Expanding
Horizons
Photo © left: monkeybusinessimages / dreamstime.com; right: monkeybusinessimages / thinkstockphotos.com
How to Succeed as an Adjunct Clinical Nurse Instructor
A
As nursing programs are challenged to recruit qualified nursing faculty to meet student ratios, “schools of nursing are turning to direct care nurses to fill the gap between academia and clinical education” (Mitchell & King-Jones, 2012, p. 58). This collaboration between schools and hospitals increases access to qualified nursing instructors (Kring, Ramseur, & Parnell, 2013). Termed “adjunct clinical instructors,” these nurses continue to provide direct patient care while also working part-time for schools of nursing as clinical educators. Staff nurses will find moving into the role of part-time clinical instructor is smoother when
NICOLE HALL MELANIE CHICHESTER they’re well-experienced and skilled in the assigned clinical field and knowledgeable of hospital policies and procedures, and when collegial working relationships with staff, managers and physicians are already established (Mitchell & King-Jones, 2012).
Orienting and Training Kring et al. (2013) identify the need for a “formal training program” to enhance instructor effectiveness and professional development of nurses as they transition into the education field (p. 36). Well-established training programs prepare clinical instructors
Abstract Adjunct clinical nurse instructors who are proactive about staying clinically current and who form collaborative relationships with nurses, physicians and other health care professionals are able to teach safe care and engender staff nurses’ trust. It’s important for nurse educators to continually work to remain effective in the clinical setting to provide an optimal learning environment for students and optimal working environment for staff. DOI: 10.1111/1751-486X.12139 Keywords adjunct clinical instructor | clinical effectiveness | nurse educator | nursing students
http://nwh.awhonn.org
© 2014, AWHONN
341
Horizons Expanding Nicole Hall, MSN, MBA, RN, is a nurse educator at the Margaret H. Rollins School of Nursing at Beebe Healthcare in Lewes, DE. Melanie Chichester, BSN, RNC-OB, CPLC, is a staff nurse, level III, in Labor & Delivery at Christiana Care Health System in Newark, DE. The authors report no conflicts of interest or relevant financial relationships. Address correspondence to: Nhall@ beebehealthcare.org.
342
adjunct instructor role will also need education concerning how to effectively communicate and offer valuable feedback to students. Coupling adjunct faculty with a preceptor who is both an expert instructor and competent clinical nurse can be of great benefit during this transition. The combination allows for on-thejob learning with a seasoned resource readily available. Orientation during the semester for a novice level faculty should be one of gradual independence. Initially new faculty may shadow a seasoned educator, then work alongside her and after a period of weeks be assigned their own student group. This model can work well when preceptors are knowledgeable as nurses and educators, supportive as colleagues and make themselves readily accessible for the varied needs of a new instructor.
are already established. Networking with nurses, physicians and other staff is a critical component of staying relevant on hospital units. Chan, Chan, and Liu (2012) found that communicating with a variety of hospital employees, both on personal and professional levels, maintains established and builds new relationships that can have positive outcomes on students’ integration of theory and practice. Providing patient care in a setting where the instructor has previously been proficient and skilled provides an environment conducive to patient, student and staff needs. Instructors must work to stay current in the clinical setting to remain effective teachers. Further efforts that can help keep full-time faculty abreast of changes include attending staff meetings, picking up hours during the summer or in between semesters and participating in unit educational days. Additional challenges occur when educators are responsible for student clinical assignments on a floor, which is not their preferred field, perhaps a cardiac or surgical unit. It can be intimidating when faced with unfamiliar diagnoses, body systems, treatments, orders and medications. This may require more preparation time prior to clinical, for researching patients, reading the textbook, preparing information, developing questions to ask students and jotting down questions to ask other faculty beforehand.
