up with the latest nursing procedures and to spend time at the bedside. Whereas professors of nursing may spend relatively little time in hospitals and clinics, the clinical educator works with patients regularly, relieving their suffering, calming their fears, and sharing their joy—often the very reasons she or he entered the profession of nursing. Many new instructors are studying as well as teaching; a teaching institution may offer a discount on tuition to nurses who will teach at their sites. In order to 66
AJN ▼ May 2014
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Vol. 114, No. 5
Although adjunct clinical instructors fill some of the many vacancies in nursing schools, and the position can be very rewarding, there are several potential drawbacks to becoming a clinical nursing instructor. Compensation. Part-time clinical faculty may be paid by the hour or by the number of credits associated with the clinical course. (Average pay for all nursing educators varies and depends on institution location and other factors.) Wages reflect the number of hours the instructor actually has contact with the student—but not, for example, time spent choosing appropriate patient assignments, preparing written feedback on assignments associated with the clinical course, or writing evaluations. When uncompensated take-home work is factored in, the job is not as lucrative. Lack of stability. Sometimes faculty are contracted for one semester only, with no guarantee that a position will be available the following semester. There are few available summer positions, and some parttime instructors hold jobs at more than one school to increase the amount and reliability of income. Furthermore, these jobs rarely come with health insurance benefits. School administrators may even limit contracted hours to ensure that nurses do not work enough to be entitled to health insurance benefits. Varied work locations. The fact that educators must work at several different sites is another potential drawback. Because of large student populations, a single school of nursing may use a variety of settings and have several site- and unit-specific assignments each semester. Nurses must accept contracts to work at different sites (and may be the only instructor at each) and may find their time divided between the laboratory, hospitals, and clinics. These frequent site changes can make it hard for part-time faculty to establish enduring work relationships with the ancillary staff, nurses, and manager of a unit. Institutional marginalization. Part-time faculty may also be excluded from the usual business of schools of nursing—such as faculty meetings, social gatherings, graduation ceremonies, and committee work. For all these reasons, they may feel marginalized.3 If the instructor works predominantly in the clinical setting, this can deepen a sense of detachment ajnonline.com
from other school faculty. In a recent survey of 21 adjunct clinical faculty, participants indicated that they did not feel like they were part of the faculty.4 Inadequate orientation. Other challenges may arise as the part-time clinical instructor struggles to keep up with a nursing school’s curriculum changes and policy revisions. Some schools will offer continuing education designed to ensure part-time clinical faculty are up to date on curriculum and policy. Without this, a clinical instructor may not know students’ expectations. Part-time instructors are at a particular disadvantage because they usually do not participate in curriculum and policy development or attend regular faculty meetings. (For instance, an adjunct instructor
The instructor must also convey to each patient’s unit nurse the level of care each nursing student is prepared to give, whether the student will be administering medications, and the hours the student will be on the unit. Many schools of nursing require the instructor to provide proof of coverage by liability insurance, which costs about $100 per year. A common misunderstanding is that the nursing student works under the license of the clinical instructor; in fact, students are often responsible for their own actions. Instructors are also responsible for their own actions, and this includes the care they personally render to patients, as well as actions related to educating the student.