Overcoming Challenges
Earning Respect and Trust
Nurses will have to overcome additional challenges when transitioning into a full-time faculty role. Functioning solely as a nurse educator frequently removes instructors from the role of direct care nurse. When clinical educators no longer provide patient care on a regular basis their ability to remain proficient is more difficult. Without regular interaction with the clinical units, full-time instructors will be disconnected from the flow of information regarding changes and improvements that continually evolve in hospital processes. There are benefits in the education setting when instructors can remain in the surroundings of a known facility and nursing unit. For example, nurse educators working on a familiar clinical unit can more easily collaborate with staff because working relationships
To succeed as a nursing instructor, one must earn the respect of fellow faculty as well as students, but another priority is establishing or maintaining the nursing staff ’s confidence. After all, this is their turf. A key characteristic of direct care nurses is that they are protective of their patients. Patients are quite literally theirs for the day and nurses desire to care for them to the best of their abilities. Collaborate with the patient’s primary nurse and be her ally in providing safe patient care. Clinical educators can build positive working relationships by introducing themselves, asking staff ’s opinion of which patients would make good clinical assignments, showing appreciation, displaying concern for patients’ comfort and safety, while also demonstrating enthusiasm to teach and respect for the students.
to meet the needs of nursing students and the challenges inherent in the educator role. An orientation program at the least must include introduction to hospital policies and review of school practices. Staff nurses assuming the
Coupling adjunct faculty with a preceptor who is both an expert instructor and competent clinical nurse can be of great benefit during this transition
Nursing for Women’s Health
Volume 18
Issue 4
Fostering Collegiality When nursing students are assigned patients for their clinical shift, some control has to be ceded to the instructor and their students, something perhaps not always acknowledged by educators. At the end of a rotation, taking the time to say “thank you” to the nurses in the department and recognize their tolerance fosters collegiality. Find out if the facility has a program that permits leaving an “official” thank you, as this also can go in personal files. Recognition for assistance throughout the semester can be both meaningful and helpful as nurse educators continue to network with staff.
Horizons
When educators are presented with the opportunity for students to perform a treatment with which they’re not familiar, they should review hospital policies and procedures with the nurse and the student together. Instructors can request nursing staff provide instruction and guidance while they and the student implement the treatment. Nurse educators should continually push themselves beyond their comfort zone and simultaneously nudge students beyond theirs, while being cognizant of maintaining a safe environment. In order to teach, nursing professionals must be willing to also keep learning. The Nursing Executive Center (2008) report “Bridging the Preparation-Practice Gap” found that “lack of clinical instructor familiarity” caused additional burden on staff nurses, slowed the teaching process and impeded learning, all negatively affecting the students experience (p. 83). Even with best efforts, most clinical instructors will need to acknowledge that lack of proficiency can affect the staff. Novice instructors must be self-aware and recognize their own shortcomings in their new role as clinical educator. Regardless
of previous nursing experience, implementation of care can remain significantly impaired when there is a lack of familiarity with the normal floor practices. Full-time instructors in particular must realize that without providing direct patient care clinical skill and knowledge can be affected. Clinical instructors whose knowledge on a unit is less than adequate must relentlessly seek information, access hospital staff and other instructors to compensate.
Expanding
Learning and Growing
To succeed as a nursing instructor, one must earn the respect of fellow faculty as well as students, but another priority is establishing or
Photo © Jupiterimages / thinkstockphotos.com
maintaining the nursing staff’s confidence
August | September 2014
Nursing for Women’s Health
343
progress, as are all efforts to become or remain an established and successful nursing instructor. They must continue to work hard, network and question, as well as maintain clinical skills to teach safe care and engender staff nurses’ trust. People are well-suited for the nursing instructor position if they enjoy the process of continued growth within themselves and others. In the best circumstances, a teacher’s appreciation for learning will inspire students. Nursing instructors should be guides and role models for their students, but should also remember to be their partners in the learning process. NWH
References Baker, S. L., Fitzpatrick, J. J., & Griffin M. Q. (2011). Empowerment and job satisfaction in associate degree nurse educators. Nursing Education Perspectives, 32(4), 234–239.
critical component of staying relevant on hospital units
The Benefits of Staying Relevant According to a study by Baker, Fitzpatrick, and Griffin (2011), nursing program directors should ensure resources for faculty to professionally expand themselves and help them maintain relevance. Staying relevant is important for all nurses in a variety of settings and roles. As a staff nurse, staying relevant is important for the benefit of patients, peers, managers and other health care providers. As a nurse leader, staying relevant enables staff to have confidence in the direction provided. As a nursing instructor, relevancy lends credibility when dealing with students, nursing staff and providers. The ability to remain relevant in a professional role is a valuable tool that enhances ones effectiveness. As a clinical instructor, one must be competent in numerous aspects to be successful as a teacher.