A common misunderstanding is that the nursing student works under the license of the clinical instructor; in fact, students are often responsible for their own actions. might allow a student to manage a heparin drip— not knowing that the student has not yet learned the drug’s purpose or how to calculate the changes needed in the infusion rate. Disconnects such as this can be managed when part-time clinical faculty are provided their students’ course syllabi and class schedules.) In addition, each different clinical site has unique orientation requirements, policies, and procedures, as well as charting methods—all of which clinical instructors must understand and comply with. Before they may teach, instructors must be oriented to the assigned unit and its staff (and may or may not be compensated for the time spent doing this). Many adjunct faculty report being inadequately prepared through orientation.4 Working concurrently at the clinical site as a staff nurse can boost the part-time clinical instructor’s efficiency and comfort level, but she or he may experience role ambiguity.3 Liability issues related to patient load. The clinical instructor also bears a certain responsibility for patient safety and care. Typically, a clinical instructor (full-time or part-time) will be assigned eight students. (Actual student numbers depend on institution- and state-specific regulations.) Since each student is usually assigned one or two patients, the clinical instructor may be involved to some degree in the care of 16 patients. Although the unit nurses assigned to those patients are ultimately responsible for them, the instructor must also understand each patient’s condition and needs. [email protected]
Experienced nurses are strong assets in the clinical education of future nurses, and as long as there is a faculty shortage, part-time faculty will continue to fill an urgent need. Future articles in this column will describe strategies to overcome problems that may arise for those teaching in the clinical field. When school administrators, clinical site administrators, and clinical faculty work collaboratively, they can often create solutions to the job’s shortcomings. ▼ Linda Koharchik is a clinical assistant professor and director of adjunct faculty and clinical affairs at Duquesne University School of Nursing, Pittsburgh, PA. Contact author: [email protected]. The author has disclosed no potential conflicts of interest, financial or otherwise.
REFERENCES 1. Benner P. Bring clinical and classroom together: integrative pedagogies. Educating Nurses. 2013. http://www.educatingnurses.com/articles/bring-clinical-and-classroomtogether-integrative-pedagogies. 2. Commonwealth of Pennsylvania. Pennsylvania Code. Chapter 21. State Board of Nursing. Subchapter A: Registered Nurses: section 21.71—nurse administrator, faculty and staff requirements. Harrisburg, PA. n.d. 3. Forbes MO, et al. Adjunct faculty development: reported needs and innovative solutions. J Prof Nurs 2010;26(2): 116-24. 4. Roberts KK, et al. The perceived needs of nurse clinicians as they move into an adjunct clinical faculty role. J Prof Nurs 2013;29(5):295-301.
AJN ▼ May 2014
▼
Vol. 114, No. 5
67
By Linda Koharchik, DNP, MSN, RN, CNE
Delineating the Role of the Part-Time Clinical Nurse Instructor This challenging but rewarding adjunct teaching position is crucial to nursing education. This article is the first in a new quarterly series on the roles of adjunct clinical faculty and preceptors, who teach nursing students to apply knowledge in clinical settings. Topics will include the preparation of clinical instructors and preceptors for these roles, the student evaluation process, and overcoming challenges that can come with teaching in the clinical field and with adjunct teaching.
N
ursing education begins in the classroom, but perhaps the most meaningful learning happens at the patient’s bedside. Patricia Benner notes that knowledge, theory, and science must be integrated with clinical know-how and ethical behavior to successfully prepare professional nurses.1 Along with preceptors (usually staff nurses who mentor new nurses on a unit as part of their job), clinical instructors are invaluable guides for nurses as they learn to apply classroom knowledge in the field. Because of the ongoing shortage of nursing faculty, programs have become increasingly dependent on part-time clinical faculty. Also called adjunct clinical faculty, part-time instructors are RNs who may concurrently hold other nursing jobs. Part-time clinical instructors’ weekly workload varies: some may work as little as six hours a week, while others may take on more than one clinical assignment and work more than 16 hours a week. Some nurses may be full-time educators and work with students in the clinical setting as part of a larger teaching load.
WHAT DOES A PART-TIME CLINICAL INSTRUCTOR DO?