344
Nursing for Women’s Health
These characteristics were identified by Reeve (1994) as an instructor’s ability to perform in a professional manner, function as a role model and resource, offer students guidance, communicate expectations and enhance student learning (p. 16). Access to adequate numbers of clinical faculty who encompass these characteristics has become a challenge and we should expect to see increasing numbers of adjunct clinical faculty.
Conclusion While stepping out of direct care nursing and into either the part- or full-time position of clinical nursing instructor is full of changes, staying upto-date, being confident and having a firm understanding of clinical knowledge are common threads that propel one toward being a high-quality educator. So are nurse educators still relevant? Perhaps, but they are a work in
Kring, D. L., Ramseur, N., & Parnell, E. (2013). How effective are hospital adjunct clinical instructors? Nursing Education Perspectives, 34(1), 34–36. Mitchell, A., & King-Jones, M. (2012). Direct care nurses transitioning to clinical faculty. Nursing 2012, 42(6), 58–60. Nursing Executive Center. (2008). Best practice report: Bridging the preparationpractice gap, volume II—Best practices for accelerating practice readiness of nursing students. Washington, DC: The Advisory Board Company. Reeve, M. M. (1994). Development of an instrument to measure effectiveness of clinical instructors. Journal of Nursing Education, 33(1), 16–19.
Volume 18
Issue 4
Photo © Wavebreakmedia Ltd / thinkstockphotos.com
Networking with nurses, physicians and other staff is a
Chan, E. A., Chan, K., & Liu, Y. W. J. (2012). A triadic interplay between academics, practitioners and students in the nursing theory and practice dialectic. Journal of Advanced Nursing, 68(5), 1038–1049. doi:10.1111/j.1365-2648.2011.05808.x
Horizons
Photo © left: monkeybusinessimages / dreamstime.com; right: monkeybusinessimages / thinkstockphotos.com
How to Succeed as an Adjunct Clinical Nurse Instructor
A
As nursing programs are challenged to recruit qualified nursing faculty to meet student ratios, “schools of nursing are turning to direct care nurses to fill the gap between academia and clinical education” (Mitchell & King-Jones, 2012, p. 58). This collaboration between schools and hospitals increases access to qualified nursing instructors (Kring, Ramseur, & Parnell, 2013). Termed “adjunct clinical instructors,” these nurses continue to provide direct patient care while also working part-time for schools of nursing as clinical educators. Staff nurses will find moving into the role of part-time clinical instructor is smoother when
NICOLE HALL MELANIE CHICHESTER they’re well-experienced and skilled in the assigned clinical field and knowledgeable of hospital policies and procedures, and when collegial working relationships with staff, managers and physicians are already established (Mitchell & King-Jones, 2012).
Orienting and Training Kring et al. (2013) identify the need for a “formal training program” to enhance instructor effectiveness and professional development of nurses as they transition into the education field (p. 36). Well-established training programs prepare clinical instructors
Abstract Adjunct clinical nurse instructors who are proactive about staying clinically current and who form collaborative relationships with nurses, physicians and other health care professionals are able to teach safe care and engender staff nurses’ trust. It’s important for nurse educators to continually work to remain effective in the clinical setting to provide an optimal learning environment for students and optimal working environment for staff. DOI: 10.1111/1751-486X.12139 Keywords adjunct clinical instructor | clinical effectiveness | nurse educator | nursing students
http://nwh.awhonn.org
© 2014, AWHONN
341
Horizons Expanding Nicole Hall, MSN, MBA, RN, is a nurse educator at the Margaret H. Rollins School of Nursing at Beebe Healthcare in Lewes, DE. Melanie Chichester, BSN, RNC-OB, CPLC, is a staff nurse, level III, in Labor & Delivery at Christiana Care Health System in Newark, DE. The authors report no conflicts of interest or relevant financial relationships. Address correspondence to: Nhall@ beebehealthcare.org.