It is the responsibility of full- and part-time clinical instructors to teach nursing students how to plan and carry out patient care in hospitals and clinics as well as community sites. The clinical instructor works collaboratively with staff nurses, who retain responsibility for their assigned patients, to provide students with opportunities to learn skills such as patient assessment and medication administration as well as documentation practices. The clinical instructor helps students review patient histories and [email protected]
physical exams, laboratory results, diagnostic tests, and progress notes so that they may understand how a diagnosis and plan of care are determined. Evaluation of student performance in the clinical arena is also the responsibility of the clinical instructor. Ideally, faculty from the school of nursing keep clinical instructors abreast of the current theory students are learning, and assignments link classroom topics to clinical situations. (For example, if a student is learning about cardiovascular disease, the instructor would assign the student to care for a patient who has a cardiac condition.) Clinical faculty may receive information about the classroom curriculum through e-mail, online learning sites, or in-person meetings. They may also have access to all or some of the same learning resources as their students, such as electronic textbooks, online skill modules and case studies, and course information. To supplement classroom learning, clinical instructors lead student conferences before and after each clinical day. In the brief conference at the beginning of the day, students are told the plan or goals for that day. The conference at the end of the day is roughly an hour long and is included in the students’ required clinical hours. The instructor may then engage students in discussions about patients’ clinical states and illnesses or debrief students when they have witnessed particularly disturbing or emotional situations. If, for example, a student’s patient has died, the clinical instructor might encourage the student to discuss her or his thoughts and reactions to the event. Similarly, the instructor might focus a discussion on patients’ experience of illness, helping AJN ▼ May 2014
▼
Vol. 114, No. 5
65
TEACHING FOR PRACTICE
teach, a nurse must, in most cases, be at least one educational level above the student. To teach in a baccalaureate program in Pennsylvania, for example, an instructor must have a graduate degree in nursing or be enrolled in graduate education with an intention to complete the degree within five years.2 The tuition discount is a win–win situation for nurses and educational programs.
DRAWBACKS OF THE JOB
Tami Olson, MS, RN, adjunct clinical faculty in Heartland Community College’s nursing program, provides care at the bedside while supervising nursing student John Cook at Advocate BroMenn Medical Center in Normal, Illinois. Photo © Associated Press.
students to see the patients’ perspective and develop empathy for their suffering.
WHY BECOME A PART-TIME CLINICAL INSTRUCTOR?
Teaching nursing students in the clinical setting can be an extremely rewarding experience. Educators may act as mentors, working closely with students and modeling empathy for them. Clinical faculty have the satisfaction of witnessing the transformation of a student afraid to touch or awaken a patient into one who confidently plans, organizes, and carries out the care of several patients. Student–faculty relationships can last a lifetime—and nothing is more gratifying than being on the receiving end of nursing care provided by a former student. Often receiving little formal training in education, clinical instructors may use their personal and clinical experience as the foundation for their teaching. Teaching also enables the clinical educator to keep up with the latest nursing procedures and to spend time at the bedside. Whereas professors of nursing may spend relatively little time in hospitals and clinics, the clinical educator works with patients regularly, relieving their suffering, calming their fears, and sharing their joy—often the very reasons she or he entered the profession of nursing. Many new instructors are studying as well as teaching; a teaching institution may offer a discount on tuition to nurses who will teach at their sites. In order to 66
AJN ▼ May 2014
▼
Vol. 114, No. 5
Although adjunct clinical instructors fill some of the many vacancies in nursing schools, and the position can be very rewarding, there are several potential drawbacks to becoming a clinical nursing instructor. Compensation. Part-time clinical faculty may be paid by the hour or by the number of credits associated with the clinical course. (Average pay for all nursing educators varies and depends on institution location and other factors.) Wages reflect the number of hours the instructor actually has contact with the student—but not, for example, time spent choosing appropriate patient assignments, preparing written feedback on assignments associated with the clinical course, or writing evaluations. When uncompensated take-home work is factored in, the job is not as lucrative. Lack of stability. Sometimes faculty are contracted for one semester only, with no guarantee that a position will be available the following semester. There are few available summer positions, and some parttime instructors hold jobs at more than one school to increase the amount and reliability of income. Furthermore, these jobs rarely come with health insurance benefits. School administrators may even limit contracted hours to ensure that nurses do not work enough to be