342
adjunct instructor role will also need education concerning how to effectively communicate and offer valuable feedback to students. Coupling adjunct faculty with a preceptor who is both an expert instructor and competent clinical nurse can be of great benefit during this transition. The combination allows for on-thejob learning with a seasoned resource readily available. Orientation during the semester for a novice level faculty should be one of gradual independence. Initially new faculty may shadow a seasoned educator, then work alongside her and after a period of weeks be assigned their own student group. This model can work well when preceptors are knowledgeable as nurses and educators, supportive as colleagues and make themselves readily accessible for the varied needs of a new instructor.
are already established. Networking with nurses, physicians and other staff is a critical component of staying relevant on hospital units. Chan, Chan, and Liu (2012) found that communicating with a variety of hospital employees, both on personal and professional levels, maintains established and builds new relationships that can have positive outcomes on students’ integration of theory and practice. Providing patient care in a setting where the instructor has previously been proficient and skilled provides an environment conducive to patient, student and staff needs. Instructors must work to stay current in the clinical setting to remain effective teachers. Further efforts that can help keep full-time faculty abreast of changes include attending staff meetings, picking up hours during the summer or in between semesters and participating in unit educational days. Additional challenges occur when educators are responsible for student clinical assignments on a floor, which is not their preferred field, perhaps a cardiac or surgical unit. It can be intimidating when faced with unfamiliar diagnoses, body systems, treatments, orders and medications. This may require more preparation time prior to clinical, for researching patients, reading the textbook, preparing information, developing questions to ask students and jotting down questions to ask other faculty beforehand.
Overcoming Challenges
Earning Respect and Trust
Nurses will have to overcome additional challenges when transitioning into a full-time faculty role. Functioning solely as a nurse educator frequently removes instructors from the role of direct care nurse. When clinical educators no longer provide patient care on a regular basis their ability to remain proficient is more difficult. Without regular interaction with the clinical units, full-time instructors will be disconnected from the flow of information regarding changes and improvements that continually evolve in hospital processes. There are benefits in the education setting when instructors can remain in the surroundings of a known facility and nursing unit. For example, nurse educators working on a familiar clinical unit can more easily collaborate with staff because working relationships
To succeed as a nursing instructor, one must earn the respect of fellow faculty as well as students, but another priority is establishing or maintaining the nursing staff ’s confidence. After all, this is their turf. A key characteristic of direct care nurses is that they are protective of their patients. Patients are quite literally theirs for the day and nurses desire to care for them to the best of their abilities. Collaborate with the patient’s primary nurse and be her ally in providing safe patient care. Clinical educators can build positive working relationships by introducing themselves, asking staff ’s opinion of which patients would make good clinical assignments, showing appreciation, displaying concern for patients’ comfort and safety, while also demonstrating enthusiasm to teach and respect for the students.
to meet the needs of nursing students and the challenges inherent in the educator role. An orientation program at the least must include introduction to hospital policies and review of school practices. Staff nurses assuming the
Coupling adjunct faculty with a preceptor who is both an expert instructor and competent clinical nurse can be of great benefit during this transition
Nursing for Women’s Health
Volume 18
Issue 4
Fostering Collegiality When nursing students are assigned patients for their clinical shift, some control has to be ceded to the instructor and their students, something perhaps not always acknowledged by educators. At the end of a rotation, taking the time to say “thank you” to the nurses in the department and recognize their tolerance fosters collegiality. Find out if the facility has a program that permits leaving an “official” thank you, as this also can go in personal files. Recognition for assistance throughout the semester can be both meaningful and helpful as nurse educators continue to network with staff.