entitled to health insurance benefits. Varied work locations. The fact that educators must work at several different sites is another potential drawback. Because of large student populations, a single school of nursing may use a variety of settings and have several site- and unit-specific assignments each semester. Nurses must accept contracts to work at different sites (and may be the only instructor at each) and may find their time divided between the laboratory, hospitals, and clinics. These frequent site changes can make it hard for part-time faculty to establish enduring work relationships with the ancillary staff, nurses, and manager of a unit. Institutional marginalization. Part-time faculty may also be excluded from the usual business of schools of nursing—such as faculty meetings, social gatherings, graduation ceremonies, and committee work. For all these reasons, they may feel marginalized.3 If the instructor works predominantly in the clinical setting, this can deepen a sense of detachment ajnonline.com
from other school faculty. In a recent survey of 21 adjunct clinical faculty, participants indicated that they did not feel like they were part of the faculty.4 Inadequate orientation. Other challenges may arise as the part-time clinical instructor struggles to keep up with a nursing school’s curriculum changes and policy revisions. Some schools will offer continuing education designed to ensure part-time clinical faculty are up to date on curriculum and policy. Without this, a clinical instructor may not know students’ expectations. Part-time instructors are at a particular disadvantage because they usually do not participate in curriculum and policy development or attend regular faculty meetings. (For instance, an adjunct instructor
The instructor must also convey to each patient’s unit nurse the level of care each nursing student is prepared to give, whether the student will be administering medications, and the hours the student will be on the unit. Many schools of nursing require the instructor to provide proof of coverage by liability insurance, which costs about $100 per year. A common misunderstanding is that the nursing student works under the license of the clinical instructor; in fact, students are often responsible for their own actions. Instructors are also responsible for their own actions, and this includes the care they personally render to patients, as well as actions related to educating the student.
A common misunderstanding is that the nursing student works under the license of the clinical instructor; in fact, students are often responsible for their own actions. might allow a student to manage a heparin drip— not knowing that the student has not yet learned the drug’s purpose or how to calculate the changes needed in the infusion rate. Disconnects such as this can be managed when part-time clinical faculty are provided their students’ course syllabi and class schedules.) In addition, each different clinical site has unique orientation requirements, policies, and procedures, as well as charting methods—all of which clinical instructors must understand and comply with. Before they may teach, instructors must be oriented to the assigned unit and its staff (and may or may not be compensated for the time spent doing this). Many adjunct faculty report being inadequately prepared through orientation.4 Working concurrently at the clinical site as a staff nurse can boost the part-time clinical instructor’s efficiency and comfort level, but she or he may experience role ambiguity.3 Liability issues related to patient load. The clinical instructor also bears a certain responsibility for patient safety and care. Typically, a clinical instructor (full-time or part-time) will be assigned eight students. (Actual student numbers depend on institution- and state-specific regulations.) Since each student is usually assigned one or two patients, the clinical instructor may be involved to some degree in the care of 16 patients. Although the unit nurses assigned to those patients are ultimately responsible for them, the instructor must also understand each patient’s condition and needs. [email protected]
Experienced nurses are strong assets in the clinical education of future nurses, and as long as there is a faculty shortage, part-time faculty will continue to fill an urgent need. Future articles in this column will describe strategies to overcome problems that may arise for those teaching in the clinical field. When school administrators, clinical site administrators, and clinical faculty work collaboratively, they can often create solutions to the job’s shortcomings. ▼ Linda Koharchik is a clinical assistant professor and director of adjunct faculty and clinical affairs at Duquesne University School of Nursing, Pittsburgh, PA. Contact author: [email protected]. The author has disclosed no potential conflicts of interest, financial or otherwise.
REFERENCES 1. Benner P. Bring clinical and classroom together: integrative pedagogies. Educating Nurses. 2013. http://www.educatingnurses.com/articles/bring-clinical-and-classroomtogether-integrative-pedagogies. 2. Commonwealth of Pennsylvania. Pennsylvania Code. Chapter 21. State Board of Nursing. Subchapter A: Registered Nurses: section 21.71—nurse administrator, faculty and staff requirements. Harrisburg, PA. n.d. 3. Forbes MO, et al. Adjunct faculty development: reported needs and innovative solutions. J Prof Nurs 2010;26(2): 116-24. 4. Roberts KK, et al. The perceived needs of nurse clinicians as they move into an adjunct clinical faculty role. J Prof Nurs 2013;29(5):295-301.
AJN ▼ May 2014
▼
Vol. 114, No. 5
67