Horizons
When educators are presented with the opportunity for students to perform a treatment with which they’re not familiar, they should review hospital policies and procedures with the nurse and the student together. Instructors can request nursing staff provide instruction and guidance while they and the student implement the treatment. Nurse educators should continually push themselves beyond their comfort zone and simultaneously nudge students beyond theirs, while being cognizant of maintaining a safe environment. In order to teach, nursing professionals must be willing to also keep learning. The Nursing Executive Center (2008) report “Bridging the Preparation-Practice Gap” found that “lack of clinical instructor familiarity” caused additional burden on staff nurses, slowed the teaching process and impeded learning, all negatively affecting the students experience (p. 83). Even with best efforts, most clinical instructors will need to acknowledge that lack of proficiency can affect the staff. Novice instructors must be self-aware and recognize their own shortcomings in their new role as clinical educator. Regardless
of previous nursing experience, implementation of care can remain significantly impaired when there is a lack of familiarity with the normal floor practices. Full-time instructors in particular must realize that without providing direct patient care clinical skill and knowledge can be affected. Clinical instructors whose knowledge on a unit is less than adequate must relentlessly seek information, access hospital staff and other instructors to compensate.
Expanding
Learning and Growing
To succeed as a nursing instructor, one must earn the respect of fellow faculty as well as students, but another priority is establishing or
Photo © Jupiterimages / thinkstockphotos.com
maintaining the nursing staff’s confidence
August | September 2014
Nursing for Women’s Health
343
progress, as are all efforts to become or remain an established and successful nursing instructor. They must continue to work hard, network and question, as well as maintain clinical skills to teach safe care and engender staff nurses’ trust. People are well-suited for the nursing instructor position if they enjoy the process of continued growth within themselves and others. In the best circumstances, a teacher’s appreciation for learning will inspire students. Nursing instructors should be guides and role models for their students, but should also remember to be their partners in the learning process. NWH
References Baker, S. L., Fitzpatrick, J. J., & Griffin M. Q. (2011). Empowerment and job satisfaction in associate degree nurse educators. Nursing Education Perspectives, 32(4), 234–239.
critical component of staying relevant on hospital units
The Benefits of Staying Relevant According to a study by Baker, Fitzpatrick, and Griffin (2011), nursing program directors should ensure resources for faculty to professionally expand themselves and help them maintain relevance. Staying relevant is important for all nurses in a variety of settings and roles. As a staff nurse, staying relevant is important for the benefit of patients, peers, managers and other health care providers. As a nurse leader, staying relevant enables staff to have confidence in the direction provided. As a nursing instructor, relevancy lends credibility when dealing with students, nursing staff and providers. The ability to remain relevant in a professional role is a valuable tool that enhances ones effectiveness. As a clinical instructor, one must be competent in numerous aspects to be successful as a teacher.
344
Nursing for Women’s Health
These characteristics were identified by Reeve (1994) as an instructor’s ability to perform in a professional manner, function as a role model and resource, offer students guidance, communicate expectations and enhance student learning (p. 16). Access to adequate numbers of clinical faculty who encompass these characteristics has become a challenge and we should expect to see increasing numbers of adjunct clinical faculty.
Conclusion While stepping out of direct care nursing and into either the part- or full-time position of clinical nursing instructor is full of changes, staying upto-date, being confident and having a firm understanding of clinical knowledge are common threads that propel one toward being a high-quality educator. So are nurse educators still relevant? Perhaps, but they are a work in
Kring, D. L., Ramseur, N., & Parnell, E. (2013). How effective are hospital adjunct clinical instructors? Nursing Education Perspectives, 34(1), 34–36. Mitchell, A., & King-Jones, M. (2012). Direct care nurses transitioning to clinical faculty. Nursing 2012, 42(6), 58–60. Nursing Executive Center. (2008). Best practice report: Bridging the preparationpractice gap, volume II—Best practices for accelerating practice readiness of nursing students. Washington, DC: The Advisory Board Company. Reeve, M. M. (1994). Development of an instrument to measure effectiveness of clinical instructors. Journal of Nursing Education, 33(1), 16–19.
Volume 18
Issue 4
Photo © Wavebreakmedia Ltd / thinkstockphotos.com
Networking with nurses, physicians and other staff is a
Chan, E. A., Chan, K., & Liu, Y. W. J. (2012). A triadic interplay between academics, practitioners and students in the nursing theory and practice dialectic. Journal of Advanced Nursing, 68(5), 1038–1049. doi:10.1111/j.1365-2648.2011.05808.x
